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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
I Can Tolerate Anything Except The Outgroup | Slate Star Codex
[via: http://www.theamericanconservative.com/jacobs/the-outgroup-and-its-errors/ ]

"One day I realized that entirely by accident I was fulfilling all the Jewish stereotypes.

I’m nerdy, over-educated, good with words, good with money, weird sense of humor, don’t get outside much, I like deli sandwiches. And I’m a psychiatrist, which is about the most stereotypically Jewish profession short of maybe stand-up comedian or rabbi.

I’m not very religious. And I don’t go to synagogue. But that’s stereotypically Jewish too!

I bring this up because it would be a mistake to think “Well, a Jewish person is by definition someone who is born of a Jewish mother. Or I guess it sort of also means someone who follows the Mosaic Law and goes to synagogue. But I don’t care about Scott’s mother, and I know he doesn’t go to synagogue, so I can’t gain any useful information from knowing Scott is Jewish.”

The defining factors of Judaism – Torah-reading, synagogue-following, mother-having – are the tip of a giant iceberg. Jews sometimes identify as a “tribe”, and even if you don’t attend synagogue, you’re still a member of that tribe and people can still (in a statistical way) infer things about you by knowing your Jewish identity – like how likely they are to be psychiatrists.

The last section raised a question – if people rarely select their friends and associates and customers explicitly for politics, how do we end up with such intense political segregation?

Well, in the same way “going to synagogue” is merely the iceberg-tip of a Jewish tribe with many distinguishing characteristics, so “voting Republican” or “identifying as conservative” or “believing in creationism” is the iceberg-tip of a conservative tribe with many distinguishing characteristics.

A disproportionate number of my friends are Jewish, because I meet them at psychiatry conferences or something – we self-segregate not based on explicit religion but on implicit tribal characteristics. So in the same way, political tribes self-segregate to an impressive extent – a 1/10^45 extent, I will never tire of hammering in – based on their implicit tribal characteristics.

The people who are actually into this sort of thing sketch out a bunch of speculative tribes and subtribes, but to make it easier, let me stick with two and a half.

The Red Tribe is most classically typified by conservative political beliefs, strong evangelical religious beliefs, creationism, opposing gay marriage, owning guns, eating steak, drinking Coca-Cola, driving SUVs, watching lots of TV, enjoying American football, getting conspicuously upset about terrorists and commies, marrying early, divorcing early, shouting “USA IS NUMBER ONE!!!”, and listening to country music.

The Blue Tribe is most classically typified by liberal political beliefs, vague agnosticism, supporting gay rights, thinking guns are barbaric, eating arugula, drinking fancy bottled water, driving Priuses, reading lots of books, being highly educated, mocking American football, feeling vaguely like they should like soccer but never really being able to get into it, getting conspicuously upset about sexists and bigots, marrying later, constantly pointing out how much more civilized European countries are than America, and listening to “everything except country”.

(There is a partly-formed attempt to spin off a Grey Tribe typified by libertarian political beliefs, Dawkins-style atheism, vague annoyance that the question of gay rights even comes up, eating paleo, drinking Soylent, calling in rides on Uber, reading lots of blogs, calling American football “sportsball”, getting conspicuously upset about the War on Drugs and the NSA, and listening to filk – but for our current purposes this is a distraction and they can safely be considered part of the Blue Tribe most of the time)

I think these “tribes” will turn out to be even stronger categories than politics. Harvard might skew 80-20 in terms of Democrats vs. Republicans, 90-10 in terms of liberals vs. conservatives, but maybe 99-1 in terms of Blues vs. Reds.

It’s the many, many differences between these tribes that explain the strength of the filter bubble – which have I mentioned segregates people at a strength of 1/10^45? Even in something as seemingly politically uncharged as going to California Pizza Kitchen or Sushi House for dinner, I’m restricting myself to the set of people who like cute artisanal pizzas or sophisticated foreign foods, which are classically Blue Tribe characteristics.

Are these tribes based on geography? Are they based on race, ethnic origin, religion, IQ, what TV channels you watched as a kid? I don’t know.

Some of it is certainly genetic – estimates of the genetic contribution to political association range from 0.4 to 0.6. Heritability of one’s attitudes toward gay rights range from 0.3 to 0.5, which hilariously is a little more heritable than homosexuality itself.

(for an interesting attempt to break these down into more rigorous concepts like “traditionalism”, “authoritarianism”, and “in-group favoritism” and find the genetic loading for each see here. For an attempt to trace the specific genes involved, which mostly turn out to be NMDA receptors, see here)

But I don’t think it’s just genetics. There’s something else going on too. The word “class” seems like the closest analogue, but only if you use it in the sophisticated Paul Fussell Guide Through the American Status System way instead of the boring “another word for how much money you make” way.

For now we can just accept them as a brute fact – as multiple coexisting societies that might as well be made of dark matter for all of the interaction they have with one another – and move on."



"Every election cycle like clockwork, conservatives accuse liberals of not being sufficiently pro-America. And every election cycle like clockwork, liberals give extremely unconvincing denials of this.

“It’s not that we’re, like, against America per se. It’s just that…well, did you know Europe has much better health care than we do? And much lower crime rates? I mean, come on, how did they get so awesome? And we’re just sitting here, can’t even get the gay marriage thing sorted out, seriously, what’s wrong with a country that can’t…sorry, what were we talking about? Oh yeah, America. They’re okay. Cesar Chavez was really neat. So were some other people outside the mainstream who became famous precisely by criticizing majority society. That’s sort of like America being great, in that I think the parts of it that point out how bad the rest of it are often make excellent points. Vote for me!”

(sorry, I make fun of you because I love you)

There was a big brouhaha a couple of years ago when, as it first became apparent Obama had a good shot at the Presidency, Michelle Obama said that “for the first time in my adult life, I am proud of my country.”

Republicans pounced on the comment, asking why she hadn’t felt proud before, and she backtracked saying of course she was proud all the time and she loves America with the burning fury of a million suns and she was just saying that the Obama campaign was particularly inspiring.

As unconvincing denials go, this one was pretty far up there. But no one really held it against her. Probably most Obama voters felt vaguely the same way. I was an Obama voter, and I have proud memories of spending my Fourth of Julys as a kid debunking people’s heartfelt emotions of patriotism. Aaron Sorkin:
[What makes America the greatest country in the world?] It’s not the greatest country in the world! We’re seventh in literacy, 27th in math, 22nd in science, 49th in life expectancy, 178th in infant mortality, third in median household income, No. 4 in labor force, and No. 4 in exports. So when you ask what makes us the greatest country in the world, I don’t know what the f*** you’re talking about.

(Another good retort is “We’re number one? Sure – number one in incarceration rates, drone strikes, and making new parents go back to work!”)

All of this is true, of course. But it’s weird that it’s such a classic interest of members of the Blue Tribe, and members of the Red Tribe never seem to bring it up.

(“We’re number one? Sure – number one in levels of sexual degeneracy! Well, I guess probably number two, after the Netherlands, but they’re really small and shouldn’t count.”)

My hunch – both the Red Tribe and the Blue Tribe, for whatever reason, identify “America” with the Red Tribe. Ask people for typically “American” things, and you end up with a very Red list of characteristics – guns, religion, barbecues, American football, NASCAR, cowboys, SUVs, unrestrained capitalism.

That means the Red Tribe feels intensely patriotic about “their” country, and the Blue Tribe feels like they’re living in fortified enclaves deep in hostile territory.

Here is a popular piece published on a major media site called America: A Big, Fat, Stupid Nation. Another: America: A Bunch Of Spoiled, Whiny Brats. Americans are ignorant, scientifically illiterate religious fanatics whose “patriotism” is actually just narcissism. You Will Be Shocked At How Ignorant Americans Are, and we should Blame The Childish, Ignorant American People.

Needless to say, every single one of these articles was written by an American and read almost entirely by Americans. Those Americans very likely enjoyed the articles very much and did not feel the least bit insulted.

And look at the sources. HuffPo, Salon, Slate. Might those have anything in common?

On both sides, “American” can be either a normal demonym, or a code word for a member of the Red Tribe."



"This essay is bad and I should feel bad.

I should feel bad because I made exactly the mistake I am trying to warn everyone else about, and it wasn’t until I was almost done that I noticed.

How virtuous, how noble I … [more]
politics  psychology  society  tolerance  scottalexander  partisanship  bias  favoritism  filterbubbles  segregation  darkmatter  tribes  subtribes  polarization  patriotism 
april 2016 by robertogreco
The Outgroup and Its Errors | The American Conservative
"One of the most troubling features of our current political and social climate is how powerfully it is shaped by sheer animus.

A couple of years ago, Scott Alexander wrote a post titled “I Can Tolerate Anything Except the Outgroup.” I strongly recommend that you read the whole thing, but essentially Alexander sets out to answer a question: How is it that, say, straight white men can be gracious and kind to, say, lesbian black women while being unremittingly bitter towards other straight white men? What has happened here to the old distinction between ingroups and outgroups? His answer is that “outgroups may be the people who look exactly like you, and scary foreigner types can become the in-group on a moment’s notice when it seems convenient.”

Then Alexander gives a powerful example. He mentions being chastised by readers who thought he was “uncomplicatedly happy” when he expressed relief that Osama bin Laden was dead.
Of the “intelligent, reasoned, and thoughtful” people I knew, the overwhelming emotion was conspicuous disgust that other people could be happy about his death. I hastily backtracked and said I wasn’t happy per se, just surprised and relieved that all of this was finally behind us. […]

Then a few years later, Margaret Thatcher died. And on my Facebook wall – made of these same “intelligent, reasoned, and thoughtful” people – the most common response was to quote some portion of the song “Ding Dong, The Witch Is Dead”. Another popular response was to link the videos of British people spontaneously throwing parties in the street, with comments like “I wish I was there so I could join in.” From this exact same group of people, not a single expression of disgust or a “c’mon, guys, we’re all human beings here.”


Even when he pointed this out, none of his readers saw a problem with their joy in Thatcher’s death. And that’s when Alexander realized that “if you’re part of the Blue Tribe, then your outgroup isn’t al-Qaeda, or Muslims, or blacks, or gays, or transpeople, or Jews, or atheists – it’s the Red Tribe.”

Since Alexander wrote that post, an article has appeared based on research that confirms his hypothesis. “Fear and Loathing across Party Lines: New Evidence on Group Polarization,” by Shanto Iyengar and Sean J. Westwood, indicates that Americans today do not simply feel animus towards those who disagree with with politically, but are prepared to act on it. Their research discovers a good deal of racial prejudice, which is to be expected and which is likely to grow worse in the coming years, but people seem to think that they shouldn’t be racists or at least shouldn’t show it. However, people of one Tribe evidently believe, quite openly, that members of the other Tribe deserve whatever nastiness comes to them — and are willing to help dish out the nastiness themselves. “Despite lingering negative attitudes toward African Americans, social norms appear to suppress racial discrimination, but there is no such reluctance to discriminate based on partisan affiliation.”

That is, many Americans are happy to treat other people unfairly if those other people belong to the alien Tribe. And — this is perhaps the most telling finding of all — their desire to punish the outgroup is significantly stronger than their desire to support the ingroup. Through a series of games, Iyengar and Westwood discovered that “Outgroup animosity is more consequential than favoritism for the ingroup.”

One of my consistent themes over the years — see, for instance, here and here — has been the importance of acting politically with the awareness that people who agree with you won’t always be in charge. That is, I believe that it is reasonable and wise, in a democratic social order, to make a commitment to proceduralism: to agree with my political adversaries to abide by the same rules. That belief is on its way to being comprehensively rejected by the American people, in favor of a different model: Error has no rights.

What is being forgotten in this rush to punish the outgroup is a wise word put forth long ago by Orestes Brownson: “Error has no rights, but the man who errs has equal rights with him who errs not.”"
alanjacobs  othering  politics  society  scottalexander  outgroup  us  2016  filterbubbles  bias  animosity  favoritism  democracy  procedure  proceduralism  error  orestesbrownson  polarization  shantoiyengar  seanwestwood  disagreement  discrimination  partisanship 
april 2016 by robertogreco

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