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Care Doesn't Scale

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Re: Care Doesn't Scale

#251

Post by MisterBastahrd »

moolcool wrote: post #144
downut wrote: post #134

Earlier quoted context omitted.

"...baker who gets up at 3 am..." But those 3am bakers are being exterminated by at scale corporate chains, no? Generalizes to just about anything that could reasonably be described using "artisanal". Social atomization inexorably spreads, and after thinking about it pretty hard for many years of travel putting eyeballs on "artisanal" processes I don't see any possibility of any other outcome. So we enjoy what is lef…

To complete the thought, the baker example is explicitly in opposition to OP's point. In the economy we exist in, a 3am artisan baker does so explicitly out of a care for craft and community.

The 3am baker currently exists because the people who benefit the most from the exploitation of labor have the extra money to buy artisan products. My great grandfather had a bakery. He and my great grandmother would bake their product and my grandfather and his brothers would deliver the product to local businesses and homes.

And then corporate breadmakers came in and made it impossible to compete from a price standpoint. Quality disappeared, and variety was subsequently crushed. The only people keeping his businesses open for a while were those who had fortunes that existed from owning a ton of land. They still wanted their oval loaves and fresh french bread and muffins.

Re: Care Doesn't Scale

#252

Post by rqtwteye »

bumby wrote: post #218
drivingmenuts wrote: post #212

Earlier quoted context omitted.

Most healthcare organizations in the US are profit-oriented, sometimes to the detriment of the patients. That is why we have large, unwieldy organizations surrounding the very few people that actually do hands-on healthcare. There’s also the issue of liability – it can be pretty litigious in the US, and companies are frequently wanting to limit their liability, which means having the paperwork to back up their decisi…

> Most healthcare organizations in the US are profit-oriented According to the American Hospital Association, less that 20% are for-profit [1]. I'm sure all are extremely budget-conscious, but that's not the same as being profit-driven. It seems to me that the US optimizes for quality to the detriment of cost and, more recently, access. [1] https://www.aha.org/statistics/fast-facts-us-hospitals

Don’t be fooled by the “non-profit” label. Many are as greedy as for-profit hospitals, except that the money goes to execs and their friends instead of shareholders.

Re: Care Doesn't Scale

#254

Post by bccdee »

kang wrote: post #248
bccdee wrote: post #198

Earlier quoted context omitted.

Do you always need that kind of prolonged argument whenever you learn a new concept? > Sometimes the YouTube video is more helpful than the private tutor. University lectures work like that. First the general lecture, which has 300 students and is not interactive. Then the tutorial, where students who want extra help can consult individually with a TA. Attendance for tutorials was typically much lower in my experienc…

Except the argument is university lecture (classroom structure) doesn't work. A personal tutor might be able to teach a concept to all their students, whereas not everyone in a classroom passes. Your argument about sufficiency can be made about books and is not relevant here.

> A personal tutor might be able to teach a concept to all their students, whereas not everyone in a classroom passes.

Why are you convinced that personal tutors are so much more effective? I'd expect the average student to be slightly better-served by having a personal tutor, but not by much. After all, personal guidance is available from TAs when necessary—my point is that it typically isn't necessary.

Re: Care Doesn't Scale

#255

Post by r14c »

anonylizard wrote: post #136
delichon wrote: post #123

It is not from the benevolence of the butcher, the brewer, or the baker, that we expect our dinner, but from their regard to their own interest. We address ourselves, not to their humanity but to their self-love, and never talk to them of our own necessities but of their advantages. Nobody but a beggar chuses to depend chiefly upon the benevolence of his fellow-citizens. -- Adam Smith Care doesn't scale but self-inte…

That's not true, and only seems true because of highly selective examples. Money can force people to work, out of the necessity of survival. What it buys is reliability. You can force a toilet cleaner to come to work day after day, and the toilets stay clean. But human progress, social progress, economic growth, does not solely come from people grinding through their jobs. It comes from people 'giving it their all',…

> People in the third world work harder than the first world, and are 10% as rich, because no one in their societies care.

typically they "care wrong" and the first world comes in and dismantles everything to keep raw resource prices at a price point that they like. advanced third world economies are a threat to first world prosperity.

Re: Care Doesn't Scale

#256

Post by r14c »

cnr wrote: post #139
delichon wrote: post #123

It is not from the benevolence of the butcher, the brewer, or the baker, that we expect our dinner, but from their regard to their own interest. We address ourselves, not to their humanity but to their self-love, and never talk to them of our own necessities but of their advantages. Nobody but a beggar chuses to depend chiefly upon the benevolence of his fellow-citizens. -- Adam Smith Care doesn't scale but self-inte…

"The story, then, is everywhere. It is the founding myth of our system of economic relations. It is so deeply established in common sense, even in places like Madagascar, that most people on earth couldn’t imagine any other way that money possibly could have come about. The problem is there’s no evidence that it ever happened, and an enormous amount of evidence suggesting that it did not.” "Debt", David Graeber

Its wild to me how often people conflate "human nature" and culture. People who share a cultural background with Adam Smith may very well be accustomed to this self-interest-first way of seeing the world. People who would struggle to see other people's life ways as valid, because there's very little value in other people's perspectives. Especially if they involve practices that undermine profitability.

Re: Care Doesn't Scale

#257

Post by ToucanLoucan »

bunderbunder wrote: post #249
bumby wrote: post #245

Earlier quoted context omitted.

I think that highlights the issue I'm poking at. "Good communication" doesn't just mean a firehose of information at your fingertips. It means getting the right amount of information at the right time. Developing systems like the latter is much harder than the former, but they both get the same sales pitch.

This is also where I really dislike a lot of this more recent push toward automating communication. One person deciding what needs to be said, to whom, and when, can have a LOT of leverage in the productivity department, by reducing the time that tens or even hundreds or thousands of other people lose to coping with the fire hose. Microsoft Copilot has been yet another downgrade in this department. Since it got adopt…

At my company we are aggressively rolling out policies to forbid the use of AI. I'm one of the bigger folks behind it. I just see no benefits. I have no desire to debug AI generated code, I have no desire to read pages and pages of AI generated fluff, I have no desire to look at AI generated images. Either put the work in or don't.

Re: Care Doesn't Scale

#258

Post by keeptrying »

“Care Doesn’t Scale” is a fractal type of truth which essentially describes life but also is a steadfast warning of the underlying state of healthcare in general.

Holistic 100% care doesn’t exist - even for the rich.

The only way to get optimal care is to pay for it with study. Even the richest in the world don’t necessarily get the best care because care is a function of the present life situation of the practitioner - something no one can control 100% of the time.

What is reassuring is that through a little study - you can refine the care provided by most nurses and doctors using your own curiosity at the point of interaction.

Surprisingly the mistakes committed by nurses and doctors on somewhat healthy patients are easily fixed with some sembalance of attention.

Study the first 2 years of med school. It’s not hard but does take time. And then ask the pertinent quesitons during your time with the doctor. Understand the diagnosis and how they came to it - it’s mostly simple and straight forward.

80% of the massive mistakes by doctors and nurses are fixable this way. Thats $800B … 800 billion dollars - with a little study.

Re: Care Doesn't Scale

#259

Post by will-burner »

I'm surprised the article and non of the comments I've seen in this thread mention effective altruism, which in the framing of the article is an attempt to scale caring in some sense.

The article helped me realize why so many people in the startup/tech/software engineering scene are drawn to effective altruism, it's a way to scale helping humanity in the best way possible. The effective altruism argument is that it's more productive to by mosquito nets in Africa than to volunteer at a food shelter because buying mosquito nets will save more lives.

But this article helps explain why I don't personally feel drawn to or buy into effective altruism. Because caring doesn't scale, you can only really care about a handful of people close to you. And to me that altruism feels better and seems like it goes further than donating money to help more people that I can't truly care for.

Re: Care Doesn't Scale

#260

Post by Aeolun »

vanderZwan wrote: post #142

If we're going to talk about how to "scale care" and how not to, then Buurtzorg has to be mentioned[0][1]. It's a Dutch home-care company that was started by nurses who basically got frustrated that managers got in the way of them doing their job. It operates by having a flat organization working with small teams of highly trained nurses, and trusting them to make the right decisions. The result is a low-cost provide…

To be fair, Buurtzorg doesn’t scale either, as they’re perpetually short staffed.
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