Education and Healthcare Suck for the Same Reasons
betterschooling.in
betterschooling.in
1) Healthcare in the USA sucks because politics prevents you from remembering how insurance works. The most basic of basic financial calculations, the advantages of a large pool to absorb risk, vs smaller pools.
2) Education has different reasons for being problematic, and it’s not just in the USA. The USA has only caught up to the problems in the rest of the developing world, having never had to content with these problems before.
Is it me, or does it feel like developing software for BigCorp sucks for at least these reasons too?
That said, there's also the Baumol cost disease: in certain service industries, productivity increases are difficult to make (or even measure, really). We've tried to automate teaching and healthcare (&art!), but the results are mixed..
If I want to ask the professor a question, or figure out why I have an arrhythmia I need to get personal attention and that is much harder.
For more entertainment in this direction, consider looking at the not-very-conclusive back&forth between SSC (a healthcare practioner) & Robin Hanson (a theorist) on the effectiveness of healthcare spending.
[It's telling that the practioner is in the house that believes that healthcare spending has been mostly effective.. re: SSC is saying that "the easy parts are still there?"]
https://www.astralcodexten.com/p/highlights-from-the-comment...
In that brave new world schools need to shift towards a focus on development of personal character. MDs, at least those that you speak to in person, need to focus on bedside manner.
* compare George V's last moments (time, manner, and place; especially time) I'd call it an influence, except it happened 4 years after BNW was published.
>Farnaby awakens on the island with a leg injury, hearing a myna bird screaming "Attention"
Here Aldous seems to have gone beyond merely reacting to neoEdwardism..
So far reminding me a bit (in backstory) of https://en.wikipedia.org/wiki/The_Twenty-One_Balloons
>Will remembered suddenly his favourite worst line of poetry.
https://harpers.org/2009/10/arnolds-to-a-friend/
>The up-beat high Victorian view of art as a cure to the woes of society
https://harpers.org/2009/10/forster-what-the-great-minds-tel...
地獄楽 https://en.wikipedia.org/wiki/Hell%27s_Paradise:_Jigokuraku
Compare https://news.ycombinator.com/item?id=42185423 (and Katya's sports car, accessorised with radio and small dog)
Huxley called "habitus" well before Bourdieu: Primroses and landscapes, he pointed out, have one grave defect: they are gratuitous. A love of nature keeps no factories busy. It was decided to abolish the love of nature, at any rate among the lower classes.
EDIT: "Hell — is other people" (JPS) "...whose interests aren't aligned [being] thrown into an enclosed space and forced to work together." (YK)
Unless there are any immortals (we saw a one-tail fox this morning) on HN, we're also all (along with several deer yesterday) sentenced to death ... although some of us pledge (logically if foolishly) to seek the Elixir of Life, or die trying.
You're egging (ikigaing) me on to find the countermanding quote in Island
The new piece to this story and in stark contrast - my wife and I recently had a child and our pediatrician is genuinely fantastic. Friendly, helpful, and actively listens to our concerns. It frankly gives me hope that such physician-ing is still possible in today's system.
I don't know what it's going to take to get us back to a reasonable place, but I am frankly kind of hopeful for like some sort of AI note taker so that the doctor could be the human in the room again.
Courts manage to have record keeping without the judge typing constantly.
It just takes money. Either hiring someone to type for the doctor or paying the doctor enough that they can spend non-patient time typing up record keeping notes.
In practice, just like with air lines, people's revealed preference is for low cost over great service.
And the one we're offering in my company is getting a lot of love from doctors for very similar reasons, and how much time it saves them.
Doctolib (premier healthcare startup in France, expanding into Italy and Germany, the vast majority of healthcare appointments happen via them) have an AI scribe project in public beta which seems to be working very well.
Seeing people standing around a classroom... hospital?... as amputees and weird shaped people in a space that's too large for them is very disquieting and distracting from the piece later on.
Was it the messed up human anatomy? The letters and numbers being misformed? The lack of faces? The weird choice of unnecessary detail and bizarre scale?
How about a quality patient care metric?
How about a metric which asks patients if they felt that the doctor could spend adequate time with them?
How about a metric that measures how long it takes from a phone call to see the doctor?
Ultimately, a lot of metric measuring management is not measuring what customers are asking for. They are only measuring BS that looks good to layers of management, with questionable value produced.
No wonder people have become cynical and unhappy. Our institutions have forgotten to serve the people they are taking money and time from.
But it's one that feels straightforward: Death.
Which is why this is a dumb metric.
You don't need to measure time to death. You need to measure time to response and time that the patient got with the doctor.
And then, build systems that minimize mttr and maximize time with patient.
To minimize mttr, hire more doctors who can be available.
To maximize time with each patient, hire more doctors.
Ultimately you need to have the right intent to begin with. And the right intent is to not measure the time to death. It is to measure the time to help and to make sure doctors get all the help in minimizing the time to help.
Since health-care became a commodity, we lost touch about what it really is and what it can really do.
For people interested in this, I can recommend Tory Sutherland's book or interviews with him on YouTube. Tory is also consistently arguing that businesses and governments are too focused on metrics.
Follow the steps specified by a school, get the minimum marks specified, that means you have learnt the basic skill set needed by you to function in society. If you need to learn extra, there are other channels available.
Same thing with health care. A patient shows some numbers, treat those numbers. If something feels off, the doctor takes the call. That's why we still have human doctors and not AI.
Also, one major difference between education and health care, in education the customer is different from the one who pays. So the goals get differently from the start(make my kid the best mathematician-parent(paying), I want to be a footballer-kid). So who should the school listen to :)
That's actually the same in education and healthcare. And probably the real root of the issues with both.
I don't pay for health care I pay for insurance. In fact I don't really pay for that. My company pays for it. I just have to throw some money in the money pit when my employer pays and when I go to get care.
I don't get to choose my healthcare, and I don't get to choose the procedures.
Hospitals pair up with insurance companies and stay with them. The hospitals work for the insurance companies.
When you pay for health insurance you are essentially paying a monthly fee to get healthcare from a specific company. The more they treat the more money they make, because if they over treat and they don't make enough money they just raise rates. You don't have a choice to switch to a new provider. Heck you can't even change your plan except once a year in November.
It's the same thing as stuff that's free. You aren't the customer you are the product.
probably a bad idea but it gets me to ponder long term measurements
I do feel the raw idea is bad then added the survey to measure [????] say quality of life kind of things. If a school produces somewhat useful people who are really happy it seems to merit more funding. The economy may die if everyone has a good life
School teachers and tropical disease specialists both make money, but they often make less money than others with similar educations. If a school is judged on future earnings it will optimize around that, and the predictable outcome to such an incentive is that programs that lead to lower paying careers will suffer.
I'm not so sure standardisation due to scaling is really as the cause of this. None of the problems the author points out are really novel observations; I've been hearing this sort of thing my entire adult life, 25 years now. So why doesn't anything change?
I suspect the cause is more a lack of trust in people, as well as a fear of things going wrong. Maybe that comes out of scaling: no one really knows what anyone is doing and everyone is a "stranger". So we have all these controls because we don't trust the nurses to nurse, the teachers to teach, etc.
I feel this matters because without identifying the cause, you're not going to find a solution, which is probably to think of ways to increase trust, and to increase societal acceptance that sometimes things go wrong and that's okay, because sometimes the cure is worse than the disease.
I'm not really sure how to go about that though – a big part of the problem are toxic media outlets that will abuse any incident to attack $disfavoured_politician without regard for truth or fairness. The incentives for politicians are pretty skewed.
I don't think that "self-directed learning pods" or "community-funded clinics" are really the path forward. It all sounds very nice, but you can't really run the entire country's system on this for a number of reasons. Sounds more of a libertarian pipe dream than anything else.
We live in a society, we are supposed to act civilized first, then throw AI tech solutions at problems. The problem is we do not act civilized, at least rich people and corps don't and rob society of basic funding. Look at food in schools big corps have regulatory capture and can put whatever shit in front of kids and get a stamp from the FDA. Unregulated hyper-concentration of wealth is going to look like and endless funnel to the richer classes and education won't get better even if you can throw some cheap ollama based tools at it.
It's a very well-to-do district, and funding per student is comparatively through the roof. Every kid has their own laptop. Small class sizes, smaller than when I attended. Smart boards and all that jazz. Test scores and the graduation rate have significantly decreased since I attended.
The problem is more fundamental than lack of funds. It's what we're teaching and how. Throwing money at the problem blindly has not helped.
Your post is, in a nutshell, why American education will never be fixed. The U.S. funds education really well. Inflation-adjusted per student spending is up 34% since 2002: https://reason.org/commentary/four-takeaways-from-the-u-s-ce.... It has tripled since 1970. But test scores haven’t budged at all!
I grew up in one of the most affluent suburbs in the country. My dad once ran into Dick Cheney at our local CVS. Per-student spending when I graduated high school in 2002 was about $16,500 in today’s dollars. The average per-student spending in the U.S. today is $18,900. Is the average school in the U.S. today better than the one I went to growing up? Absolutely not.
Funding is simply not the problem with American education. The biggest problem is probably the quality of the students, followed closely by the quality of the people willing to become teachers.
I mean, rock-solid take, I guess. Don’t bother trying to improve, folks, these kids don’t deserve it.
Assuming we rule out blindingly stupid arguments, perhaps we could ask if the distribution of that average funding might have something to do with the problem? Your anecdotal evidence doesn’t really serve to illustrate that education across the whole country is fine and of similar quality.
Those aren’t “realistic complaints” about education, as distinguished from my “unrealistic” ones. Those are simply the factors you assume must explain observed educational differences given your worldview. For most people who think this way, evidence won’t change their mind because it’s these factors that must be the explanation for their worldview to make sense.
The distribution of funding across the country is not a problem in most places. Some of the worst school districts spend the most money. The affluent school district where I grew up spends $19,750 per student per year. Baltimore spends $22,400 per year. Chicago is at $29,000. Detroit is at $28,000. Portland spends almost $49,000 per student.
Utah has just about the least spending per student and just about the highest test scores.
Spending != education.
Pretending that the issues in care are metrics and not stupid fee-for-service incentives (ignoring the myriad Rx issues and system failures) and an abject failure to improve the supply of providers is ridiculous nonsense.
Yeah, children now spend days looking at Youtube hip-hop videos, learning nothing.
> Rethink Metrics
In other words: "The victims of our 'non-education' approach crater on standardized tests. So we must destroy the standardized tests"
It’s one thing to suffer from a blinkered, reductive view of the world. It’s another thing to be proud of it.
Managers who react to known signals in predictable ways are strategically better than managers who just make stuff up on the day in unpredictable ways.
The alternative is to do the thing that doesn't scale, because all the purported ways of scaling are worse than that.
Many of the most important decisions do not have quantifiable outcomes. How many incidents did this architecture or refactor prevent? What cultural effect would that person we didn’t hire have had over the next year?
At least in early stage or growing startups, I think if every one of your actions is measurable and fully specced, you’re in trouble.
Yeah, but that is explicitly not managing them. That is the standard "I can't measure this situation, therefore I will not attempt to manage it" response of a good manager.
I am responsible for the outcomes of my teams, full stop. I am responsible for the growth and development of the engineers who report to me.
If that means sometimes standing back and letting the cook, then that’s the right thing to do. I’m not here to involve myself because otherwise people will ask “well what are you doing??”
(The answer to that is that the more independent teams can run at a high velocity of quality output, the fewer managers your company needs. That is good!)
Management is about controlling the outcomes. Nobody could claim to be managing a situation well if they are responsible but exercising literally no influence over the process. If the manager could be replaced with a garden gnome and it doesn't change the outcome then the situation is effectively unmanaged.
We seem to be in furious agreement so I don't know why my perspective is eluding you. You're looking at a situation that might have an outcome that is unacceptable. You've identified that there is no measurable way to assess progress or quality. You've concluded that there is nothing you can say, do or observe that will help. The situation is then left unmanaged because there is nothing to measure and you're waiting for something you can measure before you act. This is the basics of management, what you can measure you can manage what you can't you can't.
It just happens that in the small software is unmanageable, as quickly becomes clear if you have management experience of a non-software process and compare it to managing a software team.
At the same time, nearly all of us can identify developers who are highly, highly productive, and others who are not. We may not have great metrics for software productivity, but I can guarantee that Fabrice Bellard is about 100 times more productive than I am.
Metrics are inherently an oversimplification in attempt to get complex phenomena down to a strictly ordered value, but the real world doesn't work like that. I think your mistake is thinking that just because things can't be reduced so a small set of numbers would also mean they can't be observed, and that isn't true.
I’ve seen several teams fire less productive coders and then the team fell apart into individually good coders.
That teams require a blend of capabilities and personalities is anathema to the “everyone a widget” mentality of most corporations — but remains persistently true.
For me, the answer is no. Perhaps for you the answer is yes.
Team member says they are feeling less creative because their kid is having bullying problems in school.
"Can't measure the creativity, can't measure the bullying... Can't manage this situation, sorry"
To put it differently—measure what you can; trust your feelings on the rest.
You can measure many, many things. Instead, you should measure things whenever they are good proxies for the outcomes you want to drive AND there is good cost benefit in measuring+analyzing them.
Surprisingly few things meet these criteria.
I was simply pointing out that many situations can't be solved through metrics. In my experience, the best managers try to solve most problems without metrics, but always insist on them in places where they are valuable.
In other words, they use metrics as a tool and make metrics work for the team instead of the team work for the metrics.
A good engineering team has measurements in place that are reasonable approximations, where it is reasonable to build them, but also treats them as prompts rather than absolutes. Asking "why is this metric out of band?" is infinitely more valuable than stating "this metric is out of band, we've failed".
It's a totally valid and common jargon phrase from the web services world, apologies though, I assumed that it was wider jargon than it turns out it is...
Given a choice between two metrics, managers will usually choose the most gameable, indirect, activity-oriented metric, even if it is far less useful for driving results.
And I can’t blame them. That’s the game. They have to make a number go up, their boss also has numbers that need to go up, and so on. In the worst cases, everyone is complicit in creating a forest of bullshit numbers that went up even while the company tanked.
Hmmm... I suspect this guy has some misguided picture of what the first principles are.
Last time I checked, the first principle of healthcare was "make sure as many wounded soldiers get back to the front line", and the first principle of healthcare was "don't let hordes of poor teenagers roam the streets and earn their booze and alcohol with pretty crime and prostitution by keeping them busy somewhere".