12 ms·

Care Doesn't Scale

• tehabe 2y ago
  This is one reason why we have a state, which collect taxes and can provide those services.
  • dannyobrien 2y ago
    well, except for the fact that, as the article states, it doesn't scale. Or rather, it scales poorly: the quality of care provided by a nation state is going to differ in degree and quality compared to the 1:1 care that humans probably need (and certainly traumatised humans). I'm not sure this comes as a surprise to anyone except for those who have had no interaction with state-provided social services. I'd also say that a level of care that does not reach to that 1:1 standard is still appreciably better than no care, which may be what one might otherwise receive. The open question is can we work out better, decentralized ways of providing support that take advantage of the new social technologies that we've developed since the construction of the modern state and its welfare services in the late 19th and 20th centuries.
    • worldsayshi 2y ago
      Care doesn't scale, but a lot of activities around care should be scalable. A caregiver can be helped so they can spend as little time as possible on auxiliary tasks like admin or logistics.
      • dannyobrien 2y ago
        I agree! (Not adding much info here, but I wanted to show that you made me think, and I appreciated your contribution to my thinking and others!)
    • zeroCalories 2y ago
      I don't think there is any contradiction here. Government care can work, but it simply cannot benefit from economies of scale. Gonna need to double the income tax to pay for elders that have been abandoned by their children.
      • Uvix 2y ago
        You mean the elders who failed to take care of themselves, assuming someone else would do it for them.
        • em-bee 2y ago
          which has been the norm for as long as humanity existed
        • bccdee 2y ago
          That's how getting old works, yes. You lose the ability to take care of yourself and begin to depend on others. Do you really think infirmity is something that can be avoided with the right grindset?
          • zeroCalories 2y ago
            He means that they messed up by investing in their children and providing them a good life instead of putting everything in an index fund. They didn't realize the rug pull they were about to eat.
    • tehabe 2y ago
      Just because the government does something, doesn't mean it has to be centralised. Eventually the care has to be given from one human to another human. On the other hand, it shouldn't matter where you live to receive care or how good the care is. And the week in which private companies will be able to provide this, is the same week which has two Tuesdays.
  • KeplerBoy 2y ago
    Care is not something that is magically performed by the state or money. At some point someone has to physically wash and feed the elderly in the retirement homes. If past governments or cultural environments messed up demographics, states might end up with a significant fraction (Germany already has 22% aged 65+) of the population in need of that care, which requires another significant share of the population to just do that instead of producing actual stuff. This will either get ugly in one way or another or we will need scalable tech solutions.
    • Gare 2y ago
      Or importing even more foreign workers. Which I'm not strictly against, but does come with it's own set of challenges.
      • FirmwareBurner 2y ago
        >Or importing even more foreign workers. Except you can't force foreign workers to do shit jobs the locals don't want. They're not slaves.
        • ImPostingOnHN 2y ago
          They don't need to be forced. They come here willing to do those jobs. After all, they're not slaves.
          • FirmwareBurner 2y ago
            Exactly. They come willingly but you can't force them to wipe your old age ass once they're here.
            • Gare 2y ago
              Actually... they kinda can? If they don't work, they get deported back. Also they are in debt to the agency that got them here. It's a hair above modern slavery the way it currently works, especially in EU countries with more... lax standards than Germany.
  • intended 2y ago
    This is not the same thing. The state is ideally suited to manufacture public goods, more efficiently than private enterprise. That means armies, judiciaries, policing municipalities, governance amongst others. They address issues like management of the commons. This does not translate into scaled care - care for orphans (from the article) still needs large numbers of skilled manpower, which is in short supply across the world. These services are also often underfunded, since they are not really a first class citizen for voters. Voters today, are also deeply targeted by emotional campaigns and identity campaigns, since that is the current political state of the art. The state can be efficient, but some things don’t scale unless they are also resourced correctly. Such services will also be amongst the first to cut, since “X will render it obsolete”, is a promise as old as time, and aren’t directly tied to overall societal survival. Compared to something like defense / emergency funding
    • tehabe 2y ago
      My argument is, that care is a public good. There will never be a situation in which care can fund itself. To fund care is a political decision and when the decision is made to to not fund it or leave to a market or private enterprises it will fail, because private enterprises need something which will eventually scale.
    • tightbookkeeper 2y ago
      > The state is ideally suited to manufacture public goods, more efficiently The government does not provide a more efficient military or education. It compels individuals to pay for something which is in the collective good, but not their personal interest.
      • intended 2y ago
        > The government does not provide a more efficient military or education This is news to me, or a novel use of economic terminology. Source?
        • tightbookkeeper 2y ago
  • jimbokun 2y ago
    Doing it by a state does not make it magically scale in any way shape or form. You still need something like one-to-one or one-to-a-few for care work to be effective. Trying to provide it through the government does absolutely nothing to change this fact.
• aniviacat 2y ago
  > In any given moment, you can only really care deeply and individually for one person. What does this imply, that two parents cannot care for three children? I disagree.
  • michaelmior 2y ago
    I don't think it's implying that at all. Whether or not you agree with the statement, it's referring to a specific moment. Most parents will have many moments with their children.
  • plaidfuji 2y ago
    No, they go on to say > With four kids, the kids can feel like kids; if there were forty kids, they’d probably feel like they were cattle. The point of the article is that you’ll never achieve economies of scale (10, 100, 1000x) for situations that require individualized attention, no matter how much engineering effort you put into it. At least with today’s technology…
    • paulryanrogers 2y ago
      The quiver full movement is certainly testing the limits.
      • watwut 2y ago
        I would argue that they found it and that kids are not getting that individual attention they need.
        • paulryanrogers 2y ago
          Worse, the elder kids are forced into parenting their younger siblings.
        • themaninthedark 2y ago
          I don't know how many kids the Quiver Full families have but are they any different from Amish families? Are the kids not getting enough individual attention something from an outside perspective or from the kids perspective?
• ersiees 2y ago
  I think this is also interesting to keep in mind when thinking about the changes to the job market that are possible due to technology (e.g. AI). Most of care will not be automated any time soon. And it is a huge part of the economy.
  • johanneskanybal 2y ago
    Yes this was my first thought too. Nice to see this post on HN.
• bluetomcat 2y ago
  This is ultimately a dichotomy between having the family unit or "the state" as the central point of governance. Many totalitarian regimes looked at newborns as "belonging to the state". The result is a unified mass person who dresses, thinks and acts in predictable ways. The more power, personal connection and influence parents have over their children, the more diverse society will become.
  • dqv 2y ago
    What? What does this have to do with orphaned children?
    • rgrieselhuber 2y ago
      It’s not a reference to orphans.
      • dqv 2y ago
        Then I'm completely lost on how it is relevant to an article that specifically mentions the care of orphans as its central example for how care does not scale.
        • deleted 2y ago
          [deleted]
        • spwa4 2y ago
          I think the idea is that many totalitarian systems treat every child as an orphan, in some cases taking them physically away from their parents and then have people look after the children as a job. Hence the comparable situation. And, of course, all such systems I've ever read about do not care about the practical limitation of 1 caretaker per 1 child. I believe youth services in the Netherlands, for example, has 1 caretaker (effectively available to the child) per 15 children, or 7 or 8 if they're trouble. Does this work? No, of course not. They don't care. The kids grow up caring for nobody, probably because effectively nobody cares for them. One person watching 15 children can only hope to prevent disasters, if that, they cannot provide decent attention to children. By the standards of this article, there's probably 2 people who work in the same "group". If there's a third one, they will be shared between at least to groups. So 2 to 2.5 per 15 children ... comes to one parent figure per 7 children, which is a third to a fourth of the care children would receive in even a huge family, and much less than in a small family.
• plaidfuji 2y ago
  This is a pretty big realization and one that resonates strongly with me. As an engineer, parenting can be frustrating, of course for the usual reasons, but also because you realize there’s really no way to “hack” it. I feel like we as a society need to acknowledge that this probably applies to childcare, teaching, health and elder care to a large extent. That no matter how much private sector ingenuity you apply to some field, there is a hard upper bound to how much efficiency you can achieve. Cost savings basically just require making hard choices about who gets what.
  • sokoloff 2y ago
    I think some of the healthcare changes during my lifetime have increased efficiency and been fine (maybe even good) for patients. I used to have my vitals taken by the doctor. Now, that’s a nurse. Used to get vaccine shots from the doctor, now a nurse. I feel like docs used to do blood draws, now a nurse. All of that is good, IMO. Doctors may not like the 20 minute blocks, but overall I can get the same care at a lower total cost and the nurses are probably better at the job they do twice as frequently than the doctor whose head might be somewhere else during the “boring parts”. I suspect aspects of this apply to teaching (why does every calc teacher need to give the lecture? Why not have the top 1% of them in that skill record lectures with excellent production quality/editing and have students watch those?) Yes, there are upper bounds, but I think even +50% or +100% might be possible with minimal (or in the calc case, negative) losses. Those efficiencies can really matter when someone else has to pay the bill.
    • potato3732842 2y ago
      >I used to have my vitals taken by the doctor. Now, that’s a nurse. Used to get vaccine shots from the doctor, now a nurse. I feel like docs used to do blood draws, now a nurse. All of that is good, IMO. Doctors may not like the 20 minute blocks, but overall I can get the same care at a lower total cost and the nurses are probably better at the job they do twice as frequently than the doctor whose head might be somewhere else during the “boring parts”. The statistical you is paying statistically much more than the historical equivalent. The situation is far more complex than that. There's a million variables here. Changes in services rendered, changes in outcomes, relative wage differences, more parties taking a cut of any given transaction, more "make work" prior to rending specialized care, etc, etc. Outcomes are better than they were 40yr ago but is that because of the changes or despite them?
• deleted 2y ago
  [deleted]
• furyg3 2y ago
  This is why avoiding the need for care, while never totally achievable, is always the most scalable solution.
  • cobbzilla 2y ago
    Yes, also simultaneously why (some) smaller companies can offer exceptional service unmatched by larger competitors. I am reminded of the PG startup advice to “do things that don’t scale”, this seems to be one of those cases.
    • jasfi 2y ago
      This could be at the core of "do things that don't scale".
  • moolcool 2y ago
    Is that a world you want to live in?
    • czbond 2y ago
      Yes - to me the OP means solving issues ahead of time.... create the vaccine 1x or treat the virus causing the issue millions of times. I have spent enough of this year injured due to my own adventure sport aggressive mis steps. I was MUCH less productive during this period than before or now due to injury. Had I not needed to deal with that, is the most productive self and that has a exponential effect society.
      • moolcool 2y ago
        But you're not just a productivity machine though, and as such, you surely yearn to give and receive care in different ways.
        • deleted 2y ago
          [deleted]
  • 2y ago
• lynx23 2y ago
  Whats much more important, empathy doesn't scale. Care can be established. But no one will ever know about its quality. I know what I am talking about, I visited a k12 school for the blind, and have a mentally unstable mother. Nobody ever asked me if I am happy/content at home. They all assumed my mother is doing her best. My life only started when I managed to escape from every kind of care. Institutionalized care is the worst, because its lacking empathy the most...
• taylorius 2y ago
  I think in the future, descendants of today's LLM models and some future version of Tesla's Optimus could create a paradigm shift in how care is given. I'm hopeful that when I get old, and inevitably come to need some help with living, that such a solution will be available.
  • davidclark 2y ago
    This hypothetical bot can provide supportive actions - feeding, cleaning - but it can’t provide "care" in the way that people truly need.
  • Eisenstein 2y ago
    I would like the option to die painlessly before I end up needing a robot to change my diaper.
    • alamortsubite 2y ago
      > I would like the option to die painlessly before I end up needing a robot to change my diaper. My dad has Parkinson's and needs a human to change his diaper. If he had the option of a robot, I bet he'd take it. Not a painless die now option, though. As I write, where he is it's 8 o'clock in the morning and he's watching an old Larry David and eating an ice cream cone while my mom gets ready for them to go to breakfast.
      • jen20 2y ago
        That’s the idea of an option. Great if it works for him, but having spent a lot of time with Pieter Hintjens (of AMQP and ZeroMQ fame) before he chose the time of his own passing from recurrent cancer, the notion that this is not allowed in order to appease religious zealots is simply barbaric.
        • alamortsubite 2y ago
          I'm not sure you replied to the right post, but religious zealots don't watch Larry David.
• wazoox 2y ago
  This has been well-known for ages and is a major subject of feminist studies. Care jobs are mostly feminine, and don't scale, and this dichotomy plays a big role in the overall wage gap.
  • kome 2y ago
    yep, super important contributions but hardly understood or studied in mainstream economics
  • moolcool 2y ago
    Say it louder for the people in the back. There's a million examples of tech utopianists walking head-first into ideas and even entire disciplines they previously dismissed as irrelevant or outdated.
• kome 2y ago
  I have what I think it's a very good article on the economy of care - making exactly this point and others, but it's in the dungeon of peer review for more than one year. And the reviewers do not even answer my emails.
  • nsbshssh 2y ago
    Can it just be published on arxiv?
    • auggierose 2y ago
      But then nobody cares.
      • nsbshssh 2y ago
        So... caring doesn't scale?
      • fph 2y ago
        But you can submit the same paper both to Arxiv and to a peer-reviewed journal, in most fields.
  • baoluofu 2y ago
    I would be keen to read it if you're happy to share?
    • kome 2y ago
      sure, especially if you are an academic. how can i get in contact?
• api 2y ago
  A lot of what makes society and politics so hard comes from the fact that humans have among the most demanding offspring of any living creature. This starts with pregnancy and birth which is a life threatening medical condition with a high mortality rate without modern medicine. We can’t reproduce and raise our children without dedicating gigantic amounts of energy to it, causing an inherent tension between the need to do so and the desires of both individuals and entities like corporations and states that want claim to that labor. If we laid eggs and our young were viable more quickly our politics would be orders of magnitude simpler. It would basically be the politics of twenty somethings, but for everyone. On the plus side, it’s probably why we have among the longest life spans of any land mammal. Grandparents helped with child rearing, so societies with longevity probably did a better job raising children.
  • jimbokun 2y ago
    That is partly true due to biology. But it's partially culturally inflicted. In previous decades kids were allowed to do much more unsupervised. And the pressure to prepare for high stakes college admissions from early ages was much less extreme.
• fieldcny 2y ago
  The premise is wrong, you can care for more than one other person at a time. People have children, in this world we can only care about our spouse or one child? Hardly.
  • dagw 2y ago
    Depends on what you mean by "care for". Calling your parents a few times a week to make sure they're doing OK and dropping by on the weekend doesn't take too much time and effort. But as people get older they need more and more care. Caring for one person with dementia or other similar problems that comes with aging is for all intents and purposes a full time job.
    • saltcured 2y ago
      And eventually if you can't afford to become unemployed to do it or pay full time caregivers, you need to move them to some kind of care home where there is minor scaling effect. Being housed together, the residents can share caregivers since most do not need continuous help. A common arrangement is a board and care home with about 4 residents and 2 caregivers who work mostly non-overlapping shifts, and one sleeps onsite to (hopefully) be able to handle overnight care needs. A larger place can scale a bit better. E.g. 10-20 residents can have 5-10 staff on various shifts. But some staff could be cooks or handle cleaning while others focus more on the residents' needs. And at this level of staffing, they can manage to have an overnight shift with someone who remains awake to keep an eye on things, as well as probably having other(s) sleep onsite to be on call to help with bigger events.
  • crabmusket 2y ago
    I agree with you, but I read the article as saying you can't care deeply about more than one person at literally the same instant. Your attention is directed to one or the other. But I think even that's not literally true e.g. the social worker could make dinner for all four kids at once. And probably converse with all four of them while doing it! But, I think I agree with the broader point that care doesn't scale, even if it does scale slightly greater than 1.
  • 2y ago
• kang 2y ago
  > Scale isn’t bad, at least not necessarily. Industrial is perfectly capable of being better than custom. Sometimes the YouTube video is more helpful than the private tutor. This is not true; consider the argument that there is always a loss of quality in scaling. Industrial maybe better than average custom, but is always worse than best customs. Broadcast lecture is almost always worse than a tutor whose discourse is customised to student's current knowledge. (The word guru (literally, one who leads towards light) is wrongly translated to teacher, for which the word in sanskrit is shikshak.)
  • api 2y ago
    I don’t think that holds for everything. Industrial 3nm chips are probably better than whatever you would get if people tried to DIY this. Lots of things get better with scale: materials, precision machinery, process efficiency, power generation. But there’s also plenty of things that don’t work this way. Care is one of the most extreme things that does not.
    • karrieberrie553 2y ago
      I think the argument is that someone with the knowledge to make 3nm chips could probably know how to make some very cool yet very expensive chips, but since they target a lot of people they probably make choices that would satisfy more people but maybe not as well
    • kang 2y ago
      for eg, asic custom designed for an application is better than a generalised industrial chip
  • durumu 2y ago
    I agree the average tutor is better than the average lecturer. But if I watch a YouTube lecture, then I might have access to the best lecturer in the world, or at least a 99%ile lecturer, e.g 3blue1brown. This only works because of the scale -- it wouldn't be possible for millions to get access to tutors this good 1 on 1.
• james-bcn 2y ago
  I think this post on the same blog is much more interesting: ‘Small Village’ of Supposedly-Deceased Intellectuals Found Alive, Thriving at Caribbean Resort https://stevenscrawls.com/bucket-bump/ https://stevenscrawls.com/bucket-bump/
  • paulryanrogers 2y ago
    An interesting thought experiment
    • jasfi 2y ago
      Probably, without any sources or anything related online it seems to be fiction.
  • creesch 2y ago
    Interesting maybe, but also one that lacks sources. It is entirely possible that this passed by me and I just didn't catch the thing mentioned in the blog post. But, I also can't find much in the way of any reference to it online. Not even a hint using various search terms and combinations as mentioned in the blog post. It very much gives the impression of it being a story made up as a vehicle for the main point they are trying to make.
    • james-bcn 2y ago
      Yes I think it's made up. But it's not obvious that it is. Which makes me doubt the blog as a whole.
• Tade0 2y ago
  > But I wonder if part of that smaller focus comes from a deep realization that care doesn’t scale. My experience (and I believe it to be common) is that I'm really, really, really out of spare energy to care about anyone or anything else. Mind you, I'm in my best shape in years and I've explored my limits to find out they're actually way further than I originally thought, but still.
  • avhception 2y ago
    There was a story on HN a while ago that I can't seem to remember the title of. It was something along the lines of "The optimal amount of slack in an organization is not zero", or something like that. The argument was that, since it's impossible to plan for every eventuality, you need a certain amount of slack capacity in order to retain some flexibility. And that by always using 100% capacity, we end up dysfunctional. I think the same is true for our personal lives. But the endless treadmill of self-optimization, side-hustles and ever more commitments leaves us unable to cope.
    • nielsole 2y ago
      I can't help you with the title, but with another paragraph from that story, should you want to find it. Paraphrasing from memory: > When you are in a major Chinese city you may street sweepers sitting on the side walk chitchatting. The first thing you may think of it as waste that could be eliminated. But it also acts as a buffer.
    • ghgr 2y ago
      I think you might be referring to this comment: https://news.ycombinator.com/item?id=41952570 https://news.ycombinator.com/item?id=41952570
    • hprotagonist 2y ago
      https://www.bitsaboutmoney.com/archive/optimal-amount-of-fraud/ https://www.bitsaboutmoney.com/archive/optimal-amount-of-fra...
    • AnimalMuppet 2y ago
• gaussiandistro 2y ago
  So, maybe interesting in the context of "creating scalable structures of aid and care", one of the big points I think that makes scaling hard is how much complexity gets pushed onto a central administrator. You have societies like certain Basque communities (see https://scholarship.claremont.edu/cgi/viewcontent.cgi?article=1279&context=hmnj https://scholarship.claremont.edu/cgi/viewcontent.cgi?articl... ) where households are literally arranged in circular patterns, and there are obligations of care and service between you and your "first neighbor", "second neighbor", and so on, chains of dependencies moving clockwise and counterclockwise through the circle, allowing a potentially very large structure that still allows you to mostly interact with a small number of "near neighbors". Quoting directly from the article: "THE GIVING OF BREAD Until the 1960’s, a fundamental circular exchange was the giving of blessed bread. Each household regards its neighbor to the right as its first neighbor (The directions right and left are as viewed from the center of the circle so that right is clockwise and left is counterclockwise.) The giving of bread took place weekly and was thought of as being given from first neighbor to first neighbor. That is, each Sunday a woman from one particular household, call it H_i, bought two loaves of bread to the church where it was blessed and partially used in a church ritual. Then, before sunset, a portion of the bread was given by H_i to her first neighbor, namely to H_{i+ 1}. The following week H_{i+1} was the bread-giver and H_{i+2} the bread-receiver. Thus, the giving (and receiving) of bread moved around the circle serially, taking about two years to complete one cycle of about 100 households. While each household was both a giver and receiver of bread, this mode differs from simple reciprocity; only if there were a total of two households would H_i and H_{i+1} directly reciprocate as each other’s first neighbor."
• paulryanrogers 2y ago
  Strange definition of "one to one". It sounds more like 4-to-1 to me.
  • dagw 2y ago
    There are 4 workers taking turns looking after 4 kids. So while at any given time 1 worker is looking after 4 kids, you need 4 workers to cover all the shifts. Thus one-to-one
    • paulryanrogers 2y ago
      That's a very odd framing. So it works out to one worker per one shift/day? Wouldn't that be true if there were 10 or 20 kids yet still 1 worker per shift?
  • cj 2y ago
    4 people taking care of 4 kids 24/7 in 24 hour shifts. From article: > To get that individualized care, though, they had four social workers and four children. One-to-one. [...] But you couldn’t stray that far from one-to-one without changing the nature of the experience, without industrializing it to the point that individual care is lost. I don't think you need the ratio of worker:child to be 1:1 in order to provide 1:1 care. The alternative might be 20 social workers taking care of a group of 20 kids. It's the same ratio of workers to kids, since no 1 worker will get to deeply know individuals in the group. I agree 1:1 is confusing and not totally accurate but it's fine for illustrating the point.
    • paulryanrogers 2y ago
      Well 1-1 care for any given child at an average of 25% of the time. Which for social work is probably better than most alternatives, yet not as good as having a parent per one or two kids. Anyway, I don't mean to nit pick. Everyone has to know their limits, and I'm sad to admit that I found I can barely handle two kids with two adults. And families managing 5+ kids strike me as over natural+healthy limits, unless they've a large extended family (who have capacity to help).
• crabmusket 2y ago
  > There was some pain in that realization. So many of my utopian dreams—what if we could live in a society where everyone can get the food, the housing, the healthcare, the opportunities for growth that they deserve—come from a place of wishing that we could live in a world where people are cared for. I'd like to offer some comfort to the author on this score. Food, housing, healthcare broadly... while these are all aspects of being "cared for" by society, they aren't all care in the individual sense you describe. The food system is different from homecooked meals; the housing economy is different from the handsome breakfast nook your family DIYed into their home. We can build systems which scale and make it possible and economical for individual care to happen.
  • MichaelZuo 2y ago
    Although it’s theoretically possible and theoretically economical for individual care ‘to happen’, it doesn’t in practice for the housing economy. If anything it’s decreasing year by year on average. Especially when you look at construction quality, the average quality of say new built condos in any major city has gone way way down since the 90s. Of course on average condo designs have on average gotten fancier with quirkier architecture, and building codes have gotten more complex, so maybe it’s not due to builders caring way less, but the end result is shoddy work either way. Edit: And the average home buyer has no method of separating out all these confounding factors, so it boils down to a single congealed mess.
    • crabmusket 2y ago
      Maybe it doesn't in America. Nor here in Australia. Some European cities are showing that better is in fact possible by strongly supporting co-operative housing sectors which are better for residents. But that would break the American taboo against government intervening usefully in private markets for human rights (in this case, shelter). More from a recent report by Australia's business council of coops and mutuals: https://bccm.coop/australia-urged-to-look-to-europe-for-solutions-to-housing-crisis/ https://bccm.coop/australia-urged-to-look-to-europe-for-solu... Anyway, my advice to the author was that systems can enable care at scale. Not to say that our current systems do. Edit: to be more explicit, I'm suggesting that some approaches to the housing sector in some parts of Europe amount to care that scales; society and governments have decided that housing is a right, and have enacted policies to approach that situation. Conversely, a "we don't care" approach also scales very well with the opposite outcome.
• hardlianotion 2y ago
  Care does scale and the human race is evidence of that. It is centralisation that doesn't scale well.
  • bryanrasmussen 2y ago
    but centralization is in many ways the thing that is needed to scale all sorts of other things.
    • lucideer 2y ago
      No. Centralization isn't needed to scale, it's just needed to exploit scale. Exploitation has become so commonplace it's replaced everything as the primary "desirable metric". I'm writing this comment on a platform founded on the idea of exploitation being a desirable metric.
      • theamk 2y ago
        Try giving everyone housing without centralized production of things like nails, screws, siding electrical wire... Decentralizization is fine sometimes, but a single huge nail factory is going to beat thousands backyard forges in (average/95th percentile) quality and especially in prices.
        • amanaplanacanal 2y ago
          Yet somehow houses were still well built before the huge nail factory existed. Which means it is not required.
          • theamk 2y ago
            Sure, it's not required to build _some_ houses, but it's required for scale. Backyard forges are OK if you have few hundred million people, most of them in farming, with most families living in a house with a a single room. But you cannot build New York on without large factories.
• ForHackernews 2y ago
  Not only does care not scale, but the fact that other fields do scale is one of the sources of "cost disease" [0]. If software engineering is thousands of times more scalable than teaching, caring for children, injured or elderly people then all of those other jobs will need to pay more to prevent everyone quitting to become a software developer. [0] https://en.wikipedia.org/wiki/Baumol_effect https://en.wikipedia.org/wiki/Baumol_effect
• tmsbrg 2y ago
  Q: How many Silicon Valley software engineers does it take to change a lightbulb? A: They will refuse to change the lightbulb, claiming it "doesn't scale" unless the "lightbulb problem" is fixed globally ;) In seriousness, enjoyed this article and it's a wise realization. I think the world would be a better place if more people take the time to be a good person to the people around them, rather than focusing so much on big picture issues.
  • czbond 2y ago
    I agree with your central point, but in my estimation, the entire world minus a very small percentage point only work on or care about small, short term solutions to problems. And that is fine. Engineers are not social & feelers with high individual level empathy scores. So let them/us build large scaleable solutions with the individual 1-to-1 personal interaction removed.
• mempko 2y ago
  What most don't understand is that the economy IS us caring for each other. When you go to a restaurant when you are hungry, or a store to get what you need, or a hospital when you get sick, you are getting care. Virtually most people are taking care of other people. And yes it doesn't scale because it takes all of us to care for each other.
  • anticorporate 2y ago
    > What most don't understand is that the economy IS us caring for each other. But when those businesses we seek care from scale, the system is no longer closed. A portion of the care I give or receive is siphoned off and sent to shareholders or a wealth business owner. When caring happens through capitalism, a portion of our care is depleted with every transaction.
    • moolcool 2y ago
      It's an interesting conflict. As the businesses scales, small losses which would be acceptable in a smaller operation will scale as well. Maybe a mistake people make as they scale is being too quick to give up the extra couple french fries.
  • jimbokun 2y ago
    Non-paid human interactions exist.
• khaledh 2y ago
  This reminds me of Clay Christensen's talk: How Will You Measure Your Life?[0] He compares how most people define success by how high up the hierarchy they get, against the individual effort of making a positive impact on the people around you. [0] https://www.youtube.com/watch?v=tvos4nORf_Y https://www.youtube.com/watch?v=tvos4nORf_Y
• k__ 2y ago
  I assumed the opposite. Knew a women who worked 100% as foster mom. Had 3 children at a time, age 6 to 13. Everything was well organised. It seemed to me, child care can work pretty well of it's your main job and you get paid by the state.
  • rileymat2 2y ago
    Working well with a three one ratio does not scream scaling to me. The when you have more need than care workers it falls apart, with no way to scale it besides hiring more out of a pool that may not exist at the price you were paying the previous ones. If you think in terms of supply and demand, if they are already have the curves met, additional demand is going to scale more than linearly because you need more people at a higher pay.
  • pschoeps 2y ago
    This seems more like a very skilled caregiver to me, I would be absolutely overwhelmed in this position.
    • User23 2y ago
      Which is quite remarkable, because up until less than a century ago when women “entered the workforce” virtually every woman who had ever lived somehow managed to care for her 3+ children. Incidentally, large families do scale sublinearly with respect to the parents. The reason why is that even with merely natural spacing by the time they have a fourth child, the oldest is in a position to provide significant assistance. Every mother with a large family that I’ve spoken to confirms that the difficulty peaks with the third child and then plateaus.
      • ativzzz 2y ago
        It is remarkable. I have one child, and it is by far the hardest thing I've ever done - far harder than any job I've had. It doesn't help that both parents are working full time. Maybe parenting has changed recently and we are too hands-on, but I can't imagine having 2, much less 3+ running around. Even if one of us stops working to raise the kids full time, it's way more taxing, physically and mentally, than working a white collar job and paying for child care.
• endoblast 2y ago
  >We’re pretty limited when it comes to care. In any given moment, you can only really care deeply and individually for one person. Absolutely. Society tends to assume that people are interchangeable units and that 'care' is a commodity which can be dispensed evenly as if from an industrial nozzle in a food factory. So we have 'care homes', 'daycare', 'care packages'. We are enjoined to be more 'caring'. But the reality is that love, which is what we're really talking about, is dyadic. i.e. between two individuals. That's how it works and how it effects its magic. A patchwork of dyadic connections is what we may hope for and build.
  • steveBK123 2y ago
    Yes, it points to how hard & expensive any government attempt to backstop the traditional parental model of care actually is. The earlier the intervention the better.. and consistency is also incredible important. But you can spend incredible amounts of money just to get a slightly worse outcome than what was going to happen on its own. As a wealthy society we must do something to help those in need, especially children who are in the situation of no fault of their own. But it's not clear our current methods work. You can also generalize this problem to the healthcare industry as a whole. Costs go up much faster than the rest of the basket of goods & services citizens pay for, and they don't understand why. The underlying reason is that - care doesn't scale. You are essentially (directly or indirectly) paying for someone's (doctor, nurse, etc) time. We have not gotten much better at making care more time efficient in the field, and in many cases it has gotten worse (more paperwork/electronic record entry time/etc). Everything else we buy is the product of using automation to replace labor, making labor more efficient, or making labor cheaper (offshoring / simplifying so less training is needed / etc).
  • mmooss 2y ago
    > >We’re pretty limited when it comes to care. In any given moment, you can only really care deeply and individually for one person. The evidence very strongly points the other way, IMHO: Almost all people care deeply and individually about many others, starting with their families - spouse and children are a clear and I think irrefutable example of deep caring and love for multiple people. And for most, also siblings, parents, grandparents, and some or even many other relatives. And outside of family is friends, co-workers, etc. Many healthcare workers care deeply (depending on the meaning) about their patients. Fundamental human empathy enables us, if we choose, to see people as individuals and care about them, even people we meet briefly on the street. I've learned to do it and I'm not superhuman. Obviously we know people experience these things. Why is it important - to what ideology and why - to insist empathy and love is so limited.
• dflock 2y ago
  Infrastructure is care at scale, as Deb Cachra would say: http://debcha.org http://debcha.org
  • jimbokun 2y ago
    That strikes me as a complete non-sequitur. I have no idea what it might mean.
  • erikig 2y ago
    Her talk on "How infrastructure works" was eye-opening https://www.youtube.com/watch?v=oK6BRwwhgbo https://www.youtube.com/watch?v=oK6BRwwhgbo I'm having a hard time translating her points regarding how infrastructure serves and cares for the basic human physical needs (e.g water, clean air etc) and how it can serve social needs like child care or elder care.
• delichon 2y ago
  It is not from the benevolence of the butcher, the brewer, or the baker, that we expect our dinner, but from their regard to their own interest. We address ourselves, not to their humanity but to their self-love, and never talk to them of our own necessities but of their advantages. Nobody but a beggar chuses to depend chiefly upon the benevolence of his fellow-citizens. -- Adam Smith Care doesn't scale but self-interest scales efficiently. The baker who gets up at 3 am generally does so because she cares about her close circle of loved ones, far more than the world at large. In this sense care and self interest are not in tension but amplify by constructive interference.
  • croes 2y ago
    The countless hours of voluntary unpaid work by many people shows don’t act only for their own benefit
    • bell-cot 2y ago
      True-ish. But try talking to some old folks, about the vastly reduced scale of such volunteer work since (say) the 1950's. That "voluntary unpaid" stuff would include religious organizations, civic groups, housewives, ...
      • croes 2y ago
        You need time for that. It’s true that first you care for yourself but after survival is secured many people care for others without profit concerns. But if you need more time to satisfy your own needs you have less time for others.
      • harimau777 2y ago
        It seems to me that capitalism discourages that behavior. If the system is setup to be transactional, and you can't rely on others reciprocating altruism if you need it; then it seems like engaging in altruism would be for suckers.
        • 2y ago
• vanderZwan 2y ago
  If we're going to talk about how to "scale care" and how not to, then Buurtzorg has to be mentioned[0][1]. It's a Dutch home-care company that was started by nurses who basically got frustrated that managers got in the way of them doing their job. It operates by having a flat organization working with small teams of highly trained nurses, and trusting them to make the right decisions. The result is a low-cost provider of high-quality health-care. So when the author says care "doesn't scale", they obviously mean "you need a one-to-one ratio of caretakers", which I fully agree with. But what they're also accidentally doing in the process is explaining why creating bigger teams with bigger hierarchies and structures does not appear to increase the efficiency of care. Some projects do need big teams with hierarchies - even in healthcare. Effectively responding to a pandemic comes to mind. I suspect it's when the core problem to tackle most naturally breaks down like a tree - a hierarchy then mirrors the way the problem breaks down. For some projects, like general homecare, the efficiency sweet spot is a flat structure of autonomous individual teams, because it doesn't scale beyond those teams anyway. And just like the author concludes, I find that there's something comforting about that. [0] https://en.wikipedia.org/wiki/Buurtzorg_Nederland https://en.wikipedia.org/wiki/Buurtzorg_Nederland [1] https://www.youtube.com/watch?v=SSoWtXvqsgg https://www.youtube.com/watch?v=SSoWtXvqsgg
  • cassepipe 2y ago
    Thanks for elaborating further what we mean by "scaling". Couldn't it be said that when organization acquire ranks, it is to solve coordination problems that arise with scale but that in this case, there isn't much that is solved by more organization ?
    • vanderZwan 2y ago
      That sounds about right. If you watched the video then you also will notice that the further up the management chain we go, the more abstract the goals become compared to the most concrete ones that the nurses are dealing with. One could say that if most care work starts and ends with those concrete individualized issues, the cost of handling (or worse, prioritizing) abstract goals is far greater than the benefits that they add. Compare that to the pandemic response example I gave: that is the kind of challenge where there are concrete problems at individual, city-wide, national and international scale to tackle, and they're all interconnected too. So plenty of those coordination problems you mentioned.
• MatthiasWandel 2y ago
  Things that scale can have a big multiplier, so to say. The problem is, more often than anticipated, that multiplier, rather than being large, ends up being considerably less than one. Whereas work that doesn't scale always has a multiplier of 1, so its always useful.
• feedforward 2y ago
  > Adults often come to see small-scale solutions to major problems as childish. Yeah, you could make a couple of sandwiches for the hungry—but there are billions of people who need better access to food. Maybe your effort is better spent working on solutions that can scale. Much of this essay is baffling to me. From 2022 to 2023 the fed funds rate was jacked up. The aim of doing this was to, among other things, drive up unemployment, so that more working class people working in supermarkets and the like would become unemployed, and to increase food scarcity for their families. The rate rise affects us as well, with tech hiring somewhat dead since late 2022. Looking abroad - the International Criminal Court charged Netanyahu, Israel fires on and invades UN bases in Lebanon, Israeli television broadcasts Israeli soldiers raping in Sde Teiman (go look on YouTube for the footage) as rabbis and Knesset MPs swarm to defend them. Gazan children starve as European countries block weapons being sent to Israel. In the US, Biden sends troops abroad and Israel weapons to further the slaughtering, which has spread to the West Bank, Yemen, Syria, Iran and Lebanon. Also, the US vetoes at the UNSC effectively help block Gazan children being fed as they starve. Kamala Harris backs Biden and vows to continue arming and funding Netanyhu doing this, and Trump is even more belligerent. So Americans elected the person enabling this and over 98% who vote will vote for a candidate doing this. It is not a lack of care or attention to Gazan children, Americans, or 98% of those who vote are paying attention to Gazan children and are trying to starve them - or at least are willing to trade a specific tax cut or whatnot to enable their starvation. There's nothing about lack of individual or scaled care - the vast majority of Americans work for the opposite - to continue the famine. Going back to the point of scale - the <2% of people not voting for candidates arming Israel and continuing the Gazan famine are working together as a mass movement and at scale and many for, as the essay mentioned, "socialism", because this <2% has to coordinate and work together against the 98% who are actively pursuing the famine in Gaza, or who are neutral about it and willing to trade support for it for a tax cut and such. Gazan children don't starve because Americans don't pay individual or scaled attention to Gazan children. They starve because 98% of Americans will vote for someone who works to starve them. It is what the vast majority of Americans are and what America is. And works for domains outside Gaza - like unemployment and the fed funds rate mentioned.
• red_admiral 2y ago
  Horizontal, not vertical scaling is what you need here. Even the college-socialists, at least when they're talking about climate change, realize that the best we can do individually is save a few bags of CO_2 here and there, but if everyone in the world did this then we'd have a fighting chance. Or consider the charity ads with lines like "if everyone reading this poster donated the cost of a cup of coffee a week ..." We can care deeply for one person, or perhaps two or four. We can look out for a couple of coworkers. We can cultivate 5 or so deep and meaningful friendships. If everyone did this then we'd have improved the world a lot, at scale.
• stonethrowaway 2y ago
  > Software engineering as a field is made up of people who are very conscious of missed opportunities for scale […] It amuses me to read these articles because it’s so airy and nebulous that there is all this text that doesn’t say much. I pretend it’s another pg article instead to humour myself further. HN is perpetually being played by the storytelling of some minor event that the author saw - people taking care of orphaned children by some rotating number of adults - and is reaching conclusions “care doesn’t scale” as if to educate us. It’s like a TED talk, only even less structured. So all I’m reading is vain, egotistical puffery. There isn’t really anything here other than the author thinking they can bring the tablets to us, the blind unwashed masses. It’s not only software engineers who do this so I won’t say it’s a trait unique to them in any way, though I see software engineers trying to make grandiose life statements more often than not.
• deleted 2y ago
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• m3kw9 2y ago
  Maybe one day with robots taking over some mundane care tasks, it can free more direct care work
• keeptrying 2y ago
  “Care Doesn’t Scale” is a fractal type of truth which essentially describes life but also is a steadfast warning of the underlying state of healthcare in general. Holistic 100% care doesn’t exist - even for the rich. The only way to get optimal care is to pay for it with study. Even the richest in the world don’t necessarily get the best care because care is a function of the present life situation of the practitioner - something no one can control 100% of the time. What is reassuring is that through a little study - you can refine the care provided by most nurses and doctors using your own curiosity at the point of interaction. Surprisingly the mistakes committed by nurses and doctors on somewhat healthy patients are easily fixed with some sembalance of attention. Study the first 2 years of med school. It’s not hard but does take time. And then ask the pertinent quesitons during your time with the doctor. Understand the diagnosis and how they came to it - it’s mostly simple and straight forward. 80% of the massive mistakes by doctors and nurses are fixable this way. Thats $800B … 800 billion dollars - with a little study.
  • Aeolun 2y ago
    “First two years of med school” and “a little study” are not wuite the same thing.
  • tightbookkeeper 2y ago
    My question is why can’t we pay someone to get that 2 years of medical education to help with broken bones and stitches. In other words, there should be less expensive and less sophisticated care providers for less complex needs. Only in the US is there such a cartel on medical care.
    • keeptrying 2y ago
      There do exist physician assistants but they are terrible. Never met a good one. The lack of agency is what's primary here. You are never guaranteed to have the best care all of the time - even if you have the money.
• will-burner 2y ago
  I'm surprised the article and non of the comments I've seen in this thread mention effective altruism, which in the framing of the article is an attempt to scale caring in some sense. The article helped me realize why so many people in the startup/tech/software engineering scene are drawn to effective altruism, it's a way to scale helping humanity in the best way possible. The effective altruism argument is that it's more productive to by mosquito nets in Africa than to volunteer at a food shelter because buying mosquito nets will save more lives. But this article helps explain why I don't personally feel drawn to or buy into effective altruism. Because caring doesn't scale, you can only really care about a handful of people close to you. And to me that altruism feels better and seems like it goes further than donating money to help more people that I can't truly care for.
  • int_19h 2y ago
    I think most people's problem with "effective altruism" is rather that some of its more prominent adherents end up defining "helping humanity" in very weird and rather counter-intuitive ways. Like that whole argument that we basically should care more about future humans than present ones because there's a lot more future ones.
    • will-burner 2y ago
      I agree that's most people's problem, but it's now mine. I've tried to think about effective altruism from first principals. For me, I can rationally understand effective altruism and why it's attractive. I even believe people that follow it (and actually do good) may in some sense be "better" people than me. But it none the less rubs me the wrong way and I can't follow it, so I've tried to understand why.
  • Koffiepoeder 2y ago
    Well, this may not be the best example. Mosquito nets are oft being used as fishing nets. Since 1) the loopholes of malaria nets are much smaller than manually knotted ones (thus also killing baby fish) and 2) the impregnation chemicals kill riverbottom insects (thereby disrupting the foodchain), this has lead to a massive killing of fish. Instead of fixing malaria, this has instead led to aggrevated hunger crises in some places.
• sabarn01 2y ago
  healthy society only work if most people are virtuous and take care of themselves and their families. The cost to care for the neglected and broken isn't sustainably if its more than a tiny percentage of the population.
  • mmooss 2y ago
    Is there research on that, economic or sociological? What percentage?
• w_for_wumbo 2y ago
  I think article may overlook the power of a great idea. What seems like common sense to us, may be a gap in the knowledge of someone else. When we help fill in those gaps, people will naturally help others when they see those gaps. When approached with love, curiosity and a seeking of understanding, we enable others to help themselves. This is where great ideas scale quickly & naturally, because once we're aware of a better solution - why would you do it any other way?
• mmooss 2y ago
  > you could probably ... subtract a social worker, as a cost-saving measure. Anyone who has scheduled 24x7 work knows that you need 4+ people: 24 hrs * 7 days/wk = 168 hrs/wk So that's 4 shifts of 42 hours each. Caregiving is difficult, very draining work, so 3 shifts of 56 hours isn't going to work (even if that's feasible for any job), and especially over the long term. Then people get sick, take vacations, have family emergencies, etc., so you need additional people available too.
• brailsafe 2y ago
  This should be a crucial realization for anyone out there trying to establish worthwhile intimacy with friends or anyone else as an adult. If you use the idea of scaling in a more abstract sense, you don't get to relentlessly pursue your personal career ambitions AND come out with substantial personal intimate relationships for free. It takes deliberate time and attention to cultivate a worthwhile connection with someone, whether it's your kids, or your parents, or your friends, and that's going to come from the few hours you get after work or on the weekend, or it just simply won't. This is already very apparent to anyone who still has friends and family back home, wherever you went to school or went to grade school. If when you visit, you tell everyone you're available, you're going to give everyone a small scheduled fraction of time and then hurry yourself off somewhere else, making no more than a shallow appearance. But if you only tell the people you know you can for sure spend a good uninterrupted chunk of time with, then it'll be wildly better
• iwontberude 2y ago
  A libertarians gets their wings everytime someone mentions scaling government.
• ChrisMarshallNY 2y ago
  I do pretty “small scale” work that has a fairly outsized impact on folks. The app I released in January, currently has a bit over 600 users. I get one or two a day (plus, the odd scammer). It may accelerate, in the future, but the demographic is small. There’s only so many people that can use it. I tested with 12,000 fake users. I suspect we won’t ever see half that. To many folks here, 12K is a rounding error. But the ones that do use the app, get a top-shelf experience. On another note, I have family that used to run a group home for kids that were made wards of the state (many terrible stories). He’s really good with kids, but he’s been an EE for the last couple of decades. Running the group home was very stressful, and emotionally wrenching, so the engineering was a cakewalk.
• kanodiaashu 2y ago
  I wonder if education/teaching is fundamentally inseparable from, at least to a serious degree, caring. Every single teacher who impacted my life seems to have cared for me. Maybe not. I have learned a lot on my own too. It would be interesting to see the minimum amount of care needed for a successful education; that would directly increase how scalable education can be.
• _carbyau_ 2y ago
  Care can scale differently. Humans can have hundreds if not thousands of human-to-human (or human-intermediary-human) interactions a day. Caring for those kids when they need it - a sibling comment also mentions education/ideas - leads to adults that hopefully have thousands upon thousands of better interactions in future. Better for them AND better for the other humans in the society they live in. [snip to the point]
• miki123211 2y ago
  I think one of the most important purposes of technology, if not the most important one, is turning the things that don't scale into those that do. Fundamentally, technology increases how much change a single person can achieve in the world. The steam engine made production and transportation scalable. The printing press, radio, television and the internet did that to information sharing and knowledge preservation. The telegraph, telephone and internet did that to person-to-person communication. Writing and the computer did that to knowledge work. The record player, the radio and the internet did that to music listening. If you start noticing this pattern, you eventually notice it everywhere. To predict where technology goes next, I think it's important to look at what can't be scaled just yet. Customer interaction, childcare, healthcare and physical product delivery are obvious examples, though there are probably many more. It's not like we don't know how to do these things. We have machines (human brains) that clearly know how to do them, we just don't yet understand how to make similar machines ourselves, just like we didn't understand how to make machines that would be better muscles or better horses. This is not like e.g. faster-than-light transportation, where we don't even know whether it can be done at all. I think it's worth thinking about how a wourld where those things could be scaled would look like. Individual instruction for each child, exactly fitting their needs and abilities, is an obvious consequence, so is much better care for those who can't currently afford a (good) specialist doctor.
• erikvanoosten 2y ago
  Another non scaling field is making houses ready for the energy transition. Here in the Netherlands there is a lot of uncertainty and distrust which requires an almost one-on-one approach for each (owned) house. Only powerful neighborhood initiatives can do this and do well.
• fagrobot 2y ago
  [dead]
• Bostonian 2y ago
  Regarding caring for children, for much of the 20th century it was common for women to have half a dozen children or more. The children got less attention from their parents than a single child would, and younger children got some care from the older ones. Most turned out OK.
• deleted 2y ago
  [deleted]
• weallfeelit 2y ago
  In the Talmud, Sanhedrin 37a says "Anyone who saves a life is as if he saved an entire world." and anyone who destroys a life is considered to have destroyed an entire world. In this sense care does scale in long timelines. When pregnant women go hungry, predispositions towards obesity remain in the epigenome even after several generations[0]. As a trivial example, in Les Miserables, the criminal Valjean can only become a hero because he is forgiven completely and totally by one man. It may sound ridiculous but surely life is also ridiculous. [0] https://www.nytimes.com/2018/01/31/science/dutch-famine-genes.html https://www.nytimes.com/2018/01/31/science/dutch-famine-gene...
• yowayb 2y ago
  Scale vs care/love is a false dichotomy, and each word encompasses many phenomena. Years ago, a neighbor in Los Angeles went to social services and was diagnosed with schizophrenia and given some meds. I knew what he was going thru, and I was young and rebellious, so I told him to skip the meds and take some time with good friends. In 2 months, the symptoms were gone. I can't remember the name of the meds but the side effects were awful. On the other hand, in my mid 30s I started to appreciate all the little details around infrastructure and design in various countries, and I often get the feeling of "being loved" by workers I've never met because the way it works is so nice or because it protected me in some way I didn't think of.
• m3t4man 2y ago
  I disagree. There's plenty of historical and present evidence of people who cared deeply for a collective of people (country, village, town, group, family). There have been people who would risk their lives, and in some cases commit suicide in various capacities, for their country and people. There are people who go to world's most unstable places just to help people there. A more concrete example, one of many, would be María Santos Gorrostieta Salazar[1], who had a total of 4 assassination attempts against her, with the final one eventually getting her killed, as a result of fighting organised crime. You can't tell me this person didn't care deeply for her people and country. I think the possible cause for indifference today, especially in developed countries, is because people can afford to be indifferent with little consequence to their quality of life. You can go about your life only caring about your most immediate circle, and things will still be relatively comfortable. I speculate that it's the matter of having no need to go beyond your comfort zone apart from moral ideals. Even then, people are just fine living with a slight discomfort of not living up to their ideals, or straight up re-evaluating and adjusting them like in this post. 1 - https://en.m.wikipedia.org/wiki/Mar%C3%ADa_Santos_Gorrostieta_Salazar https://en.m.wikipedia.org/wiki/Mar%C3%ADa_Santos_Gorrostiet...
• MollyRealized 2y ago
  I don't know if I agree with the premise of the article. At the very least, you can make sure 50,000+ people have food daily. That scales. [1] [1] - https://youtu.be/qdoJroKUwu0 https://youtu.be/qdoJroKUwu0