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mwengler40

Well, let me ask a rather pointed question: Do you consider any existing successful healthcare systems undesirable?

If it is "successful" how could it be "undesirable?" The answer is that you are using one set of value judging criteria to judge success and a different set of criteria for judging desirability.

So a slightly subtle answer to your question is, I use the same set of value judging criteria to rate something successful as I do to rate it desirable, at least in health care systems. And let me state what they might be:

  • provides the maximum effect for the resources used

  • maximum effect includes:maximizing average quality-weighted lifespan of the the population covered by the system.

  • lifespan metric is weighted by degree of full functionality, that is various deficits like unable to run, unable to walk, unable to talk, blindness, deaf, missing limbs, confined to nursing home, confined to hospital, would all and each reduce the weighting of years of life in the metric. So procedures which reduce functional deficit increase the success metric. Procedures which extend your lifespan increase the metric, but they don't increase it much if the lifespan added is spent confined to a hospital.

  • physical coercion or the threat of its use 1) provides a large quality hit when actually used, and 2) is only used when the quality of the lives improved are other lives than the person being coerced. So my system would allow for the requirement of vaccinations to reduce diseases that spread through the population, as a precondition for being allowed to associate with the population. My system would not attempt physical coercion to get the obese to lose weight, the smoker to quit smoking, or the racecar driver to slow down.

  • the general coercion of taxation is not part of the medical system but rather is orthogonal. If a society which is in some broad sense "democratic" is willing to vote itself in the taxes to try a particular medical system, and that medical system works brilliantly according to the metrics above, then I consider it a success and desirable. I'm not too concerned about some medically coercive dictatorship, so I'll concede all points that relate only to them to you right up front.

Note my success criterion doesn't include whether the system is national health or free market or individual choice. It primarily includes that it ACTUALLY results in better outcomes. So a brilliant system of exercise and vegan diet would only rate highly on this metric if it ACTUALLY resulted in people living longer higher quality lives. If it fails for any reason, it is not a success, whether it is because people refuse to eat vegan or because eating vegan doesn't have the health benefits originally thought.

I think it is remarkable that none of your criteria involve a metric of success in producing or promoting health. The closest you come is access to healthcare, which I am concerned means I can easily get procedures that may or may not actually help me, but whether they actually help me is irrelevant to whether the system is succeeding, as long as I can get them.

So are our values so far apart as to explain any difficulty we have even discussing this?

Reply
fubarobfusco00

lifespan metric is weighted by degree of full functionality, that is various deficits like unable to run, unable to walk, unable to talk, blindness, deaf, missing limbs, confined to nursing home, confined to hospital, would all and each reduce the weighting of years of life in the metric.

It seems to me that this sort of procedure has some problematic consequences in how it ranks possible futures. Consider these two possible futures:

A. Alice, an able-bodied person, lives for another year as such.
B. Alice lives for another year but loses the use of her le... (read more)

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0OrphanWilde
I don't have an objective mechanism of evaluating whether or not a system actually promotes health. The issue is exemplified in comparing Japan's health system to the US; do you compare averages of everybody, or just the averages of, say, Japanese-descended people living in the US? Somebody whose lineage traces back to Japan does as well in the US as in Japan, is the issue. Comparing the two health systems of the basis of population health ignores that the healthcare system may represent only a minority contribution to the health of the population. It's not that I don't think it's an important criteria, it's that I don't believe I have any mechanism of reliably measuring it; to the extent that it can be measured, I judge it being measured in the "Innovation" column, which produces in successes a better healthcare system. (That is, I believe the metric of success in promoting health is better measured at the rate of change in the system's ability to promote health.) I do agree that taxation is orthogonal to healthcare, which is why I'd prefer a national healthcare system with private options to the healthcare bill we got, which directly violated my #1 criteria.
See in context
by OrphanWilde
1 min read
167

-4

In line with the results of the poll here, a thread for discussing politics.  Incidentally, folks, I think downvoting the option you disagree with in a poll is generally considered poor form.

 

1.) Top-level comments should introduce arguments; responses should be responses to those arguments.

2.) Upvote and downvote based on whether or not you find an argument convincing in the context in which it was raised.  This means if it's a good argument against the argument it is responding to, not whether or not there's a good/obvious counterargument to it; if you have a good counterargument, raise it.  If it's a convincing argument, and the counterargument is also convincing, upvote both.  If both arguments are unconvincing, downvote both.

3.) A single argument per comment would be ideal; as MixedNuts points out here, it's otherwise hard to distinguish between one good and one bad argument, which makes the upvoting/downvoting difficult to evaluate.

4.) In general try to avoid color politics; try to discuss political issues, rather than political parties, wherever possible.

 

If anybody thinks the rules should be dropped here, now that we're no longer conducting a test - I already dropped the upvoting/downvoting limits I tried, unsuccessfully, to put in - let me know.  The first rule is the only one I think is strictly necessary.

Debiasing attempt: If you haven't yet read Politics is the Mindkiller, you should.

Personal Blog

-4

Mentioned in
Politics Discussion Thread August 2012
3FiftyTwo
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[-]Vladimir_Nesov190

In line with the results of the poll here

The poll (link) was a mess, so it's incorrect to justify this project by its "results".

Reply
[-]steven0461270

Also, if you post a poll late in a politics thread, you'll disproportionately reach people who 1) are interested in politics and 2) didn't think the thread was a failure.

Reply
0OrphanWilde
What signal I can get from the poll suggests this project, which may be continued or discontinued based on its success or failure.
1steven0461
It seems suboptimal to only use a single poll result when we have a lot more data available. For example, there was a poll here.
0OrphanWilde
Which is measuring the result of a particular thread of conversation, which is not -quite- the same as judging whether or not the conversation should have been had to begin with. That would be substituting your posterior certainty of a particular claim for your prior certainty for all subsequent claims. It's data, but you'd need a lot more of that kind of data in order to make claims with any kind of certainty about what your prior certainty should be going forward. There's also the question of whether that data would be collected at all if a particular line of conversation were productive.
1Alejandro1
I had also made a poll on this question once; it ended up exactly tied, so I decided to keep the status quo and not create a politics thread. But I was in favor of creating one, as I argued here.
-2OrphanWilde
With consolidated evidence, LWers should Aumann update over whether or not they can Aumann update over politics...
0FiftyTwo
This thread and the other rare times I see LW commentators political leanings make me see how radically I have miscalibrated my estimations of them. This is useful information of a sort. It is probably helpful for people to be reminded that 'rational' people can disagree with them. Whether the quality of the actual discussions is much above what you'd get on any other forum I don't know, it seems notably more aggressive than standard LW discussion.
[-]BobDylan60

Is it just me or are far right wing geeks, as rare as they are, much more formidable and scary than far left wing geeks?

Reply
[-]OrphanWilde130

In terms of debate ability, or in general?

If in terms of debate, there's a selection bias at play there; left-wing is the default among geeks. Those who are out of the closet and on the right will have argued extensively with their fellow geeks and will have thought a lot harder about their beliefs.

Reply
[-]Multiheaded50

John N. Gray, an essentially hopeless, anti-progressive, left liberal. Like M.M. or yours truly, he identifies "Universalism" (or just secular humanism in his words) as the direct and "true" philosophical heir of Christianity, but claims that it is useless, leads only to suffering and cannot break the cycle of history:

Central to the doctrine of humanism, in Gray’s view, is the inherently utopian belief in meliorism, namely that humans are not limited by their biological natures and that advances in ethics and politics are cumulative o

... (read more)
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[-]mwengler40

All functioning societies have mechanisms for reducing income inequality. Therefore the only real questions are: 1) what are our preferred mechanisms and 2) how much redistribution is optimum.

Popular choices of mechanisms are non-government charity, tax policies (ranging from progressive income tax to no sales tax on food and clothing), welfare, and public education.

Popular choices of the optimum amount of redistribution are harder to characterize.

My particular political statement here: the government is uniquely efficient (potentially) at redistribut... (read more)

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0Eugine_Nier
Well, that depends on what you mean by "efficient", if you only care about how much gets distributed and not to from whom or to whom then it is certainly most efficient. If on the other hand you think of redistributing income as a sub-goal of increasing everyone's living standards, say, then this statement is highly dubious.
4mwengler
It is well established that the marginal utility of a dollar is higher for poor people than for rich people, so in the short-term, net utility is trivially increased by redistribution even though not everyone's utility is increased. Tossing out all net improvement because some people lose a small amount to support large gains elsewhere seems like poor policy to me. But I am interested in the longer term, not the shorter term. In the long term, arguing against redistribution is the concern that productive people will be disincentivized to use their talents as much if they can't accumulate more compared to a non-redistributionist scenario. Arguing for redistribution is a concern that the more unequal a society, the less basic cohesion there is with multiple bad long term results: 1) the more force (police, eavesdropping, limitations on political expression) must be used, 2) reduced input into the education of the poorer classes, resulting in less talent developed at higher expense within the society as a whole. The 2nd point is a little subtle. People tend to sort themselves into what they are good at. If all N people in my society have access to education, I'll have a reasonably close to optimum self-sorting of people into jobs that they are talented at. If instead my society has stratified, and only 10% of families have the resources to educate their children to be doctors, lawyers, and indian chiefs, and the rest wander the streets selling chewing gum to passing tourists and mowing lawns, then I the most productive cadre of my society will be reduced in efficiency since it is drawing its talent from only one-tenth the human resources it would have drawn from in a more equal society. So my reason for supporting redistribution is to keep the talent pool large so we don't pay an excess in training costs for a more mediocre top layer in our society.
1Eugine_Nier
Another argument is that in capitalist societies, someone who made a lot of money probably made it by making products people want, thus increasing general utility. This suggests that he is particularly good at figuring out how to spend money to increase utility, likely better at it then both the redistributers and whoever they're redistributing the money to.
-2Eugine_Nier
I'm not sure if this is the best place in this thread to say this, but here goes: In several of the calculations throughout this thread you seem to be assuming that the redistributers themselves are completely efficient and incorruptible.
1Manfred
Well, that depends on what you mean by "increasing everyone's living standards." If you mean "people have square-root-shaped utility of money, so moving money from rich people to poor people increases total utility," then all that really matters is the redistribution. If you mean "by increasing economic activity, since poor people have lower rates of saving, thus creating more wealth," then... no, wait, the redistribution is still pretty much what matters. Ah! If you mean "giving poor people more opportunities, thus leading to better use of human capital, increasing everyone's living standards," then you want to give the most help to the poor people who are going to take new opportunities based on more wealth. The question is then, do you have anything in mind when you refer to things that are better than, say, a public education system at providing poor people new opportunities?
1mwengler
Thank you for figuring out what I was thinking! One of my many problems in any discussion is I can't figure out which things I need to state because there are other interpretations and which things I can leave unstated because everyone will quickly read it the same way. This is the one I mean. I am fascinated by the progress human kind has made so far. I am interested in bringing that to new levels, and one way to do that is to use the pool of human resources we have ever more efficiently. Getting rid of arbitrary limits on what women or black people were allowed to do has been a great help in that goal. Avoiding a debilitating stratification may also be important. Having raised kids, it seems unlikely to me that institutionalized public education for a nominal 6 hours a day (two hours work in 6 hours?) is all that need be done. Meanwhile, we observe that the more money a family has, the more they spend on advantages for their children. So while inexpensive or free public education is one good approach, another is just making poor families relatively richer generally. Which is most efficient? That is a discussion I think we should have, and i don't think the answer is trivial, or that there is even necessarily only one "correct" answer. But the ideal that "we should all get to keep all the money we make, and spend it only on our children if we want" is a point I disagree with, and what I wanted to argue against in my OP. The captains of industry are generally from families that have given their children EVERY advantage. Of course it may be far from optimum to try to get to equality of So yes, education is a great component of the kind of redistribution that I want. I suspect a more intact family doing more "enriching" activities together, not living in relative squalor, being able to teach "healthy choices" because price is not the only consideration when acquiring food, these may make generally redistributive policies efficient. Add to that our clear knowledge t
5Eugine_Nier
With respect to education, in this essay about inequality (seriously read that whole thing) Paul Graham makes the point that improving access to education doesn't actually decrease inequality since while to makes the poor richer, it also makes the rich richer.
0Eugine_Nier
Um, Steve Jobs, Andrew Carnegie.
3gwern
"Scumbag Eugine Nier - responds to a statistical generalization with 2 famous examples."
5JGWeissman
I agree that this is wrong. Even though this is obviously a joke, with an over the top reference to popular memes, it still seems counterproductive for building a strong community.
3atorm
Turned out true though.
1Jayson_Virissimo
What statistics? All I see is an assertion.
3gwern
That captains of industry are from wealthy families? It's certainly consistent with everything I've read about the heritability of wealth and it's easy enough to supply other famous examples (eg. Bill Gates III).
0[anonymous]
Well, that's more evidence than mwengler provided.
0Kindly
Well, there's also the people you take money away from to consider. For instance, we could pick a really rich person and take away all their money and distribute it to a hundred poor people. This might suck for the rich person, but the poor people would all be really happy about it. But this is a lot like the doctor who kills a healthy person off the street to donate their organs to his patients, and I thought we all agreed not to do that.
5fubarobfusco
We could try to convince the rich person to give away a lot of their money. For instance, one of GiveWell's standout organizations is GiveDirectly which simply transfers money from donors to poor recipients in the developing world (specifically, Kenya). "The recipient uses the transfer to pursue their own goals."
0Manfred
Sort of! But argument by analogy is just not very good when the thing itself is plenty comprehensible to all involved. It can neglect the subtleties of both the situation and our desires, and also people are bad at keeping hypotheticals and reality separate on the intuition level.
2Kindly
All I'm saying is that we can't say "just look at how much money is being distributed". Obviously the situation I suggest is very different from one in which two rich people lose half their money.
-1mwengler
Way to set up a straw man and then steal his kidneys!
1Kindly
If a general argument is made, then it can be refuted by any specific counter-example.
-1Eugine_Nier
This appears to be a complete non sequitur. But, yes I do mean "increase the amount of wealth being produced". Which as mwengler points out people have less motivation to create wealth if its going to be redistributed away. Well, here in the US the public education system pretty much sucks.
1Manfred
What I mean is the typical capitalist statement "voluntary transactions create wealth." Since both sides are happier than they were (well, most of the time, this is reality after all), they've both gained wealth. This gets called "creating" wealth, even though that's a bit silly :) So if you want to make people happier, one way is to look for high-gain voluntary transactions, and make them happen more often. Thus my claim that increasing economic activity will (ceteris paribus) create wealth. This obviously isn't always applicable - sometimes investing the money (what would otherwise happen) is just fine, wealth-creation-wise. But if poor people, and the economies that poor people are part of, have high-gain voluntary transactions available to them that they aren't using yet because of lack of money in the system, there's opportunity.
[-]hesperidia30

What are the positive and negative effects of income inequality, not "redistributing" income, etc.?

Most of the answers I've received on this issue veer far through the line of color politics and come out the other side spray-painted with logos and other such blatant advertising that the viewpoint in question is the only reasonable one. I'd like to get a rather straighter answer.

Reply
8OrphanWilde
I'll give it a shot. Note that I'm going to discuss wealth inequality, not income inequality. (Because the discussion is almost always really about wealth, and not income.) The con side: Wealth inequality lead to resentment and multi-tiered systems; the rich get better healthcare, for example, and therefore live longer. It is supposed that it leads to hardening class lines, as well; if only the rich can go to Harvard, and only Harvard graduates get rich (a gross simplification, but you see the basic idea), then class mobility goes to zero, which leads to declining meritocracy in society, which leads to suboptimal economic organization. The pro side: Wealth inequality is meritocracy in action; it represents the tendency of those who are good at managing money to acquire more money (to be managed), which represents optimized (although not necessarily optimal) economic organization. It is, by dint of lost ability, a greater societal tragedy when an expert in managing wealth dies than an average given individual; therefore it's not necessarily a bad thing that wealthy people get better healthcare, given that healthcare is a finite resource. It is supposed that ability in managing wealth is necessary merely to maintain it, and therefore class mobility is not as rigid as opponents of wealth inequality would argue. Which leads to a second con side, ability in managing wealth as the sole social-value determinant is suboptimal; Richard Feynman contributes more to society than your average hedge fund manager, the argument might go, and his investment of wealth, while not generating more wealth for him personally to invest, would generate more wealth overall. Which of course leads to the second pro side, that ability in managing wealth is the only inherent property identifiable in our current system. That the system isn't perfectly optimized is a nature of imperfect information; we wouldn't necessarily recognize a new Richard Feynman, and even if a new Richard Feynman coul
5A1987dM
How many people born to very rich parents end up very poor because they are bad at managing wealth? Seriously, when I look at wealthy people, I mostly see people born from the right vagina. Or in some case people with good genes but mediocre memes (think about sportspeople or models).
3OrphanWilde
The plural of anecdote isn't data; are you basing this statement on an objective analysis of wealthy people, or a subjective case-by-case analysis subject to confirmation bias and selectivity biases? How do you "look" at wealthy people, for example? What do you even define as wealthy? Was a wealthy person who grew up in an abusive home and was driven to succeed through neurosis merely born from the right vagina? What if it was simply a middle-class home with strong ethics? Do you think mediocre memes win?
4A1987dM
From http://en.wikipedia.org/wiki/Social_mobility: (Now, it's possible that “ability in managing wealth” is heritable to some extent, but it seems unlikely that that alone would cause such an effect, without your parents being wealthy ‘directly’ causing you to be wealthy. And note that that study was across one country -- if they took quintiles worldwide I'd expect the results to be even more dramatic.)
-1OrphanWilde
Heritability in ability to manage wealth would explain this, actually. Assuming it's as likely to go down as it is to go up in any given generation, and assuming a lower bound on this ability, and assuming some percentage of people are already at that lower bound and their descendants can only improve, you'd expect something like this distribution. Not to say it -does- explain this. I don't disagree that wealth is a factor. Where I disagree is in naming it as the most important factor.
1hesperidia
This explanation is clear. Thank you.
-1ChristianKl
Very often health care isn't a finite resource. If you run a hotel you will seldom have all of your beds rented out. If you run a hospital you usually have all of your beds filled with patients. Why? The doctors in the hospital advice the patients in a way to seek treatments to fill all the hospital beds. A hotel manager has no way to archive a similar effect. When it comes to big pharma drugs, there a huge cost to find a new drug but a much smaller cost to produce the actual drugs. When you use a drug on 10,000 people instead of on 100 it even becomes better because doctors learn more about the side effects of the drug. A lot of illnesses are contagious. Even obesity might be. Treating everyone will increase the health of the elite that you are worried about. Healthcare is a lot more complicated than simply being a "finite resource".
1OrphanWilde
There are two positions on whether or not something is finite: It's finite, or it's infinite. "It's complicated" doesn't exist on the spectrum. You're arguing that a wider availability of healthcare has potential feedback effects. I don't disagree. What you fail to establish, however, is that healthcare is, in fact, an infinite resource. You make a strong argument that demand for healthcare is considerably more elastic than we might suppose; I don't disagree. You make a strong argument that wider availability of a drug results in more utility; I don't disagree. You make a strong argument that for many problems in the healthcare domain, wider availability of a cure is better even for those who would have it available anyways; again, I don't disagree. What you fail to establish is that the resources to provide healthcare are, in fact, infinite, or simply non-finite. You discuss demand; you don't discuss supply. You discuss the utility of a bigger supply; you don't discuss the mechanics of actually increasing that supply. I can confidently say that the world would be much better off if, all other things being equal, there were substantially more healthcare resources. In this, you and I don't disagree. Where we may disagree is whether increasing those resources in a world in which all other things -won't be- equal is the best course of action.
1ChristianKl
Is blue "finite" or "infinite"? If everything is either "finite" or "infinite" you should be able to answer the question.
0OrphanWilde
Finite, considered as a nonabstract referential, because blue describes a finite length of the electromagnetic spectrum. Of course, we could consider it in the abstract, in which case it's not something. If you proceed to argue that it can't be nothing, then we've been embroiled in a semantic argument from the beginning, about what constitutes something as opposed to nothing. Inwhichcase you've defined away healthcare as a meaningful referential to anything in the real world, and inwhichcase nothing you've written has any bearing on what I wrote, which considered the real problem of the real limitations of real resources.
-3ChristianKl
If I halve the wavelength of blue I don't get something that's half blue. I don't consider blue something unreal. I just don't consider it a resource in the same sense as money is a resource. Things can be real without being resources for which can be finitive in the same sense of the word 'finitive' that applies to money. To me healthcare is something like "more men-years of good health". I wouldn't measure healthcare in amount of hospital beds taken up by patients or by the number of operations that are performed. Putting people into hospital beds can increase or reduce men-years of good health. The same is true for performing operations. Hospital beds or operations are resources that are finite resources. Men years of good health aren't resources that you can allocate in the same way as you can allocate hospital beds. They behave differently. It doesn't make sense to treat them the same way.
7OrphanWilde
I think you've just described health, not health care.
2ChristianKl
If you don't think that health care is about health your initial argument makes no sense. You defined health care as societies ability to prevent people from dying. Especially those people that are valuable to society.
0OrphanWilde
Being "about" health doesn't make it health. If I have a magical machine that produces an infinite number of bleggs, I can describe the state of bleggs as being infinite, but I still can't describe blegg machines as being in infinite number. It matters. You're arguing that healthcare isn't a finite resource because allocation of healthcare could conceivably produce a non-finite amount of health. But it doesn't follow from that that healthcare is a non-finite resource. If we only have one Perfect Health Machine, a theoretical machine which enables clinical immortality, we -still- have to decide who gets to use it. If we decide to build another, that consumes finite resources. We can only have a finite number of Perfect Health Machines which can each only process a finite number of people in any finite amount of time. The potential for "infinite health", however one defines that, doesn't imply a potential for infinite healthcare.
-1ChristianKl
You argument rests on the claim that you can prevent valuable people from dying by allocating healthcare resources to them. If that's not something you believe I think I win the substance of argument and our further disagreement is about insignificant semantics.
5fubarobfusco
http://www.npr.org/blogs/money/2012/08/01/157664524/how-the-poor-the-middle-class-and-the-rich-spend-their-money Data from the Consumer Expenditure Survey point out some specific differences in how poor, middle-class, and rich people spend their money. The less money you have, the more (proportionally) you have to spend on immediate needs (food, housing, utility bills, transportation, medical care), and the less you have left for long-term goals (education, retirement savings).
[-]FiftyTwo30

Government controlled healthcare is generally superior to private systems. *

Argument: The incentives of a government body that knows it will have to pay for the costs of future healthcare is radically different from private companies. They are more likely to take preventative measures to prevent future harms to a patient rather than waiting until the point where a condition is considered serious enough to be covered by insurance or bring people to an emergency room. They have incentives to make procedures cheaper and more efficient, and they also lack the ... (read more)

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8RomeoStevens
The "preventative care saves money" meme is incorrect AFAIK. People massively over-consume expensive tests which check for conditions with extremely low base-rates of occurrence in the population. example: "Think of it this way. Assume that a screening test for disease X costs $500 and finding it early averts $10,000 of costly treatment at a later stage. Are you saving money? Well, if one in ten of those who are screened tests positive, society is saving $5,000. But if only one in 100 would get that disease, society is shelling out $40,000 more than it would without the preventive care. That’s a hypothetical case. What’s the real-life actuality in the United States today? A study in the journal Circulation found that for cardiovascular diseases and diabetes, “if all the recommended prevention activities were applied with 100 percent success,” the prevention would cost almost ten times as much as the savings, increasing the country’s total medical bill by 162 percent. Elmendorf additionally cites a definitive assessment in the New England Journal of Medicine that reviewed hundreds of studies on preventive care and found that more than 80 percent of preventive measures added to medical costs."
3Unnamed
This appears to be the Circulation study that you cite: Kahn et al., 2008, "The Impact of Prevention on Reducing the Burden of Cardiovascular Disease". The full-text is free. The authors of the Circulation study estimate that fully implementing all eleven prevention activities which they discuss would increase US medical spending by $7.6 trillion during the next 30 years, increasing medical spending on cardiovascular disease, diabetes, and coronary heart disease from $9.5T (their baseline estimate) to $17.1T (with $0.9T in savings from better prevention more than offset by $8.5T in new preventive spending). * Note that these numbers are only for the effects of preventive care on medical spending; they do not include the health benefits of the preventive care. The authors also estimate that fully implementing the prevention activities would prevent 63% of all heart attacks and 31% of all strokes, increasing adult life expectancy by over a year. In total, the $7.6 trillion would buy 244 million additional quality-adjusted life-years, for an average cost of $36,380 per QALY. * I notice that I am confused: the number "162%" appears in the paper in reference to this spending increase, but I can't figure out what it refers to. Going from $9.5T to $17.1T is an 80% increase.
0Eugine_Nier
A number of people, myself included, find it suspicious that after years of advocating preventative medicine, a bunch of studies against it are coming out just after Obamacare was passed. Prediction: If Obamacare gets repealed these studies will be refuted by subsequent studies, whereas if it stays on the books, these studies will become the baseline of a new consensus.
7billswift
Studies against the effectiveness of preventative medicine aren't new, they have been published repeatedly for decades, I have read several myself as early as 1993. And of course the RAND study that Robin discussed repeatedly.
-1FiftyTwo
Working with your example: If we assume the government health service is behaving in its own self interest, why would it spend money on test that it knew not to be cost effective? Whereas if the incentives are split between a Dr ordering a test and an insurance company paying for one wouldn't they disproportionately order tests? More generally, even if its true for particular testing procedures theres lots of low hanging fruit for intervention before things get severe. The most obvious examples would be schemes to get people to stop smoking or lose weight, that the government provides freely because they are less expensive than the projected cost of the illnesses that would arise without such intervention. Also the ability to see a general practitioner more regularly than if you paid per visit means symptoms can be picked up earlier (e.g. if someone has a mild symptom but has to pay to get it checked they are disincentivised to get it checked until it becomes severe.)
6RomeoStevens
Again, AFAIK smokers and the obese are cheaper in the long run because they die faster.
-1Eugine_Nier
Given they way other government services tend to behave this is highly dubious. The problem is that the way these kinds of schemes tend to work in practice has a lot more to do with whatever the currently fashionable moral panic is than any rational analysis.
-4mwengler
Of course finding cancer early while it can still be operated on is VASTLY more expensive than letting people die untreated. Not only do you pay for the tests on the people that don't have it, you pay for the tests on the people that do have it, and you pay for the treatment once it is discovered. Perhaps there is some other benefit to preventive care that makes it worth more money? How does the health of someone who has avoided a heart transplant through early detection and treatment of heart disease compare to that of someone with a heart transplant, for example? How does the lifespan compare? WIthout putting a price on the BENEFITS of the different mix of outcomes, it is impossible to know whether the COSTS of the preventive approaches are worth it or not. No, preventative medicine does not save money, and there were people who believed that. But it may save some lives and improve many more lives. That has to be studied (and if already studied, discussed) before preventative care is tossed as a waste of money.
-1RomeoStevens
No one is advocating tossing preventative care. The problem is that preventative care is treated as a monolithic entity rather than a collection of things, a small subset of which is responsible for most of the benefits.
2NancyLebovitz
I agree with the first half, but how sure are you that it's a small subset which is responsible for most of the benefits?
2RomeoStevens
~85% confidence that <=10% of preventative care is responsible for >=66% of the savings.
2mwengler
I'm guessing you made up those numbers?
0fubarobfusco
"Where do priors come from?"
0NancyLebovitz
I should have asked "Why do you think it's a small subset?"
5phonypapercut
Why is a government more likely to cover preventative care? If the argument is it's cheaper, a private insurer or individual paying out of pocket has just as much, if not more, incentive to pay for it.
7mwengler
If the benefits of preventative care are realized over the rest of the patient's life, then an insurance company is only incentivized to pay for it if they are obligated to insure you for the rest of your life. Which is true for gov't insurance, but not for any private insurance I am aware of. Even requiring any insurance company to insure any person in the group at any time they ask for it is not enough to change the insurance company's incentive: they would still be wise to "free ride" on any other preventative care payer than to pay for it themselves.
0OrphanWilde
I think part of the problem here is that we do not, in fact, have health insurance in the US, but rather have healthcare plans. Health insurance would be an insurance policy on your health - if your health declines, they pay out based on that. So if you come down with tuberculosis while on their policy, they pay you for the expenses of that (or possibly just pay out the average cost of tuberculosis treatment), even if you immediately drop your insurance after coming down with it. What we have are healthcare plans we -call- insurance. And I agree that the incentives are screwed up with healthcare plans, but disagree that government is necessarily the solution. I'd prefer genuine health insurance, which would have much better incentives.
2mwengler
I have auto insurance. My car is worth much less now than when I originally insured it, 7 years ago. My auto insurance does not cover that change. I have home insurance. The value of my home declined by many 100s of thousands of dollars in 2008. My home insurance did not cover that change. Isn't there some relevant Eliezer sequence I should be citing on how defining things to mean things different from what they mean to virtually everyone else who might be in the discussion is suboptimal?
-2OrphanWilde
I meant what I wrote, exactly how I wrote it. Car insurance doesn't cover the monetary value of your car; home insurance doesn't cover the monetary value of your home. If they did, they'd have covered those things. They cover the thing itself in both cases, provided you have full coverage auto insurance or live in a no-fault state. (If you have liability insurance, of course, something else entirely is being insured.) You could be leading into something about old age, but unless there's a specific health concern related to old age that you don't think should be covered, I don't think there will be anything to discuss. If I had health insurance and my heart started to go out and they declared that the value of my heart has depreciated so it's not worth the cost of replacement... well, then they haven't insured anything at all. I think I'd have some strong words for my insurance agent. Insurance isn't there to protect the value of your home, it's there to -replace- your home if it gets destroyed. Which means if your house got destroyed in 2008, odds are (although it varies by insurance policy and possibly jurisdiction), you'd get less from your insurance company than if it had been destroyed in 2007. Similarly, insurance isn't there to protect the value of my health, but to provide me the ability to restore it in the event that it gets damaged.
-4Eugine_Nier
Well here is an Eliezer post arguing that using misleading labels is suboptimal even if everyone else is using them.
0mwengler
By your definitions, EVERY country has healthcare plans and NO country has health insurance. So why do you say that is the problem "here... in the US"? Why would you choose to use language differently from everybody else, especially in a way that reduces the application of a phrase from 100s of millions of people to zero? I personally think this is a WAY sub-optimum way to use language.
0OrphanWilde
Are you attempting to persuade me that we can't have rational arguments about politics here? Because this is the second attempt you've made to attack the same comment on the basis of its semantics. The first I could get, because I saw a line of argument that might arise depending upon my clarification. In this case, you seem to be asking me to make broad generalizations.
0mwengler
An excellent question. I don't know if "we," meaning you and I in particular, can have a rational argument based on what you say in your this response. Maybe I should try harder. I don't know, maybe I can't do it. The evidence is not strong that I can, that's for sure :) It seems to me that your response proposes a form of private contract which does not exist at all in real life, and that you state a preference for this theoretical solution over any of the real systems that actually do exist. So I guess if I were rationally arguing politically with you, I would say something like this: Perhaps in some very long run, we might find health care arrangements would move in the direction that you like, that contracts such as the ones you say you would like will be offered, and will be purchased at the offered prices. But in the meantime, we have hundreds of millions of people in the systems that do exist. Does it make sense to take existence as evidence of possibility and plausibility, and emphasize in our arguments what we might do in the near term, primarily in terms of choosing among proven possibilities, to improve the health care system in the U.S.? In any case, that is what I prefer to argue or discuss politically.
0OrphanWilde
Well, let me ask a rather pointed question: Do you consider any existing successful healthcare systems undesirable? Or, from the converse, is there any healthcare system which conflicts with your political beliefs that you regard as having been successful? Did you arrive at a healthcare system after formulating criteria by which you would judge a healthcare system acceptable, or did you formulate criteria which excluded healthcare systems you don't approve of? (These are distinct questions; I'm not attempting to trick you with the second one.) For your reference, my criteria for a successful healthcare system, in order of importance as I judge it: Doesn't constrain individual choice Encourages innovation and research Provides affordable/accessible healthcare A healthcare system which forces people to be vaccinated is undesirable to me. I don't argue with the efficacy of vaccinations, nor do I contest the safety of the common vaccinations; I simply believe that the volition of rational beings is more important than their physical well-being. This is probably a point we are going to disagree on, and hard. Innovation is the delta of healthcare. In a choice between wider availability and improvement, I'll take improvement. You can't make nonexistent treatments more widely available. However, innovation cannot take place at the expense of somebody's volition; they cannot be forced to participate in a trial, for example, even if would be the only way a drug or treatment could be tested (say, there's a rare condition, and there aren't enough willing participants for the trial to be statistically meaningful). And finally, affordability/accessibility. That this comes last doesn't mean it isn't still important; it remains one of my conditions of a successful system. However, it comes after volition and innovation. I will accept trade-offs favoring volition, and I will accept trade-offs favoring innovation. If something can only be made affordable by forcing people to
4mwengler
If it is "successful" how could it be "undesirable?" The answer is that you are using one set of value judging criteria to judge success and a different set of criteria for judging desirability. So a slightly subtle answer to your question is, I use the same set of value judging criteria to rate something successful as I do to rate it desirable, at least in health care systems. And let me state what they might be: * provides the maximum effect for the resources used * maximum effect includes:maximizing average quality-weighted lifespan of the the population covered by the system. * lifespan metric is weighted by degree of full functionality, that is various deficits like unable to run, unable to walk, unable to talk, blindness, deaf, missing limbs, confined to nursing home, confined to hospital, would all and each reduce the weighting of years of life in the metric. So procedures which reduce functional deficit increase the success metric. Procedures which extend your lifespan increase the metric, but they don't increase it much if the lifespan added is spent confined to a hospital. * physical coercion or the threat of its use 1) provides a large quality hit when actually used, and 2) is only used when the quality of the lives improved are other lives than the person being coerced. So my system would allow for the requirement of vaccinations to reduce diseases that spread through the population, as a precondition for being allowed to associate with the population. My system would not attempt physical coercion to get the obese to lose weight, the smoker to quit smoking, or the racecar driver to slow down. * the general coercion of taxation is not part of the medical system but rather is orthogonal. If a society which is in some broad sense "democratic" is willing to vote itself in the taxes to try a particular medical system, and that medical system works brilliantly according to the metrics above, then I consider it a success and desirable. I'm not too co
0fubarobfusco
It seems to me that this sort of procedure has some problematic consequences in how it ranks possible futures. Consider these two possible futures: A. Alice, an able-bodied person, lives for another year as such. B. Alice lives for another year but loses the use of her legs this afternoon. This procedure (correctly, in my view) prefers A over B. However: C. Alice, who is able-bodied, lives for another year; while Bob, who has no legs, dies this afternoon. D. Alice dies this afternoon; while Bob lives for another year. The procedure prefers C over D as well. It is not clear to me that this is obviously the right answer. The procedure is asserting that saving Alice's life is more worthwhile than saving Bob's, by dint of Alice having legs. Moreover, for any degree of "weighting by full functionality", the procedure prefers to save the lives of a smaller population of able-bodied people rather than a larger population of disabled people. If the "weighting" for loss of legs is, say, 0.9, then the procedure prefers to save the lives of 901 able-bodied people rather than save the lives of 1000 legless people. It seems to me that such a procedure will — given constrained resources — prefer to maintain the health of the healthy rather than ameliorate the condition of the sick and disabled. While obviously we do not want a medical decision procedure that goes around allowing people to become disabled when it could be avoided (as in A and B), I don't think that we want one that considers someone's life less worthwhile because that person has already become disabled.
1mwengler
A stronger signal comes from the age/life-expectancy of Alice and Bob. But all other things being equal, and in the highly artificial situation that only one of Bob and Alice would be saved, it seems more reasoanble to pick the more functional than the less functional. Your intuition is the cases are equal, what would you propose as a way to allocate one life-saving in the case you have two equally valuable lives to save? If this is the worst criticism of my proposal, then it is way better than I expected it to be! What if you thought of it in terms of being able to afford to keep 1,000,000 people healthy for the same cost as ameliorating the miserable lives of 100,000 compromised individuals, and we don't have enough resources to do both. I have heard of people having babies whos quality of life sucks, which kids will die at young ages, and spending 1,000,000 of public money a year on medical care for these poor creatures. It may not seem fair, but when resources are finite, choices will be made. How would you propose to make those choices if every life is equal in worth?
0fubarobfusco
"All other things being equal" was not part of the proposal I was critiquing, though. Other factors which have at various points been used to decide whose life is more important include sex, race, social class or caste, wealth (or willingness to pay for treatment), religious belief, political affiliation, sexual orientation, criminality, the cause of a person's disease or affliction (e.g. "shameful" diseases such as syphilis, HIV ... or leprosy), military or veteran status, and their distance from a medical facility. The proposal above fails to mention any of these, preferring to mention physical disability instead as a "reasonable" basis for choosing who lives and dies. It is unclear to me that physical disability is obviously a reasonable basis for this decision, especially given that many people today consider some of the above to be obviously not reasonable bases for this decision.
0mwengler
Very clever and powerful argumentation. So how would YOU proposwe to allocate a scarce resource like "saving a life" when you have 1 available and have to choose between a few people to do it? I don't think I can be swayed by arguments against my proposal unless they propose an alternative, or somehow make the strong argument that the necessity to choose how to allocate resources doesn't apply in the case of medical care. It has been said abou democracy that it is a horrible system that perpetrates all osrts of injustices and generates all sorts of stupid policy choices, with the only thing in its favor being that it is better than all (currently known) alternative systems. Maybe one of the things that makes policical "argumentation" so difficult is that the most emotionally compelling arguments are those against something which do not bear the burden of coming up with a workable alternative.
0fubarobfusco
First: I don't know; but the fact that I don't have a perfect answer doesn't mean that I can't see things wrong with the "disabled people are worth less than able-bodied people" answer — beginning by pointing out that it can't readily be distinguished from the "men are worth less than women" answer or the "poor people are worth less than rich people" answer. Second: Saving a life isn't a resource. Food, drugs, or a doctor's time are resources. We don't have 1-up mushrooms in our world. Third: We don't have to stack-rank every two possible scenes in order to have a consequentialist ethical system. By "possible scene" I mean something much smaller than a "possible world", something deliberately disregarding consequences outside of an artificially-defined neighborhood. "Save Alice's life and let Bob die" is a possible scene, not a possible world. (A possible world in which some life-saving agency prefers to save 901 able-bodied people and allows 1000 disabled people to die might also might include significant consequences such as, oh, disabled veterans firebombing that agency's offices; or (perhaps more realistically) the social status of the life-saving agency being docked for its immorality, leading to fewer people entering the life-saving business, leading to fewer lives being saved.) Fourth: "Hard cases make bad law" — which is to say, even if one has to make a choice between saving Alice's or Bob's life, you probably can't generalize much from it. The fact that in one particular case, a person might choose to save the life of a person with traits X, Y, and Z instead of a person with traits A, B, and C does not mean that you can safely extrapolate that person thinks that anyone with trait X is more worth saving than anyone with trait B. Fifth: I'd really suggest thinking about the assumptions that led you to think that "disabled people are worth less than everyone else" was a reasonable solution? Where did you get that idea? What makes you think it's even mora
1mwengler
What if I have to choose between putting $100 million dollars into specially training gerontologists to extend the lives of institutionalized triple amputees vs putting $100 million dollars into training doctors to use stem cell thearpies to regenerate limbs? These choices get made all the time in society. I just propose we make the consciously and that we at least analyze our results quantitatively, since quantitative analysis is, in my opinion, a significant factor in the success of so many other human endeavors.
0fubarobfusco
Umm ... I'm not challenging your quantitative analysis — I'm challenging your claimed values. (Please don't respond to this comment, since the substance is elsewhere.)
1mwengler
You didn't really propose the counterfactual. But beyond that, the essence of my metric is that a world which adds 2 years to the lives of 1000 triple amputees compared to a world which regenerates the limbs of 500 of those triple amputees, but fails to extend their lifespans by two years. I don't pretend to know at exactly what numbers preference becomes confusing for most people, but I know for darn sure that most people will risk death in operations to improve or preserve their functioning. How do you include that fact in a metric other than by showing a positive value for positive outcomes?
0fubarobfusco
By extrapolating from the choices of the people involved? It seems to me that people with no legs have just as much interest in staying alive as people with two legs. That doesn't mean they have an interest in staying no-legged rather than becoming two-legged; but I don't consider "give Bob his legs back" equivalent to "kill Bob and save Alice, who has legs", either.
0mwengler
I don't know what a 1-up mushroom is, but for the life of me I can't extract any meaning from this other than that you deny a connection between doctor's time, drugs, and food and saving a life?
1fubarobfusco
A 1-up mushroom is an object in the popular "Super Mario Bros." video games, which gives the player an extra life (and does nothing else). My point here was that consequences such as "saving a life" are not resources. You can't buy a life-saving; you can buy various things that have a good chance of having life-saving among their many consequences.
0mwengler
That is not at all what I did. I proposed a metric for evaluating a health care system. For all intents and purposes, I said a health care system where the population lives 80 years and 10% of them are disabled was better than one where the health care system cost the same and the population lives 80 years but 20% of them are disabled. Is that a rank ordering you would agree with?
0fubarobfusco
Well, what you said was: That's a weighting applied to individuals, implied to be used when making individual decisions. And you clarified: And my point was to investigate the value-system behind that claim. Why value "functionality" in terms of physical disabilities — and not in terms of any of the other things that people have made this decision on — such as social status, reproductive potential, earned income, skin color, belovedness by others, moral virtue, or purity of soul?
1mwengler
First, I never based it on PHYSICAL disability. For me, the paradigm disability is reduced mental status, with vegetative state being worth nothing in terms of keeping alive. But why limit myself to mental disability? Second, I never stated, and would not agree, to make it illegal for people to spend their own resources on keeping alive anybody who wanted to be kept alive. Perhaps I am a billionaire willing to spend $1 million to keep my extremely sick 95 year old mother from dying from her cancer for another 3 months. Whoop de do for me. All I'm saying is that when totting up the value of the medical system, more accomplishment is measured from keeping a healthy 20 year old alive for an extra 3 months. Third, it seems that underlying your case is something like, "all human life is equally valuable." My problem with this is it denies the value of taking a risk of dying in order to improve a life. If I have someone who is willing to risk a shorter life in order to cure paralysis (maybe some sort of stem-cell spinal cord treatment that has an 80% chance of improving things and a 5% chance of killing you), then I want the improved functionality to show up in my plus column, which they don't if "all human life is equally valuable." Fourth, In my opinion, it is not intellectually honest to say "all human life is equally valuable, even disabled" and "it is a great improvement in life to cure a disability." Either disability is not as valuable an outcome as ability, or it is. To pretend it is both it seems to me can only lead to suboptimal policy and mistaken conclusions.
0mwengler
I wouldn't propose a healthcare system which set about curing femaleness by converting them to males, but I'd be pretty pleased with a health care system that made the lame to walk, the blind to see, and the diabetic to regulate blood sugar. So that is one rather important way to "readily distinguish" disability from gender. "poor people are worth less than rich people," I would imagine you would value a system (but not necessarily a healthcare system) which turned poor people in to rich people and did not turn rich people in to poor people. So in this sense, I'd imagine you and I would both find important similarities between "rich and poor" and "abled and disabled." But I don't think the health care system is the best place to address that social issue, so I didn't propose "making the population richer" as part of the health care metric. Please correct me where I either 1) imagine you would agree with something , but you actually disagree with it or 2) follow a chain or reasoning you would not agree with.
0fubarobfusco
Understood. I agree with you here. But I do not think that is the same question as whether to consider physical disability in saving lives. (Please don't respond to this comment, since the substance is elsewhere.)
0mwengler
I'd like to make it clear that this discussion is about how to determine the performance of a health care system. Not the metaphysical value of human life in its various combinations and permutations. Some of the assumptions behind my proposal is that 1) lower disfunction in the served population is a positive outcome from a health care system, and 2) lengthening lifespan in the served population is a positive outcome from a health care system. Do you agree with either or both of these? If you do agree with both, can you imagine a metric which reflects additional credit on a system which reduces or effectively treats disability which simultaneously does not distinguish between the value of the disabled and the abled? The reason I need a counterproposal from you, at least a partial one, is that so far what you have said amounts to "boo on not valuing disabled people, but I can't go as far as to say that your proposal isn't the best one possible." If this is what you are saying, let me know. If this is not what you are saying then show me a proposal that is better than mine, it doesn't have to be comprehensive or perfect, merely better than mine. Cheers, Mike
0fubarobfusco
That's odd, it seems to me that you introduced the idea back here, as noted elsethread. Sure. It does not follow that these are the only things that matter, though. Taken alone, these would authorize killing people to use their organs to save others. We recognize that's a bad idea not just deontologically ("murder is wrong") but consequentially also ("it wouldn't work out well, doing that would cause problems beyond the immediate neighborhood being contemplated") and, for that matter, categorically ("if you murder person A, this implies you don't value individual life, so why are you saving persons B through F?") and acausally ("if we lived in a world where we did things like that, other people would do stuff to us that we wouldn't like"). Okay, here ya go: "Instead of trying to decide whose life is more valuable, when you possess a life-saving resource and encounter a life that (to the best of your knowledge) is in need of saving, you save that life." In business terms, "first come, first served." In hippie terms, "love the one you're with." In timeless terms, "if you don't save a life when you have the chance, then what makes you think that future-you would ever choose to save a life?" In progressive terms, "if not now, when?" Take the Schelling point. Discard the assumption that you know (or should know) how to value one life over another. In the (statistically impossible) case of simultaneous arrivals, pick arbitrarily. This avoids setting yourself as judge over other people, and thus avoids all the problems mentioned above, including the acausal ones; and it thereby avoids licensing ableism or killing one to save five. Suggested reading on argumentation: * Privileging the Hypothesis * You're Entitled to Arguments, But Not (That Particular) Proof
0OrphanWilde
I don't have an objective mechanism of evaluating whether or not a system actually promotes health. The issue is exemplified in comparing Japan's health system to the US; do you compare averages of everybody, or just the averages of, say, Japanese-descended people living in the US? Somebody whose lineage traces back to Japan does as well in the US as in Japan, is the issue. Comparing the two health systems of the basis of population health ignores that the healthcare system may represent only a minority contribution to the health of the population. It's not that I don't think it's an important criteria, it's that I don't believe I have any mechanism of reliably measuring it; to the extent that it can be measured, I judge it being measured in the "Innovation" column, which produces in successes a better healthcare system. (That is, I believe the metric of success in promoting health is better measured at the rate of change in the system's ability to promote health.) I do agree that taxation is orthogonal to healthcare, which is why I'd prefer a national healthcare system with private options to the healthcare bill we got, which directly violated my #1 criteria.
0TheOtherDave
Just to be clear... you are not saying only that for all rational beings H, H's volition is more important than H's physical well-being. You are also saying that for any rational beings H1 and H2, H1's volition is more important than H2's physical well-being (and vice-versa). Yes? (Not planning to argue the point, just want to make sure I've understood you.)
0OrphanWilde
With certain necessary limitations on the valid domain of volition (as otherwise volition becomes contradictory), yes. (Negative rights as a concept encapsulate these limitations pretty well for purposes of political discussion, although I'm not sure of their value in a broader philosophical sense; I consider legality a subdomain of morality, which is to say, law should be moral, but morality shouldn't necessarily be law. Negative rights address only the legal considerations of the domain of volition.)
5Eugine_Nier
Problems: 1) the same argument applies to private insurance companies. 2) governments try to maximize votes in the next election which really isn't conducive to long term planning. 3) There's still the perverse incentive to encourage people to die in cheap ways.
1FiftyTwo
My understanding is that US insurance companies pay for some treatments but not others depending on the cost of the insurance? True. The times where this would be relevant tend to be questions of "should we treat illness X", often 'photogenic' illnesses get disproportionately treated (e.g. breast cancer). But I would imagine similar issues exist in terms of customer demand and legislators forcing insurers to pay for treatments (which you mentioned above). Also, given the choice between a mild bias to popularity and a heavy one to wealth in spending distribution I thought have thought the former would have better outcomes. General infrastructure planning tends to be decided on long term efficiency as its not a day to day political issue. Possibly, but the dead don't tend to pay taxes, I would imagine other than in the very last stages of life a living citizen is more valuable than a dead one. Interestingly the NHS spends a lot of money on people in the final stages of their lives, while they could save a lot money by legalising or enforcing euthanasia, so that seems a counterexample.
-5Eugine_Nier
2pleeppleep
Your statement was a description of the quality of government health care. Your argument provided possible reasons the government would have behind offering better care, but it didn't really back up your initial statement. If your introduction was, "The incentive for governments to provide quality health care is more reliable than the incentive for private systems," than the argument would fit. As it is your argument is just speculation on the motivations behind health care providers. Also, I could be wrong, but I thought the government only helps pay for health care, and could only control its accesibility, not its actual quality. Wouldn't the state have to own the hospital to alter the actual care?
3[anonymous]
In fact, that's how the UK's NHS works. It's like the US's VHA, where the government actually provides health care. It's unlike the US's Medicare, which is "single-payer" because the government pays for everything, but the money goes to private hospitals and doctors who actually provide the health care. See http://en.wikipedia.org/wiki/Single-payer_health_care and http://en.wikipedia.org/wiki/Socialized_medicine for more information. From the latter:
1FiftyTwo
Thanks. In retrospect I should have defined my terms more clearly, illusion of transparency bites again.
1mwengler
One of the biggest facts on the ground here is that the US spends (more or less) 2X as much as any other rich western country, and is not statistically better on any quantitative metric for its extra expense. So one would presumably benefit immensely from understanding what the US is doing wrong compared to other rich western systems. Is the difference that the US is not government controlled while others are? Arguing against that are these facts: 1) 50% of medical expenses in the US are made by the government (the number is 70% for Canada). 2) US health care insurance companies are highly regulated in the terms on which they can offer insurance, what they can require, what they can forbid and so on, 3) the US (even before obamacare) practically mandates health care through 3rd party paid insurance (through providing gigantic tax advantages for that form over any other form of health care paying.) So the US's "private" system is pretty government influenced. And if you study countries with public health care, virtually all of them have a significant private component. If the hypothesis was "the british health care system is at least twice as efficient at providing measurable benefits per pound spent than is the US system," I don't see how anybody rational could argue against that. And I would say you could put essentially any european country in place of britain and get the same result. So have I argued for or against the original proposition? To decide this, I have to decide: "Is a health care system which provides more than twice the bang for the buck necessarily "superior" to one which doesn't?" Well ceteris paribus it must be, but of course ceteris is not paribus between ANY two countries' health care systems. But you know what? I'll let someone else try to sell you on how the non-health benefits of the US system over the British actually are more than justified by the factor of 2 higher expense of the US system, because I do not agree with that and this pos
-6DanielLC
[-]Multiheaded10

Ladies and Gentlemen and Other Folks, I am the first ever Moldbuggian Christian Progressive in the world, and I'm here to bring the Good News and the Sword!

--

Some left-wing Christian sermons of recent times:

"The only church that illuminates is a burning church" - Slavoj Zizek

"Stop Teaching the Ethics of Jesus!" - Peter Rollins (Follow-up podcast: "Treating Ethics as a Failure that Succeeds")

"I pray the children of my enemies be dashed against the rocks" - Peter Rollins (that one isn't in fact ideological, just an int... (read more)

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3TimS
I'm genuinely curious about the positions of an anti-royalist Moldbuggian. Or do you mean something different by "progressive"?
6Multiheaded
No, I mean both "Christian" and "progressive" in a fairly conventional sense. It's just that while I'm aghast at MM's policy suggestions, I love his analysis of social history, at least the parts of it based on his idiosyncratic outside view. He has a very poor understanding - indeed, a denial - of the emotional factor in society and the internal workings of ideology/religion, he's very US-centric and really ignorant of more collectivist societies (e.g. Russia or Japan - he has never once written a single illuminating sentence about them), he rarely admits that his enemies can be simultaneously honest and intelligent. However, many of his key points - the identification of truly history-making social forces ("the Clergy" et al.), Pronomianism vs Antinomianism, Leftism as a fundamentally Neoplatonic/Christian current, etc - that's where he makes more sense than most other writers on the topic(s). Well, some very modern leftists, like Zizek, do approach such analysis at times - but with insufficient clarity, I'd say. So, I endorse his broad sociological description (with caveats), but I'm in complete and utter normative disagreement with him on nearly every issue. E.g. I believe that "Antinomianism" is indeed morally superior to "Pronomianism", because living through a system of artificial bindings - local, unequal, justification-free bindings - is in my opinion an affront to humanity's better side, and that outweighs the material benefits of "law and order". I think that certain states of being and feelings - especially social ones - are a more worthwhile thing for humanity to pursue than hedonism or QALYs. And many other such things, which IMO leave me in fundamental ethical opposition to him and his allies. P.S. Please note that my caveats about his description of reality are major ones, and even the post on Pronomianism vs. Antinomianism, which is one of his high points, contains many absurd statements and general misinterpretation of human behavior. Yet it is
0IlyaShpitser
Hi, I don't think Russia is culturally a collectivist society. However, I could have a biased view. Do you have any evidence for this claim?
4drethelin
As a seperate point, I think it should be on the nation (or clade or patchwork city) to provide food, medicine, etc. to its people, which is a progressive idea. Sort of like Moldbug's idea of a nation wanting to have good customer service, but moreso.
4TimS
Good customer service from government is such a strong concept. Yes, it would be nice if the teller at the DMV was nicer, but the underlying problem is that government's role in society is to provide things that don't have a willing seller (quasi-universal free education for children) or don't have a willing buyer (prisons, driver's licenses). I'm not sure that competition for citizens is likely to improve the quality of either of those services. The issue is obvious for coercive government acts, but moral hazard issues would be a serious drain on social services if free migration worked the way Moldbug suggests - I suspect that is one reason why Moldbug explicitly expects some patches to have much lower social services than provided by current governments in the West.
-2Multiheaded
You don't need to go around looking for flaws in Patchwork. It's Moldbug's one big utopian crackpot moment. IMO there's literally hundreds of reasons (chief among them being how easily humans can be misled by "free-market" manipulation) why most patches would devolve into really ugly, totalizing and rather stable corporate slavery (think singing the Wal-Mart anthem every morning and needing amphetamines just to get ahead), gradually resort to mind control technology, or just stay poor despite the law of comparative advantage because they started out as a collection of outcasts. OR, in the extremely unlikely event that it all went fine and humanely, it could create so much wealth and peace that the elites would be drawn to Universalism simply as an attractive value/goal system (shaped like the forager mind, not like a ruthlessly efficient machine), and dismantle the borders and such. Or something else. It is really so poorly thought out that it's not worth criticizing, except as mediocre science fiction. (of course, given any kind of singularity it's all rather irrelevant)
-2mrglwrf
"Crackpot moment"? Moldbug might have lucid moments, but Bircher crackpottery is the mainstream of his political writings.
7[anonymous]
I strongly disagree with this. Also I had to check out what a Bircher is: That's ridiculous. Moldbug doesn't approve of constitutional republics! ;)
0drethelin
From my point of view, I think royalty is too much of a single failure point, and would approve of a small council being rulers instead.
2gwern
No "If Jeff Buckley Had Lived"?
0Multiheaded
Oh, sure. In fact, most of their stuff is bang-on. Here's another one for LW: "Stars".
0cousin_it
Thanks a lot for The Indelicates recommendation! I really liked I am Koresh and New art for the people.
0[anonymous]
Actually Buenaventura Durutti, according to the link.
2Multiheaded
I was arranging links in a "title - author" format, so naturally the article's title, which is that entire quote, was to be followed by Zizek's name. I have, in fact, read the article in question (otherwise I wouldn't have linked to it, right?), so I am quite aware that Zizek was quoting the other guy.
1lavalamp
It's great that you knew, but that combination of characters is normally interpreted differently, so paper-machine has saved me from storing an incorrect memory (as I'm skimming this thread and not reading every link)...
[-]Multiheaded00

Apropos of nothing, opinion on the Breivik trial (sentenced to a mere 21 years with some possibility of extension, if you haven't heard):

Of course I think he ought to be killed. The thing is, Norway has no need to reinstate the death penalty just for him, then repeal it (like with Vidkun Quisling after the war; the Norwegian government in exile had reintroduced the death penalty in response to the occupation, then repealed it after executing him and several other collaborators).
Instead, Norway should've granted his request to be court-martialed, then the m... (read more)

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5mrglwrf
Assuming it is important to Norwegians' self-image that they are a state without a death penalty, it's not clear to me what compensatory benefits could be derived from executing Breivik. Appeasing foreign and domestic bubbas would definitely not be a plus for the typical Norwegian.
0Multiheaded
Norway might not have a death penalty, but Norwegians are probably OK with having a military, and a military's role does cover stopping violent insurgents with lethal force. What it does is defence, not judgment. Like I said, by accepting Breivik's narrative of his "insurgency", Norway can use an extraordinary circumstance to justify an extraordinary response, and then return to "normality". (Jeez, I just realized this sounds a little like Carl Schmitt. Ah well, fascist times call for fascist measures.)
4mrglwrf
"Accepting Breivik's narrative" sounds even less appealing. Why give him the satisfaction? Just lock him up til he dies of old age. Whether or not the Norwegian government could legally justify his execution has little bearing on whether they'd want to execute him in the first place. I think you underestimate the amount of smug self-satisfaction derived from looking down on the "barbaric" states that still have the death penalty.
2[anonymous]
... You do realize you are thinking like Moldbug here right? Just saying. Ah you do! :)
0Eugine_Nier
Well, they did more-or-less this with Quisling.
[-]Multiheaded00

Interesting reflection on the possible practical applications of Zizek's philosophy. Comes down to "Smash the current discourse first, especially liberal discourse." Hmmm.

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[-]Multiheaded-10

Yes, yes, I've read the header; direct Blue vs. Green is frowned upon - but still, a redundant observation: Mitt Romney's "campaign" is almost phildickian in its dark hilarity. The post-hoc jokes alone are going to be worth a year of Bush. Yo dawg, we heard you like bread and circuses, so we put 'em in a circus, so you can lol while you lol...

(Note: I don't find the other guy any less sad, he's just more boring at this point.)

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[-]Brigid-10

People who are pro-life in the abortion debate should also be pro- free birth control pills (those not requiring a co-pay).

If pro-lifers were more pragmatic, they would rank the issues that they care about from least-bad to worst. Most would agree that abortion is worse than pre-marital sex. Therefore, they should support efforts to eliminate the need for abortions (not just seek to eliminate the ability to have an abortion). As access to birth control reduces the likelihood of the need to have an abortion, free birth control pills would reduce the over... (read more)

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8Viliam_Bur
When discussing our opponents, it is easy to suggest that they should maximize their immediate utility. When discussing ourselves, it is easier to notice that maximizing immediate utility could have various negative long-term consequences. Maybe there are good game-theoretic reasons why pro-lifers should oppose what you suggest. For example, ranking one's values from least-bad to worst (and making the ranking generally known) could be a bad signalling move, if you really want to achieve them all in long run.
[-]Eugine_Nier130

A related outside view observation: Whenever a Green attempts to give the Blues tactical advise, no matter how well-meaning, the advise always seems to boil down to compromising on at least half the Blue positions.

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2Brigid
Fair enough. :)
1Brigid
That's a great point that I didn't consider.
7wedrifid
That doesn't follow. Do I need to sing the song?
3Manfred
This seems reasonable. But it's based on the assumption that abortion-outlawing groups are acting in a particular goal-based way. And most of them are not. Instead, the laws reflecting their values have become goals in and of themselves - it's what the organizations exist for. This definitely leads to missed opportunities.
2Petra
I'm with you on this one, and it ties in with a point that I have used several times in discussions about abortion, regarding why pro-lifers have done such a poor job thus far of accomplishing their goals. If a person truly believes that "life starts at conception" and that abortion is taking the life of a human being, a rational actor who values human life would take action to minimize the loss of life, correct? If the pro-life movement was doing this, they would be proposing options that would be palatable to a much greater portion of society than their current hard-line ideas, though it might still not be enough to get laws passed. They should be not just willing, but eager, to make concessions for rape and incest victims, and for cases in which the life of the mother is in danger. You can argue the slippery slope all you want, but the fact is, human beings are being killed (as they believe) while they stick to their guns.
6Alicorn
People are really, really bad at taking action in response to this kind of thing. Selling people on "if you care about human lives, it matters how many of them you save, and you can get information about that" is tricky and about 90% of the concept of optimal philanthropy.
2J_Taylor
Birth control pills are only as reliable as the people who take them. This intervention could very well cause an increase in abortion.
6Alicorn
That is a mechanism by which availability of birth control could theoretically increase abortion; do you have any empiricism handy?
3J_Taylor
Absolutely none whatsoever. Edit: Confound these Lesswrongers, they drive me to research. Anyways, to make a brief attempt using data from here, it seems that I was either overestimating p(oops|pill) or underestimating p(oops|condom). Of course, the hypothetical pragmatic pro-lifer really should be advocating for Dreaded_Anomaly's suggested methods as opposed to free pills. Still, I give substantially more credence to the statement: (Note: I was not giving much credence to begin with.)
4Dreaded_Anomaly
Long lasting birth control exists and the various methods have much lower failure rates than the once-a-day pill. Here's a large analysis from the Guttmacher Institute about rates of contraception use vs. rates of abortion. Increased contraception use along with improving methods dramatically reduces the abortion rate.
0drethelin
If they were pragmatic they would not be pro-life, the entire argument boils down to pragmatism versus deontological rules.
-1phonypapercut
Many forms of contraceptives are already free from non-profits. And they're pretty cheap otherwise. I don't think mandating that insurance cover contraceptives would affect their use very much.
1Brigid
While Planned Parenthood clearly could be biased, they state (noteably without a reference) that " Women typically pay between $15 and $50 a month in co-pays for birth control pills — $180 to $600 a year." Even $180 is pretty expensive. They also claim that " More than one-third of all women voters have struggled to pay for prescription birth control at some point in their lives, and have as a result used birth control inconsistently." Finally, "On average, a woman spends 30 years of her life trying to avoid pregnancy. That means 30 years of paying for birth control."
-2gokhalea
I think nearly all the responses to this question miss the point. your points (both the original comment and the responses) use a "less wrong" type definition of rationality/pragmatism/reasonableness, none of which apply to the many religious pro-lifers. When looking at abortion from a religious perspective, and not a legal or "less wrong" rationality perspective, being pro-life is absolutely consistent with not wanting people to use birth control. procreation, all relevant acts and the results relating thereto, are sacred and should not be messed with. Simple - that's all there is to it. Though i personally do not believe in these, it strikes me as a reasonable and principled way of looking at the issue (e.g., most believe life is sacred, most pro-choicers dont like abortion, etc.). The idea of "cutting your losses" and being pragmatic, from a religious viewpoint, is actually quite ridiculous. Losing the issue is 100% better than being pragmatic precisely because it allows the pro-lifer to live their life in a manner that is consistent with their guidepost -- religion. Religion serves as their moral compass. In many ways, these religious morals are consistent with the legal and pragmatic perspectives the less wrong community generally supports. When they diverge, the less wrong community looks to "rationality," the religious look to their religion. I believe a vast majority of religious folks are "subjectively rational." Objective rationality is rationality that can be proven correct. Subjective rationality is rationality that cannot be proven wrong. So long as you cannot prove there is no god (which you can't, sorry!), religious arguments, particularly ones that at its core are trying to preserve life (and embryos that result in life) will have my vote as subjectively rational. I note that most countries, paricularly the united states, were formed and flourished with religious laws carrying the day, at least from moral and personal perspective. This is not to sa
-4mwengler
Or the pro-lifers could go the other way, and require everybody between the ages of 14 and 41 who is sexually active to be assigned a new baby to take care of every two years. Or at least entered in to a lottery to be assigned a baby in case we run out of unwanted children after this policy is implemented. On its face pro-life seems to be anti-killing-fetus's. But I think the underlying morality is a belief that children ought to come from sex. As political statements go, I'm voting yours up because it chips away at anti-birth control sentiment. I don't like telling other people (pro-lifers in this case) how they "should" think, but I suspect that telling other people how they think IS the essence of a political statement! So given the constraints of political statements, I like yours!
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