site banner
PaperclipPerfector  11mo ago (text post)   31009 thread views

Culture War Roundup for the week of May 15, 2023

This weekly roundup thread is intended for all culture war posts. 'Culture war' is vaguely defined, but it basically means controversial issues that fall along set tribal lines. Arguments over culture war issues generate a lot of heat and little light, and few deeply entrenched people ever change their minds. This thread is for voicing opinions and analyzing the state of the discussion while trying to optimize for light over heat.

Optimistically, we think that engaging with people you disagree with is worth your time, and so is being nice! Pessimistically, there are many dynamics that can lead discussions on Culture War topics to become unproductive. There's a human tendency to divide along tribal lines, praising your ingroup and vilifying your outgroup - and if you think you find it easy to criticize your ingroup, then it may be that your outgroup is not who you think it is. Extremists with opposing positions can feed off each other, highlighting each other's worst points to justify their own angry rhetoric, which becomes in turn a new example of bad behavior for the other side to highlight.

We would like to avoid these negative dynamics. Accordingly, we ask that you do not use this thread for waging the Culture War. Examples of waging the Culture War:

  • Shaming.

  • Attempting to 'build consensus' or enforce ideological conformity.

  • Making sweeping generalizations to vilify a group you dislike.

  • Recruiting for a cause.

  • Posting links that could be summarized as 'Boo outgroup!' Basically, if your content is 'Can you believe what Those People did this week?' then you should either refrain from posting, or do some very patient work to contextualize and/or steel-man the relevant viewpoint.

In general, you should argue to understand, not to win. This thread is not territory to be claimed by one group or another; indeed, the aim is to have many different viewpoints represented here. Thus, we also ask that you follow some guidelines:

  • Speak plainly. Avoid sarcasm and mockery. When disagreeing with someone, state your objections explicitly.

  • Be as precise and charitable as you can. Don't paraphrase unflatteringly.

  • Don't imply that someone said something they did not say, even if you think it follows from what they said.

  • Write like everyone is reading and you want them to be included in the discussion.

On an ad hoc basis, the mods will try to compile a list of the best posts/comments from the previous week, posted in Quality Contribution threads and archived at /r/TheThread. You may nominate a comment for this list by clicking on 'report' at the bottom of the post and typing 'Actually a quality contribution' as the report reason.

9
Top New Old Controversial Comments
Jump in the discussion.

No email address required.

I couldn't say for everywhere, but in hospitals, the largest driver of healthcare spending, at least, a lot goes to administrative bloat: "A Harvard Business Review analysis shows the healthcare workforce has grown by 75 percent since 1990 . . . But there’s a catch. All but five percent of that job growth was in administrative staff, not doctors."

For the broader healthcare sector including VPBs and Pharma, as with all rent seeking systems, a fair amount presumably also goes to shareholders (excluding nonprofits) and top line executive compensation.

Sweden has a growing cost/efficiency problem with our healthcare system as well and the identified main cause is growing administrative bloat.

The interesting thing is that while documentation requirements have gone up (partially and possibly mainly due to privatisation) that isn't perceived as the main driving factor to the bloat.

The main driving factor is that the administrative department isnt doing administrative work related to the hospital care. They are engaged in more prestigious make work they create for themselves, like creating "strategic communication plans", leaving the health care professionals to deal with the actual administration despite massive administrative departments.

This is perceived as a black hole that can consume an endless amount of resources without ever helping the core business.

You wouldn't happen to have anything written in English on that would you? I might try to do a deeper dig in the topic for an effort post later on.

No, sorry. I'm not deeply immersed in this, it's just a narrative that has developed in media, among doctor friends of mine and some researchers.

If you search for news articles on the matter you're most likely going to find people decrying the unnecessary amount of administrators, noting of the rapid growth of administrators compared to caregivers.

Like this in the doctor union news paper: https://lakartidningen.se/aktuellt/nyheter/2022/11/kraver-mindre-administration-och-byrakrati-tjanstemannavalde/

When I said that the perceived reason wasn't necessarily demands for increased administration that caused bloat, i was referencing researchers studying the issue said in articles I've read in the paper and in tv interviews. I wasn't able to find any free articles on it after googling a little unfortunately.

There seems to be a growing consensus that we need to cut down on administrators but even when there has been explicit initiatives to cut down the number of administrators have kept growing. https://www.dagenssamhalle.se/samhalle-och-valfard/sjukvard/vardbyrakratin-svaller-sa-har-ostergotland-minskat-administrationen/

Now there are hiring freezes for new administrators in multiple regions/large hospitals but I'm sceptical. https://lakartidningen.se/aktuellt/nyheter/2023/04/karolinska-satter-stopp-for-ny-administrativ-personal/

Thanks for this as well as the other comment of added context.

See also: American universities.

The defense in the article is

“There’s just more and more layers of stuff that hospitals and physicians’ offices—anyone in healthcare—is being asked to do. Documenting and meeting regulatory requirements—all of these have added to the demand,” Selberg told Healthline. “Has that demand actually gone into creating better outcomes…in less time and with lower costs? I think, as the blog described, the answer is no.”

It's hard to know whether this is accurate or not without finding a trustworthy expert. But if "administrative bloat" is where all the money is going, and if there is no good reason for it, this seems more like a symptom of the lack of competition, which is driven by a ton of factors (failures of governments to prevent monopolization, lack of transparent pricing, etc.).

I know you were explicitly asked "where is the money going", but I think it's worth being clear that "where the money is going" is not necessarily the area where Solutions need to be directed. Blaming "administrative bloat" is like blaming "corporate greed" when the paper mill dumps too much pollution in your river. One of the government's core jobs is keeping people's incentives aligned with being pro-social. Forcing hospitals to downsize or pay administrators less (or whatever) is treating a symptom of the overall screwed-upped-ness of legislation of the medical system.

No disageement with the administrative bloat vs corporate greed comparison, but he does outline an upstream policy driver pushing the bloat: an increasing regulatory load that needs more staff to push papers. No clue if that's right either.

Separately, one of the panelists did recommend strengthening hospital price transparency, but I kind of wonder if it would even be a problem if hospitals weren't de facto monopolies. It's not like we need to legislate normal businesses into telling you their services cost.

Well okay, but what are those administrators doing? Is it compliance? Is it some moral mazes thing? Is it HIPAA? I must admit, it would be grimly amusing if the worst law in Modern American History passed 100-0 in the senate. What do you even do with American Democracy at that point?

I think that this somewhat old (ca. 2015) essay series on exploding costs in Healthcare in the US is interesting and worth reading.

The TL;DR is that there has been a plethora of outsourcing of core functions of healthcare-related companies, at the same time as more healthcare has been able to be provided through the march of technology. The US and larger companies have attempted to solve the issue by requiring more and more 'accountability' (which requires paperwork, man-hours, and ultimately employees to be paid).

When one company employs specialists in finding obscure reasons to deny coverage of claims to patients due to paperwork errors in their Byzantine medical coding system (which are coded by medical coding specialists), and another company employs specialists in appealing the denied coverage and proving the patients should be covered after all - all of those people's paychecks are ultimately coming out of insurance premiums, and making the system cost more. As more companies proliferate in the system, they all try to push the costs of the system onto each other - but since the costs will all ultimately get paid by someone in the end, the net result is that there is a huge amount of paperwork and people employed in thrashing out who exactly is responsible for each and every expense.

Still, though, you get a better sense of the details by reading the whole thing, so I recommend doing that.

As an actuary in healthcare (arguably part of the problem) I heartily recommend that article.

I've also heard complaints from doctors themselves that more of their time is being taken up by paperwork rather than actually seeing patients. A doctor that spends half their time seeing patients and half doing paperwork is going to need to charge twice as much per patient as a doctor who just spends all their time seeing patients.

What is this place?

This website is a place for people who want to move past shady thinking and test their ideas in a court of people who don't all share the same biases. Our goal is to optimize for light, not heat; this is a group effort, and all commentators are asked to do their part.

The weekly Culture War threads host the most controversial topics and are the most visible aspect of The Motte. However, many other topics are appropriate here. We encourage people to post anything related to science, politics, or philosophy; if in doubt, post!

Check out The Vault for an archive of old quality posts. You are encouraged to crosspost these elsewhere.


Why are you called The Motte?

A motte is a stone keep on a raised earthwork common in early medieval fortifications. More pertinently, it's an element in a rhetorical move called a "Motte-and-Bailey", originally identified by philosopher Nicholas Shackel. It describes the tendency in discourse for people to move from a controversial but high value claim to a defensible but less exciting one upon any resistance to the former. He likens this to the medieval fortification, where a desirable land (the bailey) is abandoned when in danger for the more easily defended motte. In Shackel's words, "The Motte represents the defensible but undesired propositions to which one retreats when hard pressed."

On The Motte, always attempt to remain inside your defensible territory, even if you are not being pressed.


New post guidelines

If you're posting something that isn't related to the culture war, we encourage you to post a thread for it. A submission statement is highly appreciated, but isn't necessary for text posts or links to largely-text posts such as blogs or news articles; if we're unsure of the value of your post, we might remove it until you add a submission statement. A submission statement is required for non-text sources (videos, podcasts, images).

Culture war posts go in the culture war thread; all links must either include a submission statement or significant commentary. Bare links without those will be removed.

If in doubt, please post it!


Rules


Recommended Posts And Communities

Recommended Realtime Chats