One of the things that kept me sane during my recent stay in hospital was dipping into Gabriel Winant’s, The Next Shift. It is an extraordinary account of the way in which working-class family lives, heavy industrial labour and hospital and care work were intertwined in America’s quintessential steel town, Pittsburgh and the state of Pennsylvania.
So very relieved to hear of your positive heart surgery outcome, Mr. Tooze, and appreciate you sharing both your personal experience and your reading suggestions. Wishing for you a rapid return to your old self and continued good health and perkiness to you and your Beloveds in the coming year!
Thank you for another great article. Gabriel Winant's article in Historical Materialism is open access for those wishing to read further (issue 32 number 2).
First and most importantly, it’s great to hear about your recovery - you seem to be firing on all cylinders already.
Next, you have prompted me to read the Winant book.
Finally - and from the perspective of being a doctor in a very sub-specialised field, while my wife is 37 days into staying 400 miles away to try and resolve her father’s care needs, I absolutely agree that good nursing is the glue that holds healthcare together.
My follow-on reply to your point about ultra-specialised care to guarantee best outcome (ie your cardiothoracic surgery), is the equal need for ultra-local non-specialised care with SAME aims of best possible outcome. My (95 year-old) father-in-law “just” needs someone to sort out best possible place for him to live, and in meantime help him get dressed and to the toilet.
Adam Tooze, you took us on a crucial journey about healthcare in America for the working-class, plugging into fundamental aspects of life; health, the economy, class, jobs, location and politics. Thank you for sharing your personal experience; The Next Shift by Gabriel Winant; photographer, LaToya Ruby Frazier, and her work as well as your podcast with Cam Abadi. Congratulations also to your 'brain struggling to catch up' because you delivered a big, consequential and clearly stitched story about America's medico-industrial complex.
When you're up to it, Adam, I'd love to learn from you what Polanyi got wrong in The Great Transformation -- and, for that matter, what Keynes got wrong in The Economic Consequences of the Peace. All best to you for 2025.
You also benefited from centralization of procedure-driven health care. Patient outcomes in cardiac surgery are basically related to how many procedures a year the surgeon and the care team (anesthesiologist, operating room techs, RNs, cardiac care post-op, labs, etc)--get to do and do well.
Small hospitals that do occasional procedures are generally not very good at procedures--like pilots who only do mountain landings every once in a while, and--aren't great at it--it turns out you have to do enough of a thing to be good at it.
Korea: "...the mortality rate in hospitals that performed more than 200 surgeries annually was less than half of that in hospitals that performed 49 or fewer surgeries annually."
Absolutely right Roger. Good to hear AT is on the mend - but the reality is that clinical outcomes in many specialist services are directly proportional to a critical mass of (high tech & complex) procedures routinely undertaken by medical specialists at a single institution. Even the working class prefer their operations to be successful rather than local, I think you’ll find. 😃
The image of Braddock Hospital is very striking. In this moment, it made me think of another hospital in another place: Kamal Adwan. I wonder how it might be if someone were to exhibit such images together.
Glad everything went well and wishing you all the best, dear Adam Tooze! And as always a cornucopia of brilliant thoughts, ideas, discoveries and recommendations... Thank you for inspiring this community of substackers!
I would appreciate your thoughts sometime on "Never Too Much," a review by Trevor Jackson of the University of California of Martin Wolf's new book on the relationship between capitalism and democracy. In a moment when we're struggling to see our way home, this review-cum-essay seems to me instructive.
I wish you all the best in your recovery, I ordered the book, and I’m very curious to see how that links to the Allegheny health bankruptcy in the late 90s.
"One might ask whether this can really do justice to the dynamism and performance of American health-care, which on many metrics has produced significant improvement in health outcomes through the large-scale application of sophisticated imaging and interventions."
Five year survival rates for most cancers has not improved that much in decades, causality of said increase in survival is not necessarily for "advances" in treatment:
So very relieved to hear of your positive heart surgery outcome, Mr. Tooze, and appreciate you sharing both your personal experience and your reading suggestions. Wishing for you a rapid return to your old self and continued good health and perkiness to you and your Beloveds in the coming year!
Thank you for another great article. Gabriel Winant's article in Historical Materialism is open access for those wishing to read further (issue 32 number 2).
Wishing you all the best.
Dear Adam,
First and most importantly, it’s great to hear about your recovery - you seem to be firing on all cylinders already.
Next, you have prompted me to read the Winant book.
Finally - and from the perspective of being a doctor in a very sub-specialised field, while my wife is 37 days into staying 400 miles away to try and resolve her father’s care needs, I absolutely agree that good nursing is the glue that holds healthcare together.
My follow-on reply to your point about ultra-specialised care to guarantee best outcome (ie your cardiothoracic surgery), is the equal need for ultra-local non-specialised care with SAME aims of best possible outcome. My (95 year-old) father-in-law “just” needs someone to sort out best possible place for him to live, and in meantime help him get dressed and to the toilet.
From each, according to ability…
All best to everyone. Happy Old Year!
Matt Parton
London UK
Adam
You put out such great stuff, but this for me was a fantastic one. Just wanted you to know it inspired me to upgrade.
Adam Tooze, you took us on a crucial journey about healthcare in America for the working-class, plugging into fundamental aspects of life; health, the economy, class, jobs, location and politics. Thank you for sharing your personal experience; The Next Shift by Gabriel Winant; photographer, LaToya Ruby Frazier, and her work as well as your podcast with Cam Abadi. Congratulations also to your 'brain struggling to catch up' because you delivered a big, consequential and clearly stitched story about America's medico-industrial complex.
Thank you, again, and take care.
May you have a quick recovery.
When you're up to it, Adam, I'd love to learn from you what Polanyi got wrong in The Great Transformation -- and, for that matter, what Keynes got wrong in The Economic Consequences of the Peace. All best to you for 2025.
What are the wrongs in those great books?
Glad you’re doing well, Adam!!
You also benefited from centralization of procedure-driven health care. Patient outcomes in cardiac surgery are basically related to how many procedures a year the surgeon and the care team (anesthesiologist, operating room techs, RNs, cardiac care post-op, labs, etc)--get to do and do well.
Small hospitals that do occasional procedures are generally not very good at procedures--like pilots who only do mountain landings every once in a while, and--aren't great at it--it turns out you have to do enough of a thing to be good at it.
Korea: "...the mortality rate in hospitals that performed more than 200 surgeries annually was less than half of that in hospitals that performed 49 or fewer surgeries annually."
https://pmc.ncbi.nlm.nih.gov/articles/PMC5173334/
Moreover, the longer a hospital does more procedures, the lower the fatality rate goes...
(United States: MediCare beneficiary data)
https://pmc.ncbi.nlm.nih.gov/articles/PMC4069246/#:~:text=Conclusion,compared%20to%20lower%20volume%20hospitals.
And the difference in mortality--in whether you make it off the table--can be as great as 4.5X...
(United States, MediCare beneficiary data)
https://pubmed.ncbi.nlm.nih.gov/11948273/
It's best to have a MDs and teams that do things a lot be the team that does something to you if you have to get it done.
Absolutely right Roger. Good to hear AT is on the mend - but the reality is that clinical outcomes in many specialist services are directly proportional to a critical mass of (high tech & complex) procedures routinely undertaken by medical specialists at a single institution. Even the working class prefer their operations to be successful rather than local, I think you’ll find. 😃
The image of Braddock Hospital is very striking. In this moment, it made me think of another hospital in another place: Kamal Adwan. I wonder how it might be if someone were to exhibit such images together.
May you recover quickly and well!
Glad everything went well and wishing you all the best, dear Adam Tooze! And as always a cornucopia of brilliant thoughts, ideas, discoveries and recommendations... Thank you for inspiring this community of substackers!
Dear Prof. Tooze,
I would appreciate your thoughts sometime on "Never Too Much," a review by Trevor Jackson of the University of California of Martin Wolf's new book on the relationship between capitalism and democracy. In a moment when we're struggling to see our way home, this review-cum-essay seems to me instructive.
Jeff Lang
Chapel Hill, NC
Fetterman may have once been a maverick, but now he's just another moron who doesn't get it. It might have something to do with his stroke.
I wish you all the best in your recovery, I ordered the book, and I’m very curious to see how that links to the Allegheny health bankruptcy in the late 90s.
I have a post on this quote from this post:
"One might ask whether this can really do justice to the dynamism and performance of American health-care, which on many metrics has produced significant improvement in health outcomes through the large-scale application of sophisticated imaging and interventions."
Five year survival rates for most cancers has not improved that much in decades, causality of said increase in survival is not necessarily for "advances" in treatment:
https://federicosotodelalba.substack.com/p/on-cancer-survival-rates-from-our?r=4up0lp