Emerg
Nothing screams, “EMERGENCY!” like waiting around interminably.
The other day, I was at the emergency room. No need for well-wishes. The very nice, severely put upon doctor who twice saw me diagnosed it as an acute case of hypochondria. Still, all those hours of sitting around gave me time to diagnose the problem with our severely put upon healthcare system.
If you’ve been to an ER, see if this seems familiar. I walked in. Waited a few minutes for a triage nurse to see me. The wait was long. Ish. The chat was short. Ish. I gave her my name, rank, and health system number. Oh, and my believed condition. Thumb broken from riding a mechanical bull. Not from being thrown mind you. From holding on. ‘Cause that’s how I roll. From there, I moved to a waiting area to wait to see the doctor. So he could confirm my self-diagnosed suspicions. That wait was long. No, the pronouns aren’t being used in a malicious way. This triage nurse was she. This doctor he. The chat was short. He sent me for X-rays. I waited outside the X-ray room. That wait was short. The picture taking was very short. After that, I waited a long time. Then the doctor saw me. No break. Just a sprain. I needed ice, ibuprofen, and a new hero story.
I figured out the problem. Healthcare is bottlenecked. Like that pyramid in Giza. There’s a big hospital. With a few triage nurses. That send all the people to the one ER doctor. That doctor dispatches all of us sick people to other areas of the hospital. In my case, the X-ray lab. In other cases, expensive beds behind a curtain where Carol Merrill was standing. Stuff like that. All those big funnels focus all the decisions to one doctor. Like, zoinks, this could all be fixed with just one more doctor. Double the doctors, double the throughput. Imagine if we tripled the number of docs? The hospital was branding spanking new. A new hospital, I figured, cost way more adding one more doctor. It all seemed stupidly easy.
The next night, a doctor friend of mine invited me over to hang out. It was a chance to test drive my bottleneck/pyramid hypothesis. Funnel. Throughput. What gives? Not enough med schools? Not enough doctors to teach more doctors? What’s up, doc?
Doc: You see, it’s like this. We don’t want more doctors.
Me: Say again…?
Doc: You heard me. We doctors don’t want more doctors. I make X-amount of money. If there were two of me, I’d make half-X-amount of money.
Me (thinking): The math was, as they say, mathing. For him. Not so much for me or for the greater metropolitan us.
Me (out loud): So, you get more money because we wait?
Doc: Yep.
Me: ….
Doc: The people who run medicine know this.
I looked around his house. It was… nice. Big. He had an island in his kitchen that was BIG. He called it Maui because it was near an even bigger island. As in, “Grab yourself drink, I put out some beers on Maui.”
The next-next day, I was chatting with a guy who said his grandkid is getting a music degree. I’m in this place in life where people not much older than me have college-age grandkids. He asked what he thought was a rhetorical question, “What’s he going to do with a music degree?”
Me: As opposed to what?
Grandad: I don’t know, engineering or something. Computer degree.
Me: You might like me? I have a computer degree. Ish. I graduated and never wrote a line of code. Not one. I know this lady. She graduated with MBA last year. Before that she had a natural science degree. Chemistry or something. She wanted to build an app. She just explained it to a computer running an AI. Minutes later it was built. She told the machine to make it more blue. A few seconds later it was more blue. She wanted the pictures to have rounded corners. Done. She can’t code. She built an app. Do you really need people with degrees in coding?
Grandad: How about…
Me [impolitely cutting him off]: Wanna house? Ask a machine with AI to create a blueprint. Want a bigger living room? Tell it. More rounded crown moldings? Done.
Me [impolitely cutting myself off]: OK. How about this? You’re a rich guy. Let’s say you just bought yourself the company that makes bowling balls and pins. You need to get a loan from the bank and the bank wants to see some projections. You ask a machine running AI to make some. It looks at the data and thinks (“Thinks”? Is that even the right word?) “Younger people are bowling more than the last generation. You see a lot of these glam-bowling places popping up. They’re going to need balls and pins. I see the market for balls and pins growing by 13% per year for the next decade. But… (There’s always a, “but.” Even in AI land.) As demand for balls and pins increases, more companies will make balls and pins (Sure. Stands to reason.) So, your margins will get squeezed by about 4%. Overall, I see revenue growing by X and profits growing by half-X. The math was, as the talking AI machine said, mathing.
Grandad: Um…
Me: A thirty-year old friend of mine sent me this depressing story if you like humanity from the FT with a note saying, “I felt like I got the last chopper out of Saigon.” I’m the last generation to get a job. The folks after me are… something. (Sorry, I couldn’t make out the last word. The email was smudged.) Instagram posts, Reddit threads, and other new-age supporting documents showed that 40% of graduates couldn’t get jobs. In the UK the number was closer to 60%.
Keep in mind, people with college or advanced college degrees were the cream of the proverbial crop. If they’re screwed…
Wondering how bad things were going to get, I canvassed an unscientifically small sample of friends from a variety of backgrounds about what was going on: business people, academics, the poor, the less poor, professionals, trades people, the old, the young, and the restless. Their solution… We need more people.
I love kids. Because they’re ballsy. That’s going to seem like a non sequitur. But it’s not. Kids just old enough to talk and still so young that they don’t know anything ask questions. They ask questions until they’re satisfied with your answer or until they get bored or you give them candy. More often than not, that question is, “Why?”
So, I turned on my childlike kid brain, “Why do we need MORE people?”
People: Because we’re all getting older.
Me: Yes. Why? Why do we need more people?
People: Because aging costs our society money.
Me: Yes. Why? Why do we need more people?
People: Because all those new (read, young) people are going to work and the taxes they pay will pay for our social needs.
Me [changing things up]: How?
People: Because taxes pay for stuff. (I’m fairly convinced there was an implied, “You donkey,” there.)
Me: What jobs?
People: Jobs jobs. Coders and architects and financial analysts. Stuff like that. You see, there’s this pyramid. The pyramid used to have this big base and a little top. Like the one in Giza. Now, we’re getting older. The pyramid is upside down. We need more people at the bottom. Look, it’s all over the news. We have to right the pyramid.
Me: People here can’t get those jobs. So people from elsewhere will get the jobs?
People: No. You don’t understand. We need people because… well, because. I read it in the Finance section of the daily paper. A guy named Joe wrote it. He has a history degree and a masters in scribbling. He’s been writing for the St. Jacob’s Daily Shopper for nearly twenty years. So, clearly, he knows this stuff.
There would have been a Me part. But I was bored and moved on to playing Madden with the grandad friend who just come over.
I’ve been thinking about your grandson. I think it’s great that he’s taking music. He’s going to be about as employable as people in his generation with MBAs, architectural degrees, or sheepskins with Comp Sci calligraphed on it. The difference is he’s going to be happy.
Grandad [as he lit me up with a Hail Mary on the first play of the game]: What about something more hands on? The world needs people to make beds.
Me: I knew you were going to ask that. Google makes cars that can drive themselves around LA without hitting stuff. You really think we’re going to need bedmaking people in a few years?
Grandad [he pick-sixed me]: Good point.
Me: It’s like my doctor friend told me the other day, “You want to be employed? Mint fewer doctors.” And so we wait.
Grandad: You have to wonder what all those non-working people are going to do all day?
Me: Play Madden, I guess.
