"Restore(s) a little sanity into current political debate" - Kenneth Minogue, TLS "Projects a more expansive and optimistic future for Americans than (the analysis of) Huntington" - James R. Kurth, National Interest "One of (the) most important books I have read in recent years" - Lexington Green
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This Theodore Dalrymple post is a variation on a conventional argument whose unstated main premise is that medical cost decisions should be evaluated from a public-health perspective.
The annual medical is a kind of ceremonial or ritual which, according to its critics, is without rational foundation despite the fact that so many patients, and perhaps a majority of doctors, believe in it. This proves that superstition is not dead: but perhaps that is no fatal criticism of the annual medical after all, because superstition will never be dead. If it does not attach to one thing, it will attach to another.
[. . .]
In fact, most medicals are bureaucratic procedures rather than exercises in getting-to-know-you (as The King and I put it). The doctor asks a few questions, ticks some boxes on a computer screen, performs a perfunctory physical examination equivalent to examining a cubic inch of haystack to find a pin, and does a few selected blood tests, the interpretation of whose abnormal results (if any) will be far from straightforward. In fact, what has been done and measured in annual medicals over the years has changed, without any change in their ineffectiveness.
Ineffective for whom?
The answer depends on who is paying the bill. If it’s third parties such as govts or insurance companies then the conventional argument has merit: maximizing system utility is an important goal. However, if patients control their own medical spending then the main goals should be whatever the individual customers want them to be.
Dalrymple’s analyses are usually much better than this one. Perhaps his frame blindness in this case is a function of his background with the NHS.
According to the team’s analysis, seven states, including Arkansas, Georgia, Idaho, and Kansas, all had similar laws on the books. Similar bills were being considered in states like Maryland and Oregon, and had already died in Florida and Minnesota. In total, very similar bills had been introduced 73 times around the country. The video below shows one of the earliest examples showed up in South Carolina in 2010.
Like a plagiarism detector, the prototype can detect similar language in different bills. Yet unlike in a college class, this isn’t always a bad thing. “We avoided using the word plagiarism,” says Joe Walsh, an assistant professor at the University of Chicago and mentor to the Data Science for Social Good team. “If a bill can save lives, I would want that bill passed all 50 states.”
The 100-year threshold is also a statistical guess based on data on past storms and assessments of whether they’ll occur in the future. That means the models change every time a new hurricane strikes. The numbers being used as guidelines for construction are changing as time passes.
The standard also does not mean—can’t possibly mean—that a 100-year storm will occur only once per century. It means that such a storm has a 1 percent chance of happening in any given year. So for example, it’s technically possible for several 100-year floods to occur in just a few years, although it’s highly unlikely.
One way to look at it is that the engineers need to estimate how high a wall New Orleans needs to protect itself against a reasonably unlikely flood — say, a 1-in-1000-year event. This is the line of discussion pursued in the CNBC article.
Another way to look at it is to observe that the odds of another Katrina, or worse, within a specified period are highly uncertain. In this case a radical course of action might be called for. You do something like: take the best estimate for the wall height needed to protect against a 1000-year flood and then double it. Building such a levee would probably be extremely expensive but at least the costs would be out in the open. Or you might decide that it’s not the best idea to have a coastal city that’s below sea level, and so you would discourage people from moving back to New Orleans, rather than encourage them by subsidizing a new and stronger system of walls.
In this kind of situation the political incentives are usually going to encourage public decisionmakers to ignore radical solutions with high obvious costs, in favor of the minimum acceptable incremental solution with hidden costs: probably subsidies to rebuild the levees to, or perhaps a bit beyond, the standard needed to protect the city in the event of another Katrina. And it’s unlikely that any local pol is going to advise residents to move out and depopulate his constituency. Thus, eventually, a worst case will probably happen again.
A Declaration of the Representatives of the UNITED STATES OF AMERICA, in General Congress assembled.In Congress, July 4,1776. The unanimous Declaration of the thirteen United States of America.
When in the Course of human events,it becomes necessary fora People to advance from that Subordination, in which they have hitherto remained, one people to dissolve the political bands which have connected them with anotherand to assume among thePpowers of theEearth theequal and independant Stationthe separate and equal stationto which the Laws of Nature and of Nature’s God entitle them, a decentRrespect to the opinions of Mmankind requires that they should declare theCcauses which impel them to theChange separation.
We hold these truths to be self–evident, that all men are created equal and independant, that from that equal creation they derive rights inherent and inalienable,that they are endowed by their Creator with certain unalienable rights, among which that among these are the Preservation of Life,andLiberty,and the Pursuit of Happiness. tThat to secure theseEndsrights, Governments are instituted among men, deriving their just powers from theCconsent of the governed; t.—That whenever any Form ofgGovernment shall becomebecomes destructive of these ends, it is theRright of the People to alter or to abolish it, and to institute new Government, laying itsFfoundation on such principles and organizing its powers in such form, as to them shall seem most likely to effect their Safety and Happiness. Prudence, indeed, will dictate that Governments long established should not be changed for light and transientCcauses; and accordingly all Eexperience hath shown, that mankind are more disposed toSsuffer, while Eevils areSsufferable, than to right themselves by abolishing the forms to which they are accustomed. But when a long train of Aabuses andUusurpations, begun at a distinguish’d Period and, pursuing invariably the same oObject, evinces aDdesign to reduce them under absolutePowerdDespotism, it is theirRright, it is their Dduty, to throw off such Government, and to provide new Guards for their future security. Such has been the patient Ssufferance of these Colonies; and such is now theNnecessity which constrains them to expungealtertheir former systems of government. The history ofhis present Majesty,the present king of Great Britainis a history of unremittingrepeatedinjuries and usurpations, among which no one Fact stands Single or Solitary to contradict the uniform tenor of the rest,all of which havehaving in direct object the Eestablishment of an absolute Ttyranny over these Sstates.To prove this let Ffacts be Ssubmitted to a candid Wworld., for the Truth of which We pledge a Faith, as yet unsullied by falsehood.
He has refused his assent to laws the most wholesome and necessary for the public good.
He has forbidden his Governors to pass Laws of immediate and pressing importance, unless suspended in their operation till his assent should be obtained; and, when so suspended,he has neglected utterly to attend to them.
He has refused to pass other Laws for the accomodation of large Ddistricts of Ppeople unless those Ppeople would relinquish the right of Representation in the Legislature, aRright inestimable to them, and formidable toTtyrants only.
He has called together legislative bodies at places unusual, uncomfortable, and distant from the depository of their public rRecords, for the sole purpose of fatiguing them into compliance with his measures.
He has dissolved Representative Houses repeatedlyand continually,for opposing with manlyFfirmness hisIinvasions on theRrights of thePpeople;
He has refused, for a long Space of Ttime after such Ddissolutions to cause others to be elected, whereby the lLegislative Ppowers, incapable of aAnnihilation have returned to the People at large for their Eexercise, the sState remaining, in the mean Ttime meantime, exposed to all the Ddangers of Iinvasion from without, and Convulsions within.
He has endeavoured to prevent the Ppopulation of these States; for that purpose obstructing the Laws for nNaturalization of fForeigners; refusing to pass others to encourage their Mmigrations hither, and raising the Cconditions of new Appropriations of Lands.
He has sufferedobstructed the Administration of Justice totally to cease in some of these Colonies,by refusing his Assent to Laws for establishing Judiciary Powers.
He has made our Judges dependent on his Will alone, for the Ttenure of their offices, and the amount and payment of their Ssalaries.
He has created a Mmultitude of nNew oOffices by a Self-assumed Power, and sent hither swarms of oOfficers to harass our Ppeople, and eat out their Ssubstance.
He has kept among us, in Ttimes of Ppeace, Standing Armies and Ships of War without the cConsent of our legislatures..
He has affected to render the mMilitary independent of and Superiour superior to the cCivil Ppower.
He has combined with others to subject us to a Jjurisdiction foreign to our Cconstitution, and unacknowledged by our Llaws; giving his Assent to their pretended Acts of pretended Legislation:
fFor quartering large Bbodies of armed Ttroops among us:
fFor protecting them, by a Mmock TryalTtrial from Ppunishment for any Murders which they should commit on the Inhabitants of these States:
fFor cutting off our Ttrade with all Pparts of the Wworld;
fFor imposing Taxes on as without our Consent—fFor depriving Uus in many cases of the Bbenefits of Trial by Jjury;
fFor transporting us beyond Seas to be tried for pretended offences:
fFor abolishing the free sSystem of English Llaws in a neighbouring Province, establishing therein an aArbitrary government, and enlarging its Boundaries so as to render it at once an example and fit instrument for introducing the same absolute rule into these cColonies:
fFor taking away our Charters, abolishing our most valuable lLaws, and altering fundamentally the Forms of our Government:
fFor suspending our own Legislatures, and declaring themselves invested with Ppower to legislate for us in all Ccases whatsoever.
He has abdicated Government here withdrawing his Governors, and by declaring us out of his Allegiance andpProtection,and waging war against us.
He has plundered our Sseas, ravaged our Coasts, burnt our towns, and destroyed the Lives of our Ppeople.
He is at this Ttime transporting large Armies of foreign Mercenaries to completecompleat the Wworks of death, Ddesolation, andTtyranny, already begun with Ccircumstances of Ccruelty and Pperfidy scarcely paralleled in the most barbarous ages, and totally unworthy the Head of a civilized Nnation.
He has excited domestic insurrection among us,and has endeavoured to bring on the Iinhabitants of our Ffrontiers, the merciless Indian Savages, whose known Rrule of Wwarfare is an undistinguished Ddestruction of all Aages, Ssexes, and Cconditionsof existence.
He has incited treasonable Insurrections of our Fellow Citizens, with the allurement of Forfeiture and Confiscation of our Property.
He has constrained othersour fellow citizens taken cCaptive on the high sSeas, to bear arms against their cCountry, to become the executioners of their friends and bBrethren, or to fall themselves by their hHands:
He has waged cruel War against human Nature itself, violating its most sacred Rights of Life and Liberty in the Persons of a distant People who never offended him, captivating and carrying them into Slavery in another Hemisphere, or to incur miserable Death, in their Transportation thither. This piratical Warfare, the opprobrium of infidel Powers, is the Warfare of the Christian King of Great Britain.
He has prostituted his Negative for Suppressing every legislative Attempt to prohibit or to restrain an execrable Commerce, determined to keep open a Market where Men should be bought and sold, and that this assemblage of Horrors might want no Fact of distinguished Die.
He is now exciting those very People to rise in Arms among us, and to purchase their Liberty of which he has deprived them, by murdering the People upon whom he also obtruded them: thus paying off, former Crimes committed against the Liberties of one People, with Crimes which he urges them to commit against the Lives of another.
In every stage of these oOppressions wWe have pPetitioned for rRedress, in the most humble tTerms: oOur repeated Petitions have been answered by repeated Iinjury.
A Prince whose Ccharacter is thus marked by every Aact which may define a Tyrant, is unfit to be the Rruler of a People who mean to be free people. future ages will scarce believe, that the Hardiness of one Man, adventured, within the Short Compass of twelve years only, on so many Acts of Tyranny, without a Mask, over a People, fostered and fixed in the Principles of Liberty.
Nor have wWe been wanting in Aattentions to our British Bbrethren. We have warned them from Ttime to Ttime of attempts of by their Llegislature to extend aan unwarrantedJjurisdiction over these our Statesus. We have reminded them of the Ccircumstances of our Eemigration and Ssettlement here no one of which could warrant so strange a Pretension. That these were effected at the expense of our own Blood and Treasure, unassisted by the Wealth or the Strength of Great Britain; that in constituting indeed, our Several Forms of Government, we had adopted one common King, thereby laying a Foundation for Perpetual League and Amity with them; but that Submission to their Parliament, was no Part of our Constitution, nor ever in Idea, if History may be credited; andwWe have appealed to their Nature,nativeJjustice and Mmagnanimity and we have conjured them byas well as to the Tties of our common Kkindred to disavow these usurpations which were likely towould inevitably interrupt our Correspondence and Connectionconnection and correspondance. They too have been deaf to the Vvoice of Jjustice and of Cconsanguinity.and when occasions have been given them by the regular Course of their Laws of removing from their Councils, the Disturbers of our Harmony, they have by their free Election, re-established them in Power. At this very Time too, they are permitting their Chief Magistrate to send over not only soldiers of our common Blood, but Scotch and foreign Mercenaries, to invade and deluge us in Blood. These Facts have given the last Stab to agonizing affection, and manly Spirit bids us to renounce forever these unfeeling Brethren. We must endeavour to forget our former Love for them, and to hold them, as we hold the rest of Mankind, enemies in War, in Peace Friends. We might have been a free and a great People together but a Communication of Grandeur and of Freedom it seems is below their Dignity. Be it so, since they will have it: The Road to Happiness and to Glory is open to us too; we will climb it, apart from themWe must thereforeand acquiesce in the Nnecessity which denounces our eternalSseparation andhold them, as we hold the rest of mankind, Enemies in War, in Peace Friends.
We, therefore, the Representatives of the United States of America, in General Congress aAssembled, appealing to the Supreme Judge of the world for the rectitude of our intentions, do, in the Name, and by the Authority of the good People of these StatesColonies, reject and renounce all Allegiance and Subjection to the Kings of Great Britain, and all others, who may hereafter claim by, through, or under them; We utterly dissolve and break off, all political Connection which may have heretofore subsisted between us and the People or Parliament of Great Britain, and finally we do assertsolemnly publishand declare, that theseUnitedColonies are, and of Right ought to befFree and iIndependent States;that they are Absolved from all allegiance to the British Crown, and that all political connection between them and the State of Great Britain, is and ought to be totally dissolved;and that as fFree and iIndependent States, they shall hereafter havefullPower to levy War, conclude Peace, contract Alliances, establish Commerce, and to do all other Acts and Things which independent States may of Right do. —And for the Ssupport of this Declaration, we mutually pledge to each other our Lives, our Fortunes, and our Sacred HonourHonor.
So, OK, my employer made me burn off some vacation days before the end of the fiscal year, in the form of a cap on the number of PTO hours that can be carried over from FY14 into FY15, which boundary has shifted by 3 months due to our recent change of ownership. Much lower down, my management intimated that due to certain software-release and testing milestone dates, no significant block of time off in February or March would be approved. But thanks to an unrelated M&A a few years back (a spectacularly problematic one, destined to be a business-school case study for decades to come), we now get the MLK holiday off. I decided to take the whole week and head southwest in search of sunlight. After a swing through New Mexico, I am spending a few days at Crow’s Nest, a 10-minute hike from the 6+ acres I own near Bloys Camp. It’s my first visit in four years.
Mitre Peak (1887m/6190’) as seen from my lot
This is what I would write if somebody made me enter one of those hoary MLK essay contests that middle- or high-school students get sucked into. The entries that I’ve read over the years have seemed pretty unimaginative, but it’s hardly realistic to expect much historical perspective from a teenager. The tone I’m aiming for here is, of course, originality combined with some mildly discomfiting assertions, while avoiding stereotypical politics. The structure is a simple three-parter: past, present, and (near) future.
-Stop using script-based popup menus. Go back to old-style Microsoft-standard (c. 2003) clickable nested menus emanating from a static menu bar, with standard headings (FILE, EDIT, etc.) plus the unique headings needed for each piece of software. If you are using script menus as a workaround for complexity you should redesign your user interface. If you are using script menus for any other reason you should stop.
-Knock it off with the icons. Use text buttons instead. The point of software it to economize on human effort, not to appear stylish. A trash-can icon is probably OK, but much more than that and users are forced to waste time mouse-hovering over your icons or (worse) looking things up in the online help.
-Hire focus groups of 75-85 year-old occasional computer users and turn them loose on your products. They may not understand the fine points but they will tell you quickly if your products have any gross UI deficiencies that people like you who use software all day may be overlooking.
The world weighs on my shoulders, but what am I to do?
You sometimes drive me crazy, but I worry about you
I know it makes no difference to what you’re going through
But I see the tip of the iceberg, and I worry about you …
Reading through background material on the UN’s recent request for $16.4 billion in humanitarian aid in 2015, I find that the number of displaced people was already at its highest since World War II at the end of 2013, and has risen by several million since then. Nearly all are somewhere inside or on the perimeter of the Muslim world, with Ukraine the only sizeable exception. My sense, in which I am hardly alone, is that we are reliving the mid-1930s, with aggression unchecked and chaos unmitigated by morally exhausted Western institutions. That “low dishonest decade” ended in global war with a per capita death toll around 1 in 40. A proportional event a few years from now would kill 200 million people.
While we’re honoring America’s veterans, I thought it would be interesting to see what it is the were doing to earn that honored status.
There is a site on the Internet called the Joint Electronic Library (and it’s slightly restricted cousin the JEL+). It’s where the American military officially plans what is to be done when the job’s big enough that sometimes different military services are going to be doing it next to each other.
What military people do is essentially a task list. The military publishes an unclassified universal task list every three months. It currently has 1,285 tasks. They each have performance indicators. The whole list looks very little like how civilians discuss war or think of all the things that go into the military. Exploring this disconnect and how it makes the lives of our military harder and even increases casualties is a post for another time. This is Veterans Day, not Memorial day.
Time is running out, the man explains, speaking calmly and confidently, in the manner of a university professor. A deadly disease, spread by primitive tribespeople through dead bodies, will kill vast numbers of Americans unless the Federal government uses its powers to stop it.
As I write this, the most widely-read individual blog in the English-speaking world, written by a genuine university professor, is infested with (invariably pseudonymous) commenters not readily distinguishable from Weston; we can only hope that none of them will act on their impulses as he did. Read the rest of this entry »
Posted by Lexington Green on 29th October 2014 (All posts by Lexington Green)
“The core problem in our society is political correctness.”
“We’ve become a more risk-averse society,” he said, “we’ve lost hope in the future.” The problem isn’t one of intelligence, but of character. “We live in a world in which courage is in less supply than genius.”
Posted by Kevin Villani on 17th October 2014 (All posts by Kevin Villani)
This year marks a century since the outbreak of WW I and coincidently the initiation of US Federal Reserve System operations. Prior to these events, politics were democratizing, economic growth was booming, economies were liberalizing and global trade and finance were growing, all at a pace not seen again for almost another century. Recognizing that achieving these mutual benefits required an externally imposed political discipline, all of the countries participating in this happy situation voluntarily followed a set of rules governing domestic and international trade and finance for automatic and continuous adjustment to changing economic reality, then provided by the gold standard.
It was during this enlightened period that philosopher George Santayana wrote: “those who cannot remember the past are condemned to repeat it.” Hedge fund manager and Brookings Director Liaquat Ahamed set out to remind us why countries failed to recapture this economic dynamism after the Great War with the publication of the Pulitzer Prize winning Lords of Finance: The Bankers Who Broke the World in 2009. This book took on greater significance when in 2010 Federal Reserve Board Chairman Ben Bernanke recommended only this historical account in response to the Financial Crisis Inquiry Commission’s request for a book reference explaining the 2008 financial crisis. What history had this most recent financial crisis already repeated and what was Chairman Bernanke determined to avoid repeating in the aftermath?
[Readers needing background may refer to the first member of this series, Don’t Panic: Against the Spirit of the Age, posted last month. This post, unlike that one, was hastily written due to time constraints involving, perhaps ironically, international travel to a Third World country.]
Constructive foreword: suggested case studies in disruption are the Chicago blizzard of 1/13-14/1979 (~3 million commuters immobilized) and the Milwaukee Cryptosporidiosis outbreak of 3/23-4/8/1993 (~400k residents sickened simultaneously).
Thesis: I argue that, at least with Ebola, inept and overwrought responses pose far greater risks to American society than the disease itself. With regard to managing the risks associated with Ebola in the US, it is vital that we identify easily disrupted institutions and design our processes intelligently to avoid creating bottlenecks, mostly by resisting the urge to overreact; likely candidates include … Read the rest of this entry »
Cold and misty morning, I heard a warning borne in the air
About an age of power where no one had an hour to spare …
– Emerson, Lake & Palmer, “Karn Evil 9, 1st Impression, Part 1”
Imagine that you just stepped out of a time machine into the mid-1930s with a case of partial historical amnesia. From your reading of history, you can still remember that the nation has been beset with economic difficulties for several years that will continue for several more. You also clearly remember that this is followed by participation in a global war, but you cannot recall just when it starts or who it’s with. A few days of newspapers and radio broadcasts, however, apprise you of obvious precursors to that conflict and various candidates for both allies and enemies.
As mentioned several times in this forum, I adhere to a historical model, consisting either of a four-part cycle of generational temperaments (Strauss and Howe), or a related but simpler system dynamic/generational flow (Xenakis). That model posits the above scenario as a description of our current situation and a prediction of its near future: a tremendous national trial, currently consisting mostly of failing domestic institutions, is underway. It will somehow transform into a geopolitical military phase and reach a crescendo early in the next decade. It cannot be avoided, only confronted.
Nor will it be a low-intensity conflict like the so-called “wars” of recent decades, which have had US casualty counts comparable to those of ordinary garrison duty a generation ago. Xenakis has coined the descriptive, and thoroughly alarming, term genocidal crisis war for these events. Some earlier instances in American history have killed >1% of the entire population and much larger portions of easily identifiable subsets of it. Any early-21st-century event of this type is overwhelmingly likely to kill millions of people in this country, many if not most of them noncombatants. And besides its stupendous quantitative aspect, the psychological effect will be such that the survivors (including young children) remain dedicated, for the rest of their lives, to preventing such a thing from ever happening again.
I will nonetheless argue that no matter how firmly convinced we may be that an utterly desperate struggle, with plenty of attendant disasters, is inevitable and imminent, we must avoid both individual panic and collective overreaction.
Many thanks to the commenters on my review. I won’t be agreeing with all of you, but I value your input for increasing my understanding of what others think. I have some related ideas on how to think about the issues raised specifically by Lightning Fall and generally by “preppers” and, indeed, anyone anticipating a societally disruptive crisis in the near future.
NB: this is an essay in the original sense of “attempt.” It is unlikely to fully represent my thinking on these issues even a few years hence; and whether you agree with me or not, I encourage you to think these things through based on your own abilities and experience, and then act as your specific situation appears to require. Hayekian distributed local knowledge may save us. Central planning, as I hardly need admonish this audience, will not, and therefore any attempt by me to impose a uniform mental framework should (and undoubtedly will) be firmly rejected.
Real-life performance data shows that the most important and high-impact technologies are not the gold-plated, over-engineered wonder weapons that turn majors into colonels, colonels into generals, and young Jedi apprentices into Sith Lords. Instead, data suggest the real winners are humble, simple, low-cost products made by small, rapid innovation teams — the type of projects that don’t attract much attention from the press or from the brass because all they do is get the mission done without any fuss.
While this will not be a uniformly positive review, I must immediately note that the purely literary quality of Bill Quick’s Lightning Fall (subtitled either “A Novel of Destruction” or “A Novel of Disaster,” depending on whether one is looking at the spine or the cover of the paperback edition) ranks it alongside Pat Frank’s Alas, Babylon and comes within metaphorical striking distance of Larry Niven and Jerry Pournelle’s Lucifer’s Hammer. It is a classic page-turner and a serious threat to a good night’s sleep; I began reading it after awakening shortly before 3:00 AM one morning, expecting to drift off in a few minutes, and eventually noticed that I was somewhere around page 250 and the time was after 6:00 AM. This sort of thing has not happened to me more than a handful of times in a half-century of reading, and I read a lot.
Other reviews have included – well, not exactly spoilers, but more specifics about the events in the novel than I intend to provide here. I will mention three things that I think it useful for prospective readers to know, and then use the general thrust of the novel as a springboard for extended commentary of my own.
Posted by Michael Kennedy on 2nd January 2014 (All posts by Michael Kennedy)
David has a good idea. I often read the archives of my personal blog to see how I did in forecasting the future or understanding the present. A major concern of mine is, of course, health care and what is happening. When I retired from surgery after my own back surgery, I spent a year at Dartmouth Medical School’s center for study of health care. My purpose was to indulge an old hobby. How do we measure quality in health care ? I had served for years on the board of a company called California Medical Review, Inc. It was the official Medicare review organization for California. For a while I was the chair of the Data Committee. It seems to have gone downhill since I was there. First, it changed its name in an attempt to get more business from private sources. Then it lost the Medicare contract.
Lumetra, which lost a huge Medicare contract last November, is changing its name and its business model as it seeks to replace more than $20 million in lost revenue.
The San Francisco-based nonprofit’s revenue will shrink this year from $28 million last fiscal year, ending in March 2009, to a projected $4.5 million, CEO Linda Sawyer told the Business Times early this week.
That’s in large part because it’s no longer a Medicare quality improvement contractor, formerly its main line of work. And in fact, the 25-year-old company’s revenue has been plummeting since fiscal 2007, when it hit $47 million.
Beginning Jan. 1, 2015, the Affordable Care Act no longer will provide federal grants to fund state health exchanges. In addition, California law prohibits using the state’s general fund to pay for the exchange.
Anyway, for what it is worth, here are the links to the 2013 health posts.
What can be done is Congress creating a new option in the form of a national health insurance charter under which insurers could design new low-cost policies free of mandated benefits imposed by ObamaCare and the 50 states that many of those losing their individual policies today surely would find attractive.
What’s the first thing the new nationally chartered insurers would do? Rush out cheap, high-deductible policies, allaying some of the resentment that the ObamaCare mandate provokes among the young, healthy and footloose affluent.
These folks could buy the minimalist coverage that (for various reasons) makes sense for them. They wouldn’t be forced to buy excessive coverage they don’t need to subsidize the old and sick.
Who knows ? Maybe Jenkins reads this blog. It’s so obvious that the solution should be apparent even to Democrats.
The revelation came out of questioning of Mr. Chao by Rep. Cory Gardner (R., Colo.). Gardner was trying to figure out how much of the IT infrastructure around the federal insurance exchange had been completed. “Well, how much do we have to build today, still? What do we need to build? 50 percent? 40 percent? 30 percent?” Chao replied, “I think it’s just an approximation—we’re probably sitting between 60 and 70 percent because we still have to build…”
Gardner replied, incredulously, “Wait, 60 or 70 percent that needs to be built, still?” Chao did not contradict Gardner, adding, “because we still have to build the payment systems to make payments to insurers in January.”
If the ability to pay the insurance companies is not yet written, how can anybody sign up ?
Gardner, a fourth time: “But the entire system is 60 to 70 percent away from being complete.” Chao: “There’s the back office systems, the accounting systems, the payment systems…they still need to be done.”
Gardner asked a fifth time: “Of those 60 to 70 percent of systems that are still being built, how are they going to be tested?”
Tyler Cowen, in his recent book Average Is Over, argues that computer technology is creating a sharp economic and class distinction between people who know how to effectively use these “genius machines” (a term he uses over and over) and those who don’t, and is also increasing inequality in other ways. Isegoria recently excerpted some of his Tyler’s comments on this thesis from a recent New Yorker article.
I read the book a couple of months ago, and although it’s worth reading and is occasionally thought-provoking, I think much of what Tyler has to say is wrong-headed. In the New Yorker article, for example, he says:
The first (reason why increased inequality is here to stay) is just measurement of worker value. We’re doing a lot to measure what workers are contributing to businesses, and, when you do that, very often you end up paying some people less and other people more.
The second is automation — especially in terms of smart software. Today’s workplaces are often more complicated than, say, a factory for General Motors was in 1962. They require higher skills. People who have those skills are very often doing extremely well, but a lot of people don’t have them, and that increases inequality.
And the third point is globalization. There’s a lot more unskilled labor in the world, and that creates downward pressure on unskilled labor in the United States. On the global level, inequality is down dramatically — we shouldn’t forget that. But within each country, or almost every country, inequality is up.
Taking the first point: Businesses and other organizations have been measuring “what workers are contributing” for a long, long time. Consider piecework. Sales commissions. Criteria-based bonuses for regional and division executives. All of these things are very old hat. Indeed, quite a few manufacturers have decided that it is unwise to take the quantitative measurement of performance down to an individual level, in cases where the work is being done by a closely-coupled team.
It is true that advancing computer technology makes it feasible to measure more dimensions of an individual’s work, but so what? Does the fact that I can measure (say) a call-center operator on 33 different criteria really tell me anything about what he is contributing the the business?
Anyone with real-life business experience will tell you that it is very, very difficult to create measurement and incentive plans that actually work in ways that are truly beneficial to the business. This is true in sales commission plans, it is true in manufacturing (I talked with one factory manager who said he dropped piecework because it was encouraging workers to risk injury in order to maximize their payoffs), and it is true in executive compensation. Our blogfriend Bill Waddell has frequently written about the ways in which accounting systems can distort decision-making in ultimately unprofitable ways. The design of worthwhile measurement and incentive plans has very little to do with the understanding of computer technology; it has a great deal to do with understanding of human nature and of the deep economic structure of the business.
My profession is much in the news at the moment, so I thought I would pass along such insights as I have from my career, mostly from a multibillion-dollar debacle which I and several thousand others worked on for a few years around the turn of the millennium. I will not name my employer, not that anyone with a passing familiarity with me doesn’t know who it is; nor will I name the project, although knowing the employer and the general timeframe will give you that pretty quickly too.
We spent, I believe, $4 billion, and garnered a total of 4,000 customers over the lifetime of the product, which was not aimed at large organizations which would be likely to spend millions on it, but at consumers and small businesses which would spend thousands on it, and that amount spread out over a period of several years. From an economic transparency standpoint, therefore, it would have been better to select 4,000 people at random around the country and cut them checks for $1 million apiece. Also much faster. But that wouldn’t have kept me and lots of others employed, learning whatever it is we learn from a colossally failed project.
So, a few things to keep in mind about a certain spectacularly problematic and topical IT effort:
Large numbers of reasonably bright and very hard-working people, who have up until that point been creating significant wealth, can unite in a complete flop. Past performance is no guarantee, and all that. Because even reasonably bright, hard-working people can suffer from failures of imagination, tendencies to wishful thinking, and cultural failure in general.
Morale has got to be rock-bottom for anybody with any degree of self-awareness working on this thing. My relevant moment was around the end of ’99 when it was announced, with great fanfare, at a large (200+ in attendance) meeting to review progress and next steps, that we had gotten a single order through the system. It had taken various people eight hours to finish the order. As of that date, we were projecting that we would be doing 1,600 orders a day in eight months. To get an idea of our actual peak rate, note the abovementioned cumulative figure of 4,000 over the multi-year lifespan of the project.
Root cause analysis is all very well, but there are probably at least three or four fundamental problems, any one of which would have crippled the effort. As you may infer from the previous bullet point, back-office systems was one of them on that project. Others which were equally problematic included exposure to the software upgrade schedule of an irreplaceable vendor who was not at all beholden to us to produce anything by any particular date, and physical access to certain of our competitors’ facilities, which they were legally required to allow us into exactly two (2) days per year. See also “cultural failure,” above; most of us were residing and working in what is one of the most livable cities in the world in many ways, but Silicon Valley it ain’t.
Not to overlook the obvious, there is a significant danger that the well-advertised difficulties of the website in question will become a smokescreen for the fundamental contradictions of the legislation itself. The overall program cannot work unless large numbers of people act in a counter-incentived (possibly not a word, but I’m groping for something analogous to “counterintuitive”) fashion which might politely be termed “selfless” – and do so in the near future. What we seem likely to hear, however, is that it would have worked if only certain IT architectural decisions had been better made.
This thing would be a case study for the next couple of decades if it weren’t going to be overshadowed by physically calamitous events, which I frankly expect. In another decade, Gen-X managers and Millennial line workers, inspired by Boomers, all of them much better at things than they are now, “will be in a position to guide the nation, and perhaps the world, across several painful thresholds,” to quote a relevant passage from Strauss and Howe. But getting there is going to be a matter of selection pressures, with plenty of casualties. The day will come when we long for a challenge as easy as reorganizing health care with a deadline a few weeks away.
What do modern military and corporate strategy have in common with Achilles, Sun Tzu, and primates? The answer is fluidity, flexibility, and pure unpredictability. Every day we make decisions that are built on our theory of what will give us the outcome we want. Sir Lawrence Freedman proposes that throughout history strategy has very rarely gone as planned, and that constant evaluation is necessary to achieve success—even today. Join The Chicago Council for a centuries-spanning discussion explaining how the world’s greatest minds navigate toward success.
For interested parties. Sir Lawrence Freedman has quite a few talks posted on YouTube too. Worth checking out.
What proportion of all social-media communication is by bots, spammers, people with agendas who misrepresent themselves, or severely dysfunctional people who pass as normal online? I suspect it’s a large proportion.
There’s not much hard evidence, but every once in a while something like this turns up. I’m guessing it’s the tip of an iceberg. See also this. And who can overlook the partisan trolls who show up on this and other right-of-center blogs before elections. Where do they come from?
None of this apparently widespread Internet corruption should come as a surprise. Given the low costs and lack of barriers to entry it would be surprising if attempts to game the system were less frequent than they appear to be. Nonetheless it’s prudent to keep in mind that a lot of what appears online is probably fake and certainly misleading.
Much of what medical researchers conclude in their studies is misleading, exaggerated, or flat-out wrong. So why are doctors—to a striking extent—still drawing upon misinformation in their everyday practice?
The arguments presented in this article seem like a good if somewhat long presentation of the general problem, and could be applied in many fields besides medicine. (Note that the comments on the article rapidly become an argument about global warming.) The same problems are also seen in the work of bloggers, journalists and “experts” who specialize in popular health, finance, relationship and other topics and have created entire advice industries out of appeals to the authority of often poorly designed studies. The world would be a better place if students of medicine, law and journalism were forced to study basic statistics and experimental design. Anecdote is not necessarily invalid; study results are not necessarily correct and are often wrong or misleading.
None of this is news, and good researchers understand the problems. However, not all researchers are competent, a few are dishonest and the research funding system and academic careerism unintentionally create incentives that make the problem worse.
(Thanks to Madhu Dahiya for her thoughtful comments.)
I have written several posts that use Carroll Quigley’s “institutional imperative” as a lens for understanding contemporary events.  Mr. Quigley suggests that all human organizations fit into one of two types: instruments and institutions. Instruments are those organizations whose role is limited to the function they were designed to perform. (Think NASA in the 1960s, defined by its mission to put a man on the moon, or the NAACP during the same timeframe, instrumental to the civil rights movement.) Institutions, in contrast, are organizations that exist for their own state; their prime function is their own survival.
Most institutions start out as instruments, but as with NASA after the end of the Cold War or the NAACP after the victories of the civil rights movement, their instrumental uses are eventually eclipsed. They are then left adrift, in search of a mission that will give new direction to their efforts, or as happens more often, these organizations begin to shift their purpose away from what they do and towards what they are. Organizations often betray their nature when called to defend themselves from outside scrutiny: ‘instruments’ tend to emphasize what their employees or volunteers aim to accomplish; ‘institutions’ tend to emphasize the importance of the heritage they embody or even the number of employees they have.
Mr. Quigley’s institutional imperative has profound implications for any democratic society – especially a society host to so many publicly funded organizations as ours. Jonathan Rauch’s essay, “Demosclerosis” is the best introduction to the unsettling consequences that come when public organizations transform from instruments into institutions.  While Mr. Rauch does not use the terminology of the Institutional Imperative, his conclusions mesh neatly with it. Describing the history and growth of America’s bureaucratic class, Mr. Rauch suggests its greatest failing: a bureaucracy, once created, is hard to get rid of. To accomplish whatever mission it was originally tasked with a bureaucracy must hire people. It must have friends in high places. The number of people who have a professional or economic stake in the organization’s survival grows. No matter what else it may do, it inevitably becomes a publicly sponsored interest group. Any attempt to reduce its influence, power, or budget will be fought against with ferocity by the multitude of interests who now depend on it. Even when it becomes clear that this institution is no longer an instrument, the political capital needed to dismantle it is just too high to make the attempt worth a politician’s time or effort. So the size and scope of bureaucracies grow, encumbering the country with an increasing number of regulations it cannot change, employees it does not need, and organizations that it cannot get rid of.
I used to think that the naked self-interest described by Mr. Rauch was the driving force behind the Institutional Imperative. It undoubtedly plays a large role (particularly when public funds are involved), but there are other factors at play. One of the most important of these is what business strategists call Marginal Thinking. Read the rest of this entry »