domain:vinayprasadmdmph.substack.com
netstack
Texas is freedom land
1d ago
The Venn diagram between “thinks SJ is existentially dangerous” and “has given up on liberalism” is damn close to a circle. Killing some percentage of the population is not in the liberal Overton window. You can thank the Nazis and the Soviets and maybe the television for that cultural antibody.
No, game-theoretic excuses for genocide are limited to a really tiny subset of the conversation. The kind of subset that hangs around on Internet forums. I’d go as far as to suggest it’s mostly branding, signaling, a Molochian race to the bottom for viewers and clout. The Venn diagram between these people and actual capacity for violence is, thankfully, even smaller. Incentives work, and the liberal social order makes random violence deeply unappealing.
There is a much larger constituency which wouldn’t piss on their enemies if they were on fire. That’s not a response suited to an existential threat. It’s bog-standard tribalism, the sort that liberalism kind of sort of suborned.
hydroacetylene
1d ago
State ownership of enterprise, specifically? Nothing in particular. The trumpian process of punishing and crippling thé democrats and deep state? Very much so.
Throwaway05
1d ago
I'd really rather stay focused, because you made a very specific claim, and whether or not healthcare "functions as a market" is not even relevant to it.
My claim was that the price, charge, and cost are all highly different from each other, often have minimal relationship to each other, have little value to the patient, and are highly misleading and hard to understand.
You noted "but I don't see how this is any different from any other industry that faces uncertainty (which is all of them)."
Well yes healthcare is different. That's important. It's inherently obvious in many ways. One of those is that "price, charge, and cost are all highly different..." the other is the problem with the supply and demand curves, the level of governmental intervention...... I provided several examples.
Furthermore -
Two posters in this thread neatly outlined the problem with what you are talking about.
If you charge people for what they use and only what they use and try and give them an answer in advance they get pissed when their hot dog costs 1 million dollars instead of 5.
If you add up the total costs of the ED and do some math to throw out the people who won't or can't pay and then charge people something that more resembles the true cost of the service on a per capita basis they then come on the motte and complain that they sat in a busy ED for 6 hours and got an ultrasound and it costs them how many thousands of dollars? (Sorry dev, but it's a good example).
Ugh we are back to healthcare doesn't function like anything else.
Few if any other lines of business are required by law to provide services to someone who walks in and says they will refuse to pay. Add on the fact that sometimes but not always you can get it covered by the government and the accounting is ferociously hard.
Obviously you can generate numbers like total revenue but turning that into useful information at the patient level is an ethical and political problem long before it becomes a practical one.
ArjinFerman
Tinfoil Gigachad
1d ago
Reuse is; recovery they could definitely do.
Poor choice of words on my part, but I don't think anyone suspected I meant that it's the fishing out of the melted slab of metal that's going to be a challenge.
In terms of Artemis, though, what's most likely to do them in is the schedule. They're not going to make 2027 for Artemis 3,
I'm rather bemused at the idea of giving so much shit to Bezos for being "glacial" while blaming SpaceX issues on "the schedule" that they were free to pick up, leave, or negotiate. It's not even that they're making steady progress and the fickle Congress will be cutting them off, just as they were reach the final milestone. Starship wasn't in orbit yet, it's going to be a long way to even demonstrate ship-to-ship refueling, let alone doing it over a dozen time in order to get it to the moon.
Primaprimaprima
I am trying so hard not to say the MBTI type of everyone I reply to
1d ago
The distinction starts to get blurry very quickly.
We can reasonably assume that there is a fact of the matter regarding which HBD claims are true. But the reason people take such strong stances on HBD, even in the face of inconclusive or insufficient empirical evidence, is because of their values. It’s hard to cleanly separate questions of value and questions of fact because our values influence what we think about the facts.
Throwaway05
1d ago
It's worth noting that specific market segments in the U.S. can and do do things like this but while that stuff can be a large fraction of the profit it isn't a large percentage of the overall activity.
A large part of the problem is that insurance companies will deliberately provide poor service because their clients are usually unrelated institutions and not the individual patient or anyone on the healthcare side (remember we mostly get our insurance from our employer).
When they do fuckery like the examples I'll provide below nobody has any recourse unless they randomly manage to fuck up the CEO's healthcare or something.
Right now one of the world's most prestigious health systems (Johns Hopkins) is threatening to punt United from their health system. One of the two will blink but the service insurance provides to everybody is awful as hell.
A few classic examples: -My patient has been stable on an inhaler for 20 years. They get new insurance company which is one of the ones that has some kinda of complicated kickback program where they rotate the covered inhaler every year. My patient might die if they change inhalers and switch to one that doesn't work for them, so I can spend 5-10 hours on the phone fighting insurance or just cross my fingers and switch. FUCK THIS.
-Patient is sitting in the hospital and needs rehab placement after discharge. The insurance company refuses to approve rehab. The patient sits in the hospital getting hospital level care for an extra 3-5 days before going to rehab. The insurance company pays for that care. Why did they do this? WE DON'T KNOW.
-Psych patient in the ED, clearly needs involuntary care. Insurance refuses to approve, likely hoping that the patient calms down enough to be sent home with suboptimal care or the ED gets frustrated enough to roll the dice on sending the guy home and hope he doesnt kill anybody. THIS WORKS DAMNIT.
Also the "Hawaii" example: You provide a service, you are the only one on your island who does it. Insurance offers you a deal that's barely over cost for your services. You say no. The insurance company spends the next five years flying patients to one of the other islands for their care until you break or go out of business.
The more charitable explanation for what is going on is that when the private insurance is functionally the whole system (Medicare/Medicaid aside) it has to work for all parts of the system not just the ones where you can make things simple and offer a boutique product like your UK elective stuff.
Atian_1
1d ago
Not to mention a lot of apps suck on the phone when compared to their desktop or browser versions. Wunderground app for example. I like to click on local weather stations and view their temperature history and some other stats, the app doesn't let you do as much of this and not very easily.
magic9mushroom
If you're going to downvote me, and nobody's already voiced your objection, please reply and tell me
1d ago
Did you perhaps miss the disclaimer right at the start that none of those are my true feelings? My no-bullshit personal strategy is "lay low, turtle up, wait for Armageddon - most forms of which will mortally wound SJ due to urban/rural demographic divides - and then, with the room to breathe thus granted, dismantle SJ's levers of power (most notably, its ability to gatekeep careers via tertiary education and HR; Scott's solution here and Hanania's here are some of the more obvious), but leave the adherents alive and mostly unmolested". A Leninist purge to strip people of power, not a Stalinist one to strip them of life. In point of fact, I would expect a great deal of my advocacy in the aftermath to be expended on begging people not to enact another White Terror.
(To address the elephant in the room: I will grudgingly grant that KillAllMen is not something most SJers currently believe nor, for various reasons, something they're likely to be able to implement. I wasn't especially happy at the whole "it's just a joke, find me a single person who takes it seriously" thing, though; while this was slightly before SJ's heyday, I did have a single mother who told me the Y chromosome's a genetic defect and literally starved me as a teen after I started registering to her as a "man" rather than a "child".)
IGI-111
God was a dream of good government.
1d ago
I take the opposite view that most disagreements are value disagreements that ultimately map to aesthetic disagreements about the nature of a good life.
What led you to think this? Can you take some central disagreements and drill them down to the object level?
ThomasdelVasto
Κύριε, ποίησόν με ὄργανον τῆς ἀγάπης σου
1d ago
Just no one has even tried to explain how exactly government buying up and owning private enterprise is a smart idea (something that we've been saying isn't good for decades) and why it's a solid goal towards improving the nation's economy and wealth.
Plenty of people have explained it. The race for AI is seen as existential between the U.S. and China. If Intel is owned and operated by a Chinese CEO, that's a major security risk. Therefore Trump and his team took extreme measures to make sure Intel was loyal to the U.S.
I'm not saying it will work or won't have other knock-on effects, but that was the straightforward justification.
magicalkittycat
1d ago
That probably has something to do with the fact that, while you have provided examples that you call "principled", you've largely handwaved the "revenge" assertions you've made.
I did provide examples of non traditionally conservative ideas. It includes things like government nationalizing various companies (something they are apparently considering doing more), and protectionism.
SubstantialFrivolity
I'm not even supposed to be here today
1d ago
I'll agree that effectiveness can be objectively measured. But "principles are for suckers" isn't a statement on effectiveness, it's a value judgement of what a person should do. Thus, it is not (and can't be) objective.
magicalkittycat
1d ago
Is your modeling of Trump so poor that you attribute it to deliberately wanting to wreck the US economy, during his own term, because fuck the Democrats?
Trump has never been much of a fiscal conservative, so I don't expect him to hold much fiscal conservative views. He seems to truly believe in the power of the state over private enterprise, and mercantilist thought.
This in regards to people who have actually claimed to be small government hands off capitalists joining in without an argument towards merit. They don't seem to have "changed their mind" (if that was the case, they would try to make an argument for central planning) as much as never having a strong belief in their prior claims to begin with.
DuplexFields
Ask me how the FairTax proposal works. All four Political Compass quadrants should love it.
1d ago
Pointed but fair, even the heated rhetoric at the end. I’ll clarify that blue/red tribalism changes the perception of the cooperative value lost in each defection, inflating the out-group’s tats and deflating the in-group’s tits.
If the average red-tribe American (citizens since their grandfathers’ time at least) have the perception that they’re being prevented as a class from getting jobs by blue-tribe HR choosing naturalized immigrants, H1B workers, or unnaturalized migrants, tit-for-tat looks like mass deportations. The blue-triber sees this as a massive escalation of defection against their in-group or favored far-group.
If the average red-triber sees their wages stagnant vs inflation since 2008, yet the lowest rung of blue-tribe government worker can buy a suburban house and pay “our” taxes for their kids’ soccer practice, tit-for-tat looks like mass firings of government regulators. The blue-triber sees this as a massive escalation of defection against the people keeping them safe from capitalist overreach.
And so on, and so on. Sure it’ll make the Whigs (the blue-tribe and grey-tribe Republicans who disproportionately make up the GOP’s donor class and elected representatives) take pause, but the red tribe can finally smile at the perception of having shaken off, or at least told off, their oppressors.
This is also what it looks like when the red tribe no longer sees the blue tribe as a far group but its outgroup.
magicalkittycat
1d ago
Communists and Nazis alike engaged in violent purges.
ArjinFerman
Tinfoil Gigachad
1d ago
I think we need to go back to basics
I'd really rather stay focused, because you made a very specific claim, and whether or not healthcare "functions as a market" is not even relevant to it. Literal socialized industries (including healthcare in other countries) are able to give you the price of a particular product / service, so even if American healthcare is somehow not a market, it still should be able to the patients information about the prices of it's services.
ABigGuy4U
1d ago
Pompey’s side defected 80 years earlier when they beat the Tribune of the Plebs to death with table legs, committing what was in the Roman worldview both treason and blasphemy. Then they spent most of the next century being shocked at the succession of demagogues who were suddenly willing to break all sorts of political norms, for some unknown reason.
Instrumentality is an objective metric.
What ought to be done is subjective. What can be done is objective.
My point, and Machiavelli's, is that a certain conduct is necessary to attain and retain power in the first place, independently of one's ultimate aims. Making it a necessary precondition to the enactment of any political program.
Whether one should engage in politics is a subjective question, but once one answers yes, the requirements placed on one are the same regardless of ideology. And they include the necessity to destroy one's enemies that they may not rally against one.
SubstantialFrivolity
I'm not even supposed to be here today
1d ago
Principles are objectively for suckers.
This is by definition a subjective, not an objective, topic. There can't be an objective evaluation of what values one should hold.
FiveHourMarathon
Wawa Nationalist
1d ago
Advice works poorly because of attitudes like those evinced in this article.
Or maybe we can just blame Martin Luther, if we don't want to pick on my friend @greyenlightenment. Possibly Bruce Lee.
People generally don't follow advice, even obviously good advice, because doing so would conflict with their ego. Taking advice, really taking it to heart and following it, requires a radical act of submission foreign to the modern mind. To truly accept advice, one must first place oneself below the advice giver.
Most people fail when implementing advice because they fail to truly implement the advice. They give it a half-effort, they don't persevere long enough to see results, they don't really feel the advice. Because they don't really respect the advice giver. You have to start by submitting your own will and intellect to the superior, to the rabbi or the guru or the priest or the professor or the doctor. And that act of submission is radically antithetical to the modern mind. We want to pick and choose, Jeet-Kune-Do style, take the best of all aspects of all advice and combine them, rather than take the advice of our superiors. Every one of us is trying to run our own custom set-up of values and cherry-picked advice, our own unique choices. Not to pick on @Pitt19802 but this is emblematic, saying the adulthood is all about realizing:
no one is going to walk you through life. It's on you to pull out the bits of advice that resonate with you and decide to try those out, then decide which of those you want to keep trying, which of those you want to stop trying, and what you want to try out that no one advised you to do.
If you are always keeping a part of your mind detached, observing, assessing whether the advice is working or not, then you're never really following it. At the first sign of failure, you are ready to jump ship, you have the lifeboats already inflated, you're already writing your clever comment about how the unsinkable advice sank.
When you look at cults like People's Temple, Synanon, NXIVM, or Gwen Shamblin; ok yeah they end up drinking the kool aid or murdering journalists or stealing money or abusing kids. But first, they work as self-improvement. Every cult story is full of people who join the cult, submit their will to the leader, and they get off drugs, they work hard at cult activities, they become functional members of society, they lose weight. They did all these things easily, like it was nothing, no big deal. And the key element is the submission, the surrender of will to the leader. This is why any effective advice program, like Crossfit or TRP, starts getting accused of being a "cult." When we see progress coming from submission, we defensively call it a cult, rather than question our own determined independence. I'm guilty of this myself: I disdain basically all self-help books on the principle that the person writing it doesn't impress me enough, and I giggled at Evola eviscerating the existentialists as pasty philosophy-professors who lacked real world experience while citing Nietzsche of all people.
Let's talk about fitness examples, since those were used in OP, and are also my favorite.
In the OP:
Even the best advice will still be constrained by one’s innate limitations. In my post “Individual differences of metabolism are real and matter” I give a real-life example of someone who despite only eating 1,800-2,000 calories/day, which he carefully tracks, and doing cardio, is still overweight at over 200lbs at 5’10”.
Genetic limitations are real, genetic limitations are an infohazard that prevents you from making progress. Both these facts are true. Once you are aware of and accept the idea that your genetics might be special and unique and prevent you from progressing based on basic advice, particularly where information on "slow metabolisms" or "hardgainers" is presented without a percentage-rate of the population, everyone wants to jump ship on the simple-but-difficult advice in favor of anointing oneself a hardgainer or having an unspecified and undiagnosed thyroid or metabolic problem. Some people are harmed by trying to follow advice that won't work for them because of their genetics, vastly more are harmed by not following basic fitness advice because they've given up and decided they are a special snowflake who can't follow basic advice.
This is why there is so much fluff in so many popular fitness programs. The actual program could be communicated in a spreadsheet; why do the authors give us treatises on physiology that don't matter, or stories about the athletes or champions or movie stars or secret-commandos or Soviet scientists that built or followed the program. Sometimes you get a mad-libs pile on: JALEN HURTS followed a workout program developed by SPETZNAZ COMMANDOS using hitherto ignored SCIENTIFIC PRINCIPLES that were discovered by EASTERN BLOC COMMUNIST SCIENTISISTS. And you get 20 pages about Jalen Hurts performance in the NFL, how badass the spetznaz commandos are, the intense scientific research sponsored by the USSR to develop athletes, how revolutionary these scientific principles are...and two pages with the actual program you need to follow. All the fluff is designed to get you to buy in, to actually follow the Program as written, to swallow your ego and accept that the Program and its creators are better than you and you need to follow their advice.
It's easy to dismiss the fluff as unnecessary, just give me the program, but it is probably the most necessary thing. A theoretical program with zero fluff, just sets and reps with no testimonials and no confusing pseudo-bro-science arguments about why it is effective, is unlikely to be followed by many people, a program offered with no story will not persuade people to try it. The story is necessary to convince people to do the work. A perfect program with no story probably has no adherents, or if anyone tries it they quit lacking a reason to continue when they start to dislike it or it gets hard or something seems to go wrong. A workout program that is distinctly sub-optimal, but with a narrative attached that convinces everyone who reads it to commit to doing that sub-optimal program with 100% compliance and effort, would deliver huge results.
This is all an act of self-criticism, Pride is a flaw in myself that I am struggling with in my efforts to improve in life and to find my way back to religion.
Learning jiu-jitsu has required me to radically submit, at age 33, to people I would normally avoid going to for advice on other topics. The head coach/owner at our gym is a Puerto Rican guy with barely a high school education*; though at least he has the job title "BJJ coach," most of the other upper belt teachers are blue collar by day, factory workers or in construction or government social work. They're not, broadly speaking, people I would normally seek out as my intellectual superiors. But in the gym, they know vastly more than me, and trying to exercise my own intellect, to pick and choose what I think will work, is a road to nowhere. Luckily, the demonstration of superiority is frequent, rapid, certain, violent, and kinetic. And at that point, if I can soothe my ego past excuses like "bjj is stupid and gay anyway" or "I'm [genetically weak/too old/unique and the advice won't work for me;" then I can make progress if I accept that the guys who beat me up probably have something to teach me, even if I'd smoke them on the LSAT. And without that respect, I probably won't learn anything. But even within the gym, we see the same narrativizing, the same devising of stories and lineages to techniques, used by the professors to hammer home that this move works. It was a favorite of Marcelo, or Renzo, or Gordon Ryan. It's the oldest trick in the book, or it's the brand new meta-game solution that's taking the competitive scene by storm. Because they need to convince the students to study the move diligently, and apply it with confidence, or it won't work, and will be discarded as useless advice.
Because as the Buddha tells us there are:
“Three kinds of wisdom: wisdom from hearing (suta-mayā paññā), wisdom from thinking (cintā-mayā paññā), and wisdom from development (bhāvanā-mayā paññā).”
And while I might have wisdom from hearing, or even wisdom from thinking, until I reach their level I will lack their wisdom from development, the true understanding that makes the advice part of my being.
*Though, realistically his education level does not reflect his genetics. He has two sons, one just became an anesthesiologist, the other is teenage but seems very bright, gets good grades, and is a nationally competitive BJJ phenom. Evidence that ethnic minorities are still working their way through the Great Sort?
IGI-111
God was a dream of good government.
1d ago
Of course. And the iterated prisoner's dilemma is a limited model anyways.
But do you really doubt the existence of prior defection in American politics at this point?
I am more optimistic, their currently tested designs are innately better than Falcon 9
Citation needed? I would say "currently in testing", but "tested" suggests they've made it to orbit, and AFAIK there are no non-expendable Chinese designs that have reached orbit so far. And even if you consider hop tests and engine tests to be "tested", everything seriously in the works there is basically working off the Falcon 9 playbook.
"Gravity-2 aims to operate at a similar price per kilogram as the SpaceX Falcon 9", which is about what you'd expect from a lineup that looks like someone was frantically cribbing from SpaceX. (which is mostly the right thing for them to do, to be clear; it beats the hell out of Europe's response to SpaceX)
The Hyperbola-3 hasn't had any prices announced yet but it also looks more like "cribbing from Falcon" than "innately better", except for the choice of a methalox rather than kerolox engine.
Deep Blue Aerospace is at the advanced cribbing stage, surpassing its competitors' infographics of not-Falcon-9 and not-Falcon-Heavy rockets by putting a not-Starship rocket at the end.
Pallas-1 gets us back to not-Falcon-9 and not-Falcon-Heavy territory.
The obsession with Falcon Heavy clones is IMHO a bad sign for some of these companies. Even SpaceX admits that Falcon Heavy wasn't worth the trouble in hindsight, and there was a point where if they hadn't already accepted Air Force contracts for it (or if Gwynne Shotwell hadn't talked Musk into staying on the feds' good side) they'd have probably canceled it entirely. The original rationale behind it was that they didn't think Falcon 9 would be nearly as powerful as it was, but after some engine improvements and tank stretching and propellant subcooling the F9 got pushed into the FH weight class, and FH got pushed out into a weight class where (with its small fairing) it will never have enough payloads to pay back the investment.
I don't know much about Tianlong-3. I'd give the company points for being the first Chinese startup to put a liquid-fueled rocket in orbit, but then take away a quarter of those points for being the first to launch a rocket stage unintentionally, to fly for miles out of control before impact, when a test fire stand broke.
Maybe LandSpace is the best bet here? 4 successful Zhuque-2 launches with 2 failures, VTVL and relight tests with Zhuque-3, using methalox now and working on full-flow methalox upgrades. There's no hint of Starship-scale plans in their future, but they're at least setting up to have Starship-quality institutional experience.
But I think what's impressive about the Chinese effort isn't any single rocket design, it's the sheer volume of these efforts. All but one of those companies has already reached orbit, albeit with smaller and less-ambitious designs than what they're working on now. Two of them have reached orbit with liquid-fueled stages. Even if most of them fail or come up with something mediocre, they're actually trying and achieving impressive things quicky. In the US, after SpaceX, our best efforts are probably Blue Origin (made it to orbit after only 25 years!), RocketLab (the Electron would have been impressive if they'd got reusability working, and I'm hopeful for Neutron), Stoke (still just doing hop tests, but actually trying out a potentially better-than-Falcon-9 idea), and maybe Firefly (with no impressive launch vehicle plans, but they made orbit).
and may allow rapid scaling beyond Starships, though this might take 5+ years
Even in the "I made a PowerPoint!" dreams of (the 4th redesign of) the Long March 9, a rocket scaling to Starship is supposed to be not flying before the 2040s.
Full disclosure I just hate the government and have no libertarian biases.
But this isn’t really ‘interfering’ in the economy. The government is specifically forbidding itself from being an activist investor.
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