The reason why discourse about firearms never seems to provide any insight, much less useful thought, is that such discourse is not so much policy discussion as political campaign. The goal of a political campaign is to achieve political power, not to collaborate in analysis of social problems.
This circumstance is understandable; the people who are in favor of restricting the right to bear arms have little interest in exercising that right themselves. If they can give up something that is of no value to them for something which is an ultimate goal, political power, the decision to do so is a no-brainer.
However, the popular appetite for relinquishing rights, regardless of the breadth of their exercise is unpredictable and volatile. The experience with alcohol prohibition is a good example. It is difficult to convince people that they are better off foregoing a right that they have exercised for generations.
Monday, April 02, 2018
Tuesday, March 27, 2018
Political Courage
There is one thing that modern political movements, such a #MeToo, Antifa, and #MarchforOurlives have that previous, more substantive historical movements, e.g. abolition, civil rights, fair labor laws, etc. lacked: fashion. Likewise there is something that the historical movements had that their contemporary counterparts lack: courage.
Marches on Washington in which a speaker addresses a gathering of hundreds of thousands of like-minded and approving activists, with the support of mass media and pop culture figures takes little courage. The payoff is not in achieving the stated goals of the underlying movement but in garnering the accolades of fellow travelers, all withing the safety of popular emotional trends. The courage of the mob really isn't courage, it is pandering.
If someone asserts that they are courageous for standing up to the "patriarchy," or "fascists," or the "gun lobby," ask them if they would continue to do so if it meant being labelled a racist, by one's peers. would they still be courageous? The neighbors of the San Bernadino killers weren't. The Broward county school district wasn't. the police in Rotherham weren't either. Emotional trendiness is not courage. If someone asserts that there is nothing more important than school safety, ask them if they support doing research into all of the factors that might bear upon teenage violence including race, single parent families, psychological history and drug use. Would they advocate this even though it means being accused of "shifting the focus" or injecting race, or doing something that must be similar to something the Nazis did not did not do?
Hashtag advocacy, guerrilla theater on sympathetic campuses and social media celebrity are reflections of transient emotional appeal. They lack the essential spine necessary for long lasting and just change.
Marches on Washington in which a speaker addresses a gathering of hundreds of thousands of like-minded and approving activists, with the support of mass media and pop culture figures takes little courage. The payoff is not in achieving the stated goals of the underlying movement but in garnering the accolades of fellow travelers, all withing the safety of popular emotional trends. The courage of the mob really isn't courage, it is pandering.
If someone asserts that they are courageous for standing up to the "patriarchy," or "fascists," or the "gun lobby," ask them if they would continue to do so if it meant being labelled a racist, by one's peers. would they still be courageous? The neighbors of the San Bernadino killers weren't. The Broward county school district wasn't. the police in Rotherham weren't either. Emotional trendiness is not courage. If someone asserts that there is nothing more important than school safety, ask them if they support doing research into all of the factors that might bear upon teenage violence including race, single parent families, psychological history and drug use. Would they advocate this even though it means being accused of "shifting the focus" or injecting race, or doing something that must be similar to something the Nazis did not did not do?
Hashtag advocacy, guerrilla theater on sympathetic campuses and social media celebrity are reflections of transient emotional appeal. They lack the essential spine necessary for long lasting and just change.
Saturday, March 03, 2018
Equality
Equality is one of those virtues so esteemed that we seem not to care that our conception of it is totally contrary to our experience. It has assumed sort of a free-form righteousness that anything other than unthinking deference to it is scandalous.
Equality is of course something, and our western tradition is that it is something desirable. (“…did not regard equality with God a thing to be grasped.” [Phil 2:6]; Liberté,Égalité, Fraternité; and “We hold these truths to be self evident that all men are created equal.”) But the concept enjoys much greater esteem in slogans than in practice. Evolutionary biology is possible precisely because individual organisms are not equal. The field of metrology exists only because things are unequal, and in fact the only reason to measure and rank things is because they are unequal. The number of ways that humans are unequal to each other are too numerous to list, or even contemplate. Individuality is a consequence of inequality in certain characteristics. "All animals are equal" of course, but some are more equal than others.This witticism would not resonate if the political concept of equality did not carry its own inherent contradictions.
Equality is the very rare exception to the natural rule; yet when it comes time to criticize social and political institutions, confuse sentiment with thought, and look for a cudgel with which to bludgeon social order, equality vaults to the top of the list of virtues. When the reality of inherent inequality makes us tongue tied and confused, we regain our bearings by talking about fairness.
None of this is to say that equality, in those interstices where it is actually found or seriously pursued, is bad or foolish, but those instances are limited. Religious traditions at least postulate an equality that makes sense: that humans are equal in the eyes of God. All persons are endowed with equal human dignity until they relinquish it by their choices.The legal concept that all persons are equal before the law can at least be given the benefit of the doubt. Beyond this, reality demands consideration. People are not biologically equal. They are not equal with respect to fortune and misfortune; they are not economically equal. They are, in general, not equal in any way that can be remedied by social engineering, government meddling or use of force. Decent people and wise governments treat people equally, all else being, well… equal, but they do not make people equal. The moral is that it is not equality itself that it the virtue, it is the way we freely treat each other that is. That is what we should really care about, not how we measure it, not how we enforce it, not how we codify it, but simply how we do it when no one is watching.
The role of government
With regard to the proper role of government, the issue is not whether centralization is good or bad per se, or whether people would be happy with any amount of government service as long as it is provided well. There are some things that I would want government and only government to do, and there are some things I would not want it to do at all regardless of how well it is perceived at doing them.
I want government and only government to provide an army. Same with local police protection. I only want the government to investigate the cause of plane crashes, perform foreign espionage, and operate criminal courts. I do not want the government to run newspapers, churches or social organizations (implicating respectively freedom of the press, religion and association). I don’t want the government to be responsible for the details of airplane design, or fashion design for that matter. I don;t want the government to manage musical bands or comedy tours.
These preferences arise from consideration of how different types of incentives affect different institutions. Some institutions thrive with a profit motive, others are corrupted by it. Some institutions function well because of a sense of community that is missing from larger entities. The incentives that optimize the performance of government are different than those that do the same for private enterprise or charitable organizations. Sometimes this works in favor of the government doing stuff, sometimes it means the government should defer to better options.
As a general observation, by no means rigorously verified, government seem to be at its best with projects; defeating the nazis, going to the moon, building the interstate highway system, etc. and at its worst with the ongoing management of the mundane. Hence the familiar jokes about the DMV,, Amtrak and less funny jokes that are the Veterans Administration and the Indian Health Service.
The choice is not dichotomous between government and private industry. My own personal opinion is the the hospital system in this country was at its best when it was primarily a charitable enterprise, organized by religious orders and civic organizations, and it has not been improved by intervention of either government or profit-seeking institutions. I would not want to see the Boy Scouts listed on either the New York Stock Exchange or the Blue Pages of the phone book.
Government, private enterprise and charitable organizations are all necessary and beneficial. Each does some things better than the others; and there are certain things to which each is ill-suited.
Because diversity or something.
Name calling
It is remarkable how much progressive policy discourse consists of name-calling. Rather than refine and hone the principles and substance of a particular position, energy is diverted into discovering new ways of implying malignant character on the other side. The contemporary political vocabulary contains a dearth of rights, obligations, duties, compromise and political philosophy, and an excess of racist, sexist, homophobe, climate denier, rape apologist, hater,Iislamophobe, white supremacist, bitter clinger, etc. The governor of California described those who disagreed with his views on immigration enforcement as “troglodyte.” In addition, there are more subtle forms of name calling, less directly offensive but equally content-free such as denouncing another’s “privilege,” insinuating that another is aggressive or violent by claiming they make one feel “unsafe,” and by implying that the only possible basis for disagreement is “hate.” There is also the cynical and rather deluded gibe that one;s political opponents are “on the wrong side of history.”
It is interesting to contemplate the details of this phenomenon. When did we decide that the argument methods of second graders is preferable to reason and common courtesy? When did we decide that logic is subordinate to emotional satisfaction? I would suggest that name-calling is simply a cheap way of exploiting a socializing instinct, a boorish way of implying that if ones opponent does not agree or at least silence his own argument, that he is “the other.” It attacks the emotional security one finds in a good reputation and explicitly declares that a person;s beliefs either conform with those of the name-caller, or are the result of bad character. This approach to discourse lacks room for complexity or the notion of “however.” Thus, when it moves people to action (usually poorly thought out and silly action) it is prone to excess and obsession, such as pulling the Dukes of Hazard from TVLand, disinviting commencement speakers, sanctioning fraternities, for the conduct of other fraternities (or conduct that turns out to have been imaginary) and banishing those who are insufficiently outraged by the "right" things.
I suspect that our age invented none of these things; that there have always been principled thinkers of all political orientations as well as mountebanks and populists, bullies, sophists, con artists, and demagogues. But our age seems to have been overcome lately with a discourse of name-calling and political opportunism that not only obscures thoughtful and innovative dialogue, but hinders real progress. We seem to be more interested at the moment in emotional indulgence rather than thinking through many of the complex problems in our civic life.
Moral outrage
The term “moral outrage” is misleading. The subjects are not selected for their moral basis but for their immediate emotional appeal. The progressive enterprise is not a twilight struggle between good and evil, it is a ceaseless campaign of emotional bullying. Strident emotional appeals are used, not because there is some moral principle in need of a champion, but because the tactic is a useful to those whose ultimate goals are political power.
H.L. Mencken observe that “the whole aim of practical politics is to keep the populace alarmed (and hence clamorous to be led to safety by menacing it with an endless stream of hobgoblins, all of them imaginary.” “Moral outrage” is simply a newer version of this same principle. Now the premise is that the “good” people are in constant moral peril from the “bitter clingers” who will not see the light and therefore must have their views delegitimized.
Plaintiff’s lawyers are quite transparent about the underlying principle. A good number of them have adopted the “Reptile Strategy”, so named because it appeals to the emotional “reptile” part of jurors’ brains, rather than the more troublesome, rational part. Recall that, after the Sandy Hook shootings that gun control advocates explicitly demanded that action be taken before passions cooled. Emotions tend to override reason in the short term and therefore emotional appeals demand immediate action. Emotions also tend to be notoriously bad counselors, and the strategy of using them to whip up the populace has a rather shameful pedigree: lynchings, pogroms, riots, and revenge massacres.
As practiced in modern politics, the “moral outrage” gambit has a few distinguishing characteristics:
1.) Being an emotional appeal, it cannot bear rational scrutiny; something must be done now without reflection. The science after all, is settled; the counter arguments are invalid because they were advocated by the Cato Institute or heard on Fox News (the ad hominem fallacy); “Reagan did something similar” (the tu quoque fallacy,) “a new poll says that….” (argumentum ad populum), “Experts say…” (argumentum ad verecundiam), etc., etc., If you are appealing to emotion, fallacies are your friend.
2.) There is a clearly defined, malevolent other. Dissent can only be based in bad character with no room for good faith disagreement. The goal is not to persuade but to divide and demonize. “We” are entitled to have our way because we ‘think right’.” If the opponents words are insufficiently outrage inducing, resort to one of President Obama;s favorite rhetorical device, “there are those who say…,” the straw man fallacy; there can be no good faith disagreement.
3.) Because the other is defined solely by their opposition, consistency of the proponent’s arguments is unnecessary. Therefore, President Obama can “evolve,” Senators can be for something before they are against, and we can take credit for successes that we actively opposed. It doesn’t matter if Elizabeth Warren, or Diane Feinstein, or Al Gore has one set of rules for themselves and another for everyone else, because the contest is between “us and them,” not between differing concepts of what is best for the country.
4.) People who do not think right should be banned from participating in civic life. “Moral outragers” like to ban things. Support traditional marriage, lose your job. Question global warming or campus rape statistics, face expulsion from professional institutions. Show insufficient fealty for the emotional play of the day and endure death treats on Twitter. “Moral outrage” does, and always has created a lot of ugliness; bigotry pretending to unearned virtue.
This is not to say that there are not true moral outrages. The proper response however requires a resort to reason and not emotion; to think, and not merely to feel. It is a real tragedy when moral people do immoral things because they are “outraged.”
Competition, collaboration and regulation
Competition and regulation are not alternatives for each other. Competition, collaboration and government regulation serve different purposes. I would not leave it to competition to replace the FDA or the FAA.
Competition and collaboration are optimizing mechanisms, but they are not interchangeable. Competition optimizes processes whereas collaboration optimizes resources. Both have their role.
Competition and collaboration are concerned with optimization. Regulation is (or should be) concerned with general welfare. Optimization relates to the maximum possible, regulation to the minimum acceptable. They serve different purposes and are essential in different ways. Successful societies seek out that elusive balance between competition, collaboration and regulation, and flourishing societies come close to finding it, but of course, being human, never quite get it exactly right.
Gun policymaking
There is one circumstance that even the must ardent gun control advocate must admit, if not of the fact, at least of the possibility: that the people who would profit or otherwise benefit from circumventing gun control regulations are smarter and better motivated than those doing the regulating. We see this phenomenon played out regularly with, for example, reference to the prevalence of illicit drug use, and historically with the prohibition of alcohol. The motivated creativity of someone who would make tens of thousands of dollars providing firearms manufactured in Mexico or Honduras to street gangs in a given American city is likely to trump the naive determination of earnest bureaucrats who do not understand the limited influence that government has on human nature. The semi-literate gang enforcer in Chino has much more in the way of practical smarts, at least in acquiring the minimum firepower necessary to an international criminal enterprise, than Dianne Feinstein or Bret Stephens. This disparity is likely to widen with advances in technology. Say what you will about bump sticks, the guy who came up with the idea was pretty sharp.
This is not an argument against gun control; it is an argument against the notion that restrictions will do much good. For good or ill, the technology of repeating firearms is about 150 years old; gun smithing is a community college degree, not an advanced course offering in the theoretical physics department at Harvard. An advanced civilization is much more reliant on the decency of its citizens for its survival than it is the force of its statutes. The Second Amendment applies only to the right to keep and bear arms, it is not necessary to their existence, nor to their availability in the criminal underground. Firearms themselves are not essential to the madness that perpetrates mass murder.
If Mr. Paddock, the perpetrator of the Las Vegas had not provided his own demise, one might reasonably wish to ask: was his primary motivation to shoot or to kill? Would he have foregone the anticipated satisfaction of killing if he had to forego the expected pleasure of shooting? We of course will never know, but even so, we can note, with just a cursory, off-the-top-of-the-head list, dates verified by Wikipedia, the following sample:
Date Number killed
May 18, 1927 45
December 12, 1986 98
December 7, 1981 43
April 19, 1995 168
March 24, 2015 150
March 20, 1995 12
March 11, 2004 192
June 11, 1964 10
December 19, 2016 12
March 1, 2014 31
February 27, 2002 59
May 17, 2010 44
June 3, 2017 8
July 7, 2005 56
May 18, 1927 45
December 12, 1986 98
December 7, 1981 43
April 19, 1995 168
March 24, 2015 150
March 20, 1995 12
March 11, 2004 192
June 11, 1964 10
December 19, 2016 12
March 1, 2014 31
February 27, 2002 59
May 17, 2010 44
June 3, 2017 8
July 7, 2005 56
The means used for these deaths included airplanes,, knives, sarin gas, explosives, motor vehicles, a flame thrower(!) and matches.
This list is not a sample of inadequate regulation, it is rather a specimen of psychopathic depravity against which the most competent of government is impotent.
The call for gun control is a symbolic protest against an uncomfortable fact: people that are crazy in their motives might be quite rational in their methods; they may in fact be quite ingenious in them. It is a form of inexcusable arrogance to assume that people who seem so illogical in their motives cannot outwit well-intentioned regulation, and the advice of “experts.”
None of which is to say that there should be no limits on guns or gun ownership. Reasonable regulation should be expected to have reasonable results. Expecting to confine the darker and disordered impulses of the psychopath by assuming that decent people cannot be trusted with the means of emergent defense is not reasonable.
Wednesday, April 26, 2017
Scientism
Scientism, like any ism, is an ideology, and, like any ideology, is driven as much by ambition, wishful thinking, and base emotion as it is by rational analysis. Science is not the fount of human perfection and happiness; it is a product of humankind’s ability to reason and to apply reason in human affairs. The beneficial application of science requires moral guidance and ethical scrutiny, because blind pursuit of scientific knowledge leads to uncomfortable spaces.
The Nazis dunked soviet POWs in frigid water in a “scientific” attempt to devise strategies to help downed Luftwaffe pilots survive in the North Sea. One conclusion of such experiments was that exposure to cold caused cerebral hemorrhages. This “scientific” discovery turned out to be wrong. The United States government scientifically investigated the course of untreated syphilis in African-Americans; very scientific, yet somehow unpraiseworthy. The Imperial Japanese Unit 731 did competent scientific work, so much so that their biological warfare experiments were able to decimate several Chinese villages. (The scientifically oriented American government, rather than opting for war crimes complaints gave many of the perpetrators immunity, because, hey, SCIENCE!). The soviets' use of psychiatry on political dissidents is probably not an example of “improved policies and regulations that serve our best interests.” Orbiting the white nationalist fringe is the “human biodiversity” movement that uses scientific evidence to argue that certain racial and ethnic groups have intelligence, behavioral and personality traits that are heritable and therefore partially genetically determined, a scientific hypothesis that would likely be rejected by scientism on grounds unrelated to method.
One concern that naturally arises is that of avoiding "abuses" of science. Science has no reliable way of identifying “abuses” apart from human values. Science has no inherent conscience.
The modern scientist has much in common with the prehistoric thinker who thought that virgin sacrifice kept volcanoes from erupting or that fickle gods made the sun rise and rains come., Both applied the evidence at hand to questions relevant to their interests and reached conclusions constrained by the state of their knowledge. Much of what modern science knows is wrong; there is even a book, “Ending Medical Reversals” that focuses on the harm done by adopting therapies and theories as scientific based more on apophenia and wishful thinking than on rational rigor This is why “consensus” is irrelevant to the advance of scientific knowledge, and is no substitute for it. Remember saccharin and how it causes cancer? Or how drotrecogin was the holy grail of sepsis treatment? What was the state of consensus regarding phlogiston theory 400 years ago? What does one one say about the scientific certainty regarding “gender fluidity?”
Science, is a tool without an inherent moral or ethical constraint. The scientific method is useful, for both good and ill, but is not infallible. Its usefulness derives from the ability of human reason to make sense of objective evidence, and that is all it is. It is not something to be venerated or blindly believed. It is something that can be cynically exploited by charlatans. It may be used as a prop to argue for greater government control over people’s lives just as hucksters with knowledge of solar eclipses were able to con those innocent of astronomic knowledge by implying some mysterious power. Science does not validate atrocity or immorality (as the Tuskegee syphilis and Unit 731 experiments show) merely by their being scientific, and science does not validate any ideology or political fashion that presumes otherwise. The use of science for political ends does not have a happy history.
Saturday, April 08, 2017
Healthcare policy principles
There are a few principles that should govern healthcare policy-making:
1.) The fundamental characteristic of a sustainable healthcare system is not compassion, or comprehensiveness, or justice, or equality, or cost effectiveness. It is predictability. Predictability is why we have written laws it is the characteristic that allows engineers to design aircraft and computers, and chemists to develop new pharmaceuticals. Predictability is what allows actuarial analysis and rational assessment of risk. Predictability is what allows people to make plans with a reasonable expectation of favorable outcomes. The first step in formulating a sustainable healthcare policy is to excise as much caprice, and uncertainty as possible.
2.) Healthcare policy does not determine who gets care, it determines who gets rich. In point of fact there is almost no one in this country who does not have access to at least least some healthcare. It may be inefficient; it may not be cost effective and it may not be particularly thoughtful, but no one need die of tuberculosis or typhus or beri-beri unless psycho-social factors intervene. The future of healthcare as asocial asset will be determined more by technology and the principles of economics; the future of healthcare as an industry will be determined by regulation and policy.
3.) The Pareto principle applies to healthcare: 80 % of the care can be delivered for 20% of the cost.
4.) All systems of benefits and resource allocation become multi-tiered. There is a multi-tiered educational system in this, and every country. There is a multi-tiered judicial system. there is a multi-tiered public health system and a mult-tiered infrastructure system. It does not matter if policy prescribes a single payer system, some sort of hybrid, or a totally market-based system, it will be multi-tiered. This is not the avoidable result of corruption or malign intent on the part of policy makers, although that will certainly make matters worse. It is rather the result of the uneven distribution of inherent advantages and disadvantages, tangible and intangible, across any sizable group of people.
5.) The next big revolution in healthcare will be probabilistic medicine driven by enormous strides in data processing. the cognitive aspects of computers will yield to a significant degree to massive decision algorithms that incorporate huge volumes of data from tens of millions of patients.
1.) The fundamental characteristic of a sustainable healthcare system is not compassion, or comprehensiveness, or justice, or equality, or cost effectiveness. It is predictability. Predictability is why we have written laws it is the characteristic that allows engineers to design aircraft and computers, and chemists to develop new pharmaceuticals. Predictability is what allows actuarial analysis and rational assessment of risk. Predictability is what allows people to make plans with a reasonable expectation of favorable outcomes. The first step in formulating a sustainable healthcare policy is to excise as much caprice, and uncertainty as possible.
2.) Healthcare policy does not determine who gets care, it determines who gets rich. In point of fact there is almost no one in this country who does not have access to at least least some healthcare. It may be inefficient; it may not be cost effective and it may not be particularly thoughtful, but no one need die of tuberculosis or typhus or beri-beri unless psycho-social factors intervene. The future of healthcare as asocial asset will be determined more by technology and the principles of economics; the future of healthcare as an industry will be determined by regulation and policy.
3.) The Pareto principle applies to healthcare: 80 % of the care can be delivered for 20% of the cost.
4.) All systems of benefits and resource allocation become multi-tiered. There is a multi-tiered educational system in this, and every country. There is a multi-tiered judicial system. there is a multi-tiered public health system and a mult-tiered infrastructure system. It does not matter if policy prescribes a single payer system, some sort of hybrid, or a totally market-based system, it will be multi-tiered. This is not the avoidable result of corruption or malign intent on the part of policy makers, although that will certainly make matters worse. It is rather the result of the uneven distribution of inherent advantages and disadvantages, tangible and intangible, across any sizable group of people.
5.) The next big revolution in healthcare will be probabilistic medicine driven by enormous strides in data processing. the cognitive aspects of computers will yield to a significant degree to massive decision algorithms that incorporate huge volumes of data from tens of millions of patients.
Sunday, March 26, 2017
The future of healthcare
There are a few principles that will dictate the future of the American healthcare system:
1. There will always be a two-tiered system. This will not be due to a flaw in system design or implementation, but is due to the unalterable dynamics of societies. there is not a country on earth that does not have multi-tiered healthcare. The United States will not have a single tiered system for the same reason that it does not have, in fact, a single tiered educational system, or a single tiered legal system, or a single tiered social welfare system. Economics, technology and data management will have a much greater influence on the shape of the American healthcare system than will politics. Politics however, will have a much greater influence on who becomes rich as a result.
2. Healthcare in general, and medical care in particular, can be divided up into three functional categories:
i. The technical or procedural aspect. This is the part of healthcare where someone takes out your appendix, adminsters chemotherapy, does endoscopy, or performs a CT scan;
ii. The cognitive aspect. This is where someone interprets data and makes decisions about interventions, and
iii. The clerical aspect. This is where data is collected, collated,and and packaged.
These three aspects will become more distinct and regardless of what type of healthcare reform or payment system is implemented, will dictate the future of healthcare.
The procedural aspect will be taken over by technicians. this trend has been underway for a couple of decades and has resulted in niche practices by "proceduralists.: It is also apparent in the now common practice of attending physicians or primary care providers referring patients to specialists who perform procedures on request, with no other role in diagnosing or managing a patient;s condition. In the future, these people will be less educated in broad aspects of medicine and will be hyper-specialized technicians. Since these procedures will be will established and understood, the practitioners performing them will be more like tradesmen than professional decison makers. They will have less education and more procedural training, and consequently will be expected to do less and will be paid less.
The cognitive aspect will largely be displaced by massive data management systems. This will commonly be referred to as AI, but will involve computer algorithms classifying each patient and processing huge amounts of epidemiologic, genetic, and clinical data to arrive at diagnostic and treatment plans for individual patients. These systems will become more reliable as experience is gained and they will drive down the costs associated with routine care. One offshoot of this will be a new medical specialty: the "outlierist" or the "anomalist" who will be looked to for the artisanal elements of medicine when the data driven computer algorithms are unsuccessful.
The clerical aspect is taking up a larger portion of providers time right now. They spend significant time gathering and entering data that eventually will form the databases on which the artificial neural networks, inference engines, Bayesian belief networks, and other computer modeling systems will operate. Provider systems and payers will soon realize that these tasks can be both largely automated and performed by medium skilled workers without medical degrees.
1. There will always be a two-tiered system. This will not be due to a flaw in system design or implementation, but is due to the unalterable dynamics of societies. there is not a country on earth that does not have multi-tiered healthcare. The United States will not have a single tiered system for the same reason that it does not have, in fact, a single tiered educational system, or a single tiered legal system, or a single tiered social welfare system. Economics, technology and data management will have a much greater influence on the shape of the American healthcare system than will politics. Politics however, will have a much greater influence on who becomes rich as a result.
2. Healthcare in general, and medical care in particular, can be divided up into three functional categories:
i. The technical or procedural aspect. This is the part of healthcare where someone takes out your appendix, adminsters chemotherapy, does endoscopy, or performs a CT scan;
ii. The cognitive aspect. This is where someone interprets data and makes decisions about interventions, and
iii. The clerical aspect. This is where data is collected, collated,and and packaged.
These three aspects will become more distinct and regardless of what type of healthcare reform or payment system is implemented, will dictate the future of healthcare.
The procedural aspect will be taken over by technicians. this trend has been underway for a couple of decades and has resulted in niche practices by "proceduralists.: It is also apparent in the now common practice of attending physicians or primary care providers referring patients to specialists who perform procedures on request, with no other role in diagnosing or managing a patient;s condition. In the future, these people will be less educated in broad aspects of medicine and will be hyper-specialized technicians. Since these procedures will be will established and understood, the practitioners performing them will be more like tradesmen than professional decison makers. They will have less education and more procedural training, and consequently will be expected to do less and will be paid less.
The cognitive aspect will largely be displaced by massive data management systems. This will commonly be referred to as AI, but will involve computer algorithms classifying each patient and processing huge amounts of epidemiologic, genetic, and clinical data to arrive at diagnostic and treatment plans for individual patients. These systems will become more reliable as experience is gained and they will drive down the costs associated with routine care. One offshoot of this will be a new medical specialty: the "outlierist" or the "anomalist" who will be looked to for the artisanal elements of medicine when the data driven computer algorithms are unsuccessful.
The clerical aspect is taking up a larger portion of providers time right now. They spend significant time gathering and entering data that eventually will form the databases on which the artificial neural networks, inference engines, Bayesian belief networks, and other computer modeling systems will operate. Provider systems and payers will soon realize that these tasks can be both largely automated and performed by medium skilled workers without medical degrees.
Respect
If you earn respect, you will have self respect.
If you demand respect, you will have self pity.
There are two things with which self respect should never be confused: self pity and self esteem.
When faced with challenges, self esteem often becomes self pity; self respect becomes courage and determination.
If you demand respect, you will have self pity.
There are two things with which self respect should never be confused: self pity and self esteem.
When faced with challenges, self esteem often becomes self pity; self respect becomes courage and determination.
Sunday, March 12, 2017
Monday, February 20, 2017
Speech as action
A piece by David Solway entitled "Free Speech vs. 'Hate Speech'" makes the following assertion:
Of course, speech itself can be an act, as philosopher J.L. Austin has shown in How to Do Things with Words: in his most famous example, when the minister states “I now pronounce you husband and wife,” an act has been performed since it changes the status of the participants.
This is wrong. The words themselves are innocuous absent other considerations. If a second grader speaks the quoted words to two other second graders,the latter are not thereby married. More importantly, if a minister says the words to two people who do not wish to be married, or in fact merely disagree with those words, their status does not change. In the former case, the words are powerless because of the status of the speaker. She has no authority to change the status of her classmates, regardless of the words used. The latter case is more fundamental, because it is an example of a larger principle: the effect of words in the absence of external force is dependent on the acceptance of the hearer. Certainly, when a judge pronounces a sentence, the words used wold be of little significance apart from a mechanism to enforce them. The same result holds if the judge has no authority to pass such a sentence, as for example if jury had acquitted the accused.
The effect of words in such case would depend on the subjective acceptance of their object. To put the matter more succinctly, no one is obligated to be offended by speech, and no one is required to perceive injuries in mere opinions.
Of course, speech itself can be an act, as philosopher J.L. Austin has shown in How to Do Things with Words: in his most famous example, when the minister states “I now pronounce you husband and wife,” an act has been performed since it changes the status of the participants.
This is wrong. The words themselves are innocuous absent other considerations. If a second grader speaks the quoted words to two other second graders,the latter are not thereby married. More importantly, if a minister says the words to two people who do not wish to be married, or in fact merely disagree with those words, their status does not change. In the former case, the words are powerless because of the status of the speaker. She has no authority to change the status of her classmates, regardless of the words used. The latter case is more fundamental, because it is an example of a larger principle: the effect of words in the absence of external force is dependent on the acceptance of the hearer. Certainly, when a judge pronounces a sentence, the words used wold be of little significance apart from a mechanism to enforce them. The same result holds if the judge has no authority to pass such a sentence, as for example if jury had acquitted the accused.
The effect of words in such case would depend on the subjective acceptance of their object. To put the matter more succinctly, no one is obligated to be offended by speech, and no one is required to perceive injuries in mere opinions.
Saturday, February 18, 2017
Safe spaces
The concept of civilization only makes sense in the context of interactions between humans. A solitary individual having no interactions with others would have no use for norms and traditions that are useful in public life. A civilized society is one in which the clashes and confrontations that inevitable arise when human beings interact are managed by certain understandings regarding tolerance, accommodation and compromise. The norms and institutions of civilization are means by which the clashes of individual interests and diversity of opinions are processed so as to make social interactions worthwhile. Civilization is a consequence of the public benefits which arise from preserving individuality. Civilization thrives when individual differences are allowed to compete.
A "safe space," in the current usage of the term, is a place that is free from distressing opinions or disquieting deviations from uniformity. They are precincts where feeble ideas are allowed to persist unchallenged and unimproved, not because of the intellectual validity of those ideas but because of the emotional discomfort occasioned by alternative views. Safe spaces only appear so because of uniformity and conformity, and as such are intellectually stagnant. The aversion to individual thought and dispute makes them intellectually inert and emotionally anesthetic. The adjective "safe" is a euphemism intended to disguise an environment that is intellectually desolate, intolerant and craven.
A "safe space," in the current usage of the term, is a place that is free from distressing opinions or disquieting deviations from uniformity. They are precincts where feeble ideas are allowed to persist unchallenged and unimproved, not because of the intellectual validity of those ideas but because of the emotional discomfort occasioned by alternative views. Safe spaces only appear so because of uniformity and conformity, and as such are intellectually stagnant. The aversion to individual thought and dispute makes them intellectually inert and emotionally anesthetic. The adjective "safe" is a euphemism intended to disguise an environment that is intellectually desolate, intolerant and craven.
Outcomes
The most significant difference between Donald Trump and Hillary Clinton, at least as it concerns practical politics, is that there was a significantly greater risk of corruption being normalized under a Clinton administration than under Trump. This is independent of whether a Clinton led government would be any more or less corrupt than the current administration. In the former case, corruption would be viewed by institutions such as the media and entrenched interests as a price to be paid for favorable policies; in the latter case, it is a target of opportunity by which to advance one's agenda and protect one's interests. Normalization of corruption is far more damaging than any policy which could be reasonably implemented by either candidate.
Sunday, February 12, 2017
Thought experiment
Consider a woman, a citizen in a western democracy, Now consider that it is desirable to someone, for whatever reason, to have her behave in a particular way, to conform to some model, or submit to some reform. One way to accomplish this would be to use coercion, to invoke force or the prospect of undesirable consequences to influence her in the desired direction. Another alternative would be to use persuasion, appeal to reason, and try to convince her of the wisdom and benefit of the desired behavior, model or reform.
The first method is the resort to force. She will be made to conform regardless of her her own reason, values or choice. The second is a resort to rational discourse, to principles of analysis and evidence. Only the second of these is consistent with a respect for dignity; i.e. that a person is worthy, all else being equal, of living her life in accord with her own conscience.
Now image that the second method, the use of persuasion, is discouraged on grounds that the method of persuasion, i.e. free speech, might cause offense to someone. Thus we have in stark relief the malignancy at the heart of political correctness: that it is better to use force and the threat of personal consequences to bring about some policy or other, because to allow reasoned debate might offend subjective sensibilities. Rejection of political correctness is rejection of the notion that the benefits and individual dignity must be surrendered to protect the sensitive from disquieting opinions..
The first method is the resort to force. She will be made to conform regardless of her her own reason, values or choice. The second is a resort to rational discourse, to principles of analysis and evidence. Only the second of these is consistent with a respect for dignity; i.e. that a person is worthy, all else being equal, of living her life in accord with her own conscience.
Now image that the second method, the use of persuasion, is discouraged on grounds that the method of persuasion, i.e. free speech, might cause offense to someone. Thus we have in stark relief the malignancy at the heart of political correctness: that it is better to use force and the threat of personal consequences to bring about some policy or other, because to allow reasoned debate might offend subjective sensibilities. Rejection of political correctness is rejection of the notion that the benefits and individual dignity must be surrendered to protect the sensitive from disquieting opinions..
Wednesday, March 02, 2016
Racism
Charges of racism seem to be an inexhaustible element of public discourse in the United States. Race is injected into a wide swath of public debates and the allegations of racist motives are regularly used to discredit and silence opposing views. Some people claim that the United States is an inherently racist country; others that the single minded search for any hint of potentially racist or race-tinged thought has reached the point that it is doing more harm than good.
Certainly, overt and institutionalized racism has declined steadily since the second World War. Certainly there are those, in all races who still harbor racist attitudes, and there is a corresponding disparity in perceptions of just how racist America really is. A simple explanation for this phenomenon is found not in comparing attitudes and conduct to some mythical non-racist standards, but in understanding different peoples' priorities in considering matters of race.
Let us assume you have two people of different races, each of whom honestly considers herself non-racist. Now construct a list of attitudes and actions that are, or could potentially be considered racist, and rank them, from most obviously racist to spurious at best. this list would range from the egregious, such as lynching a teenager for kissing a person of a different race, to things like refusing to hire a person because of their race, to telling stereotyping jokes, etc, to the silly, such as objecting to terms like "black sheep" or "black mark, to the weird, like complaining about "cultural appropriation" to the just plain ignorant, such as claiming that the word "niggardly" has anything at all to do with race.
If we take our two subjects and present them with this list and ask them to prioritize each item on the list against other social concerns, such as economic efficiency or freedom of expression, it is likely that there would be a great deal of agreement at the more flagrant examples; both would agree that lynching is abhorrent racism. There would most likely be agreement that discrimination in employment and housing are improper, and that stereotyping jokes do reflect racist attitudes. But as you go down the list, it would be expected that there will be a point that the two people will disagree on whether a particular act or attitude is sufficiently serious that it should override other concerns. there will be a disagreement on the priority that a potential racist thought or action should be given in everyday life, and it is at this point that one person will accuse the other of racism. And it is not just an accusation as to that contested point; it will be assumed that the point of disagreement, e.g. that "Taco Tuesday" should be condemned is simply the point where the closet racist lets the mask slip, Thus, what should be simply a good faith disagreement as to whether an arguably innocuous, or even an obviously innocuous view can be transformed by racial prospectors into invidious racism. This is why the vast majority of people honestly do not consider themselves racist, and those who suspect others of racism readily think they have evidence to support their suspicions.
The clearest example of this is affirmative action. There are competing priorities here: countering the prospect that qualified minorities will be denied opportunity because of their race, and ensuring that race-neutral merit is the basis for allocating potentially limited opportunities. Neither view is necessarily racist. The allegation of racism, when it inevitably comes out is not directed at the principles underlying either position, rather it is directed solely at opposition to the accuser's position. The allegation is not that merit is racist it is that prioritizing merit over racial considerations is.
Of course, there are racists. There are those who believe that there are certain genetic traits that justify treating races differently. But for the majority of people what determines how they treat one another regardless of race depends on their experiences. It is much more likely that a black man who loves his wife and raises his children, and respects others has much more in common with a white man who loves his wife and raises his children and respects others than either has with a black drug dealer who abuses women or with a white methamphetamine addict who steals to support his habit and abuses women.
Sure, there are racists. There are also race hustlers who would contort facts and logic to smear otherwise decent people in support of a cynical narrative that is destructive to people of all races.
Certainly, overt and institutionalized racism has declined steadily since the second World War. Certainly there are those, in all races who still harbor racist attitudes, and there is a corresponding disparity in perceptions of just how racist America really is. A simple explanation for this phenomenon is found not in comparing attitudes and conduct to some mythical non-racist standards, but in understanding different peoples' priorities in considering matters of race.
Let us assume you have two people of different races, each of whom honestly considers herself non-racist. Now construct a list of attitudes and actions that are, or could potentially be considered racist, and rank them, from most obviously racist to spurious at best. this list would range from the egregious, such as lynching a teenager for kissing a person of a different race, to things like refusing to hire a person because of their race, to telling stereotyping jokes, etc, to the silly, such as objecting to terms like "black sheep" or "black mark, to the weird, like complaining about "cultural appropriation" to the just plain ignorant, such as claiming that the word "niggardly" has anything at all to do with race.
If we take our two subjects and present them with this list and ask them to prioritize each item on the list against other social concerns, such as economic efficiency or freedom of expression, it is likely that there would be a great deal of agreement at the more flagrant examples; both would agree that lynching is abhorrent racism. There would most likely be agreement that discrimination in employment and housing are improper, and that stereotyping jokes do reflect racist attitudes. But as you go down the list, it would be expected that there will be a point that the two people will disagree on whether a particular act or attitude is sufficiently serious that it should override other concerns. there will be a disagreement on the priority that a potential racist thought or action should be given in everyday life, and it is at this point that one person will accuse the other of racism. And it is not just an accusation as to that contested point; it will be assumed that the point of disagreement, e.g. that "Taco Tuesday" should be condemned is simply the point where the closet racist lets the mask slip, Thus, what should be simply a good faith disagreement as to whether an arguably innocuous, or even an obviously innocuous view can be transformed by racial prospectors into invidious racism. This is why the vast majority of people honestly do not consider themselves racist, and those who suspect others of racism readily think they have evidence to support their suspicions.
The clearest example of this is affirmative action. There are competing priorities here: countering the prospect that qualified minorities will be denied opportunity because of their race, and ensuring that race-neutral merit is the basis for allocating potentially limited opportunities. Neither view is necessarily racist. The allegation of racism, when it inevitably comes out is not directed at the principles underlying either position, rather it is directed solely at opposition to the accuser's position. The allegation is not that merit is racist it is that prioritizing merit over racial considerations is.
Of course, there are racists. There are those who believe that there are certain genetic traits that justify treating races differently. But for the majority of people what determines how they treat one another regardless of race depends on their experiences. It is much more likely that a black man who loves his wife and raises his children, and respects others has much more in common with a white man who loves his wife and raises his children and respects others than either has with a black drug dealer who abuses women or with a white methamphetamine addict who steals to support his habit and abuses women.
Sure, there are racists. There are also race hustlers who would contort facts and logic to smear otherwise decent people in support of a cynical narrative that is destructive to people of all races.
Tuesday, March 01, 2016
Libertarians
A libertarian view begins with the premise that liberty is incompatible with coercion, and that a civil society should not substitute instruments of violence for persuasion. This view requires that all uses of force be justified, because force is never assumed to be just. There are certain categories of force, such as government force used against one person for the exclusive private advantage of another, or force used to protect subjective sensibilities, or to vindicate matters of etiquette that should never be justified.The rules for use of force should be predictable and of general application, neither singling out nor exempting particular parties. No person who is capable of reason should be subjected to force solely on grounds that it is for his or her own good.
Force and governmental violence is sometimes necessary but its legitimate use usually signals the breakdown of reason. The lapse of reason is not always on the part of the person against whom the force is directed. Force, or the ability to resort to force by authorities, is a tempting shortcut to assure compliance with questionable policies or to promote partisan interests, or worse, to attempt to compensate for incompetence in administering the laws. It is the enabler of oppressive laws and a hallmark of governing interests at odds with the will of the people.
Force is inherently inelegant and imprecise. There is no guarantee that "non-lethal" force will remain "non-lethal" just because the circumstances do not justify more severe measures.
Force and governmental violence is sometimes necessary but its legitimate use usually signals the breakdown of reason. The lapse of reason is not always on the part of the person against whom the force is directed. Force, or the ability to resort to force by authorities, is a tempting shortcut to assure compliance with questionable policies or to promote partisan interests, or worse, to attempt to compensate for incompetence in administering the laws. It is the enabler of oppressive laws and a hallmark of governing interests at odds with the will of the people.
Force is inherently inelegant and imprecise. There is no guarantee that "non-lethal" force will remain "non-lethal" just because the circumstances do not justify more severe measures.
Friday, November 01, 2013
Hostile
Of all the drawbacks of an excessive regulatory, bureaucratic state, perhaps the most significant is that all of the necessary mandates and prohibitions eventually mkes the government adverse to the citizenry.
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