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Pentashagon comments on On Walmart, And Who Bears Responsibility For the Poor - Less Wrong
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I get the impression that the real problem with health care specifically is that we are keeping sicker people alive longer with more effective (and expensive) treatments, and this increased cost is not being reimbursed by valuable work done by those sick people. In simplistic economic terms it is not cost-effective to keep a certain class of people alive or healthy. Is that analysis evil? I think so; automation will almost certainly put 99% of unmodified humans into that class at some point in the future. The practical effect is perhaps what we are seeing; Walmart and McDonalds can't afford to pay enough money to keep their minimum wage workers as healthy as a Silicon Valley tech worker or a NY banker, and the difference in achievable healthcare outcomes between a low income worker and a high income worker has increased significantly in the last 50 years. Remember when cancer and heart disease and even diabetes used to kill people (rich or poor) quickly and cheaply?
Guaranteed basic income or minimum wage aren't sufficient on their own to solve the problem. Total production efficiency (or at the very least medical/health care efficiency) has to increase at a rate equal to or above the rate that medical treatments and medical technology advance. When automation unemploys people from McDonalds and Walmart they will still get sick. at roughly the same rate, and with the same diseases. The total cost of providing healthcare will not go down, barring increases in efficiency, and the cost of welfare would increase. Given those assumptions it seems like the best action is to allow McDonalds and Walmart to continue to employ people at existing, sustainable wages and leave them on welfare, and implement as much of basic income or increases in minimum wage that the rest of the economy can bear to prepare for widespread automation, and focus heavily on automating medical care to improve its efficiency.
That's a problem. The international statistics suggest it's not the problem -- health care expenditures don't correlate particularly well with longevity at the high end.
Cultural tendencies towards proactive vs. reactive care might be responsible for part of this, but I'm unaware of any high-quality research on the issue. On the other hand, I haven't been following it closely.
Does that have anything to do with Walmart or health care for workers?
Evil? It depends on your moral code. However, I would certainly note that allowing the economy to kill people should be considered strongly contradictory with normal LessWrongian social goals like abolish effective scarcity and make everyone immortal.
People are dying for economical reasons all the time.
In most cases, when a person dies, there was an option to save them. Killed by a disease? With enough money, best doctors and medicine could be bought to save them. If that is not realistic, with some money they could be at least cryopreserved and given some chance of living again. Killed by a murderer? With enough money, there could have been a policeman standing on that street to prevent the crime. Killed by a random falling object? With enough money, something could be there to prevent the object from falling on someone's head. Killed by an obesity caused by unhealthy life style? I am sure that with enough money, something could be done to prevent this, too.
Thus speaking about not allowing the economy to kill people is merely an applause light. People die for economical reasons today, and they will also die tomorrow. The only choice we have is to move more money to some area, by taking the money from another area, so we can save some people from dying by cause X at the expense of more people dying by cause Y; and we can hope that by doing some we have increased the total value (total quality-adjusted life years, or whatever is your favorite metric).
In a perfect world, an answer to "is it worth spending $ 1 000 000 to save this person's life?" would always be yes, because in the imaginary perfect world you can always get the $ 1 000 000 without taking it from somewhere else. In real life we have choices more like "is it worth spending $ 1 000 000 to save this person's life? or should we instead let the person die and use the money to save lives of other ten people?". (And if you wish, you can make it more complicated by assuming that the first person is a Nobel price winner in medicine and invented a cure that saved millions of lives, but these days he is too old to invent anything more; and the other group contains one great poet, but also one murderer, et cetera.)
That is not true because of one simple observation: eventually everyone dies.
Millionaires and billionaires die, too, even with the best of doctors and security guards.
If this comment was made with the implicit intent and understanding of money as an abstraction of the resources we have available, I don't see why it hasn't been upvoted through the stratosphere yet.
It really, really hurts me when I see that the best options being offered by even the brightest minds and best visionaries in a given group all revolve around better redistribution of these million dollars, and not one of them asks "What if we could create a world where we don't have to take that million dollars from somewhere else?". Because I'm pretty sure that if someone cast Greater Wish and made everyone in a large rich country (e.g. USA) work together on this, it would happen.
I have the opposite perception. For the near and medium term, resources are finite and that means we have to make allocation trade-offs. When we're talking about safety and health resources, those decisions are going to have consequences for who lives and who doesn't.
I can imagine a society without resource shortages. But I can't imagine building it even with universal agreement and cooperation. You don't get a technological singularity just by wanting it.
Ah, I may have been overly abstract or generalized.
I agree with your assessment of the situation. What I would like to see is novel approaches at making it so that resource shortages that can be eliminated are eliminated. Cliché example: We are mere years away, barring opposition from invested parties and given continued funding and enthusiasm, from a fully automated transport and logistics infrastructure. AKA self-driven cars & trucks. (please leave argumentation of those two premises for another discussion - a Greater Wish or the circumstances I discussed in the grandparent would make those premises true for the purposes of this discussion)
Current wisdom is that these things should be left alone and "let the free market sort these things out" - which means, essentially, that we are to let shortages keep happening, because the margins of the free market will keep producing availability issues and shortages even on things where we can match supply to demand with positive net value after taking into account resources diverted from elsewhere (raw materials and human work time are the only relevant ones here once you trim the fat and all humans are fed, I believe).
So to come back to the virtual example of the million dollars, what I'd like to see is less people asking "How do we decide who to heal, cure and provide treatment for?" and more people asking "How do we dramatically increase the abstract availability and supply of medical resources and is there some way to do this without draining human resources from other industries?"
To craft a silly image, imagine an automated cold & flu treatment machine that looks like an ATM, is placed strategically to cover as many people as possible, does some basic automated symptom assessments to make sure it's cold & flu, and provides a printout and some dosage of medication.
Once the setup is done, all that's left is raw materials and human work to maintain the system, the human work is of a non-expert kind so not currently in any kind of shortage, and not planned to be given advances in automation, and the raw materials would be in the same ballpark as that already being consumed. An overall net gain, and the supply becomes directly tied to demand and only capped by raw materials, which in this example I'm led to believe are far more ample than what is needed to meet demand. An ideal scenario, disregarding the ridiculous feasibility issues with this scheme.
All this to say: There's too much Utopia/Reality dualistic thinking, where there are either No Resource Shortages or Limited Resources Which Require Free Markets, and nothing in between. Sure, eventually when you trim enough fat everything comes down to a few key raw resources, which could be abstracted into "money" if you tried really really hard, but those are, in most practical cases I've thought of, not the bottleneck.
What if we already have created a world of much greater wealth in absolute terms, and it still isn't benefitting the poorest?
Then we weren't looking for a solution to this problem statement, or we failed.
The problem statement I wish were posed is: Currently, there is an attribution of (e.g.) medical resources, where wealthier people have priority and every application of medical resources prevents the application of important resources in some other place, medical or otherwise. Can we change this situation around so that the opportunity cost of any given life-changing attribution of (e.g.) medical resources will always be lower than the returns of this attribution (e.g. productivity of the healed person)?
Naturally, this is intended to be a comprehensive "opportunity cost" calculation where "killing off all elders so that the overall medical opportunity cost of healing young persons becomes lower" is an appropriately taxed option. Still an option, perhaps a repugnant one, but at least one that is properly appraised. If there's currently no known good way to appraise this, then perhaps that might be a good first step?
What do you mean with "best doctor" in this case. Do you mean more than just a doctor who know which clinical trial says which drug is best for a particular condition?
There no straightforward way to throw money at the problem of obesity to solve it. Gastric bypass surgery might work to reduce the weight but it has it's own disadvantages and I wouldn't call it buying health.
I don't think that there are many cases where you can simply buy a life in a country with a health system like Germany for $1 000 000.
You're leaving out the possibility of needing to shuffle through a number of doctors to get a competent diagnosis. It's a fairly frequent problem in the US. I don't know how common it is in Germany.
Typo: I think you mean disadvantages.
Do you have a source that describes how US millionaires go through 10 doctors to get a correct diagnosis? I think most of the time in Germany what stopping people from going to more doctors isn't financial but the fact that they trust a doctor.
Fixed.
I don't have a source for how many non-millionaires in the US have to go through a number of doctors to get a correct diagnosis-- I just know a fair number of people (some online-only) who've done it. They probably have average or better incomes, though it would be worth checking. It isn't a cheap process, at least in terms of time, and I'm guessing that poor people are less likely to have the self-assurance to do it.
Your assumption is that the difference in Germany is in the degree of trust in doctors rather than better diagnosis?
I would guess that thing that separtes those people that you know online from the average person isn't only that the have more money but that the make decisions differently than the average person.
Is that because Germany has more competent doctors, or because Germans trust their doctors even when they shouldn't?
How does a non expert judge the competence of an expert?
Well, seeing if the doctor's recommendations help the problem is one way.
Like this? (I'd guess Germany would be somewhere between France and Sweden.)