Huge thanks to Andrew for joining me today! We were able to talk big picture and get into the weeds. A colleague from medical school and is an inspiring thinker who eloquates much better than I.
Transcript
keevin bybee 0:01
Welcome to the one school podcast. This is keevin Bybee. I’m a family physician exploring how we might be able to turn local public schools into 24/7 365, safe havens for our children, by speaking with experts who might have experience and perspectives that would inform this project. Today, I have the pleasure of speaking with Dr. Andrew Ramsey mph. He is an emergency physician, holds a master’s in public health and is now working on policy in the state of Virginia. Andrew, thanks for coming on today. It’s great to see you again. Well, thanks for having me. keevin. It’s great to be here. The reason I’d wanted to talk with you is because you, through your career arc have inspired me from a number of different perspectives, you have a master’s in public health, so you can absolutely see how lifestyle and the end results of health are correlated, you have seen the most acute of the acute and Louisville’s emergency room. And now you have the privilege of working on public policy. So you can see how some of how the sausage is made. And so the other thing is, I remember back in medical school, you had asked a question of, you know, once we have enough money, what would you do with your life? What would you do to stay happy. And that thought experiment realizes how quickly one can exhaust the hedonic treadmill that American Consumerism brings us to. And so that stuck with me. And I figured that if I didn’t have to do anything for money, what I would want to do is figure out how to keep kids happy and healthy and give them the tools to become Jedi as if they wanted to curious when somebody mentions the idea of turning a school into a 24/7 365 day community center. Where do you go with that? What challenges do you see?
andrew ramsey 1:55
Yeah, love the question, love the the depth that you put into this. And the podcast is great, wonderful guests. So far. So probably important to have the caveat that I’m not an education expert by any meaning of that word. I have thoughts on education, I think you know, you and I both think about it a lot in the sense that we both have young children who are going through education, and we’re both products of public education and believe in public education, and want to look at this as something viable for the future, not only to continue with the great things that were around when we were going through it, but also to make it better. And I think that’s what you’re thinking through in this podcast. And that’s fantastic. As we’re speaking about this, it is man, January 2022. So we’re still in the midst of a pandemic, we are at very high levels of, you know, the new variant coming through for Coronavirus. And obviously, I see that in my daily life a lot when I go to work. But something that provides massive impact on public education and education in general with the sense that we’ve now got essentially a group of people who are who are mandated to go in to a place where there are some mitigating things we can do to prevent that spread. But we’re now essentially asking kids to go into a place where they have a risk of not only acquiring the virus but acquiring a virus and spreading it to other people. And that is a another massive challenge coming through with this. So, you know, when we’re looking at education in my world, you know, I think they were having this discussion emergency physician and a family physician on a podcast about education in the sense that so many things we see day to dayare not related to healthcare are related to other things in people’s lives that have kind of been shuffled into a healthcare bucket because we don’t have an alternative. We’ve said,you know, I’ll bring up the example of mental health because that’s something that that, you know, you and I both see a lot of, and it’s something that comes up a lot in education, especially right now where it’s being called on for more funding for this service. I think you and I agree that a lot of the things we’ve decided on mental health as a country are not really classical mental health things. For the lay public listening to this podcast, there’s something called the DSM and it’s essentially a collection of information about psychiatric diagnoses that, you know, the true specialist, the psychiatrist and the psychologist have come up with, and when we’re looking at the things now being classified as mental health, they really don’t fit into those buckets. I mean, people can be disappointed with their lives without having depression. Those are very different things. But I think then, generally, both the lay public and policymakers put them in the same bucket. When that happens, they become medicalized. medicalizing in itself is dangerous, because not everything has a medication for a treatment or, you know, an otherwise thing that we would call a healthcare related treatment. Sometimes it requires a change in life, lifestyle life circumstances, and what we see a lot of coming into Our emergency departments in our clinics is people who have been subjected to the absence of the social services that they may have needed or the other things in their lives that they have needed, including nutrition, and excuse me exercise. And then we’ve medicalized those things to say, Well, let’s find a medical solution to this. Whereas what we need is a lot is a lifestyle solution, which may include social services, education, things like that. So that is sort of the intersection that I think you and I both have with this educational world along with being you know, people who went through public education of children going through public education, and how do we come up with the right solution for that? So the 24/7 model of education? You know, when I look at that I say it’s not specifically 24/7 Education is 24/7 Social Services with the idea that the current education infrastructure is the right vector to deliver some of these other things, which could be, as you’ve talked about another other episodes, having a nurse practitioner on site to do that primary care as opposed to either sending someone to an emergency department or telling them to go and see a doctor, we’ll do it there, because that’s where they are. And that’s been incredibly effective, both United States and in other countries for a lot of things. Most recently, United States, states that had very high rates of vaccination, often did mobile outreach via via mobile vans, I mean, essentially rolling clinics to set up vaccines, as opposed to telling everybody will go and get your vaccine somewhere. Well, that runs into the possibility that those folks don’t have the ability to do that. transportation issues, time issues, cost issues, why not bring these things to where people are, and when we’re looking at public education, this is where the children are right now. You know, they’re in school, we, we’ve decided that that’s where kids have to be. So why not offer some of these other services there. There’s a massive potential to deliver healthcare services there as well as other services, but obviously, you in my world is healthcare. So that’s covering a lot of ground and a very brief intro. Let me stop there.
keevin bybee 6:59
That was a beautiful eloquent version of exactly what was on my mind. And I love the nuance you bring to how we are medicalizing.You know, like disappointment, for lack of a better term, I only say this mildly sardonically, but many patients that I’m I deal with have life sucks syndrome. And I don’t mean that it’s their fault. It’s that the situation or the environment in which we find ourselves is not conducive, or set up intentionally for our well being. And, you know, coming from the medical world, I’m guess I’m trying to kind of grandfather or shoehorn in the fact that, okay, fine, if we are going to medicalize everything, then let’s use the best evidence based treatment to address it. And for the situations where it’s being disappointed because the environment is not conducive, then let’s use those the same medical resources, or at least the money to adjust the environment and then give people what they need where they’re at. So I guess I don’t say that we should medicalize everything, only to say that we in de facto are so then we might as well take it to its logical extreme, or at least decouple it and recognize that everything is integrated.
andrew ramsey 8:27
Yeah, so part of the challenge we get to is creating these classifications, and I think that that’s what we’re getting to with the medicalizing so the life sucks syndrome is is its life, it’s it’s this larger context of all the stimuli this excuse me, the stimuli that we get from our world and all the output we create into the world. And does that meet the expectations we have of ourselves in our lives, and things like that? Sometimes there’s not in agreement with those things, we’re not hitting the marks that we’ve set to ourselves or society sets for us or whatever. And we’re dissatisfied with that, you know, that’s not a thing. There’s a medication for, it’s also a very, very hard thing to put into a box and measure. And I think that’s so many of the interventions we get to both in education and healthcare, as well as most other things. But those are kind of the hot button issues right now, are the things that were easiest to set into a box with my epidemiology hat on I say, basically, we create a set of little boxes to compare things. And then we say, well, this, you know, within this set of box, we watched a number go up versus this other box where it went down or stayed the same or something. But you have to be able to create the box for it. And the hard part in these fields is there’s not always something measurable. It brings up a lot of questions about standardized testing, which has been wildly controversial for many years now. And increasingly a huge part of public education in the United States. Those are the things we can measure but not the intangibles. And I would say, you know, we say how do we measure writing? What is a great writer, what does that mean? Well, obviously somebody who can write in the English language is what we’re looking for, but it doesn’t measure great And yet we still create that box to say, well, this person is exceptional this person is not. But who knows what that means, because writers write in different ways. And to some degree, it’s about how you how it makes you feel. So there’s so many things like that in both of these worlds. And unfortunately, I think that it’s easiest for essentially policymakers and the money to to provide funding for the things that can be put in boxes. And to some degree, that’s not because they don’t understand that this is a problem. It’s because whatever the opposition is, will say, Well, why are we putting money in this, we don’t know if that works? Well, it’s hard to know what works because we’re just measuring these boxes, when the large majority of the things we’re trying to measure are outside of the boxes. And that’s the hard part. So, you know, that’s really where we get to where I think every state dealing with this in its own way is to say, these are the things we can measure, therefore, these are the things we’re going to put money into. And unfortunately, it means that there’s a lot of stuff that’s left out, there’s been a lot of attempts over time to change that, you know, where they were looking at some of the performance things years ago, you know, schools that were underperforming and say math, math and English, they would say, Well, kids who have enough food do much better in these things, which is critically important, unfortunately, then it creates a box, that’s a target to say, well, you know, shouldn’t the parents be providing this? And unfortunately, that’s what you see in a lot of circles that don’t want us paying for these things. And in the larger sense, you know, we run up to that with the 24/7 School idea, which is to say, why is it the public utility to provide everything for everyone all the time. And I think that that’s, you know, kind of why it hasn’t come through potentially a set of of more accurate boxes, capturing the things we’d really want to understand with this would be the solution. To, you know, the other side of that being to create new boxes, you have to have funding to create boxes and study those boxes. And so far, there hasn’t been too great interest in, in stepping outside into this world. So hopefully, getting these discussions going via your podcasts will be the way to really look at these things, you know, in a dynamic fashion and say, We know better than we used to how to do these things, right? Can we do that? And I mean, in the world of measuring,
keevin bybee 12:17
so yeah, very much. So shout out back to Dr. codnor. In medical school, one of his famous quotes was, the more you can measure something, the less it matters, not to be too trite about it. But he was touching on an important point there. And when you bring up how good writing is, it comes down to the subjective experience of reading, or putting that down on paper. And to get a little bit philosophical. We there’s valuing the internal experience, in and of its own sake, is something that I feel should be brought to the forefront, recognizing the challenge in attempting to measure it at all. But at the same time, not throwing away any attempt to measure just being able to hold the the seeming paradox of the importance of subjective experience with the inherent challenge of being able to put a metric to it and then not reducing it to some metric that ends up defeating the purpose of paying attention to it in the first place. So I don’t have a great solution. But I think calling it out is part of the the first step. And I like that you had mentioned that at all.
andrew ramsey 13:39
I think that’s completely right. I mean, so many of the things that. Again, I’m not an education expert, but some of the things that go into what we call public education are the things that archaically made sets, like it’s important for everybody to be able to read and write, everybody agrees on that, like, the idea that everybody should have that basic knowledge is, is is important for different reasons, like like, it was important that people weren’t able to be conned by these systems. I mean, some to some degree, when you educate the public and the public in the United States was often folks who were, you know, impoverished from other countries coming over for a better life and stable work. And what would happen is companies would find ways to exploit that. So the ability to read and write to understand contracts as they go into it is just such a fundamental idea of what people should know. But what does it mean to write, you know, at that point meant writing your name. That was something people didn’t know, they would sign, you know, a check or an X or something by their mark. And that was was was better than some people could do. So. What you know, goes into the basics of what we need is the question and then it comes down to you. Who is benefiting from people? Knowing this, so we’d say it’s great for democracy, it’s great for this idea that everybody has, you know, one person one vote, which which is important, then we create this inequitable distribution of these of these merits. And, you know, you wonder, with so many different interests going into creating this educational paradigm, if their understanding the truly important part, which is that we create this this, this value to every person that comes through, is that what we’re educating? And if we’re not picking that at every step of the way, in education, I don’t think that’s right. Well, we fall into is the risk that you have some various corporate interests coming in, I’m not saying this in a conspiracy theory way. But you know, you have corporations that need a thing from people, it’s to be able to do a certain thing. And often it’s to be able to color within the lines of a corporate hierarchy, which means write a certain way, read a certain way, do the right amount of math, the right type of math a certain way. And that benefits them, not necessarily the human coming through it. And I wonder back to this idea of writing being so subjective, if you know, what we’re missing is those people can write beautifully in just a different way, because we’re insisting that they learn to write emails a particular way. So they can hold down a particular job benefiting them to some degree, but benefiting a lot of other interests. In the same way. You know, there’s always the question of, should everybody have to have the same knowledge doesn’t benefit everybody to have calculus, I took a lot of calculus, and I could not tell you most pits of it pieces of it anymore, it’s just gone, you lose it, when you stop using them, you are an engineer, you know, these things to like, those esoteric bits of knowledge, once you’re switching into a life mode, that doesn’t include them, they’re just gone. So you know, there’s resources going into these things, because the schools benefit by having more people in AP classes, right? Like, that’s how they get measured on stuff. And that that to their interest, arguably, less so than the students. So what are the things that would benefit the students? And I don’t think that’s being asked enough. And these questions, so even just getting back to the education part of a 24/7 education, like, why not maximize the time that kids are there? If we’re doing education, let’s do real education, then we’ve got time for other stuff, which could be, you know, teaching kids, basic coping mechanisms for things, if they’re coming in, and they have the life suck syndrome, well, there are some solutions that are meaningful for that. That’s where you get into the meditation and the mindfulness and things like that, you know, not getting any not really getting the, you know, the West Coast, kind of hippie ism stuff, but just, you know, how do you process life in a meaningful way? Not from a from a mental health perspective of there’s pathology. But you know, not everybody comes in with that, that that proper coping skills, I certainly didn’t have it and may still not have it. But I wonder if what the problem is, is that, you know, education, really, is that we haven’t taken a step back with education to say, what are we trying to do here. And I love that you’re doing that.
keevin bybee 18:06
Right, and thinking about how the incentives are misaligned, up and down the, the economy for, like you said, we’ve, the people with the largest stakeholders are the large corporations who are using us as a product or part of the cog in the wheel. And they have a very specific design that they want out of us, which then feeds back down the chain into the the education system, and then it becomes a feed forward, Snowball. And then rather than recognizing what it is that we are as humans, and then educating around that, there’s a great book called The gardener and the carpenter, kind of a parenting advice book where, you know, for somebody like myself, I have a carpenters mindset, but unfortunately, you don’t measure your children and then cut them right you create fertile soil and attempt to cultivate them to grow into what they need. And so if the nurturing environment reflected what humans actually are and what they the the environments in which they would actually thrive, rather than trying to design them to a specific, narrow economic purpose, then I think we would end up obviating a lot of the mental health crises that we find ourselves in. When, for example, I see a lot of you know, 12 year olds with ADHD. But when you think about that 8% of the population back on the savanna African savannas needed to be constantly surveilling the horizon. And so it’s not a problem with them that we need to put them into sausage factory schools and corporate work environments. It’s a problem with the environment that we’re trying to shoehorn Something that was necessary for our evolutionary trajectory into something that makes them feel bad about themselves. And so rather than medicating them, what if we changed the environment in which they gained skills and then applied those skills back to help other people? Does that resonate?
andrew ramsey 20:20
No, I think it’s right on, and I would apply back to our discussion of boxes for that. So you know, there’s certainly kids who ADHD is pathological for them, you know, really make some struggle and they’re unhappy. It’s, it’s a world that they are not thriving in. And I think that then you start saying, Okay, so maybe this is something that is not, we don’t want to leave things the way they are here, we have great medications to help calm these kids down in a way that is beneficial for them. And that’s fantastic. The way that a lot of I mean, I don’t think the lay public understands this, but a lot of the ways that we characterize things in healthcare as to say we have, you know, these nine criteria that go into getting this diagnosis, you have to have six, or five, or for some number that someone came up with, and the idea is that that captures the number of people we want with it without excluding too many people, you know, that, essentially, its sensitivity specificity, right, we want to include as many people as possible with this pathological diagnosis. And to not not include those people. And to not include other people who don’t have that pathological diagnosis. It’s done in a controlled setting where these ideas are created. So somebody creates a database and looks at that data and says, generally, if we say, Pick this six of nine criteria, all of a sudden, we’re gonna have a pretty good number here, based on this database, the question is always, what about the people who went into the database? Did we properly characterize them? Is it a representative sample of people went into the database? Or did we capture a subsection of the population with higher rates, lower rates, different pathology, that’s now being included in this diagnosis. So when we’re looking at kids with ADHD, there’s a set of criteria that we’re generally trying to capture, unfortunately, we’ve decided to capture, I would argue, and I think you would to a lot of kids that may not need to be included in that, because they don’t have a pathological diagnosis of some attention deficit issue they have. I mean, we would say sort of a personality issue a personality disorder, which is that their personality is in direct conflict with the society that they’re in, if they were in the African savannah, it might be perfect, ideal, it was exactly what you need. Because that hyper focus on some things with the ability to quickly change that over, you know, that’s something that was incredibly beneficial. I would argue that that’s something that makes a good emergency physician hyperfocus when necessary, and interrupted constantly with other shiny objects. And that’s what we to haul day. But what happened is we medicalized a thing, and maybe now are capturing too many people into that diagnosis, not an ADHD specialist, but it seems in our lifetimes, we’ve really rapidly scaled up this diagnosis. You know, when the question is, is that correct? The only way to know would be to take a step back and say, did we do this right? Is this helping people? Is it harming people, obviously, you know, the, the medications we used to treat are not inherently harmful in the way that things like chemo therapies are. And I think that makes it easier to just just hand wave it and say, it’s probably fine. And I think we do that a lot. Is it better? Is it worse? I don’t know. But it’s certainly a thing that happens when you create that type of box in healthcare. And it happens a lot with the mental health fields, because there’s not a yes or no answer to this. It’s it’s it’s a gray area for a lot of it. And we’re trying to help as many people as possible that the question is, how many people are we harming in the process? I believe that less is more than much of health care. You know, are we harming some folks? I worry that we are. Unfortunately, that’s not something I have to do on the long term setting. I do see a lot of mental health coming through the emergency department. And what then happens is people are subjected to the system that we have the same way that we have public schools, we essentially have public mental health services through the emergency department that’s in the crisis setting. It’s different in every state, but essentially, if you know, they catch you in public and something doesn’t seem right, they bring you in, we evaluate you, you get evaluated for psychiatric as well as medical diagnoses. And if you know, our mental health services, people feel that you meet some criteria where you need inpatient services, then you’re subjected to the lack of proper mental health services across the country through budget constraints and momentum and system constraints. And that may mean sitting for several days in the emergency department waiting for help. Do you get the right help are not hard to know, again, resource strapped setting, so it makes it a very difficult situation. So it’s always about getting the right thing to the right people. And, you know, the hard part is that once things are set in motion, we often don’t take that step back to really assess to see if we’re doing the right thing. Can we do it better? It’s just how do we keep doing the right thing and or, excuse me, how do we keep doing this thing and how do we do it more? And then we call for more funding for the same service. And I think a lot of people get caught up in that.
keevin bybee 25:05
Well, yeah. And that touches on the asking for more funding. And I’m just curious how your experience, part time and policy would would inform a project like this. How do we talk to the leadership about this? Or how would we convince the population to demand this from their leadership? I’m just curious if anything comes to mind in that regard.
andrew ramsey 25:29
So huge question. How do we make people in policy do the things that need to be done? So, you know, obviously, every states can be a little bit different ways that I work in Virginia. So the way that things work here is we have a general assembly that generally, you know, the General Assembly is Congress. That’s what we call it here. There’s the Senate. And then we have government, Governor leadership, executive leadership, things like that. So the General Assembly makes decisions about the things it wants to pass through, those are the bills, essentially, there’s funding that goes for this and that, whatever priorities different legislators have, sometimes things will come through what’s called the governor’s budget, that’s what the governor wants to prioritize. So you know, the government has money to distributes to different things, that’s for the general running of day to day stuff. And then things that the leadership wants to change to make better bigger slash, because they don’t think it’s working, how they prioritize the decisions that they have. Well, that’s much harder. Sometimes people come in with a perspective, you have somebody whose career educator that knows what the problems, they’ve seen more and wants to make those things better. So they’ll put legislation up that tries to do that the way they do that would be fun, something or something else. Or you have people who have just heard from their constituents that something’s good, or a lobbyists that something’s good. I use lobbyist in both good and bad sense. I mean, lobbyists provide a lot of important services, their lobbyists for very beneficial organizations, for any of the big charitable organizations, they all have lobbyists. So lobbyists are people who basically educate legislators on an issue. Sometimes it’s specifically for for profit, corporate interests, and sometimes it’s entirely nonprofit interests. But legislators would, excuse me, legislators will hear about those and believe in it, and then they’ll say, let’s work together to write up this issue.
Or it could be that, you know, the governor or a secretary of some sort wants a thing to happen, because it’s a good idea. They’ve read about it, they’ve heard about it, their constituents are demanding it. And they say, I want this I, I expect my people to figure it out, you know, the governor would go to a secretary and say, let’s do this secretary would then go to the different people within the government and say, let’s figure out how to do this. That’s a very idealistic kind of view of a very back and forth process that happens, there’s a lot of people that have to work on all of these things. So you know, to have a opinion about something that should happen that starts with you. And then it really snowballs at that point. So you can’t just want something and then push a button, and it’s there and has to, you know, be an idea that’s proposed to the people in the agency that would do that. So say you want to do something in healthcare or education. So in Virginia, we have a, you know, a Secretary of Health and Human Resources, we have a secretary of education. So it would pass through that pipeline, they would have various people in their office that would look through the idea. They would go to, you know, whatever bureaucracy was under them and say, Is this feasible? They would say, I either expect you to figure it out, or is this feasible? Something we can figure out? How do we do it? Who’s going to do it? And often the most important question is, how much is it going to cost? So even something that decreases the cost often will require that same level of stringency. So within an agency, you know, often someone will say, this thing is expensive, and it doesn’t have any great benefit, can we stop doing it? And the agency may say, Well, we have to get that cleared, because it’s a change in the budget. So changes in the budget, often trigger red flags. And I’m not entirely sure if that’s because, like, secretaries and other kind of cabinet level, people say, Well, I just expect to know if my budgets gonna change up or down, or if it’s because the agencies themselves are scared of getting their funding cut. That’s at least the way I’d always heard of this. And, you know, prior to working in policy, like, if you don’t use up your budget at the end of the year, they won’t give you that budget next year. So agencies are scared that they’re gonna lose it, or that they’re even being looked at to say, Why have you been inefficient all this time? If you didn’t need this thing? Why? Why were you taking up all this money? So it means that things are very hard to change. There’s a lot of momentum and what all of the agencies would say in government is we are already underfunded for this stuff we’re doing and the right you know, they are largely very hardworking civil servants who are trying to make the best things work they can while getting shifted every different administration on every different priority, constant changes in their funding and the requirements for what they do and federal government requirements. So that they You know, they’re kind of shoestring all the time. I mean, it’s not like these people are are working with slush funds, they’re generally getting small amounts of money, relatively small amounts of money for massive projects, where they have to make decisions. So to do something like a complete change a paradigm shift in education, I mean, that’s gonna require the highest of the high level decision makers to be on board and to prioritize it. So probably you would require the governor to at least know that was happening probably to have made a speech about education needing a change, then it would have to be prioritized to the cabinet level. I mean, it may even need to be prioritized up to the federal level, because that’s really going to change things, it’s going to look either great or, or terrible for the people making those decisions. And they are going to need to know that it’s going to work, if that makes sense.
keevin bybee 30:53
Yeah, absolutely. It’s hard not to get frustrated that we’re still running a 21st Century economy on a 18th century political and economic model. But I don’t know that we got the time to solve that issue here other than to acknowledge that it is part of it, and thinking about how we can get more people on board and treating this like an investment, right, in the sense that, you know, you as an emergency physician are seeing the very expensive downstream costs of not doing preventative care at the earliest of opportunities. And you know, I mean, it not just getting your well child checks in your immunizations, but teaching people how to live life so that they’re less likely to step in the poop of it all. And so yeah, just curious what your reactions are to framing it as a societal investment, rather than framing it as a handout or as a benefit? Or what’s the other worm that teittleman? Do you have a sense of how the framing might get people to agree or disagree more or less?
andrew ramsey 32:04
What’s interesting to me is, as I was thinking about coming on this podcast, as I’ve been watching you, you do it for the last year or so, one of the things that I noticed my neighborhood, so we have a YMCA here. And it serves a largely under resourced community, you know, community that as far as where I live goes, is not well off. And they do unbelievably good programming. So there are, it serves the function of a community center, and community centers used to be a lot more common in the United States, we decided they were too expensive, so we don’t do them. And I think that it hits up against the idea of what can we measure? What are the things that are hard to measure, and those may be the meaningful thing. So what we saw was community centers cost money, because you have to buy the real estate, you have to improve the real estate, you have to pay taxes on it, you have to pay for people to be there, you pay for the electricity and the water and all the other things that go into running a business essentially, without an input. So it’s not as if the folks who are benefiting from the community center are able to pay these exorbitant fees to use it, it’s not a country club, nor should it be treated that way. But to measure the benefit is very difficult, because it’s a long measure. So in health care and nutrition studies are notoriously hard to do if not impossible, because you need to be measuring one thing versus not that thing. So if you’re saying I believe this, you know, Vitamin D supplement is going to make a difference in some medical outcomes, say heart disease, you don’t really know for the next 25 years. So nobody wants to sit around and wait for that supplement to run its course and see some fractional improvement in outcomes. They want to know now because they’ve got to sell that product. So when you’re looking at community centers in the benefit, well, what about having one great women’s basketball coach, you know, that might pay profound dividends 25 years from now when the well being of the people on the team and the people around the team, but nobody wants to do that study? And could you really do it? Which thing that the coach did was great. Was it just the coach being there? I mean, who knows. So, you know, the community center model is something that we are going to fund, I think is pretty unlikely because it doesn’t hit the things that we fund, which are the things that we can quote unquote, prove or beneficial, but they’re still there. So this YMCA is great. Obviously the YMCA is a massive organization doing a lot of this stuff across the country, but they’re filling that void for these communities as best they can. When they keep the doors open. They’re doing it when they can find the right staff to do it when they can afford new programs and and essentially once they get donations to do it. That’s largely the model we’ve moved to for so many of the things that you talk about on this podcast is just hope rich people are nice enough to give money for and that’s sucks, but it’s where we are. I would say that, you know the YMCA is one example of of likely hundreds of organizations doing similarly great stuff in my community. And I bet every community has those organizations but often they’re not talking to each other, it’s been a massive deficit, I think and, you know, terrible shouldn’t be charitable programming that a lot of the technology we create doesn’t really make it easier for them to do their things. I mean, maybe we have a way for people to send them money easier, but not necessarily wait for them to streamline their opposite operations better figure out the right people to target those resources to. So, you know, using the, in reality the world we have for this? I don’t know if if policy is the way to get all of these resources into the schools so much is to say what if the schools could partner with some of these organizations doing these great things, and a lot of Mardie are, I feel like just maybe doing it better is the key. And the better. That’s I mean, better is something we can do better is something where small resources go a long way, because there’s a lot of people that really want to make things better, who have coding skills, who have operation, you know, operations management skills, and figuring out how to target that type of resources to these organizations that are already doing great stuff. And making sure that the people working these organizations know they’re appreciated and making the schools aware that they’re there and not. I want to add one more thing to this at the end, but making sure that they’re not so overburdened with the stuff they’re doing. So carrying that a step further, one of the important things that I see government being able to do with itself, is to to get out of the way. And I don’t mean that in the strictly libertarian sense of stop doing stuff. I mean, that we want to stop doing harm. In healthcare, we talk about this, you know, we minimize the harm we’re doing. And I feel like that’s a thing where, you know, we haven’t quite figured out how to do that, in our larger scale policy level decisions for both healthcare and education, where we say,
There’s this quote that comes up all the time says, Go to her Done is better than perfect, right? All the time, we hear that I know, that comes up in engineering, not in engineering, but in like the coding world engineers are often very precise in what they do, they really want to get it right from day one. So we say let’s get this program up, we can fix it later. But often, that doesn’t happen, we get it up and it stays exactly the way it is, you know, I think something that can be done is looking at the policies we have or the funding that we have the way we have it distributed. And instead of being so fearful that It either is going to triple budget concern of some sort or, you know, create a backlash within a bureaucracy, we just say what are the things we can cut out that are harming people right now? You know, what ways did we create barriers so that these great organizations cannot help kids in public education. Once we get rid of those barriers, it’ll open the door conceivably for some innovative people to come in with with some really great ideas. And it’s then just about making sure that it’s keeping the kid safe at the same time. So that’s kind of two big ideas for things that you know, really are kind of out there and ready to be adopted with, you know, some potential for implementation.
keevin bybee 38:02
Yeah, fantastic. Shout out to anybody who might be an educational law or educational policy, who would be willing to enlighten me and provide some specifics on this. That’s definitely a big hole and the project so far, when we talk about budget, I just my brain can’t stop thinking about the fact that the former candidate Andrew Yang, talking about universal basic income. And I think it’s worth keeping in mind. And the timeline is not terribly specific, but the robots are coming automation is going to change how we distribute both labor and resources and wealth drastically in a very short timeframe. Regardless, if it’s five or 25 years, like on a historical perspective, that’s almost nothing. And so that’s why I really like where former candidate Yang brought up the fact that with something like a UBI, then we can start funding the jobs that don’t have an market incentive in the current system, so that the community centers and the coaches can get funded more on the intuition, rather than some reductive outcome that we can measure on a specific timeline. Right. You know, everybody has the anecdotes of that high school coach or whomever that made an enormous impact, but it’s not something that’s easily quantified. But that intuition is there and it’s valid and being able to more robustly read, you know, fun, those are resource those kinds of activities would be possible with a universal basic income. And so you know, it whether or not that specific model, just speaking to the spirit of thinking of how the future is going to be different than it is now. And you know, we’re in this for the long haul, right?
andrew ramsey 39:56
Yeah. So it’s an interesting concept and it’s come up for for a while. different years and a lot of different candidates. And, you know, Andrew Yang spoke very eloquent about it, excuse me eloquently about it, of course, when he was coming on, I hope you can have on your podcast someday, that would be really, really interesting. I agree with that concept. I mean, when we’re not having some basic social services, some basic social safety net for these, for all of these things, we’re basically forcing people into a model of figured out based on the employment models that are out there. So if the only option you have in your community is fast food, well, you’re taking the amount of money that you can get from that, there’s an idea that you can go on, get higher education will make things better. And that is a head in the clouds concept for a lot of people who have a lot of reasons why they can’t go on to get higher education, right, they have responsibilities, they’re taking care of siblings, or aging parents or, you know, sick cousins or something like that, they don’t have the ability to go on to do this, this idea of spending four years in college to go on to make a little bit more money, they need it, now they need something now, we don’t have those things in place. So you know, the idea of building communities based on some form of social safety net, whether it be universal basic income, or just really improve the things that are out there for them use, well, people wouldn’t need so much money if they had some of the services. And the services don’t inherently have to be expensive. And I think that that’s something that gets caught up in the grander political debate. It’s this idea that anything good we do is going to break the bank? Well, it’s going to have a lot of important, you know, beneficial consequences for that. It’s a question of what what do we prioritize right now. And, you know, it’s been said over and over again, but our military budget is massive. So we prioritize that, and what we’re seeing in healthcare, you know, with all these hospitals, having the National Guard come in, to help out I mean, good for them National Guard folks and doing their best. But the reason we have to bring the National Garden is we sent all the money to defense and not to health care.
keevin bybee 41:53
do you remember the comedian, Bill Hicks, he had this great line, like, couldn’t we take that same technology and conceivably use it to shoot food at Hungry people love it. We have the national guard in place, awesome. But maybe they didn’t have to be there, if we put that money somewhere else in the first place. Right?
andrew ramsey 42:15
First. And you know, there was a great book I read a couple years ago, and I can’t remember exactly who it was. But the title was something like how healthcare destroyed the American middle class. And it’s the idea of I wish I remember the title of it. But it was the concept that, you know, even if you’re taking home a paycheck, if you have benefits, you’re not understanding how much is going into those benefits. So when we talk about health insurance premiums, now it’s like, you know, $1,000 a month, or something around me, for a family of three, I don’t know exactly, because we get benefits through through work. But the idea is, whatever benefits are coming through, through employment that you know, about, there’s way bigger costs that are going on top of that. So that amount that’s going into health insurance is money, that could be your wages coming home, and arguably, then you could have systems that popped up to make health insurance cheaper, or that, you know, we wouldn’t have found a system of for profit, medical services that take every penny that you’re willing to offer and try to get more every single time. So a lot of the money that could be going into a lot of the services is really going towards health insurance and and paying for these health insurance premiums and paying the hospital systems for for, you know, whatever overhead they’re doing to implement this. Whereas, you know, a wellness system might take some of that and say, here’s the resources, you need to have better community and a life that’s meaningful to you. So you don’t have to suffer some of these longer term consequences. And we know that a lot of the things that do end up as medical pathology come from a lifestyle that creates them, and that could be eating poorly. You know, there’s certainly an element of the way we’ve distributed nutrition across the country with food deserts. But there’s also an element of fast food is probably bad for you. And it’s the only option for a lot of people. So that has a lot of repercussions in terms of obesity in terms of bone disease and heart disease, that are not being included in these costs, again, because it’s hard to measure that. So it’s kind of being exploited by those by those negatively impacted impactful systems. So, you know, how do we do those things? Well, I mean, implementation is part of the key. I mean, it’s about having programs that are that are good solid programs, ubi or some other social safety net, but really making sure it’s done well. So it doesn’t end up being another one of these things, not just dumping money on people necessarily, but dumping money on people the right way. And that’s something that if we’re going to do it, I would say, let’s have people who are really, you know, critical of it on there to discuss it. How do we do it? Right, like, that sounds okay. But what about this? What about that? They call it the red team, right? Sending the red team, let’s break this model to figure out the ways we need to make it better. And I think we don’t do enough of that. I know we don’t do enough of it in policy. You know, they don’t do this when they’re implementing things in health care. And it’s such an important part is to Have someone who disagrees with you up there to poke holes in your argument if you want to do it right. And that’s gonna be the best way to to get it
keevin bybee 45:06
done, I think. Yeah, adversarial collaboration for sure. For sure. So, it’s been about 45 minutes on a beautiful Sunday afternoon, Andrew, I want to thank you. Thank you for spending some time and contemplating stuff that’s pretty out there and providing a well thought out perspective and engaging in this project with good faith. It means a lot to me. Is there any closing thoughts or anything you’d like to plug before I let you go on and say hi to your little kid?
andrew ramsey 45:43
No, so so glad to be here. keevin It’s always good chatting with you. Nothing to plug these days.
Transcribed by https://otter.ai