recentpopularlog in

robertogreco : litigiousness   3

Considerations On Cost Disease | Slate Star Codex
[via: https://meaningness.com/metablog/post-apocalyptic-health-care ]

"IV.

I mentioned politics briefly above, but they probably deserve more space here. Libertarian-minded people keep talking about how there’s too much red tape and the economy is being throttled. And less libertarian-minded people keep interpreting it as not caring about the poor, or not understanding that government has an important role in a civilized society, or as a “dog whistle” for racism, or whatever. I don’t know why more people don’t just come out and say “LOOK, REALLY OUR MAIN PROBLEM IS THAT ALL THE MOST IMPORTANT THINGS COST TEN TIMES AS MUCH AS THEY USED TO FOR NO REASON, PLUS THEY SEEM TO BE GOING DOWN IN QUALITY, AND NOBODY KNOWS WHY, AND WE’RE MOSTLY JUST DESPERATELY FLAILING AROUND LOOKING FOR SOLUTIONS HERE.” State that clearly, and a lot of political debates take on a different light.

For example: some people promote free universal college education, remembering a time when it was easy for middle class people to afford college if they wanted it. Other people oppose the policy, remembering a time when people didn’t depend on government handouts. Both are true! My uncle paid for his tuition at a really good college just by working a pretty easy summer job – not so hard when college cost a tenth of what it did now. The modern conflict between opponents and proponents of free college education is over how to distribute our losses. In the old days, we could combine low taxes with widely available education. Now we can’t, and we have to argue about which value to sacrifice.

Or: some people get upset about teachers’ unions, saying they must be sucking the “dynamism” out of education because of increasing costs. Others people fiercely defend them, saying teachers are underpaid and overworked. Once again, in the context of cost disease, both are obviously true. The taxpayers are just trying to protect their right to get education as cheaply as they used to. The teachers are trying to protect their right to make as much money as they used to. The conflict between the taxpayers and the teachers’ unions is about how to distribute losses; somebody is going to have to be worse off than they were a generation ago, so who should it be?

And the same is true to greater or lesser degrees in the various debates over health care, public housing, et cetera.

Imagine if tomorrow, the price of water dectupled. Suddenly people have to choose between drinking and washing dishes. Activists argue that taking a shower is a basic human right, and grumpy talk show hosts point out that in their day, parents taught their children not to waste water. A coalition promotes laws ensuring government-subsidized free water for poor families; a Fox News investigative report shows that some people receiving water on the government dime are taking long luxurious showers. Everyone gets really angry and there’s lots of talk about basic compassion and personal responsibility and whatever but all of this is secondary to why does water costs ten times what it used to?

I think this is the basic intuition behind so many people, even those who genuinely want to help the poor, are afraid of “tax and spend” policies. In the context of cost disease, these look like industries constantly doubling, tripling, or dectupling their price, and the government saying “Okay, fine,” and increasing taxes however much it costs to pay for whatever they’re demanding now.

If we give everyone free college education, that solves a big social problem. It also locks in a price which is ten times too high for no reason. This isn’t fair to the government, which has to pay ten times more than it should. It’s not fair to the poor people, who have to face the stigma of accepting handouts for something they could easily have afforded themselves if it was at its proper price. And it’s not fair to future generations if colleges take this opportunity to increase the cost by twenty times, and then our children have to subsidize that.

I’m not sure how many people currently opposed to paying for free health care, or free college, or whatever, would be happy to pay for health care that cost less, that was less wasteful and more efficient, and whose price we expected to go down rather than up with every passing year. I expect it would be a lot.

And if it isn’t, who cares? The people who want to help the poor have enough political capital to spend eg $500 billion on Medicaid; if that were to go ten times further, then everyone could get the health care they need without any more political action needed. If some government program found a way to give poor people good health insurance for a few hundred dollars a year, college tuition for about a thousand, and housing for only two-thirds what it costs now, that would be the greatest anti-poverty advance in history. That program is called “having things be as efficient as they were a few decades ago”.

V.

In 1930, economist John Maynard Keynes predicted that his grandchildrens’ generation would have a 15 hour work week. At the time, it made sense. GDP was rising so quickly that anyone who could draw a line on a graph could tell that our generation would be four or five times richer than his. And the average middle-class person in his generation felt like they were doing pretty well and had most of what they needed. Why wouldn’t they decide to take some time off and settle for a lifestyle merely twice as luxurious as Keynes’ own?

Keynes was sort of right. GDP per capita is 4-5x greater today than in his time. Yet we still work forty hour weeks, and some large-but-inconsistently-reported percent of Americans (76? 55? 47?) still live paycheck to paycheck.

And yes, part of this is because inequality is increasing and most of the gains are going to the rich. But this alone wouldn’t be a disaster; we’d get to Keynes’ utopia a little slower than we might otherwise, but eventually we’d get there. Most gains going to the rich means at least some gains are going to the poor. And at least there’s a lot of mainstream awareness of the problem.

I’m more worried about the part where the cost of basic human needs goes up faster than wages do. Even if you’re making twice as much money, if your health care and education and so on cost ten times as much, you’re going to start falling behind. Right now the standard of living isn’t just stagnant, it’s at risk of declining, and a lot of that is student loans and health insurance costs and so on.

What’s happening? I don’t know and I find it really scary."
scottalexander  economics  education  history  politics  policy  prices  inflation  highered  highereducation  colleges  universities  bureaucracy  costdisease  healthcare  spending  us  government  medicine  lifeexpectancy  salaries  teachers  teaching  schools  regulation  tylercowen  poverty  inequality  litigation  litigiousness  labor  housing  rent  homes  subways  transportation  health 
january 2018 by robertogreco
Seven Reasons We Hate Free-Range Parenting - Bloomberg View
"Danielle and Alexander Meitiv of Maryland want to raise their children as "free-range kids," which is to say giving them the kind of range of movement that those of us over 30 recall as a normal part of childhood. One of my cherished childhood memories is the long walks my best friend and I would take home from church through New York's Riverside Park, which Google Maps records as a distance of a mile and a half, stopping at every playground along the way. This is slightly longer than the walk home from the playground that caused Montgomery County's Child Protective Services to investigate the Meitivs last year, after someone called the police to report the alarming sight of ... children walking down the street alone. On Sunday, after another "good Samaritan" called the cops, CPS seized the children, leaving the parents frantic with worry for hours.

One could argue that this is a good lesson for the parents. One could also argue that it would be bracing to have the police periodically break into our homes to educate us about weak points in our security systems. In fact, the sort of abduction that CPS apparently wants the Meitivs to obsess over is incredibly rare and always has been.

Why has America gone lunatic on the subject of unattended children? Parents hover over their kids as if every step might be their last. If they don't hover, strangers do, calling the police to report any parent who leaves their child to run into the store for a few minutes. What's truly strange is that the parents who are doing this were themselves left to their own devices in cars, allowed to ride their bikes and walk to the store unsupervised, and otherwise given the (limited) freedom that they are now determined to deny their own kids. The police are making arrests that would have branded their own parents as criminals. To hear people my age talk about the dangers of unsupervised children, you would think that the attrition rate in our generation had been at least 30 percent.

Even people who haven't gone crazy are afraid of the Pediatric Patrol. A mom of my acquaintance whose house backs up to a school playground, with a gate that lets her children walk straight into the schoolyard, is afraid to let them go through the gate without an adult, for fear that someone would call the same nutty CPS that has taken to impounding the Meitiv children. She compromises by letting them play alone in the playground only when she is in the backyard, so that she can intervene if the police arrive.

Think about that: Kids have the priceless boon of a playground right in their backyard, but they can't use it unless Mom drops everything to accompany them. I am running out of synonyms for "insane" to describe the state we have worked ourselves into. What on earth has happened to us?

As it happened, I looked into that for my book, and the disappointing news is that I didn't find much good research to explain this mass shift in American parenting. I did, however, develop some theories from watching parents, law enforcement officials and others discuss the pros and cons of free-range parenting.

I should add a caveat: I don't have kids, so I lack an important perspective. And I should say that if I did have kids, I'm sure I too would be a safety paranoiac, making my own baby food from organic ingredients just in case pesticides in their unsweetened applesauce turn out to cause cancer. So I'm not blaming individual parents; this is a collective insanity, not a personal foible.

So how can we explain it?

1. Cable news. When you listen to parents talk about why they hover, you'll frequently hear that the world is more dangerous than it used to be. This is the exact opposite of the truth. The New York City where I walked to school, past housing projects with major crime problems and across busy streets, was much more dangerous than the New York of today. And that is true of virtually everywhere. The world is not more dangerous. But it feels more dangerous to a lot of people because the media landscape has shifted.

Think of it this way: There were always stranger abductions, but they were always extremely rare, perhaps 2 or 3 per 1 million children under 12 in the U.S. each year. However, in the 1970s, you most likely only heard about local cases, and because these were rare, you would hear about one every few years in a moderately large metropolitan area. This made it sound like what it is: an unimaginably terrible thing that thankfully almost never happens. Very occasionally, a case would catch the imagination and make national news, like the Lindbergh baby. But these almost always happened in big cities like New York, or to rich people, so people didn't imagine that this was a risk that faced them.

Then along came cable news, which needed to fill 24 hours a day with content. These sorts of cases started to make national news, and because our brains are terrible at statistics, we did not register this as "Aha, the overall rate is still low, but I am now hearing cases drawn from a much larger population, so I hear about more of them." Instead, it felt like stranger abductions must have gone up a lot.

The Internet also enables parents to share stories of every bad thing that happens to their children. We used to be limited to collecting these stories from people we actually met, which meant that we didn't hear a lot of truly terrible stories. Now we have thousands at the tips of our fingers, and the same failures of statistical intuition make it feel like wow, terrible things are happening all the time these days.

2. Economic insecurity. As college degrees, and particularly elite degrees, have become more valuable, parents have come to feel that they must micromanage their children's lives in order to make a good showing on college applications. The result is vastly more supervised activities. This has shrunk the pool of kids who are around to play with, making free-range childhood less rewarding.

3. Mothers working. In suburbs and small towns, stay-at-home moms formed "eyes on the street," so that even if your kid was roaming the neighborhood, there was a gentle adult eye periodically sweeping across their activity. But I don't think we can lean on this too much, because kids in cities also had a lot more independence back then, and the Broadway of my youth was not exactly a sweet, sheltered world where nothing much could go wrong.

There's another reason I think this matters, however. More mothers are paying others to take care of their children. It's easy to impose severe limits on the mobility of your children when you are not personally expected to provide 24-hour supervision. When I was a kid, there were a lot of mothers at home who believed that being home with kids was important but did not actually personally enjoy playing with 4-year-olds. Those parents would have rebelled at being told that they should never let their kids out of hearing range. Those mothers are now at work, paying someone else to enjoy playing with their 4-year-old or at least convincingly fake it.

4. Collective-action problems. When it comes to safety, overprotective parents are in effect taking out a sort of regret insurance. Every community has what you might call "generally accepted child-rearing practices," the parenting equivalent of "generally accepted accounting principles." These principles define what is good parenting and provide a sort of mental safe harbor in the event of an accident. If you do those things and your kid gets hurt -- well, you'll still wish that you'd asked them to stay home and help bake cookies, or lingered a little longer at the drugstore, or something so that they weren't around when the Bad Thing happened. But if you break them and your kid gets hurt, you -- and a lot of other people -- will feel that it happened because you were a bad parent. So you follow the GACP.

Over time, these rules get set by the most risk-averse parent in your social group, because if anything happens, you'll wish you had acted like them. This does not mean that the kids are actually safer: Parents in most places "shelter" their kids from risk by strapping them into cars and driving them to supervised activities, which is more dangerous than almost anything those kids could have gotten up to at home.

5. Lawsuits. In the U.S., the liability revolution of the 1970s has made every institution, from parks departments to schools, much more sensitive about even tiny risks, because when you go before the jury in a case about a hurt child, arguing that what happened was less likely than getting hit by a bolt of lightning is going to have much less impact than the evidence of a hurt child.

6. Mobile phones. All these strangers calling 911 to report a 6-year-old who has been left in a car outside a store for a few minutes are probably doing so because it's easy. If that person had to dig for a piece of paper and a pen to write the license plate down, then take time out of their day to find a pay phone, dial the police and stand around talking to the 911 operator, most would probably think "You know, I bet his mom is going to come out of the store in a minute, and I really need to get home to start dinner." Now you can just take a picture of the license plate and call from the comfort of your car. It would be surprising if we lowered the price of being an officious busybody and didn't get a lot more of it.

7. We're richer. Richer countries can afford more safety. That's a good thing, but there can be too much safety. There are major downsides to this form of parenting, as many authors have laid out: It's hard on the parents, may result in the kids developing more phobias, and stunts the creativity and self-reliance that we theoretically want to develop in children so that they can become happy and productive adults.

I don't think there's one easy answer to why we've become insane; rather, there are a lot of forces that are pushing in this direction. But that doesn't mean we can't push back. And a good start would be for … [more]
parenting  children  safety  meganmcardle  freedom  free-rangeparenting  2015  media  news  statistics  liability  litigiousness  law  legal  helicoperparents  helicopterparenting  labor  work  economics  insecurity  micromanagment  lawenforcement  childcare  overprotection  risk  riskassessment  risktaking  lawsuits  mobile  phones  wealth  cps  via:ayjay  helicopterparents 
april 2015 by robertogreco
Why has human progress ground to a halt? – Michael Hanlon – Aeon
"Some of our greatest cultural and technological achievements took place between 1945 and 1971. Why has progress stalled?"



"Yet there once was an age when speculation matched reality. It spluttered to a halt more than 40 years ago. Most of what has happened since has been merely incremental improvements upon what came before. That true age of innovation – I’ll call it the Golden Quarter – ran from approximately 1945 to 1971. Just about everything that defines the modern world either came about, or had its seeds sown, during this time. The Pill. Electronics. Computers and the birth of the internet. Nuclear power. Television. Antibiotics. Space travel. Civil rights.

There is more. Feminism. Teenagers. The Green Revolution in agriculture. Decolonisation. Popular music. Mass aviation. The birth of the gay rights movement. Cheap, reliable and safe automobiles. High-speed trains. We put a man on the Moon, sent a probe to Mars, beat smallpox and discovered the double-spiral key of life. The Golden Quarter was a unique period of less than a single human generation, a time when innovation appeared to be running on a mix of dragster fuel and dilithium crystals.

Today, progress is defined almost entirely by consumer-driven, often banal improvements in information technology. The US economist Tyler Cowen, in his essay The Great Stagnation (2011), argues that, in the US at least, a technological plateau has been reached. Sure, our phones are great, but that’s not the same as being able to fly across the Atlantic in eight hours or eliminating smallpox. As the US technologist Peter Thiel once put it: ‘We wanted flying cars, we got 140 characters.’

Economists describe this extraordinary period in terms of increases in wealth. After the Second World War came a quarter-century boom; GDP-per-head in the US and Europe rocketed. New industrial powerhouses arose from the ashes of Japan. Germany experienced its Wirtschaftswunder. Even the Communist world got richer. This growth has been attributed to massive postwar government stimulus plus a happy nexus of low fuel prices, population growth and high Cold War military spending.

But alongside this was that extraordinary burst of human ingenuity and societal change. This is commented upon less often, perhaps because it is so obvious, or maybe it is seen as a simple consequence of the economics. We saw the biggest advances in science and technology: if you were a biologist, physicist or materials scientist, there was no better time to be working. But we also saw a shift in social attitudes every bit as profound. In even the most enlightened societies before 1945, attitudes to race, sexuality and women’s rights were what we would now consider antediluvian. By 1971, those old prejudices were on the back foot. Simply put, the world had changed."



"Lack of money, then, is not the reason that innovation has stalled. What we do with our money might be, however. Capitalism was once the great engine of progress. It was capitalism in the 18th and 19th centuries that built roads and railways, steam engines and telegraphs (another golden era). Capital drove the industrial revolution.

Now, wealth is concentrated in the hands of a tiny elite. A report by Credit Suisse this October found that the richest 1 per cent of humans own half the world’s assets. That has consequences. Firstly, there is a lot more for the hyper-rich to spend their money on today than there was in the golden age of philanthropy in the 19th century. The superyachts, fast cars, private jets and other gewgaws of Planet Rich simply did not exist when people such as Andrew Carnegie walked the earth and, though they are no doubt nice to have, these fripperies don’t much advance the frontiers of knowledge. Furthermore, as the French economist Thomas Piketty pointed out in Capital (2014), money now begets money more than at any time in recent history. When wealth accumulates so spectacularly by doing nothing, there is less impetus to invest in genuine innovation."



"But there is more to it than inequality and the failure of capital.

During the Golden Quarter, we saw a boom in public spending on research and innovation. The taxpayers of Europe, the US and elsewhere replaced the great 19th‑century venture capitalists. And so we find that nearly all the advances of this period came either from tax-funded universities or from popular movements. The first electronic computers came not from the labs of IBM but from the universities of Manchester and Pennsylvania. (Even the 19th-century analytical engine of Charles Babbage was directly funded by the British government.) The early internet came out of the University of California, not Bell or Xerox. Later on, the world wide web arose not from Apple or Microsoft but from CERN, a wholly public institution. In short, the great advances in medicine, materials, aviation and spaceflight were nearly all pump-primed by public investment. But since the 1970s, an assumption has been made that the private sector is the best place to innovate."

[See also this response from Alan Jacobs: http://ayjay.tumblr.com/post/105225967233/the-future-of-ambition

"I’m not sure this essay by Michael Hanlon on the lack of technical and scientific progress over the past 40 years adds much to other recent speculations on the same theme: Tyler Cowen’s book The Great Stagnation, talks by Neal Stephenson on our lack of visionary imagination, and so on.

But it’s an indication at least of a growing awareness that, despite the determined efforts of the advertising world to suggest that everything is getting better all the time, our society is stuck in something of a technological rut, especially with regard to travel and, more important, medical care. Flying is a more frustrating experience than it has ever been and is only getting worse; only Google and Elon Musk are even trying to innovate in automobiling; and, as Hanlon points out, a person getting cancer today will receive treatment not fundamentally different than he or she would have received in 1970, and doesn’t stand a much greater chance of beating the disease.

So why aren’t we doing better? Hanlon offers a few fairly vague suggestions, as does Cowen, but this is an inquiry in its early stages. Let me just offer my two cents — precisely two.

Cent number one: Litigiousness. Every technological development in every field, but especially in health care, is hamstrung by the need to perform due diligence, and then beyond-due diligence, and then absurdly-over-the-top diligence, before putting a product on the market lest the developing company be sued by someone unhappy with their results. How many times have you read about some exciting new cancer treatment — and then never hear about it again, as it disappears into the endless Purgatory of tiny clinical trials that dying people beg (usually unsuccessfully) to be allowed to participate in?

Cent number two: Self-soothing by Device. I suspect that few will think that addition to distractive devices could even possibly be related to a cultural lack of ambition, but I genuinely think it’s significant. Truly difficult scientific and technological challenges are almost always surmounted by obsessive people — people who are grabbed by a question that won’t let them go. Such an experience is not comfortable, not pleasant; but it is essential to the perseverance without which no Big Question is ever answered. To judge by the autobiographical accounts of scientific and technological geniuses, there is a real sense in which those Questions force themselves on the people who stand a chance of answering them. But if it is always trivially easy to set the question aside — thanks to a device that you carry with you everywhere you go — can the Question make itself sufficiently present to you that answering is becomes something essential to your well-being? I doubt it." ]
science  technology  progress  michaelhanlon  tylercowen  attention  distraction  litigiousness  law  legal  funding  economics  capitalism  research  society  channge  inequality  innovation  riskaversion  risktaking  risk  medicine  healthcare 
december 2014 by robertogreco

Copy this bookmark:





to read