4 ms·

That's a sycophantic way of framing market-dominated thinking, yes, but as other users have pointed out, market thinking having _primacy_ in society has downsid

That's a sycophantic way of framing market-dominated thinking, yes, but as other users have pointed out, market thinking having _primacy_ in society has downsides. Large downsides, in my opinion. Markets are a tool in service of humanity, but market dominated thinking abounds and we get this tweeted with a straight face by think-tank people: > I still believe in markets. Markets do not fail us. We fail markets. 1. https://twitter.com/AmityShlaes/status/1315793783951327234 https://twitter.com/AmityShlaes/status/1315793783951327234 Edit: I thought I recognised your username, and bet that you're the most upvoted user that's replied to me on this site. If you've written about your time on this site and how you got started on it, I'd be interested to read it.

WalterBright 6y ago
For a topical example, take the covid vaccine distribution system. It is done by the government, and has fared poorly in the US and Europe. The excuses are variations on "the states don't know how to set up a distribution system". But we already have a distribution system for vaccines. Where did you get your last flu shot? The local drug store, a market based system. I see the government busy trying to reproduce overnight an efficient, working system that's already there sitting idle. Of course they'll fail. I phoned my local drug store and asked if I can make an appointment for a covid vaccination. They replied they have no idea when or if they'd ever get any vaccination supply. Meanwhile, the state says they have a severe lack of people who can give vaccinations. (I know where they are hiding, they're behind the counter at your local pharmacy.) The solution is simple and stupidly obvious. Distribute vaccines to the zillion pharmacies, and pay them per vaccination in arm. They're not going to waste any time vaccinating people.
- iguy 6y ago
  There's a lot of truth in this, but one catch is that the "zillion pharmacies" aren't set up for -70C storage. Although delivering each of them a small box of vaccine to be injected that same day sounds like a problem for which we also have well-established solutions... they're just busy delivering hamburgers.
  - WalterBright 6y ago
    Dry ice is -78C and is routinely used for shipping. Amazon is good at shipping me my orders in one day, I doubt they'd have any problem shipping daily boxes of vaccines to every pharmacy in the country. I seriously do not see why the wheel has to be reinvented here.
    - iguy 6y ago
      Dry ice is indeed routine, but I think usually used to ship things which need to stay below -10C, not below -60C. So there has been some work in figuring out better shipping boxes, tracking devices, procedures for breaking down large shipments at the airport, etc. But the layer of guys driving trucks around town is of course the same.
      - WalterBright 6y ago
        I'd just call up Jeff Bezos and let him figure it out. He's the best guy in the world at effective and efficient distribution.
- DanBC 6y ago
  > take the covid vaccine distribution system. It is done by the government, and has fared poorly in the US and Europe. I live in the UK. I compare the vaccination distribution (run by the NHS and Public Health) and the Test and Trace system (contracted out at huge expense) and I see that private provision fucked it up. For vaccination we've don over 5% of the population, over 4 million people, have received at least one dose and it's working well although there is tension between vaccinating the most at risk (old people and people living in poverty) vs people at lower risk. For test and trace, well, read this: https://committees.parliament.uk/work/906/covid19-test-track-and-trace-part-1/ https://committees.parliament.uk/work/906/covid19-test-track... ---begin quote--- Contracts worth £7 billion have been signed with 217 public and private organisations to provide supplies, services and infrastructure, including test laboratories and call handlers for tracing. NHST&T has plans to sign a further 154 contracts, worth £16.2 billion, by March 2021. In total, 70% of early contracts by value were directly awarded without competition under emergency measures that were in use across government. International comparisons show that outsourcing is a part of many testing systems but is unusual for tracing. A range of stakeholders have queried why the government did not involve local authorities more in its initial approach to tracing, given their previous experience in this area. The government did not document with a business case the basis for the delivery model it initially chose until September. A target to provide results within 24 hours of in-person testing in the community has not been met. Turnaround within 24 hours peaked in June at 93% but subsequently deteriorated to reach a low of 14% in mid-October before rising to 38% in early November. NHST&T did not plan for the sharp rise in testing demand in September when schools and universities reopened. Laboratories processing community swab tests were unable to keep pace with the volume of tests and experienced large backlogs, which meant NHST&T had to limit the number of tests available and commission extra help from other laboratories. Rationing of tests meant some people were told to visit test sites hundreds of miles away. It is important to get hold of people with COVID-19 or who might have been exposed to it quickly so they can self-isolate, but the service saw increases in the time taken to reach people between May and mid-October, before improvements in the last two weeks of October. At times, parts of the national tracing service have barely been used: in May, DHSC signed contracts for the provision of 3,000 health professionals and 18,000 call handlers. The call handler contracts were worth up to £720 million. By 17 June, the utilisation rate (the proportion of time that someone actively worked during their paid hours) was low for both health professional (4%) and call handler staff (1%), indicating that they had little work to do. This means substantial public resources have been spent on staff who provided minimal services in return. National and local government have tried to increase public engagement with tracing, but surveys suggest that the proportion of contacts fully complying with requests to self-isolate might range from 10% to 59%. NHST&T acknowledges that non-compliance poses a key risk to its success and has taken steps to increase levels of self-isolation, for example by making follow-up calls to people while they are self-isolating. For as long as compliance is low, the cost-effectiveness of NHST&T’s activities will inevitably be in doubt.
- kwhitefoot 6y ago
  Here in Norway as of today we have distributed 65 k doses and administered 48 k firstly to the elderly who are in care homes, then to the over 75s in ad-hoc vaccination centres. That's 0.91% of the population vaccinated so far (first dose). There aren't many more doses available so distributing them to pharmacies would not accelerate the process very much if at all. The rate at which the vaccines are being administered is getting faster all the time. Once the vaccine starts arriving in the country in greater quantities they will start distributing them to local doctors. As for making an appointment; here in Norway people will be notified by the local authority when they can get it. Doses are being dealt out in age groups, oldest first plus those especially at risk.
  - WalterBright 6y ago
    The relevant metric is the ratio of doses the government has on hand vs the the number administered. Here in WA state, only one third of the doses delivered have been administered. Heck, Amazon is headquartered here. If I was the governor, I'd have gotten Jeff Bezos on the horn 6 weeks ago with "halp!" I bet Amazon would love to help out, they'd make some money and it'd be great PR.
    - WalterBright 6y ago
      Looks like Amazon is taking the lead! https://www.reuters.com/article/us-amazon-com-vaccine/amazon-offers-to-help-u-s-with-vaccine-efforts-in-letter-to-president-biden-idUSKBN29P2KO https://www.reuters.com/article/us-amazon-com-vaccine/amazon...
    - kwhitefoot 6y ago
      > n WA state, only one third of the doses delivered have been administered. Good grief! Norway is slower than neighbouring countries because we have a decentralised health system because we have such a scattered population and the health service has decided to use the existing infrastructure rather than try to create a new more centralised system on the fly. In addition a substantial fraction of the doses are held back to ensure that all those who have had one dose will get the second within a reasonable time. The average is about half of the distributed doses have been administered But pretty much all European health systems are performing faster than your example and they are pretty much all using the existing public health system. At least here, Norway, there seems to be no evidence that involving private actors would do any better. In the UK they have vaccinated (first dose) 8.5% of the population just using the NHS. The US doesn't seem that far behind on average with 5.7%. Norway is 1.4% And also surely adding more organizations to the existing system risks running into a version of Brook's law: Adding manpower to a late software project makes it later.

WalterBright 6y ago

For a topical example, take the covid vaccine distribution system. It is done by the government, and has fared poorly in the US and Europe. The excuses are variations on "the states don't know how to set up a distribution system". But we already have a distribution system for vaccines. Where did you get your last flu shot? The local drug store, a market based system. I see the government busy trying to reproduce overnight an efficient, working system that's already there sitting idle. Of course they'll fail. I phoned my local drug store and asked if I can make an appointment for a covid vaccination. They replied they have no idea when or if they'd ever get any vaccination supply. Meanwhile, the state says they have a severe lack of people who can give vaccinations. (I know where they are hiding, they're behind the counter at your local pharmacy.) The solution is simple and stupidly obvious. Distribute vaccines to the zillion pharmacies, and pay them per vaccination in arm. They're not going to waste any time vaccinating people.

iguy 6y ago
There's a lot of truth in this, but one catch is that the "zillion pharmacies" aren't set up for -70C storage. Although delivering each of them a small box of vaccine to be injected that same day sounds like a problem for which we also have well-established solutions... they're just busy delivering hamburgers.
- WalterBright 6y ago
  Dry ice is -78C and is routinely used for shipping. Amazon is good at shipping me my orders in one day, I doubt they'd have any problem shipping daily boxes of vaccines to every pharmacy in the country. I seriously do not see why the wheel has to be reinvented here.
  - iguy 6y ago
    Dry ice is indeed routine, but I think usually used to ship things which need to stay below -10C, not below -60C. So there has been some work in figuring out better shipping boxes, tracking devices, procedures for breaking down large shipments at the airport, etc. But the layer of guys driving trucks around town is of course the same.
    - WalterBright 6y ago
      I'd just call up Jeff Bezos and let him figure it out. He's the best guy in the world at effective and efficient distribution.
DanBC 6y ago
> take the covid vaccine distribution system. It is done by the government, and has fared poorly in the US and Europe. I live in the UK. I compare the vaccination distribution (run by the NHS and Public Health) and the Test and Trace system (contracted out at huge expense) and I see that private provision fucked it up. For vaccination we've don over 5% of the population, over 4 million people, have received at least one dose and it's working well although there is tension between vaccinating the most at risk (old people and people living in poverty) vs people at lower risk. For test and trace, well, read this: https://committees.parliament.uk/work/906/covid19-test-track-and-trace-part-1/ https://committees.parliament.uk/work/906/covid19-test-track... ---begin quote--- Contracts worth £7 billion have been signed with 217 public and private organisations to provide supplies, services and infrastructure, including test laboratories and call handlers for tracing. NHST&T has plans to sign a further 154 contracts, worth £16.2 billion, by March 2021. In total, 70% of early contracts by value were directly awarded without competition under emergency measures that were in use across government. International comparisons show that outsourcing is a part of many testing systems but is unusual for tracing. A range of stakeholders have queried why the government did not involve local authorities more in its initial approach to tracing, given their previous experience in this area. The government did not document with a business case the basis for the delivery model it initially chose until September. A target to provide results within 24 hours of in-person testing in the community has not been met. Turnaround within 24 hours peaked in June at 93% but subsequently deteriorated to reach a low of 14% in mid-October before rising to 38% in early November. NHST&T did not plan for the sharp rise in testing demand in September when schools and universities reopened. Laboratories processing community swab tests were unable to keep pace with the volume of tests and experienced large backlogs, which meant NHST&T had to limit the number of tests available and commission extra help from other laboratories. Rationing of tests meant some people were told to visit test sites hundreds of miles away. It is important to get hold of people with COVID-19 or who might have been exposed to it quickly so they can self-isolate, but the service saw increases in the time taken to reach people between May and mid-October, before improvements in the last two weeks of October. At times, parts of the national tracing service have barely been used: in May, DHSC signed contracts for the provision of 3,000 health professionals and 18,000 call handlers. The call handler contracts were worth up to £720 million. By 17 June, the utilisation rate (the proportion of time that someone actively worked during their paid hours) was low for both health professional (4%) and call handler staff (1%), indicating that they had little work to do. This means substantial public resources have been spent on staff who provided minimal services in return. National and local government have tried to increase public engagement with tracing, but surveys suggest that the proportion of contacts fully complying with requests to self-isolate might range from 10% to 59%. NHST&T acknowledges that non-compliance poses a key risk to its success and has taken steps to increase levels of self-isolation, for example by making follow-up calls to people while they are self-isolating. For as long as compliance is low, the cost-effectiveness of NHST&T’s activities will inevitably be in doubt.
kwhitefoot 6y ago
Here in Norway as of today we have distributed 65 k doses and administered 48 k firstly to the elderly who are in care homes, then to the over 75s in ad-hoc vaccination centres. That's 0.91% of the population vaccinated so far (first dose). There aren't many more doses available so distributing them to pharmacies would not accelerate the process very much if at all. The rate at which the vaccines are being administered is getting faster all the time. Once the vaccine starts arriving in the country in greater quantities they will start distributing them to local doctors. As for making an appointment; here in Norway people will be notified by the local authority when they can get it. Doses are being dealt out in age groups, oldest first plus those especially at risk.
- WalterBright 6y ago
  The relevant metric is the ratio of doses the government has on hand vs the the number administered. Here in WA state, only one third of the doses delivered have been administered. Heck, Amazon is headquartered here. If I was the governor, I'd have gotten Jeff Bezos on the horn 6 weeks ago with "halp!" I bet Amazon would love to help out, they'd make some money and it'd be great PR.
  - WalterBright 6y ago
    Looks like Amazon is taking the lead! https://www.reuters.com/article/us-amazon-com-vaccine/amazon-offers-to-help-u-s-with-vaccine-efforts-in-letter-to-president-biden-idUSKBN29P2KO https://www.reuters.com/article/us-amazon-com-vaccine/amazon...
  - kwhitefoot 6y ago
    > n WA state, only one third of the doses delivered have been administered. Good grief! Norway is slower than neighbouring countries because we have a decentralised health system because we have such a scattered population and the health service has decided to use the existing infrastructure rather than try to create a new more centralised system on the fly. In addition a substantial fraction of the doses are held back to ensure that all those who have had one dose will get the second within a reasonable time. The average is about half of the distributed doses have been administered But pretty much all European health systems are performing faster than your example and they are pretty much all using the existing public health system. At least here, Norway, there seems to be no evidence that involving private actors would do any better. In the UK they have vaccinated (first dose) 8.5% of the population just using the NHS. The US doesn't seem that far behind on average with 5.7%. Norway is 1.4% And also surely adding more organizations to the existing system risks running into a version of Brook's law: Adding manpower to a late software project makes it later.