5 ms·

An embedded requirement for a rational market is that the customer has to be able to make a rational evaluation of the costs of the good vs the quality, which j

by rtkwe 1y ago

An embedded requirement for a rational market is that the customer has to be able to make a rational evaluation of the costs of the good vs the quality, which just doesn't exist in medical fields. Patients don't know enough to make that choice and evaluate the efficacy of many potential choices of providers. Not being able to do that fundamentally kneecaps the implicit assumptions in the already faulty model that underpins the 'competitive market' analysis. We should just accept that and stop trying to treat it as one and provide it as a public good.

TheOtherHobbes 1y ago
That's a cart-before-the-horse analysis. Labelling markets "rational" is pure rhetoric. There's nothing even remotely rational about a market system, because the moral basis of calling markets "rational" is... greed. Just greed. Nothing else. All of the failed outcomes, deaths, pollution, lost opportunities, distortions of democracy, and other damages are a direct consequence of this moral system which claims that greed is rational - when in fact unfettered greed is clearly and objectively sociopathic, with predictable sociopathic outcomes.
- 20after4 1y ago
  I agree with you but this website is sociopath central so I'm not surprised this got down votes. A lot of Ayn Rand fans here. But you know that already, judging by your karma score.
- nickpp 1y ago
  We're all greedy. We all want to get the most for our money, time and effort. Greed and desire push us to spend our energy, otherwise we'd simply conserve it. It's normal, it's natural and it works. It's human (and animal) nature. Altruism works fine in individuals and small organizations. But large systems based on altruism uniformly failed to provide the most basic necessities (like food) for their citizens. Can't work against human nature.
  - nosianu 1y ago
    > We're all greedy. We all want to get the most for our money, time and effort. We are? For example, I never file taxes. I'm certain I could get quite a bit back. I am far from rich, I earn medium pay in Germany - medium overall, not medium in IT. (Because I deliberately took a more rewarding and relaxing job, but that's besides the point.) I will not fill my mind with "money" stuff. Even if that costs me some of that money. I am sure, given that the terms used are as fuzzy as can be, you can twist and shake the words until you can claim that I am "greedy", the problem with this rationality discussions is how extremely flexible the words used are, making it quite impossible to win or lose an argument. All one has to do is insist on one's own definitions... but taking a relaxed view, I don't see good way to make not-at-all-rare positions such as mine as a form of "greed", without severely twisting the commonly understood meaning(s). I think a lot of that world view is self-fulfilling. When I was a kid I LOVED working like the adults. That includes taking one to four week stints in factories, as a teenager in school. That was common in East Germany and encouraged, early acquaintance with work life. I did the same helping out my craftsman grandfather and my shop-owing grandmother. Work was FUN! But now, the reason I don't just go - which I would LOVE to do! - and work a few hours low-level jobs here and there, is because it's all been heavily commercialized. You just don't do that! Work has to be pain, and you get paid. Only an idiot would work for free! During university, during a semester break, I took a job in a chocolate factory. I did not actually need the money! My parents paid (divorced, but both paid). I actually had a lot over at the end of university (cheap dorm housing and no fees for the university itself sure helped). I took the job because I wanted to work in a factory again. It is FUN!. Until that middle manager a..ole appüeared. I had just optimized my in-between assignment of taking care of some machine chocolate thing, some mixing, I forgot the details. I had set everything up perfectly and now had to just wait a few minutes for the machine to finish. In comes that.... manager guy. Immediately, seeing me sitting there he yelled at me why I'm not working. FU manager guy. That was the day I realized work now is WORK, not fun. You are not supposed to have fun. You now need middle manager person to keep your lazy ass in check! By yourself, without continuous pressure, you would not move a hand! Right? At least for the "lower" jobs, which are the majority. > It's normal, it's natural and it works. It's human (and animal) nature. You are definitely not speaking for a lot of people, and what you see is NOT the one natural outcome. Expectations and behavior towards people determine theirs (behavior). The culture I describe existed all around me in East Germany. Yes we were waaayyy backwards with everything, but work culture was really good. I learned a technical profession in a large chemical factory before studying. Everybody worked, useful stuff too, all day. The ancient machinery in the crumbling buildings needed a lot of attention to keep them running. There was hardly any slacking off anywhere I looked. Sure, it was relaxed, but it was work, work, work. I've seen waayyy more slacking off in the offices of large American IT companies. What you describe as "natural" is natural only in the context the current society has created.
somenameforme 1y ago
For the overwhelming majority of things people to go to the hospital for, where you go doesn't really matter, because the treatment and diagnosis is extremely routine. This includes very serious things like cancer. My mother, through a variety of fortuitous events, was able to have her breast cancer treated at one of the top ranked cancer specializing hospitals in the US. She had acquaintances that had theirs treated at the local university/training hospital. They ended up receiving literally the exact same treatments. Same for my own stuff. The first time one of my children got sick it was terrifying, so I naturally took him to the most premium pediatric healthcare institution. And what did they do? Basic tests to rule out anything particularly nasty, and fever management. The exact same thing the cheapest hospital does, except I got the privilege of paying 10x more for it and feeling like a complete sucker. From that point on - 'oh he's sick? shall we go to the university hospital, or the religious nonprofit?'
- owenthejumper 1y ago
  Unfortunately it does matter. NCI designated cancer centers simply do have better outcomes than local hospitals.
  - deleted 1y ago
    [deleted]
  - somenameforme 1y ago
    This is not entirely clear. Elsewhere in this thread I found a couple of studies on this exact topic. The first [1] is just for breast cancer and after normalizing across a wide array of variables, found no improved survival rates except for black women, which I think is suggestive of further biases. The second [2] is for all sorts of cancers, but is a large observational study without much effort to control for biases. It found an overall increase in five year survival rates of 3.6% (64.3% in NCI centers, vs 60.7% in non-NCI). That's certainly something, but it's fairly certain that biases would bring that down a healthy chunk. However there were significantly better outcomes in more rare/lethal cancers. For instance in hepatobiliary cancers, the NCI survival rate was 33.8% vs 18.7% for non-NCI centers. And that is largely the point I'm making. For the overwhelming majority of things, care is mostly commoditized and you will be fine wherever you go. The value of high end institutions is mostly only realized in the case of rare/serious issues, for which transfer is always an option anyhow. --- Though I'd also add here that these examples, cancer, are on the fringe extremes of what my point was. That there is a strong argument to be made that even cancer falls within it, just further emphasizes the point. If your local hospital can competently treat cancer, they can certainly treat the overwhelming majority of reasons people go to the hospital, which are relatively far more commoditized. [1] - https://pmc.ncbi.nlm.nih.gov/articles/PMC8462568/ https://pmc.ncbi.nlm.nih.gov/articles/PMC8462568/ [2] - https://pmc.ncbi.nlm.nih.gov/articles/PMC4892698/ https://pmc.ncbi.nlm.nih.gov/articles/PMC4892698/
DangitBobby 1y ago
Most markets fail here. I can't even make good decisions about which electronics or appliances to buy, which restaurants to visit, which mechanic to use, and it's not for lack of research or unwillingness to pay. Advertising allows brands to build undeserved market reputation, and brands regularly sabotage their own legitimately established brand reputation for financialization.
- rtkwe 1y ago
  I think it's particularly bad in medical decisions though because it's so much more advanced and cases are so varied it's difficult to compare doctor performance on different procedures. At least with products you generally get similar items each time so people can test multiple products in some scenario and a buyer can know what they buy should perform similarly.

by rtkwe 1y ago

TheOtherHobbes 1y ago

That's a cart-before-the-horse analysis. Labelling markets "rational" is pure rhetoric. There's nothing even remotely rational about a market system, because the moral basis of calling markets "rational" is... greed. Just greed. Nothing else. All of the failed outcomes, deaths, pollution, lost opportunities, distortions of democracy, and other damages are a direct consequence of this moral system which claims that greed is rational - when in fact unfettered greed is clearly and objectively sociopathic, with predictable sociopathic outcomes.

20after4 1y ago
I agree with you but this website is sociopath central so I'm not surprised this got down votes. A lot of Ayn Rand fans here. But you know that already, judging by your karma score.
nickpp 1y ago
We're all greedy. We all want to get the most for our money, time and effort. Greed and desire push us to spend our energy, otherwise we'd simply conserve it. It's normal, it's natural and it works. It's human (and animal) nature. Altruism works fine in individuals and small organizations. But large systems based on altruism uniformly failed to provide the most basic necessities (like food) for their citizens. Can't work against human nature.
- nosianu 1y ago
  > We're all greedy. We all want to get the most for our money, time and effort. We are? For example, I never file taxes. I'm certain I could get quite a bit back. I am far from rich, I earn medium pay in Germany - medium overall, not medium in IT. (Because I deliberately took a more rewarding and relaxing job, but that's besides the point.) I will not fill my mind with "money" stuff. Even if that costs me some of that money. I am sure, given that the terms used are as fuzzy as can be, you can twist and shake the words until you can claim that I am "greedy", the problem with this rationality discussions is how extremely flexible the words used are, making it quite impossible to win or lose an argument. All one has to do is insist on one's own definitions... but taking a relaxed view, I don't see good way to make not-at-all-rare positions such as mine as a form of "greed", without severely twisting the commonly understood meaning(s). I think a lot of that world view is self-fulfilling. When I was a kid I LOVED working like the adults. That includes taking one to four week stints in factories, as a teenager in school. That was common in East Germany and encouraged, early acquaintance with work life. I did the same helping out my craftsman grandfather and my shop-owing grandmother. Work was FUN! But now, the reason I don't just go - which I would LOVE to do! - and work a few hours low-level jobs here and there, is because it's all been heavily commercialized. You just don't do that! Work has to be pain, and you get paid. Only an idiot would work for free! During university, during a semester break, I took a job in a chocolate factory. I did not actually need the money! My parents paid (divorced, but both paid). I actually had a lot over at the end of university (cheap dorm housing and no fees for the university itself sure helped). I took the job because I wanted to work in a factory again. It is FUN!. Until that middle manager a..ole appüeared. I had just optimized my in-between assignment of taking care of some machine chocolate thing, some mixing, I forgot the details. I had set everything up perfectly and now had to just wait a few minutes for the machine to finish. In comes that.... manager guy. Immediately, seeing me sitting there he yelled at me why I'm not working. FU manager guy. That was the day I realized work now is WORK, not fun. You are not supposed to have fun. You now need middle manager person to keep your lazy ass in check! By yourself, without continuous pressure, you would not move a hand! Right? At least for the "lower" jobs, which are the majority. > It's normal, it's natural and it works. It's human (and animal) nature. You are definitely not speaking for a lot of people, and what you see is NOT the one natural outcome. Expectations and behavior towards people determine theirs (behavior). The culture I describe existed all around me in East Germany. Yes we were waaayyy backwards with everything, but work culture was really good. I learned a technical profession in a large chemical factory before studying. Everybody worked, useful stuff too, all day. The ancient machinery in the crumbling buildings needed a lot of attention to keep them running. There was hardly any slacking off anywhere I looked. Sure, it was relaxed, but it was work, work, work. I've seen waayyy more slacking off in the offices of large American IT companies. What you describe as "natural" is natural only in the context the current society has created.

somenameforme 1y ago

For the overwhelming majority of things people to go to the hospital for, where you go doesn't really matter, because the treatment and diagnosis is extremely routine. This includes very serious things like cancer. My mother, through a variety of fortuitous events, was able to have her breast cancer treated at one of the top ranked cancer specializing hospitals in the US. She had acquaintances that had theirs treated at the local university/training hospital. They ended up receiving literally the exact same treatments. Same for my own stuff. The first time one of my children got sick it was terrifying, so I naturally took him to the most premium pediatric healthcare institution. And what did they do? Basic tests to rule out anything particularly nasty, and fever management. The exact same thing the cheapest hospital does, except I got the privilege of paying 10x more for it and feeling like a complete sucker. From that point on - 'oh he's sick? shall we go to the university hospital, or the religious nonprofit?'

owenthejumper 1y ago
Unfortunately it does matter. NCI designated cancer centers simply do have better outcomes than local hospitals.
- deleted 1y ago
  [deleted]
- somenameforme 1y ago
  This is not entirely clear. Elsewhere in this thread I found a couple of studies on this exact topic. The first [1] is just for breast cancer and after normalizing across a wide array of variables, found no improved survival rates except for black women, which I think is suggestive of further biases. The second [2] is for all sorts of cancers, but is a large observational study without much effort to control for biases. It found an overall increase in five year survival rates of 3.6% (64.3% in NCI centers, vs 60.7% in non-NCI). That's certainly something, but it's fairly certain that biases would bring that down a healthy chunk. However there were significantly better outcomes in more rare/lethal cancers. For instance in hepatobiliary cancers, the NCI survival rate was 33.8% vs 18.7% for non-NCI centers. And that is largely the point I'm making. For the overwhelming majority of things, care is mostly commoditized and you will be fine wherever you go. The value of high end institutions is mostly only realized in the case of rare/serious issues, for which transfer is always an option anyhow. --- Though I'd also add here that these examples, cancer, are on the fringe extremes of what my point was. That there is a strong argument to be made that even cancer falls within it, just further emphasizes the point. If your local hospital can competently treat cancer, they can certainly treat the overwhelming majority of reasons people go to the hospital, which are relatively far more commoditized. [1] - https://pmc.ncbi.nlm.nih.gov/articles/PMC8462568/ https://pmc.ncbi.nlm.nih.gov/articles/PMC8462568/ [2] - https://pmc.ncbi.nlm.nih.gov/articles/PMC4892698/ https://pmc.ncbi.nlm.nih.gov/articles/PMC4892698/

DangitBobby 1y ago

Most markets fail here. I can't even make good decisions about which electronics or appliances to buy, which restaurants to visit, which mechanic to use, and it's not for lack of research or unwillingness to pay. Advertising allows brands to build undeserved market reputation, and brands regularly sabotage their own legitimately established brand reputation for financialization.

rtkwe 1y ago
I think it's particularly bad in medical decisions though because it's so much more advanced and cases are so varied it's difficult to compare doctor performance on different procedures. At least with products you generally get similar items each time so people can test multiple products in some scenario and a buyer can know what they buy should perform similarly.