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Having decentralized entities maximize QALYs with grants is still optimization subject to budget constraints, in the endwateroverfire posted:Markets do simplify the problem by recruiting millions of individual self-interested agents that each solve a little piece of it. That is more efficient, though not perfectly efficient, than creating bureaucracies to try to centrally coordinate, in most circumstances. There is a ton of research about this and your understanding of the economics is just not right. coasean islands...
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Jun 4, 2019 16:45
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it's a mild poke in the ribs of the people who tend to emphasize millions of individual self-interested agents, because R. Coase, who wrote The Problem of Social Cost, also wrote The Nature of the Firm, which wonderfully describes firms as "Islands of conscious power in this ocean of unconscious co-operation like lumps of butter coagulating in a pail of buttermilk." (which is actually a quote itself, but Coase is the better-known name) the intuition is that millions of self-interested agents face substantial costs interacting with each other, and so form numerous little bureaucracies that centrally coordinate themselves, and these bureaucracies seem to do generally o.k. One should instead weigh exit vs voice re: efficiency (or, oh, fine, contestable markets), and perhaps any other number of aspects of industrial organization as well - adverse selection, etc. All considerations particularly relevant to firms of at least one person hiring at least one more person... we live in liberal capitalist democratic regulatory welfare states and the middle word there plays a large role in our regular lives; every industry, even relatively freewheeling unregulated ones, still has people who can characterize and describe its dynamics - to decide how to interact with it, if nothing else. Hayek's pencils are overrated, esp in the short term ronya fucked around with this message at 17:38 on Jun 4, 2019 |
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Jun 4, 2019 17:11
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from a planning perspective, we are all moving toward healthcare as a commodity, even if that commodity is labelled "quality-adjusted life years" and it's a this neoliberalism is not content-free - it means, e.g., one is not going to see national mass callisthenics or other deeply-involving shared lifestyle/cultural touchstones oriented/rationalized in public health terms, that one is not drafting/conscripting doctors and other medical staff as national manpower mobilization, etc. Predominantly people still choose lifestyles and careers, hence the inbuilt liberalism, and for all of the challenges from the left and right today, this doesn't seem under much contest in the developed world for the vast majority of people. The part where the gosplan assigns you a career was never the most popular part of socialism for the intelligentsia (for minority demographics there will be plenty of interesting times of course but that's always the case) ronya fucked around with this message at 18:43 on Jun 4, 2019 |
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Jun 4, 2019 18:35
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Ardennes posted:Honestly, it is very difficult to get your actual argument from want you wrote, besides the world is becoming more liberalized. I am not being hostile, but that is just a word salad. sorry yes that was peak "ronya idly sketches verbal diarrhoea into a post" er OK so relative to the grand scheme of radical approaches to healthcare in the 20th century, the span of national healthcare policies in the first world is pretty narrow - all developed countries perform some kind of technocratic quantitative assessments of aggregate outcomes, tweak similar levers of spending, approved coverage, and incentives in order to nudge decisionmaking by devolved bodies subject to some mix of competitive pressure (exit) and public consultation (voice) across some measure which is reckoned to be 1) quantified reasonably objectively, 2) partitionable into coherent chunks, and 3) substitutable between different kinds of healthcare or non-healthcare objectives along that one quantitative metric (that is to say, three characteristics of being a commodity). We do not have, e.g., conscript medical service, mandatory physical exercise (outside of conscription in a handful of countries) or otherwise mass movement campaigns, deprofessionalized healthcare (barefoot doctors a la Mao &c). We do not assign people to medical school, or not to medical school, and then to some distant rural village for their lifetime of patriotic service, on theoretical pain of imprisonment for defaulting (which the Soviets and the Chinese both did, although the penalties or enforcement certainly varied much over time). We do not have mass deliberation to identify a public health concern and then engage in mass action to root it out. &c &c so when we talk about commoditization and the neoliberal/technocratic outlook, we are focusing on what is, even relative to actually-existing historical alternatives, quite a narrow span of being slightly more commoditized or slightly less commoditized as a side effect of political winds that are not especially about commoditization, and the key aspects of what it means to be a commodity all remain salient. What is actually under debate is not the experience of healthcare for "most people", which remains largely the same in the span of alternatives, but the panoply of edge cases. Hence both the radical knowledge problem and radical decommoditification are not salient.
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Jun 5, 2019 05:59
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Barrels of oil are an actual commodity without dispute (I hope) and you can't just run out there and buy one like a loaf of bread in the grocers; they're subject to intense transport and logistical requirements, both regulatory and de facto. The oil sits happily in a silo and does not much move or change form in its relationship to the means of production, whilst its ownership, and derivatives on its ownership, might change hands many times between stakeholders. It might not even change actual ownership much (e.g. commodity fund buys a chunk of it, and then it is the derived ownership in the fund that flies through the ledger). Shuffling the labels so that the main derivative is sovereign debt, and whereby the decisions within the going concern are premised on separable tradeoffs subject to constraints, or binding agreements between subordinate departments, doesn't seem to me to be a change in nature. And in practice national healthcare delivery is devolved to a level far below even that, and devolved entities have some discretion on the disposal of their grants, and they mainly use this discretion as a market agent: making tradeoffs subject to budgetary constraints. Although the Soviet system in the Stalin period nominally avoided the concept of rate of return, interest rates, etc., the mandate to plan resources efficiently eventually innovated a concept of a "payoff period", because the social planner still has to decide how to deploy productive and scarce capital over time, and the payoff period measured the time duration for a given investment project to recover its inputs. This figure is not denominated in money and so avoided any capitalist taint, but mathematically it's just the inverse of an interest rate! (see also: LV Kantorivich's work in Soviet planning). There is no deep difference between a market and a shadow market if all of the participants, in the ideology of the day, go on to formulate prices or shadow prices respectively, and justify their decisions by appealing to these tradeoffs. The outcome is going to be, more or less, a market in a thing experienced and consumed as an alienated commodity; the underlying political struggle is about pecuniary externalities and allocations instead. ronya fucked around with this message at 08:19 on Jun 5, 2019 |
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Jun 5, 2019 08:09
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