Health: Recent Episodes
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Search Health for works on government healthcare programs, Medicare, the VA, Obamacare, school lunches, etc., and how the free market handles health issues.
The covid restriction machinery is being ramped up in time for fall, despite the fact that covid poses little danger.
Original Article: "The Unwelcome Return of Covid Restrictions and Lockdowns"
The seventy-fifth-anniversary celebration of the British National Health Service masked the real failures of this system, one that only can become worse over time.
Original Article: "The British NHS More Resembles a Statist Cult Than Advanced Healthcare"
Recorded in Windham, New Hampshire, on August 20, 2023.
Special thanks to Joe and Tracy Matarese for making this event possible.
Recorded in Windham, New Hampshire, on August 20, 2023.
Special thanks to Joe and Tracy Matarese for making this event possible.
Recorded in Windham, New Hampshire, on August 20, 2023.
Special thanks to Joe and Tracy Matarese for making this event possible.
Recorded in Windham, New Hampshire, on August 20, 2023.
Special thanks to Joe and Tracy Matarese for making this event possible.
Dr. Terrell discusses the impacts of price controls, occupational licensure, the FDA, and more.
Download the slides from this lecture at Mises.org/MU23_PPT_32.
Recorded at the Mises Institute in Auburn, Alabama, on July 27, 2023.
Public health during the pandemic was anti-science and anti-health.
Download lecture slides at Mises.org/MU23_PPT_26.
Recorded at the Mises Institute in Auburn, Alabama, on 27 July 2023.
In the Progressive Era (1897 to 1929) the American Medical Association made an effort to restrict the supply of doctors.
Download lecture slides at Mises.org/MU23_PPT_18.
Recorded at the Mises Institute in Auburn, Alabama, on 26 July 2023.
On this episode of Good Money with Tho Bishop, David Gornoski of A Neighbor's Choice joins to discuss how government policies have impacted American diets. From the subsidization of certain crops to anti-science propaganda campaigns about diet, to the consolidation of the agricultural industry, the politicization of the economy still shapes not only their wallet but their plates.
Good Money listeners can order a special $5 book bundle that includes How To Think About the Economy and What Has Government Done to Our Money? with free shipping using promo code "GoodMoney" at Mises.org/Good
Receive a free subscription to The Austrian magazine at Mises.org/Magazine
Murray Rothbard was an elite economist, historian, and avowed enemy of the state. His legacy lives on nearly three decades after his untimely passing.
Original Article: "American Dissident: The Legacy of Murray Rothbard"
This Audio Mises Wire is generously sponsored by Christopher Condon.
Two "distinguished" healthcare analysts have examined the medical system in the USA and conclude that the REAL problem is . . . large hospitals. Dale Steinreich applies economic analysis to their claims.
Original Article: "Are Large Hospitals the Problem with US Healthcare?"
This Audio Mises Wire is generously sponsored by Christopher Condon.
In its unending quest for power, the state has no problem traumatizing the innocent.
Original Article: "The State Uses Trauma as a Weapon against Innocent People"
This Audio Mises Wire is generously sponsored by Christopher Condon.
Because government officials do not worry about the consequences of making mistakes, the government should not be permitted to regulate anything as important as vaccines.
Original Article: "Governments Cannot Effectively Regulate Vaccines"
This Audio Mises Wire is generously sponsored by Christopher Condon.
The migration data from 2020 to 2022 backs up the idea that a great many people are moving from restrictionist covid states to states where the public health technocrats have less power.
Original Article: "Since Covid Lockdowns, New York Lost More of Its Population than Any Other State"
This Audio Mises Wire is generously sponsored by Christopher Condon.
Progressives are quick to blame escalating healthcare costs on free markets, yet it's government rules and policies that are responsible.
Original Article: "In Government-Regulated Healthcare, There Is No Competition Like No Competition"
This Audio Mises Wire is generously sponsored by Christopher Condon. '
Vaccine mandates imposed by governments violate individual rights and further the coercive powers of the state. They also violate Kantian ethical norms, turning people into vehicles to accomplish the ends of governing elites.
Original Article: "Mandatory Vaccines vs. Logic and Kantian Ethics"
This Audio Mises Wire is generously sponsored by Christopher Condon.
US medical provision is far from a free market, and is a mixed bag of government and markets—as are most developed countries. Flagship programs have serious fiscal problems ahead.
Download the slides from this lecture at Mises.org/MU22_PPT_29.
Recorded at the Mises Institute in Auburn, Alabama, on July 28, 2022.
Even amidst plenty of bad news, quiet revolutions happen all around us.
No American industry is more ripe for disruption than medicine. Americans are addled; sick, overweight, mentally unwell, and dependent on too many prescription drugs. The business of “healthcare” is dominated by government—Medicare—and “private” insurance company middlemen, and it is in big trouble. Premiums and out-of-pocket costs now average $23,000 per year for a family of four. And the most expensive group of insureds, those over age sixty-five, are set to double in number by 2050.
For decades we have been told healthcare is a right, and not subject to the laws of economics. Rising prices, complexity, and insurance capture—caused by state intervention—are claimed to represent market failure. Single payer government schemes are offered as the solution, even as those systems fail disastrously in places like Canada and the UK.
Happily, the market is a powerful force and always finds a way. Heroes like Dr. G. Keith Smith of the Surgery Center of Oklahoma, along with a growing number of direct primary care doctors, are eliminating the middleman and bringing cash prices back to medicine. Where third parties destroyed market discipline and interfered with the doctor-patient relationship, the growing number of cash practices reassert both. My interview with Dr. Smith gives us a look inside this medical revolution and will leave you optimistic for the future.
What does that future look like? We cannot know exactly, but we already have the model from a time when American medicine was the envy of the world:
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Patients pay cash for basic services. This might mean Walmart clinics for some people or exclusive concierge services at home for others, but either way, direct cash prices impose the coherent allocation of resources.
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Insurance covers only insurable events. Serious illnesses or accidents are covered by catastrophic insurance, with high deductibles and priced according to the buyer’s actuarial reality (age, health, and habits).
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Charitable doctors and hospitals care for the truly poor and indigent.
That simple formula is all it takes to align incentives and bring all the price competition and capital needed to revolutionize medicine. Dr. Smith and others are the entrepreneurs leading the way.
Like medicine, conservatism faces its own upheavals. Never-Trump neoconservatives and their fading outlets like National Review—call them Conservatism Inc.—are at war with a “postliberal” populist Right personified by figures like Steve Bannon. This schism has prompted several new books attempting to define conservatism for the twenty-first century, by authors like Yoram Hazony, Patrick Deneen, David French, and Matthew Continetti.
Fortunately, we have David Gordon to review them!
Continetti is the most recent entrant, with his new book The Right: The Hundred-Year War for American Conservatism. Cutting his teeth at the now defunct Weekly Standard before migrating his war cheerleading over to a comfortable sine cure at the American Enterprise (sic) Institute, he is firmly on the establishment neoconservative side of this divide. In fact, Continetti’s book makes more sense if readers consider him a progressive at his core—which is to say grandiose in his worldview and warped in his perception of what the American state can, and should, accomplish. This grandiosity apparently spills over into his perception of his own skills, as very few living writers are equipped to write an overarching history of conservatism in the US. Continetti is not one of them.
If any single issue animates Continetti’s work, it is his unflagging support for war in service of American hegemony. He gets Ludwig von Mises and the socialist calculation problem wrong, which is to say he gets the essential choice between capitalism and socialism wrong. Unsurprisingly, the ardent cold warrior Continetti dislikes Ron Paul and Murray Rothbard, viewing them as enemies whose views were correctly tossed out during the Buckleyite purges. I won’t spoil David’s great review, but in sum, Continetti writes with an authority he does not possess and a certitude he has not earned. Continetti is simply another self-serving neocon who wants to rewrite the history of American conservatism on terms favorable to his camp. As always, thank you for your support for the Mises Institute and its mission.
Jeff Deist: Welcome, Dr. Smith. I know you are a University of Oklahoma alum and your surgery center is in Oklahoma City. Are you an Oklahoma native?
Keith Smith: Yes, I am. I was born in Tulsa and lived in the Southeast corner, in the Southwest corner, and ended up right in the middle.
JD: Do you think being a Midwesterner informed your worldview or your medical career?
KS: I think so. Part of the reason I’ve remained in this area is it’s always been my impression that the ratio of people to doctors in this part of the country is higher.
JD: We know each other through your involvement with the Mises Institute, and I’ve spoken to your organization, the Free Market Medical Association (FMMA). You understand me when I ask this loaded question: Medicine in the United States is in big trouble, isn’t it?
KS: Yes. As an eternal optimist, I would say that big medicine is in big trouble. The system is dysfunctional, but people are waking up. There are alternatives out there that are free market, and people are becoming aware that they exist, that they work. With this awareness, it becomes real tough for the big monsters—that is, the cartel that controls the strings with their pal, Uncle Sam—to continue driving the getaway car in this heist.
JD: I hate hearing the term “system” to describe medicine! Nobody talks about the American shoe leather system or the Doritos distribution system. Somehow, we’re able to get all these other goods and services without a “system.”
KS: It’s a system because we in this country look at people as a collective and as groups. And anytime we look at people from a medical perspective as groups or a system, that begs for a central, system solution, and that’s part of the problem.
JD: How did the United States go from having doctors and facilities envied by the world to this third-party nightmare we have today?
KS: I think it happened in the early sixties, when the federal government decided to inflict this monster they called Medicare on us in 1965. It’s no coincidence that this happened right after Harry Truman’s Hill-Burton Act in 1946, which populated the entire country with hospitals in almost every county, whether there was a market for them or not. Those hospitals did not want to deal directly with patients to receive payment, so the federal government created this trough that hospitals could plug into to be paid directly. I believe Medicare followed the appearance of all these government hospitals to ensure that they would all be paid. That was disruptive of what was otherwise a functioning marketplace.
Physicians in the early days objected to this, but the federal government knew that they could buy the support of the physicians by agreeing to pay 100 percent of whatever they billed. Thus, physician charges, no surprise, soared, and physicians were making a lot of money for many years under the Medicare system. Eventually all the objections to it broke down except in very small enclaves of real, true-blue free marketeers, like the members of the Association of American Physicians and Surgeons. Medicare popularized the idea of third-party payment. It increased the wages, the payments to physicians and hospitals for services they provided. That probably was the most pivotal and disruptive move and what brought us this third-party monster that we have now.
JD: So, the federal government was the original third party. How did the ostensibly private third-party insurers, big HMOs and PPOs, for example, become so involved?
KS: It grew quickly in the early 1990s as the Medicare trust fund, whatever that is, began to see that they were running out of money and the current contributions taken from people to support it didn’t begin to satisfy what was going out the door. Medicare then started draconian price cuts. As an anesthesiologist, I was paid $1,100 when I started practice in 1990 for the service I provided in open heart surgery on a Medicare beneficiary. In 1992, President George Bush inflicted the resource-based relative value scale on the Medicare system and on physicians, and the payment I then received for that same procedure was $550. These folks from Harvard decided that they could assign a price to every physician service that was supplied. A year later they came in with round 2, and the last payment I received for a six-hour open heart surgery was $285 for the anesthesia component.
JD: Wow.
KS: So, I quit. I quit filing claims. I don’t mind being charitable, but not at gunpoint. I quit participating in the Medicare system. I took care of Medicare patients, but I quit filing claims. When that happened, it caused a lot of fear across the medical community, and some physicians became attracted to non-Medicare payment sources. That worked for a little bit, but then non-Medicare payment sources, whether it was Blue, Untied, Cigna, Aetna, Humana, whoever it was, realized that they could continue to charge high premiums but use the Medicare fee schedule as a benchmark and pay for medical services at a lower rate, therefore increasing their profitability and their power. That was sort of a marriage where this public-private mess got started, and that’s still where it is now.
JD: And then, of course, Obamacare comes along and literally mandates so-called health insurance for the public. It creates these exchanges and everyone starts talking about the healthcare “marketplace,” but the exchanges represent anything but. You are required to have insurance under pain of penalty, and that insurance is not priced according to your actuarial risk. It must cover things like pregnancy or alcohol abuse. You’re not allowed to have a bare-bones catastrophic policy. Some marketplace!
KS: It’s actually worse than that. They pulled the big companies in to secure their support and had to give them concessions. One was called the medical loss ratio that allowed the bureaucrats and the politicians to use a heavy-handed approach with the insurance carriers and dictated that no more than 30 percent of their revenue could be used for administrative purposes. So that meant all of the insurance companies, except for the giant ones, closed their doors. It was a consolidation and it was intentional. Now there are only four: Blue, United, Cigna, Aetna, and they all had a hand in seeing with that regulation that only the most giant players could endure.
Obamacare also banned the construction or expansion of physician-owned hospitals. That was necessary to gain the support of the American Hospital Association. The administration also recognized Big Pharma’s profits were going to come increasingly from new biologic drugs, and as more and more pharmaceuticals went generic, there was less profit for Big Pharma. To secure the support of Big Pharma, they promised a ban on foreign competition in biologic drugs, and a week after they made this promise, the FDA declared foreign biologic drugs unsafe. There were all sorts of shenanigans like that. It was anything but a marketplace. It’s very devious to call it a marketplace.
Ironically, Obamacare was great for the Surgery Center of Oklahoma because in another big favor to the insurance companies, the federal government allowed deductibles to go sky high. So, the prices we had listed online were increasingly cheaper than people’s deductibles. Obamacare actually drove patients to the Surgery Center of Oklahoma because they became shoppers. They had sticker shock. They were spending their own money to buy the service that they needed and that we provided. It was very ironic that people found out, like the Canadians, the only single payer they could count on, really, was themselves.
JD: In Mises Institute circles we talk about the “financialization” of the economy, referring to how central banking has brought about low interest rates, encouraged mergers and acquisitions activity, encouraged malinvestment, and created a lot of leverage and other distortions in the economy. Insurance for everyday basic services seems to have “medicalized” the country. Many people are sick and addled, using dialysis and taking ten prescriptions.
I was in Pennsylvania recently and saw a billboard touting the largest employer in the state. It’s not a steel company. No, the biggest employer in the state of Pennsylvania is the University of Pittsburgh Medical Center. And it really struck me as artificial.
KS: It’s on both sides. The presence of the third-party payment system, it makes the buyer, the consumer, the patient, more inclined to enter the system if the barriers are low. The presence of a third-party payment drives utilization beyond what it should be. It also invites the unscrupulous on the seller’s side. It was no mistake that when the federal government assigned pricing through the resource-based relative value scale, they got everything wrong and the prices that were too low resulted in shortages in those services and the prices that were too high caused an abundance. Some of the services that were grossly overpaid were in abundance. Suddenly there were residents deciding, I want to go into that field because Medicare pays through the nose for that stuff. The financialization affects both sides. It invites and incentivizes unscrupulous behavior on the seller-physician-hospital side, but it also drives utilization on the patient-consumer side. It’s like Ambrose Bierce said: accountability is the mother of caution. There may indeed be some unhealthy habits that people have undertaken that they might not if they thought “I’m going to have to pay for acting like this.”
JD: Let’s talk about your story. You go through medical school and residency in the late 1980s. Some of the doctors training you at that time (older doctors in their fifties, sixties, and seventies) would have cut their teeth when the country still had an excellent cash system in America. Those days were not so long ago.
KS: I was fortunate to be around some of those physicians, and so I knew it was possible for there to be a real market. My great-uncle Walter was the only physician in a town in southwest Oklahoma. Walter Bayes was a great man. He was the guy that got on his horse in the middle of the night, in the winter, went to someone’s home and delivered a baby or saw to the sick. He was a very wealthy man, and he charged very, very little but he did very, very well. He was in a cash market, but sometimes it was pigs and chickens. He was beloved. People in the town of Chickasha still call their hospital—the old timers call it Bayes Hospital because the first hospital in town was the bottom story of his house. He lived in the top story. So, I knew, in spite of much of what I was taught and learned in medical school, in residency, that there could be a market. I was market leaning when I finished my training, and that made it all the more painful to realize once I got out and into practice that I was really aiding and abetting a robbery, a real crime. I was an accomplice, and I was helping hospitals rob patients that came through the doors and had surgery in which I participated.
JD: He was your great-uncle?
KS: He was my great-uncle. My brother’s also a physician, and he has a special room in his office that displays Dr. Bayes’s exam table and his tools and books, and it’s kind of a museum room. It’s very cool.
JD: What was your first job, then, out of medical school and residency?
KS: My first job out of residency and fellowship was here in Oklahoma City. In 1990, I joined an anesthesia group that serviced three hospitals. I was focused primarily on cardiac anesthesia and pediatric anesthesia. I might do a cardiac procedure or a vascular procedure at four or five different hospitals in one day. I was very busy and traveled all over town.
I was self-employed in my first real job. I never received any kind of salary. I never received any kind of income support. When I came to Oklahoma City, I joined this group, and what that meant was I was someone on the list, that when surgeons called our group, I was available. I was one of the anesthesiologists that was available, and all of the people that were part of this anesthesia group were all friendly competitors. If a surgeon liked me better, then he would ask for me on Tuesday instead of anybody else in our group. I borrowed money to buy the anesthesia machine, borrowed living expenses, and went to work and worked as hard as I could. I was scared to death of not being busy enough. I was scared of the debt that I’d incurred. We lived very modestly, and I was out of debt within six months. I paid off all the debts. I provided good service to the surgeons I worked with, and I was very popular with them and got very, very busy and very, very successful.
JD: Did you already have a wife and children at this point?
KS: Yes, I had a wife, a child, and one on the way, so I had reason to be a bit anxious. I wanted to be successful. I had real responsibilities. I was trained very, very well. I did my anesthesia training at the University of Arkansas and was fortunate, very fortunate, to meet people who were true mentors, some of which had been in private practice and were at the end of their career and just decided that they wanted to teach. When I arrived in Oklahoma City, I hit the ground running, very well trained, very confident, and loved what I did. I still have a full-time anesthesia practice, and I love it, particularly the pediatric part.
JD: Do you worry that young people in med school today don’t have those kinds of mentors?
KS: I do, and for that reason, I’m supporting the Benjamin Rush Institute chapter at the University of Oklahoma. I was contacted by a medical student whose husband is an Austrian economist. She’s a second-year medical student, and she wanted to know if I would help her establish a Benjamin Rush Institute chapter at OU. For your readers who are not familiar with it, it is the institute that helps medical students think about practice in a free market—in other words, not to be employees.
We had our first meeting, and I provided all the pizza and beer they could eat and drink, and we had twenty-five medical students show up, which is about a sixth of their class. The next meeting was even bigger. I brought bankers in, and I had the bankers talk to these medical students about why they should rent their soul to a bank, because they can get it back, instead of selling it to a hospital as an employee, where they can’t get it back as easily. I’ve had physicians come in who were employees who broke away and can tell them, “You know, as an employee, it’s not what it’s cracked up to be, it’s really awful, and now that I’ve broken away, I not only love my practice, but I regret that I ever was an employee.” I’m bringing speakers in to help these students understand that there is another way and it’s a more ethical and honest way, and it’s a more patient-centered, patient-focused way, and they should live and die by the market discipline, just like every other business. They shouldn’t have a full waiting room just because they’re signed up on some third-party PPO plan. They should be busy because they’re really good at what they do, and if they’re not really good, they ought to find something else to do.
That’s the way the market works in every other industry, and that’s part of the problem. What we see in this country is not a failure of the free market. That’s not the system we have. The system we have is a disaster because the free market is not at work. Everywhere it is at work, you see prices fall and you see quality soar. I’m happy that I am living to see this healthy resurgence of market principles in this industry. I think that this cheaper and better approach is impossible to argue with, and I think we’ll just see it spread.
JD: We hear about the medical school debt some of these young doctors have. They can’t buy equipment or afford malpractice insurance. Their expectation is to be an employee of some big organization like Kaiser. That’s so unlike your great-uncle’s experience.
KS: That was part of why I was so excited to connect with medical students, because the people who have backbreaking debt are the residents. By the time someone gets to residency, they may be too far gone, either financially or ideologically.
JD: Terrible.
KS: I was very excited to connect with the medical students because they’re not too far gone, either financially or ideologically. You just had to be there to see it, the dropped jaws and the wide-open eyes of these medical students when a banker tells them, “I want to help you, I want you to be my customer, and I will do a good job and I will treat you right because I want you to be my customer long term, whenever you have other financial needs.” And the idea that yes, there is capital out there that I can access without selling my soul. I think that a lot of the folks in medical training who are further along are so down deep in a hole that this sort of a message is less appealing to them. That’s why I was excited to get to them early.
JD: You need to do a barnstorming tour of undergraduate schools and deliver a speech called “Before You Go to Medical School”! So, pretty early on in your career you conceived of breaking away and starting the surgery center?
KS: After I dropped out of Medicare and stopped filing claims in 1993, I realized that I was part of a profession that was not governed by market principles, and that started to bother me. I saw the care that patients were rendered in the hospital dwindling, and I didn’t want to be a part of that. The quality of the care and the cost of the care were not favorable to the people receiving and buying the care. I knew the only way as an anesthesiologist that I could ever be a part of a more market-based, more patient-focused practice was to own and control the institution, the facility. It’s not the physician charges, typically, that bankrupt patients. It’s the hospital charges that are so difficult for patients. It wasn’t always that way.
In 1993, I was aware of a surgery center that was in trouble, and I made several overtures, to buy it and they were all unsuccessful. There was talk amongst many physicians in the Oklahoma City area who were disgruntled with what they were able to collect for services rendered and how the hospitals were mistreating their patients medically and financially. I started talking and gathering people together with the idea of building a facility. We had about eighty surgeons originally involved, but it was like herding cats, and they started to splinter off and do their own thing. This turned out to be a good thing because some of what these individuals did worked better and was more efficient in a small group rather than part of a larger group. Everything sort of fell apart after awhile.
I wound up on a hunting trip by pure accident and in the lodge met the two people that I needed to talk to about this failing facility. When I told them I wanted it, they jumped at the offer because they needed to unload it. And so, Steve Lantier, my partner in crime and anesthesiologist, and I bought it, and the Surgery Center of Oklahoma was born on May 28, 1997, twenty-five years ago. We bought everyone out and had 100 percent control. It was almost five years from the time I thought “I’ve got to get out of here and control my own place” to getting it done. We were wildly successful very early on, so successful we decided to build our own place, and that’s the facility we occupy now.
JD: I’ve heard you tell a story about when you got that first call regarding a procedure and you didn’t know what the hell to charge.
KS: That’s right. We bought this place with the idea that we would provide the highest-quality care at a reasonable price, that patients would always know what they were going to pay us, and that we would never take a dime of money from the government.
A week after we opened, a young woman called and wanted to know how much we would charge her to have her breast mass removed. I had no idea. I put her on hold and called the surgeon and asked him how much he wanted, and of course, he didn’t know. I pressed him and he said $500. I said, “That’s great,” and hung up on him before he changed his mind. I knew the procedure would take about twenty or thirty minutes, and as an anesthesiologist, I bill for my time. I kind of had the number in mind for what the surgery center should charge in order to be profitable. Then I realized she would want to know if she had cancer. So, I called a pathologist friend and asked him how much he wanted to examine the specimen. He didn’t know, and he finally said $28. I added it all up, while she was still on hold, and I said it would be $1,900, and she said, “For what?” I said, “Well, for everything.” She then told me the so-called not-for-profit hospital down the street wanted $19,000, and that was just for the facility.
After the surgery, we sharpened our pencil and looked at everything and realized we made a profit. Since that time, we have found, pretty much, we are 80 or 90 percent cheaper, most of the time, than those who claim to not make a profit at these big institutions, big hospitals. Still we don’t make a lot of money. We have a good marginal profit, but it’s not a grand slam, and we’re very, very happy to run our facility in that way. I’ve had phone conversations with countless patients from foreign countries, in all fifty states, just like that one for any number of procedures, from knee replacements to cochlear implants, you name it.
JD: When you were starting and developing a menu of cash prices for surgery—all-inclusive anesthesiologist, surgeon, and after care—surely vested interests in the state of Oklahoma opposed you?
KS: You know, we had had many legislative battles, and it was coming at us from the insurance companies and the hospitals. I think by the time I put the prices online, they thought they had killed us. There was one legislative move that really hurt us, and that was when the insurance commission in the state of Oklahoma allowed the stacking of deductibles. Patients who went out of network had to meet their in-network deductible before they started again at zero out of network. That put us out of financial reach for a lot of patients, and it hurt us. It almost killed us. So, when I posted the website in 2009, it was almost as a last act of defiance. And I do think at the time, the hospitals and insurance companies thought they had finally finished us off. When I posted the website, I think it was ignored at first. Then they chuckled about it and thought this was kind of funny, a desperate thing. Then it wasn’t funny anymore and they got angry, but there really wasn’t anything they could do about it. By that time, the Republican legislators at the state capitol had begun to waive the free market flag, and they didn’t attack us like they did in the early days to protect the hospitals that were their clients. They didn’t know how to attack us.
I receive inquiries from patients who need inpatient surgery, they need their colon removed for cancer, or they need part of a lung removed or some gigantic spine surgery or heart surgery. And now I actually contact these hospitals that tried to put us out of business and ask them, “Do you want to help this patient from Florida who has a pituitary tumor? Just give me your pricing and let’s not haggle. Give me a good price so you can set that up. Otherwise, they’re going to go somewhere else.” So, these hospitals that were dead set on killing us are now vendors of a clearinghouse that I run that pays the surgery center and all the physicians at my facility. I pay hospitals too and their surgeons. This move has actually overwhelmed these hospitals that were so opposed to it in the beginning. Now, even though they’re cloaked and kind of in the closet, they are participating in this movement because it’s too powerful for them to ignore.
JD: In those early years did you have to take time away from your professional work and go lobby or testify? Did you have to get involved politically on a personal level?
KS: Yes, I did. I spent a lot of time at the state capitol defending us. We made some friends at the state capitol initially. They were Democrats. They saw us as underdogs. They found it very refreshing that we did not accept money from the government because it wasn’t that sleazy conversation where I wanted a favor. I was asking them, “Just leave us alone and let the market work.” Who goes to see their legislator and says, “I don’t really want anything from you, just please resist the attacks on us that were meant to hamstring our operation.” One of our early Democrat defenders was an avowed socialist. Our approach and our demonstration that markets work in this industry has turned my socialist colleague into a true libertarian. He just didn’t know how markets worked, and once he did, he’s as true-blue a libertarian as anybody I know now. What we did changed his whole worldview.
There was a national effort to ban physician ownership of facilities, and there were some people here in Oklahoma who were a big part of that effort. I went to Washington a couple of times and actually testified before a committee. But most of our challenges were here at the state capitol. The state health department was even weaponized against us at one point. So yes, there were a lot of challenges, there were a lot of hurdles, and I think that it helped me. It sharpened my teeth. I was in situations that I was not trained for as a physician, dealing with people who were very savvy communicators, people who could speak their mind very eloquently, even under fire. I found myself in those situations, and it made me sharper, and it made me better, and it prepared me for much of what I later had to face opening and running a surgery center. We have 116 surgeons here now, and I’ve had many media appearances, not all of which have been friendly. And, all of those experiences back then, as stressful as they were at the time, now that I look back, I know just made me better.
JD: You quoted a woman $1,900 total for a procedure that her local hospital wanted $19,000 to perform— and that was just the facility fee! These kinds of disparities, ten times or more, are incredible. Imagine the ungodly sums, the billions of dollars wasted on surgeries alone in this crazy nonmarket system. You are a threat. That’s an awful lot of money for that local hospital to leave on the table.
KS: I think we are a threat, but it’s difficult to argue against cheaper and better. Initially there were some salvos in our way to suggest quality-wise, maybe we weren’t as good as someone who charged ten times what we did. That didn’t go anywhere because we had already established a reputation in Oklahoma City and in the state of Oklahoma.
We took care of all of the Division 1 athletes. As a pediatric anesthesiologist, Steve Lantier and I had anesthetized most of the corporate execs’s children in the city. We had a solid quality reputation. Those attacks gave me a chance to talk about price equality and how the reason prices are high is that there’s no competition going on, and if there’s no competition, you don’t have to be any good. That was very uncomfortable the first time I said that to a hospital exec. A hospital exec one time asked me under fire, “How do I know that your surgeons are any good?” And I said, “Well, unlike your surgeons, we don’t make more money when something goes wrong.” Through these attacks, we learned to help make sure that their attacks backfired.
Again, I think we are a threat, but some of the big players know that this is coming. I had a major Blue Cross executive, who’s head of an entire state for Blue Cross, recently tell me that he’s a big admirer of what we’ve done but that it scares the hell out of him. They know that it’s coming and they’re going to have to accommodate this all-inclusive transparent price-approach to care.
I’m helping hospital execs get into this business. There is a network of hospitals here in Oklahoma and four or five other states that are involved. “Do you want this patient from Alabama or California?” Patients they would never know about otherwise. There’s not that much risk to them to step into this world. Working together, we help create and curate inpatient bundled prices, all of which are listed, by the way, at a different website called Atlas Billing Company.
I think people also know—even the big dogs in this industry know—it’s going this way and they want the help of someone who’s on the inside. That balances a little bit the desire they have to destroy the movement. I think that it’s gone too far for them to kill it. I knew when Donald Trump signed an executive order that mandated price transparency that as wrongheaded as that was, in terms of the results that it had, it changed the narrative. Now the weirdos are the ones who won’t tell you how much a tonsillectomy is. Now it’s the people that said “Well, we don’t really have any idea. We don’t know how long that surgery’s going to take” or “We don’t know if the patient’s going to spend a lot of time in recovery room.” Those people are seen as the sleaze that they are. The narrative has changed, and that’s one of the reasons, even though we’re a threat to the system, that the system doesn’t know how to attack back.
JD: Some surgeons and certainly some healthcare administrators must make far more money under the current system than they should.
KS: That is absolutely right. I’ll say this, though: by and large, physicians are moral, ethical folks who do the right thing. There are people out there who are operating unnecessarily, and those are the folks who are making a ton of money, people who are doing procedures that ought not to be done. We don’t allow those people in our facility, and the market has a way of sniffing those people out. One thing I’ll say is when hospitals employ primary care doctors, the primary care doctors are valued and judged, paid and bonused, based on the extent to which their referrals make money for the mother ship. So, primary care doctors refer to surgeons who are employed by hospitals, and the more surgery they do, the bigger bonus the primary care doc receives. It’s really awful.
There are administrators who shouldn’t have a job at all, and you look around a hospital and you shake your head and wonder what is it that this person does that contributes to patient care. But multimillion-dollar hospital CEOs have a lot of responsibility. We don’t have an administrator at our facility, or rather, I’m the administrator. This top-heavy administrative apparatus that sits on top of the industry is a result of government regulations, which the big players in the industry have welcomed, and it’s also a result of the third-party payment system that I think is breaking down.
JD: I suspect that those million-dollar hospital CEOs actually detract from patient care with their busywork. You had a lot of stress getting the cash surgery center up and running and breaking the mold. Your life could have been more comfortable as an anesthesiologist in the system. Was it worth it not to deal with government and third-party insurance and all the medial billing bureaucracy?
KS: Mises said, “People go from A to B because they prefer B to A.” All in all, my life is satisfying. Stress-wise, it’s the stress I’ve chosen. And the stress of the market is real. You have to perform. You have to have good results. You have to have good outcomes, or the market will murder you. We have embraced that because everyone in my organization is confident of their abilities. We’re not afraid to compete, but there’s a stress that goes along with that too because the expectations for those of us out in the marketplace embracing that discipline are higher than they are for the cogs in the wheel. But yes, I feel vindicated, and all of the battles that we endured in the early days have borne fruit. There are countless patients, tens of thousands of patients, who have benefited from our approach, whose assets and wealth have been preserved, whose children have had surgery who otherwise could never have afforded it. There are many, many success stories over the years, so I’m paid in that way too. I have a very rich existence because of the friends and relationships that I’ve had with coworkers, surgeons, employees, and people who have supported us. Yes, it’s been hard, but it’s been very, very rewarding.
JD: And of course, some of your patients come from places like Canada, where a so-called single payer system gives them “free” surgery only after a long wait.
KS: That’s right. They’re paying with their time. We operated on a Canadian recently, and this is a common story now, the woman needs a hysterectomy and is in line waiting for three years.
JD: Wow.
KS: Their system is so dysfunctional. It’s three years of getting transfusions because of her bleeding. And for $8,000, she can end her nightmare and have a hysterectomy. The wait for a knee replacement is also three years right now. And in fact, when I launched the website in 2009, the first patients to come were Canadians. People come from all over the place. About 40 percent of our patients, in any given week, sometimes even higher, are not from Oklahoma. They travel here because they hear about us for one reason or another. We turned twenty-five years old, as I said, this week, and we had a big party. We had a big crawfish boil and invited three hundred people. Ron Paul and Steve Forbes sent congratulatory videos. Larry Van Horn, a healthcare economist from Vanderbilt I’ve become friends with, he sent a nice video of congratulations.
The people in Oklahoma, the employees that I’ve worked with at the Surgery Center of Oklahoma, we know we are part of something that’s bigger than just your average surgery center. It’s provided sort of a model for others who have followed up. WellBridge Surgical in Indiana just launched and it’s a carbon copy of the Surgery Center of Oklahoma. These facilities will begin to pop up all over and there will even be some hospitals putting their toe in the water. They will do this because they are afraid that people will leave their community and travel to Oklahoma or to the guys in WellBridge to get their surgery.
JD: At those prices, you can fly first class to Oklahoma City and stay at the Four Seasons! You talked about the Surgery Center of Oklahoma and its tertiary care: anesthesia and surgical services. But there is also a revolution at the primary care level. Direct primary care (DPC) doctors who accept cash for frontline family-practice medicine are growing. You know and are friends with many, many doctors in this movement through your work with the FMMA. Can you just give us a brief sketch of the DPC revolution and where it is going?
KS: The direct primary care movement, I believe, is the most disruptive component of this free market healthcare movement. It was founded by two physicians in the United States with very different approaches: Lee Gross in Sarasota, Florida, and Josh Umber, in Wichita, Kansas. They were aware of the concierge movement, where physicians charge patients $10,000 a year whether they see them or not, just so the patient can have immediate access. Lee and Josh thought, Why can’t we have a blue-collar version of that where we offer care that regular people can afford? They kind of backed into it by thinking, How much money do I feel I ought to make as a doctor? What is fair? And I wonder if I had six hundred patients or eight hundred patients in my practice instead of three thousand, like many primary care doctors do, and they paid me $70 a month, and I’ll be at your beck and call. See me whenever you want. You can text me. This movement has exploded. And the most disruptive part of it is these are self-employed, right-up-against-the-wall capitalists and are not hospital employees. When a patient walks into the office of a direct primary care doctor, that direct primary care doctor is working for that patient. They’re not working for the hospital, and all the conflicts of interest are gone. If that patient is attracted to a direct primary care doctor, they also probably have sticker shock. They’re a member of a cost-sharing ministry or they’re part of a self-funded plan which pays for these direct primary care subscription memberships.
Recently a patient walked into a direct primary care doctor’s office with appendicitis. I get a call, “Can you do an appendectomy on this guy?” Well, yes. And that whole episode of care cost less than $6,000. Just think about that: patient goes to the ER because they don’t have access to a direct primary care doctor, and then they’re hospitalized and have an appendectomy in one of these giant price-gouging hospitals, and you’re looking at $30,000 or $40,000 minimum.
I’m proud to be friends with many in the direct primary care community and really do view their role in this movement as a most critical one.
JD: Can we conclude that big medicine is in big trouble, but the evolving cash market gives us reason for optimism? Would you agree with that assessment?
KS: I would agree with that. I keep coming back to Rothbard’s quote that the market is beautiful but it’s also powerful. We’ve been witness to that. We are seeing the beauty of the market discipline at work and how it is making prices fall and quality soar all at the same time. But we’re also seeing how this tiny movement, these individual direct primary care doctors, this surgery center in Oklahoma City, has exerted an incredibly powerful influence on the market, as small as we are. So, big medicine is, I think, in big trouble, and it’s because of market discipline and the power that it wields.
JD: Excellent, Dr. Keith Smith. I want to thank you for your time.
KS: It’s always good to talk to you.
California's progressive political classes now have a scheme to impose a single-payer system for medical care. If imposed, it will be costly but also ineffective.
Original Article: "California Scheming: The Progressive Leadership's New Plan to Impose High-Cost, Low-Quality Medical Care"
This Audio Mises Wire is generously sponsored by Christopher Condon.
Although Biden presented the formula shortage as caused by "forces" outside the USA, the shortage is homegrown. Bastiat could have explained why.
Original Article: "Bastiat Predicted the Baby Formula Crisis 170 Years before It Happened"
This Audio Mises Wire is generously sponsored by Christopher Condon.
The proposed WHO Pandemic Treaty is nothing less than an exercise in medical totalitarianism. Welcome to the rule of the medical bureaucrat.
Original Article: "The WHO's Pandemic Treaty: The End of National Sovereignty and Freedom"
This Audio Mises Wire is generously sponsored by Christopher Condon.
The Great Reset usually is framed as the reestablishment of democratic social principles. In reality, it's an attempt to do away with the last vestiges of classical liberalism.
Original Article: "Covid and Its Statist Legacy: How Did We Get to This Point?"
This Audio Mises Wire is generously sponsored by Christopher Condon.
By making covid a political virus, progressive politicians, cheered on by their media, applied political "solutions" that failed to protect the most vulnerable people.
Original Article: "Covid-19: Assessing the Madness in Year 3"
This Audio Mises Wire is generously sponsored by Christopher Condon.
The proabortion centralist line of "accept our definition of human rights, or else" is what we'd expect from the imperialists of old who claimed the "savages" in the colonies couldn't be trusted with self-government.
Original Article: "Federal Control of Abortion Laws Is Modern Colonialism"
This Audio Mises Wire is generously sponsored by Christopher Condon.
With the shortage have come the usual half-baked bromides about "evil corporations" and how they aren't regulated enough. The real fault lies with welfare statists, Trump-style protectionists, and the FDA.
Original Article: "Baby Formula: Thank Protectionists and the FDA for the Shortage"
This Audio Mises Wire is generously sponsored by Christopher Condon.
Our guest is Dr. Stanley Goldfarb, author of the recently-released Take Two Aspirins and Call Me By My Pronouns, a book that details the intrusion of critical race theory and identity politics into medical education and medical practice. He is a former Associate Dean for Curriculum at the University of Pennsylvania Perelman School of Medicine and returns to the show to discuss his book and the new organization that he is leading to push back against the new trend.
SHOW NOTES Stanley Goldfarb: Twitter
Do No Harm
Related Episode: Ep. 102 Curriculum Subverted: An Academic Leader Pushes Back Against Woke Medicine (with Stanley Goldfarb)
Related Episode: Ep. 140 Amy Wax on Wokeness in Medicine
Related Episode: Ep. 149 James Lindsay: Critical Race Theory, Post-Modernism, and Medicine
Watch the episode on the Accad & Koka Report YouTube channel
The standard line with progressives is that unless government controls medical care, prices will skyrocket. But what if the free market model costs less than government-directed care?
Original Article: "How Fully Private, No-Insurance Hospitals Help the Common Man"
This Audio Mises Wire is generously sponsored by Christopher Condon.
Recorded in Birmingham, Alabama, on April 2, 2022.
Special thanks to Mark Walker for sponsoring this event.
Recorded in Birmingham, Alabama, on April 2, 2022.
Slides used during this talk are available here.
Special thanks to Mark Walker for sponsoring this event.
Those responsible for locking down much of the US during covid blame the pandemic itself for the economic and social havoc that followed. Perhaps they should look at the lockdowns themselves.
Original Article: "Lockdowns, Not the Pandemic, Created Havoc"
This Audio Mises Wire is generously sponsored by Christopher Condon.
The late Dr. Thomas Szasz, who was well known to libertarians, believed using coercion to treat psychiatric patients was a form of torture. He left a legacy of freedom in a profession that has all but abandoned liberty.
Original Article: "Dr. Thomas Szasz’s Campaign against Psychiatric Coercion and the 'Therapeutic State'"
This Audio Mises Wire is generously sponsored by Christopher Condon.
The medical care industry is so restrictive of individual freedoms — those of both of doctors and patients — that we can legitimately classify it as tyrannical. As is always the case, the solution will come from entrepreneurship, the creative and innovative response of individuals, doctors and teams and firms and their new business models to the dissatisfactions of patients and users of today’s system.
Joe Matarese is one of those innovative individuals. In episode #162 of the Economics for Business podcast, he described the nature and cause of the problem. In episode #163, he surveys the entrepreneurial solutions, some of which are beginning to emerge and some of which still lie in the future.
Key Takeaways and Actionable Insights As with all entrepreneurial solutions, the consumer is in the driving seat. The consumer — in this case, the patient — are clear in what they want, and what they don’t always get: quality care, accessible and convenient, at an affordable price.
Their definition of quality includes the alignment of interests between medical professionals and patients. Accessibility and convenience result from timely response to patient needs as opposed to lines, waiting rooms and delays. Affordable prices will arise when pricing is open as opposed to hidden behind the veil of insurance, co-pays, and healthcare-as-a-benefit rather than as an economic good.
Direct Primary Care is the business model that aligns doctor and patient interests. The new emerging model of membership-based primary care (see BigTreeMedical.com) is a doctor or a small team of doctors setting up an independent practice and recruiting a customer base of subscription-paying patients. In return for a monthly or annual subscription, the patient enjoys access, and one-on-one consultations on demand (usually via tele-medicine visits). The doctor is often networked into a pharmacy (or the practice obtain a pharmacy license) so the patients access to drugs is facilitated, and the prices of drugs to the patient can be lowered.
Most importantly, the patients are able to build a strong relationship with their primary care doctor. Health monitoring can be closer and more personalized, and early treatment — one of the most important variables in medical care efficacy — can be facilitated.
The direct primary care practice is networked into specialists and treatment centers so that the doctor and patient together can choose the treatment pathway that is best for the individual — tailored to individual circumstances and needs.
Personalized technology supplements the Direct Primary Care model, greatly enhancing the health outcome benefits for the patient. The direct primary care model and one-on-one patient-physician relationship provide the ideal conditions for the deployment of modern personalized technologies. Condition-monitoring watches and wristbands and other wearable or portable consumer electronics can provide the doctor with monitoring data and send an alert for any change in condition or abnormal reading. The doctor or patient can call for an immediate diagnostic consultation.
A direct primary care practice can be networked into an imaging center and a testing center for supplemental data acquisition — many of the new devices are mobile and can come to the patient, rather than vice versa, or can provide more immediate and convenient accessibility.
Personalized networked tech provides a new infrastructure for patient-directed monitoring and analysis (whereas the Obamacare “standard of practice” protocol predetermines what tests and diagnostics a patient can access, locked behind a bureaucratic gateway).
An entrepreneurial ecosystem of services will emerge to support the Direct Primary Care model. The opportunities for entrepreneurs in the new medical care ecosystem are, to use Joe Matarese’s word, endless. He cited, as an example, the Surgery Center Of Oklahoma (SurgeryCenterOK.com), which posts cash prices for surgeries online (no hidden fees), and can usually provide service within 24 hours. They take no insurance and patients pay cash. On a broader geographic scale, medical tourism destinations with open pricing give patients the opportunity to find best pricing and provide the latest equipment and top doctors.
There are cost sharing services such as Sedera (Sedera.com) that offer new ways for patients to pay for healthcare in a peer-to-peer sharing of large unexpected medical costs. Sedera’s Cash Pay Directory provides educational resources and shopping tools to “help members become savvy healthcare shoppers”.
There are negotiation vendors who help patients to get fair pricing on medical bills from the big hospital conglomerates. There are online pharmacy vendors, like Mark Cuban’s Cost Plus Drug Company (CostPlusDrugs.com), to help patients shop for the best drug values.
There are entrepreneurial services like Freedom Health Works (FreedomHealthWorks.com) to help Direct Primary Care doctors with billing systems, office tech and the business infrastructure for a modern practice.
In the entrepreneurial world of healthcare, entrepreneurs compete to provide the best and most affordable services ecosystem so that patients can enjoy the best healthcare.
Open pricing and cash payments are an important component of the new system. A big problem, perhaps the biggest problem, with the current medical care system is that the price system is not able to work in the way that it works in free markets. As Joe put it in episode #161, medical care system is “price-less”. Because payments are made by a third-party payer and not by the individual consumer, pricing becomes opaque to the user and economic calculation is rendered impossible. The third-party payment veil has resulted in price escalation and price manipulation and multiple prices for the same procedure at the same facility depending on whether the payments are immediate or deferred and the degree of bureaucratic and regulatory involvement.
If patients were to pay cash for treatments, they could make better decisions about exchange value. Catastrophic insurance for unexpected and rare events would make the use of insurance more like its application in car insurance and fire insurance — a properly priced optional spreading of risk for unexpected future events.
Consumers and physicians will collaborate in the creation of a parallel system for medical care. Joe Matarese believes the status quo medical care edifice is too rigid and entangled to reform. The solution lies in a parallel system. If consumers activate their demand for improvements in quality, accessibility, convenience and payments systems, entrepreneurs will respond with new market-based offerings. Customers will flock to them because of the benefits they perceive in contrast to the current system. Market feedback loops of satisfaction and dissatisfaction will rapidly fine-tune the new parallel system to a higher level of value and acceptance. Joe estimates that to will take only 5-10 years for the new system to take over.
Additional Resource "Entrepreneurial Solutions to Medical Tyranny" (PDF): Mises.org/E4B_163_PDF
Medicus Healthcare Solutions: MedicusHCS.com
The scientific method requires free and open dissent from any scientific hypothesis. Yet JAMA is requesting that medical boards become a new Inquisition to root out heresy and apostasy from CDC doctrines.
Original Article: "Real Scientific Inquiry Requires Dissent. But That's Not What the CDC and JAMA Want."
This Audio Mises Wire is generously sponsored by Christopher Condon.
Medical care in the US exemplifies how the perverse effects of accumulated, self-reinforcing economic errors can render a system dysfunctional for consumers. As CEO of Medicus Healthcare Solutions, Joe Matarese has seen the current system from the inside — working and interacting with thousands of hospitals and thousands of providers, primarily doctors, around the country, dealing with processes, bureaucracies, government reimbursement procedures, and the full gamut of the producer side of the medical care system. In Part 1 of a two-part podcast series, he gives us the informed insider’s view.
Key Takeaways and Actionable Insights Many forces combine and interact to produce the medical care system we experience today. Politics: As in almost all cases of market destruction, politicians are highly responsible. They have decided that the medical care of individual citizens is an appropriate field for their interventions, and they meddle in their usual ignorant and incompetent fashion. Dr. Scott Atlas of Stamford University was one who documented some of this glaring incompetence and its resultant creation of the crisis response to the COVID-19 pandemic in his book A Plague Upon Our House. The impact of political incompetence on individuals’ experience of medical care is not limited to COVID-19, but Atlas’ book provides one excellent example.
Regulation: Politicians don’t just meddle; they legislate and regulate. The Affordable Care Act of 2011 is a particularly significant milestone. It created a regulatory environment in which it became virtually impossible for independent physician groups to function. Smaller and rural hospitals could not survive the regulatory burdens imposed, and many closed or were acquired by larger hospital groups. The resultant consolidation and anti-decentralization led to centralized decision-making (particularly evident in the COVID-19 pandemic, but much more broadly impactful than just that event) to the effect that individual doctors are told how to practice and how to treat their patients. The one-on-one doctor-patient relationship that flexibly exercises the experience of the doctor on behalf of the individual needs of the patient and their particular condition Is no longer operative. Doctors now apply a centrally designed pre-determined “standard of care” (and are even told by the AMA what “woke” language to use when interacting with their patients).
Bureaucracy: With regulation comes bureaucracy. Central to the medical care system is the CMS bureaucracy — The Centers For Medicare And Medicaid Services. (You can visit the behemoth at cms.gov — it’s instructive to see the breadth and depth of its reach.) This is the home, for example, of the code lists that govern medical care billing and payment policies. Every doctor must code every patient interaction and every procedure, and the code triggers a specific billing amount. The care that doctors can give patients is governed by these codes and standard-of-care protocols rather than the heuristics an experienced doctor uses to treat individual patients in individual circumstances.
Perverse incentives: Out of the regulatory bureaucracy comes a cascade of perverse incentives. The billing code system leads to one of them: hospitals and doctors will lean towards treatments and billing codes that result in the best billing and revenue outcome for them, rather than what is best for the patient. Similarly, with the fee-for-service model of the Affordable Health Care Act, there’s always the incentive to provide the service or procedure that generates the best fee.
Financial Engineering: The worst financial engineering of the medical care system is the tying of health insurance to employment, and the general misuse, misunderstanding and mispricing of insurance that results. Insurance is appropriate for classes of events (like car accidents or house fires) which are known to have distributed incidence but unknown in terms of where and when they will take place. Individuals pay into an insurance pool that can be drawn on when an unlucky individual encounters an incident; we all hope we will never have to draw on it. In health care insurance, individuals pay for coverage which they know they will draw on. They expect insurance to pay for routine things they should really pay for out of individual income or savings. Medical insurance coverage is appropriate for rare or catastrophic events, but not for everyday health maintenance. In fact, insurance totally obscures the market for health care.
The combined result of all these forces is the elimination of economics from medical care. No free market: Medical care is the epitome of interventionism. There are no unregulated voluntary exchanges between buyer and seller, in this case patient and doctor. Every interaction is regulated, bureaucratized, coded, and distorted by financial engineering. Most importantly, there is no free market pricing. Prices are the indispensable signaling and information exchange mechanisms of markets; when they are suppressed, markets can’t function. The medical care system is, as Joe Matarese puts it, price-less.
No entrepreneurship: The function that solves consumer problems in markets is entrepreneurship. Entrepreneurs identify customer dissatisfactions and devise and present solutions for consumers to choose from. Entrepreneurship can’t operate in regulated healthcare. It is suppressed. Joe pointed out that, in the few corners where an entrepreneurial breakout has occurred — he mentioned medical tourism, Lasik eye surgery, cosmetic surgery, and The Surgery Center Of Oklahoma (SurgeryCenterOK.com) — prices have been lowered, quality increased and value spread wider and wider in the market, reaching more and more consumers.
Repressed Innovation: A major output of freely priced entrepreneurial markets is innovation. Entrepreneurs bring improvement in the form of new services and offerings, improved processes, and the application of new scientific discoveries. The innovation process is highly repressed in US Health Care, as in, for example, the FDA’s long and arduous bureaucratic process for approving new drugs resulting in delays in their adoption costing millions of lives.
Replacing the free market is an edifice of massive, plodding, constraining entities. The top of the monstrous pile can probably be assigned to Big Pharma. The massive amount of funds flowing through the pharmaceutical companies empowers their commandeering of the medical community. Government healthcare agencies such as CMS, FDA and VA take up their entwined cronyist positions related to Big Pharma and Big Hospitals. Big Insurance is the financial engineering for the edifice. The bureaucracy regulates them all, but from a position of having been captured through the lobbying process. The patient sits at the bottom of this stack, squeezed by its weight, restricted by its rules, and constrained from receiving individualized care even though doctors and nurses are capable of providing it.
The COVID-19 experience was an instance of the negative consequences of regulated, bureaucratic, perversely incentivized and politicized medical care. The standard four pillars of a medical response to the COVID-19 pandemic would have been:
mitigationearly outpatient treatmenthospital treatmentvaccination Instead, we were bureaucratically and politically accelerated towards a mass vaccine solution, satisfying the perverse incentives of Big Pharma.
Mitigation could have embraced healthy lifestyles, nutraceuticals, and some stratifying of risk by patient age. Instead, it was botched with ridiculous and useless mask mandates and pointless (and damaging) lockdowns.
Early outpatient treatment for those infected would have recognized the “golden window” of outpatient treatment in the first two or three days of the case to reduce the need for later hospitalization, as documented by Dr. Serafino Fazio and others in a published paper (see Mises.org/E4B_162_Paper), with drugs like ivermectin and hydroxychloroquine, but these were ridiculed, and their use repressed. By the time hospital treatment is needed, the condition has changed from one of inflammation and clotting to pneumonia and lung infection, with potentially worse outcomes. The use of remdesivir was centrally authorized, and this drug is much more expensive and risks worse side effects than the early treatment drugs.
The four pillars were abandoned for the centrally planned decision of mass vaccination.
There is a pathway out of medical tyranny. Principles of Austrian economics can help us find the way out of the current situation. Some of the principles we might apply include:
Let free markets operate: The medical care edifice refutes and represses free markets and market pricing. The first step in a solution is to restore markets to medical care.
Customer sovereignty: Markets are built around the consumer as “the captain of the ship”, determining the purpose and direction of the voyage. Consumers would exercise their sovereignty in a one-on-one relationship with their primary care physician.
Decentralization: Decisions in markets are made close to the customer and not via centralized bureaucracies.
Network versus hierarchy: Austrian economics views markets as networks of specialized nodes connected by 2-way information flows and provider-consumer interactions. The medical care edifice is a hierarchy not network.
In Part 2 of "Entrepreneurial Solutions to Medical Tyranny," Joe Materese will identify some specific ways that we can build a parallel system outside the edifice to bring back consumer sovereignty and free markets.
Additional Resource "Entrepreneurial Solutions to Medical Tyranny" (PDF): Mises.org/E4B_162_PDF
Medicus Healthcare Solutions: MedicusHCS.com
Bob explains the friendly exchange he had with Dave Smith regarding the new Johns Hopkins study that concluded lockdowns did little to reduce mortality. Smith had tweeted that in a sane world, all those favoring lockdowns would be publicly disgraced, while Bob argues that these studies are so open-ended that people on both sides can reasonably ignore those that disagree with their preferred conclusions.
Mentioned in the Episode and Other Links of Interest: Dave Smith’s original tweet about the Johns Hopkins studyBob’s article on Nordhaus vs. the UNA Reuters “fact check” that cites Johns Hopkins experts on why lockdowns DO workA Politifact pushback on Johns Hopkins study For more information, see BobMurphyShow.com. The Bob Murphy Show is also available on Apple Podcasts, Google Podcasts, Stitcher, Spotify, and via RSS.
Business success is a function of knowledge — the right knowledge at the right time applied in the right way. But knowledge is always scarce and incomplete and sometimes wrong. It is best to regard knowledge as a process: continually gathering changing knowledge from a wide range of sources to integrate into decision-making and action. Austrian economics can provide that integration, helping businesspeople with sense-making in a complex, ever-changing world of knowledge. Yousif Almoayyed joins Economics For Business to share his knowledge journey and the ways in which Austrian Economics provided him with the required integrating theory.
Key Takeaways and Actionable Insights Business knowledge is gathered from multiple sources and multiple disciplines. Gathering knowledge that’s relevant for business success is a process, a journey, and an exploration. It’s not limited to business subjects. A rounded businessperson studies economics, of course, but also history, psychology, languages, culture, computer science, political science. Why are these all relevant? Because business is a social science, concerned with how people think and perceive and interact, and how they adapt to new knowledge and changes in context and changes in choices. All the knowledge disciplines impact business.
There’s an exploratory phase in every knowledge journey, where we cast our knowledge net wide. Yousif Almoayyed describes how his early years of schooling included multiple schools both in his native Bahrain and in the US and other countries. He started to gather comparative knowledge of different countries and cultures. He decided to continue the process by traveling to and studying in China. He developed an elevated capacity for the critical business skill of empathy: seeing things as others see them, through others’ eyes, or rather, through others’ mental models. People who grow up with a different cultural and philosophical and religious and linguistic and institutional background develop different mental models. The facility to discern, analyze and understand those mental models helps businesspeople in their interactions with customers, competitors, employees, partners, and suppliers.
The exploratory phase of knowledge gathering doesn’t require us to think about applying that knowledge in business at the time of gathering. It’s building up a knowledge inventory.
Different fields of knowledge can yield different business skills. Yousif told us how he studied computer science and developed a deeper understanding of the clarifying explanatory power of logic. Via the discipline of computer programming, which requires efficient navigation to an answer that is both right and elegant, he was able to gather principles of logical reasoning that are highly applicable across disciplines.
He studied history and — by combining these studies with empirical observations in China and Cambodia and Africa as well as the Middle East — he was able to develop his skills in causal reasoning. What causes can be credibly and realistically and logically linked to what outcomes? What he observed on the ground did not always comport with what is taught in history books, since historians may use flawed or biased logic or incomplete knowledge. Best to construct your own reasoning chain and your own web of causality. This skill is highly applicable in business.
Linguistics helps with understanding the meaning that people intend when they speak. It helps with nuance and idiom, and with assessing people through their spoken words — another critical business skill.
Austrian economics is the system of thought and logic and insight that can integrate all this knowledge into a cogent way of understanding and explaining the business world. Yousif felt that, even with his wide range of multidisciplinary knowledge and multicultural experiences, he still did not understand people and their decision making sufficiently for business. Yousif discovered Austrian economics by reading its definitive treatise, Human Action by Ludwig von Mises.
He told us that he found the insights in Human Action, derived from theory, were highly confirmable in the real world via observation. Anyone can make the same discovery. Over time, for example, you will be able to build more and more confidence in your understanding of how people make their decisions, as well as in your own decision-making about the future. By understanding how individuals’ value systems drive economic decision making, you will be able to interpret and anticipate their economic choices. You’ll deduce the theories or mental models through which people see the world, and analyze their actions that way.
Value systems are at work in firms, also. When a firm has a value system of trust and collaboration, there will be an alignment of interests among everyone who works there, and with suppliers and partners. If you take such a firm as a customer, you can apply the same values-based approach to building a strong business relationship.
Running your own business is an original and customized application of principles of Austrian economics. You can’t read a book about how to run your own business, Yousif told us. Your analysis, using the principles, must be original. He gave the example of applying price theory in his domestic market of Bahrain. It’s an island, so it’s possible to track price fluctuations in inbound commodities — a special economic case. There are unique seasonal business patterns. Trading in oil has a disproportionate effect on economic conditions, and the oil industry is government controlled, so oil prices affect government spending. Boom and bust cycles are very real, and there is observable monetary distortion of firm-level accounts.
Yousif is able to plug these real and highly specialized data into his command of Austrian price theory to arrive at not only price decisions, but a wider range of decisions about when to build inventory and when to deplete it, and when and how to refresh his capital base, replacing older high-maintenance machines with new high-reliability upgrades. Theory is applied in practice in a very real way and in very real decisions. The results have been impressive: a turnaround of a firm to become a growth business and a market leader.
This is our aim at Economics for Business: applying economic principles to help you to improve and accelerate your business.
We all seek progress: at the individual level, the team level, and the company level. Flow is the term for the experience that we feel when we are making progress on challenging activities through our own actions. Flow is high productivity and high achievement. It is the sensation you have when making progress is “winning” over being distracted or frustrated. Organizational structure is often a barrier to flow. Bart Vanderhaegen tells Economics For Business how to transcend the barrier.
Key Takeaways and Actionable Insights Learning and change are good for people and organizations, but very hard to implement. Management books, management gurus and consultants are all for change to established ways of doing things. But the business landscape is littered with failed change and transformation projects. It’s not people who resist change, it’s processes and established practices and organizational structure. In many ways, structure is the biggest barrier to change, and the enemy of learning. Even when change projects re-make a business’s structure, it’s still there, just in a different configuration.
What if it were possible to transcend structure?
The secret lies in motivation. Austrian economics reveals the secret of motivation: every individual seeks better circumstances for themselves, trading one set of conditions that’s unsatisfactory for another set that they prefer. That’s an intrinsic motivation — it comes from inside the individual.
Most business systems rely on extrinsic motivations, what Bart Vanderhaegen calls carrot and stick. The firm metes out rewards in the form of awards and bonuses and promotions for behavior it wants to encourage, and withholds them when there is unapproved behavior. The firm takes a positivist or behaviorist view of the world: people can be “nudged” into approved behavior patterns.
Rewards have many flaws. They rely on predictions — setting future targets — that can never be reliable. These predictions are often fixed, unresponsive to changes in the environment, and usually set without much discussion with the individual who is to be motivated by the target. If the target is met or not, the individual finds it hard to know exactly how their actions contributed to the result.
There is a third kind of motivation: FLOW. It is possible to harness a third kind of motivation that is neither carrot nor stick, and relies on neither reward nor punishment. It can provide autonomy and freedom to individuals to pursue what they find valuable. They can see their own activity as a contribution to a greater end or purpose for themselves. This kind of motivation comes from FLOW.
FLOW is your absorption into an activity performed well. It’s the enjoyment of performing an activity to the extent that you are actually experiencing that you are good at it, while you ae doing it. The activity itself creates the motivation for it. FLOW easily wins the internal competition between getting distracted or diverted versus making progress on the activity.
We are progress-seeking creatures, and FLOW gives us the greatest sense of progress.
FLOW is practical, and can be harnessed, practiced, and linked to work and organization. There are three conditions for being in FLOW, or getting back to FLOW when you fall out of it.
1) A clear and specific goal for the activity.
This is not to be confused with aspirational goals like a corporate vision, or target goals like the year-end sales volume target. This goal is at the level of action. For the specific activity, what represents completion? In what time specific frame? What problem will have been solved when the action is complete?
2) Capture immediate feedback from the activity.
The activity tells you if you are making progress. Measurement is in the activity itself — there is no outside judge. If you’re not making progress, the activity can steer you back to it. Bart Vanderhaegen uses a tennis analogy: if your shots are going in, you’re making progress; if not, you can adjust your action.
3) The activity must have a challenging but solvable level of difficulty.
To make progress requires taking on challenges that can elevate our skills. FLOW requires overcoming difficulties (an insight that is contrary to the old adage of “keep it simple”).
For those who are quantitatively minded, Mihaly Csikszentmihalyi, the founder of FLOW studies, measured the appropriate degree of difficulty as 10-12% harder than one’s current ability — a kind of Goldilocks number of not too hard and not too easy.
This has profound implications for organizations engaged in motivation. They must present ever-increasing levels of difficulty to their employees and teams, as they learn to perform better and better in the flow of taking on challenging tasks.
4) Organizational structure is a barrier to FLOW and to its power to solve complex business problems.
FLOW can solve complex problems. When the overarching problem to solve is how to deliver customer value — which is a problem that cuts across all elements of corporate structure — a FLOWing team can succeed, because value is a clear goal, and learning by taking on difficult challenges provides a pathway to the goal. The customer doesn’t care how the firm is structured.
Internal structures of departments and functions and conflicting goals and rules can present a major barrier to FLOW and to customer value generation. A problem-solving team representing many departments and focused on the goal of customer value can transcend the barrier, and transcend corporate structure.
Therefore, Bart Vanderhaegen recommends not to spend time and effort creating a new structure when the current one is problematic. Create FLOW over structure.
5) How to put FLOW into action.
Like everything that has value, FLOW is a subjective experience. But there are some application actions that can help to generate team FLOW.
Organize a problem-solving network on top of the structural layer.
It’s an organic network that crosses departments and regions and functions and all other structural boundaries.
Give each team in the network a mandate.
A mandate is a problem to solve without specific direction on how to solve it. The team figures out what the solution will look like and how to get there.
Make the problems as open as possible.
The problem may be to define what are the most important problems to solve.
Create transparency (via a software platform) on the problems, ideas and progress.
Everyone “taking the pen” themselves.
Make sure the goals are linked to actions.
For the most open problems, goals can be set for a small number of steps: let’s get to the next milestone in 30 days (e.g., generating a first set of preliminary ideas).
Through criticism and testing, teams will be able to FLOW to new levels of comfort in solving the most difficult of problems. They become more and more capable. And the problem-solving network is scalable: it can become bigger and bigger and solve harder and harder problems.
Additional Resources "The Value-Creating FLOW Process for Business Problem-Solving" (PDF): Mises.org/E4B_155_PDF
Bart Vanderhaegen’s TED Talk: Mises.org/E4B_155_Video
PactifyManagement.com
The Pactify Podcast: Anchor.fm/Pactify
FLOW: The Psychology of Optimal Experience by Mihalyi Csikszentmihalyi: Mises.org/E4B_155_Book1
Creativity: Flow and the Psychology of Discovery and Invention by Mihalyi Csikszentmihalyi: Mises.org/E4B_155_Book2
It is time to get back to normal life, and that starts with visible human faces.
Original Article: "Unmask America"
This Audio Mises Wire is generously sponsored by Christopher Condon. Narrated by Michael Stack.
For entrepreneurs, design is not just lines and shapes and colors and decoration, and it’s not just the look and functioning of a website or a building or another object. It’s a process of advancing from an idea or concept to marketplace realization as a customer-desired new service PR product. In fact, according to Professor Henrik Berglund, entrepreneurship is design.
Key Takeaways and Actionable Insights Entrepreneurs advance from idea to implementation via a process of design. How do entrepreneurs exercise judgment? How do they advance from an imagined idea or business concept or anticipated value to implementing their project in the marketplace and making sales to customers?
It’s a creative process. Some call the domain design science, although we Austrians would think of it in a more subjective framework as human design. In general terms, design provides the bridge from the internal environment of the firm (its capital, its capacity, its skills, its resources, etc.) to the external world of customers and the marketplace. Design facilitates the fit between the two. It’s a goal-driven process of getting to the right design: a value proposition design that attracts customers, an effective value network design for assembling all the components, a business model designed to deliver the value, and pricing and cost choices that result in profit.
The steps in the design process take the form of design artifacts. Design is not abstract. It’s action. The action takes the form of constructing design artifacts: things like sketches and flow chart diagrams and network maps and templated value propositions and business model designs and business plan spreadsheets, prototypes, landing pages and A/B tests.
There is a design pathway from more abstract and conceptual to more substantial and closer and closer to a marketable product, service, or business. The artifacts are not arranged in any specific order, but they are characterized by the progress from abstract to functional and detailed.
Most importantly, the design artifacts are measurable and testable, so that entrepreneurs can get more and more information about how well the design fits with the real world — customer assessments and feedback, simulations, beta tests and other feedback loops serve to make the design more substantial and the entrepreneur’s level of confidence higher.
Experimentation is one kind of design pathway. Professor Berglund described experimentation as a design interaction with an existing real-world situation, where the testing process is to assess how well the entrepreneurial vision works in that world. Is there demand? Will customers find the proposition useful, and will they buy? Through repeated and experimental testing, entrepreneurs measure their way to the best-fit adaptation of their concept to the market.
He used as an example of experimentation an early step in the development of Dropbox, in the form of a video that carefully described its function and benefits, and sought feedback from the market in the form of requests to join a beta test. The video was successful in attracting a beta test audience, reassuring the designers of the potential use case.
Transformation requires a different kind of design approach. Transformative ideas do not have an existing market — a “real world” — in which to experiment. There is no identifiable demand at the outset. The process is co-creation, with potential users and customers, of a new world or a transformed world. The design path is not the use of carefully constructed measurable artifacts, but of another kind, which Prof Berglund describes as mutable and transformable.
He used the example of the iPhone, transforming from the functionality of a phone — with a use case of intermittent 2-way communication events - to the concept of a handheld device with continuous use for a multiplicity of purposes aided by integration with software apps and internet connectivity. The vision was never precise, as it can be with experimentation. Apple outlined a more vague vision of possibilities and soft boundaries, and invited individuals and communities of software developers to join, collaborate, make specialized local contributions, and synthesize a new, emergent system over time.
Firms will typically employ a mixture of experimentation and transformation in a portfolio of projects. Experimentation and transformation are “ideal types” of design, not always as clearly differentiated in the real world as they are in theory. Nevertheless, it’s important for entrepreneurs to differentiate between them, and to maintain a portfolio of projects that instantiates both types.
Professor Berglund and Chalmers are engaged in a new synthesis of entrepreneurial theory and practice. Prof Berglund observes in a book chapter called "The Artifacts of Entrepreneurial Practice," that entrepreneurship scholarship has not always been very useful or helpful to practicing entrepreneurs. Now this is changing as researchers move closer to "the real time doings and sayings of practitioners involved in entrepreneurship". In the spirit of transformation, there’s a new synthesis of theory and practice that is being co-created. That synthesis is one of our guides at Economics For Business; we hope to gather from business entrepreneurs their evaluations about which elements of theory and research are of most use in practice.
Additional Resources "Opportunities as Artifacts and Entrepreneurship as Design" by Henrik Berglund, Marouane Bousfiha, and Yashar Mansoori (PDF): Mises.org/E4B_154_Paper1
"The Artifacts of Entrepreneurial Practice" by Henrik Berglund and Vern L. Glaser (PDF): Mises.org/E4B_154_Paper2
HenrikBerglund.com
Chalmers.se
Design & Assembly is the second pin (after Imagination) in the Economics For Business GPS system — the toolset to help entrepreneurs navigate their business environment. We talk to Brett Lindell, CEO of Pantheon Holdings (which includes Aegis Exteriors and Fortress Roofing) about his Design & Assembly approach that has helped him build a fast-growing business from scratch in the crowded, competitive, and demanding field of regional house construction. His advice: there are plenty of resources available; if you assemble the right resources to fit a system of assuring and delivering the best customer service, there’s a lot of growth to be harvested, whatever the industry.
Key Takeaways and Actionable Insights The entrepreneurial method uses currently available means to create the possibility of new future outcomes. The entrepreneurial method is not to try to control outcomes but to put available resources to use to explore possibilities. Brett Lindell used the method for his business launching pad:
Who am I? Experienced as a US Marine, a college student and a corporate executive in learning, planning, doing, and relationship building.
What do I know? A lot. How Marine Corps plan complex missions, and how they train inexperienced young people to implement amidst on-the-ground chaos. How the system of a global corporation puts the highly engineered products of a worldwide manufacturing web in the hands of construction site workers equipped with nothing more than hammers to produce sturdy and beautiful houses. How sandy beaches and a good climate attract residents who want to buy homes.
Whom do I know? There are companies in the construction industry craving nothing more than simple, reliable good service — which is scarce. There are young people graduating college in my region with limited job prospects who are enthusiastic and highly trainable.
Controlled downside: The entrepreneurial method controls downsides, and doesn’t pretend to control outcomes. Brett’s controlled downside was public commitment to starting, with the consequent specter of public shame if he didn’t succeed, knowing he hated the very possibility of shame.
Design is the series of steps from idea to a working system. Brett Lindell set out to design and assemble a system of systems to achieve his mission.
Geography/Market system: A magnet for homeowners (beaches, ocean, climate, beauty, great place to live) and therefore for developers and builders. Not dominated by cities and so the construction market is highly dispersed.
Labor resource system: Young people graduating college in the area face limited employment opportunities combined with high enthusiasm to stay in the area.
Organizational system: Integrate geography and labor resources via decentralized command that locates tools and decision-making autonomy in the hands of front-line customer-facing employees.
Service system: Basic research (talking to potential customers) revealed that the addressable market is for reliable service: answer the phone when they call, be on time for deliveries and appointments, keep the promises you make. Brett’s system is classic system design of simple rules: employees must (1) tell the truth, (2) pick up the phone when it rings, (3) return all phone calls, (4) customers in all directions — i.e., treat everyone like a customer and serve them as they want to be served whether they’re suppliers, colleagues, or anyone else in the system. (And for Brett, his employees are his most important customers.)
Rich knowledge encoding: Brett believes in handbooks — a belief he learned from the Marines. Handbooks encode all the knowledge of the firm on how to follow every process and implement every task. Every employee can thereby benefit from all the accumulated knowledge and experience in the firm, and the handbooks are continuously updated via new experiences and new knowledge.
Tech systems: In a relatively low-tech industry, Brett’s firm is a high-tech leader because he is always looking for and evaluating the latest technology for automation, work-reduction, and control. The technology can be in the form of apps or software or hardware, and is especially valuable when it can all be integrated together in end-to-end systems or sub-systems such as inquiry-to-order and order-to-cash. Technology integration for these sub-systems speeds up cash flow, reduces labor costs, and increases transparency, thereby enabling quick fixes and improvements. Brett would rather have too much technology than too little.
A plan: While planning can never predict or control the future, it can be an integrating theme for system design. Brett’s plans are a brief and compressed (one page) set of numbers, and those numbers are shorthand for a lot of detail. For example, if Brett’s company is to have the capacity to provide construction components and services for 50 homes in the current year and 500 the next year, then systems of procurement, logistics, sales and marketing, finance and technology must be designed to scale to handle more volume and more complexity without impeding growth. Time, resources, and personnel must be deployed appropriately.
Assembly embraces and harnesses the human element of the business system. A system combined with the right people, suitably trained, and equipped, and with the right mindset, produces the right results. When individual employees are oriented to independent problem solving and autonomous goal-driven creativity rather than central planning, the firm can cope with — and, in fact, generate — dynamic change.
Brett has injected as much humanity as he possibly can. Seeing his hires get promoted and take leadership and realize personal goals is his greatest reward. He has created a family-friendly firm where people can get home to their kids before they go to bed, and take the family on vacation without worrying about the office or the job site, knowing that the system will manage the absence. He creates jobs and makes people’s lives better. That’s the entrepreneurial society.
Additional Resources "Designing and Assembling a System for Entrepreneurial Growth" (PDF): Mises.org/E4B_153_PDF1
"The Entrepreneurial Method" (PDF): Mises.org/E4B_153_PDF2
Reach Brett at brett@aegisext.com
Why do entrepreneurs start businesses in the first place? They have a vision for the future and seek to work with other people to bring it about. Those other people may be colleagues and employees, directors and investors, suppliers, and customers. Organizing this multivalent work is hard. Thinking of your organization as a complex adaptive system yields new understanding and a new approach to organizing that results in improved goal achievement.
Laura and Derek Cabrera of Cabrera Research Lab are dedicated to sharing research findings that enhance the capability of any organization to reach business goals. They join the Economics For Business podcast to do some sharing with the E4B community.
Key Takeaways and Actionable Insights Systems Thinking resolves the mismatch between the way the real world works and the way firms think it works. World hunger is a wicked problem, yet there is enough food to feed the world. We don’t have the right mental model to account for all the social, economic, political, motivational, and cultural issues that shape the problem.
In the same vein, systems thinking in business is about building mental models that better align with the real world. Laura and Derek Cabrera provide an introduction in Systems Thinking Made Simple, and they mentioned some of the important changes in thinking that businesses must embrace to enter the new world of possibilities that systems thinking opens up. The first step is to recognize that LAMO thinking is inappropriate for a VUCA world.
The real world is agnostic about human endeavors
VUCA World
LAMO Thinking
The real world is non-linear
but we think in linear ways.
yet we tend to look sat things through a human-centered (anthropocentric) lens.
yet we tend to look sat things through a human-centered (anthropocentric) lens.The real world is adaptive and organic
yet we tend to think mechanistically and the metaphors we use reference machines (e.g., a universe like clockwork; mind is a computer).
The real world is networked and complex with a sprinkling of randomness
yet we think of things in ordered categories and hierarchies.
All businesses are complex adaptive systems. We have no choice in the matter. An organization is a living, breathing thing, organic — lots of individuals dynamically making decisions that roll up into the complex system. It’s not a machine.
An implication is that business executives and managers can’t operate on outcomes directly (e.g., via business “planning” or business “strategy”). Outcomes are emergent from the system and can be worked on only indirectly.
The traditional mental model for business organization is flawed. Laura and Derek capture the traditional mental model for organizational management in the acronym PCCU: Plan, Command, Control, Utilize.
Plan: Businesses create plans for the future, often in great detail, with rigorous discipline, and lots of numbers and projections. But the real world is changing too fast, and outlining detailed steps to reach a goal amidst rapid change introduces biases that can occlude opportunities for rapid and profitable adaptation to change.
Command: Hierarchical organization designs assume a military metaphor of command. Organizations are much more organic in the real world, tempered by social influence, compliance, resistance, and rebellion. Better to think of then organization as a network and a culture.
Control: Management likes to feel like it is in control, but the control paradigm is both unrealistic and unresponsive to organic change.
Utilize: The most detrimental organizational construct is the Human Resources department. Treating people like resources to be utilized is unsustainable. People are independent agents in the system who wish to co-evolve to a place where their individual goals and those of the organization are well-aligned.
The mental model for how complex adaptive systems work is Simple Rules. The great insight from complex adaptive systems thinking is that organizational behavior isn’t directed by leaders, but driven by followers. What are they following? Simple rules.
We can think of an organization as a superorganism. It self-organizes by following simple rules that guide the actions of individual agents in variable contexts. Autonomous agents follow simple rules based on what’s happening locally (that is, around them), the collective dynamics of which lead to the emergence of the complex, system-level behavior we observe: adaptiveness and robustness.
The simple rules for successful adaptive organizations are summed up as V-M-C-L. Vision: A seeing thing. Something we all see in the future, where we are headed. Not a tagline, not a statement on a website, not a corporate word salad. A vision is a shared mental model that everyone in the organization can see and articulate and align with. It’s in their hearts and minds. It gets employees excited and connected.
Mission: A doing thing. A mission is something that you do repeatedly over and over again to bring about the vision. It directs the work in the organization, with clarity about who does what. It’s clear, concise, easily understood and measurable.
Capacity: The organization must have the capacity to do the mission: the energy, the resources, the skills. Capacity is a system of systems all connected and working together, focused on, and directed towards doing the mission.
Learning: Learning is critical to expand capacity, reinforce mission and refine vision. It is the adaptive function. Organizations must love learning – seeking unvarnished feedback from the outside world as input into making the changes that are needed for improvement. This means loving reality and being brutally honest about the current state. Learning means improving mental models, and embracing the possibility that your current model is wrong.
In their book Flock Not Clock (see Mises.org/E4B_152_Book), where there is a detailed exposition and explanation of V-M-C-L, Laura and Derek cite the example of the app My Fitness Pal.
Vision: Healthy living is the new normal
Mission: Facilitate and motivate healthy behavior choices
Capacity: Build mission-critical systems: design, engineering, R&D, sales, and marketing, etc.
Learning: Feedback on whether living healthy is getting easier, whether more people are making healthy choices, whether more people are feeling joyful and powerful as a result.
Think of the elements of V-M-C-L as a pyramid you can construct from first principles: Thinking drives Learning, which drives Capacity, which drives Mission, which brings about Vision.
The emergent result of V-M-C-L is culture. Laura and Derek talk about training people to think in order to be able to learn. The first step is often unlearning the misleading mental models we’ve been taught to believe. When people start to think about mental models, they can recognize their own and those of others, and make comparisons, make changes, and find common ground.
If your mental model about your current situation is real — "brutally honest," as Derek put it — then the chance of changing that situation for the better is good. You’ll be able to identify a path out.
Culture can be built around the simple rules of vision, mission, capacity, and learning, by purposely constructing the four mental models of V-M-C-L. There is enormous organizational and economic power in the new understanding of complex adaptive systems and how they work in getting a group of disparate people to work together towards a goal as if they are a single unified organism.
Additional Resources Sign up for Laura and Derek’s Vision-Mission Bootcamp: Go.CabreraResearch.org/VMBootcamp
Visit Cabrera Research Lab online at CabreraResearch.org and on LinkedIn (Mises.org/E4B_152_LinkedIn).
"20-Point V-M-C-L Checklist" (PDF): Mises.org/E4B_152_PDF1
"Constructing the VMCL System" (PDF): Mises.org/E4B_152_PDF2
Flock Not Clock: Align People, Processes and Systems to Achieve Your Vision by Derek and Laura Cabrera: Mises.org/E4B_152_Book
Our guest is Tracy Høeg, MD, PhD, who has made remarkable research contributions pertaining to SARS-COV2 transmission in schools and to vaccine-related myocarditis. She has published her findings in the CDC’s MMWR and has given oral testimony to Congress.
SHOW NOTES Tracy Høeg, MD, PhD: Twitter
Watch the episode on the Accad & Koka Report YouTube channel
Imagination is the first stage of any value generation journey — starting a development project, enhancing the customer experience, embarking on innovation, or building a business for the next year or the next decade. Imagination might sound like a fuzzy concept, but it’s a robust business tool, the engine of the entrepreneurial design process. Mark Packard joins the E4B podcast to put imagination into a business context and describe the possibilities it opens up.
Key Takeaways and Actionable Insights Imagination is central to entrepreneurs and entrepreneurship, and to innovation and advance in all aspects of business. We see business through mental models, as a kind of a movie our minds play for us. In this movie, we remember result and experiences from the past (which requires imagination) and we create images of what might have been, or, in the future, what might be. We know these images are not real, but they play through our mental model of business reality. They inform our plans and projects. We imagine cause-and-effect relationships between imagined concepts and ideas, and between actions and outcomes.
From new product development to efficient administrative processes, every aspect of business involves — and requires — imagination.
We can use imagination in simulating possible results. Not only do we employ imagination in our regular business activity, we also use it for advanced complex modeling. We add new inputs to what we have constructed in our imagination — in the form of “what if” queries - to create a new mental model that’s different from the current one: a prospective reality that we can plan for and try to achieve.
As we try to achieve that prospective reality, we receive feedback in various forms, which we use adaptively to further adjust and improve the mental model we hold in our imagination. Imagination is dynamic, always changing.
Customers are also imagining, and entrepreneurs must imagine what they are imagining. We’ve highlighted in earlier episodes, the Value Learning Cycle that customers complete in the process of learning what to want and what to value (see Mises.org/E4E_44). The cycle begins with predictive valuation — consumers predicting to themselves how much value they’ll experience from the product or service a business is pitching to them. That’s imagination at work. If they buy and consume, value is an experience that results — and experience is a mental representation that includes imagination. Then in their post-experience valuation, customers adjust their mental model based on their new value knowledge. Future predictive valuations will be imagined with this updated knowledge.
Imagination is central to customer expectations of value and to customers’ decision-making.
Businesses use three kinds of imagination to make a value proposition. Businesses develop value propositions for customers, utilizing 3 kinds of imagination: creative imagination (imagining the design of a future product or service that will deliver a valued customer experience); empathic imagination (imagining how the customer will feel as a result of the experience); and predictive simulation (imagining what the world will be like after pursuing the contemplated action).
Creative imagination is a combination of needs knowledge (what customers want) and technical knowledge (what can be produced with available resources). In both cases, more knowledge is an aid to the imaginative process.
Similarly, empathic imagination can benefit from more knowledge about the customer’s mental model, developed through relationships and conversations.
Predictive simulation is aided by rapid learning from testing and prototyping and developing design artifacts (like landing pages and A/B tests) that enable interim simulations of customer responses.
Imagination can’t be shared but visions can. When we work on a team or in a firm, it’s productive to be aligned on the imagined future at which the group is aiming and is working towards. Strictly speaking, we can’t share imagination. Everyone’s imagination is subjective and individual. You can’t imagine what I’m imagining.
What can be shared is a vision, because it can be described in words developed from a shared language. Of course, every individual may interpret the meaning of the words differently, but with repetition, explanation and persuasive presentation, the group can get closer and closer to shared meaning. The vision becomes a cultural artifact — how we think in this firm, what we aim for in this firm, how we see the future in (and of) this firm.
Similarly, in selling value propositions to customers, businesses are trying to get those customers to share a vision. We persuade them with storytelling, whether it’s in the form of advertising, or PR or social media or the words printed on a package.
Rhetorical skills — being able to communicate in a way that enable other people to see and share a vision, and to adapt it to their own vision — are key to successful entrepreneurship.
Some people are better at imagination than others — but you can work on the skill set. Many business icons are or have been symbols of great imagination at work, such as Steve Jobs in the past and Elon Musk today. They’re better at seeing the future than others.
But everyone who understands imagination at the foundational level, as Mark Packard explained it in the podcast, can get better at it, and train others to get better at it, too.
Imagination is a simulation run through our mental model based on knowledge we possess. One important step is to improve the knowledge set available for the simulation — better quality knowledge, more accurate knowledge, more detailed or intimate knowledge.
More needs knowledge and more technical knowledge will improve creative imagination. Keep up with new technologies and with consumer trends and marketplace developments.
More customer knowledge will enhance empathic imagination. Spend more time with customers. Use qualitative research (such as the E4B contextual in-depth interview: Mises.org/E4B_151_PDF) to understand their mental model better, so that the empathic simulations you run through that mental model will improve.
Predictive simulation is an act of imagination that improves with learning about what works and what doesn’t. Run more tests and new kinds of explorations. Explore, explore, and explore more. Don’t take your own predictions too seriously; rather, expect to be wrong in ways you never imagined. Be humble, be adaptive, be agile, and recognize that you do have to predict in order to act. Triangulate with what others are doing because they’re imagining too, and they may have more and better knowledge than you. Try to reconstruct their mental models and assess whether they’d be helpful for you.
Additional Resources Elon Musk’s Imagination (Video): Mises.org/E4B_151_Video
"Subjective Value in Entrepreneurship" by Mark Packard and Per Bylund (PDF): Mises.org/E4B_151_Paper
"Empathy for Entrepreneurs: How to Understand and Identify Customer Needs and Wants from Their Perspective" (PDF): Mises.org/E4B_151_PDF
"Mark Packard on The Value Learning Process" (Episode): Mises.org/E4E_44
We’re highlighting six of our 2021 podcasts that have special value for value creators. We invite you to listen to the special year-end podcast, and to sample each of those we’ve highlighted here, review the Key Takeaways we provide as a summary for each one, and download the free tools that accompany each podcast.
Per Bylund explains that all successful entrepreneurs are Austrians.Episode #143: Mises.org/E4B_143Resource: "Explore and Realize (and Keep Exploring): How Austrian Entrepreneurs Generate Value on the Path to Business Success" (PowerPoint): Mises.org/E4B_143_PPT
Mark Packard joins Per Bylund to explain how Austrian Value theory enables entrepreneurs to radically re-shape business thinking for greater value generation.Episode #108: Mises.org/E4B_108Resource: "The Value Generation Business Model" (Video) Mises.org/E4B_108_Video
Matt McCaffrey outlines the Austrian approach to business strategy: emergent not planned.Episode #127: Mises.org/E4B_127Resource: "Emergent Strategy Process Map" (PDF) Mises.org/E4B_127_PDF
Mark McGrath orients entrepreneurs to purposeful adaptation to emergence via the OODA loop.Episode #138: Mises.org/E4B_138Resource: John Boyd's "OODA Loop Graphic" (PPT) Mises.org/E4B_138_PPT
Ulrich Moeller provides the organization design model for the adaptive entrepreneurial firm: it’s boss-less.Episode #133: Mises.org/E4B_133Resource: "The Future Of Organization Design" (PDF) Mises.org/E4B_133_PDF
Saras Sarasvathy pulls it all together in the form of The Entrepreneurial Method.Episode #131: Mises.org/E4B_131Resource: "Better Lives and a Better Society" (PDF) Mises.org/E4B_131_PDF
Human action lies at the core of the application of Austrian economics to business: how do people act and how can we develop the best understanding of why they act that way. We apply that thinking to customers, and we can also apply it to business organizations. If we are able to answer these questions well, we can develop a profitable business model and an effective management model. Our guest Diana Jones has a distinctive perspective about the management model that’s based on understanding people’s personal and private experiences rather than their place in the hierarchy or their formal role in the process.
Key Takeaways and Actionable Insights Relationships are fundamental to all systems thinking, and to all business management. Sociometry is a tool to measure relationships. Sociometry measures relationships between people and within groups. The unit of measure is distance. People can feel close to each other and other group members, and this closeness results in certain types of behavior. People can feel distant from each other, resulting in a different kind of behavior. They can also feel close or distant to concepts, like the company mission or the annual plan, and to institutions, like the Board of Directors or the HR department or a firm’s way of pursuing innovation. They can feel close or distant to colleagues in a meeting, or to the meeting purpose and agenda. Measuring and understanding relationship distance contribute directly to performance management.
Sociometry reveals the disproportionate importance of informal structures over formal structures. It’s easy to think of the formal organization chart as the model for managing a firm. Planning descends from higher levels to lower levels, along with instructions on how to implement and what to do. It’s not how companies function in reality.
What makes companies work is relationships. People form bonds with each other, and the bonds they form shape the work that they do and how they do it. The bonds are often forged via sharing of knowledge and experiences that are private and personal rather than business and process knowledge. Productivity comes from people connecting on shared experiences, so that these personal and private relationships become more relevant to business operations than the formal structures, such as hierarchy. When relationships change, behaviors change, and vice versa. When relationships shift, the whole business system shifts.
Formal structures don’t work, at least not in the way top management thinks. And the titles associated with hierarchical position can be alienating and toxic to relationships, symbolizing and reinforcing distance rather than closeness.
Sociometry helps to focus on these informal relationships and especially on the most important ones that make a big difference: for example, to improve customer service.
There’s a role for leadership in this system of informal relationships, but it’s not the one that generally taught or written about. Leadership can emerge amidst informal relationships, but it doesn’t come from authority. Leadership is not to be confused with position in the hierarchy. Leadership entails the communication of vision and helping people understand it, share it, and do the right things to achieve it.
The informal structure and its relationships make the formal structure work. The formal structure produces cynicism, anxiety, and reactionary behavior. The informal structure can eliminate these negative tendencies, unleashing untapped talent and enabling and refreshing the firm.
Leaders help people as guardians of these informal relationships: monitoring, empathizing, and nurturing.
Many people need help working in groups. It’s typical practice in business management to assign people to groups: agile teams, project teams, product development teams, functional teams, and so on. It’s seldom questioned whether or not individuals understand how to work in groups. Usually, they don’t. They’re unsure whether to speak up or be compliant, or whether conflict is valued to arrive at consensus or is to be avoided.
This is one more element of Diana Jones’ thinking and method that tells us that the traditional thinking of business organization and management process is mostly wrong. Hierarchy and formal organizational models don’t work, titles and authoritative roles are counter-productive, and reporting relationships are irrelevant when compared to relationship distance / closeness. There’s a lot of the traditional management model blueprint we need to scrap.
The better route to exceptional team participation and team results is via empathy. In Economics For Business, which is the application of the principles of Austrian economics to business management, we allocate great importance to the use of empathy as a tool, usually in the relationship between a business or brand and its customer. For example, we use empathic diagnosis to understand a customer’s dissatisfactions and unmet wants.
In Diana Jones’s model, empathy is an internal organizational tool. She deploys it in a sophisticated way that identifies four different types of application.
Cognitive empathy: imagining and understanding how a person feels and what they might be thinking.Emotional empathy: accurately reading and sharing the feelings of another person, and reflecting on those feelings in a way that helps everyone involved.Compassionate empathy: going beyond understanding to taking action that helps people deal practically with difficult situations about which they’re emotional.Group empathy: the capacity to read the emotional tone of a group that’s sharing a challenging experience. The core competency is the ability to read people and their emotional tone or state. Diana Jones gives the skill a name: interpersonal perception. It’s a skill that can be developed in a learning loop of experience, experimentation, curiosity, and intuition.
Additional Resources "Trust-Distance Matrix: Assessing the Cost of Distance in Business Relationships" (PDF): Mises.org/E4B_148_PDF
Leadership Levers: Releasing The Power Of Relationships For Exceptional Participation, Alignment, and Team Results by Diana Jones: Mises.org/E4B_148_Book
Diana-Jones.com
Entrepreneurship is fulfilling and exciting and inspiring. It’s fun. It’s learning. It’s a sense of achievement. It’s a journey. Economics For Business loves to spotlight individual journeys to illustrate what’s possible, provide learning about how to create and grow opportunities, and to inspire new entrepreneurship. This week, we are joined by Victor Chor, who leads us on a journey from a hobby of flipping on eBay to creating a brand and orchestrating a high-energy global value generation community.
Key Takeaways and Actionable Insights The journey starts with action — develop your “doing skills”. Victor Chor started his journey via “flipping” on eBay: sourcing items to offer for sale, and using sales feedback (what sells, what doesn’t) to determine future offerings. He developed the “doing skill” (as opposed to a “knowing skill” that comes from formal business education) as he made more and more sales. Flipping was a hobby that became a business.
What’s the benefit? Well, it’s fun. There’s money profit. There’s a sense of achievement. And there’s learning.
Experimentation is at the heart of entrepreneurial success. How do you find out what works? You experiment. Try this, try that. Learning results. Victor learned the products that sell best. He learned scaling, as a repeatable process yielding increasing returns. He learned the best feedback loops for adaptiveness — in his case inventory management and how to keep it low through accelerated sales.
Experimentation is a learning loop: experiment, gather feedback, learn, improve, run more experiments.
Adopting customer centricity is a further advance on the journey. To a large extent, Amazon, with its “customer obsession”, led the way in making customer centricity the norm for e-commerce and internet selling. They not only continuously raise the bar for customer service excellence in terms of quality, speed, convenience, availability, and range of choice, they also introduced wide ranging competition between 3rd party sellers on their platform. Competition is a virtuous circle for customer satisfaction: if one firm establishes an advantage or a superior offering to which customers flock, then competitors must improve their offering even more to re-qualify for customer acceptability.
In this environment, entrepreneurs learn about continuous improvement and the need to create a unique customer experience that can establish some sustainable advantage. The ability to grow in sales revenues morphs into the design of unique customer experiences.
A further advance in the mastery of customer centricity is to engage customers in product and service development — what we’ve been calling co-creation of value. Through surveys and e-mail marketing and just hanging out and talking with customers, Victor’s team has developed an acute understanding of customer wants, needs and preferences.
And the technology field lets us all think like customers. Victor points out that he and his team are all customers for the products they take to market. They’re all looking for quality and convenience and technological excellence, all experiencing what inconveniences customers, and therefore even better able to serve their market.
The next level of advance on the journey is brand building — imagining, designing, assembling, and marketing a differentiated branded offering. There is a transition point where a project can become a brand. A project to develop and deliver a high-function technology product can cross into the branded perception and branded experience area. Branding is the ultimate power in delivering uniqueness. A brand can establish a sustainable and unassailable perception.
Victor Chor advanced into brand building through building his community. The people he hired into his growing business has ideas for establishing and growing a brand. Wholesaling and distribution and manufacturing partners contributed both ideas and capacity. Victor developed a very original concept of a brand as a representation of all the people involved together in the venture. His image for a brand is that “it’s a ballroom”: set it up and throw a party in which many can participate and all are welcome to help shape new products and the future of the brand.
Infinacore is the brand name around which Victor and his team have assembled their community. It’s focused on wireless charging and related high-tech convenience: the brand mission refers to “making the wonderful world we live in as simple as plug and play”. This is a brand platform with unlimited future potential, based on how customers define simplicity and plug-and-play in the future, and how they judge what they find to be wonderful.
Reaching out more and more widely expands opportunity and opens up new avenues. Early in his journey, Victor utilized the services offered via Alibaba. He made contacts, built up a buddy list, engaged in chat on the platform, and used the network to source products. Many of his contacts in manufacturing and trading companies stayed in touch over time. Some of them started their own venture and their own factories. Long term relationships developed, and links to capability and capacity multiplied and grew stronger.
Everyone in this network is on their own journey, feeling what Victor called the “shared vibe” of connection and collaboration.
Alibaba proved to be a catalyst for learning — for example, learning a shared language, learning to negotiate, learning to communicate, and learning working practices like minimum order quantities — and an opening of new avenues, such as contacts with factories that could provide white labeling opportunities and technology improvements for original products.
Ultimately, Victor was able to develop a leadership skill in entrepreneurial orchestration: pulling together and integrating resources, people and processes in a value network dedicated to the shared pursuit of high-tech brand building.
The journey is arriving at a new peak, but never ends. There’s a new product / wireless charging system launch coming up for Infinacore. It represents a new peak in both technology and brand, a unique original design with new benefits. The Infinacore community has advanced to a new higher level.
The company has refined its vision and mission, not simply as communication, but as a picture of the future around which everyone in the community can gather and in which all can invest their effort and emotional energy. It’s ingrained. There‘s shared passion and shared emotion.
This is the step that removes the anxiety of uncertainty. When the vision is shared and the mission — what the community does repeatedly every day to make progress towards the vision — is clear, then the future is not a scary unknown, but a goal towards which there is continuous advance. There’s no fear.
Additional Resources "The Evolution Of A Global High-Tech Brand" (PDF): Mises.org/E4B_149_PDF
Visit Infinacore.com
Follow Infinacore on Instagram: @Infinacore
Strategic management theories and entrepreneurship theories have diverged in academia. One perspective can’t recognize the other. Yet the most promising and successful new business approaches demonstrate an agile combination of both sets of theories. Professor Mohammad Keyhani joins Economics For Business to explain this phenomenon and help us point the way to the future of strategic entrepreneurship.
Key Takeaways and Actionable Insights. In business school thinking, there is a dichotomy between strategic management and entrepreneurship. In management scholarship, strategic management and entrepreneurship are distinct fields of study. Professor Keyhani calls them “two logics” of business.
Both logics have gained legitimacy from their origins in economics. As business theories, they base their arguments on models from the field of economics, which, of course, is older and more mature. By importing thinking from economics, these business disciplines are able to construct generalizable theories (as opposed to, for example, a case study approach). The most famous generalizable theory in strategic management is Michael Porter’s five forces framework, which borrowed from industrial organization economics. Most strategic management theories have been based on general equilibrium models of neo-classical economics. Strategic management became a theory of structures and constraints, and of imperfections in equilibrium (such as the concept of competitive advantage).
The entrepreneurship discipline has been more varied and diverse and less dominated by economic models. Entrepreneurship scholars look to Austrian economics, which is based on verbal logic rather than mathematical models. But Professor Keyhani, in his Ph.D. dissertation, found an integration route between strategic management and entrepreneurship using the framework of game theory, adding elements of time and dynamics (both critical in Austrian theory) and adding the innovation of computer simulation (to which more and more Austrian economists are open as a way of adding computable algorithmic rigor to verbal logic).
He established a way for strategic management and entrepreneurship to communicate with each other.
Strategic management is a theory of competitive structures. Strategic management models are based on models of competition among players with similar value propositions, maybe with slightly different cost structures and other small differences, but all considered as competitors to each other. The models look at the nature of the competition, the structure of the competition, and seek insights into why some companies may have advantages over others.
Strategy becomes an approach of identifying and building on strengths, about sustaining and managing an existing system, about operations rather than innovation, and about control and prediction.
The consequence is a series of blind spots, mostly to do with the dynamics of action over time, the uncertainty that accompanies action, and the learning that results.
Entrepreneurship is a theory of dynamic value creation. The question in entrepreneurship is how to create value and how to build a value creation system in the first place. The entrepreneur faces the questions, “Am I creating any value at all? Is anyone going to pay for this innovation and be happy with it? And will I be able to get more customers?” These questions precede the models that strategy and strategic management theory have been based on. Those models start off with the entrepreneur’s questions having been answered, so they are not useful at the value creation stage.
Based on Austrian economics, the entrepreneurship literature has provided mental tools and mental models for entrepreneurial thinking and an entrepreneurial approach to business. These include the emphasis on subjective value and customer sovereignty, and on uncertainty and unpredictability in business. There is value in action in the face of uncertainty, because it creates new information, which can support better decision-making. That mechanism is totally lacking in the equilibrium models of strategy.
Theories of entrepreneurial action to generate learning are useful not only for startups but also for larger companies, to help them think and act more entrepreneurially, and to counter the defensive and anti-innovative thinking of building on strengths and defending position. Managing an existing value generation system can result in losing the long-term perspective of innovation, adding new product lines, taking advantage of opportunities, and potentially building new strengths.
“Do both!” The best approach combines strategy and entrepreneurship. Professor Keyhani argues that, ideally, firms think strategically and act entrepreneurially, and he recognizes that, in the real world of practitioners, this is what businesses do.
He uses blockchain as an example. No company can say that they have an existing strength in blockchain because it’s a new technology and the business concepts that utilize it are only just emerging. It’s a level playing field.
Are there any advantages a company could have? Maybe a company has a lot of computer scientists and mathematicians. That might be a slight strength. But getting into blockchain businesses is an entrepreneurial action, largely different than building on strengths.
The approach to innovation we support here at Economics For Business is “Explore And Expand”, and Professor Keyhani sees a good match between the explore-expand dichotomy and the entrepreneurship-strategy dichotomy. Exploration is a blind spot in strategic management theory and modeling — there is pretty much no exploration in the five forces framework or the RBV (resource-based view) framework. Exploration — acting for the learning value to open up options for more things that can be done in the future — is the entrepreneurial way of thinking.
Effectuation (covered in episode #131: Mises.org/E4B_131) is another form of entrepreneurial logic. It recognizes that the entrepreneur faces so much uncertainty that it may not be possible to set specific objectives. But the entrepreneur knows that they want to do something, that they have knowledge and resources and relationships, and that they may be able to create some value from them. Effectuation is the “fuzzy front end” of value creation.
Another way to combine entrepreneurship and strategy is speed of learning. The general capability to be more adaptive than competition, to go through the learning cycle faster, is a dynamic capability that can be strategic.
Competitive moats in the software world. Is the structure-and-constraints approach of strategic management useless in the digital era we live in? Sustainable competitive advantage seems to be inapplicable when anyone can write software (or download it from Github), and access hosting and storage at scale from AWS.
But in fact, software entrepreneurs do think in terms of competitive advantage. The modern term for it is “moats”. Venture capitalists look favorably on businesses that can surround themselves with a moat to keep out competition.
The most discussed moat is network effects. This concept did not come from the neo-classical economics equilibrium models, but from the dynamic analysis of more users coming in to join existing users. The five forces framework suggests that advantages lie either in cost or differentiation, but a network effects advantage can be both.
Two-sided platforms with two-sided network effects add even more complexity. It’s strategic to achieve that status, but the theory did not emanate from traditional strategic management thinking.
Professor Keyhani introduces the next entrepreneurial strategy breakthrough: generativity. We talked in episode #104 (see Mises.org/E4B_104) about the new phenomenon of digital businesses identified by Professor Keyhani: generativity. Achieving generativity confers significant competitive advantage for any entrepreneurial firms who can develop it through technology. It’s an advantage that is not identified by existing strategy theories.
Generativity can be thought of as the automation of open innovation. Products and services can be designed to offer features that enable outsiders to innovate with them, and these outside innovations benefit the company. For example, the Google Pixel smartphone and the Apple iPhone are generative products or generative systems. With the tools these firms provide in the phones, outside developers can create new apps, that they offer on the Pixel or iPhone platform for other outsiders to use. The app developers make money, and so do Google and Apple, both from sales of outsider-developed apps in their app stores, and from in-app purchases. Google and Apple are not utilizing their own knowledge — they don’t know the problem the app is solving, or even who developed it or where they are. They don’t have to make the solution, don’t have to take the risk, and don’t have to pay salaries or development costs. Yet they profit from the innovation. It’s a huge competitive advantage for these two entrepreneurial companies.
Additional Resources "The Strategic Management Model versus the Entrepreneurial Model" (PDF): Mises.org/E4B_147_PDF
"The Logic Of Strategic Entrepreneurship" by Mohammad Keyhani: Mises.org/E4B_147_Paper1
"Was Hayek an ACE?" by Nicolaas J. Vriend: Mises.org/E4B_147_Paper2
The ultimate list of tools for entrepreneurs—"Entrepreneur Tools" by Mohammad Keyhani: Mises.org/E4B_147_Tools
Our guest is Ben Recht, Associate Professor of Electrical Engineering and Computer Science at UC Berkeley, who recently got hold of and analyzed the raw data from the Bangladesh cluster randomized control trial of masking which made headlines in September.
SHOW NOTES Ben Recht: Twitter and webpage
Ben Recht’s recent blog post: Revisiting the Bangladesh Mask RCT
Michel Accad Why N-of-1 is Enough
Ep. 97 with Peter Klein on “Evidence-Based Economics: What the Doctor Ordered?“
Watch the episode on the Accad & Koka Report YouTube channel
Ceaseless flux. Those are words Ludwig von Mises used to describe the perpetual change in business conditions that entrepreneurs experience. The consequent need, he told us, is for a process of constant adjustment. The current word for that process is adaptation. Economics For Business talks to Luca Dellanna, a leading business expert who advises companies of all sizes on managing the challenge of continuous adaptation.
Key Takeaways and Actionable Insights Adaptation is a necessary capacity of all businesses. Adaptation is a necessity. The marketplace changes, customers change, technology changes. Change is the norm. Firms that don’t adapt will suffer and potentially die, so adaptation must become the norm for business. In complex systems theory, adaptation is the selection of strategies or actions that enhance survival or any other measure of success (or fitness, as its sometimes called) amidst swirling change. In business, adaptation means choosing your degree and pace of change.
Change will be externally imposed if it is not internally embraced. Businesses can influence the level of change impact. They can critically examine their mental models, and assess their products, processes, beliefs, and people, to evaluate their fitness for adapting to market change. To avoid change being imposed from outside the firm — to avoid negative natural selection, in the evolutionary metaphor – all layers of the firm must embrace change, and proactively adapt. Eliminate unfit products and processes, pursue the development of new ones that are better adapted, and upgrade people resources through thoughtful hiring and active learning.
Adaptation is different than responsiveness — it’s embracing harm. We talk a lot about a business’s responsiveness to customer wants and preferences, especially when those preferences are fluid and incompletely articulated and require interpretation. Responsiveness is critical — but it’s different from adaptation. It’s response to an external signal. Adaptiveness is embracing change inside the firm.
Luca Dellanna has a striking way of communicating this: he advises his clients to deliberately expose themselves to what he calls “harm” — new problems never before encountered. The exposure must not be to a problem that could overwhelm the firm, but one that can be addressed at a subsidiary level or component level or via adjustment in a shared mental model. Luca calls this “small harm” — specific problems (e.g., the price of a product or service compared to the customer’s willingness to pay). Proactively probe the problem, e.g., in a high pricing test, generate feedback and actively use the learning to adapt. Another word for “small harm” is stressors: situations that put stress on the firm. Set up systems to seek out these stressors so that adaptation is deliberate, and can be enculturated, rather than wait for a crisis that requires an emergency response.
Lack of discomfort is a problem to avoid.
Identify the leading indicators that describe the conditions that will change the future. Lagging indicators — such as revenue — are metrics that describe the past. There are leading indicators available such as number of customer contacts (describing what the pipeline might look like in the future), and satisfaction scores (describing future repeat sales). Luca recommends pairing one lagging indicator with one leading indicator to develop a metrics system.
This is not the same as popular consultant-proposed metrics systems such as OKR (Objectives and Key Results). Objectives are not leading indicators. The best leading indicators are behaviors, because these can be easily adjusted if observed to be in need of change. Falling behind on objectives does not yield an actionable response if not linked to a causal factor. Inadequate behaviors (e.g., conducting a sales call without following the proven process) can be addressed, especially if they are clearly linked to positive outcomes.
This is the same principle as Amazon’s focus on what they call controllable inputs, and Amazon knows a lot about driving business growth.
There are several strategies to pursue adaptation. Redundancy (having more than needed): A focus on efficiency and “no waste” can be detrimental to adaptation if it leaves no resources for experimentation and exploration. Employees need time to work on new things, not just on current tasks and issues.
Bottom-up initiatives: Central command and control can’t run everything, anticipate every harm, or plan every experiment. Ensure entrepreneurial empowerment of front-line employees and functions so that they can initiate learning.
Avoid game-over: In experimenting, calibrate the risk to ensure that a negative result is not overwhelming, and, in regular operations, be aware of any possibility of a major crisis — a Black Swan event — and be sure that it will not destroy the firm or deliver a setback from which it will be hard to recover.
Never stop exploring, in a culture of anti-fragility.
Nassim Nicholas Taleb famously coined the term “anti-fragile”. The company that has the most well-developed capacity to learn from problems and harm is the most anti-fragile. The culture of anti-fragility is always to surface problems when they are encountered and address them at the source. Luca stresses that culture is built when everyone in the company can see a consistent set of actions in which the trade-offs of addressing problems are consistent with the stated vision. For example, a culture of safe operations will be reinforced when safety precautions are taken even when the cost, in time or money or both, is high.
The leading indicator is that every individual and every operation and sub-operation is following safe practices, and that the company readily commits resources when a new safety procedure or installation is proven to be effective. If the trade-off is made that the new procedure is effective but too expensive to install, the culture will be punctured because the company has acted contrary to its declared vision.
Additional Resources "The Power Of Adaptation" (PDF): Mises.org/E4B_146_PDF
Read Luca Dellanna’s book, The Power Of Adaptation: Mises.org/E4B_146_Book
Another application of adaptation, Teams Are Adaptive Systems: 12 Principles For Effective Management by Luca Dellanna: Mises.org/E4B_146_Book2
Visit Luca Dellanna’s website to find more resources: Luca-Dellanna.com
E-mail Luca at luca@luca-dellanna.com
Vaccine mandates are not a new invention, and states have long pushed a narrative exaggerating the success of mandates in the past.
Original Article: "Smallpox: The Historical Myths behind Mandatory Vaccines"
This Audio Mises Wire is generously sponsored by Christopher Condon. Narrated by Michael Stack.
Our guest is Jenin Younes, a Litigation Counsel for the New Civil Liberties Alliance. She joins us to discuss her involvement in advocacy and in legal challenges against vaccine mandates. She holds a B.A. degree from Cornell University and a J.D. from New York University School of Law. She has been featured on several national media outlets for her commentary and she recently penned an op-ed in the Wall Street Journal building the case against mandatory vaccination in children.
SHOW NOTES Jenin Younes: Twitter and webpage
Watch the episode on the Accad & Koka Report YouTube channel
The field of medical care is so ripe for new entrepreneurial solutions. As is always the case, solution design begins with understanding subjective value, both for customers (patients) and providers (doctors) Christopher Habig of Freedom Healthworks (FreedomHealthworks.com) joins Economics For Business to explain how an Austrian, subjective-value focused approach is bringing market freedoms to medical care.
Key Takeaways and Actionable Insights Step 1: Like many entrepreneurs, Chris Habig started a revolutionary business from a place of familiarity and existing knowledge. The so-called effectual process in entrepreneurship begins with two straightforward questions: what do I know and who do I know? Chris Habig grew up in a family where both parents are physicians. This vantage point gave him the opportunity to observe the critical doctor-patient relationship first hand, as well as the way in which modern bureaucratized medicine imposes obstacles and complexities that strangle the value generation potential of that relationship.
Step 2: Assessing the subjective value gap. From his Austrian analytical perspective, Chris was able to identify the subjective value gap. For customers (patients) it is the loss of the positive feelings that they associate with the doctor-patient relationship. Chris summarizes them as advocacy, access and affordability: my doctor is on my side and looking out for me; my doctor is always available to me; I will not be excluded for economic reasons. These feelings are negated by bureaucratic medicine.
There’s a subjective value gap on the physician side, too. Research shows that doctors are stressed, and no longer find fulfilment in their work. Their mental health declines and there is an increasing rate of defection (leaving the industry) and even suicide. It’s a sign of a dysfunctional system to exert such an effect on its human capacity.
Step 3: Identifying the barriers to remove. Value generation often consists in the removal of barriers to the realization of the desired experience. Chris identified two major barriers: insurance and government. The current approach to medical insurance actually hampers the market for what customers truly desire, which is the positive feelings of the doctor-patient relationship. Now it’s a patient-insurer relationship: will my visit / test / procedure be covered? Will there be a big bill in the mail?
And, of course, the participation of government to enforce the current system through legislation and regulation perpetuates the barriers.
Step 4: The entrepreneurial solution. The solution is to free the system from its constraints through entrepreneurship. The physician is the entrepreneur on the supply side. Via a new business model called Direct Primary Care (DPC), the physician-entrepreneur creates a new value proposition for customers. Access is provided via a subscription model, and this financial innovation enables the thriving of a practice composed of a small number of patients to whom the physician can devote more time per visit, more attention, and more personal and individualized care. The physician is networked into a web of complementary secondary and specialist services that can be orchestrated for the individual patient’s need. All the associated business services are clustered around the DPC practice, and the physician does not need to be bound by a hospital system bureaucracy.
The new financial model enables the customer to take charge of their medical expenses, paying cash for current needs and reserving insurance for catastrophic events, which is the way it should be used. Consumer prices are lowered throughout the system.
Lives are improved on both sides of the doctor-patient relationship.
Step 5: The support system for the entrepreneurial model. We live in an age in which distributed entrepreneurship can be embedded in an enabling system of digital infrastructure. Part of the innovation that Freedom Healthworks brings to the renaissance of the doctor-patient relationship is the platform on which the DPC business model can run.
Chris has identified 158 steps for the set-up, operation, and maintenance of a DPC business model. These can all be hosted, enabled, and implemented on the physician’s behalf. Finance, technology, operations, marketing, and vendor relationships can all be systematized and partially or fully automated. The doctor can focus on the relationship component of interacting with patients.
Step 6: Scaling. Can entrepreneurs build out a fully-functioning cash-based direct care system to rival and ultimately replace the government-insurance company nexus? It’s already happening. As each DPC practice proves itself, more entrepreneurial physicians will make the transition and momentum will build.
DPC is an important example of the future of entrepreneurial economics.
Additional Resources "Enabling A Direct Primary Care Practice" (PDF): Mises.org/E4B_145_PDF1
"FreedomDoc Launch Process" (PDF): Mises.org/E4B_145_PDF2
Healthcare Americana podcast: Mises.org/E4B_145_Pod
Visit FreedomHealthworks.com and FreedomDoc.care
What would the effect of a 100 percent vaccination rate be on the virus? Contrary to claims, the virus will not disappear. The next outbreak would occur within a year with 100 percent breakthrough cases with a vaccine-resistant strain.
Original Article: "Why Biden's Vaccine Mandate Hasn't Delivered the Promised Results"
This Audio Mises Wire is generously sponsored by Christopher Condon. Narrated by Michael Stack.
Every company starts as an innovation. Thereafter, the unceasing challenge is to keep innovating because the market continues to change, technology continues to advance and, crucially, customer expectations continue to rise. Economics For Business speaks with Joe Matarese, Executive Chairman of Medicus Healthcare Solutions, about how to build the culture of continuous innovation and overcome the countervailing forces of the status quo.
How to understand consumer expectations and build organizational culture that rewards continuous innovation: Mises.org/E4B_144_PDF.
Key Takeaways And Actionable Insights Every company starts as an innovation. The challenge is to continue — and ideally accelerate — innovation without pause. As Joe Matarese puts it, innovation gets you into the game. It’s how every company starts. There’s the identification of a gap in the marketplace and the operationalizing of a new innovation to fill the gap, better than any other competitor or rival entrant.
Innovation is seldom a great new invention or unprecedented leap. It’s more often the day-to-day incremental changes and improvements in products and processes to meet customers’ changing expectations.
The great challenge is to continue or even accelerate innovation as the company grows and expands.
Continuous innovation combines mindset, processes, technology, empathy, and organizational empowerment. The world is complex and ever-changing. Innovation is necessary for all businesses to keep up or even move ahead. Innovation is not simple, and it’s not easy — in fact it’s a continuous struggle against opposing forces. Joe Matarese has directed innovation from three vantage points: big corporate, startup, and large growth company. To achieve the goal of continuous innovation requires attention to multiple factors:
Mindset: Innovation must be the commitment for everyone in the company. That means always asking the question, “How can we do better?” Such a mindset requires both tolerance of discomfort — since there’s never any rest — and humility in the face of feedback. Innovative companies hire people with these characteristics and cultivate constant vigilance throughout the firm.
Processes: Things get done through the implementation of processes. Innovative are always seeking to improve their processes — make them faster, lower cost, and more efficient in their use of inputs, especially the use of people’s time. Innovation itself is a process, and process improvement is a form of innovation.
Technology: Irrespective of how innovative any one company may be, technology is progressing at an increasing rate of change with potential to render all processes faster, lower cost, and capable of higher quality and fewer errors. One way to ensure continuous innovation is the rapid adoption and early implementation of new technologies as they become available.
Empathy: Even more powerful than technology is the capacity to tap in to customers’ expectations. This is the source of knowledge about future requirements. Customers are experiencing new technology, are absorbing innovation from other firms in the market (whether they are firms that are competitive to yours or simply adjacent), are experiencing change, and their expectations are changing and becoming more demanding by the moment. By sensing their changing expectations, the innovative firm is in position to be a first responder or an innovator before the expectation has even hardened or matured. Being ahead of expectations is a powerful place to be.
Empowerment: People in front line sales and service functions are closest to customers and their expectations. Line operatives are closest to process implementation. Supply chain managers are closest to business partners and vendors. It is these front-line positions that are best placed to deliver information about expectations and what’s changing. They are also best placed to sense dissatisfaction and unease, and to make real-time changes and adjustments. If they are empowered to make changes and to both suggest and implement improvements — even if what they try doesn’t work — they will be more highly motivated and more likely to serve as an internal engine of innovation.
Tools: Joe shares how his company, Medicus, has developed tools for innovation. Internally, all employees have access to communications tools that ensure the customer data they collect, and the ideas they generate as a result, are widely circulated and responded to. Externally, doctor whom Medicus reimburses for services have access to a tool to record their time that is administratively simple and generates fast payment, addressing two measures of unease.
Our Econ4Business.com platform curates many tools for entrepreneurs. One example relevant to this episode is the "Continuous Customer Expectations Monitor" (see Mises.org/E4B_144_PDF2). It guides entrepreneurs through the continuous process of tracking and keeping up with changing customer expectations.
There is a constant counterforce to innovation that the innovative company must recognize and overcome. There is an innate human resistance to innovation and change. Consider this from a leading brain scientist and psychologist:
When information streams in through our sensory systems, it first stops off at our amygdalae, which are there to ask the question, “Am I safe?” We feel safe in the world when enough of the sensory stimulation coming in feels familiar. When something does not feel familiar, however, our amygdalae tend to label that unfamiliar thing as dangerous, and they respond by triggering our fight-flight-or-play-dead fear response. —Jill Bolte Taylor, Ph.D., Whole Brain Living (Mises.org/E4B_144_Book)
It’s natural in humans to resist change. It may not be safe. It may threaten my job, or my comfortable routine, or generate unwanted uncertainty. Fear of change is real. The function that exercises the fear response in companies is bureaucracy. Bureaucracy exists to ensure compliance with existing rules, and their consistent and uniform implementation. Bureaucracy is anti-innovation.
When a business leader commits to improving a product or process, he or she is undoing what someone else in the firm had championed and nurtured and maintained. It’s a constant battle that must be waged between change and the maintenance of the status quo.
The adoption of new technologies is an effective technique of innovation, but it can also trigger a fear response. Technology is the continuous innovator’s weapon. It advances at its own pace, as a form of evolutionary advance. Every technological innovation spurs new applications in the marketplace. The adoption of these new technology applications is a catalyst for continuous innovation in the firm, supporting both product and service improvements and the incremental efficiency of processes — faster, leaner, lower cost.
The fear mechanism exhibits itself as employees worrying about their jobs. Perhaps the application of technology will reduce the number of people supporting a particular process from 5 to 4 to 3 or 2 or even one or none. They fear that progress will punish them. They adopt a defensive mindset. The innovator’s goal is to change the mindset to one of anticipation of rewards for progress.
Basic economics tells us that resources which are no longer utilized in a process that is rendered more efficient are thereby released for higher and more productive uses. Innovation leaders can communicate that, and make sure employees know they will be rewarded for progress via new and better opportunities for them to contribute more through the higher productivity that innovation brings.
The greatest resource for continuous innovation comes from customer intimacy and empathy that senses customers’ escalating expectations. When we talk about a changing marketplace, we are really talking about customer expectations. Innovation elevates customer expectations and thereby triggers the next round of innovation in a never-ending cycle.
For example, now that many people carry iPhones and other smartphones, they’ve become used to unprecedented levels of convenience, interconnection, functionality, and intuitiveness. Their expectations for every other piece of technology they encounter, and every interface they navigate, are raised to a new level. There’s a marketplace of expectations and every new technology raises the bar.
The way to keep pace, and to have any chance of anticipating and meeting the next level of raised expectations is to get as close to the customer as possible, to be with them when they’re using your product or service or technology and listen and empathize when they express a wish (or expectation) that the experience could be easier, better, faster, less frustrating, more enabling. “I wish it were as easy as my iPhone” is the expression of an expectation that everything should be as easy as the iPhone.
Innovating firms build in mechanisms that make continuous innovation not only possible but likely. There’s a quote in the book Working Backward, about continuous innovation at amazon, to the effect that “Good intentions don’t work, mechanisms do”. The intent to improve a process or product is not enough; people already had good intentions in the first place. Mechanisms turn intentions into actions and achievements. Some of the mechanisms Joe Matarese recommended are:
Mechanisms for taking in data from and about customers: Customer intimacy has a mechanism, in the form of frictionless and unstructured data collection. Give front line employees and the technology they use the unfiltered capacity to gather customer information about their dissatisfactions and report it back.
Let people experiment: The E4B technique of explore and expand applies to everyone in the organization. Elevate experimentation over compliance. That’s the way learning happens.
Eliminate bureaucracy that is not mission-supportive: Every company eventually builds bureaucracies in order to support consistent application of business rules. Innovators differentiate between bureaucracy that is mission-supportive and bureaucracy that is mission-obstructive. HR is often a department where bureaucracy grows. If HR is helping to recruit talented people who will contribute to innovation, then the bureaucracy is mission-supportive. If HR imposes rules that unnecessarily impede innovation, then that part of the bureaucracy should be shut down. The goal is to liberate the value-generating creativity of everyone in the organization, and not to impede it.
Decentralization and entrepreneurial empowerment: Decentralization is a mechanism of innovation. The goal is for your organization to consist of hundreds of individuals thinking creatively and solving problems for customers. You want them all to think and to learn! They must know that the firm cheers them on for doing so.
Additional Resources "Designing An Organization For Continuous Innovation" (PDF): Mises.org/E4B_144_PDF
"Continuous Customer Expectations Monitor" (PDF): Mises.org/E4B_144_PDF2
Medicus Healthcare Solutions: MedicusHCS.com
Econ4Business.com
Whole Brain Living: The Anatomy of Choice and the Four Characters That Drive Our Life by Jill Bolte Taylor: Mises.org/E4B_144_Book
Successful entrepreneurs are Austrians, they just don’t know it yet. This is a famous assertion from Dr. Per Bylund, and we dissect its meaning in the latest Economics For Business podcast.
Key Takeaways and Actionable Insights Success starts from a deep understanding of subjective value (see Mises.org/E4B_143_PPT). What’s the value of a successfully completed Google search? What’s the value of the feeling of satisfaction that results from having cooked an excellent meal enjoyed by your family? What’s the value of the PowerPoint template you utilized to make a well-received boardroom presentation that may boost your corporate career?
Austrian entrepreneurs know not to ask the question in that form. First, value is not measurable; it’s a feeling or experience in the mental domain. It may have great intensity, it may have long duration, but it can’t be measured in dollars or with any other number.
Yet the generation of customer value is the entrepreneur’s goal. How can the goal be achieved when the understanding of value is so challenging and its measurement is impossible? This is the brilliant advantage of the Austrian entrepreneur.
The customer learns what a value experience feels like. A customer can’t describe the value they are seeking or what goods and services will deliver it. The value process is not one of demand and supply. As Ludwig von Mises understood, customers feel a sense of unease — “things could be better” — and begin to explore possible avenues to relieving their unease. Of course, this exploration takes place within a complex system of needs: individual and personal goals, family comfort and security, job success and economic status. Customers sort through possibilities with incomplete information and in the context of uncertainty. The gap between feeling unease and finding the best good or service to address it is large. They might try multiple potential solutions with varied cost/benefit profiles before they arrive at one that seems best, or better than alternatives. In other words, they learn: value is a learning process.
The entrepreneur helps their customers to learn. The customer’s value thinking is constrained: in the present, they can’t imagine a solution that they haven’t yet tried or that has not been available to them. The entrepreneur innovates around the constraint, by providing and communicating new means that the customer could utilize in the future.
Entrepreneurs can’t directly shape the customer’s choice. It’s a fallacy to believe that advertising or promotions or presentation of features and benefits can accomplish that. The customer’s context is too complex for such a simple mechanism to work. The entrepreneur creates a tomorrow in which the customer will feel better off, and provides the means to facilitate the experience, a means for the customer to learn what a better tomorrow feels like. They meet customers in a market that doesn’t yet exist.
Austrian entrepreneurs have a unique value generation tool. The complexity of the customer’s value system — all the components of value interacting and changing in time — can be simplified with the use of a key that Austrians call the hierarchy of values. Every individual has a set of goals or values they pursue in life. Some of these are more important than others — we call them the highest values. For example, people who engage in sport and athletic activities may have several values for doing so: for fitness and health, for social reasons, for self-improvement, and so on. One value may be the most important in their own individual hierarchy — for many people it is the sense of achievement. By improving their speed or time of running or bicycling, by winning a tournament or a league or playing on a winning team, the individual can experience a sense of personal achievement that is rare, valuable, and fulfilling.
It is a commercially strong behavior to appeal to this highest value among customers. Nike does this for example with its “Just do it” appeal. To simply undertake the athletic activity is achievement: you’ve done something. And, of course, Nike wearables help the process of experiencing the highest value.
All entrepreneurs can appeal to customers’ highest values, and the Austrian entrepreneur has deeper insight into this action.
Austrian humility is a success factor. So much of business success is projected as heroic implementation of superior strategy. Austrian entrepreneurs do not suffer from such hubris. They take a humble approach to business, understanding that the customer is often engaged in searching and learning without a clear outcome in mind, and that, therefore, the entrepreneurial business cannot be certain of any future results. Entrepreneurs humbly follow, letting the searching customer take the lead, and accepting the customer’s terms of service.
This is how entrepreneurs learn how to facilitate value — often from the harms they suffer from getting their value proposition out of alignment with the customer’s preferences. If the value proposition is wrong, or the price is too high, or the convenience not to the customer’s liking, then no transaction is made, and the entrepreneur must — humbly — adjust. The most successful entrepreneurs are able to maintain their attitude of humility at all points in the value cycle.
Austrian entrepreneurs take the role of fitting in to the customer’s value system. It’s a flow, not a plan. Conventional business planning is anathema to Austrian entrepreneurs. The linear process of producing and selling to generate transactions with the goal of meeting a targeted volume or revenue in a fixed period of time is not appropriate for the humble, learning, exploring business of entrepreneurship.
Entrepreneurial success stems not from good planning but from adaptively fitting in to the evolving value system we call the market — a system that is different for every individual customer, and into which many overlapping and competing entrepreneurial value propositions are also trying to fit.
Planning is not a good tool for this purpose. Creativity, imagination, and adaptiveness are called for. The dynamic of learning from the customer and adjusting to changing signals calls for responsiveness not plans. The entrepreneurial journey with the customer is a flow, sometimes through white water. In this context, the Silicon Valley concept of pivoting is appropriate, although not quite as the West Coast gurus see it. Their pivot is a one-time major shift in direction, perhaps to a new business model when the original one proves inadequate. The Austrian pivot is continuous and flowing, adjusting the boat to the subtle and frequent signals sent by customers.
Explore, Realize, Then Keep Exploring. We’ve talked in the past about an “explore and expand” model for entrepreneurial value generation. The entrepreneur co-explores various paths to value with the customer, and when one emerges as productive of significant value, the entrepreneur can expand the allocation of resources to that path and drive revenue growth, through selling more to the same customers, or recruiting new customers or both.
Professor Bylund added some nuance to this: the entrepreneur never stops exploring. When an exploration results in substantial value realized, there remains a lot of further exploration to understand the value experience of the customer in greater depth and detail, and continuous monitoring of changes and adjustments in the customer’s system and value network. The entrepreneur is continuously tested.
The entrepreneurial ethic is an ethic of service; profit is a shared outcome of consumer and producer choices. Entrepreneurial firms are in business to serve customers. This principle may be appropriately expressed via mission statements and expressions of purpose; it remains the core of all entrepreneurship. Profit is an outcome of two collaborative choices: the exchange price the consumer is willing to pay for the value they anticipate receiving, and the choice of costs the entrepreneur considers proportionate to the value he or she expects to generate for the customer. There are many entrepreneurs in the market for resources bidding on costs at the same time, and so the individual entrepreneur’s choices are conditioned by those made by others. Profits emerge from this system.
Cash flow is a better indicator of the capacity of the entrepreneur’s business model to convert resources into exchange value for customers (although not the artificial cash flows of engineered P&L’s — rather, the true cash flow of the customer’s eagerness to exchange for the newly produced offerings from the entrepreneur).
There’s a distinctly Austrian approach to entrepreneurial business. In a famous paper called "Inversions of Service-Dominant Logic," (see Mises.org/E4B_143_PDF) professors Stephen Vargo and Robert Lusch called for inverting “old enterprise economics or neoclassical economics” in favor of a new perspective. One of their proposals was an inversion of “entrepreneurship and the view that value creation is an unfolding, emergent process” to a position “superordinate to management”. Business schools, they stated, teach a management discipline rooted in the industrial revolution. There’s an emphasis on centralized control and planning. Vargo and Lusch sought to replace this approach with value creation as “an emergent process within an ever-changing context, including ever-changing resources; it is, by necessity, an entrepreneurial process”.
The distinctive Austrian entrepreneurship approach captures and expresses the emergent process, and provides entrepreneurs (and managers) with the tools and methods to help them shape thriving businesses as they discover new solutions to relieve customer unease.
Additional Resources "Explore and Realize (and Keep Exploring): How Austrian Entrepreneurs Generate Value on the Path to Business Success" (PowerPoint): Mises.org/E4B_143_PPT
"Inversions of Service-Dominant Logic" by Stephen L. Vargo and Robert F. Lusch (PDF): Mises.org/E4B_143_PDF
New tech shows some light at the end of the tunnel. But for decades, government bans on a market for human organs has condemned millions of people to early deaths and immense pain.
Original Article: "The Tragedy of the Government's Ban on Human Organ Sales"
This Audio Mises Wire is generously sponsored by Christopher Condon. Narrated by Michael Stack.
Includes an introduction by Joey Clark. Recorded in St. Petersburg, Florida on October 22, 2021.
The weekend revolves around a discussion of strategy. Nearly 25 years ago, Professor Hans-Hermann Hoppe delivered his famous "What Must Be Done" speech on the pressing topic of how—and whether—to engage the state. Today his prescription for a bottom-up ideological revolution beginning at the local level rings more true than ever. With Hoppe's admonitions in mind, all of our speakers and panels will consider three vital questions: Where are we? How Bad is it? And what should we do now?
Government healthcare is centrally planned healthcare. Innovations in the decentralized "digitalization" of medicine could finally move medicine back in the direction of markets.
Original Article: "Digitalization Could Move Medical Care beyond 'Government Healthcare'"
This Audio Mises Wire is generously sponsored by Christopher Condon. Narrated by Michael Stack.
Entrepreneurial businesses acknowledge and understand the inevitability of boom-bust cycles in the Fed-manipulated economy. But they refuse to be defeated or even deterred. They find the profitable pathway through both the boom and the bust. Murray Sabrin has compiled a guide in his latest book, Navigating The Boom/Bust Cycle, An Entrepreneur’s Survival Guide (Mises.org/E4B_142_Book).
Key Takeaways and Actionable Insights So long as we have central banking, entrepreneurs will experience boom-bust cycles. They adapt to this reality. Entrepreneurship is, in its essence, focused on the generation of new value, producing betterment, growth, and improvement. While customer preferences and the nature of competitive offerings may change, and conditions such as pricing and contracts may vary, entrepreneurs work towards continuous enhancement of markets.
Their efforts are thwarted by governments, who can’t leave markets alone to function smoothly, and especially to central banks who aim overtly at manipulating markets through artificial credit creation. Austrian entrepreneurs are acutely conscious of this problem, since they understand Austrian business cycle theory. But they must nevertheless adapt to the boom-bust problems the central bankers bring about.
The first tool of adaptiveness is the recognition that there is the private economy and the public economy are different and separate. Some economists talk of a mixed economy, but, as Mises pointed out, such middle-of-the-road thinking is socialist. The public economy is where the government trades, including trading in money, debt, and credit manipulation, and in the regulations that governments use as their management tool.
Entrepreneurs seek to establish a private economy where the government does not trade. The most important part of the market where the government is absent is the creation of customer value, especially in the form of innovation. Governments destroy value and deny innovation. When entrepreneurs can operate in the light of value generation, leaving governments in the dark, there’s room for profitable operations.
Entrepreneurs can further protect their safe haven with good anticipatory timing of the boom-bust cycle. There are signals that help. Murray Sabrin’s book provides a long list of websites and links where relevant data is published that can help entrepreneurs watch the trend that might signal the timing of the boom-bust cycle.
The first signal is the so-called inversion yield curve, when short term interest rates start to elevate, and even get to higher levels than longer term rates. This is unnatural, implying that there is greater uncertainty in the short term than the long term. It can only happen when markets are fearful of the short-term consequences of government policies and interventions, even though they are confident of entrepreneurially-induced growth and improvement in the long run.
As a rule of thumb, according to Murray, the beginning of a recession can be anticipated roughly one year from the inversion of the yield curve. Of course, other factors can intervene, such as the government’s idiotic shutting down of businesses over the fake COVID-19 pandemic. Nevertheless, entrepreneurs should pay attention to the yield curve signal. They can monitor it at Mises.org/E4B_142_Fred.
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Another signal for entrepreneurs to monitor in the overall economy is the unemployment rate. This rate declines during the boom, and actually starts declining as the recession is ending or a few months afterwards. There are variations in the pattern by industry, which Murray describes in detail in the book. He provides a list of 12 St. Louis Fed employment data series to monitor, covering sectors such as manufacturing, durable consumer goods, finance and insurance, and construction.
He offers many more signals — such as homebuilder stock prices — to monitor boom-bust timing. There is plenty of data for the savvy entrepreneur.
Strengthening value effectiveness and value security beats managing for efficiency. The economics profession has been guilty of misguiding entrepreneurs with its focus on efficiency, i.e., managing for fewer inputs per unit of output, and eliminating “waste”. It can cause fragility, impede value generation, and slow down innovation and responsiveness to change.
One example is the management of supply chains. Managing them for maximum efficiency can also make them insecure, if, for example, there are no ready supplier replacements when one slips up. We are experiencing the impacts of supply chain fragility right now in the US. It’s for reasons extraneous to regular business operations, but the effects serve to highlight the need to keep supply chains secure under attack from government interventions. Entrepreneurial businesses that develop the strongest possible upstream supplier relationships and cultivate a richly connected value network may be able to perform better when boom-bust hits the supply chain.
Entrepreneurs fight the Fed on inflation. The Federal Reserve insists on maintaining its 2 percent inflation target, which is economically destructive in many ways (see "Why the Fed's 2 Percent Inflation Standard Is So Bad" by Ryan McMaken: Mises.org/E4B_142_Article). Entrepreneurs pursue deflation, always aiming to deliver better quality at lower prices. Why? Because it’s what customers want, and entrepreneurs are in business to serve customer needs. Entrepreneurs bring abundance. The Federal Reserve, taking the position that higher prices are good for the economy, promotes scarcity.
Entrepreneurs make their workforce a strong resource, rather than a source of cost-cutting in economic downturns. The purveyors of so-called efficient management traditionally see the workforce as a cost, and urges entrepreneurs to cut costs by firing people in economic downturns. Entrepreneurs focus on effectiveness instead, and see their workforce as a resource and a source of ideas and initiatives for improvement and adaptation in all environments. A motivated frontline workforce is closest to customers and can bring back information, ideas, and new initiatives to make the business more responsive to customer needs and more capable of delivering desired customer experiences. This is the case whatever the state of the Fed-manipulated economic cycle.
Growth entrepreneurs think expansively at all times. Entrepreneurs create new value for customers, and they don’t call a halt to their pursuit of value just because of the macro-economic data that’s being reported in the mainstream media.
They understand that customer preferences, or the order of those preferences, may well change in a boom or a bust time, and they maintain their vigilance in monitoring and responding to these changes. These are the signals to which they respond, not the economic headlines. Entrepreneurs look for the opportunity to introduce new goods and services at all times, and not just at the “right” moments in the economic cycle. They’re always looking for new ways to deliver more value. Perhaps, in a downturn, there’s a greater call for service and repairs on existing equipment than for buying new equipment. Entrepreneurs can adjust and recombine their assets to provide more repair work and thus make up for lost sales revenue.
Entrepreneurs are great cash flow managers, and tend to keep cash on hand or available for those times when this level of money can be utilized for expansion. One potential application in this book is the acquisition of assets from other businesses in a downturn, when business operators who are less savvy run out of cash and offer assets for sale at low cost. Murray calls this “picking up the pieces”.
There may also be the opportunity to expand geographically into new regions. There’s always growth somewhere.
In sum, the answer to the boom-bust cycle is value agility. In the 4Vs business model on the Economics For Business platform, the fourth phase of the value cycle is value agility. We use this term to indicate the speed of responsiveness that successful entrepreneurs exhibit in response to customer feedback. Murray Sabrin uses the same term in his book, and defines it as “a process where entrepreneurs... adapt and adjust to continue to meet consumers’ perceptions of value your business delivers” (p. 111).
He asks, “do entrepreneurs stick it out when the economy is in a slump or wave the white flag and close the doors?” Mastering value agility means never being faced with that agonizing decision.
Additional Resources Purchase Navigating The Boom/Bust Cycle, An Entrepreneur’s Survival Guide at Mises.org/E4B_142_Book. Use promo code BOOM20 for 20% off.
See a preview of Murray Sabrin's book at Mises.org/E4B_142_Preview (PDF).
"The 4Vs Business Model" (Video): Mises.org/E4B_142_Video
The Economics For Business platform: Econ4Business.com
"Why the Fed's 2 Percent Inflation Standard Is So Bad" by Ryan McMaken: Mises.org/E4B_142_Article
10-Year Treasury Constant Maturity Minus 2-Year Treasury Constant Maturity (Chart): Mises.org/E4B_142_Fred
All value is subjective. But often, when an exchange is to be made, a numerical value is required. It’s a special kind of economic calculation, what Bharat Kanodia terms “a subjective opinion based on objective facts”.
Bharat has built a career on valuations, from 2-founder garage start-ups to the Eiffel Tower. He shares his knowledge, experience, and insights with the Economics For Business podcast.
Key Takeaways And Actionable Insights Valuations start with a “what?” and a “why?” What is the subject of the valuation? Is it a building but not the land it’s sitting on? Is it a patent? Is it a monetized patent or just an approved patent? Is it the assets of a business or is the going business? All these definitions and classifications of what’s being valued clearly make a big difference to the outcome.
What is the purpose of making a valuation? It might be a step in buying a business. Or in selling a business. It may be a valuation of an asset for insurance purposes, or for estate tax estimation. The valuation may be a tool for raising capital, or an assessment following a capital raise. The same asset can have different valuations for different purposes.
That’s why it’s important to start with the what and the why.
The most challenging business valuation is for a start-up. Two founders working from a garage have a business idea and some code but no customers and no revenue. The business needs a valuation in order to raise capital. It makes no sense to value it on the basis of discounted future projected cash flows. They’re imaginary.
The business is going to be valued based on the story the founders tell, and a rule of thumb valuation that works backwards from the percentage of the business the founders are willing to give to a seed investor.
Most 2-founder garage pre-revenue businesses are deemed worthy of a $1 million valuation, because an investor can be given 20% of the business for a $200,000 investment, which are reasonable heuristics for both parties. Bharat advises founders not to haggle too much over this valuation stage — if the business is successful, this initial financial structure is largely irrelevant for the founders.
In subsequent post-revenue investment rounds, operations have more impact on valuation than future revenue projections. Even once there’s revenue and a validated business model, projected future revenues are seldom the basis for valuation. There’s usually a hockey stick projection, or a long list of unverifiable assumptions. It’s more important to investors — and valuers — to examine operations, and specifically whether the business owners have a valid, detailed, and convincing plan to scale up. This kind of operations planning demands great rigor, both for purposes of implementation and for convincing investors.
Often, it’s the quality of storytelling that underpins the valuation. With a detailed operations plan in place, the selling business founder or proprietor can build a persuasive story about future growth and potential. Here, emotion plays a big part. Can the business owner communicate how intensely the need is felt by potential customers? Can he or she communicate the passion they feel to deliver a solution to those customers? And the deep emotional commitment to the years of hard work it will take to attain appropriately ambitious goals?
The story, well-executed, validates the valuation.
For businesses like CPA firms, medical practices, and construction, 2 major factors have an outsize influence on valuations. When an investor buys a mature service business, especially a local one, they are generally seeking hassle-free cash flow. They’re not looking to buy problems to fix.
Two factors stand out for these kinds of buyers. One is reliable recurring revenue from loyal customers. It must be revenues that are fully attributable to the service, and unlikely to be cut when there is a change of ownership.
The second is automation or established smooth-running and self-maintaining operations mechanisms. Bharat’s advice to sellers of these kinds of businesses is to automate everything you can, with reliable control software wherever possible.
These kinds of service businesses may have high levels of reputation and trust based on surveys and qualitative data, but those intangibles must be backed up with the behavioral reliability of the customer base.
In today’s markets, followers are a highly valued asset. In many ways, recurring revenue is a metric to quantify followership. Ryan Reynolds has a followership. Nike has a followership. Tom Cruise has a followership. These followers are all monetizable as buyers of goods or services or movie tickets associated with these personalities and brands. Your personal brand has value if you have followers and if the followership can be monetized.
Every asset can be assigned a valuation — even the State of Hawaii and the Brooklyn Bridge. Bharat has been called upon to give valuations of the Brooklyn Bridge, the Atlanta airport, and the state of Hawaii, among many other famous places or things. Sometimes, the valuation is for insurance purposes, sometimes for accounting. In all cases, there’s a number (or a range).
Once the what and the why are established, there is a mechanism for valuation that can be applied to any asset or stock or flow.
Additional Resources "Pathways To Business Valuation" (PDF): Mises.org/E4B_141_PDF
"How to Double Valuation?" (Video): Mises.org/E4B_141_Video1
"What’s Pre-IPO Worth?" (Video): Mises.org/E4B_141_Video2
Family businesses play a major role in the US economy. According to the Conway Center, family businesses comprise 90% of the business ventures in the US, generate 62% of the employment in the nation, and deliver 64% of US GDP.
And, they’re good at venture capital. Samuele Murtinu, Professor of Law, Economics, and Governance at Utrecht University, visits the Economics For Business podcast to share the findings and insights (see Mises.org/E4B_140_PDF) from his very recent analysis of venture capital databases.
Key Takeaways and Actionable Insights Corporate venture capital is a special animal. There are many types of venture capital. Professor Murtinu focused first on the distinction between traditional or independent venture capital (IVC) and corporate venture capital (CVC). Independent venture capital funds are structured with a general partner in the operational, decision-making role, and investors in the role of limited partner.
Corporate venture capital funds are fully owned and managed by their parent corporation. The CEO or CFO of the corporation typically appoints a corporate venture capital manager, who selects targets, conducts due diligence and so on from a subordinate position in the corporate hierarchy.
The important difference between IVC and CVC lies in objectives and goals. IVC goals are purely financial — the highest capital gain in the shortest possible time. CVC funds often have strategic goals in addition to, or substituting for, financial goals. These strategic goals might include augmenting internal R&D capabilities and performance, and accessing new technologies and new innovations, or entering new markets.
Another form of CVC licenses patented technologies to startups in cases where the corporate firm does not have the capacity to exploit the IP, but can oversee the implementation at the startup with a view to further future investment or acquisition. This is the method of Microsoft’s IP Ventures arm, for example.
Typically, IVC investments are easy to measure against financial performance benchmarks or targets. CVC’s strategic investments are harder to measure. Goals such as technology integration are too non-specific to measure, and normal VC guardrails like specified duration of investments are not typically in place and so can’t be used as benchmarks. On the other hand, CVC investments often expand beyond the financial into strategic support via corporate assets such as brand, sales and distribution channels and systems.
Corporate venture capital out-performs traditional venture capital in overall economic performance. Professor Murtinu’s performance metric in his data analysis was total factor productivity — performance over and above what’s attributable to the additions to capital and labor inputs. IVC’s performance for its investments was measured in the +40% range, and CVC’s was measured at roughly +50%. IVC performs better in the short term, while CVC performs better in the longer term. This difference reflects the lower time preference of CVC. It extends to IPO’s: corporate venture capital funds stay longer in the equity capital of their portfolio companies in comparison to independent venture capital.
Family CVC is another animal again — and even higher performing than non-family CVC. Professor Murtinu separated out family-owned firms (based on a percentage of equity held) with corporate venture capital funds for analysis. Some of his findings include:
They prefer to maintain longer and more stable involvement in the companies in which they invest.They prefer to maintain control over time (as opposed to exiting for financial gain).They look to gains beyond purely financial returns, including technology acquisition / integration into the parent company and/or learning new processes.They are more likely to syndicate with other investors, for purposes of portfolio risk mitigation.They target venture investments that are “close to home” both in geographic terms and in terms of industries closely related to their core business. The resultant outcomes are superior: a higher likelihood of successful exits (IPO or sale to another entity), and a greater long term value effect on the sold company after the IPO or exit. Further, there is evidence from the data of a higher innovation effect for Family CVC holdings, as measured by the post-exit value of the patent portfolio held by the ventures.
Family CVC is resilient in economic downturns. During the last economic downturn, family CVC invested at double the amount of corporate venture capital, reflecting family businesses’ preference for long-term investing and for control.
The lower time preference of family businesses and family CVC is crucial for the achievement of superior financial performance, especially in the longer term. Family CVC’s lower time preference and longer investment time horizons result in beneficial effects. Ownership in the venture companies is more stable, and the value effect after IPO (when family CVC stability continues because these funds stay in the post-IPO company longer) is significant.
Professor Murtinu relates this phenomenon to Austrian economics. The longer time horizon permits a closer relationship between investor and entrepreneur — it develops over time — and their subjective judgment about the future state become more aligned. Frictions and information asymmetries are reduced, and a shared view of the future emerges. This stability can scale up to the industry level and national level when there are more family CVC funds at work. Instead of pursuing unicorns and gazelles, an environment more conducive to duration and resilience is created.
Additional Resources "Types of Venture Capital" (PDF): Mises.org/E4B_140_PDF
"Families In Corporate Venture Capital" by Samuele Murtinu, Mario Daniele Amore, and Valerio Pelucco (PDF): Mises.org/E4B_140_Paper
Although the experts assured us Sweden would experience a disaster and a bloodbath without covid lockdowns, the Nordic nation has fared better than Europe on excess deaths.
Original Article: "Without Lockdowns, Sweden Had Fewer Excess Deaths Than Most of Europe"
This Audio Mises Wire is generously sponsored by Christopher Condon. Narrated by Michael Stack.
Our guest is Jay Bhattacharya, Professor of Medicine and Health Policy at Stanford University. Professor Bhattacharya is also research associate at the National Bureau of Economics Research, a senior fellow at the Stanford Institute for Economic Policy Research, and director of the Stanford Center on the Demography of Health and Aging.
Dr. Bhattacharya gained international prominence during the COVID pandemic for his contributions to determining the infection fatality rate of the virus, and for his criticism on broad coercive lockdown policies and vaccine mandates. Along with colleagues Martin Kulldorff and Sunetra Gupta, he wrote the Great Barrington Declaration of focused protection which has garnered 860,000 signatures to date.
SHOW NOTES Jay Bhattacharya: Twitter and Stanford page
Watch the episode on our YouTube channel
Entrepreneurship is a method, and it’s also a mindset. Fabrice Testa has written a book that brilliantly integrates the two: he calls the integration "Super Entrepreneurship," and his book title is therefore Super Entrepreneurship Decoded (Mises.org/E4B_139_Book). He has the appropriate credentials as a proven super-entrepreneur who has created and nurtured numerous great companies (and successfully sold a couple of them).
Fabrice knows the true meaning of the phrase, “The day before something is a breakthrough, it’s a crazy idea”.
Entrepreneurs are animated by their purpose. Super entrepreneurs embrace a massive transformative purpose. The motivation for entrepreneurs is to help others — to solve problems for others, as we sometimes phrase it. Super entrepreneurs, in Fabrice Testa’s language, are those who choose to dedicate their businesses to solving the biggest problems. By setting big goals, they attract many like-minded partners, collaborators, and employees. By targeting transformation, they aim to change the world in a significant way.
In making this choice, super entrepreneurs are delving deeply into their own personal story to understand their own drivers and their own passionate commitment. There’s a major self-discovery component.
Having set their MTP, super entrepreneurs develop a systematic approach to the pursuit of their goal. Fabrice Testa recommends that super entrepreneurs combine what he calls CRAZY thinking with a relentless sense of purpose. CRAZY is an acronym for elements of entrepreneurship that Testa calls the Five Secrets. We agreed not to give them away, but they add up to a five-step method entrepreneurs can follow, and a checklist that they can use to assess the market power of their own concepts and business models.
The context for the 5-step method is the exponential rate of growth of available and applicable technologies for entrepreneurship, and the convergence of those technologies that results in a compounding of productivity. When, for example, sensor-based data collection can be combined with A.I. and robotics, whole new fields of automation open up, potentially helping billions of people.
A relentless sense of purpose is a major element in the super entrepreneurial mix. Super entrepreneurs are highly motivated. They display high levels of ambition and drive, and they generate strong momentum. They seek change, and aim for breakthroughs. They love to set the bar high.
There is a spirit to super entrepreneurship, an intangible spark of super energy and boldness that sets the best entrepreneurs apart and powers them to unusual levels of achievement.
There’s a plan, but it’s not fixed. Fabrice Testa identifies a master plan for the activities of high-achieving entrepreneurs, but it’s not the restrictive plan of the business school strategist. One term he used was Roadmap: there’s a goal to get from A to B, but it’s OK to visit C, D and E along the way, and to learn and double back and embrace recursive procedures to reach the targeted end-results. The key to success is keeping the goal in mind with flexibility on the route to get there.
Let the customer be the guide. Testa subscribes to the protocol of involving the customer early and often in the process of designing and building a product or service or a company. Entrepreneurs are always working with assumptions, and, at minimum, must validate them with customers.
He introduced us to the “Starbucks method” of customer validation. Park yourself in Starbucks, order a beverage of your choice, then look around for likely-looking people who might be open to a brief conversation about your idea or proposal or even prototype. It’s easy to engage people, they’re willing to help, and you can offer to buy them a coffee to lubricate the relationship. A few hours investment of your time and a few dollars invested in coffee will result in a deep, broad and rich set of reactions and responses and a meaningful feedback loop.
Success is more about fitting in than it is about timing. When writers and historians are trying to analyze the unusual success of a particular business, they often attribute a lot of the cause of the outcome to timing — the product or service or technology came along at just the right time. This is a misinterpretation. The happy correspondence of a new offering with a receptive context is not timing but fitting in.
According to Fabrice, to fit in in a big way is to fit in with the zeitgeist of the era. The dictionary definition of zeitgeist is the general intellectual, moral, and cultural climate of an era. What Fabrice is pointing towards is a heightened ability to sense the movement of the time, and the direction of its flow, and to step into that river at the right point.
Entrepreneurship is everywhere, and can be achieved at multiple scales. Super entrepreneurship is not limited by the scale of resources, but it can certainly be augmented wherever resources are abundant. That’s why we seek to encourage entrepreneurship for individuals, teams, and firms of all size, including the largest corporations. Big companies under-perform at entrepreneurship for two reasons. First, they spawn bureaucracy, which is a form of organization that is counter-entrepreneurial. Second, they have existing businesses to defend and fear the consequences of self-disruption.
The solution is to change the purpose of big corporations so that they can become super-entrepreneurial. The purpose would be to create new businesses with no bureaucracy and separated from the defense mechanisms of existing business units or divisions.
Additional Resources Super-Entrepreneurship Decoded: 5 Secret Keys to Create Breakthrough Businesses that Change the World by Fabrice Testa: Mises.org/E4B_139_Book
"Super Entrepreneurship" (PDF): Mises.org/E4B_139_PDF
Austrian economics is distinctive in its recognition and, indeed, embrace of continuous change: customer preferences change, competitors’ actions change, markets change, technology changes, prices change, business methods change. New knowledge is continuously created and accumulated. And Austrian economics equally recognizes that entrepreneurial businesses must change in response: capital combinations change, supplier and customer relationships change, organization structure changes, business portfolios and value propositions change. Continuous change is required — which is something business has not traditionally been designed for. How do businesses manage continuous change?
In the current digital age, the rate of change in the external business environment is accelerating, largely as a consequence of rapid technological evolution and the ways in which customer behavior and preferences change in response. We plan to cover the issue of continuous change from multiple angles in the coming weeks and months.
This week, Mark McGrath joins us to review a tool for value creation amidst continuous, roiling change. It has been around for a while and so is proven in multiple arenas and situations. It goes by the name of OODA.
Key Takeaways and Actionable Insights The OODA loop is a deeply sourced tool that draws on eastern philosophy, western science, and aligns with Austrian economics. When a firm as a network of individuals, knowledge, ideas, tools, processes and resources works with clients and customers and their systems, all should be better off as a result of their co-ordinated action. The better the capacity to learn and make adjustments together, the better the capability to recognize and seize opportunities, and to act at co-ordinated speed. Those who can handle the rate of change fastest will be the most successful.
The originator of the OODA loop model, John Boyd, synthesized thinking from multiple sources about this problem. In business, we can call it the Adaptive Entrepreneurial Method.
The loop is triggered by uncertainty, or what is referred to in the model as VUCA:
Volatility — circumstances change abruptly and unpredictably;
Uncertainty — knowledge is incomplete and the future is indeterminate;
Complexity — we are individuals in a dynamic interconnected whole with emergent outcomes;
Ambiguity — multiple interpretations from multiple observers, and multiple conclusions.
VUCA enters the OODA loop as unfolding interaction with the ever-changing external environment or market, as information and data coming into the company, and as unfolding circumstances, whether these are the company’s own sales trends and customer relationships or the activities of competitors.
VUCA is the state of the universe. It’s the normal condition that entrepreneurs should assume as the basis for action. It also creates an exciting state of opportunity in which dynamically adaptive entrepreneurial businesses can thrive.
OODA is a feedback loop. OODA stands for observing, orienting, deciding, acting — a continuous process.
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Orientation is critical to successful operation of the model. For a firm or for an individual entrepreneur, orientation is a mélange of inputs: mindset, personality, our way of thinking and interpreting, previous experiences and how we’ve processed them, our ability to process new information, our ability to handle change, our ability to analyze and break things down while simultaneously piecing things together and synthesizing them into an insight or construct that never existed before.
Orientation houses all our biases, and all our cognitive models. It’s how we perceive and how we experience the world. It determines how we process all the information we observe.
Decisions are hypotheses. From our orientation-determined analysis and synthesis of incoming data, we envision a future state: what could happen if we did something? In Misesian terms, we imagine what it would be like in the future if we were able to address our own uneasiness — if we were to change our current state and trade it for another one. Any action that follows must be preceded by a decision, a hypothesis of what we think might happen.
Action is an experiment to test the hypothesis. In applying the OODA loop, entrepreneurs demonstrate a bias for learning and a bias for action. We learn by testing what happens when we act and making new observations of the outcomes of the action. These outcomes will give us new signals to employ in re-orienting to ensure that our decisions and actions are well-aligned with reality.
The OODA loop model is consistent with the Explore and Expand approach to business strategy. At Economics For Business, we have frequently urged entrepreneurial firms to abandon business school strategic thinking and replace it with an Explore-And-Expand approach, running many fast, low-cost exploratory experiments and quickly expanding investment in those that work, discarding others. In OODA loop, experiments are decisions and actions, and re-orientation results in expanding application of the successful ones.
In OODA, we continuously build and re-build our perception of the VUCA world and attempt to match our perception with reality through exploration and expansion. We aim to ensure our orientation is attuned to the way the world is and not to the way we want it to be or imagine it to be.
The more we learn, the more we build and re-build, the faster we can advance. Speed of learning is important, so long as it is based on well-processed information.
Guidance and control. In the OODA loop graphic, there are two areas designated “implicit guidance and control”: our actions and our observations. Our orientation implicitly guides and controls both. Our orientation as entrepreneurs or as economists will always affect how we perceive things. Where some might see an obstacle, others see an opportunity. That’s orientation at work. On the action side, orientation implicitly guides and controls our actions. There are some things we can do automatically, employing heuristics or procedures that we don’t stop to think about. This also is orientation at work — and at speed.
Continuous testing. The OODA loop, processing VUCA information into decisions and action via continuous reorientation, is a test. An entrepreneur is always being tested. As time moves unstoppably forward, new challenges continuously emerge. It’s the ceaseless flux of human affairs, as Mises put it in Human Action.
If we maintain an open and flexible or agile approach or orientation to this continuous testing, we’ll avoid failure.
Focusing on a well-understood purpose will eliminate wasted time and wasted action. The Adaptive Entrepreneurial Model has three major elements: VUCA, the way the world is; OODA, as described above; and IOT. IOT stands for In Order To: the purpose or mission. As we deal with VUCA, and continuously change our orientation as we learn from our decisions and experiments, quickly finding out what works and what doesn’t, we must never lose sight of our purpose and our intent. What are we trying to accomplish?
Everyone in our firm, or on our team, must share the same purpose and be able to articulate it in the same way. When that’s the case, creative and co-ordinating action can move forward without instruction: we don’t have to tell people what to do when they’re in the middle of VUCA so long as they have the same shared purpose in mind. Everyone focuses on what needs to happen and why. There’s never action for action’s sake; it’s always with a shared purpose. If team members do not share the same understanding of purpose, then they’re creating more VUCA. If they do share understanding, the orchestration of their individual efforts produces harmony.
People, ideas, things — in that order. All action is human action, all decisions are human decisions, all teams are human teams. When orientations are aligned, harmonious co-ordinated action is possible. There’s a high priority on relationships — with teammates, colleagues, customers, vendors, partners.
In a business utilizing the OODA model, people always come first because they are the ones who act. Ideas follow, judged through the lens of helping people to decide and act. Things — technology, property, money — are at the third priority level to ensure they support people and enable their ideas.
"A sound understanding in application of these comments will yield geometric results." Improved results are the repayment for the effort expended to study the Adaptive Entrepreneurial Method.
Additional Resources "The Adaptive Entrepreneurial Model — Core Thesis" (PDF): Mises.org/E4B_138_PDF
John Boyd's "OODA Loop Graphic" (PPT): Mises.org/E4B_138_PPT
"The Epistemology of the OODA Loop" (PDF): Mises.org/E4B_138_PDF2
"Destruction And Creation" by John R. Boyd (PDF): Mises.org/E4B_138_Boyd
The Theory Of Dynamic Efficiency by Jesús Huerta De Soto: Mises.org/E4B_138_deSoto
The Ultimate Foundation Of Economic Science by Ludwig von Mises: Mises.org/E4B_138_Mises
Despite all the data we have on lockdowns, hospitalization trends, and newly emerging vaccination data, one can only marvel at how trust in the public health system and ruling elite can persist in any capacity.
Original Article: "The Public Health Officials Say "Trust Us." The Data Says Otherwise."
This Audio Mises Wire is generously sponsored by Christopher Condon. Narrated by Michael Stack.
Entrepreneurs solve problems for customers. There are few problems bigger than the horribly perverse medical care system under which patients suffer in the US. The system has evolved over time, with the stimulus of bad decisions, bad actors, and bad incentives. Entrepreneurship can solve the system problem with specific actions at the component level, each of which are practical and do-able, and can interact to create a new outcome at the system level.
Murray Sabrin has studied both the system and the component solutions, and he joins the Economics For Business podcast to enumerate his proposed actions.
Key Takeaways and Actionable Insights Healthcare is a consumer good, and a consumer responsibility. Medical care is a provider proposition. Consumer sovereignty is a cornerstone concept in Austrian economic theory. Consumers determine what is produced as a result of their buying or not buying. Does this principle apply in healthcare?
To answer requires us to differentiate between healthcare and medical care. Healthcare is an individual choice and a personal responsibility: we do everything we can to maintain a healthy lifestyle of eating and drinking, exercise and sound physical and mental health practices. In the internet age, there is plenty of knowledge available to help us in our decision-making. Medical care is what we turn to when sound healthcare proves to be insufficient to keep us off medication and out of hospital.
How do consumers realize value from medical care providers? To do so is very challenging due to (among other barriers) price fixing, price opacity, price inflation, monopolistic and duopolistic market structures, the misuse of insurance, bureaucratic management, perverse incentives, government intervention, and barriers to entrepreneurial entry.
Are there potential solutions in the face of this systemic dysfunction? Yes: solutions that come from the best countervailing source — entrepreneurship.
Entrepreneurial Solution #1: Direct Primary Care — Restoring the doctor-patient relationship. Murray Sabrin recalled the $5 doctor visit of the past, characterized by a personal relationship with no bureaucracy or insurance forms. Entrepreneurs are now re-establishing that relationship via Direct Primary Care. DPC is retainer fee-based access to unlimited doctor visits, including office-based testing and additional services, with no insurance forms. DPC doctors have fewer patients in their practice and can consequently provide more time and attention. Stronger relationships are built, which is the essence of entrepreneurial value-generation.
Entrepreneurial Solution #2: Transparent versus distorted pricing. Pricing is one of the most important bulwarks of free markets. In medical care, pricing is opaque to the point of invisibility, distorted, and inflated. It is unresponsive to the normal choice-based supply-demand mechanisms, and not indicative of value.
Some entrepreneurs are acting to change these pricing conditions via what is termed fee-for-service: transparent pricing for specific services. An often-cited example is Surgery Center of Oklahoma, where specific prices for specific surgical services are openly posted on their website. Other members of the Free Market Medical Association provide similar price transparency.
One of the results is revelatory price comparison: Murray told the story of a DPC practice patient who identified a 75% price reduction at Surgery Center of Oklahoma compared to a local South Florida hospital.
Entrepreneurial Solution # 3: One stop shopping at local non-profit clinics. Murray described the launch and success of several non-profit local and regional clinics, including one for which he was the founding trustee. These are philanthropically established and funded local clinics with volunteer staff, providing a range of services. Equipment and pharmaceuticals may be fully or partially donated by the manufacturing companies. The combination of direct primary care doctors and specialists can make these clinics one-stop shopping solutions for patients seeking quality medical care. With a little philanthropic assistance, they could eliminate the need for Medicaid.
Entrepreneurial Solution #4: Direct Contracting. Insurance companies purposefully inflate medical care prices to fund their business model. Murray told the story of a large (4-500 employees) company that contracted directly with a service that brought a vehicle with an MRI machine to the employers location, and charged $400 per MRI to the employees. The same vehicle was utilized by a nearby hospital that charged $6,000 for the same MRI. Direct contracting saved $5400 per unit cost, or 90%.
Direct contracting has the potential to significantly reduce costs in the Medical Care system, while opening access and increasing convenience.
Entrepreneurial Solution #5: The 3-tier household medical care budget system. Murray has a well-constructed and eminently practical household medical care budget system. There’s a version for families with at least on member in employment and an alternative for those on Medicare today. There are three elements:
Direct Primary Care for a monthly fee, covering unlimited office visits and routine tests.A Health Savings Account to cover costs of specialists, prescription drugs, medical equipment, major tests and brief hospitalizations.Catastrophic insurance coverage for major operations and hospitalizations and long term care. Greater detail is provided in Murray’s book, Universal Medical Care From Conception To End Of Life.
Download our corresponding PDF, which features an adapted table from Murray’s book: Mises.org/E4B_137_PDF
In a system of personal responsibility, we would all manage our household medical care budgets with these kinds of tools.
Entrepreneurial Solution #6: Voluntarism And Mutualism. Voluntarism has a long tradition in America. Mutual aid societies were prevalent before the New Deal. Ethnic, religious and trade groups joined together for mutual support. The Federal Government co-opted these functions and now people look to Washington DC to solve their problems.
But young people today are more interested in voluntarism and non-political social activism. 30 years ago in the Wall Street Journal, Peter Drucker argued for the non-profit sector to replace the welfare state. Creative and innovative people find ways to surmount institutionally-erected barriers in all phases of life, and medical care is certainly one of those. There’s a liberating and energizing sense of acting as the custodian of one’s own life and helping others who need it. It’s the entrepreneurial ethic.
Entrepreneurial Solution #7: Distributed Knowledge. There is so much available knowledge today about healthy life habits and about the symptoms and characteristics of various medical conditions, and about options for treatment. We as individuals are free to explore, and responsible for gathering our own store of knowledge. The outcome of the research may not be definitive, and we may find ourselves making a choice between alternatives. But doctors and hospital administrators make choices too, and they are not infallible. It may be possible for an individual to gather more knowledge about their own specific condition from the internet than any single doctor can know, simply as a consequence of concentrated effort. Each of us can take responsibility for our own life.
Summing up: Murray Sabrin’s prescription: Eliminate employer-based insurance.Make a single exception for the case in which the employer pays the direct primary care fee for the patient.The resultant employer savings are deposited in employees’ health savings accounts.Employees determine their best medical care options.Phase out Medicare and Medicaid.Let young people create super health savings accounts so that they don’t need Medicare in the future.Hospitals price at realistic market pricing, not insurance-inflated prices.All prices are transparent.Get the government out of medical care — it’s none of their business.Free up resources from the medical-pharmaceutical-insurance complex and redirect them to savings, investment and philanthropy. Additional Resources Read Murray’s book, Universal Medical Care from Conception to End of Life: The Case for A Single-Payer System: Mises.org/E4B_137_Book It’s self-published and all proceeds go to charity and non-profits.
"Individual Single-Payer Alternative For Employer-Based Insurance" (PDF): Mises.org/E4B_137_PDF
Surgery Center Of Oklahoma: surgerycenterok.com
Forward: goforward.com
Direct Primary Care Coalition: dpcare.org
Volunteers in America: vimamerica.org
When asked, "'I’ve recovered from covid, is it absolutely essential that I get vaccinated?' many public health officials have put aside the data and responded with a synchronized 'yes.'"
Original Article: "Why "Natural Immunity" Is a Political Problem for the Regime"
This Audio Mises Wire is generously sponsored by Christopher Condon. Narrated by Michael Stack.
Our guest is Euzebiusz (Zeb) Jamrozik, MD, PhD, a practicing internal medicine physician and fellow in ethics and infectious diseases at the Wellcome Centre for Ethics and Humanities at the University of Oxford. He is head of the Monash-WHO Collaborating Centre for bioethics at the Monash Bioethics Centre. His academic work on infectious disease ethics is focused on vaccines, vector-borne disease, and drug resistance. Dr Jamrozik is lead author of the report of a Wellcome Trust funded project on ethical and regulatory issues related to human challenge studies in endemic settings.
SHOW NOTES Zeb Jamrozik, MD, PhD: Twitter and Webpage
Jamrozik E and Heriot G. “Imagination and remembrance: What rolw should historical epidemiology play in a world bewitched by mathematical modelling of COVID-19 and other epidemics.” (In History and Philosophy of the Life Sciences free text available)
Jamrozik E and Heriot G. “Not in my backyard: COVID-19 vaccine development requires someone to be infected somewhere.” (In The Medical Journal of Australia free text available)
Euzebiusz Jamrozik and Michael Seldeling. Human Challenge Studies in Endemic Settings: Ethical and Regulatory Issues (Springer, 2020, free text available)
Watch the episode on our YouTube channel
Our guests are Thomas Wingert, a patient, Bogdan Enache, an electrophysiologist at Centre Hospitalier Princesse Grace in Monaco, and Saurabh Jha, an Associate Professor of Radiology at the Perelman School of Medicine and the University of Pennsylvania.
SHOW NOTES Point/Counterpoint on Halting the Implantation of Subcutaneous ICD. Editorial by B. Enache and J. Mandrola in JACC Electrophysiology.
Watch the episode on our YouTube channel
On the heels of Biden's vaccine mandate announcement, Dr. Murray Sabrin joins the show to discuss his new book on escaping the state's medical fascism. Universal Medical Care from Conception to End of Life lays out the sobering reality of our unsustainable "health care" system. It explains the ruinous policies which changed doctors from respected guardians of patients to functionaries for government and third party insurance companies—and the unsustainability of our current path. But the book also shows us the way out. The model for market medicine is simple enough: patients pay cash for basic services, have high-deductible catastrophic insurance for emergencies (priced according to actuarial realities), while charitable hospitals and clinics serve the truly poor and indigent.
Heroic entrepreneurial doctors already operate in this cash-only marketplace, and Sabrin's book gives us a road map for delivering better and cheaper medical care to millions of Americans.
Additional Resources Watch the Mises Institute's Medical Freedom Summit held in June: Mises.org/Med21
Order Dr. Sabrin's fascinating new book: Mises.org/SabrinBook
SurgeryCenterOK.com
Governments are seeking to mandate vaccine usage in a variety of ways, even while vaccine producers are shielded from full legal accountability should their treatments cause harm. That should raise some red flags.
Original Article: "WaPo Editors: "Liberty" Requires Us to Implement Vaccine Passports"
This Audio Mises Wire is generously sponsored by Christopher Condon. Narrated by Michael Stack.
Canadian hospitals operate under fixed budgets dictated by the government. When this tax revenue is depleted before the end of the year, as often happens, new patients are put on a waiting list. This problem isn't getting any better.
Original Article: "British Columbia’s Supreme Court Gets an F in Healthcare Economics"
This Audio Mises Wire is generously sponsored by Christopher Condon. Narrated by Michael Stack.
When we think in terms of the foundational law of property, it's clear that broad charges of aggression through infection are spurious at best.
Original Article: "Pandemics, Infection, and Libertarianism"
This Audio Mises Wire is generously sponsored by Christopher Condon. Narrated by Michael Stack.
If every new virus or variation warrants shutdowns or new vaccines, we will face an unending dystopian hellscape of state intervention in our medical decisions.
Original Article: "End the Shutdown, Again"
This Audio Mises Wire is generously sponsored by Christopher Condon. Narrated by Michael Stack.
Canada's "private" long-term care homes are anything but private. But the fact a small sliver of the marketplace is allowed to charge fees for services means activists want even more socialized medicine.
Original Article: "Canada's Wait Times for Healthcare Are Huge. Activists Blame Free Markets."
This Audio Mises Wire is generously sponsored by Christopher Condon. Narrated by Michael Stack.
An Indiana University health officer laments that incentives such as access to events, donuts, french fries, and even hard cash are no longer moving many Americans to fall in line with vaccination.
Original Article: "Sticks, Not Carrots: Vaccines Must Be Forced, Says Indiana University Health Chief"
This Audio Mises Wire is generously sponsored by Christopher Condon. Narrated by Michael Stack.
Download the slides from this lecture at Mises.org/MU21_PPT_29.
Recorded at the Mises Institute in Auburn, Alabama, on July 22, 2021.
Financial journalist John Tamny has written the definitive book on the disastrous political mismanagement of Covid-19—and the resulting (still unfolding) calamities. When Politicians Panicked is a superb analysis of the economic tradeoffs ignored by alarmist Covid policymakers, and a blow by blow account of their bungling in the early months of 2020. But this is also a book about economic growth, employment, markets and prosperity, with well-supported arguments written in Tamny's clear prose. Tamny helps readers See the Unseen, namely that terrible consequences of lockdowns far exceed any danger posed by the virus.
Let's hope the experts he skewers in this book take notice.
Mentioned in this Episode When Politicians Panicked: The New Coronavirus, Expert Opinion, and a Tragic Lapse of Reason by John Tamny: Mises.org/Panicked
JohnTamny.com
Our guest is Ted Okon, a nationally recognized expert on the policy and politics of cancer care. Mr. Okon has testified before Congress on cancer issues and is frequently on Capitol Hill discussing the nation’s cancer care delivery system.
SHOW NOTES Ted Okon: Twitter and Community Oncology Alliance website
Watch the episode on our YouTube channel
"The groupthink that exists among scholars of healthcare, among policymakers, among politicians—even among the public—is alarming."
A new world of medical entrepreneurship is growing. Concierge and cash-only practices, walk-in cash clinics, medical tourism, and cost-sharing plans are just a few of the ways free-market approaches are changing the landscape. Our expert speakers will discuss several of these developments, and more.
Recorded in Salem, New Hampshire, on June 17, 2021.
A new world of medical entrepreneurship is growing. Concierge and cash-only practices, walk-in cash clinics, medical tourism, and cost-sharing plans are just a few of the ways free-market approaches are changing the landscape. Our expert speakers will discuss several of these developments, and more.
Recorded in Salem, New Hampshire, on June 17, 2021.
"Austrian economics is very much the economics of innovation, because we understand change, we understand uncertainty, and we understand that there is a constant search for betterment." A new world of medical entrepreneurship is growing. Concierge and cash-only practices, walk-in cash clinics, medical tourism, and cost-sharing plans are just a few of the ways free-market approaches are changing the landscape. Our expert speakers will discuss several of these developments, and more.
Recorded in Salem, New Hampshire, on June 17, 2021.
"It's the economic science people need to listen to to figure out if there is a rationale for a type of government regulation during this pandemic, and if so, what that looks like. And, I'll tell you what it does not look like: lockdowns or any of the policies we got over the past year."
Recorded in Salem, New Hampshire, on June 17, 2021.
Peter St. Onge explains how government-sector healthcare in Canada is aging, lower-quality, and generally behind the times. After all, in Canada, as everywhere else, you get what you pay for. But when healthcare is controlled by bureaucrats, much of every dollar spent on "healthcare" is really going to pay for something else.
A new world of medical entrepreneurship is growing. Concierge and cash-only practices, walk-in cash clinics, medical tourism, and cost-sharing plans are just a few of the ways free-market approaches are changing the landscape. Our expert speakers will discuss several of these developments, and more.
Recorded in Salem, New Hampshire, on June 17, 2021.
"Primary Care is about access, continuity, and responsibility."
A new world of medical entrepreneurship is growing. Concierge and cash-only practices, walk-in cash clinics, medical tourism, and cost-sharing plans are just a few of the ways free-market approaches are changing the landscape. Our expert speakers will discuss several of these developments, and more.
Recorded in Salem, New Hampshire, on June 17, 2021.
"The cronies and their government pals are increasingly exposed. As the co-founder of the Free Market Medical Association, I am filled with optimism watching the growth and acceptance of market discipline in this industry."
A new world of medical entrepreneurship is growing. Concierge and cash-only practices, walk-in cash clinics, medical tourism, and cost-sharing plans are just a few of the ways free-market approaches are changing the landscape. Our expert speakers will discuss several of these developments, and more.
Recorded in Salem, New Hampshire, on June 17, 2021.
Healthcare is inaccessible in many ways, and it is notoriously inefficient. There is a fundamental misalignment between patients and the system.
A new world of medical entrepreneurship is growing. Concierge and cash-only practices, walk-in cash clinics, medical tourism, and cost-sharing plans are just a few of the ways free-market approaches are changing the landscape. Our expert speakers will discuss several of these developments, and more.
Recorded in Salem, New Hampshire, on June 17, 2021.
Medicine is fundamentally poised for an incredible entrepreneurial breakthrough. The kind of breakthrough that will revolutionize the practice and delivery of medicine and how we think about health.
A new world of medical entrepreneurship is growing. Concierge and cash-only practices, walk-in cash clinics, medical tourism, and cost-sharing plans are just a few of the ways free-market approaches are changing the landscape. Our expert speakers will discuss several of these developments, and more.
Recorded in Salem, New Hampshire, on June 17, 2021.
Our guest is Professor David Heymann, an American physician and epidemiologist based at the London School of Hygiene and Tropical Medicine. He has held leading positions at the WHO for more than 20 years, coordinating global responses to epidemics such as Ebola, AIDS, polio, and SARS. He also served as Chairman of Public Health England from 2009 until 2017. Professor Heymann shares his perspectives on post-pandemic life and on opportunities for the public health sector.
SHOW NOTES David Heymann: Professional page and Wikipedia page
Related Episode: Ep. 140. Gabriela Gomes: Why Herd Immunity May Be At Hand
Related Episode: Ep. 148. Herd Immunity Models and Realities, with David Heymann and Paul Fine
Watch the episode on our YouTube channel
Our guest is Dan Morgan, MD, MS, a physician and epidemiologist in Baltimore, Maryland. He is Associate Professor of Epidemiology and Medicine at the University of Maryland School of Medicine, Chief Hospital Epidemiologist at the Baltimore VAMC, and a fellow at the Center for Disease Dynamics, Economics and Policy (CDDEP). We discuss a recent paper he co-authored about probabilistic diagnostic reasoning among clinicians.
SHOW NOTES Dan Morgan Twitter and Website
Morgan D, et al. Accuracy of practitioners estimate of probability of diagnosis before and after testing. JAMA Internal Medicine. 2021.
Watch the episode on our YouTube channel
Unfortunately, the corporate press and public health officials have determined that unilateral rule by executive decree, unimpeded by any conception of individual freedom, is necessary to respond to the coronavirus.
Original Article: "Who's to Blame for Normalizing One-Man Rule?"
This Audio Mises Wire is generously sponsored by Christopher Condon. Narrated by Michael Stack.
Our guest is Shawn Whatley, a physician in Canada who is the author of the recently released book When Politics Comes Before Patients: Why and How Canadian Medicare Is Failing. Dr. Whatley is past-president of the Ontario Medical Association and is a senior fellow at the MacDonald-Laurier Institute for Public Policy in Toronto.
SHOW NOTES Shawn Whatley, MD. Blog and Twitter
When Politics Comes Before Patients: Why Canadian Medicare Is Failing
No More Lethal Waits: 10 Steps to Transform Canada’s Emergency Departments
Dr. Whatley's previous appearance on the show: Ep. 40 Practicing Medicine in Canada: Promises and Realities
Watch the episode on our YouTube channel
Of course, scientists were never supposed to run our society. The technocrat class cannot possess all of the knowledge necessary to effectively run the lives of 330 million Americans. But that will not stop them from trying.
Original Article: "The Tyranny of the "Enlightened" Experts"
This Audio Mises Wire is generously sponsored by Christopher Condon. Narrated by Michael Stack.
Lockdowns advocates claim fear of the virus is really what kept people home—and has thus led to the economic destruction of the past year. But they also claim that without forced lockdowns, people will quickly go back to normal. Both can't be true.
Original Article: "Lockdowns Are More Economically Devastating Than Voluntary Social Distancing"
This Audio Mises Wire is generously sponsored by Christopher Condon. Narrated by Michael Stack.
Donald Devine is a legend in Washington, DC conservative circles, where he gained fame wrestling civil service bloat as head of Reagan's Office of Personnel Management. His new book The Enduring Tension: Capitalism and the Moral Order starts with Schumpter's creative destruction and asks the tough question: can capitalism alone hold America together? Channeling Hayek, Devine argues that markets are critical but not sufficient. Free and equal individualism requires a mythos and a logos, a moral order rooted in God, morality, law, or tradition—otherwise we devolve into warring factions. Bureaucratic, centralized, and unworkable government perversely encourages these factions as America rejects its federalist structure and Thomist underpinnings. This is a challenging and far-ranging book, and an excellent one for readers concerned with the tension between Locke's liberty and politically engineered license.
Find The Enduring Tension: Capitalism and the Moral Order at Mises.org/DevineBook
While some countries in Europe are showing signs of lifting all restrictions soon, Ireland’s so-called leaders are telling citizens it cannot be guaranteed that they’ll even be able to holiday in their own country this summer.
Original Article: "In Some Countries, Lockdowns May Be the "New Normal"'"
This Audio Mises Wire is generously sponsored by Christopher Condon. Narrated by Michael Stack.
Dr. Accad interviews Dr. Koka regarding his latest article entitled “Correlative Adventures with COVID”
SHOW NOTES Anish Koka: “Correlative Adventures with COVID“
Anish Koka: “In Defense of Small Data“
Anish Koka: “The Price of Progress“
Michel Accad: “The Devolution of Evidence-Based Medicine“
Michel Accad: “Why N-of-1 is Enough“
Watch the episode on our YouTube channel
Our guest is Christopher Snowdon, a freelance journalist with a focus on the intrusion of public health into the daily lives of ordinary people. He is the author of many books, including Velvet Glove; Iron Fist, A History of Anti-smoking, published in 2009, and more recently, Polemics, an anthology of articles on economics, politics, science, and culture. He is also Head of Lifestyle Economics at the Institute for Economic Affairs in London. We discuss his position on lockdowns which has surprised many and put him at odds with other libertarians.
SHOW NOTES Chris Snowdon: Website and Twitter
“The Rise of the Coronavirus Cranks” (article in Quilette)
“The Great Lockdown Debate: Chris Snowdon v. Toby Young” (YouTube on talkRadio channel)
Watch the episode on our YouTube channel
Medical doctor Keith Smith returns to the show to explain how government intervention allows insurance companies to distort health care prices. Rather than merely diagnosing the problem, Smith has formed organizations that are providing affordable care to patients.
Mentioned in the Episode and Other Links of Interest: The YouTube version of this interviewThe Surgery Center of OklahomaThe Free Market Medical Association (FMMA)The Medical Freedom Summit, hosted by Mises Institute, on June 17, 2021 in New HampshireA short YouTube video in which Keith Smith explains $100 hospital aspirin.Bob’s book (co-authored with emergency room doctor Doug McGuff) on the economics of health care, The Primal Prescription For more information, see BobMurphyShow.com. The Bob Murphy Show is also available on Apple Podcasts, Stitcher, Spotify, and via RSS.
Our great friend Daniel Lacalle joins the show from Madrid to discuss the post-Covid economy from the framework of his newest book, Freedom or Equality. Real human cooperation happens via markets and property, not government or central bank edicts. Socially beneficial behavior needs the right incentives—without prices and profits, we have no way to measure merit or benefit.
If leaders are serious about economic recovery after lockdowns, they need to dispense with authoritarian controls and let markets work. Lacalle considers interest rates, inequality, stakeholder theory, global debt, and much more in this powerful discussion of today's economic reality.
Find Freedom or Equality: The Key to Prosperity Through Social Capitalism at Mises.org/DLbook
Ryan McMaken and Tho Bishop discuss five reasons why Rothbard's work is so memorable. From his fearlessness in the face of opposition, to his commitment to peace and decency, Rothbard provides us with a model of principled scholarship.
Additional Resources "Nations by Consent": Mises.org/RR_54_02
Egalitarianism as a Revolt Against Nature, and Other Essays: Mises.org/RR_54_03
"A Strategy for the Right": Mises.org/RR_54_04
A History of Money and Banking in the United States: The Colonial Era to World War II: Mises.org/RR_54_05
An Austrian Perspective on the History of Economic Thought, Volume 1: Economic Thought Before Adam Smith: Mises.org/RR_54_06
Be sure to follow Radio Rothbard at Mises.org/RadioRothbard.
Normally we discuss books on The Human Action Podcast, but this new academic paper by Professor Philipp Bagus is too important to ignore. "COVID-19 and the Political Economy of Mass Hysteria" is the one journal article you need to read this year. In only about ten pages it makes the devastating case that perverse political incentives—along with a nexus of state-connected media and scientists—combine to create and amplify "public health" hysteria. Echoing Hoppe and public choice theory, Bagus explains how politicians enjoy asymmetric rewards for exaggerating risks and creating fear. The result is gross policy errors we will all pay for over many decades. Don't miss this show!
Read Dr. Bagus's paper at Mises.org/BagusPaper And read Jeff Deist's summary of the paper at Mises.org/DeistBagus Find Deep Freeze: Iceland's Economic Collapse online at Mises.org/DeepFreeze Find The Tragedy of the Euro online at Mises.org/TragedyEuro
Our guest is Charlie Deist, author of Hormetics: Physical Fitness for Free People. We have an engaging and somewhat philosophical conversation on principles of health. How do we identify good nutritional and exercise habits? Amongst the myriad of fads, what rules should guide one’s health choices and behaviors?
SHOW NOTES Charlie Deist: Website and Twitter
Hormetics: Physical Fitness for Free People (on Amazon)
Watch the episode on our YouTube channel
Tho Bishop and Zachary Yost join Ryan McMaken to discuss covid politics in three states, and whether anyone is paying any attention to social distancing rules anymore.
Be sure to follow Radio Rothbard at Mises.org/RadioRothbard.
Forcing one person to take medication or vaccines for the benefit of another person is directly opposed to basic notions of self-ownership and human rights.
Original Article: "State-Mandated Vaccines Are a Moral Minefield"
This Audio Mises Wire is generously sponsored by Christopher Condon. Narrated by Michael Stack.
Our guest is Elise Amez-Droz, program manager for the Open Health program at the Mercatus Center at George Mason University, where she also manages the health policy portfolio. Ms. Amez-Droz is a Public Policy Fellow with the Fund for American Studies and a member of the Millennial Cohort of American Enterprise Institute’s Leadership Network.
SHOW NOTES The Mercatus Center website
“Labeling Us ‘Essential’ or ‘Non-Essential’ Makes Us Less Human” (Discourse Magazine)
Related episode: 21. Inside the Swiss Healthcare System (with guest Marc Fouradoulas, MD)
Watch the episode on our YouTube channel
Our guest today is Terence Kealey, Professor Emeritus of clinical biochemistry at the University of Buckingham in the United Kingdom, where he served as Vice Chancellor until 2014. He is also a Research Fellow at the Cato Institute. Professor Kealey trained in medicine at Bart’s Hospital in London and obtained his doctorate at Oxford University following which he pursued a career in clinical biochemistry research, before joining the faculty at Buckingham University.
He is the author of 3 books. The first, published in 1996 and titled The Economic Laws of Scientific Research is a sweeping exploration of the relationship between government and science and argues against public funding of scientific research. The second, Science, Sex, and Profits, published in 2008, continues the same theme and develops the notion that science is not a public good but is organized around what he terms “invisible colleges.” His third book, Breakfast is Your Most Dangerous Meal, was published in 2014 and links government intervention to very unhealthy nutritional advice.
SHOW NOTES Watch the episode on our YouTube channel
Biden’s pick for assistant secretary of health forced nursing homes to accept patients with covid and wants to ration healthcare based on social justice.
Original Article: "Biden Nominee Rachel Levine Was a Disaster in Pennsylvania. Now She's Headed to Washington."
This Audio Mises Wire is generously sponsored by Christopher Condon. Narrated by Michael Stack.
"We find no clear, significant beneficial effect of [lockdowns] on case growth in any country….In none of the 8 countries and in none out of the 16 comparisons [examined] were the effects of [lockdowns] significantly beneficial."
Original Article: "Yet Another Study Shows—Yet Again—That Lockdowns Don't WorK"
This Audio Mises Wire is generously sponsored by Christopher Condon. Narrated by Michael Stack.
Many healthcare professionals have happily embraced the same attitude as cops: "We're experts, don't you dare question us." But the 100,000 yearly medical-error deaths suggest this expertise ought to be questioned more often.
Original Article: "Medical Errors and the Cult of Expertise in the Age of Covid"
This Audio Mises Wire is generously sponsored by Christopher Condon. Narrated by Michael Stack.
Our guest is Professor Stephen Senn, a world renowned statistician whose career has spanned the gamut of activities that involves statistical analysis in medicine, from teaching to research to consultancy. Professor Senn obtained his PhD in Statistics from the University of Dundee and became a Chartered Statistician from the Royal Statistical Society in 1993. He has held professorships at University College London and at the University of Glasgow. He is the author of several books, notably Statistical Issues in Drug Development and Dicing with Death: Chance, Risk, and Health.
SHOW NOTES Stephen Senn, PhD: Twitter and Website
Wood FA, et al. N-of-1 Trial of a Statin, Placebo, or No Treatment to Assess Side-Effects (Open Access in New Engl J Med)
Araujo, A Julious S, Senn S. Understanding variation in sets of N-of-1 trials (Open Access in PLOS One)
Senn S. Statistical pitfalls of personalized medicine (Open Access in Nature)
Senn S. Mastering Variation: Variance components and personalized medicine (Open Access in Stat in Med)
The trouble with China’s new five-year plan is that it attempts to solve problems while leaving their underlying structural causes unaddressed. In this it is not unlike the final Soviet five-year plans of the 1980s.
Original Article: "China's New Five-Year Plan Exposes the Wishful Thinking behind Socialist Regimes".
This Audio Mises Wire is generously sponsored by Christopher Condon. Narrated by Michael Stack.
In 1923 Lenin released a propaganda pamphlet titled Down with the Private Kitchen. It explained how private dinners with one's family are reactionary, bourgeois, and generally something requiring total destruction.
Original Article: "Why Commies Hate Your Thanksgiving Dinner".
This Audio Mises Wire is generously sponsored by Christopher Condon. Narrated by Michael Stack.
Government planners have embraced a materialistic view of human beings which cheapens the importance of family and social events. These "experts" fail to understand what being human really means.
Original Article: "Lockdowns Destroy What Makes Us Human".
This Audio Mises Wire is generously sponsored by Christopher Condon. Narrated by Michael Stack.
If there were a reduction in mortality from these vaccines, that information would be in the first paragraph of the announcement. But it's not there, which suggests the vaccines aren't as effective as claimed.
Original Article: "What the Covid Vaccine Hype Fails to Mention".
This Audio Mises Wire is generously sponsored by Christopher Condon. Narrated by Millian Quinteros.
Presented at the Symposium with Ron Paul on Saturday, 7 November 2020, in Angleton, Texas.
This is the greatest public health fiasco in the history of the world, and the media has distorted it so badly, that much of the general public is celebrating villains and hissing at heroes. And, even — perversely enough — celebrating the destruction of their own lives and their children's lives.
Presented at the Symposium with Ron Paul on Saturday, 7 November 2020, in Angleton, Texas.
Does it matter if we call irreversibly comatose patients “dead?” Our guest is Doyen Nguyen, OP, MD, STD. Dr. Nguyen was previously an academic hemato-pathologist and is currently a Catholic moral theologian and bioethicist. She has authored books and articles both in medicine and in moral theology/bioethics and authored a 600-page monograph that takes a critical look at brain death from a variety of perspectives.
SHOW NOTES Nguyen D. The New Definition of Death for Organ Donation: A Multidisciplinary Analysis from the Perspective of Christian Ethics. (2018, Amazon link)
Nair-Collins, M and Miller, FG. “Do the ‘Brain Dead’ merely appear to be alive? (in J of Med Ethics, open access)
Related Episode: Ep. 35. Why Brain Death Isn't Death: An Introduction to "Shewmon's Challenge" (with Guest Alan Shewmon, MD)
Related Episode: Ep. 45. Brain Death at the Bedside (with guest Fred Rincon, MD)
Related Episode: Ep. 146. Diagnosing Brain Death: Clinical and Legal Quagmire (with guests Alan Shewmon and Doyen Nguyen)
Watch the episode on YouTube
The true cost of covid-19 lockdowns has become so apparent that even WHO officials must now admit these policies lead to mass impoverishment and immense cost in terms of human lives and human health.
This Audio Mises Wire is generously sponsored by Christopher Condon. Narrated by Michael Stack.
Original Article: "Even WHO Officials Now Admit Lockdowns Are Extreme Policies with Disastrous Results".
Because politicians have no liability for the economic damage they inflict, they have no incentive to minimize the disruptions they decree.
This Audio Mises Wire is generously sponsored by Christopher Condon. Narrated by Michael Stack.
Original Article: "Pandemic Follies: Tyranny Won’t Keep Us Safe".
We have had nearly eight months of life and liberty stolen from us by politicians and their hysteria-promoting accomplices in media. How much more will we accept?This Audio Mises Wire is generously sponsored by Christopher Condon. Narrated by Michael Stack.
Original Article: "The Absurdity of Covid 'Cases'".
Covid has exposed how easy it is for government to weaponize healthcare. How long will the doctor-patient relationship remain sacred?
This Audio Mises Wire is generously sponsored by Christopher Condon. Narrated by Michael Stack.
Original Article: "Covid and the Escalation of Medical Tyranny".
Given the overt hostility that progressives have toward private enterprise in the first place, politicians will take shutdown-caused shortages and empty shelves as “proof” that private enterprise has failed.
This Audio Mises Wire is generously sponsored by Christopher Condon. Narrated by Michael Stack.
Original Article: "The Second Act Will Be Worse Than the First: Lockdowns Are Not the Answer".
[From the 2020 Supporters Summit, presented at the historic Jekyll Island Club Resort on Jekyll Island, Georgia, on October 9, 2020.]
Today I’m going to talk to you about what’s been going on in our country for over half a year now, not just in the United States, but around the world. Some of this we all know, but we’ve been getting, let’s say, not the entire story for much of the time and we’ve had to wait to hear additional experts chime in to say, Wait a minute, maybe the first experts were all wrong. It’s been hard to know exactly what to think and what numbers we ought to be looking at when it comes to this covid-19. Should we be looking at cases, should we be looking at percent positive rates, hospitalizations, deaths? All kinds of numbers have been thrown at us, some with context, some without. So, I’m going to spend a little time reviewing this and making a bit of a clarion call to enjoy human life the way it’s meant to be enjoyed. Now since March, we’ve experienced lockdowns and restrictions of various kinds, supposedly all in the name of science, you understand. If you don’t support these things, you must hate science. That’s the intellectual level of the conversation. We were told, We need fifteen days to flatten the curve—fifteen days. I believe we’re on day number 209 of fifteen days to flatten the curve. Remember the old days when the concern was, We don’t want to overwhelm the hospitals? We can’t cure this thing, but at least we could get the hospitals in the condition they need to be in and allow them to be able to cope with reasonable numbers of people, and we would flatten out the number of hospitalizations and deaths over time, so as to allow the hospitals to be able to cope with them rather than have everybody arriving at the hospital all at once.
OK. Then, you start to see on social media all your friends saying the hospitals are overwhelmed. It was like a memo had gone out that the word we were all going to use was “overwhelmed.” Like your friends couldn’t even be creative enough to come up with a different word; they all had the same word: the hospitals are overwhelmed. Because their other friend said the hospitals are overwhelmed, because the other friend said that. What actually happened was that in April alone, 1.4 million jobs in healthcare were lost, because far from being overwhelmed, the hospitals were mostly empty. As a matter of fact, in May, NPR ran a story with this headline about all those field hospitals that they built because of all the overflow that was supposedly going to happen. Headline: “US Field Hospitals Stand Down, Most without Treating Any COVID-19 Patients.”
Hmm, what was going on here? The hospitals were never overwhelmed at any time, with the possible brief exception of New York City. In California, we began to see how the goalposts began to be changed. What they were worried about at the time they were telling us about flattening the curve was thirty thousand hospitalizations. We really have to be careful about hitting that number. The current hospitalization number in California as of this time—we’re in October 2020—is just over three thousand and they’re still so panicked that they won’t open anything. They’ll open a little tiny thing and you have to put your mask on in between bites while you’re eating at a restaurant. So, it’s one-tenth what they feared. There’s state after state after state. Washington, DC, not a state, but nevertheless, Washington, DC, that’s an example of one of many places in the US where the numbers all indicate, have indicated for months, that the state is clearly at the phase justifying reopening. The numbers clearly indicate, from what they said at the beginning—we need to reach such and such—well, they’ve reached it, and now they keep changing it.
Now it’s not hospitalizations anymore, now it’s “cases” and as we’ll talk about, the way that testing is being done even the New York Times had to say Maybe your coronavirus test shouldn’t have been positive. Even the New York Times was reduced to admitting this—that as many as 90 percent of the tests, because the testing is so sensitive, are yielding just viral debris that isn’t infectious at all. But you’ve got to go and isolate yourself for X number of days for no reason. And we’re going to use this number, and we’re going to wait till this number hits zero, which even just given the problem of false positives is impossible. So, you can’t have your life back in some states unless you more or less take it back. That’s what they’ve done to us. Also, in Washington, DC, the public schools have been closed, but they put a cap of eleven students per room on private schools, no matter how big the room is. That basically cripples the private schools, for no reason. There’s no scientific basis for that.
Then it became You can have your life back once there’s a vaccine. What? There might never be a vaccine. As Martin Kulldorff of Harvard Medical School puts it, “The timeline for a vaccine is anywhere between 6 months from now and never.” So, at some point, we have to figure out how to live with this kind of situation. Well then, when it started to look like maybe we might get a vaccine, then the story became Even with a vaccine, you can’t have your life back. And if you object to that, you’re the problem. You’re not listening to the science. Everything that brought people joy was abruptly taken away and every time it looked like it might creep back in, you get another headline about how you can’t have this back, you can’t have that back, this’ll never be the same, maybe we’ll never have sports again, maybe we’ll never do…And it’s almost like they take a perverse delight in this. Well, if ever there were a use of the expression “get bent,” I would say it’s right about now.
Now, of course people will say, Wait a minute, what, do you just want people to die? Again, this is the intellectual level of the conversation. You just want people do die. How do you talk to somebody like that? So, in order to do that, I’m going to appeal to the above midwit-level population and I’m going to remind people of the important lesson in Henry Hazlitt’s great book Economics in One Lesson. This is a book that’s sold millions of copies and Hazlitt’s one lesson, as we all know in this room, is that if you’re going to evaluate an economic policy, it’s not enough to evaluate the short-term consequences for one earmarked group. Any blockhead can do that. If you want to know the long-term consequences or the real consequence of it, you look at the long-term effects on everybody, not the short-term effects on an earmarked group.
For example, suppose the government taxes the public to build a stadium. Well, the midwit will simply point to the stadium and say, “Hey, look at this wonderful thing that the government did. It’s a stadium.” And yes, we can all see with our physical eyes that there’s a stadium there, but they think that’s the entirety of the analysis: a stadium has somehow appeared. There’s no thought of costs, opportunity costs, where the money came from, where it would have gone otherwise—none of that is even considered, because those things can’t be seen with your physical eyes. To understand the fullness of the policy, you have to be able to think and see with your mind’s eye.
Likewise, with rent control people think, You impose rent control and people get lower rents, and that’s the entirety of the analysis as far as they’re concerned. There’s nothing further we need to consider. We just take these fat cats and just force them to lower rents, and then everybody gets lower rent and that’s, as far as the midwit is concerned, that’s the end of the discussion, because that’s what he sees with his physical eyes. But, for people capable of seeing with their mind’s eye, they ask other questions like, How many people are going to start building low-cost rental housing if they know that this ceiling has been imposed? There will obviously be far less housing built, which will make the problem of housing people worse. We also know that at these particular rates, you have a million people and surfeit of demand, so if you’re a landlord, you can be a jerk, you don’t have to fix that leaky pipe, you don’t have to do any maintenance, because if somebody’s upset about it, you got 8 million other people who would be very happy to take that person’s place.
So, in other words, if you see with your mind’s eye, you understand that rent control is a lot more complicated than just Duh, we forced them to lower the rent and it’s low for everybody. And in fact, if, for some reason, you wanted to lower rents through the means of government impositions, you would actually want to do the exact opposite of rent control. You would want to control every single price in the entire economy except rents, because that would make entrepreneurs not want to go into the production of anything other than rental property because everything else would be unprofitable. The one thing they could produce would be rental property, which would lead to a collapse in rental prices, which would be great for everybody. So, literally the opposite of what these people recommend would be the best thing. But the point is, we have to think about all the consequences for everybody.
Well, the same thing goes for public health, because my talk could be called “Public Health in One Lesson.” Because yes, if you simply focus monomaniacally on one virus, you might be able to say, Look at what we did for this one virus. You might be able to say that. I’m not even sure they can say that, but they might be able to say, Look what we’ve done for people with this one virus, and then, being midwits, they leave the discussion right there. They don’t bother to investigate the seventeen other aspects of health that have catastrophically collapsed because of that one thing they did. All they say is, look at what they did in the short run for this targeted group instead of saying, Look at the long-run consequences for everybody. And because they don’t look at that, it’s not even mentioned.
When was the last time Dr. Fauci, who is viewed superstitiously by everybody, even acknowledged that there are collateral damages from lockdowns, even mentioned them? Nothing. And so they’re, therefore, able to turn around and say, You just want people to die. Okay, well, let’s play that game. They want to play it, let’s play it. How about this? We know, for example, coming out of the UK, that there will be more likely to be at least as many, if not more, preventable cancer deaths than covid deaths because of the diversion of resources into covid and the panicking of everybody about it. And so we read Richard Sullivan, professor of cancer and global health at King’s College London, director of its Institute for Cancer Policy, saying “The number of deaths due to the disruption of cancer services is likely to outweigh the number of deaths from the coronavirus itself. The cessation and delay of cancer care will cause considerable avoidable suffering. Cancer screening services have stopped, which means we will miss our chance to catch many cancers when they are treatable and curable, such as cervical, bowel and breast. When we do restart normal service delivery after the lockdown is lifted, the backlog of cases will be a huge challenge to the healthcare system.”
We read on October 6 in the Daily Mail coming out of the UK, that health secretary Matt Hancock says, “Cancer patients may only be guaranteed treatment if COVID-19 stays under control.” How about that? This is the Daily Mail, which is much more honest than the American press. “Almost two and a half million people missed out on cancer screening, referrals or treatment at the height of lockdown—even though the NHS was never overwhelmed.” They had the honesty in the UK to say that. “Experts now fear the number of people dying as a result of delays triggered by the treatment of coronavirus patients could even end up being responsible for as many deaths as the pandemic itself.” Now, we won’t see that kind of effect right away. It’s not like a huge number of cancer patients are going to die immediately in 2020, but it does mean that people who might have lived an extra fifteen to twenty years, may live just another three or four, and we’ll see those numbers in the coming years.
Then we heard a United Nations report in April saying that “economic hardship generated by the radical interruptions of commerce could result in hundreds of thousands of additional child deaths in 2020.” UNICEF later increased that number to 1.2 million child deaths, and at Oxford University Professor Sunetra Gupta has reminded us several times, in recent weeks and months, of the UN’s prediction that as many as 130 million people could be at risk of starvation because of the lockdown, because of the possibility of famine in several dozen places around the world. Now who are the ones who don’t care about human life?
But, that’s not all, because in the United States in Oakland, California, we have Benjamin Miller of the Well Being Trust who tells us, as coauthor of a study on deaths of despair—so that’s drug or alcohol abuse or suicide—that an excess—that is to say, above what would normally occur—of 75,000 deaths will occur as a result of all this. Not to mention the CDC itself estimates that in the United States alone, there will be more than 93,000 excess noncovid deaths this year because of what’s been going on, including over 42,000 from cardiovascular conditions, over 10,000 from diabetes, and 3,600 from cancer. A recent UK study just out found that the risk of death was increased because of lockdowns by 53 percent among seniors with dementia and another 123 percent among seniors with severe mental illness. For four decades, India Nobel Peace laureate Kailash Stayarthi rescued thousands of children from slavery and human trafficking and he fears that that’s going to be reversed. He says the biggest threat is that millions of children may fall back into slavery, trafficking, child labor, child marriage. Well, with millions of families being pushed into poverty, they’re being pressured to do something, to put their children to work to make ends meet. So this is being done.
They’re trying these lockdowns even in the developing world, where people live hand to mouth. When you live hand to mouth, it means that every day you earn enough money to feed yourself for that day, and they’re being told to stay home for weeks and months. I think we see where this is going. Now, the people of Malawi, one of the poorest countries in the world, when they got wind of their government’s lockdown plans, they rose up and said, We’re not abiding by this. There will be no lockdown. And so there wasn’t. We could learn from them.
Even The Atlantic had to admit, “When you ask them to stay home, in many cases, you’re asking them to starve.” In the UK, The Telegraph says, “The absurd demand that developing countries adopt economically disastrous lockdowns is driving untold misery.” How often is that mentioned in the US? Ever? Any of our people ever mention that? No, it’s You want to kill people, because you want to live your life. Or because you don’t want two years of your kids’ lives taken away from them. Because now we’re being told, Maybe you can have your life back in the spring of 2022. Not fifteen days to flatten the curve, probably spring of 2022 you can start getting back all these pleasurable things that make life worth living. Okay. So, it seems to me that the crazies who think that public health should mean a monomaniacal fixation on one virus and then pretending that none of the other stuff is happening should have to answer for this a little bit more.
Now, some of this stuff that I’m talking about now appears in—wait for it—the free e-book I wrote on this subject: Your Facebook Friends Are Wrong about the Lockdown. They’re even wronger than you thought—wrong as wrong can be if you value human life and flourishing. So, in the United States, you can get this free book by just texting the word lockdown to the number 33444, and you’ll like it because it smashes these SOBs completely. Or you can get it at wrongaboutlockdown.com. Yes, I bought that domain, I was so happy to nab that one.
Not to mention that of course over the course of this people’s life savings have been depleted, their livelihoods have been destroyed and things that give their lives meaning and fulfillment abruptly removed. So, we’re supposed to believe that all that matters is just biological existence. And this prompts some interesting philosophical questions. If I could live to be 120 and enjoy robust health for all those years, but the price was we would destroy all the architectural treasures of Europe, we would abolish music altogether, and we would restrict social life to 5 percent of its formal level, would I choose that? Who would? Human happiness is not some optional extra. These things, like close, intimate relationships or so-called large gatherings, like concerts, theater, lectures, church, sporting events, the arts in general—if you think these are merely dispensable adjuncts to human life and flourishing, you have no business being in charge of anything. These are life itself, and as I’ve said in a previous talk, for anybody who performs in front of an audience—and particularly think about your children, dancers, musicians, athletes, magicians, comedians, singers, actors, whatever—they’re basically being told, Maybe you can never have this. Maybe you can never ever do what brings your soul happiness. And yeah, maybe we can’t have these until we have a vaccine, said Dr. Zeke Emanuel. “We may have to give up cherished things for a long time,” he says—things like schooling and income and contact with our friends and extended family for at least eighteen months. Maybe this talk could also be called “Get Bent.”
Well, another terrifying statistic came out recently, showing the grim if entirely predictable effects all this inhuman regimentation has been having on the young, particularly those between 18 and 24. Now, the federal government has a Substance Abuse and Mental Health Services Administration. And they, among other things, look at percentages of people who have considered suicide within the previous twelve months. Now typically, before all these lockdowns occurred, in the 18–25 group, it fluctuates between just under 7 percent and 11 percent of those people have contemplated suicide in the previous 12 months. What we now know is that just in June—not twelve months, just one month—it’s now over 25 percent of them have contemplated suicide in just one month. Now why is that? We’ve taken away everything they love, deprived them of the opportunity to socialize and to experience those irreplaceable moments of youth and demanded they accept this dystopia as the new normal and tell them there’s something wrong with them if they long for normal human life, the kind that is lived by humans. Yeah, that’s selfish, that right there. That’s selfish.
One of my friends has a friend in Melbourne, Australia, which is under a severe lockdown. Here’s what this friend wrote:
It’s been three months since I saw another human face besides [my partner’s].
Seven months since [my partner] and I had a little break together in the form of going and having a coffee down the street.
Over a year since I last sat out in nature. Sitting staring at the wall for two hours, again, unable to move.
Despair
Horrible negative emotions virtually all day.
Awake and tired nights, distress.
I can’t think of anything to look forward to because I don’t know when we will be allowed to do anything.
Just go for a drive, go to the forest.
Just go somewhere together, far from all this.
We are not allowed.
The police could enter our homes at any point and arrest us if we say the “wrong” thing online. That has happened.
This doesn’t feel human.
I don’t smile.
I don’t laugh.
I worked out the other day and I felt nothing, no pain.
Nothing would register as pain.
I couldn’t feel anything.
I feel far away from myself.
Sometimes I forget how long the day has been going for.
Does it matter?
You’re not allowed to leave, even if family members are terminally ill. They could die before we are let out of Melbourne. We got told it isn’t a good enough reason to be let out.
You aren’t allowed more than five kilometers from your house.
You aren’t allowed to buy a takeaway coffee and sit under a tree or on the ground anywhere that isn’t your house.
This isn’t human.
This isn’t human.
This isn’t human.
This isn’t human.
There is no empathy here.
No price is too high.
Suicide is not too great a price to pay.
Self-harm is not too great a price to pay.
Structural brain changes in large portions of the population is not too high a price to pay.
Do you know what prolonged social isolation does to the brain?
We are made to feel it does not matter because all we are, are numbers.
We are not people; we are the masses without a say
Without a time period to look forward to when we can hug again
I am sharing my experience because you should know the truth.
Sincerely,
A faceless number in Melbourne.
And we’re the ones who don’t care about human lives. Screw these bastards.
Over at Stanford, Dr. Jay Bhattacharya put it this way. “To get zero COVID, I don’t know if it’s even technically feasible.” We know that we’re going to have to destroy our society in order to get it. Essentially, it’s so high a cost that it’s not worth it. Oh, we’re just doing it until there’s a vaccine. But, in just half a year of doing it, the consequences have been, to quote Dr. Bhattacharya again, “catastrophic.” Sunetra Gupta, of Oxford, whom I mentioned before, who has been called the world’s preeminent infectious disease epidemiologist, says, “It’s a good thing for young and healthy people to be exposed.” She says, “This is how we have always managed viruses. Why is this so different? If we keep introducing restrictions and lockdowns while we wait for a vaccine, it will be the young that suffer the most, particularly those from more deprived backgrounds. We can’t keep doing this. It would be an injustice.” One Yale professor came back with, “Well, no serious scientist is calling for lockdowns everywhere all the time.” Some of them are, so that’s not even true. Some of them are. But all these other scientists want are just sudden lockdowns here, there, and everywhere, then partial resumptions, then lockdowns, all the while with the arts completely shut down. Oh yeah, that’s a whole lot different. We cannot run a society like this. And without the arts, as Professor Gupta put it, “What are we alive for in the first place?” What kind of a life does this portend? Everything that makes life worth living.
Now, we hear this a lot. If you knew someone who died of it, maybe you’d take this virus seriously. Well, how about this? I’ll take the virus seriously, whatever that means, if you take seriously or even mention even once, the seventeen areas of noncovid life, where your supposedly anticovid strategy has left wreckage everywhere. How about that? Is that a deal? Or how about this one? All the people who have died from covid, all those people had families and we should honor them, respect it. Of course no one’s denying that. But, how about the 1.4 million people who according to the New York Times will die of tuberculosis because of the lockdown, over and above the number of tuberculosis deaths we would have had otherwise? Do those people have families? We don’t have to think about that because they don’t exist, because don’t forget, public health just means the monomaniacal fixation on one virus. Tuberculosis, sorry. Didn’t make the cut. Those people’s families don’t matter; they’re not even going to be mentioned. How about the extra 385,000 malaria deaths, the extra half a million HIV deaths? Do those people have families? Can we not be narcissists for five seconds and consider that maybe other people matter too, not just your friends, but other people and their friends? How about that for a change? A hundred and thirty million people at risk of starvation from the lockdowns and we’re even having this debate anymore?
But Woods, you’ll say, you’ve got to listen to the science. “Listen to the science” has become the rallying cry of the most irrational, anecdote-driven, fact-free believers in voodoo I have encountered in my lifetime.
I had Martin Kulldorff on my podcast, the Tom Woods Show. I actually bought the domain Tomspodcast.com, get there very easily. He is an infectious disease epidemiologist at Harvard Medical School and he told me that it may be that a lot of scientists think lockdowns are the way to go. He said, But I basically talk to infectious disease epidemiologists and among that group, from what I would see, a majority of us are against the lockdowns, have been from the beginning, and we favor a totally different strategy of what we call focused protection of vulnerable groups. But yeah, the infectious disease epidemiologists, he said, we’re not calling for lockdowns.
Huh, isn’t that funny. We don’t really hear from these people very much, do we? By some odd coincidence, we don’t hear from them.
Can you believe the people who shout at you for jogging without a mask or who hurriedly cross the street when they see you so that they can maintain social distance? You don’t get covid by a chance passing on the street. Those people don’t get to lecture you about science. If they themselves were less ignorant of the science, they’d be embarrassed by their irrational behavior.
The “listen to the science” people warned us about opening schools. The results have been fine. Even The Atlantic just ran an article, like within the past twenty-four hours, saying, Hmm, the crazy warnings over the summer seem to have been overblown. Well, there’s an understatement. At the universities, we’ve had so far seventy thousand so-called cases, three hospitalizations and zero deaths.
Then there’s the general craziness. In the county where the city of Gainesville, Florida, is, they established a one-person-per-one-thousand-square-feet rule for private businesses. And at a meeting the county commission chair was asked to justify this. Now, did he justify this on the basis of Well, science tells us that…You already know the answer. This is all voodoo. None of it has to do with science. His answer was, Well we put that in there “because it’s easy math for everybody to do.”
If I were one of these “listen to the science” people, I would be mortified right now. I mean, I feel like I am listening to the actual science—not the voodoo practitioners, but the actual science. Lockdowns aren’t science, by the way. There’s no book that they’re following that tells them lockdowns are the way to go. So, when we get told, Well the reason that lockdowns didn’t work is that you didn’t do it right—this is based on literally nothing.
And I asked, again, Professor Kulldorff about this. He said, there’s essentially no chance of eradicating a virus in this way. What you can do is cause a huge number of ancillary problems that will be worse, but you won’t eradicate it. Now they can get away with that because we just don’t mention those ancillary problems. We shouldn’t even call them ancillary. If I show you charts of different American states or different countries, and we look at cases or deaths or whatever, you will not be able to tell me which ones locked down, when they locked down, how hard they locked down, when they lifted the lockdown, whether they had a mask mandate, when they imposed the mask mandate, and when and if they lifted the mask mandate. You have absolutely no way of knowing that. Now, if these things were as powerful as we’re told, there darn well better be some clear and obvious way of distinguishing one jurisdiction from another, and there is not. Therefore, it is voodoo. And I think the more we use the word “voodoo,” the better.
I have an article linked on a special page I put together that goes through and justifies this and looks and says, Look, obviously the lockdowns do not solve the problem. So, you can find that on my website, TomWoods.com/covid and you’ll find some other very interesting things there as well, but in the interest of time, I’ll refer you to that there. Same with mask mandates. Is it possible that certain types of masks in certain types of situations when worn correctly could have some minor effect? Sure it is. But the religious fervor behind masks, which clearly cannot be justified, because we’re being told if we had worn masks sooner or if we just wear masks for six weeks this will all stop or whatever. Again, go to TomWoods.com/covid, I’ve got the charts up there, for place after place after place after place and on. In each chart, it’s indicated exactly when the mask mandate went into effect, and you ask yourself: If I hadn’t told you where on that chart the mask mandate had gone into effect, would you have been able to tell? Would you have had any idea? So, if they’re that effective, they’re so effective that the director of the CDC says they’re better than a vaccine, you would think we’d be able to see it on the charts. Can’t see it at all, nothing. Oh, it would be worse if we didn’t…Come on. We should see something. Nothing.
There’s a guy on Twitter, Eric Topol, who is one of the big the-world-is-ending apocalyptic people on the virus, and he told us the reason Japan did well is their government shipped masks to the people. Okay. If you needed any more evidence this guy’s a BS artist, there you go. Because number one, yeah, they sent enough masks to last people one day. Secondly, the masks were all the wrong size. It’s the government, after all. They’re all child sized; nobody can fit them. So, everybody in Japan laughed and joked about these masks and nobody wore them, but this know-nothing idiot is on Twitter lecturing us about this. He doesn’t know a thing. Again, look at the charts for the Philippines, the most mask compliant country in the world. Hawaii doesn’t have a neighbor for two thousand miles and they wore masks religiously. Didn’t do a thing, in terms of cases.
What exactly would the graphs have to look like in order for the lockdowners to say, Maybe none of this does any good. What would they have to look like? I think they’d have to look exactly the way they look now. Meanwhile, in the Sunbelt (I live in Florida), the spike there fizzled out on its own, everywhere, despite different policies. We were told, I saw on Twitter, we were going to have half a million deaths, we’re going to have dozens of New Yorks if they don’t lock down. We didn’t lock down; we didn’t come anywhere near that. In Florida, the only thing that happened in some places was that some bars closed, but what really happened was the bars pretended to be restaurants and they kept going and that was it. And I guess the virus was tricked by the bars pretending to be restaurants. What kind of BS is this? California, where they had this massive lockdown, their curve looks exactly like Florida’s.
And a friend told me [that] at his work they’re scared of an applicant from Florida and they said, We got to be careful, they do things differently there. Their curves are the same. Paul Krugman, when Governor DeSantis said he was opening up Florida, Paul Krugman said, “Oh, that’s very unwise. They’re sill having over 100 deaths per day in Florida.” No, they’re not, you ignorant moron. We’re not having a hundred deaths per day. They’re reporting a hundred deaths per day. Now, reporting date is very different from actual date of death. So, for example, I just looked at October 1. October 1, there were I guess 130 deaths reported. Sixty-five of them were in September, fifty-four were in August, another eleven were in July. There are no hundred deaths occurring per day, and with hospitalizations plunging, it’s not like three months from now when we recount today it will turn out to be a hundred. No. So, he doesn’t even know that or maybe he does and he’s just being…I don’t know.
And now we’ve learned from the New York Times, as I mentioned before, that up to 90 percent of these tests that are coming back positive could be in people who are not contagious and therefore are being ordered to isolate for no reason. Because the PCR tests that they’re using are being calibrated in a way that they’re super sensitive in the United States. So, in Europe they’re using about let’s say thirty cycles. In the US, it’s thirty-seven to forty. In Arizona, it’s forty, at forty they’re detecting nothing. That is completely pointless and most of what’s going on in Arizona is at forty. So, in Washington, DC, a fellow named Phil Kerpen from American Commitment asked them, What’s the cycle threshold that you’re using for these tests? And DC Health got back to him. DC Health “does not have information about cycle thresholds.” What kind of a joke is that? So, the tests could be completely meaningless and we haven’t even looked into it.
Now finally (I am going a little bit over and I hope the Mises people will let me do it, but I’ll make it up to you somehow, I promise), an immunologist, like somebody who is an expert on immunology like Dr. Fauci, is not taught how to balance public health concerns. People say, Oh, just listen to the experts, and, You won’t listen to the experts. Well, I feel like I am listening to the experts, but there are some questions that no expert can answer or that some experts aren’t trained to answer. There’s no class that an immunologist takes that teaches, well, if you lock everybody in their houses, there could be other effects of this that…He doesn’t learn anything like that. And here’s how you balance it: well, if you do this, there’ll be this many of that. He doesn’t learn anything like that. So, it’s just, again, it’s rank superstition, like this is some kind of priesthood. It’s rank superstition to think that Dr. Fauci could view this so holistically as to have the overall answer.
We have the answer. What is worth doing and what isn’t? We could all drive our cars at five miles an hour and save a lot of lives. We don’t think that’s worth doing. We don’t wait for Dr. Fauci to tell us what the speed limit should be. We understand the absurdity of that. And here’s what Dr. Bhattacharya said. I love this guy. He’s from Stanford. He is the consummate professional. He’s not like me, gets really worked up, and that makes him all the more effective, because he’s slicing and dicing with his calmly delivered sentences. So, here’s what he said about Dr. Fauci, and it’s about time this crazy priesthood was taken down a peg: “Dr. Fauci’s been involved in infectious disease control for a very long time. He’s a preeminent scientist for a good reason; he’s an expert. But, in early February, March, we sort of put him on a pedestal, to essentially give his knowledge about a whole range of things, some of which were in his control and knowledge set, some of which were not. And I saw him a few months ago where he very humbly said, ‘Look, I’m giving you my expertise as an infectious disease expert on how to manage this disease. I’m not looking at the broader policy context.’”
Exactly my point. Dr. Bhattacharya again: “We think about science as giving us all the answers, but that’s a mistake. What science does is tell us if we do A, we might get B. It’s up to nonscientists to make a decision. Do we want to get B if we know the costs of getting B are C, D and E? Do we really want zero COVID?” Well again, only a blockhead would think that’s a scientific question. That’s a philosophical question. And again, this is where he says, “If you get zero COVID, we know that we’re going to have to destroy our society in order to get it. We’ll have to get rid of all our freedoms, we’ll have to make sure that very few people interact with each other. It’s so high in cost that it’s not worth it. Science can tell us, here’s how you can minimize the probability of getting COVID, but it’s up to nonscientists to decide whether it’s worth it. You can’t put one person on a pedestal and ask him to make that decision for society. I love that I live in a democratic society where those kinds of decisions aren’t up to experts. It’s up to people deciding together through electoral processes what we value.” That’s Bhattacharya.
So, of course, no expert can tell you if the costs are worth the benefits because no expert can know your value scale. So, when people say we need to listen to the experts as they urge us to dismantle everything that makes a society function and brings people joy, they have no idea what they’re talking about. This is a philosophical question, not one that a scientific source would have the standing to answer. Unfortunately, for some people, science is not an ongoing search for the truth and whose findings can help us make good decisions. It’s a kind of priesthood, and whatever scientists tell us about anything, no matter how far removed from their areas of expertise, these people will obey, and the dangers of that should be obvious. Not only do we have a priesthood that isn’t even thinking about tradeoffs or collateral damage from their covid monomania, but we also have tens of millions of devoted followers who will help enforce whatever lunacy the priesthood proposes. And your hopes, dreams, and livelihood will be placed on that alter, of that you can be sure.
Now, what should have been done instead? Well, here I refer you to Drs. Bhattacharya and Kulldorff and Gupta, who have a recent statement explaining that so-called focused protection makes much more sense and is certainly feasible. That is to say, you give young people their lives back. Have the arts be resumed immediately. And again, Dr. Gupta said, why are we even living? What is the point of living? If living is simply having a pulse, I could do that in a windowless room eating cans of navy beans for seventy-five years. Is that a human life? These are the kinds of questions we need to ask ourselves.
Finally, how about Sweden? You’re not supposed to mention Sweden. Now, I could mention Japan; they had one of the highest covid infection rates in the world, the world’s oldest population, yet one of the lowest death rates and they did that with very halfhearted measures and no mass testing. So, there are a million explanations. They had to explain this away. But the key example was Sweden. Now what they used to say to us was, You can’t use the example of Sweden because Sweden has a high death rate. Sweden had five thousand deaths out of a country of 10 million. About two-thirds to three-quarters of those were in long-term care facilities, and they did a horrendous job there and they admit that. But, look at the rest of them. So, that means that they actually have a very small number in the general society. The question of how did people do in nursing homes when they’re completely isolated from society, is now in a way a commentary on how the strategy works for society at large. And now that Sweden’s example is looking really good because their curve looks like this. I mean they basically have no…They’ve resumed normal life. Just look at pictures from Stockholm. It lives right down here. Whereas if you look at Spain, it’s like this and France it’s like this. Sweden is just like that.
So now we don’t mention Sweden and what we say is, Oh, well, the reason Sweden did so well…so now notice it switched. First it was, Sweden, they’re dying everywhere. Now it’s, The reason Sweden did so well…They can’t just stop and say, Maybe I don’t have all the answers. The reason they did so well is people voluntarily complied with these measures and they wouldn’t do that in the US because you’re all a bunch of stupid hicks and whatever. Okay. All you have to do is look at pictures from Stockholm over the summer and you decide if that’s true or not, but the key thing is, they never closed schools for ages 1 to 15; they never closed down businesses and they had no mask mandate. How do you account for this? And you don’t get an answer. You do not get an answer.
It seems to me the only answer, at this point, is the one that was obvious from the beginning. Let people decide how they want to live, what risks they’re willing to take and what life means to them. Governor DeSantis, when he had his press conference, reopening Florida, said, You know, we shouldn’t assume we know what everybody wants, because I know a lot of older folks who when they get visited by their relatives wearing masks, they say, please take off your mask, I want to see your smile. And who are we to say no? Or, You should see your grandchildren only over Zoom forever? Or, You should be isolated in a nursing home forever with no human contact? Or, You can see people through a window if you like. We’re really not going to ultimately say. You decide what’s best for you, because we all take different risks that we’re willing to tolerate.
Martin Kulldorff at Harvard Medical School says, “The experts are afraid to speak out.” You have a lot of blah-blah-blah people who are not entitled to an opinion. He says the experts, the infectious disease epidemiologists, are afraid to speak out. Nice society you’ve given us, hysterics, where the actual experts qualified in this field are afraid to speak out, a society of fear. Nice going. Now, incidentally, my view is there are people who have lost their livelihoods, their lives, things that give them meeting, and all you have to do is speak out. Speak out. Enough is enough. By now, we’ve all gotten the message that you’re selfish if you want to do the kinds of things that once gave your life meaning. For these people, life is about nothing but the avoidance of death and you can’t have anything back until they say so. How did we let this happen? They wouldn’t dare have told us this back when it was fifteen days to flatten the curve. No way. Nope, it’s, You’ve got to have virtual events over Zoom, and no hugs and no weddings and ten people at your father’s funeral, and all these other grotesque demands that we’ve gone along with.
What metrics are they using to tell us when we can have things back? Not the ones they told us at the beginning. We’ve met all those and we still can’t have any back. Well, maybe you can have it in 2021. Fauci says spring of 2022, if everybody gets vaccinated. Okay. So, part of the natural order is that parents make sacrifices for their children, not the other way around. If vulnerable people want to isolate themselves, and I can understand why they would, then they should do that. But, as I am going through middle age it would never occur to me to make those demands of young people, never. Because I would think that was selfish, selfish of me that when I was young I got to experience all these things, all these irreplaceably beautiful moments of youth, but you can’t have them, to keep me safe. No, I’ll stay safe by following precautions and limiting my contacts, but you go out and enjoy the one life you get. That’s what a good and decent human being says. That’s what an unselfish person says.
The CDC is now saying we should go have a virtual Thanksgiving. Nope, not doing that. Not doing that. I’m going to go see people and hug them on Thanksgiving like a human and that is what we should do.
A lot of older people I talk to say, We don’t want out children’s lives ruined. We don’t want our grandchildren’s lives ruined. We don’t want you to do this for us. Enough is enough at this point. The doomers keep having this crazy comic book view of the virus. When Wisconsin’s bars were allowed to open, that was supposed to lead to a million deaths. It didn’t. The Sunbelt spike was supposed to kill everybody. It didn’t. Those spikes were long over; they were brought up and down without lockdowns. South Dakota never closed at all. They’re doing fine. But then they had that Sturgis motorcycle rally and we got told, The Sturgis Motorcycle Rally led to 260,000 cases. It was a superspreader event. Well then Slate, you know Slate, the enemy of mankind, Slate, the website? They ran an article saying, Look, let’s be honest. The Sturgis Motorcycle Rally did not lead to 260,000 cases. You’re only saying that because you want it to have led to 260,000 cases, but this is BS. Now, Slate is not known for standing up for Trump-loving biker dudes. So, the only reason they would run an article like that is that it’s true. The virus does what it will do, regardless of what our priesthood with their white coats and clipboards tries to do.
There’s a sickness out there, all right, but I’m not talking about covid-19. I’m talking about the irrational fact-free response. We should demand our lives back, take our lives back. This is not selfish. It is selfish to be ignoring all the collateral damage that’s being done by this policy. You get one life, you want to live it, that’s normal. What’s selfish and abnormal is the presumption that other people are entitled to your life or to take an arbitrary number of years away from your life. If they want to live as prisoners in their own homes and experience life over Zoom, they can be our guests. The rest of us—I think I can speak for all of us in this room—intend to live. Thank you.
[From the 2020 Supporters Summit, presented at the historic Jekyll Island Club Resort on Jekyll Island, Georgia, on October 9, 2020.]
Our guests are Professors David L. Heymann and Paul Fine from the London School of Hygiene and Tropical Medicine. Professor Heymann is a physician who held leading positions at the WHO for more than 20 years, coordinating global responses to epidemics such as Ebola, AIDS, polio, and SARS. He also served as Chairman of Public Health England from 2009 until 2017. Professor Fine is also a leading academic figure in epidemiology and public health with broad interests in infectious diseases. Professor Heymann and Professor Fine, along with colleague Ken Eames, have co-authored an landmark review paper on the concept of herd immunity.
SHOW NOTES David Heymann: Professional page and Wikipedia page
Paul Fine: Professional page
Paul Fine, Ken Eames, and David Heymann: “Herd Immunity”: A “Rough Guide (Open Access in Clinical Infectious Diseases)
David Heymann: How SARS Was Contained (Opinion in New York Times)
Related Episode: Ep. 140. Gabriela Gomes: Why Herd Immunity May Be At Hand
Watch the episode on YouTube
Our guest is physician and author Sally Satel, MD. Dr. Satel is a resident scholar at the American Enterprise Institute and staff psychiatrist at a local methadone clinic in the Washington DC area. She earned a bachelor’s degree from Cornell University, a master’s degree from the University of Chicago, and an MD degree from Brown University.
She has written widely in academic journals on topics in psychiatry and medicine, and has published articles on cultural aspects of medicine and science in numerous magazines and journals. She has testified before Congress on veterans’ issues, mental health policy, drug courts, and health disparities. She is the author of numerous books including The Health Disparities Myth: Diagnosing the Treatment Gap with co-author Jonathan Klick and, most recently, Brainwashed: The Seductive Appeal of Mindless Neuroscience co-authored with Scott Lilienfeld.
SHOW NOTES Sally Satel, MD: Twitter and Website
“The Hypocritical Oath” (in Persuasion online community)
The Health Disparities Myth: Diagnosing the Treatment Gap (with co-author Jonathan Klick)
Watch the episode on YouTube
The introduction of Obamacare was only the natural evolution of many decades of increasing state control of the healthcare industry.
This Audio Mises Wire is generously sponsored by Christopher Condon. Narrated by Michael Stack.
Original Article: "One Hundred Years of Medical Fascism".
It is sad that the contemporary American university has sunk so low from the heights of medieval Oxford, Cambridge, Paris, and Salamanca. Fortunately, private alternatives are still available.
This Audio Mises Wire is generously sponsored by Christopher Condon. Narrated by Millian Quinteros.
Original Article: "The Collapsing Universities—and What We Can Do about It".
Far from stopping the spread of covid-19, lockdowns, only push deaths into the future. Unless a vaccine is imminent or a 100 percent total lockdown is imposed, lockdown won't cause big reductions in total deaths.
This Audio Mises Wire is generously sponsored by Christopher Condon. Narrated by Millian Quinteros.
Original Article: "It's Far Too Late to Think Lockdowns Can Make Covid-19 Go Away".
Jeff Deist joins David to discuss the latest news of Nashville officials withholding covid numbers from bars and restaurants. What lessons can future generations learn from the stupidity of governments shutting down economies on bogus information? Are mainstream journalists sacrosanct in our culture?
Find more from David Gornoski on A Neighbor's Choice.
Dr. Damian Carabello discusses the depths insurance companies go to make sure they end up on top.
SHOW NOTES Damian Carabello, MD: Twitter
Anish Koka long read on surprise billing
Damian Carabello “Let’s end surprise billing without a Trojan horse” blog on KevinMD about the problems with benchmarking.
Twitter thread on the history of Ingenix
Andy Slavitt’s involvement with health insurance fraud case
Watch the episode on YouTube
We are fortunate to have vaccines as options in many cases. But mandatory vaccination can never be justified. If a vaccine were clearly 100 percent efficacious and 100 percent safe, there would be no need for coercion; people would voluntarily line up to take it.
This Audio Mises Wire is generously sponsored by Christopher Condon. Narrated by Michael Stack.
Original Article: "Mandatory Covid-19 Vaccination Is Unethical and Unscientific".
Extraordinary measures require extraordinary evidence. Have the advocates for lockdowns made their case? The data suggests they have not.
This Audio Mises Wire is generously sponsored by Christopher Condon. Narrated by Michael Stack.
Original Article: "The Evidence Keeps Piling up: Lockdowns Don’t Work".
Dr. John Mandrola returns to the show to discuss why doctoring and politics shouldn’t mix and how he got into hot water on Twitter for holding that unacceptable view.
Dr. Mandrola is an electrophysiologist in Louisville, Kentucky. He is is cardiology editor on Medscape where he writes a regular column and produces a weekly podcast.
SHOW NOTES John Mandrola, MD: Twitter and Website
John Mandrola: “Doctoring and Activism“
Sally Satel: “The Hypocritical Oath“
Mandrola et al: The Case for Being a Medical Conservative (in the American Journal of Medicine)
Watch the episode on YouTube
Dr. Mandrola's previous appearances on the show: Ep. 12 and Ep. 107
American healthcare practitioners already do a relatively poor job of caring for birthing mothers. Haphazard and harmful covid prevention policies show an alarming disregard for their mental and physical well-being.
This Audio Mises Wire is generously sponsored by Christopher Condon. Narrated by Millian Quinteros.
Original Article: "How Unscientific Covid Policies Are Harming Birthing Mothers and Their Newborns"
Our guest is Robert Yeh, Associate Professor of Medicine at Harvard Medical School and Director of the Smith Center for Outcomes Research in Cardiology at the Beth Israel Deaconess Medical Center in Boston. We discuss the challenges of outcomes research and his excellent work to improve the reliability of observational studies.
SHOW NOTES Robert W. Yeh, MD: Twitter and professional web page
Watch the episode on YouTube
Strom JB, et al. Use of Administrative Claims Data to Assess Outcomes and Treatment Effects in Randomized Trials of Transcatheter Aortic Valve Replacement (in Circulation)
Faridi KM, et al. Use of Administrative Claims Data to Estimate Treatment Effects for 30 days versus 12 months of Dual Antiplatelet Therapy After Percutaneous Coronary Intervention (in Circulation)
Konstam M. Real World Data as trial End Points: Off and Running with a Long Way to Go (editorial in Circulation)
Previous Guest Appearance: Ep. 19 Public Reporting: Necessary Evil or Harmful Fake News?
Jeff Deist calls in to comment on the CDC sneaking in under COVID regulations to become America’s new landlord. What are the implications of this takeover? Deist says that they are certainly radical. Deist also offers his insights on the surveillance-like supervision in children’s education, pre-existing conditions in COVID deaths, societal depression under economic shutdowns, Andrew Cuomo’s policies, and more.
Find more from David Gornoski on A Neighbor's Choice.
If we want to understand the numbers behind the need to "flatten the curve," we must look at how government programs like Medicare have reduced hospital capacity in recent decades.
This Audio Mises Wire is generously sponsored by Christopher Condon. Narrated by Millian Quinteros.
Original Article: "How Government Healthcare Has Reduced Access to Hospital Beds"
Key Takeaways And Actionable Insights Dr. Keith Smith, co-founder of The Free Market Medical Association (FMMA.org), is an entrepreneur and free market warrior who is undaunted by the seeming scale of his innovation task: to bring to healthcare the kind of customer experience only entrepreneurial free markets can deliver (see "Pillars of the Free Market Medical Association" (PDF): Mises.org/E4E_81_PDF).
He is laser-focused on the problem to solve.
The aim is to bring buyers and sellers together. As Dr. Smith explains, simply stating that there is a need to bring buyers and sellers together is an indication of dysfunction in the market for healthcare. Buyers and sellers talking directly with each other is what makes a market: willing buyer, willing seller, mutually agreed price.
Buyers are patients who care what healthcare costs. Today, they have sticker shock. Buyers who care about price can be direct-buying individuals, and their proxy buyers, who can include self-funded employer health benefits systems, more and more of which are emerging. Innovations like Health Savings Accounts and high-deductible insurance policies are bringing more direct buying into the market.
Willing sellers should be complete and comprehensive advocates for the patient, across the whole range of their needs, including financial aspects. The targeted customer experience is for patients to feel confident when they visit a doctor that they have an unapologetic advocate. Today, physicians are medical advocates, but to be a more complete advocate, physicians must think and act like entrepreneurs, bearing some risk in serving their patients. Many say, “I don’t want anything to do with the business side or the money side of medicine.” By doing so, they are abandoning their patients to the financial wolves, many of whom are willing to step in and make a living off the patient. It’s not so much willful neglect of the patient’s interests, as simply caving in to a system that has become extremely difficult to navigate.
A problem in healthcare is the dominant presence of intermediaries between the buyer and the seller. Dr. Smith described the wide range of intermediaries, cartels and proxies that get in the way of a direct, transparent and mutually beneficial relationship between buyer and seller. Insurance companies are “money handlers and money changers”, keeping healthcare prices high, so they can offer false discounts and skim off the difference. There are brokers and consultants to employers, whom Dr. Smith calls “self-dealing”, who add a layer of costs. There is Big Pharma, the pharmaceutical industry that largely funds the FDA, making it inevitable that the regulator will protect the pharmaceutical companies and their business model and their pricing.
In the end, the “ultimate culprit” is the Federal Government. None of the financial abuse of the patient would be possible “without Uncle Sam riding shotgun for all of this thievery”.
A solution lies in decentralization, disintermediation and the application of Hayekian knowledge theory. Dr. Smith alluded to F.A. Hayek’s concept of dispersed tacit knowledge in describing the FMMA’s decentralized approach. The Free Market Medical Association establishes local chapters, who follow a small number of “pillars” regarding price and value and mutually beneficial exchange, including equal pricing to all cash buyers of the same service. The chapters are completely free to respond to customer preferences in their own local market. These chapters create new knowledge based on their transactions and experiences in their local market, and can share it with all other chapters.
Austrian principles of decentralization, free exchange without intermediaries, and the recognition of the value-creating dispersed knowledge of patients and entrepreneur-practitioners are Dr. Smith’s starting point.
Additional Resources "Pillars of the Free Market Medical Association" (PDF): Mises.org/E4E_81_PDF
The Free Market Medical Association's annual conference, "Mission Possible: Healthcare Entrepreneurship as the Antidote to the Broken Healthcare System": Mises.org/E4E_81_FMMA
Our guest is Amy Wax, Robert Mundheim Professor of Law at the University of Pennsylvania Law School. Before attending law school she obtained her undergraduate degree from Yale University in biophysics and biochemistry, graduating summa cum laude. She then attended Harvard Medical School and trained as a neurologist at New York Hospital-Cornell Medical Center before completing her law degree at Columbia University. She is the author of Race, Wrongs, and Remedies: Group Justice in the 21st Century. In 2017, she was the target of academic backlash after co-authoring an opinion piece in the Philadelphia Inquirer on the societal benefits of “bourgeois values.”
SHOW NOTES Amy Wax: Faculty page and Wikipedia entry
Watch the episode on YouTube
Our guest is Gabriela Gomes, Professor of Mathematics at the University of Strathclyde. She specializes in population dynamics and the modeling of herd immunity and her recent work suggests covid-19 herd immunity may be at hand. We discuss how herd immunity thresholds are estimated and why she thinks classic models are flawed and must incorporate a measure of variation in individual susceptibility.
SHOW NOTES Gabriela Gomes, PhD: Twitter and website
Gomes et al. (May 2020 paper), "Individual Variation in Susceptibility or Exposure to SARS-CoV-2 Lowers the Herd Immunity Threshold" in MedRxiv
Aguas et al. (July 2020 paper), "Herd Immunity Thresholds for SARS-CoV-2 Estimated from Unfolding Epidemics" in Medrxiv
Britton et al., "A Mathematical Model Reveals the Influence of Population Heterogeneity on Herd Immunity to SARS-CoV-2" in Science (open access)
Kevin Hartnett, "The Tricky Math of COVID-19 Herd Immunity" in Quanta Magazine
Fine et al., "'Herd Immunity': A Rough Guide" in Clinical Infectious Disease (open access)
Watch the episode on YouTube
Pennsylvania is telling hospitals to distribute covid-19 drugs based on race. Those from "disadvantaged communities" get the drugs first.
This Audio Mises Wire is generously sponsored by Christopher Condon. Narrated by Millian Quinteros.
Original Article: "Pennsylvania Is Playing Politics with Drug Rationing".
A recent article authored by Dr. Norman Wang on the history and current state of affirmative action programs in medical schools and cardiology departments has led to a storm of controversy and to Dr. Wang’s demotion as fellowship program director. To discuss that article and the controversies we are joined by Dr. Martha Gulati, division Chief of Cardiology at the University of Arizona. She is also the best-selling author of Saving Women’s Hearts and editor-in-chief of ACC’s CardioSmart.
SHOW NOTES Martha Gulati: Twitter and Website
The now retracted Wang paper
Journal of the AHA comment on retraction
Regents of Univ. of California v. Bakke, SCOTUS decision
Watch the episode on YouTube
Marion Mass is a pediatrician in the Philadelphia area where she has practiced in hospital, Emergency Room, delivery room, outpatient, and urgent care settings. She graduated from Duke University Medical School and trained in Pediatrics at Northwestern Memorial Hospital in Chicago. She has been writing about life inside medicine, published in the WSJ, Washington Times, and the Philly Inquirer. She is also co-founder of Practicing Physicians for America, a physician lead organization that advances the interests of practicing physicians. She has written extensively on the role of third party intermediaries in medicine.
Dr. Rupali Chadha is a Board Certified Psychiatric Physician who diagnoses and treats mental illness. She is also Board Certified Psychiatric Physician in the specialty area of forensics. She serves the LA Superior Courts in identifying inmates who are incompetent to stand trial and has also served as a forensic expert in criminal trials. She recently traveled to Washington DC to visit the White House and witness signing of a recent Presidential Executive Order on intermediaries in healthcare.
SHOW NOTES White House Executive Order
Overview of third parties that suck up most of the health-care dollars
The rebates that may fuel higher drug prices
John Arnold in statnews discusses the role of Pharmacy benefit managers (PBM)
A detailed look at Group Purchasing Organizations and PBMs
Needle stick story referenced in the podcast
Watch the episode on YouTube
Anish Koka and Michel Accad discuss lockdowns in light of the experience of the last few months.
SHOW NOTES Michel Accad: It’s Not About Trade-OffsWatch the episode on YouTube
What’s going on in the gold market? Is cryptocurrency the way forward? How can we map out our economic future in light of the GDP drop and unemployment? Jeff Deist calls in to A Neighbor's Choice and discusses Biden’s call for mask mandates, moving on from the lockdowns, and how to realistically deal with the virus.
Find more from David Gornoski on A Neighbor's Choice.
The "experts" intend to keep locking populations down again and again until there's a vaccine. But what if there's no vaccine coming?
This Audio Mises Wire is generously sponsored by Christopher Condon. Narrated by Millian Quinteros.
Original Article: "The Media Said Europe "Beat Back" Covid. But Now Lockdowns Loom Again".
Joshua Gottlieb is an economist who co-authored a recent paper examining the effect of government policy and physician income. The paper was recently presented at a conference co-sponsored by the NBER and NIA and its pre-publication has generated significant controversy among doctors.
SHOW NOTES Joshua Gottlieb, PhD: Twitter and WebsitePaper: Who Values Human Capitalists’ Human Capital? Healthcare Spending and Physician Earnings Watch this episode on YouTube
A survey of the research shows that the science of mask wearing is hardly "settled." And this up-in-the-air nature of it all is a reminder of how immoral it is to impose mandates on people, backed with state violence.
This Audio Mises Wire is generously sponsored by Christopher Condon. Narrated by Millian Quinteros.
Original Article: "When It Comes to Masks, There Is No 'Settled Science'".
Manny Sethi is a trauma surgeon running to be the next senator from the state of Tennessee. He is the son of immigrants, and an unabashed conservative who discusses his journey from medicine to politics, as well as his views on healthcare.
SHOW NOTES Manny Sethi: Twitter and BioWatch this episode on YouTube
Reopening schools in the midst of a pandemic is a controversial topic. FREOPP, a non-partisan think tank founded by Avik Roy recently released a plan for reopening schools. We discuss some of the data from around the globe, as well as practical considerations related to opening schools.
SHOW NOTES FREOPP: Reopening America’s Schools and Colleges During COVID-19Iceland Study (NEJM)Dutch National Institute StudySupreme Court Decision on school fundingWatch this episode on YouTube
Every major scientific advance challenged the “settled science” of its day and was often denounced as pernicious and false, even dangerous.
This Audio Mises Wire is generously sponsored by Christopher Condon. Narrated by Millian Quinteros.
Original Article: "The COVID-19 Panic Shows Us Why Science Needs Skeptics".
Dr. Leamer is a Professor of Economics and Statistics at UCLA who comes on the show to discuss the recent arrival of econometric analyses in medicine. He is a longstanding skeptic of the robustness of conclusions derived from econometrics and has some advice for clinicians puzzling over what to do with these analyses.
SHOW NOTES Ed Leamer warns of the science of econometrics in 1983The Credibility Revolution in Empirical Economics: How Better Research Design is Taking the Con out of Econometrics – Angrist and Pischke argue in 2010 that new econometric tools : pseudorandomization, instrumental variables, and natural experiments mark a credibility revolution for the fieldTantalus on the Road to Asymptopia- Ed Leamer responds to Angrist/PischkeWatch this episode on YouTube
"Public health crisis" is essentially a left-wing stock phrase at this point, as is reflected by the fact that the solutions proffered to the social ills in question are virtually always some sort of government regulation or income redistribution scheme.
This Audio Mises Wire is generously sponsored by Christopher Condon. Narrated by Millian Quinteros.
Original Article: "How the Left Uses "Public Health Crises" to Get What It Wants".
Download the slides from this lecture at Mises.org/MU20_PPT_28.
Recorded at the Mises Institute in Auburn, Alabama, on July 16, 2020.
Our guest is Rohin Francis, MD. Dr. Francis is a Cardiologist in London, who also hosts a popular YouTube channel. He recently discussed what COVID may tell us about racism in science and medicine, and comes on the show for a wide ranging discussion on racism in medicine, COVID in Britain, and how minority groups have fared in Britain.
SHOW NOTES Watch Rohin’s video on Racism in Science and MedicineWatch the episode on YouTube
Pointing to a recent Twitter thread from a progressive detailing his white male cisness, Bob shows how narrow the focus is on only particular "privileges" and not others. More generally, the effort to demonize white men is causing young people great harm, whether white or otherwise. The movement is based on power politics and relies on economic ignorance.
Mentioned in the Episode and Other Links of Interest: Nathan Tankus’ twitter thread on his privileges.News story on US national women’s soccer team losing to U15 boys.Bob Murphy Show episodes covering the economics of slavery: 71 with Mark Thornton and 81 with Jeffrey Rogers Hummel.Walter Block’s paper on reparations for slavery.Help support the Bob Murphy Show. For more information, see BobMurphyShow.com. The Bob Murphy Show is also available on iTunes, Stitcher, Spotify, and via RSS.
The government's plan for "contact tracing" to prevent the spread of COVID-19 relies on huge amounts of government spending, plus unproven science as to the nature of the disease.
This Audio Mises Wire is generously sponsored by Christopher Condon. Narrated by Millian Quinteros.
Original Article: "The Problem with Government 'Contact Tracing'".
Did the hardliners win at Versailles because the Americans were too weak with the flu to object? If so, it would be just one way that disease profoundly affected public policy in the wake of the 1918 flu.
This Audio Mises Wire is generously sponsored by Christopher Condon. Narrated by Millian Quinteros.
Original Article: "1918: A Study in How Disease Can Shape Public Policy".
Marilyn Singleton, MD, JD joins the Accad and Koka Report.
Dr. Singleton comes from a long line of American physicians. She shares with us her fascinating family history and her insights into the rich history of Black physicians in America. We also discuss the deleterious effects of race victimization manifest today.
In the wake of the murder of George Floyd, Dr. David Howard comes on the show to discuss his experiences in America, and more broadly racism in America.
Dr. David Howard was originally born in Jamaica and immigrated to the U.S. at the age of eighteen. He received his Bachelor of Arts in Psychology from the Johns Hopkins University and then pursued his Md and PhD in Epidemiology through the Medical Scientist Training Program at the Johns Hopkins School of Medicine. He completed an internship at the New York Presbyterian Hospital followed by a residency in Obstetrics and Gynecology at the University of Missouri-Kansas City. He also completed a post-doctoral fellowship in Epidemiology at the University of North Carolina Chapel Hill. He is currently a Board Certified Obstetrics/Gynecology Specialist practicing in Las Vegas, Nevada, and is affiliated with several different hospitals in the area.
Our guests Mary Davenport and George Delgado have developed a treatment protocol that can reverse the effects of the abortifacient mifepristone and be given to women who change their mind after a medical abortion. They tell us the story of their pioneering work and of the international network of physicians that is now in place to provide the therapy. We discuss the challenges that remain when the medical establishment is ideologically resistant to supporting women in their second choice.
Links: Abortion Pill Rescue websiteDelgado, G, et. al. A Case Series Detailing the Successful Reversal of Mefiprestone Using Progesterone (In Issues in Law and Medicine)Creinin, M, et al. Mifepristone Antagonization with Progesterone to Prevent Medical Abortion: A Randomized Clinical Trial (free access in Obstetrics and Gynecology)Graham, R. A New Front in the War Over Reproductive Rights: “Abortion-Pill Reversal” (in The New York Times)Grossman D and White K. Abortion “Reversal”: Legislating Without Evidence (in New England Journal of Medicine)
The medical profession has long employed the state to pad doctor salaries and influence. Before the Flexner Report, mechanics made more than doctors and the brightest students avoided the profession to enter the clergy.
Narrated by Daniella Bassi.
Original Article: "The Flexner Report and Our Modern Medical Cartel".
Dr. Rao is an interventional cardiologist and researcher who has been at Duke University for over 10 years. He also works in the Veteran’s hospital in Durhum, is a leader in the cardiology social media community with 16k followers on Twitter, and is also editor-in-chief of the journal Circulation Interventions. In this podcast he discusses his perspective on the recent retractions of papers involved in the Surgisphere scandal.
Links Article from the-scientist on Lancet/NEJM retractions
Our guest is Neurosurgeon Chengyuan Wu. Dr. Wu specializes in functional neurosurgery, a field that focuses on using brain surgery to restore function to patients. He discusses Elon Musk’s initiative to create a new brain-human interface using implants in the brain that communicate with the environment.
In a free country, doctors would be free to prescribe whatever drugs they wish to anyone for any reason. In fact, individuals should be free to buy drugs without a special government-required doctor's note.
This Audio Mises Wire is generously sponsored by Christopher Condon. Narrated by Millian Quinteros.
Original Article: "The Hydroxychloroquine Controversy Is a Reminder That Prescription Laws Are a Government Racket"
What does it mean to promote a politically conservative vision for health care? Our guest is Dr. Leo Valentin, a radiologist running as a Republican candidate for US Congress in Florida’s District 7.
Americans were once harangued by government "experts" about the need to slow down on highways in order to save lives. Few listened. Today, laws demanding everyone "stay at home" may suffer a similar fate.
This Audio Mises Wire is generously sponsored by Christopher Condon. Narrated by Millian Quinteros.
Original Article: "What the Failed 55-MPH Speed Limit Law Tells Us about COVID Lockdowns"
Extraordinary claims require extraordinary evidence. The prolockdown crowd has been making extraordinary claims. Meanwhile, they have produced little evidence to support their claims.
Narrated by Daniella Bassi.
Original Article: "The CDC Slashed the COVID-19 Fatality Rate to a Fraction of Earlier Estimate Used to Justify Lockdowns"
The state currently enjoys a vastly unbalanced share of the power within a society, such an arrangement is not in any way preordained, and the assumption that it must be betrays a narrowness of vision and a lack of historical knowledge.
This Audio Mises Wire is generously sponsored by Christopher Condon. Narrated by Millian Quinteros.
Original Article: "The Fed Is Doing "Whatever It Takes" to Prop Up the Economy. That's a Very Bad Thing."
The 1958 pandemic killed twice as many people as COVID-19 has so far. Yet, the economy in 2020 has collapsed far worse than either in 1958 or the far worse pandemic of 1918.
Narrated by Daniella Bassi.
Original Article: "Why Didn't the 1958 and 1918 Pandemics Destroy the Economy? Hint: It's the Lockdowns"
Most of the world's regimes enthusiastically destroyed their economies and consigned millions to destitution (and a rising tide of resulting health problems) in pursuit of a trendy and unproven theory. There's still not evidence that the lockdowns worked.
This Audio Mises Wire is generously sponsored by Christopher Condon. Narrated by Millian Quinteros.
Original Article: "Do Lockdowns Work? Mounting Evidence Says No"
Our guest is Eric Weinhandl, an epidemiologist whose investigation of a JAMA paper on dialysis patients lead to its retraction—and subsequent republication.
Eric discusses the steps leading to the paper’s eventual retraction, and what this signals about the larger research enterprise. Eric also discusses the role of bias, conflicts of interest, big data and home dialysis, as well as some thoughts on the field of epidemiology during the COVID pandemic.
Eric Weinhandl is an epidemiologist with fourteen years of research experience in kidney disease, mostly regarding dialysis and pharmaceuticals. Eric worked at the United States Renal Data System (USRDS) Coordinating Center between 2004 and 2015 and has conducted studies with Amgen, Baxter, DaVita, NxStage, Sigma Tau, and the Peer Kidney Care Initiative.
He recently worked for Fresenius Medical Care, one of the major dialysis companies in the United States, and currently works with the chronic disease research group as part of the Hennepin County Medical Center.
With their bizarre and extreme lockdowns, governments are forcing very low-risk populations to endure social isolation and unemployment. The mental health effects will be significant.
This Audio Mises Wire is generously sponsored by Christopher Condon. Narrated by Millian Quinteros.
Original Article: "State Lockdowns Are Creating a Mental Health Disaster"
Presenting "saving lives" as a more or less equal alternative to commerce and community is a misguided view of what the lockdown debate is really all about.
This Audio Mises Wire is generously sponsored by Christopher Condon. Narrated by Millian Quinteros.
Original Article: "Viruses versus Lockdowns: It's Not about Tradeoffs"
Our guest is Gregg Gonsalves, Assistant Professor of Epidemiology at Yale University Medical School as well as Associate (Adjunct) Professor of Law and Research Scholar in Law at Yale Law School. His research focuses on the use of quantitative models for improving the response to epidemic diseases and he will help us understand better what a strategy of testing and contract tracing might look like, and what the challenges ahead are.
Our guest is Adam Rodman, host of the podcast Bedside Rounds, a great show on the history of medicine. With his deep knowledge of the vagaries of medical thought, Dr. Rodman sheds light on the COVID-related challenges that clinicians are now confronting.
While the Left has agitated for more government spying and harsher "lockdowns," Brazil's president—perhaps fearing economic implosion—has been reluctant to crack down. Narrated by Daniella Bassi.
Original Article: "Why Does Brazil’s Bolsonaro Refuse To Lock Down His Country's Economy?"
Our guest is Andrew Althouse, statistician at the Center for Clinical Trials and Data coordination in Pittsburgh. He holds an undergraduate degree in Statistics and a PhD in Epidemiology from the University of Pittsburgh. His main area of interest is the design of randomized control trials. He discusses adaptive randomized control trials, and dissects the recent news of the positive Remdesivir trial.
Mark Thornton delivered this talk via Zoom to the Auburn Rotary Club on Wednesday, May 6, 2020.
Proponents of mandatory vaccines and enhanced surveillance are trying to blackmail the American people by arguing that the lockdown cannot end unless we create a healthcare surveillance state and make vaccination mandatory.
This Audio Mises Wire is generously sponsored by Christopher Condon. Narrated by Millian Quinteros.
Original Article: "Next in Coronavirus Tyranny: Forced Vaccinations and "Digital Certificates""
Thirty million Americans are now unemployed, in part thanks to government "lockdowns." Meanwhile, unemployment in many cases doubles the unemployed person's risk of death through disease, suicide, or drug overdose.
This Audio Mises Wire is generously sponsored by Christopher Condon. Narrated by Millian Quinteros.
Original Article: "Unemployment Kills: The Longer Lockdowns Last, the Worse It Will Get"
Our guest is Dorit Reiss, Professor at UC Hastings College of the Law in San Francisco, California. She holds an undergraduate degree in Law and Political Science from the Faculty of Law at Hebrew University in Jerusalem and a PhD in Jurisprudence and Social Policy from the University of California, Berkeley. She is a legal authority on the question of vaccines and vaccine mandates. She has published numerous articles on this topic in a variety of law review journals and her expertise is recognized around the world.
Many argue that unregulated markets would fail due to lack of consumer knowledge, or information asymmetry. But competition in free markets actually gives rise to all kinds of mechanisms that help consumers make informed decisions. This is as true of medical tests for any other good.
This Audio Mises Wire is generously sponsored by Christopher Condon. Narrated by Millian Quinteros.
Original Article: "Testing Deregulation Can Help Fight COVID-19"
Our guests are Dr. Swapnil Hiremath for the University of Ottawa and Saurabh Jha from the University of Pennsylvania. We discuss the controversies surrounding the COVID-related opinions and research findings of John. P.A. Ioannidis, the notorious Stanford data scientist and physician.
The shortages and lack of flexibility caused by government red tape during the COVID-19 crisis has forced many governments to rethink their many arbitrary and unnecessary regulations. This Audio Mises Wire is generously sponsored by Christopher Condon. Narrated by Millian Quinteros.
Original Article: "The Crisis Has Exposed the Damage Done by Government Regulations"
Our guest is Dr. Anupam Singh, Assistant Professor of Medicine at Santosh Medical College and Hospital, one of the designated COVID hospitals in Ghaziabad, Utter Pradesh, India. He returns to the show for a great conversation about the surprising aspects of the pandemic in the Indian subcontinent.
Regardless of government actions, many consumers, workers, and producers may seek changes that reduce exposure to disease in the workplace. The best way to do this is through markets.
This Audio Mises Wire is generously sponsored by Christopher Condon. Narrated by Millian Quinteros.
Original Article: "How Markets Price a Pandemic—and How They Lower Risk"
Should we wait for COVID testing benchmarks to be met before we can reopen the economy? What if testing remains imperfect and uncertainty remains high? Our guest is Avik Roy, head of the Foundation for Research on Equal Opportunity. He returns to the show to discuss FREOPP’s plan to bring people back to work.
Readers of a certain age may remember the hysteria that surrounded AIDS for a period of the 1980s. Anthony Fauci was a central player in that, too.
This Audio Mises Wire is generously sponsored by Christopher Condon. Narrated by Millian Quinteros.
Original Article: "Anthony Fauci: When Politics Trumps Science"
Although it may seem as if landlord simply collect money from tenants without working, nothing could be further from the truth. Landlords invest their stored labor—savings—at a risk and with the knowledge that they won't recoup their money for some time. In the creating or renovating rental properties, they aid those who can't store their labor yet—tenants and laborers.
This Audio Mises Wire is generously sponsored by Christopher Condon. Narrated by Millian Quinteros.
Original Article: "In Defense of Landlords"
Governments are set to make mask-wearing mandatory in many places. Yet, some companies are committed to limiting supply and charging monopoly prices thanks to government-created patents.
This Audio Mises Wire is generously sponsored by Christopher Condon. Narrated by Millian Quinteros.
Original Article: "If Face Masks Are Mandatory, Then It’s Time to End Mask Patents"
Collecting government data on the total number of cases of COVID-19 has always been a mess. The number is likely far higher than the "official" numbers, and this means government proclamations about fatality rates are little more than bad guesses.This Audio Mises Wire is generously sponsored by Christopher Condon. Narrated by Millian Quinteros.
Original Article: "The Experts Have No Idea How Many COVID-19 Cases There Are"
Bureaucrats cannot conjure wealth from nothing. They only have what they extract from the private sector. Unfortunately, the bureaucrats are now starving the private sector of funding while making government budgets ever larger.
This Audio Mises Wire is generously sponsored by Christopher Condon. Narrated by Millian Quinteros.
Original Article: "Bureaucrats Can't Fix This"
Many left-wing pundits and politicians are claiming that the Centers for Disease Control budget was "gutted" in recent years. But the CDC's budget is now higher than it was in the final years of the Obama administration.
This Audio Mises Wire is generously sponsored by Christopher Condon. Narrated by Millian Quinteros.
Original Article: "The CDC's Budget Is Larger Now Than Under Obama"
The Italians could learn some lessons about healthcare from the South Koreans, who still maintain a robust private market in health insurance. Although the Koreans have relatively ample resources for COVID-19 patients, Italy's state-dominated system is quickly running out of options.
This Audio Mises Wire is generously sponsored by Christopher Condon. Narrated by Millian Quinteros.
Original Article: "Markets vs. Socialism: Why South Korean Healthcare Is Outperforming Italy with COVID-19"
Many Americans could die in the coming weeks and months thanks to the FDA’s blockade on coronavirus testing. Should we consider those victims as martyrs for the principle of bureaucratic supremacy?
This Audio Mises Wire is generously sponsored by Christopher Condon. Narrated by Millian Quinteros.
Original Article: "It's Time to Track the FDA's Death Toll"
Our guest is economist Ryan McMaken, senior editor at the Mises Institute. He was the economist for the Colorado Division of Housing from 2009 to 2014. He is also the author of Commie Cowboys: The Bourgeoisie and the Nation-State in the Western Genre — a book that reveals his aptitude for analyzing economic events in their broader cultural context.
Additional Reading Thanks to Lockdowns, State and Local Tax revenues Are PlummetingThe Fed’s Balance Sheet Skyrockets As It Doubles Down on Inflating Asset PricesAnother Right Abolished by the Government’s COVID Lockdown: The Right to a Speedy TrialColorado County Says It Will Arrest All Tourists, Including Those Who Own Property ThereThe COVID Lockdowns Are What Twenty-First Century Mob Rule Looks Like
Our guest is Jeff Deist, President of the Mises Institute. We discuss the unprecedented governmental response to COVID, the trade-offs that are unaccounted for, and the inability of local communities to set their own course when, in fact, “all crises are local.”
Additional Reading "End the Shutdown" by Mises.org Editors
"What Governors Can Do" by Jeff Deist
"All Crises Are Local" by Jeff Deist
Levi Machado is a Brazilian pathologist who trained and now works in the NYC hospital network. As a fan of libertarian writers, Levi recognizes the problems with coercive “solutions” to a pandemic. However, Levi explains in the discussion what COVID-19 actually can do to the body, and why it’s not really comparable to the flu. The conversation wraps up with tips on staying healthy.
For more information, see BobMurphyShow.com. The Bob Murphy Show is also available on iTunes, Stitcher, Spotify, and via RSS.
Our guest is Per Bylund, Assistant Professor of Entrepreneurship at Oklahoma State University where he holds the Records-Johnston Professorship of Free Enterprise in the School of Entrepreneurship. We talk about regulations in the age of COVID, and he also shares his perspective on Sweden’s response to the pandemic.
Our guest is Dr. Nicole Saphier. She is a radiologist and a breast imaging specialist at Memorial Sloan Kettering, Monmouth, New Jersey. She appears frequently as a medical contributor on Fox News, and comments on a variety of medical as well as health policy issues. She comes on today to discuss her new book – Make America Healthy Again.
After weeks of bungling, faulty tests, and policy reversals the CDC bureaucrats managed to achieve some semblance of competence. But by then they were already far behind the curve.
Narrated by Daniella Bassi.
Original Article: "How the CDC Prevented Fast and Accurate Testing for COVID-19"
Bob Murphy urges skeptics not to dismiss the panic over the coronavirus as merely due to anti-Trump fear-mongering. Although government coercion is not justified, the underlying health crisis is very real. Bob also explains the economics of the toilet paper shortage, and gives practical tips he is using to try to keep his own household safe.
For more information, see BobMurphyShow.com. The Bob Murphy Show is also available on iTunes, Stitcher, Spotify, and via RSS.
The hilarious stand-up comic and Rothbardian Dave Smith invites Bob onto his show, Part of the Problem, to talk about the government’s response to the coronavirus.
For more information, see BobMurphyShow.com. The Bob Murphy Show is also available on iTunes, Stitcher, Spotify, and via RSS.
Pete Quinones, host of the Free Man Beyond the Wall podcast invited Jeff Deist to return to the show to go over the government’s response to the coronavirus, and to see if there are any positives that can be found in this situation.
Our guest is Aaron Kheriaty, MD, Associate Clinical Professor of Psychiatry at the University of California, Irvine, where he is Director of the Bioethics Program. Dr. Kheriaty is the chair of his hospital’s ethics committee and is presently working on a task force with the University of California Office of the President to prepare for the possibility that a surge in demand for intensive care due to the coronavirus pandemic will outstrip the supply of equipment and staff. He is the author of numerous articles in peer-reviewed journals and in the lay press, many of which are focused on end-of-life issues.
Our guest is intensive care specialist Mark Tonelli, Professor of Medicine at the University of Washington Medical Center in Seattle. He shares with us the encounter with the COVID-19 pandemic as it emerged from a nursing home in King County, Washington, and how the Seattle area medical community has responded to this first US cluster of cases.
Accad and Koka welcome Dr. Paul Offit, an expert on vaccines, immunology, and virology. He is the Maurice R. Hilleman Professor of Vaccinology, Professor of Pediatrics at the Perelman School of Medicine at the University of Pennsylvania, and Director of the Vaccine Education Center at The Children’s Hospital of Philadelphia. He shares his thoughts on the response to the COVID pandemic, a response that should take into account the health costs of a severe economic downturn.
Anish discusses the COVID19 pandemic with Dr. Daniel Jafari, an emergency physician and surgical critical care specialist working at the North Shore University Hospital in New York. Dr. Jafari speaks to us about watching the pandemic unfold, the problems being wrestled with, the remarkable response, and what’s needed in the coming weeks.
Bob Murphy comments on various aspects of the response to the coronavirus. Although many libertarians are accusing the authorities of exaggerating the threat, it would also be a “libertarian take” to accuse them of downplaying the threat early on, misleading the public on how to stay safe. Bob also tries to clarify thinking about the Fed’s repo bailouts and the outrage over hand sanitizer price gouging.
For more information, see BobMurphyShow.com. The Bob Murphy Show is also available on iTunes, Stitcher, Spotify, and via RSS.
Anish Koka discusses the COVID19 pandemic with Christos Argyropoulos, Chief Nephrologist at the University of New Mexico.
Dr. Argyropoulos has been warning for some time about COVID19. Here he discusses from where his early concerns emerged, missteps by the US in handling the virus early on, and what to do now.
Economist Tim Terrell explains why the common rankings of "health outcomes" are so often biased against the United States, and why big businesses often support certain environmental regulations. Hint: it's not for reasons progressives will like.
For more information, see BobMurphyShow.com. The Bob Murphy Show is also available on iTunes, Stitcher, Spotify, and via RSS.
Hordes of independent nurse practitioners are on the horizon. Many physicians are raising the alarm bell, but Dr. John Mandrola views things differently.
Geoffrey Rose published The Strategy of Preventive Medicine in 1992, and thus gave birth to the “Population Health” movement. In this podcast episode, Dr. Michel Accad critically examines Rose’s influential ideas.
Dr. Bob Gill, producer of the documentary The Great NHS Heist, discusses what life in the National Health Service is like, how it differs from practice in the United States, and most importantly, his fears of what is undermining the mission of the NHS — a hostile takeover by American corporate interests.
Many physicians feel ambivalent about assisted suicide and neither endorse the practice nor outright condemn it. As a result, they also avoid discussing the topic altogether. Accad and Koka's guest is Dr. Adam Cifu, who kindly agreed to engage in a conversation on this difficult question. Dr. Cifu is author of Ending Medical Reversal and Symptom to Diagnosis.
Accad and Koka's guest is the highly successful and widely respected blogger who writes anonymously under the pen name “Skeptical Scalpel.” He is a former Chairman of Surgery at an academic institution, and they discuss the state of surgical education and its present-day challenges.
Should the medical school curriculum include health inequity, climate change, and gun control? Accad and Koka interview Professor Stanley Goldfarb, author of a recent and controversial op-ed in the Wall Street Journal on the politicization of medical education.
As a follow-up to the episode on the Ranbaxy Scandal, Accad and Koka are joined by medicinal chemist John Tucker, PhD, and hypertension specialist Swapnil Hiremath, MD. The guests share their perspectives and impressions on the unsettling question of generic drugs.
Generic drugs represent 90% of the pharmaceutical market. Their use has been encouraged through decades of favorable legislation and subsidies, with authorities claiming they are as safe and effective as brand name drugs. Yet generic preparations tainted with impurities are being reported with increasing frequency. What should doctors and the public know about generic drug manufacture? Our guest, Dinesh Thakur, is the chemist who was at the center of the most important scandal to rock the global pharmaceutical industry in decades.
A health policy of choice—not of constraints—is what we need, says our guest David Balat. He is currently the Director of the Right on Healthcare initiative with Texas Public Policy Foundation. He has a broad base of experience throughout the healthcare spectrum with special expertise in healthcare finance. He is a former Congressional candidate in Texas’ 2nd Congressional District and a seasoned hospital executive with more than 20 years of healthcare industry leadership and executive management experience.
David is focused on education and advocacy in an effort to simplify coverage that is too expensive, complicated, and untrustworthy. He is an ardent advocate of Physicians and believes the restoration of the Physician/Patient relationship is critical to fixing our dysfunctional system. He often volunteers of his time to help families navigate their bills and how to understand their benefits.
As a medical discipline, psychiatry has often been the target of severe criticism, particularly in the last fifty to sixty years. Is the criticism valid or not? What is the outlook for the science of mental illness and the practice of psychiatry? Our guest today defends his chosen medical specialty.
George Dawson, MD, DFAPA, is a Staff Psychiatrist at the Hazelden Betty Ford Foundation and an Adjunct Professor at the Hazelden Betty Ford Graduate School of Addiction Studies. His clinical interests have been in acute care, geriatric psychiatry, neuropsychiatry, and addiction psychiatry. He currently practices addiction psychiatry, providing psychiatric consultation on patient care to the professional staff, and lectures on the neurobiology, epidemiology, and the clinical aspects of addiction psychiatry.
Dr. Dawson completed his training in psychiatry at the University of Wisconsin where he was a research fellow. Scholarly interests include biological psychiatry, consciousness studies, and the medical, philosophical, and political aspects of psychiatry. In his spare time, he writes a blog (RealPsychiatry) about some of these topics
Longtime libertarian journalist Bretigne Shaffer explains the de facto mandatory vaccinations now enforced for school children in California, and the concerned parents who are protesting the policy. She also discusses her fictional books that will appeal to libertarian readers.
For more information, see BobMurphyShow.com. The Bob Murphy Show is also available on iTunes, Stitcher, Spotify, and via RSS.
Will the randomized control trial bring more clarity and certainty to economic science? Is “evidence-based economics” something to be hailed as a welcome innovation or should it be appraised with a more sober attitude? To examine this topic and discuss the relative place of randomized trials in economics and medicine we have as our guest Peter G. Klein, W. W. Caruth Chair and Professor of Entrepreneurship at Baylor University’s Hankamer School of Business. Professor Klein is also the Carl Menger Research Fellow at the Mises Institute. He obtained his PhD in Economics from the University of California Berkeley, and his BA from the University of North Carolina Chapel Hill.
His field of interest is in the area of the economics of entrepreneurship and business organization. He taught previously at the University of California, Berkeley, the University of Georgia, the Copenhagen Business School, and the University of Missouri, and served as a Senior Economist with the Council of Economic Advisers. He is the author of five books and numerous peer-reviewed articles.
Do hospital-based physicians benefit from being out-of-network? Are policy wonks who attack “surprise billing” fully aware of the relevant factors? In this second episode on this topic, Dr. Koka leads a conversation with our guest, Dr. Amy Cho, an emergency physician from Minnesota.
Dr. Cho graduated from the University of Michigan with a joint MD/MBA and completed her residency in Emergency Medicine at Advocate Christ Medical Center in Chicago. Prior to medical school, she worked as a management consultant with Bain & Co., and as a product manager with Convio, a venture-funded software company.
Has cardiovascular genetics come of age? Are “polygenic risk scores” ready to inform us in clinically meaningful ways? In the final analysis, who or what are epidemiological data informing? Our guest is A. Cecile Janssens, PhD, Professor of Translational Epidemiology at the Rollins school of Public Health at Emory university in Atlanta, Georgia.
Professor Janssens’ research concerns the translation of genomics research to applications in clinical and public health practice and focuses on the genetic prediction of common diseases such as diabetes, cardiovascular disease and cancer. She also studies how the predictive ability and utility of genetic testing can best be measured.
Are out-of-network physicians deliberately trying to price-gouge patients in need of emergency care? Will “surprise billing legislation” solve the problems of narrow networks in a socially responsible manner? In this episode, Dr. Koka leads a conversation with our guest, Dr. Daniel E. Choi, on the topic of surprise billing legislation.
Dr. Choi obtained his MD degree from Northwestern University Feinberg School of Medicine in Chicago, completed his residency training at Rutgers State Univeristy of New Jersey, and completed a combined neurosurgical and orthopedic fellowship in spine surgery at Harvard Medical School.
Can a graduate of the Harvard Kennedy School hold on to free market principles? Evidently so! We talk health policy and economics with our guest Richard Menger, MD, MPA, a neurosurgeon serving as Chief of Complex Spine Surgery at the University of South Alabama.
Dr. Menger completed medical school with honors at Georgetown University School of Medicine where he was elected to the Alpha Omega Alpha Honor Society and received the Barbara Bregman PhD Award. He then trained at Louisiana State University Shreveport and at Columbia University for a fellowship in scoliosis treatment. At the Harvard Kennedy School of Government he completed a Master in Public Administration and was awarded the Hale Champion Public Service Fellowship.
Dr. Menger has authored numerous scientific papers in academic journals and is the lead editor of the textbook The Business, Policy, and Economics of Neurosurgery. His op-ed/policy work has been published in the Wall Street Journal, Forbes, Navy Times, The Hill and others. He has a joint appointment as Assistant Professor of Political Science at the University of South Alabama.
Big Pharma is abandoning its R&D efforts for antibiotics. What are the regulatory, scientific, and economic factors responsible for this potentially dangerous trend?
Our guest on this episode is Dr. David Shlaes. Dr. Shlaes is an infectious diseases specialist who trained was formerly professor of medicine at Case Western medical school in Cleveland, Ohio. He left academia in 1996 to become Vice President for infectious diseases at Wyeth Pharmaceuticals. He has been very prominent in the field of antibiotics research and development. In 1998 he was on the cover of Business Week in recognition of his contributions. In 2005 he established a consulting company and has been active in advising companies and policy makers. He has since retired but remains involved in the field. as an editor for the journal Antimicrobial Agents and Chemotherapy and as a blogger on his site called Antibiotics, The Perfect Storm, which is the title of a book that he wrote a few years ago.
How do businesses purchase healthcare services for their employees? What are the factors that bear on their purchasing decisions? These important questions are rarely part of the policy conversation. Our guest on this episode is Jay Kempton, President and CEO of the Kempton Group, helping employers obtain and administer health care benefits for their employees. He relates his professional journey, shares his insights as a third-party administrator, and tells us about his recent efforts to turn employers away from the wasteful and corrupt health insurance benefit model.
Mr. Kempton is one of the founding members of the Free Market Medical Association, a board member of the Society of Professional Benefit Administrators, and a member of the Health Care Administrators Association. He obtained a Bachelor of Science degree in Business Administration from Oklahoma State University and holds Life, Health, AD&D, and Property and Casualty Insurance licenses in multiple states.
According to our guest, American health care is stuck in a fortress mentality that stifles innovation, constrains medical advances, and yields low quality care. That fortress was erected more than one hundred years ago but, in many ways, is being circumvented by creative actors who are seizing opportunities to make changes outside of the political process.
Bob Graboyes is Senior Research Fellow at the Mercatus Center at George Mason University. He holds a PhD in Economics from Columbia University, and has held a number of academic positions in higher education in Virginia. He is the author of “Fortress and Frontier in American Health Care,” a booklet which offers many examples of individuals adopting a risk-tolerant frontier attitude to compete with insiders and pave the way to the future without having to rely on political reform. Prior to focusing his career on healthcare, Bob Graboyes was regional economist and director of education at the Federal Reserve Bank of Richmond.