Yascha Mounk and Jonathan Haidt; Ed West on cultural dispersion; Balaji on Twitter; Matt Yglesias on the rush to treat gender dysphoria; Steven Hsu on informal networks
I am curious as to whether any nation has something close to a real free market for health care services and, if so, how it compares to others. There are so many things about the U.S. healthcare system that strike me as utterly bizarre, e.g., the lack of price transparency, the lack of competition on price, the expectation that an “insurer” -- I thought insurance was generally for unpredictable and potentially catastrophic events -- will pay for my doctor visit and medicine, etc. I understand that medical treatment can sometimes be critical for life, but so is food and shelter, and competitive markets seem to work pretty well in those areas.
As far as I can tell, s/he applies more data on this question than anyone. And the conclusion is that Americans spend pretty much exactly what you would expect on health care given how much they spend on everything else. That means the question of how the system is structured is second-order with regards to this particular issue.
The key takeaway is that people's spending behavior on health care looks like their spending behavior on other goods. Policy that treats it as if it's categorically different, may be a mistake.
‘…America’s system of rationing health care based on the ability to pay leads to overtreatment of some even while access is denied to others.’
With a lifetime’s (to date) experience of State controlled/provided healthcare, UK’s NHS, where everyone has ‘access’ to it free at the point of delivery, I can with authority tell you that whilst healthcare in the USA is rationed on the ability of individuals to pay, healthcare in the UK is rationed on the ability of the State to pay.
And healthcare you get in the UK is what the provider decides you’ll get, to serve their needs, not what you want to serve your needs - because it’s ‘free’ so shut up and be grateful. And there’s nothing you can do about it because there is no competition: like it or lump it.
Access is not the same as getting… currently 6 million people have access to ‘free’ healthcare sitting on a waiting list, expected to increase substantially over the next year. More than half of Emergency Room patients are there because it is easier/quicker than trying to see their doctor.
All resources are scarce and have to be rationed somehow. Rationing by price has been shown time and time again to be the best and fairest (not perfect) way of rationing.
When something is ‘free’, many consume it who don’t need it at the expense if those who do. Rationing by quotas or waiting lists never serves the needy first and most, it’s just luck of the draw and people with sharp elbows.
"Nearly a quarter — 24 percent — of community hospitals in the U.S. were classified as for-profit in 2019, while more than 57 percent were nonprofit and nearly 19 percent were controlled by a state, county or city government."
Haidt is so confirmation biased and closed about Bloom's 1987 "The Closing of the American Mind" - US colleges secretly (openly?) discriminate against Republicans and have been doing so for many decades. He, like J. Rauch, says good things, but fails to actually follow that advice honesty:
"you have to have viewpoint diversity, you have to have people pushing against each other. And by design, we always used to have that in universities, journalism—the adversarial legal system is set up that way—and when that fails, when you systematically intimidate dissenters, the institution gets structurally stupid. It cannot do smart things. And that's what happened beginning in 2014. " When he wrote "The Coddling of the American Mind" - clearly aware of and thus pointedly ignoring Bloom & college discrimination.
Yes to viewpoint diversity - but colleges have been long against this tho they've become far more strongly against this since 2014. Claiming it started then fits his story better and the many decades of mild but increasing discrimination don't.
He's correct about the increased mob intimidation effectiveness, and especially Yale's willingness to accept mob rule in 2015. And he does want better intellectuals, as do I, without being willing to call out how often the Democrat supporting intellectuals are dishonest. Lots of Republicans are called out as dishonest for lesser lies.
Let's also remember America elected it's First Black President in 2008 - but every single person who opposed any of his policies was called a "racist" by some number of paid intellectuals (academics, journalists).
Mounk mentions that "American elites don't seem to hold beliefs" , which I don't think is true. Instead, they strongly hold false beliefs and obfuscate the truth. Somewhat like Arnold Kling does when he implies that human life does NOT start at conception. Life is not the same as human rights.
A better point for the start of polarization is ... Roe v Wade in 1972. With the dishonesty about Federal Power (unwritten penumbra of privacy vs explicit 10th Amendment) as well as claiming the question is "when does human life begin" rather than "when does the gov't begin protecting human rights that all humans have"?
Many biological processes undergo an S curve of slow expansion, than rapid explosive expansion up to some plateau or peak. The intellectual domination of pro-choice (pro-abortion) on colleges seems to have followed this S curve, along with the questioning of free speech based on being against hate speech. Perhaps pro-abortion domination on colleges had already been achieved by 1987. So in 1994 with Murray's "The Bell Curve" that highlighted racial differences in IQ, the "politically correct" response was to lie and claim Murray was lying. His data was lightly questioned, but he was pilloried for his conclusions about IQ differences in racial averages.
Larry Summers was fired from Harvard in 2006, partly because he truthfully noted that few women were top physicists. The dishonest PC folk claim women and men are "equal" in intelligence, altho SAT & IQ tests don't show this. See MIT's recent winners of the Putnam Exam:
5 guys in the first 5 spots, the top woman "in the top 15" (clearly not in top 10) - all Asian. No Hispanics, no Blacks, no Whites. Groups and averages in groups are not equal. We as a society need to deal with those truths - but PC lies make it more difficult to be honest about it, and Twitter makes it easier to stop the truth. (Optimal policy seems to be treating each as an individual...)
Haidt's a smart guy and does seem to want better discourse. A key idea in his Twitter / social media critique is to get human ID verification. He emphasizes this even more in his longer Atlantic article - yet in that article he utterly fails to note that many voters want Voter ID. If Haidt supports voter ID, why doesn't he claim so? If he opposes it, why not be honest? (because opposition is clearly hypocritical, but support outrages the Democrat intimidation crowd and he's unwilling to accept flak on this issue at this time?)
Arnold should be thinking about a FIT system which operates more on likes or ratings, with self-refereeing rather than needing a person or an AI (benign philosopher dictator).
So many great links to make me think so many different things.
Twitter is the one big thing where I'm 100% with you as opposed to Tyler. When my academic friends tell me they're on Twitter, I try to get some digs in, lecture them about how they should quit, whatever I think might work on them.
Re Robin Hanson on healthcare spending, the problem with his argument is that Hanson completely ignores the value of the *information* we get from health care. Diagnosis and prognosis is a huge part of what we’re buying with that money, and I think it’s extremely worthwhile. Compared with our ancestors, we know a huge amount about what’s going on with our bodies, how long we are likely to live, what ailments we’re likely to face in the future. Whether a problem is going to get better or become chronic. I think it’s a huge benefit to our peace of mind and our ability to plan our lives.
This is not to say that there isn't a grain of truth to his argument, but the idea that he has *proven* that most healthcare is a waste of money with the really basic (un-nuanced?) points he usually makes is silly.
Arnold, I think you are spot on in terms of what ails U.S. healthcare. The 3rd party payor system (i.e., the patient and those who pays the bills are not the same person). I would hazard to guess that one reason your book didn't gain much traction is that so many pundtis have spent their lives in govt, non profit sector or journalism. Unless you have worked in business, and especially a small business, the whole process of trying to make a profit by delivering value to paying customers (and how dynamic, challenging and fragile that process can can be) can easily be completely neglected and misunderstood.
If you or I see other interesting comments about how to improve the net benefits of our health-insurance system, I'll pass them along to Slow Boring.
Personally I place some blame on doctors for not being more economic optimizers on behalf of their patients, treating on the basis of total costs not costs to the patient and insurance companies for not pushing them in that direction. I think the US system that inserts employers as purchasers of insurance exacerbates the problem. We should move toward ACA for everyone.
I am curious as to whether any nation has something close to a real free market for health care services and, if so, how it compares to others. There are so many things about the U.S. healthcare system that strike me as utterly bizarre, e.g., the lack of price transparency, the lack of competition on price, the expectation that an “insurer” -- I thought insurance was generally for unpredictable and potentially catastrophic events -- will pay for my doctor visit and medicine, etc. I understand that medical treatment can sometimes be critical for life, but so is food and shelter, and competitive markets seem to work pretty well in those areas.
On health care, I apologize if someone has already pointed you to this, but if not, you should read Random Critical Analysis.
https://randomcriticalanalysis.com/why-conventional-wisdom-on-health-care-is-wrong-a-primer/
As far as I can tell, s/he applies more data on this question than anyone. And the conclusion is that Americans spend pretty much exactly what you would expect on health care given how much they spend on everything else. That means the question of how the system is structured is second-order with regards to this particular issue.
The key takeaway is that people's spending behavior on health care looks like their spending behavior on other goods. Policy that treats it as if it's categorically different, may be a mistake.
‘…America’s system of rationing health care based on the ability to pay leads to overtreatment of some even while access is denied to others.’
With a lifetime’s (to date) experience of State controlled/provided healthcare, UK’s NHS, where everyone has ‘access’ to it free at the point of delivery, I can with authority tell you that whilst healthcare in the USA is rationed on the ability of individuals to pay, healthcare in the UK is rationed on the ability of the State to pay.
And healthcare you get in the UK is what the provider decides you’ll get, to serve their needs, not what you want to serve your needs - because it’s ‘free’ so shut up and be grateful. And there’s nothing you can do about it because there is no competition: like it or lump it.
Access is not the same as getting… currently 6 million people have access to ‘free’ healthcare sitting on a waiting list, expected to increase substantially over the next year. More than half of Emergency Room patients are there because it is easier/quicker than trying to see their doctor.
All resources are scarce and have to be rationed somehow. Rationing by price has been shown time and time again to be the best and fairest (not perfect) way of rationing.
When something is ‘free’, many consume it who don’t need it at the expense if those who do. Rationing by quotas or waiting lists never serves the needy first and most, it’s just luck of the draw and people with sharp elbows.
"Nearly a quarter — 24 percent — of community hospitals in the U.S. were classified as for-profit in 2019, while more than 57 percent were nonprofit and nearly 19 percent were controlled by a state, county or city government."
https://www.beckershospitalreview.com/rankings-and-ratings/10-states-with-the-most-for-profit-hospitals-by-percentage.html#:~:text=Nearly%20a%20quarter%20%E2%80%94%2024%20percent,state%2C%20county%20or%20city%20government.
But yeah, the problem with the US healthcare system is that it's too entrepreneurial.
Haidt is so confirmation biased and closed about Bloom's 1987 "The Closing of the American Mind" - US colleges secretly (openly?) discriminate against Republicans and have been doing so for many decades. He, like J. Rauch, says good things, but fails to actually follow that advice honesty:
"you have to have viewpoint diversity, you have to have people pushing against each other. And by design, we always used to have that in universities, journalism—the adversarial legal system is set up that way—and when that fails, when you systematically intimidate dissenters, the institution gets structurally stupid. It cannot do smart things. And that's what happened beginning in 2014. " When he wrote "The Coddling of the American Mind" - clearly aware of and thus pointedly ignoring Bloom & college discrimination.
Yes to viewpoint diversity - but colleges have been long against this tho they've become far more strongly against this since 2014. Claiming it started then fits his story better and the many decades of mild but increasing discrimination don't.
He's correct about the increased mob intimidation effectiveness, and especially Yale's willingness to accept mob rule in 2015. And he does want better intellectuals, as do I, without being willing to call out how often the Democrat supporting intellectuals are dishonest. Lots of Republicans are called out as dishonest for lesser lies.
Let's also remember America elected it's First Black President in 2008 - but every single person who opposed any of his policies was called a "racist" by some number of paid intellectuals (academics, journalists).
Mounk mentions that "American elites don't seem to hold beliefs" , which I don't think is true. Instead, they strongly hold false beliefs and obfuscate the truth. Somewhat like Arnold Kling does when he implies that human life does NOT start at conception. Life is not the same as human rights.
A better point for the start of polarization is ... Roe v Wade in 1972. With the dishonesty about Federal Power (unwritten penumbra of privacy vs explicit 10th Amendment) as well as claiming the question is "when does human life begin" rather than "when does the gov't begin protecting human rights that all humans have"?
Many biological processes undergo an S curve of slow expansion, than rapid explosive expansion up to some plateau or peak. The intellectual domination of pro-choice (pro-abortion) on colleges seems to have followed this S curve, along with the questioning of free speech based on being against hate speech. Perhaps pro-abortion domination on colleges had already been achieved by 1987. So in 1994 with Murray's "The Bell Curve" that highlighted racial differences in IQ, the "politically correct" response was to lie and claim Murray was lying. His data was lightly questioned, but he was pilloried for his conclusions about IQ differences in racial averages.
Larry Summers was fired from Harvard in 2006, partly because he truthfully noted that few women were top physicists. The dishonest PC folk claim women and men are "equal" in intelligence, altho SAT & IQ tests don't show this. See MIT's recent winners of the Putnam Exam:
https://news.mit.edu/2022/mit-students-take-first-place-82nd-putnam-mathematical-competition-0311
5 guys in the first 5 spots, the top woman "in the top 15" (clearly not in top 10) - all Asian. No Hispanics, no Blacks, no Whites. Groups and averages in groups are not equal. We as a society need to deal with those truths - but PC lies make it more difficult to be honest about it, and Twitter makes it easier to stop the truth. (Optimal policy seems to be treating each as an individual...)
Haidt's a smart guy and does seem to want better discourse. A key idea in his Twitter / social media critique is to get human ID verification. He emphasizes this even more in his longer Atlantic article - yet in that article he utterly fails to note that many voters want Voter ID. If Haidt supports voter ID, why doesn't he claim so? If he opposes it, why not be honest? (because opposition is clearly hypocritical, but support outrages the Democrat intimidation crowd and he's unwilling to accept flak on this issue at this time?)
Arnold should be thinking about a FIT system which operates more on likes or ratings, with self-refereeing rather than needing a person or an AI (benign philosopher dictator).
So many great links to make me think so many different things.
Twitter is the one big thing where I'm 100% with you as opposed to Tyler. When my academic friends tell me they're on Twitter, I try to get some digs in, lecture them about how they should quit, whatever I think might work on them.
Re Robin Hanson on healthcare spending, the problem with his argument is that Hanson completely ignores the value of the *information* we get from health care. Diagnosis and prognosis is a huge part of what we’re buying with that money, and I think it’s extremely worthwhile. Compared with our ancestors, we know a huge amount about what’s going on with our bodies, how long we are likely to live, what ailments we’re likely to face in the future. Whether a problem is going to get better or become chronic. I think it’s a huge benefit to our peace of mind and our ability to plan our lives.
This is not to say that there isn't a grain of truth to his argument, but the idea that he has *proven* that most healthcare is a waste of money with the really basic (un-nuanced?) points he usually makes is silly.
Arnold, I think you are spot on in terms of what ails U.S. healthcare. The 3rd party payor system (i.e., the patient and those who pays the bills are not the same person). I would hazard to guess that one reason your book didn't gain much traction is that so many pundtis have spent their lives in govt, non profit sector or journalism. Unless you have worked in business, and especially a small business, the whole process of trying to make a profit by delivering value to paying customers (and how dynamic, challenging and fragile that process can can be) can easily be completely neglected and misunderstood.
If you or I see other interesting comments about how to improve the net benefits of our health-insurance system, I'll pass them along to Slow Boring.
Personally I place some blame on doctors for not being more economic optimizers on behalf of their patients, treating on the basis of total costs not costs to the patient and insurance companies for not pushing them in that direction. I think the US system that inserts employers as purchasers of insurance exacerbates the problem. We should move toward ACA for everyone.
“We live in an age of dispersion, meaning that most people behave in more extreme ways than they would have a few decades back.”
The golden age is not evenly distributed.
https://infovores.substack.com/p/irrational-institutions-3?s=w