Listening to Podcasts Is So Gen X

There are a lot of people, myself included, who think Kamala Harris may have lost the election by not going on the Joe Rogan Experience. He has a huge audience of young males – a weak demographic for her – yet one that is split roughly evenly between Republican, Democrat, and independent (according to Edison Research). Trump appeared, as did JD Vance and RFK Jr., but not the VP or Gov. Walz. She did plenty of other podcasts, but somehow chose to avoid JRE.

TV? No, Gen Z is watching podcasts. Credit: Bing Image Creator

As Tatiana Siegal and Todd Spangler wrote in Variety: “it is clear that Harris relied on an outdated playbook — one that opted for Howard Stern, who pioneered bro radio in the ’90s but whose influence is now negligible — and failed to see the significance of Rogan.”

The above notwithstanding, I promise this is not going to be about politics. It’s not even going to be about listening to podcasts. Rather, it’s about a trend with podcasts that took me by surprise: we’re more likely to watch podcasts than listen to them, and when we do, we’re most likely to do so on YouTube -- not the usual podcast kings, Apple and Spotify,

Ben Cohen reported on this trend in The Wall Street Journal a few days ago, based on research Edison Research published last month. Edison found that 31% of weekly podcast listeners chose YouTube, whereas 27% for Spotify and 15% for Apple Podcasts. Edison said: “A few years ago, YouTube might have seemed like an unlikely platform for podcasts. But as the world of podcasting evolves, many podcasters have embraced video podcasting, recording their shows in both audio and video formats.” 

In fact, Edison goes on to say:

…84% of Gen Z monthly podcast listeners ever listen to or watch podcasts with a video component. For this younger audience, the ability to watch their favorite podcasters, not just listen, adds a layer of engagement that traditional audio platforms lack. Forty-nine percent of Gen Z monthly podcast listeners say video provides a better understanding of context/tone through facial expressions and gestures, while 45% feel more connected to the podcaster(s) through video podcasts. The preferences of the Gen Z demographic are redefining the podcasting landscape, and YouTube is uniquely positioned to cater to their habits.

Mr. Cohen notes: “The most improbable thing about how YouTube made the podcast market all about video is how swiftly it happened. Only four years ago, when it was less popular for podcasts than both Spotify and Apple, YouTube becoming a podcasting colossus sounded about as realistic as Martin Scorsese releasing his next movie on TikTok.”

“We saw this trend organically emerging,” Tim Katz, YouTube’s vice president of partnerships, told him, “and then we wanted to invest in it.” And, boy, it sure is paying off.

Mr. Cohen further points out that YouTube has also recently passed Netflix as the most watched TV streaming service in the U.S., with 150 million households. That’s important because, as he says: “We’re also consuming more podcasts through YouTube because we’re consuming more of everything through YouTube.”

It’s interesting to note that when Joe Rogan signed a new, $250 million deal with Spotify, it was no longer exclusive – and he has some 18.5 million subscribers on YouTube already.

Spotify is not sitting idly. Last week it upped its video game too, announcing “a series of new offerings aimed at helping creators significantly grow their audiences and better monetize their video podcasts on Spotify.” 

Spotify founder and CEO Daniel Ek promised creators:

By delivering a best-in-class video offering uninterrupted by ad breaks, combined with Spotify’s flexibility and ubiquity, we can provide an experience for your audience that is superior to any platform. And by giving you, the creators, another path to monetization beyond ads, we’re freeing you up to spend more time doing what you love: creating.

Listeners “can expect an array of great video features, including chapters, comments, pinch-to-zoom, thumbnail scrubbing, and new ways to find and go deep on podcast,” but, more importantly, starting in January they can view videos uninterrupted by ads.  

All told, Spotify thinks the changes are “the biggest update to podcasts on Spotify ever.”

The announcement admits: “We’ve seen shifts in podcast trends across the industry globally, and one of them is that video consumption hours have expanded rapidly—more than 250 million users have watched a video podcast on Spotify, and nearly two-thirds of podcast listeners say they prefer podcasts with video.”

As Mr. Elk told Anne Steele of WSJ: “It’s becoming all about video. It’s kind of an irony,” He went on to add: ““If you said five years ago that people would want to watch people talking and sitting in front of a microphone, I’d say probably not.”

Mr. Cohen describes this new world:

All of this is beginning to change the entire medium in a fundamental way. For a decade, podcasts were something you listened to while you were doing something else: driving, working out, unloading the dishwasher. That was a passive experience. Now an entire generation has been conditioned to think of podcasts as something they can actively watch any time on any kind of screen—a phone, a computer, a TV. 

Which might sound nuts to you. But to young people, it just sounds normal.

Video podcasts are the new normal.

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I don’t really listen to podcasts, but, if I did, I’d be more inclined to watch than just listen. I waste plenty of time as it is on YouTube and if I wanted to spend some of that time on podcasts, I’d probably use YouTube for them as well.

But I feel about podcasts and especially video podcasts much the way I started to worry about TikTok a few years ago: I don’t really get it, but I have to acknowledge that young people do. Baby Boomers like me and Ms. Harris, and maybe many Gen X, are operating with “an outdated playbook” when it comes to how younger people want to get their information. 

I hate to admit it, but Joe Rogan knows something that many traditional media, marketers, advertisers, and executives don’t, and they better learn those lessons quickly. Podcasts should be a great way to get good information: lengthy discussions with experts. But those experts often have “expertise” that is dubious, and can become major sources of misinformation/disinformation. 

Those of us who care about that better get a new playbook, soon, and that playbook better include podcasts – preferably video ones.    

America the Schizophrenic

I must admit, last week’s election took me by surprise. I knew all the polls predicted a close race, but I kept telling myself that the American I believed in would not elect such a man, again, knowing full well all the things he has said and done – in his personal, professional, and political lives.  I was giving us too much credit.

There's the America we believe in, and the America we actually live in. Credit: Bing Image Creator

Democrats might tell the public that Wall Street was hitting record highs, that GDP growth was among the best in the world, that unemployment was low, and that inflation was finally back under control, but voters didn’t believe them. For most people, the economy isn’t working.

Where you live matters to what you make. Credit: Visual Capitalist

When two-thirds of voters say the country is on the wrong track (NBC News), when almost three-quarters of Americans are dissatisfied with the way things are going in the U.S. (Gallop), when 62% of voters think the economy is weak and 48% say their personal financial situation is getting worse (Harvard CAPS/Harris) – well, threats to democracy tomorrow don’t compare to the price of eggs today.  

Let’s face it: we are on the wrong road. We’re not on a road that is good for most people. We’re not on a road that is getting us ready for the challenges and opportunities that the 21^st century is bringing/is going to bring us. And we’re kidding ourselves about the America we believe in versus the America we actually live in.  Our views about our country are delusional, they’re disorganized thinking, they may even be hallucinations. I.e., they’re schizophrenic. 

For example:

The land of opportunity: The great thing about America is supposed to be that anyone can make it, if they just work hard enough. And there is some truth to that; everyone has their favorite rags-to-riches story. Americans like to believe we have high economic mobility, but, in fact, we’re pretty mediocre, ranking only 27^th in the last Global Social Mobility Index Western European countries do particularly well). “Intergenerational mobility, on average, is significantly lower in the United States than in most other developed countries,” says Professor Raj Chetty, the guru of the field. Mobility matters where you live, how good local schools are, and what kind of family structure you grow up in.

Robust middle class: If lower and middle income workers feel they are not benefiting as much from economic growth as they used to, they’re right. Most workers have seen, essentially, wage stagnation over the past fifty years, in part due to increasing share of the economy going to executives. CEOs make, on average, almost 200 times as much as workers do, and the ratio increasing.  As a result, the U.S. has some of the highest income inequality in the world. Unions – one of the few counterweights to income inequality – have been on the decline for decades, although 54% of US adults think that is bad for the country and 59% think it is bad for workers.

The wealth inequality is even worse. According to the Fed, the top 10% of US households have 67% of total wealth; the lowest 50%, only 2.5%. Blacks owned 23 cents for every $1 white families have; Latinos only 19 cents. Intergenerational transfers perpetuate the gaps.

Liberty and justice for all: America is the jailor of the world. We have about 1.8 million people incarcerated; China is next, with about 1.7 million – but, of course, it has over four times as many people. Think about that. We’ve created a private prison industry to house them all, so someone can get rich off them. Even worse, our prisoners are disproportionately people of color.  All that says more about us than it does them.

We care about the poor: Some 37 million people live in poverty (12 million of whom are children). Some 42 million rely on SNAP to help pay for food. Some 26 million school children receive subsidized lunches. We replaced welfare with TANF, but it has largely just hurt poor people. At least a half million people – and I have to assume the real; number is much higher – are homeless.  We not only accept these, we allow spending on social services to be the first to be cut.

Education is key: Our K-12 educational outcomes trail many other countries, and scores are at their lowest level in decades. Only 28% of America adults think our STEM education is above average compared to other countries…a third think it is below average.  Our worse schools are often in the areas that need them most.

Instead of investing in our public education system, politicians would rather divert that money on vouchers to private schools, with less oversight (and, in many cases, less diversity).

Best health care in the world: Some 26 million Americans (about 8%) have no health insurance (and that is much better than it was pre-ACA). One in four Americans have skipped health care in the last 12 months due to costs, and one in five have not filled a prescription due to costs. We lead the world in chronic diseases, and die sooner than in peer countries. Our infant and maternity mortality rates are shameful, comparable to supposed third world countries. So called “deaths from despair” are higher than in other countries. Our gun violence is at levels unfathomable in other countries, as are our motor vehicle deaths. And, of course, as much as 25% to 33% of our healthcare spending is considered wasted, even though that spending is the highest in the world. 

Democracy is priceless: I’m not sure that was ever true, but ever since Citizens United we’ve learned that it does have a price, and that the rich are willing to pay it. Think the Trump victory reflected the will of the working class? They might have voted that way, but their perceptions were heavily influenced by megadonors like Timothy Mellon and Elon Musk. Five Republican donors gave over $100 million each.  In total, federal election spending in 2024 reached about $16b. Hey, the Republicans are looking to give away $4 trillion in tax cuts next year, mostly favoring the ultra-rich, so $16b seems like a great investment.

I could go on, but if I haven’t made my point by now, I’m not going to.

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We cannot have a democracy when the plutocrats buy elections. We cannot have an economy where the rich get richer and everyone else works in an Amazon warehouse or at Walmart, with maybe some gig jobs on the side. We cannot hold together as a country where most of our counties are struggling economically while a few areas boom. We cannot give our children a future in which they don’t think they will be able to buy a house or raise children. And we can’t let politicians persuade us climate change isn’t real and, in any event, we don’t need to do anything yet.

Right now, I don’t see that either political party is willing to acknowledge these problems, much less take them on. Too many of our politicians are mainly interested in staying in office, which means not rocking their donors’ world. They stay in office too long and are woefully unprepared to take on the technological, social, and economic issues facing us. We keep electing them anyway.

I’m hoping for the movement that will take on these challenges, but I’m fearing the revolution we’ll have if we don’t.

Inventors (and Innovators) Wanted

I thought about writing about tomorrow’s election, but I’m too anxious – and a little terrified – about it, so I’ll take a pass. I was intrigued by Oracle Health’s promise of an AI-driven, “next-generation” EHR, or the news that OpenAI was introducing ChatGPT search, but I felt that each was inevitable and yet that both would prove underwhelming in the short term.

So I decided to write about invention.

Credit: Bing Image Creator

The November issue of IEEE Spectrum magazine is all about invention, starting with the tantalizing overview Why the Art of Invention Is Always Being Reinvented. “Invention doesn’t come from some innate genius, it’s not something that only really special people get to do,” says Stephanie Couch, executive director of the Lemelson MIT Program. 

Still, authors Eliza Strickland and Peter B. Meyer warn, “…the limits of what an individual can achieve have become starker over time. To tackle some of the biggest problems facing humanity today, inventors need a deep-pocketed government sponsor or corporate largess to muster the equipment and collective human brainpower required.”

Tell that to UTEP student Tayia Oddonetto. While an undergraduate, she had an epiphany. “During class, the professor said that if someone discovered how to turn brine, water with a high salt concentration, into something of value, it’d be revolutionary for the planet. At that moment, I told myself I was going to be the one who found the solution for brine, and that thought has never left me.”

And she did it. Instead of the more common reverse osmosis (RO) method of desalination, which at best converts 85% of salt water into fresh water and leaves a problematic 15% of concentrated brine, Ms. Oddonetto used something called salt-free, electrodialysis metathesis. As the press release describes it: “Salt-free electrodialysis metathesis treats brine by passing it through ion exchange membranes, thin sheets or films, and electrical currents that work to separate salt from water at the molecular level.”

Her approach produced over 90% fresh water, and generated higher levels of valuable metals and minerals that can be repurposed across several industries including technology, health and food.

“Tayia’s research will help public utilities save money while enabling people nationwide to reduce their utility bills in a meaningful way, advancing society's aim of water conservation,” said Ivonne Santiago, Ph.D., an associate professor in the Department of Civil Engineering at UTEP and now Ms. Oddonetto’s doctoral advisor. “In the next few years, I anticipate that we will see Tayia’s research applied on a large scale and fully see the tremendous benefit her work can have on humankind. Her journey is a testament to her perseverance, the importance of working on challenging problems and the value of a strong work ethic and positive attitude.”

“Earning an award and funding for my research is incredibly validating. This is a complex and difficult challenge to tackle and the journey has been full of roadblocks and setbacks,” said Ms. Oddonetto. “But I kept at it, and to be recognized for the value of my work is proof that all my effort and belief in this project was worthwhile.” She’s now working with the National Alliance for Water Innovation (NAWI), El Paso Water, the Kay Bailey Hutchison Desalination plant, New Mexico State University and the U.S. Bureau of Reclamation to refine the process.

UTEP doctoral student Tayia Oddonetto (right) and doctoral advisor Ivonne Santiago, Ph.D., (left). Credit: UTEP

Or take a group of four engineering students at the University of Toronto. As profiled by The Wall Street Journal, the four students entered into an anti drone technology competition (Counter Uncrewed Aerial Systems Sandbox 2024) hosted by the Canadian military, and – against competitors like Boeing and Teledyne -- tied for second, winning some $375,000 (Canadian). First place was C$1 million.

Ms. Poletaev, a material science student, was having coffee with Parth Mahendru, an aerospace-engineering student while discussing the competition. They enlisted Asad Ishaq, a robotics student, and Michael Acquaviva, an electrical engineering student.

Instead of using flashy approaches like lasers, the team used sound to take down drones. “Not everything has to be violent or… destructive,” Anna Poletaev said. “[Our technology can make a drone] think that it’s 5,000 feet off the ground when it’s actually just a few metres above,” Mr. Mahendru explained.

According to the UT press release, “the system can also disrupt visual feeds for drones relying on cameras, making navigation nearly impossible. It can reduce visuals to mere pixels or even disable the camera.”

They did all this spending $17,000 of their one money, mostly via credit cards.

The students have founded Prandtl Dynamics as they seek to commercialize their product, as well as make it more robust (for example, extending its range from 100 meters). “We have a different market that does not… conflict with anyone else, just because of the novelty of the idea,” Mr. Mahendru noted. The team is also actively seeking partnerships and expertise from industry experts.

They have some challenges ahead. As WSJ notes: “Funding for earlier-stage companies, though, is often hard to come by. Globally, only two seed-capital investments, worth a total of $14.2 million, were made in defense startups last year, according to the data provider PitchBook. The federal government has spent billions in recent years on technology from top national-security startups, but most U.S. defense spending continues to go to traditional military contractors.”

Still, Mr. Mahendru insists, “Working for ourselves, that’s what’s most exciting.”

Prandlt Dynamics team. Credit: Joel Rodriguez

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In the IEEE Spectrum invention issue, inventor Dean Kamen warned: “Today, while invention is getting easier and easier, I think there are some aspects of innovation that have gotten much more difficult.” He defines innovation as when something reaches the scale to impact or transform the world. For software, that’s easy; for physical objects, not so much. He blames competition and regulatory environments.

If any sector inhibits inventions from becoming actually innovations, it has to be health care. All anyone has to say is “patient safety” and inventors get cold feet. The hoops inventors have to jump through to get FDA approval or to be covered by health insurers is daunting. Innovators beware.

But I’m reminded of people like Susannah Fox, who writes about the Maker movement in health care, where patients and their families aren’t willing to wait for “the system” to get around to solving their problems. Instead, they invent solutions on their own. We need more Makers in health care, and we need to help them reach Mr. Kamen’s innovation stage of transforming the world – or, in this case, the healthcare system.

More of us need to take Ms. Oddonetto’s attitude: “I told myself I was going to be the one who found the solution.”

Engineers: Heal Thyselves (and Healthcare)

The article I can’t get out of my head is one by Greg Ip in The Wall Street Journal: Crises at Boeing and Intel Area National Emergency.

Boeing and Intel offer healthcare some lessons about the importance of engineers

I’m old enough that I remember when the Boeing 707 took airline passenger travel from the prop age to the jet age. I’m old enough that I remember that we all wanted PCs with Intel chips when companies starting giving office workers their first PCs. I’ve read enough history to know the storied engineering background and achievements of both. I mean, those B-52s that have been the backbone of the U.S. Air Force bomber command for the past 70+ years: those are Boeing planes.

To younger people, though, Being is the company whose doors pop out mid-flight, or which abandons astronauts in space. When they think of Intel – oh, I’m just kidding; when younger people think about chip companies, it’s NVIDIA or TSMC. Intel’s stock is doing so badly it may get kicked out of the Dow Jones Industrial Average.

So, as Mr. Ip says: “A generation ago, any list of America’s most admired manufacturers would have had Intel and Boeing near the top. Today, both are on the ropes.”

He goes on to add:

The U.S. still designs the world’s most innovative products, but is losing the knack for making them.

At the end of 1999, four of the 10 most valuable U.S. companies were manufacturers. Today, none are. The lone rising star: Tesla, which ranked 11th.

Intel and Boeing were once the gold standard in manufacturing groundbreaking products to demanding specifications with consistently high quality. Not any longer. 

What is most frustrating, Mr. Ip points out, is: “Neither fell prey to cheap foreign competition, but to their own mistakes. Their culture evolved to prioritize financial performance over engineering excellence.”

As an example, in a Blockbuster-could-have-bought-Netflix parallel, The New York Times reports that Intel could have bought NVIDIA in 2005, but the reported $20b price was considered too expensive. NVIDIA is now worth $3.5 trillion. Whoops.

Boeing’s new CEO, Kelly Ortberg, admits: “The trust in our company has eroded,” and that Boeing needs “a fundamental change in culture.” It doesn’t help that its machinists have been on strike almost 2 months, with the union rejecting Boeing’s latest offer last week. Boeing is slashing some 17,000 jobs, considering selling off its Starliner business, and trying to raise as much as $25b. 

Intel has also cut jobs, is trying to beef up its manufacturing through a revitalized foundry business (which some believe Intel should spin off), and has seen its stock crater (down 52% YTD), but CEO Pat Gelsinger vows: “We see the finish line in sight.”

Intel is still waiting for some $8.5b in CHIPS Act funding, “There’s been renegotiations on both sides,” Mr. Gelsinger told The New York Times. “My simple message is, ‘Let’s get it finished.’” But, as former Commerce Department official Caitlin Legacki noted: [There is fear that] Intel is going to take chips money, build an empty shell of a factory and then never actually open it, because they don’t have customers.”  Its much-hyped plants in Arizona and Ohio have both faced setbacks.  

Meanwhile, the vultures are circling: there are rumors that Samsung and Apple may want to acquire Intel.

The trouble is, which is Mr. Ip’s point, neither has any real domestic competition; if either would fail, it would throw even more of our economy to the mercy of foreign manufacturers (or, in its space business, make the U.S. even more dependent on Elon Musk’s SpaceX). That’s the national emergence he is warning about.

My point with all this is not so much to add another lament about the decline of U.S. manufacturing as to emphasize the decline of the role of engineers. Earlier this year Jerry Useem, writing in The Atlantic,  argued: “When the wave of Japanese competition finally crashed on corporate America, those best equipped to understand it—the engineers—were no longer in charge. American boardrooms had been handed over to the finance people.”   

 Mr. Useem points out that a revitalized GE “is belatedly yielding to the reality that workers on the gemba [Japanese term for the shop floor, where value is actually created] are far better at figuring out more efficient ways of making things than remote bureaucrats with spreadsheet abstractions.” That sounds a lot like what Mr. Ortberg is saying: “We need to be on the factory floors, in the back shops and in our engineering labs.”

So what, you might ask, does this have to do with healthcare? 

It turns out that there is something called a healthcare engineer. In fact, there is an American Society of Healthcare Engineers, which says is “dedicated to optimizing the health care built environment. ASHE’s 12,000+ members design, build, and operate hospitals, and are involved in improving the health care physical environment from the time hospital blueprints are drawn throughout the lifespan of a facility.”

I rather prefer a definition from much-cited 2015 paper: Healthcare Engineering Defined: A White Paper, which asserted that, despite being in use for decades, “the definition of “Healthcare Engineering” remains ambiguous.” It sought to resolve that.

The authors – and there were 41 of them – didn’t agree with ASHE that it was (just) about building hospitals and other healthcare facilities. The authors believe: “Healthcare Engineering is engineering involved in all aspects of healthcare.”

More specifically:

Healthcare Engineering is engineering involved in all aspects of the prevention, diagnosis, treatment, and management of illness, as well as the preservation and improvement of physical and mental health and well-being, through the services offered to humans by the medical and allied health professions.

The definition covers both engineering interventions (for patients), and engineering for healthcare systems – “the complete network of organizations, agencies, facilities, information systems, management systems, financing mechanisms, logistics, and all trained personnel engaged in delivering healthcare within a geographical area.”  

That’s quite a bigger role than I expect most of us think of engineers in healthcare...to the extent we think about them at all.

Credit: Healthcare Engineering Alliance Society

Many think our healthcare system has become so dysfunctional because businesspeople run it, not clinicians. Others blame the clinicians, such as for focusing more on income than on, say, quality and equity. We can all agree: however we got here and whomever is to blame, our healthcare system is a mess.

I think healthcare should take a lesson from Boeing and Intel: let the engineers take charge. E.g., not just build the building but design the processes of interventions as well as the buildings that house them.   

After all, they could hardly do worse.  

Health Care's Endless Loops

Last week the Federal Trade Commission (FTC) issued its final “click-to-cancel” rule, making it easier for consumers to cancel various kinds of subscriptions, such as gym memberships or streaming services. It will require enrollments to be as easy to cancel as they were to enroll.

Gym membership cancellations aren't the only "endless loop. Credit: FTC

“Too often, businesses make people jump through endless hoops just to cancel a subscription,” said Commission Chair Lina M. Khan. “The FTC’s rule will end these tricks and traps, saving Americans time and money. Nobody should be stuck paying for a service they no longer want.”

Oh, boy, Chairperson Khan: if you want to talk about jumping through endless loops, let’s talk about health care.

The FTC rule was part of its effort to modernize its 1973 Negative Option Rule. It had issued a preliminary rule in March 2023, which drew some 16,000 comments. Laura Brett, vice president of the National Advertising Division of BBB National Programs, explained the need for the rule to CNN: “(Consumers) had to jump through hoops online to find out where to cancel. Other times they might’ve been able to sign up online, but in order to cancel they had to call and talk to a representative. Other kinds of memberships required them to actually show up in person to cancel their subscription,”

Credit: FTC

The new rule is also part of a broader Biden Administration Time Is Money initiative, “a new governmentwide effort to crack down on all the ways that corporations—through excessive paperwork, hold times, and general aggravation—add unnecessary headaches and hassles to people’s days and degrade their quality of life.”

Predictably, not everyone agrees. The U.S. Chamber of Commerce called the whole Time is Money initiative a heavy-handed effort to micromanage business practices and pricing, and warned it would lead to “fewer choices, higher prices, and more headaches.”

But of course they do; I mean, if you asked an AI to create a Chamber of Commerce response to virtually any regulation, it would probably sound much like that.

Critics see politics behind the rule. In her dissent, Melissa Holyoak, one of the FTC’s two Republican commissioners, wrote: “Why the rush? There is a simple explanation. Less than a month from election day, the Chair is hurrying to finish a rule that follows through on a campaign pledge made by the Chair’s favored presidential candidate.” The same could be said of the Biden Administration’s new proposed rules to make over-the-counter birth control to be covered by insurers at no cost to patients.

Be that as it may, we all have more subscriptions than we probably really want, the gym membership scam has been going on so long that there was a Friends episode about it almost 30 years ago, and who among us hasn’t gotten caught in endless loops with supposed customer service representatives – if you can ever reach a live person – about some problem with a company?

Which leads me to health care.

Providing health care has always been complex, as physicians like to remind us, but just trying to receive health care has grown more and more complex over the past several decades (while growing drastically more expensive). Time is Money, the Biden Administration tells us, but in health care, the only people whose time is valued are the people billing us. We are, after all, patients, so we are supposed to be patient.

The FTC, and the Biden Administration more generally, has this right: Time is Money, and that’s our time and our money. The initiative specifically included healthcare – “…the unnecessary complications of dealing with health insurance companies…” – but I don’t think that goes far enough, fast enough.

We've all been there. Credit: Bing Image Creator

I like the precept that things should be as easy to get out of as they were to get into, although I want to use that more as a parameter than a restriction in expanding the discussion to healthcare.

For example, many of us have been complaining for years about lack of health information interoperability. Despite valiant efforts to bring it about, we all fill out too many of the same forms, asking for the same information, in too many different medical offices, and too many of us find that crucial parts of our health information do not make their way to subsequent health care practitioners, unless we make it happen. E.g., ever have to photocopy a medical record or obtain a CD of imaging results so that a new physician can see them?  You shouldn’t have to.

It should be easy – or, at the very least, easier.

Other examples, in no particular order:

• It should be harder for health care organizations to send patients to collections (or to sue them) than it would be to meet with them in person to try to negotiate a settlement.
• Claim denials should be as easy to appeal as the claim was easy to deny.
• Preauthorizations should be as easy to obtain as they are to deny.
• It shouldn’t be any easier to disenroll insurance members as it is to enroll them (I’m thinking of you, Medicaid disenrollments!).
• It should be as easy for patients to find new in-network providers as it is for their existing provider to become out-of-network.  
• It should be as easy for a patient’s appointment to start on time as it was to make the appointment. And late or cancelled appointments should result in financial considerations to the patient.
• It should be as easy for patients to find information on physicians’ actual expertise/experience as it is for them to find their marketing promises.
• It should be as easy for patients to obtain second opinions/referrals as it would be to make appointments with their current physicians.

I’m sure many of you have your own ideas/suggestions – feel free to note them in the comments below, or as responses to posts about this on Twitter or LinkedIn.

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I admit that I don’t think that subscription cancellations is one of the more important things the FTC could be working on, or that the above suggestions are the top things they should focus on in health care. I’d rather, for example, that they expand their work on assuring health care competition or the role of private equity in health care.

Still, our time is money, and sometimes that time is our health too, so anything they can do to help reduce the endless loops, in healthcare and elsewhere, I’m all for.

Make Mine Möbius

As both a long-ago math major and someone with an overdeveloped sense of whimsey, I’ve long been fascinated by Möbius strips. You know Möbius strips: they look like they should be two sided, but they are actually one sided (as you can test by tracing a line all the way around without lifting your pencil). They’re simple to make, but deceptively complex (mathematicians would add that it is a non-orientable surface with no boundaries, but let’s not go there).

The Gboard double-sided keyboard. Credit: Google Japan

You probably never found yourself thinking, hmm, I wish I had a keyboard that was a Möbius strip, but the good folks at Google Japan thought some of us wished we had a keyboard that we could type on both sides of. So, voila: they invented a Möbius strip keyboard.

"'I want to use the back of the keyboard as well as the front!'," Google Japan writes, in one translation, of the problem it aimed to solve. "In response to the voice of such users, I made a keyboard that has no front or back. A unique keyboard with two sides. Gboard double-sided version."

“If you turn the keyboard upside down, you can’t type at all. After racking our brains trying to find a solution to this major problem, we came up with this keyboard,” Google Japan noted in another translation of the blog post.

They call it the Gboard double-sided, aka the “Infinity Keyboard.” (I’m kind of disappointed they call a Möbius strip “double-sided,” but I’ll blame the marketing people, not the product people).

"The endless structure has no front or back," Google Japan claims of its design. "You can type at any angle. If you put the Gboard double-sided version [somewhere], suddenly a circle of people will form there. If we used it together, smooth 'teamringWorkin.' You'll come up with some original ideas.” 

One can certainly hope so.

Now, that's teamwork. Credit: Google Japan

The Infinity Keyboard has some 208 mechanical keys, able to be accessed at any angle and from both “sides.” They are laid out in ortho-linear 26x8 layout, with per key RBG lighting (ergo, using as a Christmas wreath is one application the developers mention). The keys are hot-swappable, allowing users to easily customize the array. With all those keys, users can have keys specifically for typing, gaming, and coding, as well as in other languages. Sadly, it isn’t wireless, using a USB-C connection.  

Google Japan estimates it weighs “20.8 donuts,” which Fast Company figures is about 2.2 pounds (based on the weight of a Krispy Kreme Original Glazed).  

Google Japan shows a number of uses for the keyboard, including simultaneous use by several people but also to wear as a bracelet or as the aforementioned Christmas wreath. And, they point out, it would be great in weightless conditions, since it has no top or bottom.

It turns out that Google Japan has been releasing unique keyboard designs each year on October 1, because – I had never counted -- 10/1 = 101 = number of keys on a typical keyboard.  Previous efforts include the Gboard Bar, which has all the keys laid out horizontally (some 5 feet long!), the Gboard Bending Spoon, which allows users to input by – you guessed it – bending a spoon, and Gboard Caps, a wearable keyboard in the (rough) shape of a cap.

Although each of these keyboards exist and are functional, Google has no plans to commercialize them. They’re intended to engender some smiles, and, perhaps, spur some creative thinking. However, Google has made the schematics and firmware open source on GitHub, with 3D printing STL files. You can make one yourself and see what it can do for your creativity/productivity.

Have at it. Credit: Google Japan

Or, if you’re not that technically oriented, they have a PDF that lets you make a paper version just to get a sense of it.  

Marcus Mears III, reviewing the Infinity Keyboard in TechRadar, says: “I love seeing these bizarre keyboard designs pop up…It's this type of ingenuity and playful creation that we need to keep advancing in the world of computer peripherals - where would we be if we never moved on from trackballs and beige membrane keyboards? Certainly not at the Gboard Double-Sided Version.” 

Jesus Diaz, in Fast Company, goes further in his praise: “If anything, this ongoing keyboard joke shows that there’s nobody in the world like the Japanese to create the quirkiest, most fun designs on the planet.” He adds: “Nobody else can compete with their imagination, but here I humbly submit, Google Japan, two final words for the next Gboard: hula hoop.”

I look forward to seeing what they come up with next October.

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We live in a world that, for the most part, has never advanced from the QWERTY keyboard design, which, as you may recall, was originally intended to slow typists down so they wouldn’t jam the typewriter keys. Obviously, it’s been a long time since that’s been our big problem, yet we’ve gotten so used to that layout that we’re still using it. So if it takes a double sided, Infinity keyboard, Möbius strip keyboard to jar our thinking about keyboards (or anything else), I say: good work, Google Japan!

Much as I love the concept, I have to admit that I’ll probably never use a Gboard double sided keyboard, and I’m certainly not going to attempt to build one. But I love that the design team at Google Japan thought of it, and I hope others are inspired to build their own, to play around with it, and to see what new ideas it might spark.

I’ve written before about people trying to break traditional design paradigms – e.g., umbrellas or even the wheel. We get so used to doing things in a particular way using existing designs that we often don’t remember that, hey, other designs are possible, and some of those designs may open up not only new ways of doing the things we’re doing but also help us identify new things to do. Design should be an enabler, not a constraint.

Their video talks about wanting “a keyboard with a twist, one that turns the problem space outside-in.” That’s what design should be helping us do.

You're Not Going to Automate MY Job

Last week U.S. dockworkers struck, for the first time in decades. Their union, the International Longshoremen’s Association (ILW), was demanding a 77% pay increase, rejecting an offer of a 50% pay increase from the shipping companies. People worried about the impact on the economy, how it might impact the upcoming election, even if Christmas would be ruined. Some panic hoarding ensued.

Then, just three days later, the strike was over, with an agreement for a 60% wage increase over six years. Work resumed. Everyone’s happy right? Well, no. The agreement is only a truce until January 15, 2025. While money was certainly an issue – it always is – the real issue is automation, and the two sides are far apart on that.

Fighting automation isn't going to work

Most of us aren’t dockworkers, of course, but their union’s attitude towards automation has lessons for our jobs nonetheless.

The advent of shipping containers in the 1960’s (if you haven’t read The Box: How the Shipping Container Made the World Smaller and the World Economy Bigger, by Marc Levinson, I highly recommend it) made increased use of automation in the shipping industry not only possible but inevitable. The ports, the shipping companies, and the unions all knew this, and have been fighting about it ever since. Add better robots and, now, AI to the mix, and one wonders when the whole process will be automated.

This is the world of shipping today. Credit: Logistics Management

Curiously, the U.S. is not a leader in this automation. Margaret Kidd, program director and associate professor of supply chain logistics at the University of Houston, told The Hill: “What most Americans don’t realize is that American exceptionalism does not exist in our port system. Our infrastructure is antiquated. Our use of automation and technology is antiquated.”

Eric Boehm of Reason agrees:

The problem is that American ports need more automation just to catch up with what's considered normal in the rest of the world. For example, automated cranes in use at the port of Rotterdam in the Netherlands since the 1990s are 80 percent faster than the human-operated cranes used at the port in Oakland, California, according to an estimate by one trade publication.

The top rated U.S. port in the World Bank’s annual performance index is only 53^rd.  Sixty-two ports worldwide – out of some 1300 – are considered semi- or fully automated. According to Heather Long in WaPo, the U.S. has 3 ports that are considered fully automated and another three that are considered semi-automated.  Loading and unloading times in the U.S. are longer than competing ports. Increased use of automation, in some fashion and to some degree, is necessary to stay competitive.

Yet the dockworkers are unmoved. In a letter to members, the ILW leader vowed: “Let me be clear: we don’t want any form of semi-automation or full automation. We want our jobs—the jobs we have historically done for over 132 years.” He insists the new six-year contract must include “absolute airtight language that there will be no automation or semiautomation” 

“The rest of the world is looking down on us because we’re fighting automation,” said Dennis Daggett, executive vice president of the ILA. “Remember that this industry, this union has always adapted to innovation. But we will never adapt to robots taking our jobs.”

This is what needs to get resolved by January. Wages are important, but only for those who have jobs. It very much reminds me of last year’s Hollywood writer’s strike, which was partly about money, but also about not letting studios use generative AI to do their jobs.

Seem familiar? Credit: Mandalit del Barco/NPR News

It’s worth pointing out that dockworkers may not quite fit the typical blue collar union worker stereotype. The Wall Street Journal reports that the average, full-time dockworkers on the West Coast made $233,000, while more than half of their East Coast counterparts earned over $150,000. Not all dockworkers earn such amounts, nor has full-time work available, but – still.  

Resisting automation is a great rallying cry to union members, but is not realistic. “The argument to stop automation now is slamming the barn door decades after the horse has gotten out. This is not going to work long term. The economic incentives behind it are too strong,” Harley Shaiken, a professor emeritus at the University of California at Berkeley, told The Washington Post.

Mr. Levinson told WaPo: “In the past, the longshore unions have agreed to various types of automation, but there’s always been some kind of price attached in terms of protecting the jobs and protecting the union’s jurisdiction. And I assume that there is some price at which this dispute will be resolved.”

Professor Kidd, in The Hill, urged: “The ILA needs to be looking at a long-term vision. There’s no industry — journalism, academia, manufacturing — that hasn’t been changed by technology,”

Along those lines, Erik Brynjolfsson, the director of Standford University’s Digital Economy Lab, suggested to The Hill:

I find it very short-sighted of the dockworkers, or any workers, to be pushing against automation if you can instead, find a way that the gains get shared. I would hope that there’s an opportunity there to strike an agreement where there is a lot more automation, not less automation and that some of the benefits get shared with the dockworkers and others.

This is not just a dockworker’s issue. As Ms. Long wrote in WaPo, “the bigger reason everyone should pay attention is that this is an early battle of well-paid workers against advanced automation. There will be many more to come.” Or, as Allison Morrow quipped in CNN: “The bots come for all of us, which is why the outcome of the port strike is particularly important to watch.”

Maybe you’re not a longshoreman, or a Hollywood writer. But the future is coming for your job too. I was struck by the title of an NYT op-ed by Jonathan Reisman, M.D.: I’m a Doctor. ChatGPT’s Bedside Manner Is Better Than Mine. As Dr. Reisman concludes:

In the end, it doesn’t actually matter if doctors feel compassion or empathy toward patients; it only matters if they act like it. In much the same way, it doesn’t matter that A.I. has no idea what we, or it, are even talking about.

I think of another quote from Professor Brynjolfsson, from a WSJ article earlier this year: “This recognizes that tasks—not jobs, products, or skills—are the fundamental units of organizations.”  I.e., when it comes to thinking about the future of your job, you really need to be recognizing which tasks in it could be done as well or better by automation/AI. They’re going to be more than you might like.  

The future is here.