Tag: Systems

Can Markets Work Without Human Sacrifices?

Can Markets Work Without Human Sacrifices?

Posted on by jabittan
In Tell Them Who I Am Elliot Liebow writes, “Unemployment, underemployment, and substandard wages are system failures only when viewed from the bottom. Looking from the top down, they are seen as natural processes essential to the healthy functioning of a self-correcting market system. From that perspective, it is as if the market system requires human sacrifice for its good health.” Liebow argues that markets can and should function without such failures. He argues that we have deliberately crafted a system that allows and accepts these market failures at the expense of greater marginal profits and returns on investments. The costs of the failures become spread over society, while the marginal gains are concentrated in the few market leaders.
Liebow encourages us to see homelessness as a system failure. He encourages us to see the support of the homeless as a responsibility of everyone within society and as a responsibility of the system as a whole. His book argues that we cannot rely on the few shelters, the minimal government assistance, and family members of those in need if we want to reduce homelessness. We all have to recognize the costs of homelessness, the way that social and market forces can drive people to homelessness, and the actors who are not helping to solve the problem. In particular, Liebow argues that businesses are not doing enough to solve homelessness:
“As if by magic, the onus of welfare and dependency is lifted from the system of work and the employers and placed on the workers and the unemployed right in front of our very eyes, and no one is any the wiser.”
I don’t think markets need to operate in a way that sacrifices the poorest people. There are statistics about the numbers of employees at companies like Walmart who receive food stamps or Medicaid benefits. Companies are able to pay minimum wage to their employees, and Liebow argues the companies themselves are subsidized for their low wages by our system that provides free healthcare and food to those individuals who cannot earn enough through their job. This shifts the burden of supporting the workforce from the companies that require the workforce in order to be profitable to the workers themselves. This accepts that we will have human sacrifices in order for profits to stay high and for the price of cheap goods to remain low. Liebow thought this was a problem and believed that it was possible for effective markets to exist without such human sacrifices.
I would also argue that there are many jobs that are not being done because we focus so highly on private markets. Companies want to be as efficient as possible, meaning they focus on where they can generate the highest profit. As a result, we don’t build enough affordable housing, our parks and greenspaces are littered with trash that no one is incentivized to clean, and lots of recycling goes to landfills instead of being sorted and reused. These are not all wonderful jobs and it would be hard to get homeless people to do these types of jobs, but the point is that our system which sacrifices the poor also sacrifices those jobs that don’t make the marginal cost benefit analysis worthwhile for corporations. There is work that can be done if we can find a way to allow public institutions to do it. Shifting from a sense of sacrificing the poor may encourage them to actually participate in society by doing these jobs, especially if we can make them suck a little less. Such a system would be a big departure from our current approach to markets, but it is probably necessary if we want greater social cohesion and less poverty and homelessness.
When Personal Responsibility Runs Into Trauma

When Personal Responsibility Runs Into Trauma

Posted on by jabittan
Recently, my reading and writing has been critical of the idea of personal responsibility. Because we live in a society that is hyper focused on personal responsibility, because we live in an economic system where success is taken a representation of individual characteristics, and because the dominant religious views in our nation have viewed success as rewards for good individual choices and attributes, I find it necessary to push back against that narrative and look for examples of how personal responsibility can be discounted in evaluating the success or failure of another person. Perhaps living in a society that hyper devalued personal responsibility I would feel the need to highlight the role of individual responsibility in our lives, but as things are, it feels important to me is to write about the ways that structural and systemic forces can influence our lives, including the level of personal responsibility we are able to bring to individual situations and circumstances.
Trauma is one of those large structural and systemic forces that should make us re-think personal responsibility. Entrepreneurial autobiographies, self-help books, and even philosophical thinkers (like Ryan Holiday who I really find influential) talk about the importance of being able to overcome obstacles to become successful. However, a failure to adequately address and process trauma, something almost no one can (perhaps no one at all), can do on their own can prevent individuals from being able to overcome even the smallest of obstacles. Trauma can originate from incredibly early on in our lives, at a time when our brains are in their infancy and unable to even remember and recall the trauma. This doesn’t mean that trauma won’t still influence a life for decades to come. There have been lots of studies that look at childhood violence, food scarcity, and other traumatic factors and life outcomes for individuals as adults and found that those who experienced trauma have worse economic outcomes later in life.
This isn’t surprising, but somehow these findings never seem to properly make it into self-help books or our narrative around personal responsibility. Often, if past trauma is addressed in our personal responsibility culture, it is presented as another personal responsibility of the individual facing the trauma to seek out the proper help and therapy to be able to reprogram their mind.
This leaves individuals who have faced trauma in a precarious position. Their trauma is ignored and when it is recognized, it falls back onto the individual to do something to overcome it. Larger structural forces and systems don’t make an effort to understand an individual’s trauma and we don’t have larger systems and structures to provide a robust social support system to encourage and provide therapy to those who need it.
In $2.00 A Day authors Kathryn Edin and H. Luke Shaefer demonstrate how severe the trauma of others can be in shaping their lives and driving them into $2.00 a day poverty. Regarding one individual presented in the book they write, “surviving repeated abandonment by the adults in her life and a nearly constant exposure to danger had left Rae with underlying feelings of rage. Even at the relatively calm Parma store, Rae’s temper could flare up unexpectedly with slight provocation.”
For Rae, past trauma made it almost impossible for her to function in an individualistic and capitalistic society. Our individualism and capitalism has helped propel America to be the richest country on earth and has given us great luxury and has improved our world in many ways, but it has also left those who faced severe trauma, such as repeated abandonment as a child and physical danger, left alone with no appropriate way to cope with routine stresses and anxieties. It is no surprise that Rae had trouble holding a job, trouble connecting with other people to be a stable roommate, and  trouble containing her anger when provoked by rude customers. When living with the kind of trauma of physical abuse and abandonment that Rae experienced, self-preservation required a fierce and powerful reactions to threats, and that mindset could not simply be turned off even if Rae had read the best self-help book on the market.
We need to think of the trauma of others in our daily interactions and judgements of them. The United States does not have ample social support systems such as professional therapists, well trained mentors, or robust family networks for most people to receive the support necessary to overcome severe trauma. It is easy to dismiss someone who seems to act irrationally, as we can imagine Rae often did on the job or in her personal relationships, because we focus so intensely on the individual and personal responsibility. However, if we don’t recognize the role that trauma plays and the importance of social support for individuals who have been traumatized, then we risk pushing people to ruin, to $2.00 a day poverty, and potentially to suicide. It is not unreasonable to argue that our society needs to do more to support these people than say it is their personal responsibility to seek out the help they need on their own.
Anecdotal Versus Systematic Thinking

Anecdotal Versus Systematic Thinking

Posted on by jabittan
Anecdotes are incredibly convincing, especially when they focus on an extreme case. However, anecdotes are not always representative of larger populations. Some anecdotes are very context dependent, focus on specific and odd situations, and deal with narrow circumstances. However, because they are often vivid, highly visible, and emotionally resonant, they can be highly memorable and influential.
Systemic thinking often lacks many of these qualities. Often, the general reference class is hard to see or make sense of. It is much easier to remember a commute that featured an officer or traffic accident than the vast majority of commutes that were uneventful. Sometimes the data directly contradicts the anecdotal stories and thoughts we have, but that data often lacks the visibility to reveal the contradictions. This happens frequently with news stories or TV shows that highlight dangerous crime or teen pregnancy. Despite a rise in crime during 2020, we have seen falling crime rates in recent decades, and despite TV shows about teen pregnancies, those rates have also been falling.
In Vices of the Mind, Quassim Cassam examines anecdotal versus systematic thinking to demonstrate that anecdotal thinking can be an epistemic vice that obstructs our view of reality. He writes, “With a bit of imagination it is possible to show that every supposed epistemic vice can lead to true belief in certain circumstances. What is less obvious is that epistemic vices are reliable pathways to true belief or that they are systematically conducive to true belief.”
Anecdotal versus systematic thinking or structural thinking is a useful context for thinking about Cassam’s quote. An anecdote describes a situation or story with an N of 1. That is to say, an anecdote is a single case study. Within any population of people, drug reactions, rocket launches, or any other phenomenon, there are going to be outliers. There will be some results that are strange and unique, deviating from the norm or average. These individual cases are interesting and can be useful to study, but it is important that we recognize them as outliers and not generalize these individual cases to the larger population. Systematic and structural thinking helps us see the larger population and develop more accurate beliefs about what we should normally expect to happen.
Anecdotal thinking may occasionally lead to true beliefs about larger classes, but as Cassam notes, it will not do so reliably. We cannot build our beliefs around single anecdotes, or we will risk making decisions based on unusual outliers. Trying to address crime, reduce teen pregnancy, determine the efficacy of a medication, or verify the safety of a spaceship requires that we understand the larger systemic and structural picture. We cannot study one instance of crime and assume we know how to reduce crime across an entire country, and none of us would want to ride in a spaceship that had only been tested once.
It is important that we recognize anecdotal thinking, and other epistemic vices, so we can improve our thinking and have better understandings of reality. Doing so will help improve our decision-making, will improve the way we relate to the world, and will help us as a society better determine where we should place resources to help create a world we want to live in. Anecdotal thinking, and indulging in other epistemic vices, might give us a correct answer from time to time, but it is likely to lead to worse outcomes and decisions over time as we routinely misjudge reality. This in turn will create tensions and distrust among a society that cannot agree on the actual trends and needs of the population.
Case Explanations Versus Structural Explanations

Case Explanations Versus Structural Explanations

Posted on by jabittan
In Vices of the Mind Quassim Cassam asks whether we can understand the behaviors of an individual based on individual characteristics or if we have to rely on larger structural and systemic explanations for their behavior. The question is important for Cassam because his book focuses on epistemic vices, which are vices that get in the way of knowledge. If such vices change people’s thoughts and behaviors in predictable ways, then they are something we should think about and work to change in ourselves and others. If, however, they don’t make a difference in people’s behaviors because larger structural explanations exist, then they are not worthy of our attention.
Given that Cassam wrote an entire book about epistemic vices, it is not surprising that he believes that they are useful in explaining behavior. He writes, “Epistemic vices are obstacles to knowledge that can in appropriate cases explain how people think and what they do. Sometimes, though, structural or systemic explanations are better.” This sentence feels a little weak, as though Cassam is admitting that epistemic vices can take a back seat to structural factors. However, the sentence is a useful summation of how we should think about individual level factors and larger structural and systemic factors.
Our lives are shaped to a great degree by large structural and systemic forces that are beyond our control. Family structures drive specific types of behaviors. Markets produce predictable outcomes. The rules of a sport determine what actions can and cannot be taken. However, within these larger structures and systems there is room for individual variation. Cassam’s argument is that we can understand some of the individual variation within larger structures by understanding epistemic vices.
Case explanations can include individual choices, characteristics, and epistemic virtues and vices to help us understand behavior. These explanations can be built on top of structural and systemic explanations which shape the range of possibilities and narrow some of the individual variations. We cannot entirely define someone by their individual choices and differences, but we can view them within a system and ask how their choices within a system differed from others, whether their differences were positive or negative, and why.
Systematically Obstructing Knowledge

Systematically Obstructing Knowledge

Posted on by jabittan
The defining feature of epistemic vices, according to Quassim Cassam, is that they get in the way of knowledge. They inhibit the transmission of knowledge from one person to another, they prevent someone from acquiring knowledge, or they make it harder to retain and recall knowledge when needed. Importantly, epistemic vices don’t always obstruct knowledge, but they tend to do so systematically.
“There would be no justification for classifying closed-mindedness or arrogance as epistemic vices if they didn’t systematically get in the way of knowledge,” writes Cassam in Vices of the Mind. Cassam lays out his argument for striving against mental vices through a lens of consequentialism. Focusing on the outcomes of ways of thinking, Cassam argues that we should avoid mental vices because they lead to bad outcomes and limit knowledge in most cases.
Cassam notes that epistemic vices can turn out well for an individual in some cases. While not specifically mentioned by Cassam, we can use former President Donald Trump as an example. Cassam writes, “The point of distinguishing between systematically and invariably is to make room for the possibility that epistemic vices can have unexpected effects in particular cases.” Trump used a massive personal fortune, an unabashed bravado, and a suite of mental vices to bully his way into the presidency. His mental vices such as arrogance, closed-mindedness, and prejudice became features of his presidency, not defects. However, while his epistemic vices helped propel him to the presidency, they clearly and systematically created chaos and problems once he was in office. In his arrogance he attempted to bribe the prime minister of Ukraine, leading to an impeachment. His closed-mindedness and wishful thinking contributed to his second impeachment as he spread baseless lies about the election. 
For most of us in most situations, these same mental vices will also likely lead to failure and errors rather than success. For most of us, arrogance is likely to prevent us from learning about areas where we could improve ourselves to perform better in upcoming job interviews. Closed-mindedness is likely to prevent us from gaining knowledge about saving money with solar panels or about a new ethnic restaurant that we would really enjoy. Prejudice is also likely to prevent us from learning about new hobbies, pastimes, or opportunities for investment. These vices don’t always necessarily lead to failure and limit important knowledge for us, as Trump demonstrated, but they are more likely to obstruct important knowledge than if we had pushed against them.
Consequentialism

On Consequentialism

Posted on by jabittan
In his book Vices of the Mind, Quassim Cassam argues that patterns of thoughts and mental habits that obstruct knowledge are essentially moral vices. Ways of thinking and mental habits that enhance the acquisition, retention, and transmission of knowledge, according to Cassam, are moral virtues. Cassam defends his argument largely through a consequentialist view.
Cassam is open about his consequentialist frame of reference. He writes:
“Obstructivism is a form of consequentialism. … Moral vices systematically produce bad states of affairs. … The point of systematically is to allow us to ascribe moral virtue in the actual world to people who, as a result of bad luck, aren’t able to produce good: if they possessed a character trait that systematically produces good in that context (though not in their particular case) they still have the relevant moral virtues.”
I think that this view of epistemic vices is helpful. I know for me that there are times when I fall into the epistemic vices that Cassam highlights, and they can often be comforting, make me feel good about myself, or just be distractions from an otherwise busy and confusing world. However, recognizing that these vices systematically lead to poorer outcomes can help me understand why I should stay away from them.
Epistemic vices like scrolling through Twitter to look at posts that bash on someone you dislike are structurally likely to produce bad outcomes by wasting your time, making you more prone to distractions, and prejudicing yourself against people you don’t agree with. What you spend your mental energy on matters, and in the case of Twitter scrolling, you are allowing your mind to indulge in shallow quick thinking, closed-mindedness, and biases. It plays off confirmation bias, giving you the ability to only see posts that confirm what you believe or want to believe about a person or topic. It feels nice to bash on someone else, but you are reinforcing a limited perspective that might be wrong and rewarding your brain for being shallow and inconsiderate. In the moment it is rewarding, but in the long run it will lead to worse thinking, shorter attention spans, and biased decision-making that is hard to get away from once you have closed the Twitter tab. Consequentialism helps us see that the epistemic vices involved in Twitter scrolling, which feel harmless in the moment, are more likely to result in negative outcomes over time. The systematic nature of these epistemic vices, the consequences and outcomes of indulging them, is what defines them as vices.
Consequentialism, Cassam’s argument shows, can be a useful way to think about how we should behave. People who try to do good but experience bad luck and don’t produce the same good outcomes as others can still be viewed as morally virtuous. Even though in their particular situation a good result did not occur, those who practice moral virtues can be praised for behaving in a way that is systematically more likely to produce good. Conversely, people who behave in ways that systematically produce negative outcomes can be deterred from their negative behavior through social taboos and norms, even if a poor behavior might provide them with an opportunity to succeed in the short term. It is hard to take absolute stances about any position, but consequentialism gives us a frame though which we can approach difficult decisions and uncertainty by recognizing where systematic patterns are likely to lead to desired or undesired outcomes for ourselves and our societies.
Base Rates Joe Abittan

Base Rates

Posted on by jabittan
When we think about individual outcomes we usually think about independent causal structures. A car accident happened because a person was switching their Spotify playlist and accidently ran a red light. A person stole from a grocery store because they had poor moral character which came from a poor cultural upbringing. A build-up of electrical potential from the friction of two air masses rushing past each other caused a lightning strike.

 

When we think about larger systems and structures we usually think about more interconnected and somewhat random outcomes that we don’t necessarily observe on a case by case basis, but instead think about in terms of likelihoods and conditions which create the possibilities for a set of events and outcomes. Increasing technological capacity in smartphones with lagging technological capacity in vehicles created a tension for drivers who wanted to stream music while operating vehicles, increasing the chances of a driver error accident. A stronger US dollar made it more profitable for companies to employ workers in other countries, leading to a decline in manufacturing jobs in US cities and people stealing food as they lost their paychecks.  Earth’s tilt toward the sun led to a difference in the amount of solar energy that northern continental landmasses experienced, creating a temperature and atmospheric gradient which led to lightning producing storms and increased chances of lightning in a given region.

 

What I am trying to demonstrate in the two paragraphs above is a tension between thinking statistically versus thinking causally. It is easy to think causally on a case by case basis, and harder to move up the ladder to think about statistical likelihoods and larger outcomes over entire complex systems. Daniel Kahneman presents these two types of thought in his book Thinking Fast and Slow writing:

 

“Statistical base rates are facts about a population to which a case belongs, but they are not relevant to the individual case. Causal base rates change your view of how the individual case came to be.”

 

It is more satisfying for us to assign agency to a single individual than to consider that individual’s actions as being part of a large and complex system that will statistically produce a certain number of outcomes that we observe. We like easy causes, and dislike thinking about statistical likelihoods of different events.

 

“Statistical base rates are generally underweighted, and sometimes neglected altogether, when specific information about the case at hand is available.
Causal base rates are treated as information about the individual case and are easily combined with other case-specific information.”

 

The base rates that Kahneman describes can be thought of as the category or class to which we assign something. We can use different forms of base rates to support different views and opinions. Shifting the base rate from a statistical base rate to a causal base rate may change the way we think about whether a person is deserving of punishment, or aid, or indifference. It may change how we structure society, design roads, and conduct cost-benefit analyses for changing programs or technologies. Looking at the world through a limited causal base rate will give us a certain set of outcomes that might not generalize toward the rest of the world, and might cause us to make erroneous judgments about the best ways to organize ourselves to achieve the outcomes we want for society.
A Religious Start to Ideas of Drug Prohibition

A Religious Start to Ideas of Drug Prohibition

Posted on by jabittan
In his book Chasing The Scream Johann Hari briefly writes about human practices of using drugs dating back well over 2000 years ago. He uses a story about Greek rituals at the Temple at Eleusis to show how common and widespread drug use was, and how it occupied a central and almost sacred role in human life for ancient Greek civilizations. Hari writes about the downfall of the ritual use and near celebration of drugs which occurred at the temple. A downfall that doesn’t appear to have been brought about by negative consequences of drug use, but a downfall that was a deliberate power grab.

 

“The early Christians wanted there to be one rout to ecstasy, and one rout only – through prayer to their God,”  Hari writes. “The first tugs towards prohibition were about power, and purity of belief. If you are going to have one God and one Church, you need to stop experiences that make people feel that they can approach God on their own.”

 

Hari writes that drugs alter states of consciousness and can give people a new sense of wonder, of awe, and of being something more than themselves. These senses, he argues, were what the Christian Church wanted to offer people through their religious experiences. Church and drugs were competing for the same mental faculties and experiences, and the Church wanted to limit outside exposure to sources that gave people a supernatural feeling.

 

I like to think about the world in terms of the systems and structures that shape the possibilities of our lives. Institutions matter, and they can inform what we find to be immoral, just, and common (or uncommon) parts of human nature. Hari’s research suggest that human desires to change their states of consciousness with chemicals are not in fact the immoral and uncommon problematic desires that we have portrayed them. Institutions, such as religions, have shaped the ways we think about and understand drugs and chemical intoxication. There are probably some true elements of public safety and health in our drug prohibition today, but much of our policy stems from and still maintains a system of authority, power, fear, and xenophobia. Drug use can be widespread and accepted, even if it is problematic – just look at alcohol use in the United States and across the globe. It can also be prohibited and marginalized, it just depends on the institutional systems and structures we chose to attach to drug use. We can develop ways to use drugs responsibly and safely, or we can force drug use into illicit and shady corners of society, where a guarantee of safety and protection is a laughable idea.
Design Matters - Healthcare Systems Edition

Design Matters – Healthcare Edition

Posted on by jabittan
In his book The Opioid Crisis Wake-Up Call, Dave Chase quotes Dan Munro by writing, “The [healthcare] system was never broken, it was designed this way.”

 

I’m a fan of Debbie Millman’s podcast, Design Matters. When we are making something that other people will use and engage with, it is important to think about all the various aspects of how the thing will be used and how it can meet the needs and expectations of others. Whether what we are producing is art, a branding campaign, or a national healthcare system, design matters.

 

Unfortunately, the Untied State’s healthcare system wasn’t built on a design matters philosophy. We see inefficiencies everywhere, with some people getting care they don’t need while others can’t get routine basic care that could save their lives. Dan Munro says that the system was built this way, meaning that the inefficiencies, the inequalities, and the high costs were part of the system from the beginning, intentionally built in. The dysfunction we see in the system, according to Munro, is not so much a bug but rather a feature, helping someone make a profit or get priority access to the healthcare they want.

 

I think Munro is a little wrong. I think the system is a hodgepodge of pieces smashed together over the years. It is an incoherent patchwork of tools and players that has been haphazardly assembled over the years, with some working to truly do good, and others taking advantage of design flaws for their own aims. The system, in my argument, was never designed at all.

 

Design matters and what needed to happen decades ago was a real conversation about how the country would design a healthcare system that could innovate, that could meet the needs of citizens, that could ensure basic access to medical services, that could help provide preventative care rather than just emergency interventions, and that could be sustainable. Instead, doctors went about providing medical services, insurance companies popped up to help pay for some pieces here and there, and eventually businesses got in the mix and offered health insurance to employees. Each new step in healthcare in the Untied States has happened almost randomly, without a lot of deliberate planning.

 

Now the system is so large and complex that planning feels impossible. Legislation to address the challenges of the system is thousands of pages long, and because the most comprehensive law to restructure the program adopted the namesake of the nation’s first black president, a Democrat that became a polarizing figure, half the country derided the attempt to design something better. We can try to reshape bits and pieces of the system now, but design matters, and I understand why so many want to hit a restart button and rebuild a system from scratch.
Value in Healthcare

Value in Healthcare

Posted on by jabittan
A common complaint about healthcare in the United States is that it has traditionally operated on a fee for service (FFS) based model. It is a natural and easy to understand system, and generally the type of system that both patients and providers prefer. The idea is that you pay for the services you receive from a healthcare provider. So if you need a tooth extracted, you go and have the tooth extracted and pay for the extraction. If you need a skin check, you go and get a skin check and pay for it. However, this FFS model can encourage a lot of waste through unnecessary medical procedures, and the value in healthcare is sometimes lost when we wait until someone has a problem before we help them with their health.

 

A lot of government programs, employers, and insurance companies are making efforts to push against FFS in an effort to provide greater value in the healthcare services we pay for, but it is worth asking, what is value and how can healthcare systems provide it? Is value just better health? Is it services that a patient said they were happy about? Is it care that saves a life or can it just be care that makes a life somewhat more comfortable? Dave Chase helps explain one aspect of value in healthcare in his book The Opioid Crisis Wake-Up Call, “Value is defined as the ratio of quality to cost. Value increases as the quality of the care increases or the cost of care decreases.”

 

FFS encourages short appointments where doctors cram as much as they can bill for into the shortest possible time before moving on to the next patient to do the same. Value based models, on the other hand, seek to improve the quality of the care provided without adding more costs to the patient and their insurer. As opposed to simply cramming in more tests, treatments, and procedures to get more money, value based systems that increase quality focus on improving health outcomes while keeping costs stable.

 

Alternatively, value based models might seek to keep quality the same, but reduce overall costs. This can wade into territory we don’t necessarily want to support, such as cutting nurse management staff to keep overhead low, but it could also look like more comprehensive care to reduce costly re-admissions after a procedure. When we think about value and try to build systems around value, we ultimately have to think about quality and cost, and how those are related. We can cut pieces out of the system that are just meant for signaling and cut pieces out that might be unnecessary without diminishing quality. But at the same time, we really need to examine whether the pieces we want to cut really do help with the quality of the care, especially over the long run.

 

Thinking about value in healthcare isn’t entirely new, but it is receiving increased focus, which is important if we want to have a healthcare system that people actually trust and are willing to engage with when necessary.