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Parasites always expand as far as possible without actually killing the host. I'm an administrator and I'm here to help. There is actually a symbiosis between

Parasites always expand as far as possible without actually killing the host. I'm an administrator and I'm here to help. There is actually a symbiosis between the government administrators creating more and more regulations, and the healthcare administrators who implement them. There are also self-reinforcing effects in licensing professions, which demand more qualifications, feeding the vocational training industry. Same in finance, with Dodd-Frank, AML and KYC (all justified by fake 'wars on terror' and 'war on drugs'). It is an infestation of the western world. Social democracy is a self-reinforcing doom loop of bureaucrats and welfare recipients voting for more bureaucracy and handouts. Overheads and taxes expand to crush productivity, but not quite enough to kill it. Whatever happened to small government and small bureaucracies? Time to invent some antiadminotics, but then they will eventually develop resistance.

craftyguy 8y ago
> Whatever happened to small government and small bureaucracies? It doesn't protect citizens against wrong-doing by for-profit companies, hence the regulation. There was a time when the medical field was largely unregulated[0], and it was a dangerous/misleading time. Snake oil, anyone? 0. https://www.webmd.com/a-to-z-guides/features/look-back-old-time-medicines https://www.webmd.com/a-to-z-guides/features/look-back-old-t...
- CodeCube 8y ago
  This is it right here. I can be convinced to be somewhat sympathetic to the view of excessive regulation, and ineffective bureaucracy ... however, I certainly can't be convinced that it's wholesale not necessary. Bad actors can and will take advantage of people, and it needs to be reigned in by "something". I refuse to believe that we can't achieve a balance ... when there's too little regulation, add more. When it becomes too onerous, pare it back. The thing that seems to be missing is that balancing force. The body's immune system is important for regulating and protecting bodily functions, however when things go wrong, they go very wrong (auto-immune diseases, etc); I feel like that's where we are right now.
  - mrguyorama 8y ago
    >When it becomes too onerous, pare it back Unfortunately one man's onerous is another's not enough when it comes to regulation, and seemingly due to ideology, not rationality.
    - Retric 8y ago
      Worse, well done regulation makes problems go away. Which makes it seem like they are not needed. Consider those mattress tags which actually saved hundred of thousands of lives, but now seem pointless. We could probably get rid of them and nothing bad would happen for decades, but the risk is higher than you might think.
      - null000 8y ago
        Link for the interested https://www.livescience.com/33039-why-do-mattresses-have-do-not-remove-tags.html https://www.livescience.com/33039-why-do-mattresses-have-do-...
    - flowerbeater 8y ago
      Exactly. It's also due to our inability to give straight up answers to questions like, What is the value of a human life? How does that value vary depending on age? What is the worth of an extra month of life? How should we decide where limited medical resources go? Without straight answers to these, every bad story becomes a mob outcry for more regulation.
      - moorhosj 8y ago
        Why would we care about the answers to these questions other than for regulation?
    - da_chicken 8y ago
      At the end of the day "rationality" and "ideology" are more or less synonymous. Few individuals believe their ideology is irrational, after all, and all "rational" really means is, "that which is most consistent with everything else I believe to be true."
- User23 8y ago
  Regulation also doesn’t protect citizens against wrongdoing because of regulatory capture. What actually does protect citizens from corporate wrongdoing is the law of torts. Unsurprisingly corporate lawyers and lobbyists are big fans of tort “reform.”
  - sharemywin 8y ago
    You think the only part of government that can't be captured is the executive? Obviously, the legislative and judicial system can be captured. And, the first step is to convince the populace that the only solution is non governmental. That run-amok capitalism is inevitable. That all politicians are crooks. That voting/change is a waste of time.
    - User23 8y ago
      It’s much harder to capture the court system because it is so much more distributed than administrative regulators. Also judges are much less likely to retire in 4 years to work for the people they judged. Regulators routinely retire to work for those they regulated. For example it’s the courts that are reining in Monsanto. Regulators didn’t care a whit about the harm they caused. Big tobacco is another example. the list goes on and on.
      - kevin_thibedeau 8y ago
        The East Texas judges did a great job enriching their community by showing off their rubber stamp to patent litigants.
        User23 8y ago
        For a while, but a stop was put to it. Look, this isn't that hard. I'm not saying any branch of government isn't corruptible, we're all smart people here and we know that any human organization can be manipulated. But that doesn't change the fact that it's observably true that centralized power structures, like administrative regulation, are much more easily captured than distributed ones. This is basic civics, but sadly that isn't taught anymore. Even so I shouldn't have to tell anyone here why distributed systems are more fault tolerant and robust than centralized ones!
- erentz 8y ago
  The strongly libertarian/anti-regulation folks really don’t seem to have an answer for this. And it’s where thier whole philosophy falls down because it so fundamentally ignores human behavior so it’ll never work. Sure, imagine you could just pull a trigger and one day remove all regulations. Then see what happens. Buildings will collapse, people will organize to require building standards. Quacks will kill patients. People will organize to require testing of drugs. It’ll all just build up again. Rules (however you want to define and manage them) exist everywhere, they’re an unavoidable consequence of society. I think the strongly libertarians/anti-regulation folks need to come up with solutions to over regulation, bad regulation, regulatory capture, etc that work within a realistic understanding that humans are humans. Then they might get somewhere, propose some changes that help everyone in the process. (Though I sometimes think there’s a contradiction there that if you do understand other humans you don’t tend to end up so far down the libertarian scale in the first place)
  - InitialLastName 8y ago
    > Though I sometimes think there’s a contradiction there that if you do understand other humans you don’t tend to end up so far down the libertarian scale in the first place I've started to come to the conclusion that anyone who studies economics, systems, and political science more than they study psychology, sociology, and history is at dire risk of becoming a libertarian.
    - logfromblammo 8y ago
      If you think you might be becoming a libertarian, just do a video search for "Chinese escalator", and cling as hard as you can to the necessity of building codes, regular inspections, insurance underwriting, and civil torts.
      - InitialLastName 8y ago
        I'll never be a libertarian; I think it's too important that humans have the ability to live their lives with dignity, and I'm fully aware of how infrequently that happens when government is limited.
- specialist 8y ago
  I assume the genesis of every regulation is either a) some moron couldn't color within the lines or b) some player wants to ice out competitors.
core-questions 8y ago
Also known as "rent seeking" behaviour. Administrators who are successful in their careers are those who are ambitious about moving up, which requires continual expansion of the departments and work that they oversee. They want more budget to hire more people, they want more work to justify the budget, they produce no wealth and generally just collect rent off of everyone subjected to their administrative powers. > There are also self-reinforcing effects in licensing professions, which demand more qualifications, feeding the vocational training industry. Same in finance, with Dodd-Frank, AML and KYC (all justified by fake 'wars on terror' and 'war on drugs'). Call me a conspiracy theorist, but I believe accounting is one such discipline. 90% of it could have been automated out of existence decades ago - the CPA industry exists to ensure the continuation of the employment of the people in the industry by artificially making the whole thing more complicated than it has any reason to be.
- tim333 8y ago
  Complexity in accounting is mostly down to tax laws which politicians seem to enjoy complicating without needing to be nudged by the accountants.
  - felix_nagaand 8y ago
    If taxes were simple the IRS could be just a few engineers, a couple advisors mgmt, and a warehouse of servers.
- akanet 8y ago
  I think you are mistaken about CPAs and accounting. For one, they cost relatively little, and two, they perform actually a pretty substantial task. It's very difficult to tie spend together end-to-end through a company automatically. Tooling for CFOs is getting better, but we are nowhere near this being something that can be done completely automatically. There are some nascent SaaS platforms like Bench and Pilot that provide bookkeeping services augmented by some computer automation, but a human usually has to supervise, still.
lliamander 8y ago
The Surgery Center of Oklahoma has managed to do with almost no administrative staff[0] and have considerably lower than typical costs. One of the founders commented[1] on the cost disease article linked elsewhere in this discussion and noted that, while they've had their struggles with the government regulators, the state government has actually provided them with some cover. This is in large part because it saves the state a boat-load of money to send their employees there for medical treatment. [0] https://reason.com/reasontv/2012/11/15/the-obamacare-revolt-oklahoma-doctors-fi https://reason.com/reasontv/2012/11/15/the-obamacare-revolt-... [1] http://slatestarcodex.com/2018/06/20/cost-disease-in-medicine-the-practical-perspective/#comment-640948 http://slatestarcodex.com/2018/06/20/cost-disease-in-medicin...
dv_dt 8y ago
When you look at the costs between US and European healthcare, the difference isn't in gov't regulation. In the US each private healthcare company creates it's on medical billing codes and private health providers each need to employ specialists to decipher the codes of each insurer. In europe, governments generally regulate costs (and indirectly provide unified medical billing codes), and a variety of public/private entities all use the same codes... The "amount" of regulation is mostly a red herring. One needs the right regulation.
- dragonwriter 8y ago
  > In the US each private healthcare company creates it's on medical billing codes In the US all public and private insurers are required by law (HIPAA) to use a specified sst of standard billing transaction formats and code sets. Well, at least if they do billing electronically, as virtually all of them do.
  - dv_dt 8y ago
    So they at least have a common language of sorts on what is being done, but not how much it costs nor if it's covered or accepted. https://en.wikipedia.org/wiki/Healthcare_Common_Procedure_Coding_System https://en.wikipedia.org/wiki/Healthcare_Common_Procedure_Co... Implemented in 1996, but had a Level 3 for "local" interpretation, only disallowed in at the end of 2003 with electronic records only required in 2012 under the ACA... so I think the US is still making it's way to "standard".
  - specialist 8y ago
    By analogy, like with most standards, those formats and codes are syntax, the semantics are continuously debated.
    - dragonwriter 8y ago
      The mandated standard code sets are actually mappings of code values to prescribed meanings, so they are in fact prescribed semantics and not just bare syntax. Likewise the mandatory transaction standards prescribe semantics and not just syntax.
umvi 8y ago
> Parasites always expand as far as possible without actually killing the host. Another way of stating the Shirky Principle[1]: > Institutions will try to preserve the problem to which they are the solution. [1]: https://kk.org/thetechnium/the-shirky-prin/ https://kk.org/thetechnium/the-shirky-prin/
specialist 8y ago
"government administrators creating more and more regulations" David Graeber makes the compelling case that corporations begat bureaucracy, which then metastasizes into government. The Utopia of Rules: On Technology, Stupidity, and the Secret Joys of Bureaucracy http://a.co/ih4ixmv http://a.co/ih4ixmv Comparing the medical loss ratios of public vs private, single payer systems like Medicare vs private guarantors, seems to support Graeber's thesis. Anecdotally, providers claim their overhead dealing with government is less than dealing with private insurance. I'd like to find some comparative studies. TL;DR: Overhead in healthcare administration is driven by private insurers.

craftyguy 8y ago

> Whatever happened to small government and small bureaucracies? It doesn't protect citizens against wrong-doing by for-profit companies, hence the regulation. There was a time when the medical field was largely unregulated[0], and it was a dangerous/misleading time. Snake oil, anyone? 0. https://www.webmd.com/a-to-z-guides/features/look-back-old-time-medicines https://www.webmd.com/a-to-z-guides/features/look-back-old-t...

CodeCube 8y ago
This is it right here. I can be convinced to be somewhat sympathetic to the view of excessive regulation, and ineffective bureaucracy ... however, I certainly can't be convinced that it's wholesale not necessary. Bad actors can and will take advantage of people, and it needs to be reigned in by "something". I refuse to believe that we can't achieve a balance ... when there's too little regulation, add more. When it becomes too onerous, pare it back. The thing that seems to be missing is that balancing force. The body's immune system is important for regulating and protecting bodily functions, however when things go wrong, they go very wrong (auto-immune diseases, etc); I feel like that's where we are right now.
- mrguyorama 8y ago
  >When it becomes too onerous, pare it back Unfortunately one man's onerous is another's not enough when it comes to regulation, and seemingly due to ideology, not rationality.
  - Retric 8y ago
    Worse, well done regulation makes problems go away. Which makes it seem like they are not needed. Consider those mattress tags which actually saved hundred of thousands of lives, but now seem pointless. We could probably get rid of them and nothing bad would happen for decades, but the risk is higher than you might think.
    - null000 8y ago
      Link for the interested https://www.livescience.com/33039-why-do-mattresses-have-do-not-remove-tags.html https://www.livescience.com/33039-why-do-mattresses-have-do-...
  - flowerbeater 8y ago
    Exactly. It's also due to our inability to give straight up answers to questions like, What is the value of a human life? How does that value vary depending on age? What is the worth of an extra month of life? How should we decide where limited medical resources go? Without straight answers to these, every bad story becomes a mob outcry for more regulation.
    - moorhosj 8y ago
      Why would we care about the answers to these questions other than for regulation?
  - da_chicken 8y ago
    At the end of the day "rationality" and "ideology" are more or less synonymous. Few individuals believe their ideology is irrational, after all, and all "rational" really means is, "that which is most consistent with everything else I believe to be true."
User23 8y ago
Regulation also doesn’t protect citizens against wrongdoing because of regulatory capture. What actually does protect citizens from corporate wrongdoing is the law of torts. Unsurprisingly corporate lawyers and lobbyists are big fans of tort “reform.”
- sharemywin 8y ago
  You think the only part of government that can't be captured is the executive? Obviously, the legislative and judicial system can be captured. And, the first step is to convince the populace that the only solution is non governmental. That run-amok capitalism is inevitable. That all politicians are crooks. That voting/change is a waste of time.
  - User23 8y ago
    It’s much harder to capture the court system because it is so much more distributed than administrative regulators. Also judges are much less likely to retire in 4 years to work for the people they judged. Regulators routinely retire to work for those they regulated. For example it’s the courts that are reining in Monsanto. Regulators didn’t care a whit about the harm they caused. Big tobacco is another example. the list goes on and on.
    - kevin_thibedeau 8y ago
      The East Texas judges did a great job enriching their community by showing off their rubber stamp to patent litigants.
      - User23 8y ago
        For a while, but a stop was put to it. Look, this isn't that hard. I'm not saying any branch of government isn't corruptible, we're all smart people here and we know that any human organization can be manipulated. But that doesn't change the fact that it's observably true that centralized power structures, like administrative regulation, are much more easily captured than distributed ones. This is basic civics, but sadly that isn't taught anymore. Even so I shouldn't have to tell anyone here why distributed systems are more fault tolerant and robust than centralized ones!
erentz 8y ago
The strongly libertarian/anti-regulation folks really don’t seem to have an answer for this. And it’s where thier whole philosophy falls down because it so fundamentally ignores human behavior so it’ll never work. Sure, imagine you could just pull a trigger and one day remove all regulations. Then see what happens. Buildings will collapse, people will organize to require building standards. Quacks will kill patients. People will organize to require testing of drugs. It’ll all just build up again. Rules (however you want to define and manage them) exist everywhere, they’re an unavoidable consequence of society. I think the strongly libertarians/anti-regulation folks need to come up with solutions to over regulation, bad regulation, regulatory capture, etc that work within a realistic understanding that humans are humans. Then they might get somewhere, propose some changes that help everyone in the process. (Though I sometimes think there’s a contradiction there that if you do understand other humans you don’t tend to end up so far down the libertarian scale in the first place)
- InitialLastName 8y ago
  > Though I sometimes think there’s a contradiction there that if you do understand other humans you don’t tend to end up so far down the libertarian scale in the first place I've started to come to the conclusion that anyone who studies economics, systems, and political science more than they study psychology, sociology, and history is at dire risk of becoming a libertarian.
  - logfromblammo 8y ago
    If you think you might be becoming a libertarian, just do a video search for "Chinese escalator", and cling as hard as you can to the necessity of building codes, regular inspections, insurance underwriting, and civil torts.
    - InitialLastName 8y ago
      I'll never be a libertarian; I think it's too important that humans have the ability to live their lives with dignity, and I'm fully aware of how infrequently that happens when government is limited.
specialist 8y ago
I assume the genesis of every regulation is either a) some moron couldn't color within the lines or b) some player wants to ice out competitors.

core-questions 8y ago

Also known as "rent seeking" behaviour. Administrators who are successful in their careers are those who are ambitious about moving up, which requires continual expansion of the departments and work that they oversee. They want more budget to hire more people, they want more work to justify the budget, they produce no wealth and generally just collect rent off of everyone subjected to their administrative powers. > There are also self-reinforcing effects in licensing professions, which demand more qualifications, feeding the vocational training industry. Same in finance, with Dodd-Frank, AML and KYC (all justified by fake 'wars on terror' and 'war on drugs'). Call me a conspiracy theorist, but I believe accounting is one such discipline. 90% of it could have been automated out of existence decades ago - the CPA industry exists to ensure the continuation of the employment of the people in the industry by artificially making the whole thing more complicated than it has any reason to be.

tim333 8y ago
Complexity in accounting is mostly down to tax laws which politicians seem to enjoy complicating without needing to be nudged by the accountants.
- felix_nagaand 8y ago
  If taxes were simple the IRS could be just a few engineers, a couple advisors mgmt, and a warehouse of servers.
akanet 8y ago
I think you are mistaken about CPAs and accounting. For one, they cost relatively little, and two, they perform actually a pretty substantial task. It's very difficult to tie spend together end-to-end through a company automatically. Tooling for CFOs is getting better, but we are nowhere near this being something that can be done completely automatically. There are some nascent SaaS platforms like Bench and Pilot that provide bookkeeping services augmented by some computer automation, but a human usually has to supervise, still.

lliamander 8y ago

The Surgery Center of Oklahoma has managed to do with almost no administrative staff[0] and have considerably lower than typical costs. One of the founders commented[1] on the cost disease article linked elsewhere in this discussion and noted that, while they've had their struggles with the government regulators, the state government has actually provided them with some cover. This is in large part because it saves the state a boat-load of money to send their employees there for medical treatment. [0] https://reason.com/reasontv/2012/11/15/the-obamacare-revolt-oklahoma-doctors-fi https://reason.com/reasontv/2012/11/15/the-obamacare-revolt-... [1] http://slatestarcodex.com/2018/06/20/cost-disease-in-medicine-the-practical-perspective/#comment-640948 http://slatestarcodex.com/2018/06/20/cost-disease-in-medicin...

dv_dt 8y ago

When you look at the costs between US and European healthcare, the difference isn't in gov't regulation. In the US each private healthcare company creates it's on medical billing codes and private health providers each need to employ specialists to decipher the codes of each insurer. In europe, governments generally regulate costs (and indirectly provide unified medical billing codes), and a variety of public/private entities all use the same codes... The "amount" of regulation is mostly a red herring. One needs the right regulation.

dragonwriter 8y ago
> In the US each private healthcare company creates it's on medical billing codes In the US all public and private insurers are required by law (HIPAA) to use a specified sst of standard billing transaction formats and code sets. Well, at least if they do billing electronically, as virtually all of them do.
- dv_dt 8y ago
  So they at least have a common language of sorts on what is being done, but not how much it costs nor if it's covered or accepted. https://en.wikipedia.org/wiki/Healthcare_Common_Procedure_Coding_System https://en.wikipedia.org/wiki/Healthcare_Common_Procedure_Co... Implemented in 1996, but had a Level 3 for "local" interpretation, only disallowed in at the end of 2003 with electronic records only required in 2012 under the ACA... so I think the US is still making it's way to "standard".
- specialist 8y ago
  By analogy, like with most standards, those formats and codes are syntax, the semantics are continuously debated.
  - dragonwriter 8y ago
    The mandated standard code sets are actually mappings of code values to prescribed meanings, so they are in fact prescribed semantics and not just bare syntax. Likewise the mandatory transaction standards prescribe semantics and not just syntax.

umvi 8y ago

> Parasites always expand as far as possible without actually killing the host. Another way of stating the Shirky Principle[1]: > Institutions will try to preserve the problem to which they are the solution. [1]: https://kk.org/thetechnium/the-shirky-prin/ https://kk.org/thetechnium/the-shirky-prin/

specialist 8y ago

"government administrators creating more and more regulations" David Graeber makes the compelling case that corporations begat bureaucracy, which then metastasizes into government. The Utopia of Rules: On Technology, Stupidity, and the Secret Joys of Bureaucracy http://a.co/ih4ixmv http://a.co/ih4ixmv Comparing the medical loss ratios of public vs private, single payer systems like Medicare vs private guarantors, seems to support Graeber's thesis. Anecdotally, providers claim their overhead dealing with government is less than dealing with private insurance. I'd like to find some comparative studies. TL;DR: Overhead in healthcare administration is driven by private insurers.