During the Cold War, a heated debate arose over the role of economic planning. Did the “planned” economy of the USSR or the “free market” economy of the U.S. allocate resources more productively?

Arguments against planned economies centered on the limits of information processing, the feasibility of production forecasts and the inflexibility of centralized plans.

The Soviet Union’s collapse seemed to relegate the economic planning concept to the dustbin of history. But issues raised in those debates are still relevant today.

New research finds that the top 1% of American companies control 90% of U.S. production-related assets and account for 80% of sales revenue. This means a relatively small number of companies are responsible for the majority of U.S. economic activity.

For these companies, planning – particularly the coordination of activities across global supply chains – represents a significant strategic focus. Americans rarely think about the importance of planning, but it plays a crucial role not only in the availability of consumer products but the economy overall.

Thousands of products, millions of transactions

As a professor who teaches about supply chain issues, I have worked to understand the implications of planning.

Supply chain planning refers to the set of iterative, interconnected decisions aimed at continuously aligning company capacity, inventory and other assets to maximize profits. It integrates a range of decisions across different time horizons, from longer-term optimization of global supply networks to near-term scheduling of deliveries.

Planners also decide how much product to make or buy based on shifting consumer demand. And perhaps most importantly, they manage the time required to ensure that products arrive at the right time, in the right place and in the right form. They do this not just once but across thousands of products and millions of transactions each day.

Consider a typical Walmart store, which offers roughly 120,000 different products – technically known as stock-keeping units, or SKUs – at any given time. These products must be made available in over 10,000 stores worldwide – as well as online and at homes – 24 hours a day, seven days a week.

And they must be made available in an assortment that changes continuously, sometimes dramatically, based on consumer preferences and outside events. Products must be competitively priced, fueling a relentless search for lower input costs. Planners attempt to coordinate this vast network of people, products and places to profitably match supply and demand.

The best-laid plans

Sometimes plans work; sometimes they don’t. The most obvious signs of planning dysfunction are empty shelves and long wait times. Less obvious are billions of dollars in excess inventories. And even more deeply hidden are innovation delays and massive waste across the supply chain.

These dysfunctions are pervasive in most companies. But it took the COVID-19 pandemic to expose what many planners already knew: Dated planning technologies, gaps in talent and overstretched supply chains keep companies from delivering the goods.

For decades, planners have relied on enterprise resource planning systems – a form of business-management software – to integrate companies’ core business processes from raw material purchase to point of sale. Developed in the 1990s but often based on models from the 1960s, these systems can be rigid and have numerous built-in flaws.

What’s more, companies often use dozens – sometimes hundreds – of different systems to manage workflows and databases. As a result, planners must cobble together incomplete information from multiple sources to determine dynamic supply-and-demand requirements.

Automation’s potential

Automation, especially when it incorporates learning algorithms, has enormous potential for overcoming technological challenges. But the data requirements are daunting.

Those of us with a pantry full of toothpaste because we subscribed to a set-it-and-forget-it delivery service will appreciate the dangers of automating decisions based on a forecast. Solving that problem for a global supply chain requires extremely high-quality data coupled with sophisticated analytics. Most companies aren’t there yet.

And even if the systems are available, it isn’t clear that the people needed to operate those systems are ready. Businesses are increasingly turning to planners to direct supply chain processes.

But the knowledge, skills and attitudes that today’s planning professionals need are very different than what was needed just a few years ago. Planners today must be far more comfortable managing ambiguity, leading change and adapting to new technologies.

The need for planning talent comes at a time when labor shortages and training issues plague the supply chain. While innovative educational programs have emerged, it will take time to develop the needed talent.

Challenges and solutions for supply chain management

Finally, the global scope of today’s supply chains creates daily challenges for planning. Even assuming a company has the systems and people to optimize inventories for future demand, it still needs to move that inventory around the world.

So, in addition to solving a complex demand-supply matching problem, planners must execute that solution with planes, trains, trucks and ships. Even a passing glance at the headlines will give you a sense of how difficult that can be. Risks include global conflicts and infrastructure breakdown.

Companies are slowly shifting their supply chains to lower-risk places and establishing more regional networks. But creating new facilities and adding business partners takes time. It also takes systems and talent, because it’s planners who will make these decisions.

A brave new-ish world

The challenges facing companies today mirror the economic planning debates of the Cold War, with many of the same issues returning. There are clear differences with Soviet-style centralized planning. But an increasingly consolidated set of companies plan huge swaths of the U.S. economy.

For individual companies, planning failures can easily lead to business failure. And at the economy level, planning dysfunctions produce both excess and scarcity. That means too much stuff, but not the right stuff people need to improve their lives.

As the U.S. economic system faces its own challenges, the question may be whether it’s possible to plan our way to prosperity.

Daniel Pellathy, , University of Tennessee

This article is republished from The Conversation under a Creative Commons license. Read the original article.

More than 53,000 Americans are projected to die from colorectal cancer this year. Although colorectal cancer is the second-most common cause of cancer deaths in the United States, it can be cured if caught early. Detecting a tumor as soon as possible can help you get treatment as soon as possible, giving you the best chance for survival.

In my work as a gastroenterologist, I treat patients from every background and walk of life. Uniting them are a growing number of insurance barriers threatening access to timely care. All too often, payers take a long time to make coverage determinations, or they even deny them outright.

With the alarming rise of colorectal cancer diagnoses among Americans under 50, it is more important than ever for people to know their cancer risk and when to get screened.

Here are common questions I and other gastroenterologists get from patients about colorectal cancer:

What is my colorectal cancer risk?

Anybody at any age can develop colorectal cancer. However, some people may be more likely to get the disease than others.

For example, people with a family history of colorectal cancer or a personal history of polyps, which are abnormal growths in the tissue of the colon or rectum, may have a higher risk.

Inflammatory bowel diseases like Crohn’s and ulcerative colitis can also increase your risk of developing colorectal cancer. This is because the chronic inflammation associated with these diseases can promote the development of abnormal growths.

Race and ethnicity may also affect colon cancer risk. Black and Indigenous Americans are significantly more likely to develop – and die from – colorectal cancer. While genetics does play a role in disease development, much of the risk of colorectal cancer is linked to environmental factors. These include a person’s income level, types of food and groceries available in the neighborhood, access to primary care providers and specialists, and a wide variety of other social determinants of health.

Lifestyle factors like smoking, not exercising regularly and poor diet can also increase your colon cancer risk. Researchers have shown that red meat releases chemicals that can cause inflammation, while high-fiber foods and vegetables can help lower inflammation. Similarly, a sedentary lifestyle can also increase inflammation. Smoking can lead to harmful genetic changes in colon cells.

What are my screening options?

People with colorectal cancer usually don’t exhibit symptoms until the disease progresses to a later stage. That is why early and regular screening is critical.

The U.S. Preventive Services Task Force recommends Americans begin regular screenings at age 45. Recognizing that the incidence of colorectal cancer has grown among younger adults, the task force lowered the age from 50 in 2021. Screening may start earlier and occur more frequently for people who have an increased risk of colon cancer.

There are various screening methods, and your medical provider can recommend procedures based on your risk factors.

Many people choose to get a colonoscopy, which is a screening test that can also prevent cancer by removing precancerous polyps. It involves using a long, flexible tube with a light and a camera on the end to visually inspect the colon for signs of cancer, abnormalities in the colon lining, or growths such as polyps. Ultimately, colonoscopy screening can significantly reduce the incidence and mortality of colorectal cancer.

Other screening strategies include noninvasive stool testing, imaging scans and a combination of endoscopic visualization with stool-based testing.

Your doctor can help you select a test that aligns with your preferences, values and risk factors. Suggested screening approaches in people with an average colon cancer risk include a colonoscopy every 10 years, stool-based testing every one to three years, or CT scans every five years for those who are unable to have a colonoscopy as an initial screening test. A positive test result for these alternative approaches should be followed by a colonoscopy.

With routine screening, one out of every three colorectal cancer deaths can be avoided.

Why won’t my health insurance pay for my colonoscopy?

While colorectal cancer screening is free as a preventive service under the Affordable Care Act, some insurers are making it harder for people to get care.

For example, Blue Cross Blue Shield of Massachusetts proposed a 2024 policy that would have deemed the use of anesthesia in endoscopies, colonoscopies and other vital procedure as medically unnecessary. This meant patients would have had to pay out of pocket to cover the anesthesia needed for colorectal cancer screenings, potentially creating major cost barriers. The insurance company only reversed course after an outcry from physicians and patients.

Another troubling trend is expanded use of prior authorization, a process some health insurers use to determine if they will cover the cost of a medical procedure, service or medication. Insurers can delay or deny coverage of medically necessary care that physicians and medical guidelines recommend because they deem certain health care services unnecessary for a patient or too expensive to cover.

In 2023, UnitedHealthcare proposed a policy that would have required the 27 million people under their plan to obtain insurance approval before they could get diagnostic or follow-up colonoscopies. After protests from physicians and patients, the insurer put the policy on hold.

UnitedHealthcare has also made plans to introduce a program in 2024 that could involve prior authorization for colonoscopies. The insurer has released little information about why it feels such requirements are necessary, what services would require prior authorization and how it would protect patients from unnecessary delays and denials.

How can I lower my risk of colorectal cancer?

If you haven’t already, look into getting screened for colorectal cancer. Talk with your doctor’s office and check with your insurance company to understand what will be covered before your procedure. If you’re 45 or older, a colonoscopy can screen for and prevent colorectal cancer.

Younger adults can take steps to reduce their risk of colon cancer by adopting healthy eating and lifestyle behaviors. Being aware of personal risk factors and seeking medical attention for symptoms – such as changes in bowel habits, rectal bleeding, abdominal pain or unexplained weight loss – can help you discuss screening options with your health care provider.

If you have already had a colonoscopy and had polyps removed, make sure you know when you are due to return for a follow-up colonoscopy. It could save your life.

Andrea Shin, Associate Professor of Medicine, University of California, Los Angeles

This article is republished from The Conversation under a Creative Commons license. Read the original article.