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£¨"Insanity: doing the same thing over and over again and expecting different results."£©

Some selected comments from my former colleagues:

1.

Thanks for sending this document.

One observation that I might make about this document is lack of realistic tests and environmental assumptions.  Without realistic assumptions of the current system under study and realistic tests of those assumptions, the systems engineering process will likely fail to produce desired results.

One of the hallmarks of systems engineering process is realistic assessments of assumptions, environment and tests of both.  The assumption is that a system engineering approach will help within this domain.  There is an implicit assumption that the system under study is not corrupt. or in other words the services performed were actual services required and performed.  Audits are an accepted form of tests within the business world.

Despite the many deficiencies within the current healthcare system, at least Baucus managed to insert and provide incentives for audit recovery.

http://www.jdsupra.com/legalnews/cms-publishes-annual-update-on-recovery-48507/

Coupling the outlined systems engineering process with sufficient audit testing may help the methodology espoused within the document.

A quick look w/in the newspapers suggests that the US can not afford expanded healthcare for it's citizens.  To test this assumption please review within the Federal Reserve Audit

see Table 8 please (around page 144, to review how private interests moved private dept into public debt).  If we cannot afford healthcare then why did we just hand out $16 trillion to private investment bankers. I have been told by a former Wall Street VP of derivatives (a Bell Labs colleague of mine) that the mortgage based derivatives leveraged / bet$100-to-$1 against default. The # of bad mortgages was$200 billion x 100 = $20 trillion. I guess we were lucky or since there has not been a recent federal reserve audit there is another$4 trillion dollars that have not yet been accounted for. This may indeed explain why the interest rates have been held low for quite some time. If the investment / too-big-to-fail banks are at the Fed window w/ nearly 0% interest loans they can continue to sustain holding bad debt on their books w/o incurring derivative penalty / defaults.

Additionally, there are a wide variety of analytic methods that can be applied but many current ones don't scale to the size of a nation.  I know of a couple that would work but perhaps that is another note in the future after the "associates and colleagues of Terry" argue about the statements made within the verbiage above.

2.

A number of issues were raised yesterday that can lead to progress.

One was related to repetition of requests for consultation WITHOUT clear statement of expectation of a better answer which would impact QUALITY OF LIFE. Had there been threat of non-payment for such requests or for the reply, "healthcare" costs would have been decreased over 50%.

It was clear that BIAS is a large factor in the attempt to apply systems engineering methods to human systems - especially in the context of leaving loopholes that encourage personal gain for individuals and groups. This is common in the way laws get written. Congress is notorious for writing laws that encourage "gaming the system." Is this not the process where we see headlines of

K Street Firms  Scramble To Save Millions In Business ?

Even the review which is now under way in the VA health care system is already showing that bonus money was paid for administrators gaming the appointment system.

The flaws now found in the way our government has joined with the insurance industry to set up payment systems has been riddled with a methodology that sought political rather than public health goals.

Just as our nation has wasted lives and trillions of dollars in fighting wars of convenience based on ideology, so also many lives still continue to be lost in the government-industry model of "health care" that encourages manipulative micro-management based on skills of gaming.

Oversight of a system created by government in the VA, Medicare, Medicaid, and based on free-enterprise profit merely watches over a process riddled with flaws and opportunities to place personal gain over the good of a nation.

One area where all those in surgery, medicine, public health, engineering, law, and government

can likely agree is, " Insanity: doing the same thing over and over again and expecting different results."

Albert Einstein

This is a very important document.

The participants are to be respected.

It deserves discussion in DEPTH.

3.

Would love to participate in a serious discussion of this document.

I read the executive summary, and recalled a story that Terry once used in a beginning class, and which I have used in meetings and conferences for years now.  Here¡¯s how it goes:

If you went to a civil engineer and said I want to build a bridge: she would study the site, look at the river and the soil conditions and this and that, and say, here's a recommendation for a specific type of bridge that would cost a bunch of dollars and here¡¯s my bill.

If you went to a systems engineer and said, I want to build a bridge: he would talk with you a bit and maybe say, you know, your real problem is not that you want to build a bridge, your real problem is you want to cross the river.  How about renting a boat.  (in my version of the story, the systems engineer leans back in his chair, puts his feet up on his desk, his hands behind his head, thinks a while¡­)

I agree totally with Jack - I think this document is saying a lot of very important things.  But I keep seeing the bridge in there.

http://blog.sciencenet.cn/blog-2374-807204.html

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