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This Is the Number 1 Sign of High Intelligence, According to Jeff Bezos
This is what the Amazon founder looks for when he wants to know if someone is really smart.
Amazon founder Jeff Bezos sits atop one of the most successful companies of our time, not to mention a personal fortune of some $150 billion. I think we can all agree that by any meaningful definition the guy is pretty smart. It’s also obvious he has a talent for surrounding himself with other smart people who can help make his vision reality.
How does he find them? It’s a question he addressed when he stopped by the Basecamp offices a few years ago, the company’s founder, Jason Fried, reports on the Basecamp blog. And the answer Bezos gave was the exact opposite of what most folks would expect.
Smart people are actually wrong a lot.
Most of us, when we want to figure out if someone is smart, ask if the person is frequently right: Do they have correct knowledge about the world and their area of expertise? Do they come up with the right answers when faced with hard problems? Do their predictions turn out to be right?
But Bezos’s counterintuitive strategy isn’t just to look at how often people are right. Instead, he also looks for people who can admit they are wrong and change their opinions often.
Bezos has “observed that the smartest people are constantly revising their understanding, reconsidering a problem they thought they’d already solved. They’re open to new points of view, new information, new ideas, contradictions, and challenges to their own way of thinking,” Fried reports the Amazon boss saying.
“Consistency is the hobgoblin of little minds.”
That willingness to consider new information goes hand in hand with a willingness to admit your old way of thinking was flawed. In other words, to be super smart you have to change your mind a lot. Essayist Ralph Waldo Emerson
“He doesn’t think consistency of thought is a particularly positive trait,” Fried reports. “It’s perfectly healthy – encouraged, even – to have an idea tomorrow that contradicts your idea today.”
It’s not just 19th-century philosophers who agree with Bezos. Modern science does too, although psychologists have a less poetic way of speaking about the flexibility of mind Bezos prizes. They call it intellectual humility. Studies of decision making show that people who are more willing to entertain the idea that they’re wrong make markedly better choices. Being wrong, they understand, isn’t a sign of stupidity. It’s a sign of curiosity, openness to new information, and ultimately smarts.
If famous essays, top CEOs, and the latest research aren’t enough to convince you that to be smarter, you need to also be frequently wrong, you can also take it from the undoubtedly smart futurists at Palo Alto’s Institute for the Future. According to Stanford professor Bob Sutton, they encapsulate this trait of highly intelligent folks this way: “strong opinions, which are weakly held.”
As the futurists explained to Sutton, weakly held (and therefore often changed) opinions are important because they mean you aren’t “too attached to what you believe,” which “undermines your ability to ‘see’ and ‘hear’ evidence that clashes with your opinions.”
So next time you’re trying to determine if someone is actually super smart or simply bluffing, don’t ask whether they’re always right. Instead, ask when was the last time they changed their opinion. If they can’t name lots of times they were wrong, they’re probably not as smart as they want to appear.
Healthcare Triage News: Election Results Impact the ACA, Medicaid Expansion, and Marijuana
Healthcare Triage News: Election Results Impact the ACA, Medicaid Expansion, and Marijuana
Yesterday’s election results have a lot of impact on health care in the United States. The new Democratic House of Representatives and the ACA, expansion of Medicaid in red states, and medical and recreational marijuana are all affected by last nights returns.
What the 2018 Midterm Elections Means for Health Care
Whatever you want to call the 2018 midterm elections – blue wave, rainbow wave, or purple puddle – one thing is clear: Democrats will control the House.
That fundamental shift in the balance of power in Washington will have substantial implications for health care policymaking over the next two years. Based on a variety of signals they have been sending heading into Tuesday, we can make some safe assumptions about where congressional Democrats will focus in the 116th Congress. As importantly, there were a slew of health care-related decisions made at the state level, perhaps most notably four referenda on Medicaid expansion.
In this post, I’ll take a look at which health care issues will come to the fore of the Federal agenda due to the outcome Tuesday, as well as state expansion decisions. And it should of course be noted that, in addition to positive changes Democrats are likely to pursue over the next two years, House control will allow them to block legislation they oppose, notably further GOP efforts to repeal the Affordable Care Act (ACA).
Drug Pricing
Democrats have long signaled they consider pharmaceutical pricing to be one of their highest priorities, even after then-candidate Trump adopted the issue as part of his campaign platform and maintained his focus there through his tenure as President.
While aiming to use the issue to drive a wedge between President Trump and congressional Republicans, who have historically opposed government action to set or influence prices, Democrats will also strive to distinguish themselves by going further on issues like direct government negotiation of Medicare Part D drug reimbursement.
Relevant House committee chairs, perhaps especially likely Oversight and Investigations chair Elijah Cummings (D-MD), will also take a more aggressive tack in investigating manufacturers and other sector stakeholders for pricing increases and other practices. Democratic leaders believe it will be easier to achieve consensus on this issue than on more contentious issues like single payer (more detail below) among their diverse caucus, which will include dozens more members from “purple” districts as well as members on the left flank of the party
Preexisting Condition Protections
If you live in a contested state or district, you have probably seen political ads relating to protecting patients with preexisting conditions. As long as a Republican-supported lawsuit seeking to repeal the ACA continues, Democrats believe they can leverage this issue to demonstrate the importance of the ACA and their broader health care platform.
A three-legged stool serves under current law to protect patients with chronic conditions: (1) the ban on preexisting condition exclusions; (2) guaranteed issue; and (3) community rating. Democrats will likely seek to bolster these protections with measures to shore up the ACA exchange markets. In the same vein, they will likely strive to rescind Trump Administration proposals to expand association-based and short-term health plans, which put patients with higher medical costs at risk by disaggregating the market.
Opioids
Congressional Democrats believe that there were some stones left unturned in this year’s opioid-related legislation, especially regarding funding for many of the programs it authorized. This is a priority for likely Ways & Means Committee Chair Richie Neal (D-MA) and could potentially be a source of bipartisan compromise.
Medicare for All
While this issue could become a bugaboo for old guard party leaders, the Democratic base will likely escalate its calls for action on Medicare for All now that the party has taken the House. Because the details of what various camps intend by this term are still vague (some believe it is tantamount to single payer, others view it as a gap-fill for existing uninsured, etc.), we will likely see a variety of competing proposals arise in the coming two years. Expect less bona fide committee action and more of a public debate aired via the presidential primary season that will kick off about, oh, right now.
Surprise Bills
The drug industry is not the only health care sector that can expect heightened scrutiny of their pricing practices now that Democrats control the people’s chamber. Most notably, the phenomenon of surprise bills (unexpected charges often stemming from a hospital visit) has risen as a salient issue for the public and thus a political winner for the party. Republicans have shown interest in this issue as well, so it could be another source of bipartisanship next year.
Regulatory Oversight
Democrats believe they are scoring well with the public, and certainly their base, every time they take on President Trump. The wide range of aggressive regulation (and deregulation) the Administration has pursued will be thoroughly investigated and challenged by Democratic committee leaders, especially administration efforts to dismantle the ACA and to test the legal bounds of the hospital site neutrality policy enacted in the Bipartisan Budget Act (BBA) of 2015.
Extenders
While it instituted permanent policies for Medicare physician payments and some other oft-renewed ‘extenders’, the Medicare Access and CHIP Reauthorization Act (MACRA) of 2015 left a variety of policies in the perennial legislative limbo of needing to be repeatedly extended. While the policies in the Medicare space have dwindled to subterranean, though not necessarily cheap, affairs like the floor on geographic adjustments to physician payments, a slew of Medicaid-related and other policies are up for renewal in 2019.
For example, Medicaid Disproportionate Share Hospital (DSH) payments face a (previously delayed) cliff next year. That and the most expensive extender, ACA-initiated funding for community health centers, alone spring the cost of this package into the high single digit billions at least, driving a need for offsetting payment cuts and creating a vehicle for additional policy priorities.
A likely addition to this discussion will be the fact that Medicare physician payments, per MACRA, are scheduled to flatline for 2020-2025 before beginning to increase again, albeit in divergent ways for doctors participating in the Merit-Based Incentive Payment Program (MIPs – 0.25 percent/year) and Advanced Alternative Payment Models (APMs – 0.75 percent/year). The AMA assuredly noticed this little wrinkle in the celebrated legislation but hundreds of thousands of doctors probably did not.
Medicaid Expansion
Of the variety of state-level health policy decisions voters made on Tuesday, perhaps the most significant related to Medicaid expansion. In there states where Republican leaders have blocked expansion under the ACA – Nebraska, Idaho, and Utah – voters endorsed it via public referenda. Increasing the Medicaid eligibility level in those three states to the ACA standard will bring coverage to approximately 300,000 people.
Notably, voters in Montana rejected a proposal to continue funding the Medicaid expansion the state enacted temporarily in 2015 by an increase to the state’s tobacco tax. Their expansion is now scheduled to lapse in July 2019 if the legislature doesn’t act to maintain it. If they do not act, about 129,000 Montanans will lose Medicaid coverage.
Finally, Democratic gubernatorial wins in Maine, Kansas, and Wisconsin will make Medicaid expansion more likely in those states.
As they say, elections have consequences. While the Republican-controlled Senate and White House can block any Democratic priorities they oppose, the 2018 midterm elections assure a busy two years for health care stakeholders.
HEALTHCARE WINNERS AND LOSERS FROM ELECTION NIGHT 2018
https://www.healthleadersmedia.com/strategy/healthcare-winners-and-losers-election-night-2018
The most significant developments of the night focused around Medicaid expansion, how healthcare leaders who ran for public office fared in the elections, and several down-ballot healthcare initiatives.
KEY TAKEAWAYS
Healthcare leaders who were elected: Gov. Rick Scott, Lauren Underwood, RN, and former HHS Secretary Donna Shalala.
Races where healthcare was a major factor: mixed bag for vulnerable House Republicans who voted to repeal-and-replace the ACA, as well as Medicare for All proponents.
Healthcare ballot initiatives: Three states approve Medicaid expansion, one does not; Massachusetts votes down Question 1.
The 2018 midterm elections are over but made a significant impact on healthcare policies at the federal and state level across the country, while also determining who will be in office to enact them.
The future of healthcare policymaking will be influenced by the decisions made by millions of voters on Tuesday night, as Democrats took back the House while Republicans held onto control in the Senate.
Healthcare was a top priority for voters as they made their way to the polls to vote on issues such as Medicaid expansion and the healthcare leaders seeking to represent them on Capitol Hill.
Below are some of the most significant healthcare-related developments from the 2018 midterms:
MEDICAID EXPANSION APPROVED IN 3 RED STATES, DEFEATED IN MONTANA
Three traditionally conservative states joined Maine in approving Medicaid expansion via ballot initiative, while voters in Montana sank the measure which was attached to a proposed tobacco tax hike proposal.
More than 300,000 residents across Nebraska, Idaho, and Utah are likely to receive extended Medicaid coverage as a result of expansion. The number of places with Medicaid expansion now totals 37 states as well as the District of Columbia.
Support for the measure exceeded 60% in Idaho, while Utah and Nebraska approved Medicaid expansion with 54% and 53% of the vote, respectively.
Montana, voting on the most expensive ballot measure in state history, voted down the expansion proposal, which will sunset at the end of the year.
NURSE STAFFING RATIO PROPOSAL SHOT DOWN IN MASS.
Last night, Massachusetts voters had their say on ballot Question 1, which sought to implement nurse- to-patient ratios in hospitals and other healthcare settings.
It was met with a resounding ‘no’ from the electorate, with about 70% voting against the measure and almost 30% voting for it.
For months, the law has been hotly debated. Those in favor said it would improve patient safety and care. Those opposed said it didn’t account for patient acuity and would create a financial burden on hospitals and healthcare systems.
Had the law passed, Massachusetts would have joined California as the only other state to require that level of mandatory ratios.
PROPONENTS OF MEDICAID WORK REQUIREMENTS
As expected, two of the three governors who received federal approval for Medicaid work requirements and were on the ballot for the midterms, Gov. Chris Sununu, R-N.H. and Gov. Asa Hutchinson, R-Ark., cruised to election night victories.
Sununu defeated Democratic challenger Molly Kelly by a 52% to 46% margin while Hutchinson dispatched Democratic opponent Jared Henderson with 65% of the vote.
The most vulnerable of the three Republican incumbents, Wisconsin Gov. Scott Walker, was unseated by Democratic opponent Tony Evers by just over a single percentage point.
Wisconsin had just received CMS approval for its Medicaid work requirements last week, which was the latest development in a race dominated by healthcare issues that ultimately pushed Walker out of office.
ADDITIONAL HEALTHCARE BALLOT INITIATIVES YIELD MIXED RESULTS
Oklahoma voters rejected the Walmart-backed Question 793, which would have amended the Oklahoma Constitution to give optometrists and opticians the right to practice in retail stores. Walmart gave nearly $1 million in the third quarter alone to proponents of the initiative, which was narrowly defeated by less than 6,000 votes.
Nevada voters approve exemption of durable medical goods from state sales tax. Local media in Nevada are reporting that more than 67% of voters in state voted for Question 4, which amends the Nevada Constitution to require the state legislature to exempt some durable medical goods, including oxygen delivery equipment and prescription mobility-enhancing equipment, from sales tax.
California voters roundly rejected an initiative to cap the profits of kidney dialysis providers at 15% above direct patient cost. However, Golden State voters approved a ballot initiative that authorizes $1.5 billion in bonds to fund capital improvements at the state’s 13 children’s hospitals.
BITTERSWEET NIGHT FOR VULNERABLE HOUSE REPUBLICANS AND MEDICARE FOR ALL PROPONENTS
The race in Kentucky’s 6th Congressional District set the tone for the night among House races, as Rep. Andy Barr, who was targeted by Democrats for his support of House GOP plans to repeal-and-replace the ACA, faced Democratic challenger Amy McGrath, who voiced support in Medicare-for-All legislation.
A neck-and-neck race throughout the early part of the evening, Barr ultimately defeated McGrath, but other vulnerable House Republicans did not fare as well.
In New York, Rep. John Faso lost to Democratic challenger Antonio Delgado in the 19th Congressional District, a race highlighted by disagreements over healthcare policy, and Rep. Claudia Tenney, a vocal critic of the ACA, was unseated by Democratic opponent Anthony Brindisi in the 22nd Congressional District.
Sen. Bernie Sanders, I-VT, and Rep. Pramila Jayapal, D-Wash., two of the most notable proponents of Medicare for All were reelected, while newcomer Alexandria Ocasio-Cortz, a self-described Democratic Socialist, became the youngest woman ever elected to Congress in New York’s 14th Congressional District.
However, other Medicare for All proponents did not perform as expected across the country, with Tallahassee Mayor Andrew Gillum losing a tight gubernatorial race in Florida to Republican Rep. Ron DeSantis, and Rep. Beto O’Rourke falling to Republican incumbent Sen. Ted Cruz in the Texas Senate race.
HEALTHCARE LEADERS ON THE BALLOT
After a lengthy primary season and contentious general election cycle, numerous healthcare leaders won their respective elections Tuesday night.
Healthcare was one of the most prominent issues concerning voters in the midterm election cycle, punctuated by more than 60 declared candidates with healthcare backgrounds running for public office in 2018.
Around 35 candidates made it to the general election ballot and more than two dozen received a stamp of approval from the voters.
Most notably were Gov. Rick Scott, former head of Columbia/HCA, who won a neck-and-neck race against Sen. Bill Nelson, D-Fla.,Lauren Underwood, RN, a former HHS adviser under former President Barack Obama, who defeated Rep. Randy Hultgren, R-Illi., and former HHS Secretary Donna Shalala, who won a hotly contested campaign in Miami.
Shifting the Healthcare Debate
Welcome to Wednesday’s Overnight Health Care, where Democrats have won back the House, opening the door to a shift in the health care debate.
Here’s what we’ll be watching for on health care when the new Democratic House majority takes over:
- Oversight. Democrats are sure to launch investigations and hearings into all sorts of actions Republicans have taken that they think undermined the Affordable Care Act, from expanding skimpier short-term health insurance plans to cutting outreach efforts. They could also bring up different industry executives to testify, for example those from drug companies. We’ve seen some of this happen already with Martin Shkreli and Heather Bresch, but Democrats may want to go even further to shame the industry for high prices.
- Drug pricing. Speaking of which, legislation to fight high drug prices is an early priority for House Democrats. They think it could be an area for bipartisan support, as President Trump has also focused on the issue. Democratic Leader Nancy Pelosi said Tuesday she thinks there could be “common ground” with Trump on the idea, and Trump listed the issue as a possible area of cooperation Wednesday as well. But any drug pricing action always faces an uphill climb.
- Pre-existing condition protections. If a federal judge rules in favor of Texas and the other Republican state attorneys general challenging the law, Congress is going to need to have a backstop in place. Republicans in the Senate already passed their versions of such legislation, but left the door open to insurers charging higher premiums for people with pre-existing conditions. If the law’s protections are truly at risk, Senate Republicans will need to back up their campaign rhetoric with action.
- Medicare for All. The most sweeping change Democrats have discussed does not have any real chance of being enacted into law with a Republican Senate and president. But it’s worth watching whether liberal Democrats start planning and agitating for some action on Medicare for all, with hearings, revised legislation, etc.
Medicaid wins big at the polls
It was a big night for Medicaid. Three red states voted to expand Medicaid, giving health coverage to potentially hundreds of thousands of newly eligible people.
Idaho voters approved expansion with more than 61 percent of the vote, Utah passed expansion with 54 percent and Nebraska passed it with 53 percent. In Nebraska and Utah, the approval came despite opposition from the states’ Republican governors.
Democrats also won close gubernatorial races in Kansas and Wisconsin, putting expansion on the table. In Kansas, expansion legislation passed in 2017 but former Gov. Sam Brownback (R) vetoed it. In Wisconsin, Gov. Scott Walker (R) lost to Democrat Tony Evers, who campaigned on a platform that included expansion.
The Trump administration finalized two rules today making it easier for some employers to avoid complying with the Affordable Care Act’s contraception mandate. Here’s what they do:
- The first rule provides an exemption to the mandate for entities that object to contraception based on their “sincerely held religious beliefs.”
- The second rule gives ax exemption to nonprofits, small businesses and individuals that have non-religious, moral objections to the mandate.
These rules are largely similar to two interim final rules released by the administration last year. But the second rule was amended to state that the moral exemptions don’t apply to publicly traded businesses and government entities.
The rules take effect 60 days after their publication in the Federal Register.
Context: These rules are already the subject of multiple lawsuits against the administration. From National Women’s Law Center President Fatima Goss Graves:
“The Trump Administration decided to finalize these outrageous rules, despite several pending lawsuits and two federal courts blocking them. It’s clear that this Administration will stop at nothing to attack women’s health care… if the Administration thinks it can move these rules forward without a fight, they’re wrong.”
On the topic of abortion, two states last night laid the groundwork to ban abortion if the Supreme Court makes changes to Roe v. Wade.
Voters in Alabama and West Virginia approved sweeping amendments to state constitutions that could put major limitations on access to abortions if Roe v. Wade is overturned by the Supreme Court.
Alabama’s amendment makes it state policy to protect “the rights of unborn children” and “support the sanctity of unborn life.” It also says there are no constitutional protections for a woman’s right to an abortion.
Fifty-nine percent of voters approved the measure.
West Virginia narrowly passed a similar amendment that states nothing in the state Constitution “secures or protects a right to abortion or requires the funding of abortion.” That vote was 52 percent to 48 percent.
Health Care Is on Agenda for New Congress
After months of polls, mailbox fliers, debates and seemingly endless commercials, the mid-term elections are over and the results are in. As predicted by many, the Democrats have won back the majority in the U.S. House of Representatives, while the Republicans have expanded their majority in the Senate.
This means that for the first time since 2015 we have a divided Congress, which leaves me pondering the possible consequences for Scripps Health and the broader health care sector.
Without a doubt, health care will be on the agenda for both parties over the coming months. That became apparent during pre-election campaigning as voters on both sides of the political spectrum voiced concerns about a wide range of health care-related issues.
Exit polls found that about 41 percent of voters listed health care as the top issue facing the country, easily outpacing other issues such as immigration and the economy.
That’s really no surprise. Health care affects all of us, whether we’re young or old, poor or well off, or identify as more conservative or more liberal. And despite all of the division around the country, most Americans seem to agree on at least a few things – health care costs too much, more needs to be done to rein in those costs, everyone should have access to health insurance, and pre-existing condition shouldn’t be a disqualifier for getting coverage.
When the new Congress convenes on Jan. 3, a wide range of health care issues will be on the agenda.
Here are a few of the issues that I’ll be watching as our lawmakers adjust to the reshuffled political dynamics in Washington.
- Repealing elements of the Affordable Care Act (ACA) is likely off the table now that Democrats control the House. Previously, House Republicans had voted to change a number of ACA provisions that required health insurance policies to cover prescription drugs, mental health care and other “essential” health benefits. But even before the election, Republicans had reassessed making changes to measures that protect people with pre-existing conditions as that issue gained traction with voters.
- Efforts to expand insurance coverage and achieve universal health care will likely increase. A number of newly elected Democrats vowed to push for a vote on the single-payer option, but other less politically polarizing options such as lowering the eligibility age for Medicare and expanding Medicaid likely will draw more support.
- While Republicans used their majority in the House to reduce the burden of government regulations in health care and other industries, Democrats might use their new-found power to initiate investigations on a wide range of matters such as prescription drug costs.
We could see some significant changes take place at a more local level as well. On Tuesday, voters in three states approved the expansion of Medicaid, the government program that provides health care coverage for the poor.
And here in California, we will be watching newly elected Governor Gavin Newsom to see what plans he will put forward for expanding health care coverage in this state.
At Scripps, we believe everyone should have access to the health care services that they need, and we have worked hard in recent years to do all that we can to bring down the costs of delivering that care to our patients.
In this new world of divided government, gridlock likely will prevail and President Trump’s initiatives will struggle in the Democrat-controlled House. Everyone will be focused on positioning themselves and their party for the next presidential and congressional elections in two years.
Compromise and bipartisanship are clearly the best options for addressing the health care challenges we now face in ways that have the best chance to win wide public support.
If Democrats in the House fail to reach across the aisle to Republicans or try to make too many changes too quickly, they surely will face many of the same pitfalls that confronted Republicans over the last two years.
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HENRY KOTULA 