The Best And The Brightest—NOT!


Leonard Zwelling

It’s bad enough when we have seen the death of truth due to a President of the United States who is only occasionally acquainted with it. When irony dies, that is sad indeed.

In Marc Tracy’s op-ed in the New York Times on February 5, he, a sportswriter for the paper, notes his chance meeting with Steve Bannon, the ex-Breitbart chief and current policy adviser to Mr. Trump. Mr. Tracy noted that Mr. Bannon was reading David Halberstam’s book, The Best and the Brightest. This 1972 work of non-fiction is about how the Kennedy team embroiled the United States in an unwinnable war in Southeast Asia. Mr. Tracy notes that the title was meant to be ironic because all of these brilliant people, most from Harvard, got the country into the most costly conflict in its history despite their putative brilliance. They were smart all right. What they weren’t was knowledgeable or wise about Southeast Asia and they were unwilling to listen to the career experts in the government who warned them about the hopelessness of a military engagement in that part of the world.

I confess that I have not read the book, but now probably will because I find that the sentiment reflected in the Tracy opinion piece is the one that I carry with me about both the current masters of the universe in the newly installed executive branch of the federal government as well as the geniuses running MD Anderson. Namely, they may be geniuses in something, but not what they are supposed to be doing now.

Mr. Bannon seems to have been a successful leader of Breitbart dealing in alt-right propaganda. Apparently he was also in the Navy, a movie producer and obviously pretty good at getting a know-nothing elected President. But now that he’s on the National Security Council he will have to advise the President on decisions that are as key as the ones those young Harvard grads helped President Kennedy make. Whoops! He knows nothing about national security, defense or economics.

In addition hundreds of members of the State Department and people involved in US intelligence had cautioned that the non-ban travel ban will make the country less safe, yet President Trump is tweeting that the “so-called judge” who stopped the ban has no right to do so. We shall see as this undoubtedly moves to the Supreme Court. Is the ban constitutional? Does it cripple American science, technology and education in a prejudicial fashion? To me, another know-nothing on such matters, that seems obvious. To Trump’s best and brightest, this seems a reasonable course of action despite the fact that never has a person from any of the seven named countries committed an act of terrorism in the US. And, countries like Saudi Arabia and Pakistan have donated a fair number of militant miscreants to our country. Why aren’t those countries on the list? As Saturday Night Live noted, probably because there are Trump hotels in those countries.

I am afraid the same is true at Anderson where none of the leaders of the institution has the life or work experience to address what needs to be done to fix the cascade of red ink and the dysfunction in the faculty spirit.

Now I have had a little experience in some of these matters as one of the leaders of institutional strategic planning in the mid-1990s (that didn’t go so well as the leaders then were not interested in planning for anything. I said I had experience, not success) and someone with a little experience working on health care reform both in Houston and on Capitol Hill. Here is what is needed at Anderson to get the ship sailing in the right direction.

1. A complete review of all non-revenue generating programs. And I don’t mean to exclude the pet ones of the current MD Anderson president that he told the Regents would throw off money, but have not. IACS and the Moon Shots must be included in the review.
2. A complete analysis of all contracts with third party payers. Who is paying and who isn’t? If they aren’t, why not? Are insurers diverting patients to lower cost providers? And by the way how is the efficiency of billing and coding at Anderson? Judging from the fact that I have been getting bills for three months that I paid last year, not great, I surmise.
3. What is the benefit and cost of all non-1515 Holcombe MD Anderson care sites? Does Anderson really need to franchise the number one cancer center in the world? If so, will Anderson remain number one? Who says it is anyway?
4. A detailed review of the true quality of care delivered at Anderson and I am talking about outcomes not parking. If Anderson is really better, prove it and not by saying it is so like Trump counts Inaugural crowds.
5. Where’s the money? What’s making money and what is costing money? For those things costing money without making money, why are they needed?

These are just some of the questions I would like to see answered, but I would like to see them answered by outsiders who really are the best and the brightest and actually know something about cancer care, how it’s delivered and how it’s paid for.

What a concept! Yes, that last sentence was ironic.

Leonard Zwelling