https://books.google.co.uk/books/about/Tracts_N_50_Antidote_...
https://books.google.co.uk/books/about/Tracts_N_50_Antidote_...
As for society itself being robust, it’s a much harder property. Being robust is nice but no one actually wants to live in a metered society where there’s insufficient resources - they’d generally rather kill for resources greedily and let others fail without helping them. That’s why socialized healthcare struggles - while it guarantees a minimum of care for everybody, the care provided has longer wait times and most people are not willing to wait their turn.
Healthcare is more complicated. It can never work as an efficient free market since nobody goes comparison shopping for the hospital with the best value-for-money when they have a car crash. That's why socialized healthcare achieves much better results per dollar spent. But it's often hamstrung by attempts at efficiency.
I think a better societal example is disaster relief: helping people back up after they have been hit by a hurricane is the humane thing to do, but how much is that encouraging people to settle in high risk areas with insufficient precautions?
I think the complexities of modern societies make it too difficult to measure this risk adequately. We just don’t have the bandwidth to think about the second-and-third order effects for every social/financial interaction we encounter. And people are generally very poor at estimating high-consequence/low-probability events. This means people will often take very outsized risks without realizing it; when bad things happen it creates an unstable society. I don’t think we’ve evolved to personally manage all the c risks in a large complex society and farming those risks out to institutions seems to be the current way most societies have decided to mitigate those risks.
I can see how you could arrive at similar conclusions from a risk management perspective, but it's not a morally just system. Within the system risk taking must be accepted.
Unfortunately, those institutions --be they governments, insurance companies, UL Labs, banks, venture capitalists, etc.--also need to be vetted.
Even when staffed with impeccably well credentialed and otherwise highly capable people, their conclusions may be drawn using a different risk framework than your own.
The risk that they mitigate may even be the risk that you won't vote for them, give them money, etc.
There is also the risk of having too little risk, a catastrophe no worse than too much risk. The balloon may not pop, but it may never be filled.
Socialized healthcare has its advantages and is probably more cost effective on average. But we also see affluent Canadians coming to the USA as medical tourists and paying cash for MRI scans in order to avoid the queues back home.
Patients have the time but rarely have the actual ability to shop around outside asking "is this provider in my coverage plan?" They demand me to sign a document stating I'm willing and able to pay while often never being able to actually tell me what the procedure will actually cost. Often, they won't even know that same day the procedure is done, it'll be weeks before I'm actually invoiced. And don't even get me started when you've chosen the surgeon in your plan, the facility in your plan but it turns out the anesthesiologist they scheduled wasn't in your plan. Oops. That's an expensive mistake you made, should have shopped around!
My knee kept locking up and I'd experience tremendous pain. Only once every few weeks though, so I had time to "shop around". I called up several places and tried to get an estimate of what it would cost ahead of actually seeing the doctor. Nobody would actually offer that, they could only make an appointment to see the doctor. No idea what the doctor would actually want to do during that appointment, so who knows what things will cost. Will they want x-rays? Will they want an MRI? Can they do the MRI there? Won't know until you commit to paying!
And out of the few dozen choices of kinesiologists around me which were covered by my insurance few had any appointments available within the next several weeks. Many weren't seeing new patients. So really it was deal with my knee randomly causing me immense pain for several more months or take whoever had the first appointment. And this is in one of the top five largest metro areas in the country, not some small town in the middle of nowhere.
Shopping for which hospital to do the delivery of my children, the estimates for our costs after insurance had a massive amount of uncertainty to the point of being useless. Could be $4k, could be $20k, who knows. Imagine going to a burger joint and the menu says a burger could be anywhere from $1 to $50, we'll invoice you in a month. Go down the street, menu says it could be $3 to $48, we'll invoice you in a few weeks. What an ability to shop around! Free market at work!
> avoid the queues back home.
I already mentioned, most kinesiologists around me were fully booked for months. Very few had anything within several weeks. That's queueing.
I tried to book an appointment with a new dermatologist a few months ago. Once again, in this very large metro area. For dermatologists in my area covered by my insurance, the earliest appointment was six months out. It took several months to get a family member's hip replacement scheduled. We have queues in this country as well.
Getting medical imaging is generally pretty quick and easy though, and places like MRI imaging centers just want to keep moving people through so if they have an empty spot in an afternoon having someone in the machine constantly is important. It's also generally the easiest thing to automate in healthcare; mostly just a matter of getting enough machines and lightly trained techs to rotate people through. Radiologists are often off-site contractors getting paid for every scan they review.
The No Surprises Act does give patients some protection against high charges for out-of-network services.
https://www.cms.gov/newsroom/fact-sheets/no-surprises-unders...
Ok, but then it goes back to this idea of queueing and the "free market". Ok, so it'll take me a few weeks to go to the first doctor just to get his paid estimate. If I don't like whatever estimate he gives (which once again he probably won't directly) what am I to do? Start calling around, make another appointment with someone else several weeks later and pay yet another appointment fee? Hope his prices are better? Rinse and repeat to get a few quotes?
And so continuing the burger example, you call ahead to book a time well in advance and pay $2 just to be able to look at the menu. What a free market.
One of my kids had to get tubes in his ears. I didn't actually get a good faith estimate of cost until that morning in the hospital despite calling several times. I had to schedule, wait weeks, show up early in the morning, and refuse to sign for the financial liability until I got an actual estimate. Free markets at work here guys, totally not a broken system, easily just shop around. And yeah, sure, I could have gone to see a different audiologist and then gone through scheduling it all again and waiting another few months and a couple hundred dollars. After all its just my kid's speech development, no big deal delaying that another month or two (or three).
At least it's good to see this No Surprises Bill solved at least that one example of the healthcare industry screwing people over. Thanks for sharing that.
“Too big to fail” is a meme that only applied to a tiny handful of companies during the financial crisis. Take a look at SVB for how fast a stalwart huge bank can implode with zero fucks given by the government.
What you’re thinking of is FDIC which is completely the opposite of a bailout for the bank. It’s a bailout for depositors (a huge portion of which were normal people). Arguments for the FDIC protecting people from keeping money in bad banks is a different argument, but it most certainly isn’t a bailout.
If you think going bankrupt and the FDIC seizing your company and wiping out shareholders is a bailout, you don’t know what a bailout is at all. That’s standard bankruptcy with an extra heavy boot on the throat from the government because they are ruthless about maintaining consumer confidence in the banking system.
My idea on working around this: for any business with actively traded stock there is a salary cap, say $1m/yr *per year*. You want to pay that guy $10m/yr? No, you pay him $1m and he gets 9 sets of shares that are worth $1m now, but they will be delivered one a year. Next year, same thing, you give him $1m, one set of shares from the previous year is delivered to him, he's got 9 new sets coming. So long as you have such shares forthcoming you are not permitted to engage in any trade where you would gain from the stock going down. If you do so inadvertently (say, investing in a fund that shorts the stock) any income from that is taxed at 100%.
The idea is to make your top people care about the long term prospects of the company, not merely the prospects of their area for whatever time they're in charge of it.
In fact I think a pretty small fraction of patients arrive at the ER unconscious.
I expect the objections are in how quality is measured and enforced.
It reminds me of education system in the US - most people (project 2025 aside) think it's good to have a public education system; having a pipeline of skilled workers makes it easier to build an economy filled with a diverse set of businesses.
However, the attacks start to fly when there is disagreement about who should be allowed to teach, how they should be measured, and how they should be paid.
* has the same capacity to research an unknown number of medical procedures and the doctors performing them as they do researching onion prices or CPU specs
* faces a similar scale of consequences when failing to properly analyze medical procedures as they do when they fail to properly price-compare onions or PC services
* has the same freedom of choice to "purchase their preference" in an emergency, life-threatening situation as they have when shopping for PCs or groceriesI think it is fine to have some preferences for a hospital, but not sure how much benefit that confers outside of some narrow situations.
(This is quite unlike the common view that businesses inevitably grow to take over the world.)
I.e. business is much like a living organism.
Problems set in when the government bails out failing businesses.
Even worse are government "businesses". They are not allowed to fail, and the inefficiencies, parasites, corruption, grow and grow. When can you remember a government agency being abolished? Eventually, the government will collapse.
I'm thinking of a reasonably recent article I saw that was talking about helping people navigate the 30+ assistance programs they might be eligible for. There's your problem right there--there should not be 30+ programs doing approximately the same thing! That's an awful lot of duplication of effort.
Or look at what happens with business licenses. Two things I see:
1) They want their $ from entities that shouldn't really be "businesses" in the first place. Around here an awful lot of licensed professionals have to have a "business" license--never mind that the nature of their work means they're inside some other entity that actually is reasonable to license. And that means a sales tax registration which has an annual minimum that such people almost certainly will never reach. (Sales tax includes use tax--but it's their office that actually engages in such transactions.)
2) Businesses that perform their work on-site have to have business licenses for every license area of the metropolitan area they work in. Hey, guys, get together and define the superset of the rules of your area and allow someone to get a license that covers the whole area based on that superset.
The Republicans are "right" in that we have far too many regulations. But they are very wrong in wanting to take an axe to them--most of the rules are individually sensible (and when they produce nonsense it's often situations where it's not worthwhile to special case), there is a horrible problem of duplication of effort and fingers in the pie. It's not chopping that's needed, it's organization.
In the UK the last I specifically remember is DFID, which shut down in 2020.
In Commonwealth countries and the UK itself there are plenty of businesses called “crown corporations” which are owned by the government. Change in attitudes towards more liberalism led governments to deregulation and selling off bits and pieces or the entire corporation. Here are some Canadian examples:
https://www.cbc.ca/news/politics/canada-post-it-innovapost-s...
https://policyoptions.irpp.org/magazines/march-2024/mulroney...
America is a relatively young country and has very peculiar philosophies sometimes not found in the rest of the world. Be very careful extrapolating an American perspective abroad or as capturing some elemental truth of the universe.
And the owners could have sold when the business was propped up by unknown fragility.
Human lives are too short for these kinds of feedback loops to be all that effective.
Very long waiting times are the first thing that comes to mind regarding such failures, with UK and Canada at the top spot. It is not uncommon to die waiting for a consultation to be diagnosed in 1-2 years.
Almost all EU countries with socialized healthcare beat US and even UK. Canada is more near EU level.
Do you also want US anedoctal evidence? What’s the consultation time for diagnose in the US for people without insurance/ insurance doesn’t cover/insurance says it doesn’t cover/no money?? Never? How does that affect the average/mean?
Life Expectancy:
Italy 83.7; Spain 83.7; France 83.3; Sweden 83.3; Canada 82.6; Portugal 82.4; Germany 81.4; United Kingdom 81.3; United States 79.3; Poland 78.6;
https://ourworldindata.org/grapher/life-expectancy-unwpp?tab...
Edit: I would also add that it is probably better to look at health outcomes, e.g., survival rates for cancer.
Here in BC, we have (mandatory) auto insurance provided by a crown corporation with a monopoly. The neo-liberal government before the current more socialist leadership hated it and wanted desperately to privatize car insurance. The problem is that ICBC is dearly loved by most residents here. There is a playbook for this problem.
They appointed a fairly incompetent civil servant to run things, and also started raiding the fund, to the tune of billions of dollars.
After about a decade of this, the company was a mess and nearly broke. They were forced to raise rates. The premier characterized the situation as a "dumpster fire" and editorials started popping up arguing for privatization.
That government was defeated, and the new leadership sorted it all out. Within a couple of years, drivers in BC were getting cheques in the mail because ICBC was making too much profit.
There are powerful interests very interested in getting a piece of healthcare in Canada, and some of the shenanigans you see here smell a lot like a set-up to make things become broken enough that the voters will demand privatization.
Just for one example, in the last few years staffing agencies have been hiring away nurses by offering higher wages and then contracting them back to the health authorities at ~$130/hr. This has cost billions to taxpayers and lead to great resentment within the regular staff.
Some folks somewhere allowed this to happen. Why?
Maximizing efficiency in the short-term is not the same as maximizing survival in the long term.
[0] https://www.sciencedaily.com/releases/2017/09/170908205356.h...
This is something that Nassim Taleb and the people working on https://realworldrisk.com/ have been saying for decades already.
Highly optimized systems take full advantage of their environment and rely on a high degree of predictability in order to avoid redundant operations.
These systems minimize the free energy in the system, and so very little free energy is available to counteract new forces introduced to the environment which act on the system.
You'll find parallels in countless domains, since the very basis for learning and stabilization of a system revolves around becoming more or less sensitive to a given stimulus. Examples could be attention, supply chain economics, institutions, etc.
The only solution I see is for the FDA to include supply reliability in it's determination of whether a system is acceptable.
>capital concentration increases
>expectations for what capital owners can do with money increases
>expectations exceed available capital
>investment returns must increase (race to the top)
>cooperation among capital owners must increase to get better returns
>capital owning group begins to self-select and become less diverse, if this wasn't already caused by the background/personality required to accrue capital
>investment theory converges on a handful of "winning" ventures
>because this is where capital is flowing, workers are forced to divert to these ventures
>competition increases, hyperspecialization increases
>expertise in and sophistication of other areas begins to decline, causing quality decline, garnering less investment; feedback loop
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*debt cannibalizes future productivity
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)diversity in capital ownership and management increases likelihood of diversity in investment venture target
)increased competition, increased likelihood that ventures will cover needs, decreased likelihood of overweighting in one area/overproduction
)solution: capital redistribution. Perhaps globally
It does both, eg. if the environment is stable then fitness is correlated with efficiency, if the environment is unstable then it's robustness.
It's tempting to minimize waste, but excess capacity is required to adapt if things are evolving quickly.
His main thesis is that very high performance (which he defines as efficacy towards a known goal plus efficiency) and very high robustness (the ability to withstand large fluctuations in the system) are physically incompatible.
…what about humans? We’re far more efficacious than any other animal, and far more capable of behavioral adaptation.Plus, isn’t “physically impossible” a computer science argument, not a biological one? Unless we’re using the OG “physis”==“nature”, I guess
I know I'd tolerate a digital experience of far lower fidelity (fewer pixels, for instance, or even giving up GUIs altogether) if I could get it in a way that doesn't break every time some far away person farts near a cloud console: A trade of performance for robustness.
A major mechanical casualty beyond what the crew can repair usually means a tow to a shipyard. Flying more engineers in by helicopter would seldom help, and often isn't feasible.
Btw- reliability optimization doesn’t necessarily mean it is optimized to not fail. They are optimized to fail within some predetermined risk level. What that risk level should be is an entirely different discussion.
Why do you think this?