Being Mortal


My mother gave me Atul Gawande’s new book, Being Mortal, for Christmas.

In our family, we celebrate this Christian holiday by telling each other what gifts we want, so in some sense I gave this book to myself. That being said, I do try and tell my mother to give me gifts that I think she will enjoy giving me, so I did put some thought into the request. Gawande is an exceptional writer and Indian, a combination that appeals to my mother.

Personal Preferences and the Practices of a Profession 

Although the elderly population is growing rapidly, the number of certified geriatricians the medical profession has put in practice has fallen in the United State by 25%…. Whether we admit it or not, a lot of doctors don’t like taking care of the elderly.”

This is a small but important point: personal preference can drive the priorities of a profession, especially in non-market based sectors of the economy.

I think about this a lot in terms of executing the No Excuses model. A lot of this execution can be a grind. It would not shock me if the limits to the model scaling include the personal preferences of educators.

Design Thinking From the Wrong Perspective

“As one scholar put it, describing the history of the nursing home from the perspective of the elderly ‘is like describing the opening of the American West from the perspective of mules; they were certainly there, and the epochal events were certainly critical to the mules, but hardly anyone was paying very much attention to them at the time.'”

Could we make the same argument for children / schools?

Perspective and Meaning 

“Even when a sense of mortality reorders are desires, these desires are not impossible to satisfy.”

According to research, the more we have to contend with life’s fragility, the more we find meaning in circumscribed pursuits (close friends, simple pleasures); when we feel death is far away, on the other hand, we find meaning in expanding both our knowledge base and friendships.

As it happens, old people are generally happier than young people.

Or to think about it another way: the activities that likely lead to societal innovation (ambition, pursuit of knowledge, etc.) don’t necessarily lead to the highest levels of happiness.

The negative here is that it’s hard to manage ambition and happiness.

The positive is that, to the extent happiness can be achieved by narrowed pursuits, it’s likely that it’s not a state that requires immense wealth.

It can be there for everyone.

Cost Benefit

“In the United States, 25% of all Medicare spending if for the 5% of patients who are in the final year of life, and most of that money goes for care in the last couple of months that is of little apparent benefit.”

Annual medicare spending is about $600 billion.

As it happens, annual K12 public spending is about $600 billion as well.

So we could increase K12 spending by 25% by shifting funds out of Medicare for which there is “of little apparent benefit.”

Why do we spend this money when there is no apparent benefit? Robin Hanson would say because it makes us feel like we’re good people. He’s probably right.

Would increasing education spending by 25% do any good? That’s an open question.


Gawande ends the book by writing about his father. It is beautiful and moving.

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