ControlsFreak
No bio...
User ID: 1422
ControlsFreak
3mo ago
Do you mean "not regulated at all" or "not regulated by a federal bureaucracy"? ... The latter statement is what is at stake
I mean, not even that is at stake. Congress could still give agencies pretty broad authorities and pretty broad discretion. It would only be that, given the particular wording the statute uses, if there is an ambiguity, the gov't wouldn't auto-win every time. They'd have to cry a little tear for the poor federal agencies out there make their case in court for their reading of the statute.
ControlsFreak
4mo ago
What number of states removing Trump from the primary ballot will count for you as being larger than losing a Supreme Court Justice? What number of states removing Trump from the general ballot will count for you as being larger than losing a Supreme Court Justice? Set a goal post in the here and now, before we get to the culmination of this trend, so that we can look back and gauge whether they ended up escalating or not.
ControlsFreak
2mo ago
The current contours, given existing statutory law for material support, were outlined in last year's case Twitter v. Taamneh. Worth a read. Of course, if you listened to oral arguments there, they did try to grapple with whether they could say something about 230 or about Constitutional limits, but the opinion they converged on dodged all of that and focused purely on statutory interpretation, making their job a lot easier and kicking the can down the road a bit. The upshot, at least for folks who want to impose some sort of legal liability on these companies is that, since this was purely about statutory interpretation, it's entirely possible that they could just pass a different statute that can provide a different standard. It will likely only be when more statutes are passed that pull that line closer and closer to Constitutional/230 limits that we'll really see where the boundaries are.
As an aside, in that case last year, these companies were all swearing up and down that their algorithms are totally passive, agnostic to the nature of the content, and that they are indifferent to the customers who use them. Compare to this week's arguments, where many of those same companies were all swearing up and down that they expend significant time, money, and effort to carefully curate a newspaper-like editorial product that reflects the company's desired expression, and that being able to prohibit Tucker Carlson or Rachel Maddow from using GMail just because they don't like their politics is just a regular part of their editorial discretion. This massive hypocrisy was pointed out multiple times, and we'll see if it matters in the final decision. There have been times before that the Court has been pissed off by repeat litigants who appear to make a mockery of the Court's standards and processes by making contradictory claims about the same underlying facts in different cases at different times to achieve the results they want.
ControlsFreak
5mo ago
I think the intersection between the set of people who adopt natural law and the set of people who adopt a consent-only sexual ethic is possibly the empty set.
ControlsFreak
5mo ago
That’s why the Trump administration briefly floated the idea of relocating headquarter offices outside the DC beltway.
This has long been one of my favorite reform proposal, but it's hard to make it stick. Every agency out there feels like their highest imperative is to ensure that their overlords "understand" what they're trying to do, finds value in their organization, and keeps the resource train flowing. So it is not uncommon that even when the bulk of an agency is actually located elsewhere, their leadership either all have offices in DC or spend significant amounts of time "traveling" there. So, one likely immediate consequence is that this "travel" to DC will ramp up even more, such that agency leadership essentially all have "temporary offices" there that become less and less temporary. They'll delegate more internal power down the chain as their jobs become more "externally-focused". The result may be a bit of a rift between agency upper/lower-upper management. In the balance, how does this actually affect the day-to-day operation of the agency? It probably depends a lot on agency specifics and how much their upper/upper-middle layers cohere through the process.
In sum, I sort of thing that just firing and turning management into political appointees accomplishes a certain amount, while relocation sort of severs upper management from agency operations, which may actually reduce the effectiveness of turning those folks into political appointees. The permanent bureaucracy already does a lot to isolate political appointees to make sure they can't "stir up too much trouble", and that may actually be a bit easier to do if they can just ship them all off to DC all the time, while they take the real reins of power over day-to-day agency operations.
ControlsFreak
5mo ago
Regardless of what happens in the legal case, that BBC article is a prime example of how the propaganda machine rolls. "A man has been arrested..." Literally no other references to this man. You can't make this stuff up.
ControlsFreak
4mo ago
Romney's one of the last Republican's who have actual ideas.
Your chauvinism is showing. What makes an idea "actual", besides it "actually" being a Dem policy position?
ControlsFreak
5mo ago
"Picking up pennies in front of a bulldozer," is the phrase that came to mind when reading your comment.
ControlsFreak
8mo ago
I have posted about secrecy in voting here before, and I included a discussion of the historical reason for adopting the "Australian ballot". This iswas a hugely important issue for a very long time, not in the sense that it was an important and controversial issue. No, it was hugely important and not controversial, at least among generally free countries.
Unlike how organizations like the ACLU officially changed course and explicitly disclaimed their prior views on vaccine mandates, my sense is that most organizations still overtly claim to value secrecy. Just a casual web search provides things from IPU:
Acknowledging and endorsing the fundamental principles relating to periodic free and fair elections that have been recognized by States in universal and regional human rights instruments, including the right of everyone to take part in the government of his or her country directly or indirectly through freely chosen representatives, to vote in such elections by secret ballot, to have an equal opportunity to become a candidate for election, and to put forward his or her political views, individually or in association with others,
From the Bureau of International Information Programs (IIP), U.S. Department of State:
Free and fair elections require:
...
Secret ballots — voting by secret ballot ensures that an individual's choice of party or candidate cannot be used against him or her.
USAID helpfully cites the Universal Declaration of Human Rights Article 21.3:
The will of the people shall be the basis of the authority of government; this will shall be expressed in periodic and genuine elections which shall be by universal and equal suffrage and shall be held by secret vote or by equivalent free voting procedures
and the International Covenant on Civil and Political Rights Article 25:
Every citizen shall have the right and the opportunity, without any of the distinctions mentioned in article 231 and without unreasonable restrictions... To vote and to be elected at genuine periodic elections which shall be by universal and equal suffrage and shall be held by secret ballot, guaranteeing the free expression of the will of the electors.
They call "secrecy of the ballot" a "core election-related international obligation" and define it in the annex as:
Secret ballot: Voters should be able to cast their ballot in secret without fear of intimidation. Ballots should not be able to be linked with individual voters.
If those organizations are a little too America-linked, here's OSCE, circa 2010:
Voting by secret ballot Voters should mark their ballots alone, in the privacy of a voting booth, and in such a way that the marked ballot cannot be seen before it is cast and cannot be later connected with a particular voter. Exceptions can be made only under specified conditions, such as at the request of voters who require assistance, e.g., disabled or illiterate voters. Any voting outside of a voting booth compromises the secrecy of the vote. The presence of more than one person in a voting booth should not be permitted, as it compromises the secrecy of the vote. Open voting or unlawful voting by proxies are violations of the secrecy principle. Arrangements for voting by members of the military and by prisoners should ensure their votes are secret and not subject to coercion.
Reading their COVID-era publication sheds some light on the difficulty:
The right to cast vote by secret ballot is another cornerstone of a democratic electoral process, enshrined in:
1990 OSCE Copenhagen Document, paragraphs 5.1 and 7.4;
1948 UDHR, Article 21;
1966 ICCPR, Article 25;
1996 UN HRC General Comment No. 25, paragraph 20;
1953 ECHR, Additional Protocol, Article 3; and
2002 VC Code of Good Practice, sections I.3.2 and I.4.
Effective protection of secrecy of the vote is one of the key challenges posed by some alternative voting methods, particularly when voting takes place outside the controlled environment of polling stations, such as postal or Internet voting, or when voters' choices are revealed to their appointed representatives, as in the case of proxy voting. Secrecy should therefore be at the forefront of decision-making when introducing or expanding the use of alternative voting methods. It requires safeguards in law and regulations, as well as due care and proactive steps by polling staff to protect it and to prevent any breaches. The importance of the secrecy of the vote, as well as measures taken to protect it should be addressed in civic and voter education programmes, as well as through prompt investigation by law enforcement bodies of its potential violation.
Secrecy considerations are also central in the context of polling station layout and set-up, equipment used, as well as in voter processing and flow management. They need to remain as one of the priorities when considering adjustments to polling station arrangements, including any special measures to mitigate public health risks
They continue in detail:
The secrecy of the vote may also be challenged by remote voting systems like postal voting, as it takes place without the presence of election officials or observers. Postal voting also provides for less oversight of certain behaviours, like influencing the vote of others and family voting. States, nevertheless, have an obligation to take measures to ensure that the principle of secrecy is maintained.
Ballot delivery, marking, and counting systems used in postal voting present considerable and unique challenges to the integrity of elections. There are several commonly used procedural safeguards for voting by mail, such as ballot secrecy envelopes, witness requirements and signature verification. However, these technical solutions may not be enough to instill confidence in postal voting if there is diminished public trust in electoral processes and administration.
You can just tell that they know that this is a problem. They know that their 2010 position was widely considered to be the correct position for good reasons. They even point out some of those good reasons. But what can be done about it? "Eh." Probably nothing. Why yes, everyone must obviously agree with the position that ensuring strict voter secrecy is, in principle, an obligation of States holding free and fair elections, but it just doesn't seem like we can figure out any specific advice to make it actually work, since it's, like, not 2010 anymore. So, well, if we can't come up with any good ideas to actually implement the principle in the face of the concrete thing that we want to do right now, the "principle" will just be attested to verbally, as a signalling mechanism, while we proceed in just trodding all over it.
It's absolutely maddening from a historical and theoretical perspective. What's worse is that it threatens to be yet another issue where we had broad consensus across essentially the entire free world, but now could end up being another issue associated with "loony Trumpists", making it ripe for the chopping block. The impact may not be felt today, or even in the next decade... but I cannot imagine what the long-term consequences could be of simply jettisoning this principle for the rest of time.
ControlsFreak
1yr ago
Now do food.
Suppose there is a food cartel that has gained sufficient market power that they could restrict output, raise prices, and profit according to standard monopoly theory. If you are in a position where you can't afford food, you're going to go without food or you're going to be saddled with food debt. If the food cartel perfectly price discriminates, then you can get food for exactly your willingness-to-pay (i.e., you have basically nothing left for any other aspect of the Good Life).
This is the threat that the cartel issues in order to get you to be willing to have the government come in and hand them the tools to price discriminate perfectly. But that's all it is. It's a threat. Blackmail. From their position of market power.
You're right that once we've gotten ourselves into such an abhorrent situation with the food cartel, maybe it's an appealing trade-off. But hot damn is the vastly better deal to break the food cartel, create a competitive market, watch the price of food fall to the marginal rate of production, and see everyone eat plenty of cheap food and have money left over for, like, flatscreen TVs or whatever.
This is sort of the point of my OP. We see this progression of reasoning happening over and over again in all these domains where the gov't comes in; they subsidize demand, restrict supply, create a de facto cartel, completely destroying the competitive market. Then, when your back is against the wall and all seems lost, they issue the threat. "Just let us take all the surplus now; it'll be epsilon better for the poorer part of the population." And they're right! It is epsilon better for the poorer population (and significantly worse for the richer part of the population).
The real problem is that you put yourself in such a vulnerable position to such a threat. That you let the gov't subsidize demand, restrict supply, and set up a de facto cartel. The first best solution is to undo all of that shit. The second best solution is to observe on the internet how the same dynamic that results in this threat seems to keep materializing over and over again. A distant third is to just give in to the threat, trading what's left of consumer surplus for the richer part of the population in exchange for an epsilon improvement for the poorer part of the population.
ControlsFreak
1yr ago
Concerning the @Esperanza post:
Pope Francis said that a man’s gayness was less important than whether “he searches for the Lord and has good will.”
No, he asked who was he to judge, forgetting his position. He could decide to make homosexual actions not a sin. It is within his power.
I've been seeing the question lately in a few places, most recently when Bryan Caplan did a podcast with Richard Hanania: how much "power" do people "in power" actually have? In the podcast, they talked about university presidents, but I've heard it discussed for all sorts of positions. The idea is that, to become a university president, you have to do so many things to please certain people, who have certain interests. To what extent do you need to continue pleasing them to remain university president? Even if you can't be formally kicked out of your role for a particular action, to what extent does your role require cooperation/acquiescence from a variety of stakeholders? If you spend all of your political capital accomplishing one thing that is incredibly controversial among your stakeholders, they may proceed to do everything they can to neuter every last shred of remaining power that you have until they can actually kick you out.
I imagine these constraints vary significantly across different positions of power, but as a non-Catholic, I would argue that the pope does not have the power to "decide to make homosexual actions not a sin", even within the Catholic church. The bulk of the power centers within the Catholic church are committed enough to the position that the bible means something, that one of the somethings that they can easily interpret the bible as meaning is that homosexual actions are sinful, and that this is supported by so great a weight of history and tradition that it would be near inconceivable for a mere pope to, on his own, without a long careful process of arguing for and convincing many stakeholders of his position, suddenly reverse course. They would feel as though a "foreigner" has somehow invaded their group, a spy, a saboteur, an enemy operative. They would view it as illegitimate, do all that they can to remove the invader or at least neutralize his further power until he can be removed. Then, they would go about reversing the decision to whatever extent their history and tradition allows them to. They will declare that it was not "conformable with Sacred Scripture and Apostolic Traditions" (to just copy the words from wikipedia).
In a different time, maybe the pope will gain such power. If the cultural memeplex continues propagating among enough of the rest of the leadership of the Catholic church, perhaps enough will get on board with whatever new argument arises to shift around their traditional position. Different levels of support (or even just apathy) across the leadership will require different expenditures of political capital by a hypothetical future pope, but I think that right now, it's not reasonably "within his power".
ControlsFreak
1yr ago
Nah, I think there's a plenty-accessible frame in which someone believes that the US did it and believes that doing it was an affirmative good in the world. I mean, the entire concept of the US funneling arms/money to Ukraine could be viewed in the frame of, "Intervening in wars abroad is bad, so the US meddling in Ukraine is bad, which means America isn't the Good Guys," but there's also a frame of, "Actually, intervening in Ukraine is good for [reasons], so the US meddling in Ukraine means that America is the Good Guys."
Now, which set of these frames is actually right is more difficult, and I won't take a position at present. But there are far far far more obvious historical examples of the US very clearly not being the Good Guys that this particular action is highly unlikely to tip anyone's scales on that score.
ControlsFreak
1yr ago
We have very little clue. About on par with how little we know about most things that are somewhere on the hazy nature/nurture spectrum. As a bellwether, consider the APA's brief in Obergefell. This was an opportunity for them to lay out the best science to ground their theory of the cause of homosexuality and properly argue that it's innate or whatever it is that they wanted to be able to say for political purposes.
You know what evidence they brought? An opinion poll and a report from their "LGBT Concerns Office" which said that basically all the research into conversion therapy was methodologically unsound. Seriously. We know pretty much garbage.
ControlsFreak
1mo ago
I think Alito is pretty obviously right to make comparisons to print media, though even with that, there's still plenty of tricky. In fact, I think that we really shouldn't even speak the words "social media" or "internet" in this discussion. Instead, from a historical perspective, this really seems like a core freedom of the press issue. That is, for centuries after the printing press was created, governments around the world went to great lengths to control its use. Examples are found in Acemoğlu and Robinson. Private entities or companies would operate a printing press, and regular people could go interact with these operators in sort of a regular way; say, if they wanted to print up a pamphlet to hand out about their views or a newspaper or something, they would go to the printer, submit what they wanted to have printed, pay them however much money, then come back and receive their product after it was printed. Much the same as today, you could say that those private entities had some rights of their own to do business, and they might refuse to print something if they really disagreed with it (they didn't have to bake the cake or make the website; could ban the local Alex Jones, or whatever analogy you want). So what did governments do? They pressured press operators to adopt criteria that the government found favorable. Maybe they'd even issue local monopolies and say that only so-and-so had the right to run a press in a particular area. Of course, the guys they picked always somehow knew what sets of views they needed to have (and which they needed to reject to print) in order to keep their license and continue making bank.
As countries became more liberal democratic, they realized that this was a problem. Some countries kept the monopolies, but passed pretty strict non-discrimination laws, saying that they had to just print whatever the customers wanted; no letting pro-monarchists print their pamphlets and rejecting revolutionary pamphlets. Others, like the US, passed freedom of the press provisions, simply saying that the government needed to stay TF away from press operators; no monopolies, no threats of shutting them down if they don't toe the party like, just leave Britney press operators alone. All of them. Whoever wanted to just buy a press and print.
As such, I think the freedom of speech part is kind of a distraction for what should really be considered freedom of the modern press. It's not an institutional press, like NYT/CBS/whatever. It's literally anybody who waltzes down to their press company and wants to use the press. And I think the underlying motivation, while not putting in words that it's effectively a non-discrimination law, was understood to have a non-discrimination effect. Whether or not there could be enough history here to make a legal determination given our current laws, just from a 'theory of good institutions in the vein of Why Nations Fail', it would be a pretty rough outcome for countries that went down the "freedom of the press" route rather than the non-discrimination route to discover that natural monopolies might arise to make this whole branch of the endeavor ultimately fruitless, if governments could just discreetly threaten the natural monopolists. I just hope we don't have to see a nation or three literally fail from going down this route before we either rekindle the non-discrimination-type theoretical roots of the freedom of the press or we explicitly adopt something that is a standalone non-discrimination provision.
Some additional nice things that this view captures: The third-party business is important and captured here. Old school printing presses were also third parties. It doesn't matter whether the guy who is asking the printer to print the thing is the NYT or Joe from across the street; if the government doesn't have a reason that is compelling enough to overcome 1A speech scrutiny, so that they can go directly to NYT/Joe and directly tell him that he can't say that, then they should be prohibited by 1A press scrutiny from going down the street to the local print shop or the commercial entity that actually does the physical printing for NYT and telling them that they shouldn't print it.
I think this distinction also captures some of the "government need" doctrine, as well. I accept that there are some genuine government needs that can overcome 1A speech scrutiny. For example, they can legitimately tell folks who have security clearances that they're not allowed to just write a book blowing a bunch of classified information. Of course, how is this balanced with things like the Pentagon Papers precedent? Well, in my view, the Pentagon Papers precedent is quite strong - if someone who didn't agree to keep classified information secret gets that classified information, for the most part, the government can't prohibit them from publishing it. There is some obvious danger here, but it's actually not all that far off from the tradeoffs we make in cybersecurity all over the place. If Party A discovers a flaw in Party B's software, even if Party B is a sensitive government function, the sort of accepted solution is that they tell Party B that they'll only have X days to implement a fix, to do what they can to protect some equities, and then they're going public. Yet, at the same time, some flaws are viewed as soooooo potentially damaging, that even Google's vulnerability team has failed to follow through on the threat to go public when the company with the flaw didn't bother repairing it. We basically let that decision be up to the Googles/Party A's.
Similarly, when the Intercept/Guardian got the Snowden files, they met with the NSA. The NSA did try to express the government's perspective on the matter. They asked the journalists to withhold some things from publication, arguing that some of the items were completely noncontroversial, directly within the government's known mission, were of extremely little "news value", and would cause significant damage to national security and/or sources/methods. I'm mostly fine with this, even though there is a lot of conversation here about government discussions being inherently coercive. It is genuinely difficult to draw lines here, and it's hard to come up with a good limit that prevents the Intercept/Guardian from getting the Elon Musk Harassment Treatment.
That said, I think it is infinitely preferable to the option of going to third parties. The Intercept/Guardian definitely have to weigh a lot of things, including the possibility of the Elon Musk Harassment Treatment, but at least they're the ones with skin in the game and the ability to actually weigh them. Whoever it is that prints their physical copies or hosts their website may have some skin in the game, just because it is possible for people to flee to other printers/hosters out of fear of being censored, themselves, but that skin is wayyyyyyy thinner than the actual party who wants to publish the information/opinion that they have.
Of course, this would make it much harder for the government to do what they want to do. There are lots of bozos on twitter spouting bullshit that the government would like to get rid of. If they actually had to go through the bozos rather than twitter, there would be substantial refocusing of efforts towards things that actually matter for national security, not bozos spouting off about their personal beliefs on COVID or whatever.
ControlsFreak
3mo ago
Because far more prominent individuals who encouraged others to go [in]to the Capitol and were not even charged
First off, I think you mean "into" here. But anyway, complete side track, but it's sort of hilarious watching this regularly-scheduled program on a completely different screen than watching the Section 3 disqualification program. Like, here, the fact that someone just encouraged others to go into the Capitol is good reason to not charge them. But ya know, with Trump, he didn't even do that, yet it is clearly and obviously "engaging in insurrection".
The ruling is absurd, but the Constitution is pretty clear that states get to decide how their elections are run, including their national elections.
That's not really the way "judicial federalism" works, though. Yes, states have a lot of leeway in how they run elections, but this state is specifically appealing to the text of the federal Constitution in order to rule that he is ineligible. The fun history here to really drive the point home is that there are a lot of state Constitutions that have clauses that are word-for-word identical to the federal Constitution. Suppose that for some clause (not necessarily the one here), State A has a word-for-word identical clause in its state Constitution, but State B does not. Perhaps both states' Supreme Courts rule that that clause means X. Now, SCOTUS jumps in and says, "No no no, in the federal Constitution, that clause does not mean X." Well, State A's Supreme Court can (and some have in various cases) go back to the same issue and say, "Well, even if that clause in the federal Constitution doesn't mean X, we think that the same clause in the state Constitution means X." This has happened plenty of times. State B, on the other hand, has no such luck. The only thing they had to appeal to in this extremely sanitized hypothetical was the federal Constitution, and SCOTUS simply outranks them when it comes to interpreting what the federal Constitution means. [EDIT: Right after submitting, I realized that linking to this book is a good cite for an example of how this has definitely happened, concretely.]
"Judicial federalism" can work the other way, too. There are sometimes cases in the federal courts that turn on an interpretation of state law (or state Constitution). There have also definitely been examples where the federal courts essentially punt the question back over to the state Supreme Court, saying, "Yo! You guys need to tell us what your law means."
In this case, I don't believe Colorado has an equivalent-to-Section-3-of-14A in their state Constitution; they are purely interpreting the federal Constitution. As such, I don't think there's any reason why an appeal can't be made in the federal courts. There is a substantial federal question here, specifically that of interpreting the meaning of Section 3 of 14A of the federal Constitution.
[EDIT EDIT: Realize now that I should have read further in the comments; I was totally scooped. Oops.]
ControlsFreak
5mo ago
Christianity is life-denying to the core: man is fallen, the world profane and corrupt, and the only refuge is the kingdom of heaven which only God can bring about.
Like, maybe your Christianity, but I feel like there are tons of others out there. The ones where man is made in God's image, told to be fruitful and multiply to fill the earth with little beings that are meant to "graduate" by resurrection into basically being God. Where the God man came to let himself be killed, apparently "so that you can have life more abundantly". As KnotGodel points out, many of your intermediate claims are pretty debatable (and debated by different groups of Christians), which likely means that your personal view is not necessarily that authoritative concerning Christianity's "core", at least not to the point that one should fail to understand how other interpretations could exist.
ControlsFreak
5mo ago
trump has an EO ready to go to reclass a huge percentage of federal enployees as contractors, making them much easier to fire
ROFL at "huge percentage". The article says like 50k positions. There's close to 2M federal employees. And they wouldn't become "contractors"; they'd just be more politically-controlled. There's something like 4k political appointees currently. Going to 50k would be a significant step toward making civil service leadership more politically-accountable when someone actually wins an election, rather than it just being de facto Democrat-controlled, but who knows how deep the rot is. In any event, it's definitely not putting a huge percentage of federal employees on the political chopping block.
ControlsFreak
6mo ago
Anglophones when they meet other anglophones with a different accent: "Cool accent bro!"
Francophones when they meet other francophones with a different accent: "Your mockery of our beautiful language is a disgrace to all that is holy."
ControlsFreak
7mo ago
Why don't we teach young women 'please never send mixed signals to men about your sexual interest as ambiguous coquettishness muddies the water around consent'?
Because a small but influential portion of society decided that while marriage norms solve this problem nearly entirely, they are the enemy to their political goals.
ControlsFreak
10mo ago
Crimes were committed. That is legitimate grounds on which to premise an investigation.
Not of the Trump campaign.
That investigation of those crimes then looking at the primary beneficiary of those crimes is natural.
This is not probable cause or grounds for an investigation. (Notice I said "or", which responds to your second paragraph.) It's wayyyy too subjective. One could legitimately believe there was probable cause to investigate, say, the release of Trump's tax records. Very possibly a crime was committed. Very possibly not (that's the nature of PC/investigations). If they had something specifically pointing to a particular individual for an actual crime, they could go about investigating them, with the level of what they're able to do being dependent on the nature of the evidence in question. It would be insane to say, "Whelp, law enforcement can just willy-nilly decide 'who benefits' from the release of Trump's tax returns and use that as a predicate for a far-reaching investigation into them."
The investigators said this was why they were looking into it (Mueller Report, p. 5)
Bullshit. Page five is just facts and narrative. Page 11 is where they describe why they were doing what they were doing. Nowhere in this document do they ever say that any investigation was predicated on anything as ridiculous as, "We picked who benefited and started investigating them."
Citation?
Check out the DOIG.
ControlsFreak
11mo ago
How would price transparency even look if it's not just "Medicare for all, you pay taxes, we provide healthcare"?
This seems like it would actually be the opposite of price transparency, at least from the perspective of consumers. Each item of healthcare would still have a price, but they would be totally and completely oblivious to it. It would be entirely up to bureaucrats to look through the prices and decide what procedures seem to be worth it.
Concerning (1), selection of a doctor is approximately as difficult as any other selection of a good or service. There are a variety of solutions other industries have used. Branding, reviews, spec sheets, etc. Compare your ENT to very similar services that don't get to play the "insurance made me do it" shell game, like lasik or cosmetic surgery. Since they have to actually convince you to pay a real sticker price, they're vastly more open about it. They usually have free consultations; they tell you on their website what cool expensive tech they use; if you're the type of person who wants to shop around, ask questions, and figure out who you're comfortable with, you can do it. Some people are still going to view it as, "Well, you just go, do the thing, and pay whatever price," but if you want to be more informed, you at least can. You can at least usually get them to not lie to you and say that it's impossible to know what the price will be.
Concerning (2), this is obviously a more difficult one. Let's scope out a bit and consider a comparison with a hypothetical ENT who doesn't have access to their own CT. My experience has been that with someone like this, they send you out with orders to get a CT from somewhere and have the results sent to them. But then, when you come back, usually, you don't pay for an "additional" visit. Instead, it's treated as an extension of the original visit, which needed to be interrupted because of the need for a test. There is a true tension here that is hard to resolve. For legacy reasons, we don't just pay doctors by the hour, we pay them by the service. If we paid them by the hour, it wouldn't matter whether we got the CT there or somewhere else; that doctor is still just spending the time of "make recommendation for CT + evaluate result of CT", and those things are just more or less stretched out across different days.
The fundamental thing happening here is some sort of bundling. Bundling often makes sense. I had a dental implant, and there were multiple visits. Several were just, "Let's follow-up in two weeks; I want to see how it's healing to make sure there aren't any issues." Every one of those was bundled with the price of the original service, not charged as an "additional visit". Honestly, I was naive at the time, didn't ask a lot of questions, and sort of didn't know that they were bundled until after the follow-up appointment was finished, asked if I needed to pay anything, and they said no. This sort of bundling makes tons of sense. Other times, people don't bundle. I got stitches for a cut one time, and when I went to get them taken out, I had no idea whether this <5min followup was going to be bundled or not. Turns out it wasn't. Honestly, if I had known that it wasn't bundled, I probably wouldn't have spent the money for them to use scissors for 10 seconds. Again, we can compare to lasik. I haven't had it yet, but I've looked at websites. They often publicly state that certain follow-ups are bundled, because that is valuable price information for consumers.
In any event, the extent to which a service is bundled/unbundled is also usually not transparent. Are you sure you'd have had to pay for an additional visit if you had the CT done elsewhere? Did you ask? I'm not 100% against the idea that they might want to essentially give you a discount on the evaluation of the CT if you have them do the CT, but I want them to have to tell you this explicitly. "If you get the CT done here, we will bundle the price of the next step where we evaluate the result of the CT and decide what to do next. Alternatively, if you get a CT done somewhere else, we will not bundle it, and you'll have to pay extra for that." Most critically, I think this should not be a pressure tactic. It shouldn't be, "If you just sign on the dotted line RIGHT NOW, we'll give you a GREAT DEAL on this new carCT follow-up!" Like, if they're bundling, they're probably not bundling strictly based on things happening right now. What if it's the end of the day; the guy in the office who actually runs the CT machine is about to go home; maybe it'll be better if you come back in the morning; "we'll do the CT first thing and then evaluate the results immediately after". Do they still bundle the follow-up? I'm guessing probably. So, there shouldn't be any difference between that and if you go home, shop around, then decide to have them still do the CT a few days later. If they're still going to bundle in this situation, I think we've gotten most of the benefits that we're going to get.
So in sum on this point, I just want them to have to be more explicit about what is/isn't bundled. When they say, "We should do a CT; we can do it today," they should have to follow it up with, "Here is our price for a CT. That price includes the follow-up evaluation of the results. That price is good even if you shop around and then decide to have us do the same CT service tomorrow or next week. You can get a CT somewhere else if you want, but then we won't bundle the follow-up evaluation of the results, and it'll be an additional charge of $X." At least then, we can see what they're doing. We can see how their price is structured and make comparisons. It's still a bit anti-competitive to be integrated in this fashion and to have this type of preference for their own product. Honestly, anti-competition cases have been brought on less in other industries. I don't even think we need to get there now. Just get the prices and what is/isn't included out there in the open. Then, when people actually see what's happening under the hood, when they're actually seeing what games are played where and what things cost, they can decide which games they're willing to play and which prices they're willing to pay.
Finally, I also agree that true emergencies are tough. Sometimes, health situations naturally create their own pressure tactic. I don't have great solutions for this. I also think that true, really time-critical emergencies are far far more rare than most people think. Probably more than 90% of healthcare transactions simply won't matter that much if it waits a day or even a week. Don't stop us from putting good rules in place to improve the 90% just because those rules may not help the small minority. Even if we just exempt the small minority from the rules, we've made nothing worse (the small minority is in the same situation it was before), and we've made the 90% better. That's a pareto improvement.
But I do think that they should still have to be transparent if it's possible. Yeah, some people might take a risk in going to another hospital, hoping the stitches hold. Some people might even get burned by their choice (that's the nature of risk). Maybe they'd have needed the extra surgery a few days later at the first place, too. Lots of ways it could play out. I'm not saying my solution makes literally 100% of situations/choices turn out 100% optimal and that there is never a case where something bad/expensive happens. Literally no solution can accomplish that; again, that's the nature of risk. But I would rather be informed of the price and be able to make my own choices concerning my personal risk tolerance than not. Maybe the difference is $60, so I don't think the risk is worth it. Maybe the difference is $600, and I'm indifferent. Maybe the difference is $6000, and I think the risk is worth it. Someone else may be really risk averse and still pay the extra $6k. Yet someone else may estimate the risk differently and want to save the $600. Which of us made bad choices? Which of us got burned? Which of us came out ahead? Nature decides that, and no policy that either of us comes up with can possibly guarantee that no one will ever get burned. I just want people to be able to have the information and be able to make their own choice.
ControlsFreak
1yr ago
people making $10m+ are a tiny fraction of
...people. There is nearly no system imaginable that wouldn't result in them being a tiny fraction of those being audited, unless we're willing to let large quantities of even the most obvious errors/frauds go without audit in every other income range.
ControlsFreak
1yr ago
"anti-communists"
Unlike the Nazis, who are essentially all dead and gone, the world still has e.g., North Korea.
I find that looking at these aggregate numbers to be fascinating, and also difficult to really understand, especially because I really get the feeling that it's tough to understand without really digging in to the data sources, seeing if there are discrepancies between sources and how they choose to do their groupings. For example see the wiki article, which has different tables that are listed from the 2014, 2019, 2021, and 2022 ACS.
Especially the "detailed ancestry" section. Median Indian household income is $152k?! That's wild and dwarfs the top line white/black gap. Makes me wonder if composition effects are significant. That is, are Indian "households" just bigger? Like, more people, plausibly more working people, living in the same house? Conversely, many articles have been written claiming that poor family relations and divorce have plagued black communities more. If Indian households have 2-3 individuals earning incomes on average, while white households have 1.5-2, while black households have 1-1.5, could that be a huge effect? I do recall EconTalk mentioning household composition effects being rather important when talking just about the country-wide median household income statistics, and I wonder how much of a story they tell here.
Additionally, in the detailed ancestry section, they don't have a category for "African Americans (Black Americans)" at all, like they do in the top line chart. So, how are they actually describing these group boundaries? The number from the top chart for this category would be at the absolute bottom of the bottom chart (coming in just below Appalachian), and that's kind of wild to me, too. Even the "Subsaharan African" number is substantially higher. Is the general African American number being pulled down specifically by people who don't identify with any other ancestry, even if they have some sense of where their family came from? It would have to be a pretty strong pull, and I don't have a sense for how relatively big these groups are.
What about self-identification issues? If Cletus decides that Appalachia sucks and that you can't make a living there, so he moves out, finds a job in the fancy city, meets someone there, marries her, makes a family there, etc., how many years will it be until he stops identifying as Appalachian? He thought Appalachia sucked! "Nah; I'm just American." Possible analog to an evaporative cooling mechanism.
I don't think today will be the day that I have time to pour through all the details, but thanks for another reminder that I really need to sometime.
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