Month: December 2023

A new direction

PNRJ personal, science and academia , , , , , , , , , , , ,

Dec 31 JDN 2460311

CW: Spiders [it’ll make sense in context]

My time at the University of Edinburgh is officially over. For me it was a surprisingly gradual transition: Because of the holiday break, I had already turned in my laptop and ID badge over a week ago, and because my medical leave, I hadn’t really done much actual work for quite some time. But this is still a momentous final deadline; it’s really, truly, finally over.

I now know with some certainty that leaving Edinburgh early was the right choice, and if anything I should have left sooner or never taken the job in the first place. (It seems I am like Randall Munroe after all.) But what I don’t know is where to go next.

We won’t be starving or homeless. My husband still has his freelance work, and my mother has graciously offered to let us stay in her spare room for awhile. We have some savings to draw upon. Our income will be low enough that payments on my student loans will be frozen. We’ll be able to get by, even if I can’t find work for awhile. But I certainly don’t want to live like that forever.

I’ve been trying to come up with ideas for new career paths, including ones I would never have considered before. Right now I am considering: Back into academia (but much choosier about what sort of school and position), into government or an international aid agency, re-training to work in software development, doing my own freelance writing (then I must decide: fiction or nonfiction? Commercial publishing, or self-published?), publishing our own tabletop games (we have one almost ready for crowdfunding, and another that I could probably finish relatively quickly), opening a game shop or escape room, or even just being a stay-at-home parent (surely the hardest to achieve financially; and while on the one hand it seems like an awful waste of a PhD, on the other hand it would really prove once and for all that I do understand the sunk cost fallacy, and therefore be a sign of my ultimate devotion to behavioral economics). The one mainstream option for an econ PhD that I’m not seriously considering is the private sector: If academia was this soul-sucking, I’m not sure I could survive corporate America.

Maybe none of these are yet the right answer. Or maybe some combination is.

What I’m really feeling right now is a deep uncertainty.

Also, fear. Fear of the unknown. Fear of failure. Fear of rejection. Almost any path I could take involves rejection—though of different kinds, and surely some more than others.

I’ve always been deeply and intensely affected by rejection. Some of it comes from formative experiences I had as a child and a teenager; some of it may simply be innate, the rejection-sensitive dysphoria that often comes with ADHD (which I now believe I have, perhaps mildly). (Come to think of it, even those formative experiences may have hit so hard because of my innate predisposition.)

But wherever it comes from, my intense fear of rejection is probably my greatest career obstacle. In today’s economy, just applying for a job—any job—requires bearing dozens of rejections. Openings get hundreds of applicants, so even being fully qualified is no guarantee of anything.

This makes it far more debilitating than most other kinds of irrational fear. I am also hematophobic, but that doesn’t really get in my way all that much; in the normal course of life, one generally tries to avoid bleeding anyway. (Now that MSM can donate blood, it does prevent me from doing that; and I do feel a little bad about that, since there have been blood shortages recently.)

But rejection phobia basically feels like this:

Imagine you are severely arachnophobic, just absolutely terrified of spiders. You are afraid to touch them, afraid to look at them, afraid to be near them, afraid to even think about them too much. (Given how common it is, you may not even have to imagine.)

Now, imagine (perhaps not too vividly, if you are genuinely arachnophobic!) that every job, every job, in every industry, regardless of what skills are required or what the work entails, requires you to first walk through a long hallway which is covered from floor to ceiling in live spiders. This is simply a condition of employment in our society: Everyone must be able to walk through the hallway full of spiders. Some jobs have longer hallways than others, some have more or less aggressive spiders, and almost none of the spiders are genuinely dangerous; but every job, everywhere, requires passing through a hallway of spiders.

That’s basically how I feel right now.

Freelance writing is the most obvious example—we could say this is an especially long hallway with especially large and aggressive spiders. To succeed as a freelance writer requires continually submitting work you have put your heart and soul into, and receiving in response curtly-worded form rejection letters over and over and over, every single time. And even once your work is successful, there will always be critics to deal with.

Yet even a more conventional job, say in academia or government, requires submitting dozens of applications and getting rejected dozens of times. Sometimes it’s also a curt form letter; other times, you make it all the way through multiple rounds of in-depth interviews and still get turned down. The latter honestly stings a lot more than the former, even though it’s in some sense a sign of your competence: they wouldn’t have taken you that far if you were unqualified; they just think they found someone better. (Did they actually? Who knows?) But investing all that effort for zero reward feels devastating.

The other extreme might be becoming a stay-at-home parent. There aren’t as many spiders in this hallway. While biological children aren’t really an option for us, foster agencies really can’t afford to be choosy. Since we don’t have any obvious major red flags, we will probably be able to adopt if we choose to—there will be bureaucratic red tape, no doubt, but not repeated rejections. But there is one very big rejection—one single, genuinely dangerous spider that lurks in a dark corner of the hallway: What if I am rejected by the child? What if they don’t want me as their parent?

Another alternative is starting a business—such as selling our own games, or opening an escape room. Even self-publishing has more of this character than traditional freelance writing. The only direct, explicit sort of rejection we’d have to worry about there is small business loans; and actually with my PhD and our good credit, we could reasonably expect to get accepted sooner or later. But there is a subtler kind of rejection: What if the market doesn’t want us? What if the sort of games or books (or escape experiences, or whatever) we have to offer just aren’t what the world seems to want? Most startup businesses fail quickly; why should ours be any different? (I wonder if I’d be able to get a small business loan on the grounds that I forecasted only a 50% chance of failing in the first year, instead of the baseline 80%. Somehow, I suspect not.)

I keep searching for a career option with no threat of rejection, and it just… doesn’t seem to exist. The best I can come up with is going off the grid and living as hermits in the woods somewhere. (This sounds pretty miserable for totally different reasons—as well as being an awful, frankly unconscionable waste of my talents.) As long as I continue to live within human society and try to contribute to the world, rejection will rear its ugly head.

Ultimately, I think my only real option is to find a way to cope with rejection—or certain forms of rejection. The hallways full of spiders aren’t going away. I have to find a way to walk through them.

Compassion and the cosmos

PNRJ cognitive science, core principles, current events, ethics, tribal paradigm , , , , , , , , , , , , , , , , , , ,

Dec 24 JDN 2460304

When this post goes live, it will be Christmas Eve, one of the most important holidays around the world.

Ostensibly it celebrates the birth of Jesus, but it doesn’t really.

For one thing, Jesus almost certainly wasn’t born in December. The date of Christmas was largely set by the Council of Tours in AD 567; it was set to coincide with existing celebrations—not only other Christian celebrations such as the Feast of the Epiphany, but also many non-Christian celebrations such as Yuletide, Saturnalia, and others around the Winter Solstice. (People today often say “Yuletide” when they actually mean Christmas, because the syncretization was so absolute.)

For another, an awful lot of the people celebrating Christmas don’t particularly care about Jesus. Countries like Sweden, Belgium, the UK, Australia, Norway, and Denmark are majority atheist but still very serious about Christmas. Maybe we should try to secularize and ecumenize the celebration and call it Solstice or something, but that’s a tall order. For now, it’s Christmas.

Compassion, love, and generosity are central themes of Christmas—and, by all accounts, Jesus did exemplify those traits. Christianity has a very complicated history, much of it quite dark; but this part of it at least seems worth preserving and even cherishing.

It is truly remarkable that we have compassion at all.

Most of this universe has no compassion. Many would like to believe otherwise, and they invent gods and other “higher beings” or attribute some sort of benevolent “universal consciousness” to the cosmos. (Really, most people copy the prior inventions of others.)

This is all wrong.

The universe is mostly empty, and what is here is mostly pitilessly indifferent.

The vast majority of the universe is comprised of cold, dark, empty space—or perhaps of “dark energy“, a phenomenon we really don’t understand at all, which many physicists believe is actually a shockingly powerful form of energy contained within empty space.

Most of the rest is made up of “dark matter“, a substance we still don’t really understand either, but believe to be basically a dense sea of particles that have mass but not much else, which cluster around other mass by gravity but otherwise rarely interact with other matter or even with each other.

Most of the “ordinary matter”, or more properly baryonic matter, (which we think of as ordinary, but actually by far the minority) is contained within stars and nebulae. It is mostly hydrogen and helium. Some of the other lighter elements—like lithium, sodium, carbon, oxygen, nitrogen, and all the way up to iron—can be made within ordinary stars, but still form a tiny fraction of the mass of the universe. Anything heavier than that—silver, gold, beryllium, uranium—can only be made in exotic, catastrophic cosmic events, mainly supernovae, and as a result these elements are even rarer still.

Most of the universe is mind-bendingly cold: about 3 Kelvin, just barely above absolute zero.

Most of the baryonic matter is mind-bendingly hot, contained within stars that burn with nuclear fires at thousands or even millions of Kelvin.

From a cosmic perspective, we are bizarre.

We live at a weird intermediate temperature and pressure, where matter can take on such exotic states as liquid and solid, rather than the far more common gas and plasma. We do contain a lot of hydrogen—that, at least, is normal by the standards of baryonic matter. But then we’re also made up of oxygen, carbon, nitrogen, and even little bits of all sorts of other elements that can only be made in supernovae? What kind of nonsense lifeform depends upon something as exotic as iodine to survive?

Most of the universe does not care at all about you.

Most of the universe does not care about anything.

Stars don’t burn because they want to. They burn because that’s what happens when hydrogen slams into other hydrogen hard enough.

Planets don’t orbit because they want to. They orbit because if they didn’t, they’d fly away or crash into their suns—and those that did are long gone now.

Even most living things, which are already nearly as bizarre as we are, don’t actually care much.

Maybe there is a sense in which a C. elegans or an oak tree or even a cyanobacterium wants to live. It certainly seems to try to live; it has behaviors that seem purposeful, which evolved to promote its ability to survive and pass on offspring. Rocks don’t behave. Stars don’t seek. But living things—even tiny, microscopic living things—do.

But we are something very special indeed.

We are animals. Lifeforms with complex, integrated nervous systems—in a word, brains—that allow us to not simply live, but to feel. To hunger. To fear. To think. To choose.

Animals—and to the best of our knowledge, only animals, though I’m having some doubts about AI lately—are capable of making choices and experiencing pleasure and pain, and thereby becoming something more than living beings: moral beings.

Because we alone can choose, we alone have the duty to choose rightly.

Because we alone can be hurt, we alone have the right to demand not to be.

Humans are even very special among animals. We are not just animals but chordates; not just chordates but mammals; not just mammals but primates. And even then, not just primates. We’re special even by those very high standards.

When you count up all the ways that we are strange compared to the rest of the universe, it seems incredibly unlikely that beings like us would come into existence at all.

Yet here we are. And however improbable it may have been for us to emerge as intelligent beings, we had to do so in order to wonder how improbable it was—and so in some sense we shouldn’t be too surprised.

It is a mistake to say that we are “more evolved” than any other lifeform; turtles and cockroaches had just as much time to evolve as we did, and if anything their relative stasis for hundreds of millions of years suggests a more perfected design: “If it ain’t broke, don’t fix it.”

But we are different than other lifeforms in a very profound way. And I dare say, we are better.

All animals feel pleasure, pain and hunger. (Some believe that even some plants and microscopic lifeforms may too.) Pain when something damages you; hunger when you need something; pleasure when you get what you needed.

But somewhere along the way, new emotions were added: Fear. Lust. Anger. Sadness. Disgust. Pride. To the best of our knowledge, these are largely chordate emotions, often believed to have emerged around the same time as reptiles. (Does this mean that cephalopods never get angry? Or did they evolve anger independently? Surely worms don’t get angry, right? Our common ancestor with cephalopods was probably something like a worm, perhaps a nematode. Does C. elegans get angry?)

And then, much later, still newer emotions evolved. These ones seem to be largely limited to mammals. They emerged from the need for mothers to care for their few and helpless young. (Consider how a bear or a cat fiercely protects her babies from harm—versus how a turtle leaves her many, many offspring to fend for themselves.)

One emotion formed the core of this constellation:

Love.

Caring, trust, affection, and compassion—and also rejection, betrayal, hatred, and bigotry—all came from this one fundamental capacity to love. To care about the well-being of others as well as our own. To see our purpose in the world as extending beyond the borders of our own bodies.

This is what makes humans different, most of all. We are the beings most capable of love.

We are of course by no means perfect at it. Some would say that we are not even very good at loving.

Certainly there are some humans, such as psychopaths, who seem virtually incapable of love. But they are rare.

We often wish that we were better at love. We wish that there were more compassion in the world, and fear that humanity will destroy itself because we cannot find enough compassion to compensate for our increasing destructive power.

Yet if we are bad at love, compared to what?

Compared to the unthinking emptiness of space, the hellish nuclear fires of stars, or even the pitiless selfishness of a worm or a turtle, we are absolute paragons of love.

We somehow find a way to love millions of others who we have never even met—maybe just a tiny bit, and maybe even in a way that becomes harmful, as solidarity fades into nationalism fades into bigotry—but we do find a way. Through institutions of culture and government, we find a way to trust and cooperate on a scale that would be utterly unfathomable even to the most wise and open-minded bonobo, let alone a nematode.

There are no other experts on compassion here. It’s just us.

Maybe that’s why so many people long for the existence of gods. They feel as ignorant as children, and crave the knowledge and support of a wise adult. But there aren’t any. We’re the adults. For all the vast expanses of what we do not know, we actually know more than anyone else. And most of the universe doesn’t know a thing.

If we are not as good at loving as we’d like, the answer is for us to learn to get better at it.

And we know that we can get better at it, because we have. Humanity is more peaceful and cooperative now than we have ever been in our history. The process is slow, and sometimes there is backsliding, but overall, life is getting better for most people in most of the world most of the time.

As a species, as a civilization, we are slowly learning how to love ourselves, one another, and the rest of the world around us.

No one else will learn to love for us. We must do it ourselves.

But we can.

And I believe we will.

Lamentations of a temporary kludge

PNRJ cognitive science, core principles , , , , , , , ,

Dec 17 JDN 2460297

Most things in the universe are just that—things. They consist of inanimate matter, blindly following the trajectories the laws of physics have set them on. (Actually, most of the universe may not even be matter—at our current best guess, most of the universe is mysterious “dark matter” and even more mysterious “dark energy”).

Then there are the laws: The fundamental truths of physics and mathematics are omnipresent and eternal. They could even be called omniscient, in the sense that all knowledge which could ever be conveyed must itself be possible to encode in physics and mathematics. (Could, in some metaphysical sense, knowledge exist that cannot be conveyed this way? Perhaps, but if so, we’ll never know nor even be able to express it.)

The reason physics and mathematics cannot simply be called God is twofold: One, they have no minds of their own; they do not think. Two, they do not care. They have no capacity for concern whatsoever, no desires, no goals. Mathematics seeks neither your fealty nor your worship, and physics will as readily destroy you as reward you. If the eternal law is a god, it is a mindless, pitilessly indifferent god—a Blind Idiot God.

But we are something special, something in between. We are matter, yes; but we are also pattern. Indeed, what makes me me and makes you you has far more to do with the arrangement of trillions of parts than it does with any particular material. The atoms in your body are being continually replaced, and you barely notice. But should the pattern ever be erased, you would be no more.

In fact, we are not simply one pattern, but many. We are a kludge: Billions of years of random tinkering has assembled us from components that each emerged millions of years apart. We could move before we could see; we could see before we could think; we could think before we could speak. All this evolution was mind-bogglingly gradual: In most cases it would be impossible to tell the difference one generation—or even one century—to the next. Yet as raindrops wear away mountains, one by one, we were wrought from mindless fragments of chemicals into beings of thought, feeling, reason—beings with hopes, fears, and dreams.

Much of what makes our lives difficult ultimately comes from these facts.

Our different parts were not designed to work together. Indeed, they were not really designed at all. Each component survived because it worked well enough to stay alive in the environment in which our ancestors lived. We often find ourselves in conflict with our own desires, in part because those desires evolved for very different environments than the ones we now find ourselves—and in part because there is no particular reason for evolution to avoid conflict, so long as survival is achieved.

As patterns, we can experience the law. We can write down equations that express small pieces of the fundamental truths that exist throughout the universe beyond space and time. From “2+2=4” to “Gμν + Λgμν = κTμν“, through mathematics, we glimpse eternity.

But as matter, we are doomed to suffer, degrade, and ultimately die. Our pattern cannot persist forever. Perhaps one day we will find a way to change this—and if that day comes, it will be a glorious day; I will make no excuses for the dragon. For now, at least, it is a truth that we must face: We, all we love, and all we build must one day perish.

That is, we are not simply a kludge; we are a temporary one. Sooner or later, our bodies will fail and our pattern will be erased. What we were made of may persist, but in a form that will no longer be us, and in time, may become indistinguishable from all the rest of the universe.

We are flawed, for the same reason that a crystal is flawed. A theoretical crystal can be flawless and perfect; but a real, physical one must exist in an actual world where it will suffer impurities and disturbances that keep it from ever truly achieving perfect unity and symmetry. We can imagine ourselves as perfect beings, but our reality will always fall short.

We lament that are not perfect, eternal beings. Yet I am not sure it could have been any other way: Perhaps one must be a temporary kludge in order to be a being at all.

How do we stop overspending on healthcare?

PNRJ inequality, macroeconomics, market failure, politics, public policy, statistics , , , , , , , , , , , , , , , , , , , ,

Dec 10 JDN 2460290

I don’t think most Americans realize just how much more the US spends on healthcare than other countries. This is true not simply in absolute terms—of course it is, the US is rich and huge—but in relative terms: As a portion of GDP, our healthcare spending is a major outlier.

Here’s a really nice graph from Healthsystemtracker.org that illustrates it quite nicely: Almost all other First World countries share a simple linear relationship between their per-capita GDP and their per-capita healthcare spending. But one of these things is not like the other ones….

The outlier in the other direction is Ireland, but that’s because their GDP is wildly inflated by Leprechaun Economics. (Notice that it looks like Ireland is by far the richest country in the sample! This is clearly not the case in reality.) With a corrected estimate of their true economic output, they are also quite close to the line.

Since US GDP per capita ($70,181) is in between that of Denmark ($64,898) and Norway ($80,496) both of which have very good healthcare systems (#ScandinaviaIsBetter), we would expect that US spending on healthcare would similarly be in between. But while Denmark spends $6,384 per person per year on healthcare and Norway spends $7,065 per person per year, the US spends $12,914.

That is, the US spends nearly twice as much as it should on healthcare.

The absolute difference between what we should spend and what we actually spend is nearly $6,000 per person per year. Multiply that out by the 330 million people in the US, and…

The US overspends on healthcare by nearly $2 trillion per year.

This might be worth it, if health in the US were dramatically better than health in other countries. (In that case I’d be saying that other countries spend too little.) But plainly it is not.

Probably the simplest and most comparable measure of health across countries is life expectancy. US life expectancy is 76 years, and has increased over time. But if you look at the list of countries by life expectancy, the US is not even in the top 50. Our life expectancy looks more like middle-income countries such as Algeria, Brazil, and China than it does like Norway or Sweden, who should be our economic peers.

There are of course many things that factor into life expectancy aside from healthcare: poverty and homicide are both much worse in the US than in Scandinavia. But then again, poverty is much worse in Algeria, and homicide is much worse in Brazil, and yet they somehow manage to nearly match the US in life expectancy (actually exceeding it in some recent years).

The US somehow manages to spend more on healthcare than everyone else, while getting outcomes that are worse than any country of comparable wealth—and even some that are far poorer.

This is largely why there is a so-called “entitlements crisis” (as many a libertarian think tank is fond of calling it). Since libertarians want to cut Social Security most of all, they like to lump it in with Medicare and Medicaid as an “entitlement” in “crisis”; but in fact we only need a few minor adjustments to the tax code to make sure that Social Security remains solvent for decades to come. It’s healthcare spending that’s out of control.

Here, take a look.

This is the ratio of Social Security spending to GDP from 1966 to the present. Notice how it has been mostly flat since the 1980s, other than a slight increase in the Great Recession.

This is the ratio of Medicare spending to GDP over the same period. Even ignoring the first few years while it was ramping up, it rose from about 0.6% in the 1970s to almost 4% in 2020, and only started to decline in the last few years (and it’s probably too early to say whether that will continue).

Medicaid has a similar pattern: It rose steadily from 0.2% in 1966 to over 3% today—and actually doesn’t even show any signs of leveling off.

If you look at Medicare and Medicaid together, they surged from just over 1% of GDP in 1970 to nearly 7% today:

Put another way: in 1982, Social Security was 4.8% of GDP while Medicare and Medicaid combined were 2.4% of GDP. Today, Social Security is 4.9% of GDP while Medicare and Medicaid are 6.8% of GDP.

Social Security spending barely changed at all; healthcare spending more than doubled. If we reduced our Medicare and Medicaid spending as a portion of GDP back to what it was in 1982, we would save 4.4% of GDP—that is, 4.4% of over $25 trillion per year, so $1.1 trillion per year.

Of course, we can’t simply do that; if we cut benefits that much, millions of people would suddenly lose access to healthcare they need.

The problem is not that we are spending frivolously, wasting the money on treatments no one needs. On the contrary, both Medicare and Medicaid carefully vet what medical services they are willing to cover, and if anything probably deny services more often than they should.

No, the problem runs deeper than this.

Healthcare is too expensive in the United States.

We simply pay more for just about everything, and especially for specialist doctors and hospitals.

In most other countries, doctors are paid like any other white-collar profession. They are well off, comfortable, certainly, but few of them are truly rich. But in the US, we think of doctors as an upper-class profession, and expect them to be rich.

Median doctor salaries are $98,000 in France and $138,000 in the UK—but a whopping $316,000 in the US. Germany and Canada are somewhere in between, at $183,000 and $195,000 respectively.

Nurses, on the other hand, are paid only a little more in the US than in Western Europe. This means that the pay difference between doctors and nurses is much higher in the US than most other countries.

US prices on brand-name medication are frankly absurd. Our generic medications are typically cheaper than other countries, but our brand name pills often cost twice as much. I noticed this immediately on moving to the UK: I had always been getting generics before, because the brand name pills cost ten times as much, but when I moved here, suddenly I started getting all brand-name medications (at no cost to me), because the NHS was willing to buy the actual brand name products, and didn’t have to pay through the nose to do so.

But the really staggering differences are in hospitals.

Let’s compare the prices of a few inpatient procedures between the US and Switzerland. Switzerland, you should note, is a very rich country that spends a lot on healthcare and has nearly the world’s highest life expectancy. So it’s not like they are skimping on care. (Nor is it that prices in general are lower in Switzerland; on the contrary, they are generally higher.)

A coronary bypass in Switzerland costs about $33,000. In the US, it costs $76,000.

A spinal fusion in Switzerland costs about $21,000. In the US? $52,000.

Angioplasty in Switzerland: $9.000. In the US? $32,000.

Hip replacement: Switzerland? $16,000. The US? $28,000.

Knee replacement: Switzerland? $19,000. The US? $27,000.

Cholecystectomy: Switzerland? $8,000. The US? $16,000.

Appendectomy: Switzerland? $7,000. The US? $13,000.

Caesarian section: Switzerland? $8,000. The US? $11,000.

Hospital prices are even lower in Germany and Spain, whose life expectancies are not as high as Switzerland—but still higher than the US.

These prices are so much lower that in fact if you were considering getting surgery for a chronic condition in the US, don’t. Buy plane tickets to Europe and get the procedure done there. Spend an extra few thousand dollars on a nice European vacation and you’d still end up saving money. (Obviously if you need it urgently you have no choice but to use your nearest hospital.) I know that if I ever need a knee replacement (which, frankly, is likely, given my height), I’m gonna go to Spain and thereby save $22,000 relative to what it would cost in the US. That’s a difference of a car.

Combine this with the fact that the US is the only First World country without universal healthcare, and maybe you can see why we’re also the only country in the world where people are afraid to call an ambulance because they don’t think they can afford it. We are also the only country in the world with a medical debt crisis.

Where is all this extra money going?

Well, a lot of it goes to those doctors who are paid three times as much as in France. That, at least, seems defensible: If we want the best doctors in the world maybe we need to pay for them. (Then again, do we have the best doctors in the world? If so, why is our life expectancy so mediocre?)

But a significant portion is going to shareholders.

You probably already knew that there are pharmaceutical companies that rake in huge profits on those overpriced brand-name medications. The top five US pharma companies took in net earnings of nearly $82 billion last year. Pharmaceutical companies typically take in much higher profit margins than other companies: a typical corporation makes about 8% of its revenue in profit, while pharmaceutical companies average nearly 14%.

But you may not have realized that a surprisingly large proportion of hospitals are for-profit businesses—even though they make most of their revenue from Medicare and Medicaid.

I was surprised to find that the US is not unusual in that; in fact, for-profit hospitals exist in dozens of countries, and the fraction of US hospital capacity that is for-profit isn’t even particularly high by world standards.

What is especially large is the profits of US hospitals. 7 healthcare corporations in the US all posted net incomes over $1 billion in 2021.

Even nonprofit US hospitals are tremendously profitable—as oxymoronic as that may sound. In fact, mean operating profit is higher among nonprofit hospitals in the US than for-profit hospitals. So even the hospitals that aren’t supposed to be run for profit… pretty much still are. They get tax deductions as if they were charities—but they really don’t act like charities.

They are basically nonprofit in name only.

So fixing this will not be as simple as making all hospitals nonprofit. We must also restructure the institutions so that nonprofit hospitals are genuinely nonprofit, and no longer nonprofit in name only. It’s normal for a nonprofit to have a little bit of profit or loss—nobody can make everything always balance perfectly—but these hospitals have been raking in huge profits and keeping it all in cash instead of using it to reduce prices or improve services. In the study I linked above, those 2,219 “nonprofit” hospitals took in operating profits averaging $43 million each—for a total of $95 billion.

Between pharmaceutical companies and hospitals, that’s a total of over $170 billion per year just in profit. (That’s more than we spend on food stamps, even after surge due to COVID.) This is pure grift. It must be stopped.

But that still doesn’t explain why we’re spending $2 trillion more than we should! So after all, I must leave you with a question:

What is America doing wrong? Why is our healthcare so expensive?

The problem with “human capital”

PNRJ core principles, critique of neoclassical economics, ethics , , , , , , , , , , , , , , ,

Dec 3 JDN 2460282

By now, human capital is a standard part of the economic jargon lexicon. It has even begun to filter down into society at large. Business executives talk frequently about “investing in their employees”. Politicians describe their education policies as “investing in our children”.

The good news: This gives businesses a reason to train their employees, and governments a reason to support education.

The bad news: This is clearly the wrong reason, and it is inherently dehumanizing.

The notion of human capital means treating human beings as if they were a special case of machinery. It says that a business may own and value many forms of productive capital: Land, factories, vehicles, robots, patents, employees.

But wait: Employees?


Businesses don’t own their employees. They didn’t buy them. They can’t sell them. They couldn’t make more of them in another factory. They can’t recycle them when they are no longer profitable to maintain.

And the problem is precisely that they would if they could.

Indeed, they used to. Slavery pre-dates capitalism by millennia, but the two quite successfully coexisted for hundreds of years. From the dawn of civilization up until all too recently, people literally were capital assets—and we now remember it as one of the greatest horrors human beings have ever inflicted upon one another.

Nor is slavery truly defeated; it has merely been weakened and banished to the shadows. The percentage of the world’s population currently enslaved is as low as it has ever been, but there are still millions of people enslaved. In Mauritania, slavery wasn’t even illegal until 1981, and those laws weren’t strictly enforced until 2007. (I had graduated from high school!) One of the most shocking things about modern slavery is how cheaply human beings are willing to sell other human beings; I have bought sandwiches that cost more than some people have paid for other people.

The notion of “human capital” basically says that slavery is the correct attitude to have toward people. It says that we should value human beings for their usefulness, their productivity, their profitability.

Business executives are quite happy to see the world in that way. It makes the way they have spent their lives seem worthwhile—perhaps even best—while allowing them to turn a blind eye to the suffering they have neglected or even caused along the way.

I’m not saying that most economists believe in slavery; on the contrary, economists led the charge of abolitionism, and the reason we wear the phrase “the dismal science” like a badge is that the accusation was first leveled at us for our skepticism toward slavery.

Rather, I’m saying that jargon is not ethically neutral. The names we use for things have power; they affect how people view the world.

This is why I always endeavor to always speak of net wealth rather than net worth—because a billionare is not worth more than other people. I’m not even sure you should speak of the net worth of Tesla Incorporated; perhaps it would be better to simply speak of its net asset value or market capitalization. But at least Tesla is something you can buy and sell (piece by piece). Elon Musk is not.

Likewise, I think we need a new term for the knowledge, skills, training, and expertise that human beings bring to their work. It is clearly extremely important; in fact in some sense it’s the most important economic asset, as it’s the only one that can substitute for literally all the others—and the one that others can least substitute for.

Human ingenuity can’t substitute for air, you say? Tell that to Buzz Aldrin—or the people who were once babies that breathed liquid for their first months of life. Yes, it’s true, you need something for human ingenuity to work with; but it turns out that with enough ingenuity, you may not need much, or even anything in particular. One day we may manufacture the air, water and food we need to live from pure energy—or we may embody our minds in machines that no longer need those things.

Indeed, it is the expansion of human know-how and technology that has been responsible for the vast majority of economic growth. We may work a little harder than many of our ancestors (depending on which ancestors you have in mind), but we accomplish with that work far more than they ever could have, because we know so many things they did not.

All that capital we have now is the work of that ingenuity: Machines, factories, vehicles—even land, if you consider all the ways that we have intentionally reshaped the landscape.

Perhaps, then, what we really need to do is invert the expression:

Humans are not machines. Machines are embodied ingenuity.

We should not think of human beings as capital. We should think of capital as the creation of human beings.

Marx described capital as “embodied labor”, but that’s really less accurate: What makes a robot a robot is much less about the hours spent building it, than the centuries of scientific advancement needed to understand how to make it in the first place. Indeed, if that robot is made by another robot, no human need ever have done any labor on it at all. And its value comes not from the work put into it, but the work that comes out of it.

Like so much of neoliberal ideology, the notion of human capital seems to treat profit and economic growth as inherent ends in themselves. Human beings only become valued insofar as we advance the will of the almighty dollar. We forget that the whole reason we should care about economic growth in the first place is that it benefits people. Money is the means, not the end; people are the end, not the means.

We should not think in terms of “investing in children”, as if they were an asset that was meant to yield a return. We should think of enriching our children—of building a better world for them to live in.

We should not speak of “investing in employees”, as though they were just another asset. We should instead respect employees and seek to treat them with fairness and justice.

That would still give us plenty of reason to support education and training. But it would also give us a much better outlook on the world and our place in it.

You are worth more than your money or your job.

The economy exists for people, not the reverse.

Don’t ever forget that.