ControlsFreak
No bio...
User ID: 1422
ControlsFreak
11d ago
wholesale spying on the contents of almost everyone's Internet traffic --- see Snowden, et al
That's not what Snowden showed. Like, not even close.
Clapper lying to Congress about it
Clapper gave the correct, classified answer to Congress after the unclassified, televised to the public, hearing was completed.
However as this is America many places will prohibit providing this type of information as a matter of policy because of the risks associated with doing so (like being sued if the bill is higher than the estimated number).
Cite one example of a provider being sued because a bill was higher than an estimate. Do you think this commonly happens in other industries which provide estimates, even though the final bill might end up higher? (E.g., auto mechanics, plumbers, etc.) Fake "liability concerns" is a common excuse for shady practices in a variety of industries. In fact, it's funny that you bring up realtors, because they definitely bring up fake "liability concerns" for all sorts of shady practices.
It's actually extra funny, because realtors did just last year have a huge, billion dollar lawsuit because of their attempts to hide prices. It resulted in industry-wide practice changes, the largest of which is that they now give people prices up front, in writing.
ControlsFreak
13d ago
You are correct. I didn't realize that "reddit" looked like it does. I totally just picked "dark" and didn't cycle through a bunch of others to see. I think I'll try "reddit" for a while. Thanks a bunch for the tip and the code!
ControlsFreak
13d ago
Seven years ago, I saved this @JTarrou comment, for the purpose of remembering to monitor future developments:
The current Republican president is always the worst person in history. The last one is always surprisingly human. The one before that is always a pretty decent dude.
The current Democratic president is Star Trek Jesus with sprinkles, the last one was a corrupt liar who wasted his vast potential, and the one before that was a Republican.
I'd say that Obama is probably still well-regarded, possibly having something to do with some people thinking that he was pulling the strings during the Biden Administration. I'll be interested to watch his future trajectory as years continue to pass, but I do think it might be hard for people who lean left to say much that is negative about the first black president. I suppose I've heard some criticisms from the left that he "was a Republican" in terms of his national security policies, but I certainly don't think I've seen him go through a "corrupt liar" phase. At least not as of yet.
ControlsFreak
13d ago
Small request from a scientific coder, not a web page coder. In dark mode, the visible change when I upvote a comment is basically imperceptible to me. (I don't think I'm color blind.) Can you whip up what I need to adjust it?
ControlsFreak
18d ago
If you show up the ED with diverticulitis you could be seen in the ED and sent home with conservative management. You could be put in obs for a day and started on Zosyn and fluids and kept NPO, you could have a perf leading to surgical management, necrosis, and a 3 month hospital stay. Nobody knows any of the numbers associated with this visit until it's done.
What is the number for the next procedure that you are just about to get informed consent for?
Physicians aren't in control of this.
Then you should have no problem supporting a requirement that your employer figure it out.
Health systems aren't in control of this. Most importantly we can't control insurance.
No one has asked you to.
ControlsFreak
19d ago
I mean, sure? Got any suggestions for how to do that? I don't think, "Do everything you can to make sure patients never get prices," is particularly helpful for that problem.
ControlsFreak
19d ago
They may send it to a collector. They may also just sue you directly, which is apparently a thing that has been happening more often. One of those things where, sure, if you're flat broke and judgment proof, then perhaps you can 'get away with something'. I was under the impression that you were inclined to disfavor systems that inherently gave free stuff to broke, judgment proof folks and crushed upstanding citizens with assets to lose.
I mean, the patient likely can get the treatment regardless (see also the main NYT article). Doing so with a not-yet-settled pre-auth battle is approximately equivalent to doing so without a pre-auth battle at all.
Also without pre-auth, the patient has more leverage; it's the provider who is on the hook if nothing is done
This isn't really true, though. If they get the treatment without the pre-auth completed and agreed (or none done at all), and the insurer ultimately denies it after-the-fact, the patient still owes the bill. There's still a whole range of things that can occur with the resulting cluster of a negotiation after-the-fact. The only thing that I see that has changed is that services have already been rendered, the patient is now potentially liable for a gigantic bill, and the negotiation for who actually pays what just hasn't happened yet. The patient has even less leverage, because they've already agreed to buy the thing. They almost certainly can't un-buy the thing. They're purely at the mercy of the other parties to decide how much they're going to get stuck paying.
ControlsFreak
20d ago
I don't think I'm being naive enough to say that the providers and insurers will sing kumbaya and everything will get happily approved perfectly as it should be. As evidenced by the doctor's comments elsewhere in this thread, both parties take every single interaction as a chance to negotiate and improve their take. If anyone has an idea to fix this, I'm all ears. But I'm certainly not counting on it.
Consider the case without the pre-auth. Services are rendered, a bill exists that shall be paid, one way or another. Nothing really stops the insurance company from just saying "no" regardless of whether the policy covers the thing or not... at which point, either the provider will argue with them, or the provider will say that the insurance company said "no" and leave the patient to argue with them if they care to. (Otherwise, of course, they must pay the bill themselves.) But now, all of this happens after the fact. What have we improved?
Instead, the only choice I think we have much hope of making is whether they have to hash out their beef before or after patients have to make decisions that could bankrupt themselves because of the crossfire. I'm certainly open to ideas for reforming pre-auths, so that they get that hashed out before patients have to make these decisions. Time limits, whatever. Any ideas for how to do any better?
ControlsFreak
20d ago
prior auth reform
I am sad that you won't see this, because I am genuinely curious to find out what you mean by this. Like, it could mean anything. We could reform it in a way that is even pretty painful for insurers. Could make it basically mandatory for many of the things (at least anything that has some minimal level of denials happening), and require insurers to respond within certain timelines, electronically or whatever. Then, you'd have less uncertainty about what they'll want to do, and you'll have good information to give to your patients. I kiiiinda think that this isn't what you have in mind, and yeah, am just super curious.
ControlsFreak
20d ago
The problem is that the cost to provide the healthcare, the price the hospital wants to charge the insurance company (and therefore you), the price the hospital actually charges the insurance company, the price the insurance company actually pays, and how much you are on the hook for are all totally different, often completely unrelated to each other, and involve information that other parties don't have.
Adding to @ArjinFerman's response, most of these don't matter.
Your health system can usually functionally guess how much your insurance will want you to pay for something but it's a guess and insurance companies deviate frequently and quite substantially.
You know what you're planning to bill, right? You know what the list price and the negotiated price are, right? You can give that to the patient. If you're doing something where you think there's a substantial chance of a substantial deviation, perhaps inform your patient and consider asking them if they'd like to do a pre-auth to help reduce the uncertainty?
If the insurance company knows exactly how much something costs they'll low ball the hospital
You're slipping back to one of the numbers that aren't relevant and that no one is asking for. We just want what you're going to bill and what you've already negotiated with the insurance company. The insurance company already knows these things. You already know these things.
Smuggled into here is the expectation that the doctor specifically and the healthcare system in general provide information about what another actor (the insurance company) will do.
You don't need that to provide what you're planning to bill and what your negotiated price are. Sure, if you're significantly worried about what this other actor will do, then see above.
Physicians themselves having awareness of some of the specific numbers is possible in an environment like one guy only doing total knees with a few major insurance companies but that doesn't usually happen. Asking us to know
Yup. The "Why should that be the doctor's job?" argument. You know full well that I don't care whose job it is.
ControlsFreak
20d ago
I read the article as criticizing both the provider and the insurance company, rightfully. They never once put the blame for "dropping the ball" solely on one party or the other. I don't either. Both parts of the industry need to get over the ridiculous idea that prices don't matter to patients and do better at informing them prior to decisions. It is mostly the gestalt sense that prices don't matter and that there's no point in informing patients that causes both of these players to fail so miserably.
It is unfortunate that the author didn't tell us much more about UHC's perspective on the matter. That might have given some choice quotes to make my point further that they're not getting it, either. But we did get choice quotes from MSK which very clearly and directly make my point.
ControlsFreak
20d ago
I agree that there are plenty of situations where the patient doesn't really have much skin in the game or where price mostly doesn't matter for whatever reason. I wrote about an example of the former here.
The latter are probably quite routine, too. This is sort of unsurprising in economics. Demand curves slope downward, and everyone to the left of the equilibrium point gets consumer surplus. The further left you go, the more surplus they get. If I'm a customer who would buy an apple for $2, and prices usually vary a bit around $1, but maybe if there's a bad harvest, they're like $1.50, then yeah, for the most part, the price doesn't matter to me. That doesn't really imply that the price doesn't matter in general. So, riffing of what you say:
Price transparency is nice for society, but not crucial for patients.
Price transparency of apples is not crucial for a bunch of people whose willingness to pay isn't somewhat close to what the price actually is. But it's actually pretty important for society and for a bunch of people whose willingness to pay is much closer to the actual price.
Many people are discovering the headline-grabbing version of the problem, too. Imagine if apples usually cost about a dollar. It varied from day to day, but they didn't tell you up front. Some times, incomprehensibly to the individual, they suddenly cost $1k. But they also didn't tell you this until after you'd eaten it (after services were rendered). Everyone knows it's kind of sketch, but no one can bring themselves to just make the grocery stores give people a price up front. This is how a lot of people view the current lack of transparency. Memes abound about how you got a papercut, spun the roulette wheel of the American Medical Industry, and found out later whether it cost you $1 or $100k.
Secondly, the health insurer and the hospital already have a pre-existing agreement on a price list. What they are negotiating about is which medical procedures (and line items) are indicated.
Yup. This cuts out most of the arguments for why patients shouldn't get prices. At the very least, providers can provide an estimate of what procedures (and line items) they're planning to bill. They can look at the pre-existing, agreed upon price list, that they have, and give you the relevant information. Of course there will be cases where 'something happens', and it turns out to not be correct. The classic example is that you're going in for a relatively routine surgery, and there's like a 1% chance they're going to find something that 100x's the price. Well guess what? There's a good chance that the doctor already told the patient that there was something like a 1% chance of finding something that significantly changed the nature of the procedure. That's just good informed consent. That same informed consent should at least include some form of, "...and yeah, if that happens, it'll 100x the price." (Now, that may not meaningfully matter for some insurance cases, but just inform them, people!)
For the most part, providers and insurance know where the line items are that typically get argued over. Sometimes, a pre-auth is actually good to do. Providers can at least tell the patient what their plan is, but it would also be nice if they gave their perspective on whether the planned billing was likely to run into difficulties or not. As the linked article puts it:
Given that presurgery mental health is surely part of the institution’s concern, it could have sent out a note saying: “Hey, you’re about to get a scarygram. Don’t worry, we’ve got you. Here’s why.”
Just communicate. If there's likely to be some sort of issues with haggling over line items, inform your patient the best you can.
ControlsFreak
20d ago
This is one of those issues that are prone to a gish gallop. There are a bunch of different argument variants, and folks often slip back and forth between them, often not letting a response to one form become the actual topic of discussion, deflecting to a different form, and then swinging back later, as if the initial response was never made. I will try to cover a few variants, of course trying to steelman some where I can.
There is some historical sense of medicine as charity. Historically, many hospitals were, indeed, primarily charities. Medicine is often considered an unalloyed good, and of course, when it's being provided as a charity, doctors and patients should only be thinking about the medical decision, itself.
Robin Hanson talks about how this historical sense has lingered, even as it has transformed significantly into one of the largest industries in modern society. He thinks that medicine is 'sacred' in his terminology. He believes that money is 'profane', and one of the primary rules of the sacred is that is shall not be mixed with the profane.
This makes a bit of sense, and we can sort of steelman it. Medical decisions can, indeed, be life/death sorts of things. (Not all of them, of course.) Plenty of folks have a generic sense that when it comes to such life/death decisions, money shouldn't come into it. They may think so from a personal perspective ("It could save your life; you have to do it; you can figure out the financial stuff later; if you're dead, the financial stuff won't matter anyway") or from a societal perspective ("Society shouldn't allow anyone to have to decide to not get a life-saving treatment just because of the price"). There are pieces of this in @quiet_NaN's comment:
In a borderline sane medical system (e.g. what we have in Germany), that should be wholly between the health insurer and the clinic. The doctors use whatever procedures they see medically indicated, and then their billing department will settle with the health insurer.
Or, as I quoted above, the way the NYT journalist's surgery provider put it:
“MSK is committed to ensuring we are only communicating clinically necessary information to a patient prior to their procedure.”
Or, part of the quote I had above from the old doctor-written NYT Op-Ed:
I saw my colleagues prescribing suboptimal drugs and thought they weren’t practicing evidence-based medicine. In reality, they were doing something better — practicing patient-based medicine. When people said they couldn’t afford a medication that their insurance didn’t cover, they would prescribe an alternative, even if it wasn’t the best available option.
As a young doctor, I struggled with this. Studies show this drug is the most effective treatment, I would say.
There really is a sense for a variety of people that prices are simply conceptually divorced from what the Objective Right Medical Choice is. That there is a simple and sharp divide between the one true optimal thing, which is the Platonic Ideal of Evidence-Based Medicine, and every other possible consideration, which is pure bollocks. That anything else is, or should be, someone else's problem. That patients and doctors should only talk about direct medical costs/benefits. That price 'costs' just aren't even costs, and some other magic either will or should take care of it. And of course, if some other magic doesn't, well, then, you'll be fine figuring out how to manage your gigantic bill; you should just be happy that you got the best care.
Of course, while I get where this is coming from, I don't really buy it. There are plenty of situations where there isn't necessarily an Objectively Right Medical Choice that is conceptually divorced from price. The silly example I use to illustrate this is to imagine having some minor pain in your wrist. For a lot of people, it's probably just fine to take some painkiller and just wait to see if it goes away in a few weeks. The chance of it going away is decently high, and the cost of doing a whole lot more often isn't worth it. However, suppose that same minor wrist pain presents in a superstar NFL quarterback. Say it's in their throwing arm. There may be a ton of value in doing a whole lot more, gathering information, possibly trying an intervention, deciding whether they should sit out for a week or two before the playoffs to have a better chance then, etc. In this situation, the price is much much more worth it.
Obviously, this is an extreme example to make a point, but again, many many people don't think this way. They want prices to not matter. It's probably part of the impetus for many people to support government-run healthcare, because then no patient has to directly make decisions based on price. For many people, just the idea that a patient might "have to" consider price in their medical decisions is an affront to their sense of what medicine "should" be about.
Equally obviously, the medical industry would prefer if no patients ever thought about prices. You don't even need to jump to a nefarious provider who is sneakily deciding to perform procedures for the purpose of making more money rather than the patient's best interest. For one, it contributes to their status image. Their expertise is so valuable that you can't even put a number on it. Obviously, they know best, way way better than you do, and you really ought to mostly defer to them. Dovetailing with this, their expertise is in the medicine; that's what they want to focus on; there's a half-decent chance they don't know anything about the prices anyway. So you should really just acknowledge their status and expertise and view things the way they do, leaving any petty concerns about money out of it.
Second, very related, they don't want to bother. The other thing that the doctor who kept trying to argue here that prices don't matter would slip to is, "Why should that be the doctor's job?" I get it. I do. They're very busy. They have many, many things that they need to know. Prices are complicated. This isn't really along the lines of "customers don't want to see prices in healthcare", but trust me, when doctors get going on this topic, they will slip into this one.
On this front, I just say that I don't care who actually does it, so long as it gets done. Most healthcare providers have plenty of non-doctor staff. Insurance companies likely deserve blame, too. Neither the providers or insurance really cares to inform patients much, and they're more than happy to point the finger and say it should be someone else's job.
This is why I have mostly defaulted into just saying that it should be a requirement. That a patient cannot consent to a procedure (or the corresponding billing) unless they've been provided a price. Legislation can mayyybe even be a bit coy as to who actually hands it over; so long as the outcome is required to happen, let them figure out how to do it.
I suppose, since @ArjinFerman mentioned another variant, I should give a sentence to it. The "all the numbers are fake, so nothing matters" argument. Sigh? Get your shit together and make not fake numbers? When the patient actually gets a bill, it's not going to be a 'fake' number. It's going to be a number that they're expected to pay. With potential threats of collections/bankruptcy, etc. Sure, some providers may make some allowances sometimes, but that's hardly here nor there. If you can provide actual bills with actual numbers that patients are expected to pay (and you do), then you can do a lot better to inform your patient. At least a lot better than the current default, which is 'not at all'.
ControlsFreak
21d ago
NYT Continues Medical Pricing Beat
They're starting to get closer.
It is well-known that the NYT will plan out long-term foci for sustained coverage, taking their own perspective, keeping it in their pages in a variety of ways. I've covered a few in recent months; this one is in the "Your Money" section.
The piece focuses on the author's experience with his wife's mastectomy for breast cancer plus reconstructive surgery and the role that prior authorization played in it. What's that?
prior authorization, where doctors must get approval from health insurance companies before performing big procedures or prescribing certain medications.
About half of Americans with insurance have needed their insurer’s blessing for services or treatments in the last two years, according to a poll from KFF, a health research group.
Why? The only reason they describe comes from their characterization of the insurance industry's response:
The insurance industry defends prior authorizations as a step to keep people safe — say, by preventing unnecessary procedures — and make sure they are getting cost-effective care.
I'd like to steelman the idea of prior authorization by rolling it into my own perspective that I've been trying to sustain over time.
The fundamental principle is that prices matter to patients. This statement simultaneously seems trivial and is also quite profound in context of the medical industry. There are doctors even here on The Motte who have sworn up and down that prices don't matter, but frankly, they're just wrong about this. This NYT piece reinforces this basic principle, though it does not state it quite so forthrightly.
That is, the story of the article is that, two days before the planned surgery, the author and his wife
found a letter in the mailbox from UnitedHealthcare stating that prior authorization for the operation was partially denied.
This was disconcerting to them, which is somewhat strange if one thinks that prices don't matter. It seemed to matter to them. He writes:
Our minds raced: If the denial stood, the cost could upend our financial lives and years of careful planning. Good luck to us, trying to sort this out on Sunday before we were supposed to show up at the hospital in the predawn hours on Monday. Should we even show up at all?
Contrary to what you might have heard doctors say, that prices don't matter because patients can't possibly make choices with price information, they actually can. Here are actual people, considering making the choice to skip a possibly life-saving surgery, because they have uncertainty concerning the price. I've pointed before to another, doctor-written op-ed in NYT that acknowledges this reality:
One of my first lessons as a new attending physician in a hospital serving a working-class community was in insurance. I saw my colleagues prescribing suboptimal drugs and thought they weren’t practicing evidence-based medicine. In reality, they were doing something better — practicing patient-based medicine. When people said they couldn’t afford a medication that their insurance didn’t cover, they would prescribe an alternative, even if it wasn’t the best available option.
As a young doctor, I struggled with this. Studies show this drug is the most effective treatment, I would say. Of course, the insurer will cover it. My more seasoned colleague gently chided me that if I practiced this way, then my patients wouldn’t fill their prescriptions at all. And he was right.
It also tells the story of an emergency room patient, in quite bad condition, that the author really felt should be admitted as an inpatient. The patient was concerned about the possible cost. No one could tell him anything. He chose to go home that evening.
Prices matter. Patients will make choices based on prices. Patients will make choices based on uncertainty about prices. This week's NYT piece drives this home with yet another example, this time concerning a surgical procedure.
They ultimately decided to go through with it, and it turns out that the author managed to talk to a billing specialist from the surgery provider while his wife was under the knife. What he learned:
Turns out MSK had known about the prior authorization problem about a week earlier, when UnitedHealthcare rendered its judgment. So the insurance company told MSK immediately — but not us.
The billing specialist told me that the partial denial was related to some minor procedure codes, not the most important ones. If big money trouble had been brewing, she said, someone would have told my wife not to come that day. Moreover, MSK would have eaten any out-of-pocket charges related to the prior authorization issue if it couldn’t get the insurance company to back off. After all, it had greenlit the surgery that day knowing that there was a lingering insurance issue.
Let's ignore the whackiness (and the veracity) of the claim that the provider would eat any uncovered charges for now. The article makes a fair amount of hash over the issue that they hadn't opted-in for electronic communications from their insurance company, so they only received a delayed snail mail, but the provider was notified earlier and didn't tell them either! Why not?
“MSK does not communicate secondary denials to patients because they are often resolved the day of or postsurgery,” said Robyn Walsh, MSK’s vice president of patient financial services, in an emailed statement. “MSK is committed to ensuring we are only communicating clinically necessary information to a patient prior to their procedure.”
They are just sooo addicted to price opacity; it's ridiculous. The author is not buying it:
This is a pretty clinical definition of clinical. Given that presurgery mental health is surely part of the institution’s concern, it could have sent out a note saying: “Hey, you’re about to get a scarygram. Don’t worry, we’ve got you. Here’s why.”
Prices matter. Prices matter. Prices matter. Get it through your thick skulls, providers and insurers. Just tell your patients. Tell them. They need to know. They're currently making decisions under uncertainty, and you can just tell them. The author closes with basically this exact plea:
As for the doctors, ask them a number of questions: Will there be a need for prior authorization for this procedure? How quickly are you requesting it, so there isn’t any last-minute scramble or fear? Will you or your institution call me immediately if the insurance company informs you of any trouble? If that’s not your normal practice, how about changing that? And if you won’t change your policy, will you please just do it for me? Who in your office should I call or email if I hear about a problem?
But for all of the opt-ins, app notifications and checklists, there doesn’t seem to be anything stopping all insurance companies from doing the simple and obvious thing right now: If there’s a problem, just alert everyone, always — as many ways as you can and as quickly as possible.
Just tell the patient what's going on. Just tell them the price. Do it before services are rendered.
Ok, with the basics out of the way, I should probably get around to that steelman of prior authorization that I promised. The fact of the matter is that there are going to be some drugs/procedures that insurance won't cover, at least under some circumstances. There's probably not a reasonable way out of this with a rule like, "Insurance must just cover literally anything all the time, no matter what." Obviously, there's going to be a spectrum, with some routine things being covered ~100% of the time, with others having significantly more variance. The useful idea behind prior authorization is that the provider and the insurance company should get together... get their shit together... and figure out what the price is going to be for the patient. And, frankly, that makes sense, especially for items that often have significant variance. It's hard to make hard and fast rules here, but my sense that many insurance companies have a list of items where there is significant variance and so they require prior authorization.
It is good for them to get their shit together. It would be even better for them to get their shit together more routinely and then to tell the patient what things are going to cost. It is a pox on both their houses that they haven't gotten their shit together. The old NYT op-ed was written by a doctor, so it's no surprise that they wanted to put all the blame on the insurance companies. This week's was written by just a guy, one of the journalists on staff, talking about his own experience, and he more rightfully pointed out that both providers and insurers are failing.
NYT is getting closer, but they're not quite there yet. They've given multiple examples of why giving patients prices matters, but they haven't quite figured out that they just need to beat that drum directly.
Agreed that this makes districting quite the tough nut to crack.
I had a thought that I should learn more about the history behind the adoption of the Seventeenth Amendment, which was ratified by the very people that it took power away from. I did a little bit of reading, but there are competing historical perspectives that I'll have to ruminate on further.
There are definitely parallels in terms of national/state-level dynamics, impinging on one another. It also seems unlikely to me to propose that people at that time were simply naive to the possibility that such a rule change would be likely to advantage/disadvantage them. Some explanations try to argue that some of the main implications had already effectively come about via other means, so it wasn't a terribly sharp break. I don't know.
In any event, perhaps worth ruminating on and reading more history. It seems not entirely impossible to come up with something, but perhaps it is the case that nationalized interests are too entrenched and 'smart' to the scene that even minor steps will be more effectively blocked. In that case, we'd probably need to be more clever to messy up the predictive capabilities.
I haven't totally given up on toying with various schemes, but it is a difficult problem that is seriously resistant to most flippant proposals.
ControlsFreak
24d ago
Yup. It's internecine war on the left. The foundational group desire is atheism. This part is the sacred, in Robin Hanson's terminology. There is a long history of trying to wield science as a sword for atheism, but in doing so, one runs headlong into pesky intellectual challenges. The core of this conflict is how to deal with them.
One common attempt is to just deny that there's any problem to be solved. The charitable view is to observe that such folks have mistaken methodological constraints for a metaphysical theory. But you sort of can't keep it from bubbling up, so you have to keep denying, keep refusing to talk about it. For example, since mathematics is so useful to the scientific method, it is natural to desire to include some grounding there. But, like, how does that work? What is the philosophy of mathematics, and how does it fit into the scientismist view? Let's not talk about it.
On the morality front, it has left most of the left just grasping for a naive form of meta-ethical relativism. When poked, there are often half-hearted appeals to game theory. I think that both sides of the internecine war do feel like this is their best grounding, but it's sort of interesting that one side just doesn't actually understand even the most basic components of what game theory is about. That's why they're surprised by the most basic concept in game theory - unilateral defection. The other side, the wokies, grok unilateral defection. They grok that once it has been accepted that it is declared not possible to reach the truth of a matter via rational argumentation, when the only thing left is game theory, one can simply move to brainwashing, shaming, canceling, deplatforming, intimidating, and maybe even having struggle sessions or genocides.
The thin line of hope for scientism on these issues was, "Since we have no clue what else to do, but we're trying to prop up science as the answer to all the things, I guess what we'll do is just ask the scientists to answer everything for us." That ran hard into unilateral defection. When the scientists are the new priesthood, it's pretty straightforward (and unsurprising to religious folks) to see that a simple strategy is to just corrupt the priesthood. The biggest difference between the corruption of the academic priesthood and the ratheism/atheism+ schism was that the former took time and was done with most people somewhat unaware, while the latter was quite sudden and visible. Neither is surprising; it's just unilateral defection, fighting the sectarian war by the only means remaining once one abandons intellectual rigor in favor of scientism.
ControlsFreak
25d ago
Yup. This is what I proposed six months ago. Later, I got showered in downvotes when I said maybe, perhaps, they should do something like this, targeting the institutions and policies in a way that could actually affect change rather than using 'indiscriminate chemotherapy' on academia. Tons of people here seem to have bought into the idea that the entire university system is 'enemy' and must be destroyed rather than changing their behavior.
I find that perspective mostly ignorant of theoretical premises, instead jumping in at the level of 'grunt'. That is, one should start by considering the conceptual nature of war. Clauswitz and all; politics by other means. Even modern political science treatments talk about war with the phrase "coercive bargaining". You actually have a goal that you want to accomplish. Usually that goal is not to simply genocide a people.1 It may be that war or the threat of war furthers that political/bargaining objective.
Now, it's only after elites think that war or the threat of war may further their political/bargaining objective that you start propagandizing the proles about the other side being the 'enemy' that must simply be eliminated. Their weak minds lap that drivel up, likely blind to the political/bargaining objectives that are underlying the entire endeavor in the first place. These are the 'grunts'.
Early on, from what I could tell from the grapevine, they were genuinely just blowing up shit randomly. From what I heard, there was no rhyme or reason that could be discerned; just some random things getting cut randomly, without any meaningful reason attached. Like if some private was suddenly thrust into generalship, not even knowing the terminology or how the systems worked to align efforts with the objective. Such a private would, understandably, make all sorts of random decisions with random and unpredictable effects. Some here were happy with that pathway, with the aforementioned analogy to 'indiscriminate chemotherapy'.
Now, it seems like the administration has either gotten up to speed or put someone in charge who actually knows how to be a general. They might still not be perfect at it, but I'm glad they're at least trying something more like my six month old suggestion. Concerning Tao, specifically, I wrote previously on how this affects individual incentives:
Moreover, it also changes the individual incentives. If you're a hard sciencer who doesn't give a shit about wokeness, you might still find yourself accepting a job at a woke-ass uni, because that might be the place that really enables you to get grants, have equipment/space, top students, whatever. If suddenly, it doesn't matter what you personally do/don't do in your research, but staying at a woke uni means you're forbidden from getting grants, while moving to a cleaned up uni means gravy train, the unis that manage to clean house are going to get showered in top tier talent. No more unis managing to somehow attract some set of possibly politically-neutral, bank-making talent that they skim from to fund their crazy wokies.
1 - Possibly one might have a goal for which genociding a people is the most effective means by which to attain one's goal. Without getting into that conversation too deeply, the actual end being served is still not the actual genocide.
ControlsFreak
1mo ago
I mean, I did just accurately describe your behavior before. We were having a nice pleasant conversation until you went wild and declared the conversation over due to the difficulty in your position.
But to each their own. You can put your hands over your eyes and also plug your ears with your thumbs at the same time. I'll still just be here, pleasantly pointing out where there are problems with attempts at meta-ethics or philosophy of mathematics.
ControlsFreak
1mo ago
No, I showed that my point was coherent
We can just read the comments. You never told me what your terms meant, because you couldn't. Perhaps you missed my edit back then, even though I recall doing it quickly, so I'll repeat it here just in case:
Let's change the syntax to make it clear. Suppose you had said, "I know my values are just as blurf (or not) as everyone else's." Suppose I inquired as to what you meant by values being blurf or not, or multiple values being equally blurf. It's not really helpful to say that there is nothing objective about blurf. It still simply fails to tell me anything about what blurf actually means.
Not with you, I'm afraid. @Primaprimaprima is far more pleasant to talk to, hence I am more than happy to discuss that in detail with them.
I'm a pretty pleasant guy. What have I said that is not pleasant? I think you might be confusing a pleasant conversationalist with a pleasant conversation. Most people don't like conversations where large problems with their stated positions are brought to the fore. That's fair enough. But that's probably what you find displeasing, the clear and obvious feeling in your gut that you know your position has a problem, and that you don't know what to do about it. I sympathize; I've been there. Just a piece of advice, though; thinking that you're going to be able to avoid the problem by avoiding the person who points out the problem never works. Moreover, it's unMottely.
ControlsFreak
1mo ago
Fair enough on the positive claim concerning meta-ethics. If you'd prefer to leave that one in incoherence, you can leave that one in incoherence.
Would you like to take a shot at your negative claim with analogy to philosophy of mathematics? Any sort of clarity or argument there?
ControlsFreak
1mo ago
I have a strong conviction that objective morality does not exist. The evidence against it is a vast, silent ocean; the evidence for it is a null set. I consider it as likely as finding a hidden integer between two and three that we've somehow missed.
It's rather ironic that your own choice of analogy willingly jumps into the thicket of the philosophy of mathematics. Perhaps you're just doing so unknowingly or just with a general lack of care, but that would indeed be apropos.
What sort of 'evidence' do you think one would gather to determine the status of mathematical objects? Is it empirical? Do you perform an experiment? Is that the means by which one 'finds' or, say, 'discovers' things like integers?
My own stance is that I am both a moral relativist and a moral chauvinist, and I deny these claims are contradictory.
I hate to do this, but last time we did this, you were unable to even explain what it is that those terms meant. Would you like to take another go at it?
ControlsFreak
1mo ago
Is there any indication that jumping to a paid, but publicly-available model is a significant improvement for math? I'm probably not going to spend the time right now to create my own bespoke setup.
Do any of the folks you've read talk about how they do their prompting? Like, can I just plop significant amounts of LaTeX straight from one of my papers into it for problem setup? Is there a better way of going about it?
Nope. Still wrong. Please just educate yourself on this. I've been over this with you before. There's a nice PCLOB report and everything that detailed how it actually worked. You just need to read it. As a quick check to see if you have read enough to have any idea how any of it works, what is the meaning of "specific selection term" and what role does it play in this supposed "wholesale collection"?
More options
Context Copy link