Why Everything We Think We Know about Health Care Is Wrong

The dramatic title of David Goldhill’s book Catastrophic Care caught my attention. I bought it, read it, and have now recommended it to a dozen or so people.

Goldhill describes the current state of the healthcare industry as an “island” unto itself. Due to many factors including regulation, history, and the legacy of government entitlement programs, the island operates quite differently than the “mainland.” The mainland, Goldhill states, houses all other industries such as banking, retail, travel and more. Because the financial incentives are vastly different on the island and the mainland, major differences in consumer satisfaction, quality, and pricing have appeared as a result. While industries on the mainland have been transformed by consumerism and digital technology, the island remains isolated, inefficient, and low-tech. Worst of all for the American economy, prices on the island are highly distorted.

The main drivers of this distortion are what Goldhill calls the “Surrogates.” The insurers, both private and government, are placed between you and me, the patients, and our healthcare providers. This gulf between the consumer and the provider causes mis-aligned incentives and financial distortion that doesn’t exist in other more consumer-driven industries. Driving the point home, Goldhill breaks down what a young employee at his company can expect to pay into the U.S. heathcare system over her lifetime and the findings are alarming. If you want to be a part of the healthcare debate, I’d highly recommend this book.

Review of Georgia Tech OMSCS

As of Fall 2016, I’m enrolled in the Online Master of Science – Computer Science, dubbed “OMSCS”, at Georgia Tech.

A few different personal goals led me to enroll in the program: 1) to obtain an advanced degree to aid in progressing towards more senior roles in my career; 2) to accomplish point #1 in a cost effective way; and 3) to keep my technical skills sharp.

I’m happy to say that this program has met and exceeded my expectations in addition to helping accomplish my three goals above. I can’t say enough good things about the program, but I’ll let the New York Times describe what makes this program special.

In spite of being a completely online program, the community aspect of the OMSCS is especially strong. I find that students are more engaged due to the availability and “always on” nature of the online class forum (called Piazza) than in my on-campus Computer Science classes during undergrad. With a large population of students across the globe participating in OMSCS, odds are that your question will be answered quickly by someone in some timezone at any given point in the day.

In addition, the course technology gives the OMSCS several advantages. For example, I can watch the Youtube-based lectures on my own schedule, versus a defined class time each week. Also, when a professor or TA holds office hours, it’s typically recorded and posted for all students to review. During my undergrad, if you had a conflict during the scheduled time for office hours, you were out of luck. Finally, for courses that involve closed-book tests (2 out of 4 of my courses thus far), advanced proctoring software allows you to take the test in the comfort of your own home. While this does involve the personal privacy sacrifices that come from being recorded via webcam and microphone, it does ensure the program remains high quality and worthy of Georgia Tech’s top ranking in the Computer Science field.

I’m currently in my second semester of the program and have taken two classes each during both semesters. With a full time job alongside the OMSCS, it’s a very demanding schedule. However, the program allows students to complete courses at their own pace, even one per semester, with a maximum of a one semester break in between.

All in all, it’s been a fun ride participating in what appears to be, by many accounts, the future of education.

The Mike Holmes of Stereo Repair

Adapted from an email I sent on December 9th, 2015:

I bought a “vintage” stereo receiver (made in 1979) on Craigslist mainly because it looked cool. I’ve been wanting to add some speakers in my living room for music since I’m tired of the computer speakers on my desk. They aren’t bad but just sound a little sterile and boring to me. As a bonus, I knew my parents had a record player lying around unused so I wanted to fire it up, something that I could only do with an older receiver that has phono inputs. I got some Micca MB42X speakers on Amazon to use with the receiver.

Back to Craigslist: The guy said everything worked but it turns out the right channel was blown. I could have used two speakers on the same channel, but they’d both be the left audio feed, bummer. I think he probably knew it was broken. Oh well, he lives too far away to go back.

I decided to search around for someone to fix it. There’s a crummy electronics shop right near my apartment that I went into but it turned out that their reviews are awful on Yelp. It didn’t surprise me as the store was chaotic and disorganized, equipment scattered everywhere. I guess electronics repair isn’t exactly in demand these days.

I hunted around a bit on Yelp and came across these guys. All 5 star reviews. I sent them an email asking for a quote. They quickly replied and said that for a price of $119 to $169 they’ll rehab the whole unit and give a one year warranty on everything – not just the damaged components, the whole receiver. Judging by the photos on their website and the Yelp reviews, they are the real deal and know exactly how to restore these things. Their website describes how the main technician was an apprentice to an electronics repair guy starting at a young age.

However, there’s no address posted on the site or the Yelp page. The guy emails back – great, they’re located in the Rogers Park neighborhood not too far from home. He says come after 6pm. I Google StreetView’ed the address and it looks like someone’s house or apartment rather than a commercial building. Weird, but I thought “let’s give this a shot.”

I arrived after work around 6:15pm, went up the back stairs to the 3rd floor like the email said and Casper let me in. Guy in his 30s in a sweatshirt, looks normal, has a slight lisp, ok. Kind of white like a ghost, come to think of it. He led me back through the apartment which had a ton of old-looking receivers and jukeboxes and parts lying around. Everything was very, very neatly arranged. The whole apartment had a very cool vibe and was mostly dark except for some neat LED accent lighting. He has a big screen in the kitchen with about twelve security camera feeds showing.

Then we got to the workshop – again, wow, incredibly organized and equipment stacked everywhere. It was somewhat dark in that room except for the bright desk lamps shining on the workbench. Newports on the table. Big-ass speakers mounted on the wall for testing. An array of meters (multi-meter, oscilloscope, other gizmos I didn’t recognize) on the bench. He took my broken receiver, popped it open, and said he knew the problem. That was within about 10 seconds. He then talked me through the whole architecture of the device and how certain transistors power each channel. As he went through each component, he took the multi-meter and told me which exact voltages should be showing – left channel appeared to be in spec, right channel was definitely fried. A couple resistors had burned up and the transistor that powered the right was also not working correctly. This crash course was a little over my head, but I could at least understand some of what was going on with my background as an occasional electronics hobbyist.

I realized later that Casper’s the kind of guy you’d want around if you were living post-apocalypse or even embargoed Cuba for that matter. Seems like he could fix anything.

After examining the receiver he asked if he can be frank with me. I say of course he can. “This thing is a piece of s***. I will do whatever you want me to do, and I can fix this, no problem. I just don’t want you pouring money into a crappy receiver. It’s dinged up, scratched up, and not that great of an original build anyway.” I replied that, while I appreciate the honesty, I really just wanted something that looks cool, sounds decent, and will power a record player.

He said he’ll hold on to it until I made a decision of whether to go forward with the repairs. He also offered to call a guy who sends a lot of equipment his way. Casper “doesn’t do sales” but often does work for this guy who “flips” vintage receivers and sells them. He recommended another unit which he had just restored personally for the flipper, and I ended up buying that one the very next day. Casper could have taken my money but didn’t.

Long story long, it was a pleasure to see a true expert apply his trade and with honesty to boot. P.S. don’t trust Craigslist.

Is Staying In the New Going Out?

I don’t have much to add to this excellent T Magazine Article: Is Staying In the New Going Out?

Let’s strip away the censure, for a moment, by analogizing the trend to personal wealth management. If we define “capital” in this metaphor as a mixture of our time and emotional stasis, then staying in is the ultimate conservative investment. It’s like pouring your money into a savings account: You’ll grow marginally; you’ll stay safe; your expectations will be met and never exceeded. The worst-case scenario is that your delivery fries are soggy and your premium cable TV episode is a B+ instead of an A. You can always pull the ripcord on your show and go to bed early. A failed night means that you got a good night’s sleep. That’s still a win. A modest win, but a win.

Timelapse: One Year on North Paulina Street

About one year ago, I installed a camera out my street-facing window.

The timelapse below is composed of hourly still frames from 6AM-7PM between March 25th, 2015 through March 25th, 2016.

The location is North Paulina Street in Chicago, IL across from Ravenswood Elementary School.

Keep an eye out for sewer construction, parking tickets, and more. Enjoy!

Plane Tracker Project

I built an airplane tracker. You might call me a nerd, I’d say I’m just curious about what’s going on around me.

I live in Chicago, home of O’Hare International Airport (ORD). While Hartsfield-Jackson in Atlanta is the champion of the world in terms of passenger volume, O’Hare is perpetually fighting for the #1 spot in terms of “aircraft movements” – basically the total of arrivals and departures over the course of the year.

Regarding my location: I live close to Lake Michigan, but almost on an exact line with the O’Hare flight path coming off the lake. If you live in this neighborhood and you don’t notice all of the planes flying around, you must be blind or deaf.

Since the runway layout at O’Hare was reconfigured a couple of years ago, air traffic controllers run planes in and out of the airport according to east or west flow. 70% of the time, planes land and take off westward, leading them directly over my building at a pretty low altitude. The other 30% of the time, planes come and go facing east. Finally, a very small percentage of the time, wind and weather force ATC to use O’Hare’s diagonal runways. Here’s a picture that shows the difference between east and west flow:

O'Hare East/West Flow

Long story short, a friend passed this link on to me, detailing someone’s Raspberry Pi-powered airplane tracker in operation near LaGuardia Airport in New York.

The documentation at the original link is pretty decent, and after ordering the parts and putting everything together, I have a working airplane tracker!

Plane arriving from LAX

Here are a few of the details you’ll need besides the instructions linked in the original blog post:

  • Soldering skills: you need these to put together the Adafruit LED screen. Turns out I am terrible at soldering, but somehow just barely good enough to do this project. I had only one row of lights on the display that did not function on the first try – re-soldering one of the pins did the trick. It’s probably worth it to practice first and then try your hand on the LED display afterward.
  • Python dependencies: Jeremy’s original code references a few Python dependencies (requests>=2.7.0, geojson>=1.3.1, shapely>=1.5.13) that I did not have installed on my instance of Raspbian. You’ll need to use apt-get or pip to pull them down. I also had to change #!/usr/bin/python3 to #!/usr/bin/python in one of the code files, as I don’t have Python 3 installed on my Pi.
  • Location: within the code you’ll need to program in your home airports (KORD and KMDW in my case) and coordinates where you want the software to look for airplanes – I used http://geojson.io/ to do this.
  • LED screen driver: follow the Adafruit instructions closely, especially how to install the library that makes the LED screen function (you need to run the “install” function or nothing will happen).
  • Kernel module fun: to use the RTL2832U software defined radio on my Pi, I had to run the command sudo rmmod dvb_usb_rtl28xxu before I was able to get it to operate.
  • The code currently doesn’t display international arrivals, and will always display the closest plane to your location. I’ve noticed that the screen sometimes jumps between arrival flights as they land in parallel at O’Hare and both take turns closer/farther from my building.
  • All in all, fun & cheap project to learn a little more about what’s going on in the skies just above. Special thanks to Garreth for the soldering assistance.

    My 2015 Reads

    This list is too short for my liking, to be improved in 2016. On a scale of * to ***:

    ***The Glass Cage – Automation and Us by Nicholas Carr
    ***The Martian by Andy Weir
    **How We Got to Now by Stephen Johnson
    **The Happiness of Pursuit by Chris Guillebeau

    (In progress) The Idea Factory: Bell Labs and the Great Age of American Innovation by Jon Gertner

    The Glass Cage

    Nicholas Carr’s book The Glass Cage is an excellent analysis and cautionary tale about the rise of automation over the last two centuries. Carr describes how technological advances such as autopilot, self-driving cars, and (some day) robotic soldiers introduce critical moral dilemmas about automation’s role in our society. In addition, Carr proposes practical design features such as haptic feedback and elimination of superfluous system alerts. In combination with increased automation, these features ensure that human operators can intervene in situations requiring judgement, improvisation, and experience – all functions and characteristics that computers cannot (currently) replicate. A quote on the back jacket sums up the book well: “The Glass Cage should be required reading for everyone with a phone.”

    The Best Beer in the World

    Westvleteren 12, the title of the so-called “best beer in the world”, inspires awe among beer aficionados. The beer is a product of the Abbey of St. Sixtus in the town of Westvleteren, Belgium. St. Sixtus is one of few Trappist abbeys in the world and one of just six located in Belgium.

    Trappist monks devote their lives to prayer and to the work of their hands while living life in isolation and devotion to God. Thankfully for the rest of us, a select few monasteries produce beer. It’s an interesting contrast: a drink with connotations of vice is the very lifeblood of these abbeys. Without the profits from the sale of beer, the monks of St. Sixtus would not have been able to repair their roof in 2013. Beyond supporting the monastery, the brewery operation is not intended to make a profit. Because of this, the abbey produces a very limited quantity and forbids resale of the beer. St. Sixtus produces three varieties including the Westvleteren Blond, 8 and 12. In my opinion (and that of many beer nuts) the Westvleteren 12 is the only one worth flying 4,000 miles to try.

    View from the abbey

    View from the abbey

    My personal love affair with Westvleteren 12 began in 2011. I was fortunate enough to spend six months living in Brussels. I had heard off-hand of this mysterious abbey located in the West Flanders countryside about an hour and a half from the Belgian capital. By the time my six months was up I had made three visits, dialed the “beer line” hundreds of times, and even tasted the beer at a Brussels establishment that has chosen to ignore the abbey’s strict no-resale rule.

    Westvleteren 12

    The pictures in this post are from my most recent visit in June of this year. Westvleteren 12 induces a kind of high unlike anything I’ve ever drank before. Maybe it’s the peacefulness of the abbey and the surrounding farm land. Maybe it’s the French and Flemish chatter with the rare English or German conversation mixed in. Maybe it’s the whopping 10.2% alcohol content. Maybe because it’s just so darn difficult to get the beer! For those dedicated enough to try, here’s a brief guide:

    Method 1 – Reserve a crate via the “beer line”
    Step 1: Follow the instructions here and call to reserve a crate. Good luck getting through! Despite a valiant effort, I was never successful at Method 1. Tip from a friend: enlist a group and use every phone at your disposal.

    Step 2: Be in Belgium

    Step 3: Pick up crate during the designated time and enjoy!

    Method 2 – Drive or Bike
    Step 1: Be in Belgium

    Step 2: Ensure that the cafe In de Vrede is open by checking the website

    Step 3 (driving): Open Google Maps, search for In de Vrede, and enjoy the beautiful Flemish countryside. Drink all the beer you can while there! (responsibly)

    Step 3 (biking): Traveling from Brussels, take the train and connect once in Gent, again in Kortrijk, and end up in Poperinge. Walk to the center of town, find a friendly hotelier and ask to rent a bike. I rented from the Hotel Belfort after a brief misunderstanding (they thought I was trying to break into the hotel). Drink all the beer you can while there! (responsibly and retaining your ability to ride a bike)

    Step 4: Be sure to pick up a 6-pack of Westvleteren 12 to take home. If you bike, make sure you have room to carry it!

    Time to head home

    Cheque’s in the Mail

    Call me crazy but sometimes I like bureaucracy. I like the idea of another human being, most likely located in an office park or nondescript government building, receiving a letter from me and opening it. What does that person look like? Are they having a good day? Where are they going for lunch today? It’s full of mystery.

    The rules are usually well-defined. It’s like maintaining your car: put in the right type of oil, gas, and other fluids and you’ll get a smooth ride in return. In this case, I wanted a refund for the 5£ deposit I put down to purchase an Oyster transit card on a recent trip to London. Yeah, yeah, I know. All that trouble for a measly 5£? Of course, I could have stopped at a Tube station while I was still in London to return the card and get a refund. But why not give it a try from 4,000 miles away?

    I filled out a refund request form on the Transit For London (TFL) website, put on the proper postage (just over $1), threw the Oyster card in the envelope and sent it on it’s way!

    Today, a few weeks after I mailed the letter, I received this personalized note from a nice gentleman at TFL named Nico Williams. I was delighted to learn that my refund has been “authorised” and a “cheque” is on it’s way! It took about a half hour of my time to fill out the form and mail the letter. The postage paid by TFL was 1.17£ but other things like the paper, envelope, ink, and Nico’s time certainly cost something too.

    That’s the joy of bureaucracy – I put in all the right inputs and someone 4,000 miles away put a smile on my face. Here’s to you, Nico. Hope you had a great lunch today!