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I think we can safely blame both owners and employees of the clinics and the people in government who devised and implemented the program. We can blame the own

by sreque 6y ago

I think we can safely blame both owners and employees of the clinics and the people in government who devised and implemented the program. We can blame the owners of the clinics because we have a right to expect people to to make morally correct decisions. We will never invent the perfect system of laws to incentivize everyone's good behavior. At the end of the day, society only functions when the majority of people are at least somewhat selflessly contributing to it. We can blame those who devised and implement the program because we can expect them to do more auditing as well and ensuring the program isn't gamed. People in government are responsible for spending taxpayer money wisely.

mattcwilson 6y ago
The trouble is that blame doesn’t address the problem either. We want the government to make wiser, less gameable policy. We want businesses to act ethically. How do we acheive those? It’s not blame. I think the answer is incentives. The government had the incentive to “help the poor” - so they did. The clinics had the incentive to “fix teeth for people in need” - so they did. Just like in software development, so much rests on properly defining the desired outcome.
- robertlagrant 6y ago
  The problem is also that in the game of "helping people afford all their needs", governments will rarely construct solutions that involve less government. Which might well be the right answer.
  - Normal_gaussian 6y ago
    Can you exemplify this?
    - throwaway0a5e 6y ago
      Deregulation of airlines led to the modern era of cheap air travel.
      - ineedasername 6y ago
        That may have helped, but you can't ignore other factors such as relatively stable inflation adjusted fuel costs, combined with better fuel efficiency, lowering operating costs, or the trend towards eliminating amenities and increasing passenger density. Or the continued increase in airline safety while overseen by the not deregulated role of the FAA. Deregulation was only part of the picture.
      - heavenlyblue 6y ago
        Deregulation of energy companies led to Enron. What exactly did you just prove by this overly generalising statement?
        deleted 6y ago
        [deleted]
        deleted 6y ago
        [deleted]
    - bluGill 6y ago
      Examples are impossible: governments are too complex. Any government that does this (however it is done), that government is also doing other things that are confounding factors. The idea is simple: a government that does less costs less, so it needs to collect less taxes. That means people just over the edge could pay for their dental work instead of the government and all the overhead of having a third party involved. It doesn't help those completely unable to care for themselves, but those who are close are no longer pushed over the edge.
- ggrrhh_ta 6y ago
  "less gameable policy" -> clinics do not get a blank check, for good or bad, they have to comply with government's bureaucracy requirements, i.e., explicitly take action that attests that the clinic considers the procedure to be necessary and covered under that particular government aid. That is, if the clinic does the bureaucratic 'work' when the procedure would not have been recommended otherwise, their actions border: fraud and healthcare crime. "The clinics had the incentive to “fix teeth for people in need” - so they did", in the case at hand, being the procedures unnecessary, the incentive was not "fix teeth for people in need", but "increase profits".
  - mattcwilson 6y ago
    I agree completely that “increase profits” was a goal for the clinics, but I mean something a little different by incentive. I mean “a behavior that is being encouraged or rewarded by others.” You are asserting that the government’s policy was sufficiently specific regarding “medical necessity” that would clearly show these claims would not qualify. If that were the case, then the government itself should not have paid out those claims in the first place. The fact that they did pay the claims (at least until someone blew a whistle) suggests either that their policy was vague enough to not be so enforceable, or that their review and enforcement was lax (or both). That’s my point - if the policy and enforcement had been clear from the get go this wouldn’t have been so big a deal. One or two bad apples try something and get sanctioned and the whole thing stops being an incentive to bad actors. We agree that something changed in the situation such that this is no longer occurring, right? What was that change, and why was it not so in the first place?

by sreque 6y ago

mattcwilson 6y ago

The trouble is that blame doesn’t address the problem either. We want the government to make wiser, less gameable policy. We want businesses to act ethically. How do we acheive those? It’s not blame. I think the answer is incentives. The government had the incentive to “help the poor” - so they did. The clinics had the incentive to “fix teeth for people in need” - so they did. Just like in software development, so much rests on properly defining the desired outcome.

robertlagrant 6y ago
The problem is also that in the game of "helping people afford all their needs", governments will rarely construct solutions that involve less government. Which might well be the right answer.
- Normal_gaussian 6y ago
  Can you exemplify this?
  - throwaway0a5e 6y ago
    Deregulation of airlines led to the modern era of cheap air travel.
    - ineedasername 6y ago
      That may have helped, but you can't ignore other factors such as relatively stable inflation adjusted fuel costs, combined with better fuel efficiency, lowering operating costs, or the trend towards eliminating amenities and increasing passenger density. Or the continued increase in airline safety while overseen by the not deregulated role of the FAA. Deregulation was only part of the picture.
    - heavenlyblue 6y ago
      Deregulation of energy companies led to Enron. What exactly did you just prove by this overly generalising statement?
      - deleted 6y ago
        [deleted]
      - deleted 6y ago
        [deleted]
  - bluGill 6y ago
    Examples are impossible: governments are too complex. Any government that does this (however it is done), that government is also doing other things that are confounding factors. The idea is simple: a government that does less costs less, so it needs to collect less taxes. That means people just over the edge could pay for their dental work instead of the government and all the overhead of having a third party involved. It doesn't help those completely unable to care for themselves, but those who are close are no longer pushed over the edge.
ggrrhh_ta 6y ago
"less gameable policy" -> clinics do not get a blank check, for good or bad, they have to comply with government's bureaucracy requirements, i.e., explicitly take action that attests that the clinic considers the procedure to be necessary and covered under that particular government aid. That is, if the clinic does the bureaucratic 'work' when the procedure would not have been recommended otherwise, their actions border: fraud and healthcare crime. "The clinics had the incentive to “fix teeth for people in need” - so they did", in the case at hand, being the procedures unnecessary, the incentive was not "fix teeth for people in need", but "increase profits".
- mattcwilson 6y ago
  I agree completely that “increase profits” was a goal for the clinics, but I mean something a little different by incentive. I mean “a behavior that is being encouraged or rewarded by others.” You are asserting that the government’s policy was sufficiently specific regarding “medical necessity” that would clearly show these claims would not qualify. If that were the case, then the government itself should not have paid out those claims in the first place. The fact that they did pay the claims (at least until someone blew a whistle) suggests either that their policy was vague enough to not be so enforceable, or that their review and enforcement was lax (or both). That’s my point - if the policy and enforcement had been clear from the get go this wouldn’t have been so big a deal. One or two bad apples try something and get sanctioned and the whole thing stops being an incentive to bad actors. We agree that something changed in the situation such that this is no longer occurring, right? What was that change, and why was it not so in the first place?