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Too much efficiency makes everything worse (2022)

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Re: Too much efficiency makes everything worse (2022)

#231

Post by whatshisface »

RandomLensman wrote: post #204
whatshisface wrote: post #193

Earlier quoted context omitted.

I don't see why people can't comparisons shop for hospitals before they get in a car crash. Unless I am literally unconscious I would go to the hospital in my area that I trust the most, and I have plans for which urgent care, clinics and hospitals I would take someone else to if they needed a driver. In fact I think a pretty small fraction of patients arrive at the ER unconscious.

How would develop the "trust" and why would it be correct? How would you diagnose yourself or others before selecting a hospital if those have different trust for different things? How do you balance urgency vs different trust levels if the hospitals are not all the same distance?

You could ask the same questions about grocery shopping or buying a PC.

Re: Too much efficiency makes everything worse (2022)

#232

Post by whatshisface »

mikeyouse wrote: post #206
RandomLensman wrote: post #204

Earlier quoted context omitted.

How would develop the "trust" and why would it be correct? How would you diagnose yourself or others before selecting a hospital if those have different trust for different things? How do you balance urgency vs different trust levels if the hospitals are not all the same distance?

It also ignores that huge swaths of the country have no choice at all and the only hospital within a hundred miles is only viable due to huge Federal subsidies. We’ve been helping a close family member navigate that scenario and sure, he could vote with his dollars but it would involve a three hour drive to a neighboring state for an 80-yr old. I’d rather just enforce minimum quality standards on everyone like most o…

I can't imagine anyone would object to minimum quality standards for anything receiving federal subsidies.

Re: Too much efficiency makes everything worse (2022)

#233

Post by RandomLensman »

whatshisface wrote: post #231
RandomLensman wrote: post #204

Earlier quoted context omitted.

How would develop the "trust" and why would it be correct? How would you diagnose yourself or others before selecting a hospital if those have different trust for different things? How do you balance urgency vs different trust levels if the hospitals are not all the same distance?

You could ask the same questions about grocery shopping or buying a PC.

A mis-assessment there might be far less consequential and those also do not require a medical diagnosis before making a decision where to go.

Re: Too much efficiency makes everything worse (2022)

#234

Post by nradov »

wongarsu wrote: post #192
vlovich123 wrote: post #170

Earlier quoted context omitted.

I don’t think it’s smart to proactively back track without being very careful. One thing that’s needed is for corporate death to be allowed to occur. Right now the downsides of risky behavior is bailed out for large enough risk. Then the companies that fail aren’t robust and the ones that don’t are but bailouts let non robust companies keep going. Otherwise “robustness” is a property without a measure which means tha…

In a free market economy we shouldn't demand robustness, we should create a system that promotes and rewards robustness. A strict commitment against bail-outs would certainly be part of that. Companies (and private people) can decide to lower their risk exposure (at the cost of efficiency/profit) or take out insurance against risks. And if they go the insurance route they have to assess how likely their insurance is…

Patients have time to shop for most healthcare services. Only a small fraction of healthcare spending is for emergencies. The highest cost stuff is mostly elective procedures. If you need a colonoscopy or hip replacement then you have time to shop around.

Socialized healthcare has its advantages and is probably more cost effective on average. But we also see affluent Canadians coming to the USA as medical tourists and paying cash for MRI scans in order to avoid the queues back home.

Re: Too much efficiency makes everything worse (2022)

#235

Post by kzz102 »

I think of efficiency as one example where naive economic thinking has poisoned common sense. Economists view inefficiency as a problem. Because a healthy economy is efficient, therefore inefficiency is unhealthy. Any inefficient market is a "market failure". Efficiency is also the primary way a manager can add value. But the problem is, efficiency assumes existence of metrics, and indeed is counter productive if your metrics are wrong.

Re: Too much efficiency makes everything worse (2022)

#236

Post by nradov »

mikeyouse wrote: post #206
RandomLensman wrote: post #204

Earlier quoted context omitted.

How would develop the "trust" and why would it be correct? How would you diagnose yourself or others before selecting a hospital if those have different trust for different things? How do you balance urgency vs different trust levels if the hospitals are not all the same distance?

It also ignores that huge swaths of the country have no choice at all and the only hospital within a hundred miles is only viable due to huge Federal subsidies. We’ve been helping a close family member navigate that scenario and sure, he could vote with his dollars but it would involve a three hour drive to a neighboring state for an 80-yr old. I’d rather just enforce minimum quality standards on everyone like most o…

CMS does enforce minimum clinical quality standards on hospitals (at least those that accept Medicare). The problems in areas without meaningful competition tend to be more around shortages of qualified practitioners, high prices, and abusive billing policies.

Re: Too much efficiency makes everything worse (2022)

#237

Post by kortilla »

CuriouslyC wrote: post #213
wongarsu wrote: post #192

Earlier quoted context omitted.

In a free market economy we shouldn't demand robustness, we should create a system that promotes and rewards robustness. A strict commitment against bail-outs would certainly be part of that. Companies (and private people) can decide to lower their risk exposure (at the cost of efficiency/profit) or take out insurance against risks. And if they go the insurance route they have to assess how likely their insurance is…

That solution is never going to work when black swan events occur on the order of every 5-10 years and executive vision is focused on the next quarter with little concern paid to anything outside the next 2-3 years. Nobody is going to want to give up short term performance to mitigate risks that probably won't manifest until after they've left for a better job.

That solution is how it already works for the vast majority of companies in the US.

“Too big to fail” is a meme that only applied to a tiny handful of companies during the financial crisis. Take a look at SVB for how fast a stalwart huge bank can implode with zero fucks given by the government.

Re: Too much efficiency makes everything worse (2022)

#239

Post by bumby »

nradov wrote: post #217
bumby wrote: post #195

Earlier quoted context omitted.

There are also a lot of engineering examples where the goal is to optimize for reliability. I think the most common domain is marine platforms where it is prohibitively expensive to induct and repair (you have to send a team out by helicopter, for example).

And yet most large merchant ships are designed with a single engine, propeller, and rudder to optimize for cost instead of reliability. We have seen some spectacular failures of that approach recently, although it probably still makes sense in aggregate. A major mechanical casualty beyond what the crew can repair usually means a tow to a shipyard. Flying more engineers in by helicopter would seldom help, and often is…

This is true, but different than the maritime platforms I was talking about. The ones that tend to focus on reliability-centered optimization are platforms used for drilling, not transport. Even then, you will see instances where they decide to optimize for cost/schedule (eg Deepwater Horizon). IMO, that is a company-cultural issue.

Btw- reliability optimization doesn’t necessarily mean it is optimized to not fail. They are optimized to fail within some predetermined risk level. What that risk level should be is an entirely different discussion.

Re: Too much efficiency makes everything worse (2022)

#240

Post by xerox13ster »

naming_the_user wrote: post #167
bmicraft wrote: post #162

Earlier quoted context omitted.

Sorry to put it so bluntly, but you're basically saying: "I don't care it the climate's fucked, I want to live away from civilization and drive 100 miles a day everywhere" Of course we shouldn't hyper-optimize everything, but sooner people realize our environment depends on not everyone getting exactly what they want whenever they want the better. Living in a (walkable) city is just one such concession towards the en…

Or we could just compete with each other for resources as we have since forever. I’d rather do that than have no choice but to live in Kowloon. Just whack an externality tax on fossil fuels and things like cutting down wilderness, job done.

Or we can stop acting like there’s only two options: living in wide-open fields with a clear horizon or the fucking walled city of Kowloon.

Also, you have the mindset of a typical anti-social coastal elite who thinks “oh no big deal we can just raise the cost of living for all the poor rural types by sticking on a tax because I want to go LARP as a Victorian manor lord. And people don’t bend to my every whim immediately or live exactly like me so I want to be in total control of the 50 miles around me.”

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