8 ms·

Graeber in "Bullshit Jobs" quotes President Obama, but I can't find an independent source of the quote right now. To account for that persistence, Graeber quot

Graeber in "Bullshit Jobs" quotes President Obama, but I can't find an independent source of the quote right now. To account for that persistence, Graeber quotes President Barack Obama on the topic of privatized health care. “Everybody who supports single-payer health care says, ‘Look at all this money we would be saving from insurance and paperwork,’ ” the former President noted. “That represents one million, two million, three million jobs.” https://www.newyorker.com/books/under-review/the-bullshit-job-boom https://www.newyorker.com/books/under-review/the-bullshit-jo...

bunderbunder 8y ago
A more optimistic formulation would be that that represents millions of people who could be doing something a bit more generally useful than mastering the intricacies of the layers and layers of bureaucracy built up around medical billing. And probably wouldn't mind having a slightly less mind-numbing job themselves. Too bad the US is also epically bad at supporting people in career transitions.
- ethbro 8y ago
  The magnitude of the data systems migration is usually discounted as well. Insurance companies generally have atrocious IT (it's not their core competency) and consequently inflexible IT stacks. Elimination the layers and layers of bureaucracy also means change / rewritting all the places that's embedded in code. ... and the real kicker? Those changes have to happen on both sides of any party / counterparty transaction. While supporting a normal volume of work. Small example? ICD-10 code support https://www.cms.gov/Medicare/Coding/ICD10/index.html https://www.cms.gov/Medicare/Coding/ICD10/index.html
  - darawk 8y ago
    That's a capital cost though, not a marginal cost. Amortize it over the essentially infinite savings on a long enough time horizon and it's basically free.
    - ethbro 8y ago
      Assuming success. Which has a pretty atrocious probability from what I saw (see above reply).
  - bunderbunder 8y ago
    I think, though, that they would find a way to clean this all up toute de suite, if only they were given a proper incentive to do so. For example, if there were real competition in the marketplace (say, by moving to a system where most consumers go to actually shop around and choose their own health insurance company), I expect you'd find insurance companies start to streamline their own processes, both internal and external, more-or-less immediately.
    - ethbro 8y ago
      I think the issue there is risk. Specifically, what is the likelihood of success if I attempt to migrate / change / remove X system? I can't understate the complexity and intricacies. Imagine legally defining all possible medical transactions, then writing software thats compatible with those legal agreements, then running it, changing the agreements, and adding features over 50 years. While the systems being interacted with also mutate. And all of this being done haphazardly and uniquely because there's no one in control of the entire process (Medic-are/aid aside). I'm hard pressed to think of a messier computing system in aggregate. I'd guess even the financial system is more rigidly defined, has fewer players, and doesn't have to map with as high fidelity to real life. ACA provided a fair number of incentives and penalties, re: actual vs industry standard overhead. And it caused change, but there were a lot of failures.
    - mmt 8y ago
      Indeed, imagine a system where some providers are cash-only. They wouldn't even care about that ICD-10 stuff, let alone pay even the cost of entry for the proprietary coding system. Of course, I realize, that were an insured patient to use such a provider, that would shift the insurance claims burden onto the patient (much as is often the case PPO out-of-network claims today), but this could be a point of competition for would-be insurers under your proposed system.
      - ethbro 8y ago
        If a patient is cash-only, how would their electronic records be stored, if not ICD-* compatible?
  - LyndsySimon 8y ago
    > Insurance companies generally have atrocious IT (it's not their core competency) and consequently inflexible IT stacks. I've been working at startups in the healthcare industry for a few years now, and agree. It's not just insurance companies, either - hospitals are just as bad if not worse. It's even worse for hospitals that are affiliated with a University.
  - dragonwriter 8y ago
    > Insurance companies generally have atrocious IT And mandatory IT standards (e.g., those adopted under HIPAA) in the healthcare field are written almost entirely by insurance industry IT.
    - ethbro 8y ago
      Everyone gripes about HIPAA, but from where I sat, it was a pretty sane standard. Admittedly I wasn't in implementation. But it read a lot like an IETF RFC. "Covered entities shall implement network protection." "Covered entities shall not disclose PHI." Outcome-specified, implementation-agnostic. And then set penalties based on whether the breach was accidental / willful / limited / or ongoing.
      - dragonwriter 8y ago
        > Everyone gripes about HIPAA I am not griping about HIPAA. The quality of stone of the specific transaction standards developed by industry groups and adopted as mandatory in regulations implementing HIPAA, OTOH, are another story.
- jonhendry18 8y ago
  "A more optimistic formulation would be that that represents millions of people who could be doing something a bit more generally useful than mastering the intricacies of the layers and layers of bureaucracy built up around medical billing. And probably wouldn't mind having a slightly less mind-numbing job themselves." The same could be said of coal miners. And miners probably didn't take on school loans to learn their profession. It's easy to handwave retraining millions of workers, but it's not that simple, and the jobs have to exist.
philipkglass 8y ago
The source appears to be this 2006 article in The Nation: https://www.thenation.com/article/mr-obama-goes-washington/ https://www.thenation.com/article/mr-obama-goes-washington/ It's interesting that Obama's argument for protecting health insurance administration jobs precedes both his presidential campaign and the Great Recession. The whole article is a telling foreshadowing that future-President Obama was not going to be as progressive as progressives hoped (or as conservatives feared). It's also a painful reminder that propping up low-value or even negative-value activities to "preserve jobs" is a bipartisan sport.
- wahern 8y ago
  Obama and Hillary competed on their healthcare plans. Obama's plan was more favorable to existing interests. His argument was that Hillary's plan was too aggressive and would never make it through Congress, whereas a vote for him and his plan ensured successful passage of a reform package. From the article, "If I think we can achieve those same goals within the existing institutions, then I am going to try to do that, because I think it's going to be easier to do and less disruptive and less costly and less painful...." ... Obama is telling the truth--he's not opposed to structural changes at all. However, he appears to be interested in fighting only for those changes that fit within the existing boundaries of what's considered mainstream in Washington.... It was funny because Hillary spent years working behind the scenes with insurers and providers and had their [tepid] buy-in. It's not like her plan was particularly radical, and really Obama just tweaked her framework. But Obama moved right to out-flank Hillary, capturing more centrist votes in both the primary and the general. Despite GOP rants to the contrary, Obama spent most of administration to the right of mainstream Democrats. His policies were typically crafted to at least be tolerable to conservatives, but his sensibilities were wasted in the spiteful partisan political culture. It wasn't until his last 1 or 2 years in office that the Democratic leadership convinced him to start pushing policies demanded by the Democratic base (e.g. Dreamers, etc).
- jonhendry18 8y ago
  "It's also a painful reminder that propping up low-value or even negative-value activities to "preserve jobs" is a bipartisan sport." They have positive value to the people in those jobs, and losing those jobs is high negative value to them and their communities.
oh_sigh 8y ago
Propping up useless jobs is only unacceptable to some when it is blue-collar jobs in red states(eg steel and coal).
criddell 8y ago
Isn't Obama just arguing for a version of the broken windows fallacy?
- crpearce 8y ago
  If many people currently rely on breaking and repairing windows for their livelihood, a “stop breaking windows” type law has real negative consequences, unfortunately.
  - wu-ikkyu 8y ago
    Only in the extremely short term and only for those who are participating in the racket. It would be a great net gain for society.
    - phobosdeimos 8y ago
      The US is a democracy. The people in the racket vote. Its why democracies are oil tankers that can only change course slowly.
- greeneggs 8y ago
  Obama wasn't arguing for anything, he was just explaining the politics of why single payer would be difficult to get through Congress. (For better or worse, Obama was famously disconnected from writing "Obamacare" and left it to Congress.) As an explanation of the politics, Obama's quote—"That represents one million, two million, three million jobs"—is exactly right. Sen. Lieberman (Ind, Connecticut) killed the public option, allegedly because of the importance of the insurance industry to Connecticut.
phobosdeimos 8y ago
I was watching the Expanse tv show and they were talking about how half the population was on Basic Assistance. I am not sure if it will ever happen, especially not in America were work is sacred. But paying people not to have jobs seems like a good deal. Keeps them from fucking up and maybe they can do something productive for society like growing wine or teaching children in Bangladesh to read.
bnolsen 8y ago
And think of all the doctors who would be pissed off to become de facto slaves of the state. Of course they could get paid by catering to the rich who would pay them out of pocket...

bunderbunder 8y ago

A more optimistic formulation would be that that represents millions of people who could be doing something a bit more generally useful than mastering the intricacies of the layers and layers of bureaucracy built up around medical billing. And probably wouldn't mind having a slightly less mind-numbing job themselves. Too bad the US is also epically bad at supporting people in career transitions.

ethbro 8y ago
The magnitude of the data systems migration is usually discounted as well. Insurance companies generally have atrocious IT (it's not their core competency) and consequently inflexible IT stacks. Elimination the layers and layers of bureaucracy also means change / rewritting all the places that's embedded in code. ... and the real kicker? Those changes have to happen on both sides of any party / counterparty transaction. While supporting a normal volume of work. Small example? ICD-10 code support https://www.cms.gov/Medicare/Coding/ICD10/index.html https://www.cms.gov/Medicare/Coding/ICD10/index.html
- darawk 8y ago
  That's a capital cost though, not a marginal cost. Amortize it over the essentially infinite savings on a long enough time horizon and it's basically free.
  - ethbro 8y ago
    Assuming success. Which has a pretty atrocious probability from what I saw (see above reply).
- bunderbunder 8y ago
  I think, though, that they would find a way to clean this all up toute de suite, if only they were given a proper incentive to do so. For example, if there were real competition in the marketplace (say, by moving to a system where most consumers go to actually shop around and choose their own health insurance company), I expect you'd find insurance companies start to streamline their own processes, both internal and external, more-or-less immediately.
  - ethbro 8y ago
    I think the issue there is risk. Specifically, what is the likelihood of success if I attempt to migrate / change / remove X system? I can't understate the complexity and intricacies. Imagine legally defining all possible medical transactions, then writing software thats compatible with those legal agreements, then running it, changing the agreements, and adding features over 50 years. While the systems being interacted with also mutate. And all of this being done haphazardly and uniquely because there's no one in control of the entire process (Medic-are/aid aside). I'm hard pressed to think of a messier computing system in aggregate. I'd guess even the financial system is more rigidly defined, has fewer players, and doesn't have to map with as high fidelity to real life. ACA provided a fair number of incentives and penalties, re: actual vs industry standard overhead. And it caused change, but there were a lot of failures.
  - mmt 8y ago
    Indeed, imagine a system where some providers are cash-only. They wouldn't even care about that ICD-10 stuff, let alone pay even the cost of entry for the proprietary coding system. Of course, I realize, that were an insured patient to use such a provider, that would shift the insurance claims burden onto the patient (much as is often the case PPO out-of-network claims today), but this could be a point of competition for would-be insurers under your proposed system.
    - ethbro 8y ago
      If a patient is cash-only, how would their electronic records be stored, if not ICD-* compatible?
- LyndsySimon 8y ago
  > Insurance companies generally have atrocious IT (it's not their core competency) and consequently inflexible IT stacks. I've been working at startups in the healthcare industry for a few years now, and agree. It's not just insurance companies, either - hospitals are just as bad if not worse. It's even worse for hospitals that are affiliated with a University.
- dragonwriter 8y ago
  > Insurance companies generally have atrocious IT And mandatory IT standards (e.g., those adopted under HIPAA) in the healthcare field are written almost entirely by insurance industry IT.
  - ethbro 8y ago
    Everyone gripes about HIPAA, but from where I sat, it was a pretty sane standard. Admittedly I wasn't in implementation. But it read a lot like an IETF RFC. "Covered entities shall implement network protection." "Covered entities shall not disclose PHI." Outcome-specified, implementation-agnostic. And then set penalties based on whether the breach was accidental / willful / limited / or ongoing.
    - dragonwriter 8y ago
      > Everyone gripes about HIPAA I am not griping about HIPAA. The quality of stone of the specific transaction standards developed by industry groups and adopted as mandatory in regulations implementing HIPAA, OTOH, are another story.
jonhendry18 8y ago
"A more optimistic formulation would be that that represents millions of people who could be doing something a bit more generally useful than mastering the intricacies of the layers and layers of bureaucracy built up around medical billing. And probably wouldn't mind having a slightly less mind-numbing job themselves." The same could be said of coal miners. And miners probably didn't take on school loans to learn their profession. It's easy to handwave retraining millions of workers, but it's not that simple, and the jobs have to exist.

philipkglass 8y ago

The source appears to be this 2006 article in The Nation: https://www.thenation.com/article/mr-obama-goes-washington/ https://www.thenation.com/article/mr-obama-goes-washington/ It's interesting that Obama's argument for protecting health insurance administration jobs precedes both his presidential campaign and the Great Recession. The whole article is a telling foreshadowing that future-President Obama was not going to be as progressive as progressives hoped (or as conservatives feared). It's also a painful reminder that propping up low-value or even negative-value activities to "preserve jobs" is a bipartisan sport.

wahern 8y ago
Obama and Hillary competed on their healthcare plans. Obama's plan was more favorable to existing interests. His argument was that Hillary's plan was too aggressive and would never make it through Congress, whereas a vote for him and his plan ensured successful passage of a reform package. From the article, "If I think we can achieve those same goals within the existing institutions, then I am going to try to do that, because I think it's going to be easier to do and less disruptive and less costly and less painful...." ... Obama is telling the truth--he's not opposed to structural changes at all. However, he appears to be interested in fighting only for those changes that fit within the existing boundaries of what's considered mainstream in Washington.... It was funny because Hillary spent years working behind the scenes with insurers and providers and had their [tepid] buy-in. It's not like her plan was particularly radical, and really Obama just tweaked her framework. But Obama moved right to out-flank Hillary, capturing more centrist votes in both the primary and the general. Despite GOP rants to the contrary, Obama spent most of administration to the right of mainstream Democrats. His policies were typically crafted to at least be tolerable to conservatives, but his sensibilities were wasted in the spiteful partisan political culture. It wasn't until his last 1 or 2 years in office that the Democratic leadership convinced him to start pushing policies demanded by the Democratic base (e.g. Dreamers, etc).
jonhendry18 8y ago
"It's also a painful reminder that propping up low-value or even negative-value activities to "preserve jobs" is a bipartisan sport." They have positive value to the people in those jobs, and losing those jobs is high negative value to them and their communities.

oh_sigh 8y ago

Propping up useless jobs is only unacceptable to some when it is blue-collar jobs in red states(eg steel and coal).

criddell 8y ago

Isn't Obama just arguing for a version of the broken windows fallacy?

crpearce 8y ago
If many people currently rely on breaking and repairing windows for their livelihood, a “stop breaking windows” type law has real negative consequences, unfortunately.
- wu-ikkyu 8y ago
  Only in the extremely short term and only for those who are participating in the racket. It would be a great net gain for society.
  - phobosdeimos 8y ago
    The US is a democracy. The people in the racket vote. Its why democracies are oil tankers that can only change course slowly.
greeneggs 8y ago
Obama wasn't arguing for anything, he was just explaining the politics of why single payer would be difficult to get through Congress. (For better or worse, Obama was famously disconnected from writing "Obamacare" and left it to Congress.) As an explanation of the politics, Obama's quote—"That represents one million, two million, three million jobs"—is exactly right. Sen. Lieberman (Ind, Connecticut) killed the public option, allegedly because of the importance of the insurance industry to Connecticut.

phobosdeimos 8y ago

I was watching the Expanse tv show and they were talking about how half the population was on Basic Assistance. I am not sure if it will ever happen, especially not in America were work is sacred. But paying people not to have jobs seems like a good deal. Keeps them from fucking up and maybe they can do something productive for society like growing wine or teaching children in Bangladesh to read.

bnolsen 8y ago

And think of all the doctors who would be pissed off to become de facto slaves of the state. Of course they could get paid by catering to the rich who would pay them out of pocket...