encode health into a market utility function, first we create financial contracts with an expected value which captures long-term health. We can accomplish this with a long-term contract that generates positive cash flow when a human is healthy, and negative when unhealthy—basically an insurance contract.
That’s broadly the structure of taxpayer supported public healthcare system. The government is incentivised to keep people alive and paying tax, and disincentivised to treat people unnecessarily. I can vouch that under that kind of system, the authorities aren’t shy about promoting preventative measures.
I generally agree that the government is more value aligned, but it is also much less efficient.
In particular it has trouble with fine grained credit assignment. It works well for running a military, it doesn’t work as well in the modern era for research—where anybody with some smarts, the internet, and luck can come up with an idea that is potentially worth billions—without any credentials.
yep, alive and paying tax or dead quickly if they’re going to die.
There’s a reason there was a big push for anti-smoking measures in recent years. Cancer treatments got better, people with lung cancer suddenly lived longer and cost more so the incentive to stop people smoking grew.
Better, of course, is still better than worse. “Perfectly aligned”, I’d say, is an overly strong claim to make for anything in this mortal world, ahaha, that was not explicitly designed and verified to be perfectly aligned, or at least aligned in-the-limit of increasing resources.
Also it is largely a command economy setup.
There are countries with non-command economy public healthcare. I lived in one (Israel).
It’s also important to note that markets, in the sense of allocatively-efficient combinatorial price-seeking and price-taking as such, are not the magic super sauce of Western economies as we know them. As far as economists were able to study, the magic super sauce is actually just allowing firms to enter and exit business as they please, enabling economic agents to plan reliably, and containing liability when things go wrong.
Command economies violate that first guideline, which takes away the ability of an economy to explore a combinatorially-large solution space in parallel.
The last problem was once “solved” via limited liability corporations, but nowadays bailout/hostage capitalism and the increasing financialization of Western economies has created a previously-unrecognized creature: distinctly capitalist economies defined by catering to a small number of agents who can punish everyone else with toxic liabilities when they don’t get their upside.
The middle problem is where different societies have usually had to fudge things. A strong sense of private property often helps, but an overly strong institution of private property allows hostage-taking (as described above with banks, or as is the case with natural-resource rents, or as witnessed in any Bay Area urban planning meeting). Things like collective bargaining, universal health care, or Flexicurity seem to run against the grain of private property, but actually help increase the total planning reliability across society, and certainly people like having them. There doesn’t seem to be a secret sauce for building institutional structures that give people the Freedom To Optimize.
There’s also a timeline of related events on page 16.
Peak tobacco use corresponded with the period where scientific studies were establishing that smoking causes cancer and various other diseases. It was several years into the decline of smoking popularity before “nonsmoker’s rights” (i.e. measures against smoking in public) started taking off.
The government is incentivised to keep people alive and paying tax, and disincentivised to treat people unnecessarily.
Unfortunately I don’t think that’s true:
Many Californians—most Californians—are assets. That is: productive citizens, or children who will grow up and become productive citizens. Their place is the left side of the balance sheet. Their presence in California increases California’s productive power, and thus its value as a financial asset.
As the King begins the transition from democracy, however, he sees at once that many Californians—certainly millions—are financial liabilities. These are unproductive citizens. Their place on the balance sheet is on the right. To put it crudely, a ten-cent bullet in the nape of each neck would send California’s market capitalization soaring—often by a cool million per neck.
And we are just getting started. The ex-subject can then be dissected for his organs. Do you know what organs are worth? This is profit!
If we claim to derive the responsibility of government from mere financial prudence, we must explain why the business strategy of culling unwanted subjects for their organs is not viable. Most would not find this profitable strategy consistent with responsibility. Yet, since a sovereign is sovereign, no higher sovereign can exist to outlaw or preclude it. The design must solve this problem on its own.
I can see that private health insurance companies wouldn’t want to take in bad risks. They don’t in some US states, and are forced to by the federal government in others, I can also see that a profit driven GovCo would behave like a giant private insurer. But actual in-GovCo governments are incentivised to provide universally access to healthcare as they do to the law and education. I can vouch that where you have public healthcare, any hint that some group is excluded creates a stink. Health insurance provides better incentives than piecemeal provision, but public healthcare has better incentives than both.
I appreciate the point and agree with it, but in fairness to the financial prudence folks if the government were to start executing citizens that would have major costs down the line. I would not expect a government concerned with financial prudence to do such executions if they were at all intelligent. It’s cheaper to give unproductive people welfare than to round them all up and kill them, once you take matters of political economy into consideration on the accounting sheet.
That’s broadly the structure of taxpayer supported public healthcare system. The government is incentivised to keep people alive and paying tax, and disincentivised to treat people unnecessarily. I can vouch that under that kind of system, the authorities aren’t shy about promoting preventative measures.
I generally agree that the government is more value aligned, but it is also much less efficient.
In particular it has trouble with fine grained credit assignment. It works well for running a military, it doesn’t work as well in the modern era for research—where anybody with some smarts, the internet, and luck can come up with an idea that is potentially worth billions—without any credentials.
Do you want rewards as a means of getting good outcomes, or as an end in itself?
yep, alive and paying tax or dead quickly if they’re going to die.
There’s a reason there was a big push for anti-smoking measures in recent years. Cancer treatments got better, people with lung cancer suddenly lived longer and cost more so the incentive to stop people smoking grew.
Better aligned but not perfectly.
Also it is largely a command economy setup.
Better, of course, is still better than worse. “Perfectly aligned”, I’d say, is an overly strong claim to make for anything in this mortal world, ahaha, that was not explicitly designed and verified to be perfectly aligned, or at least aligned in-the-limit of increasing resources.
There are countries with non-command economy public healthcare. I lived in one (Israel).
It’s also important to note that markets, in the sense of allocatively-efficient combinatorial price-seeking and price-taking as such, are not the magic super sauce of Western economies as we know them. As far as economists were able to study, the magic super sauce is actually just allowing firms to enter and exit business as they please, enabling economic agents to plan reliably, and containing liability when things go wrong.
Command economies violate that first guideline, which takes away the ability of an economy to explore a combinatorially-large solution space in parallel.
The last problem was once “solved” via limited liability corporations, but nowadays bailout/hostage capitalism and the increasing financialization of Western economies has created a previously-unrecognized creature: distinctly capitalist economies defined by catering to a small number of agents who can punish everyone else with toxic liabilities when they don’t get their upside.
The middle problem is where different societies have usually had to fudge things. A strong sense of private property often helps, but an overly strong institution of private property allows hostage-taking (as described above with banks, or as is the case with natural-resource rents, or as witnessed in any Bay Area urban planning meeting). Things like collective bargaining, universal health care, or Flexicurity seem to run against the grain of private property, but actually help increase the total planning reliability across society, and certainly people like having them. There doesn’t seem to be a secret sauce for building institutional structures that give people the Freedom To Optimize.
There’s a great chart of the popularity of tobacco, and of various modes of consuming it, on the first page of this paper:
http://cancercontrol.cancer.gov/brp/tcrb/monographs/8/m8_2.pdf
There’s also a timeline of related events on page 16.
Peak tobacco use corresponded with the period where scientific studies were establishing that smoking causes cancer and various other diseases. It was several years into the decline of smoking popularity before “nonsmoker’s rights” (i.e. measures against smoking in public) started taking off.
Unfortunately I don’t think that’s true:
source
I can see that private health insurance companies wouldn’t want to take in bad risks. They don’t in some US states, and are forced to by the federal government in others, I can also see that a profit driven GovCo would behave like a giant private insurer. But actual in-GovCo governments are incentivised to provide universally access to healthcare as they do to the law and education. I can vouch that where you have public healthcare, any hint that some group is excluded creates a stink. Health insurance provides better incentives than piecemeal provision, but public healthcare has better incentives than both.
un-GovCo, I believe?
I appreciate the point and agree with it, but in fairness to the financial prudence folks if the government were to start executing citizens that would have major costs down the line. I would not expect a government concerned with financial prudence to do such executions if they were at all intelligent. It’s cheaper to give unproductive people welfare than to round them all up and kill them, once you take matters of political economy into consideration on the accounting sheet.