What a thoughtful post! I'm not sure whether some or all of the questions are rhetorical, but I'll give answers, nonetheless.
1. Your mother rationally prioritized healthy eating. That's unfortunately a luxury for most.
2. Zillionaires spending money they don't need as an insurance policy against an apocalyptic event, however unlikely, is rational.
3. Health is better than ever for those who can afford it. There's a shameful ten year gap in life expectancy between the riches and poorest male 1%. That's an awful choice we as a country are making.
4. I suspect the move inland is relative value, i.e., still more house and space for your money inland than on the coast.
5. I think the evils of the smartphone were an unintended consequence. There are benefits as well to those who resist obsession.
6. We all want authenticity. To the extent AI interferes with authenticity, it will and should be shunned.
7. I'm 100% with you here. First album at the age of ten was Elton John "Don't Shoot Me, I'm Only the Piano Player." I played it over and over and communed with those songs.
I'm also 100% with you on your last three conclusions about values and wisdom of the humanities and personal and intimate interactions in real life in small groups. Nothing more precious or important to human flourishing.
My first CD (I was born in 1991) was Smah Mouth’s “All Star”, my mom told the cashier at Tower Records it was my first music purchase (I was in the 4th grade) and the cashier told me how his first music purchase was a Beach Boys cassette, that he wore out listening to.
Can’t get that experience from Spotify, but it’s the world my 1.5 year old son will live in.
Hah no kidding! In high school I got heavy into metal and started making weekly runs to Rasputin and Streetlight records in Campbell. Many good memories seeking out new and used CD's back then, pretty wild to think how I only own a tiny fraction of the music I used to...
Oth, he'll be able to listen to an immense amount of music and artists that he'd have no way of being aware of by going to the record store. And the reverse is also true bands are able to find their audience so much easier. However, I am concerned about who is the real economic beneficiary. It's important that the musicians benefit more than they presently do.
A useful and imperfect simplification may be that technology has mostly continued to do what it has done: expand the range of human choices. Most things are more accessible to more people than at any other point in human history. In the process, we're finding out how people handle that ability. The results are certainly mixed. As somebody who thinks we should prioritize the respect of human agency, I struggle to reason about what we should do about that -- if people want to stare at their phones instead of talk to their families, that sounds bad to *me*, but these seem to be the rules of freedom.
"if people want to stare at their phones instead of talk to their families, that sounds bad to *me*, but these seem to be the rules of freedom."
We shape the environment we live in (or well, companies, tech, laws, etc and us last of all, shape it for us) and the environment shapes us in return.
It's not some magical "rules of freedom" as if we're equally likely to chose among all options, and make a "totally detached from the world" free choice. The environment "we" created, influences us or even pushes as to certain choices more than others.
Quite literally: not only there's a huge cost if you don't make the choices your environment pushes you to - like the impact of not having a mobile phone or social media on your career, but there's also billion dollar industries working on ways to manipulate us with tech shennanigans ("dark patterns", habit tracking, etc.) and psychology (from messing with your social feed to make it more addictive, to investigating shelf placement or music playing in buying behavior in supermarkers).
True enough! This leads us to pursue the lowest hanging fruit, but not necessarily the healthiest. Control is ceded to folks in powerful but defensive positions, not positions that truly expand human experience (it's all the same). It's similar to "plausible deniability"; we know there are no real or enriching answers in this charade, but it allows the controlling to continue pushing their high cost/low benefit pseudo-solutions.
I agree that significant resources have been deployed to attract and maintain people's attention. Resisting these efforts is not trivial, but I don't think it's extremely difficult either. There is a thread of online discourse that shakes it fists at engagement-driven algorithms and dark patterns and then goes back to scrolling Twitter. The information is pretty available to participants in that discourse. Hardly anybody truly needs to use social media. Talking about phones as if breaking away from them requires some herculean effort seems counterproductive.
> Talking about phones as if breaking away from them requires some herculean effort seems counterproductive.
Well, shouldn't whether that's the case be determined by looking at the current situation? Which points to the opposite: that is kind of IS a herculean effort.
As you wrote: "There is a thread of online discourse that shakes it fists at engagement-driven algorithms and dark patterns and then goes back to scrolling Twitter."
Isn't this more evidence about how difficult it is (not just because of the psychological manipulations and dark patterns, but also because it piggybacks on millions of years of evolutionary instincts - kind of like our liking for sugar)?
I mean, as you write, even the people who have the info and are aware of it, and against it, stick back to it.
It doesn't have to be impossible to quit (social media and smartphones and the like) to be a problem. It's enough that it's more difficult than not quiting them, and thus a large number doesn't and wont.
Maybe an analogy to cigarettes can clarify. I think your argument is something like "social media and smartphones are like cigarettes, because they are designed to create addictions that are hard to break, and they are real addictions because the affected people want to stop but fail to do so". If that is true, the notion of choice weakens -- addicts aren't choosing, they're addicted.
Two things about this analogy seem suspect to me. First, I don't think social media and smartphones are as simply negative as cigarettes are. They aren't necessarily generating the itch they scratch. They can still live up to their old lofty goals of connecting people and enriching lives, if used carefully. I think this is part of why people stick with them -- some actual value is being provided, even as the discourse says the hip thing is to say it's all dystopian late-stage capitalism.
Second, I do think they are easier to quit than, say, cigarettes. Cigarettes are everywhere, and it is easy to slip back into a life where you smoke. In contrast, if you delete your Twitter/Facebook/Instagram, you pretty well detonate that part of your life. You could build it back up, but it would take a while. So there's a "make it pretty inconvenient to keep doing this" button that other addictions don't have. The infrequency with which that button gets used -- even addicts will flush their last pack or throw away their bongs or whatever, for a fresh start -- makes me question how people actually feel about what they're doing.
I'm not sure about the analogy between phones and cigarettes, but I definitely think a phone addiction is far harder to quit. Unlike cigarettes, phones are used by nearly everyone and welcome nearly everywhere. It's nearly impossible to navigate modern life without one.
people's mental wellbeing is worse the earlier they have access to smartphones. It's as small a difference as 10-11 vs 14-15. It seems to be that since adolescence is the time when children start learning to interact and socialise as adults, if there is an obstacle at that time - whether abuse, social isolation, or smartphones - it hurts them badly. But by mid-late adolescence they will have developed enough social skills and personal resilience and sense of self that they will be fortified against the smartphone's more detrimental effects.
My first albums, once I woke up to their existence at the age of 13, were Dark Side of the Moon and Led Zeppelin 4, not long after they came out. Which both basically depth-charged my childhood 🤣
(Don’t can me from the group Ted, my first jazz album a year later was Sketches of Spain!)
"We all want authenticity. To the extent AI interferes with authenticity, it will and should be shunned."
Perhaps should be, but will? I don't think so. After all, is CGI shunned over models? Is plastic surgery shunned? Is television shunned over theatre? Are scripted stories shunned over improvised stories?
AI will be shunned not because it is unauthentic, but because it will remain autistic and retarded. Humans learn by interactions with other humans ("Mummy doesn't like it when you hit"), but AI is not permitted to do so, lest we humans turn the AI into a violent bigot; it can only passively absorb what's put out onto the internet, which increasingly is produced by AI. It's like locking an infant in a room with a television for its lifetime and having no human contact, and over time showing it nothing but other children watching TV.
Without the "only goal" you mention regarding health care I wouldn't be alive. The doctors who have used their amazing skills to keep me alive worked their asses off to be as good as the are using that "health care" have earned my respect and admiration. If the US had a single payer system I'd be dead, just ask the wealthy politicians from Canahda who've traveled to US hospitals (i.e. the Salk Institute). I've paid a lot in insurance, co-pays, etc., but I don't waste money on stupid things like $1000 "smart phones" either. And if you'd do a little research you'd find "the rich" pay the vast majority of the taxes in the US. But you won't. go ahead, take all of the US' billionaires' money and run the country for ninety days. Real numbers, not studies, are at odds with your claims.
Actually the discrepancy isn’t due to the medical system. The Financial Times did a great analysis last year and most of the gap in life expectancy comes from non-healthcare sources: traffic accidents, drug abuse, gun deaths, and obesity and the related diseases primarily.
The survival rate for many diseases in the US is higher than in other countries--and once you already are in your 60s and 70s US life expectancy is about equal with other countries.
We have a lot of things we need to fix, including the very messed up employer-based health insurance system which is far from a market with all the many regulations, but the actual medical care you do receive in the US is world class.
You're obviously exempt from reality. In January 2009 I almost kicked the bucket and spent ten days in the hospital. My insurance deductible was $1000, and I was done for the year, no more money from me had to be spent on staying alive. Then, with the assistance of Harry Reid, Little o care was passed while the politicians who voted for it blamed "the health insurance lobby." In 2023 my insurance cost over $15K, I had to pay a $3500 "deductible," but wait, deductibles don't mean the same thing they did in 2009. I had to fork over $9K to meet my "out of pocket" expenses. So I'm out almost 50% of my take-home pay. Thanks to our stout leftist politicians Big Insurance's stocks have soared, hospitals have become corporatized, and the quality of care has diminished. Big Gubmint intervention (socialism) has never worked nearly as well as greedy free market capitalism, but you go ahead and keep telling yourself that it does.
Now I'm done talking about the misadventures of those who want to control my life. I generally don't mention politics in Ted's comment sections, but there are times when others do and I can't sit back and take their BS.
There's an argument, which I would agree with, that "medicine" should include prevention as well as care. If not workplace deaths and so on, certainly physicians are in a position to address the circumstances which tend to lead to substance abuse and obesity.
To call the health care system “free market” is to misunderstand the meaning of the words. Our system is heavily regulated and highly cartelized. There are many reasons why our health care results are worse, drug and alcohol abuse, diabetes and obesity, violence and crime to name only a few.
If you want to make a strong argument for universal healthcare to Americans then the ideal system to pick is that of Australia. It's a publicly commissioned system which is almost entirely privately provided. If we contrast Australia with the UK then it's easy to see that Australia's system is measurably superior- roughly similar levels of public investment yet Australia manages seven times as many hospital beds, a much more thorough level of treatments and measurably better outcomes than any of the largely state-run alternatives, including Canada.
It's worth noting that America combines the worst aspects of state-run medicine and capitalism. It's better described as an oligopoly rather than free market, with crony capitalist barriers to entry ensuring that no medical services is commodified on the basis of price, quality or convenience. Australia is the best of both worlds- everybody gets treated and through a libertarian system of commissioning which means that dollars stretch far further in terms of treatment than in any other comparable system.
The main other positive countries are Switzerland and Sweden, the latter of which has been extending the range of the universal healthcare terrain by commission out treatments to the private sector since the early 2000s and reinvesting the savings in quality healthcare outcomes.
Here's a source which uses statistical measurement to compare outcomes in various high income countries.
Interesting comment. I also find it interesting that, despite government's intervention, the US is still leading the world in new and advanced medical care. But, as a result of that intervention, that will likely not continue. Also, simple observation shows that true free market medical care can drive costs down. See the costs for two segments that health insurance won't cover: lasik and plastic surgery.
Stats on the UK pharma industry are quite informative on the subject of American innovation and success. The US produces somewhere between 65% and 70% of new pharma. Although the UK as a research venue accounts for 13% of new global pharma, this doesn't translate well into the UK pharma industry which is only an anaemic 2.3% to 2.6% of the global pharma market.
This points to two conclusions. First, that there is a distinct difference between innovation and monetising innovation (we Brits are great at the former, but terrible at the latter). Second, America has a special genius for monetising innovation- but it doesn't necessarily follow that America's crony capitalism towards pharma plays a substantial role in its success, if anything it makes new entrants like Vivek Ramaswamy's biotech company a rarity, through barriers to entry for startups- particularly with regard to the expense of drug trials.
I completely agree with you on the lasik and plastic surgery. A more libertarian approach to commissioning is definitely what the doctor ordered. In all probably the American market could become a lot more cost-effective and efficient through a simple statutory requirement for transparent medical markets, something like a medical exchange which allows users to search by region, procedure type and doctors rating in commissioning either their own healthcare, or via a third party commissioning specialist.
On the subject of monetising innovation, we really are terrible at in the UK. Globally, the financing for finding graphene applications totalled around $100 billion last time I checked. Sure, the UK managed to attract about $5 billion, but it was for nutty projects like everlasting trainer soles (something no manufacturer is ever going to want). Meanwhile, other investors are incorporating graphene into batteries and one Singapore-based project involves utilising graphene cables in geothermal (graphene cables have 100% conduction at lengths of up to a mile, with zero heat bleed- and also negate the need to frack to access the geothermal heat).
I think I'm going to take another look at graphene. It does appear as though useful types of graphene seem to have come down in price significantly since the last time I looked at it.
Holy cow, Batman, that was an amazing comment. I'm glad to see not all of the US' forebears are silly. I still have family friends across the pond from when my Dad was stationed at Upper Heyford from 68 to 70. They are magnificent people. I could spend hours discussing the things you mentioned, but I can't spend that much time away from work. I will touch on a few.
US pharma is in trouble because of its incestuous relationship with government. Big Pharma + Big Gubmint is a destructive equation and will not end well. See Wuflu vaccines.
You call it libertarian (correctly), I call it free market. Socialists' distortion of the effects of free market capitalism (not corporatism) benefit all who actually participate. In the medical services arena it would be best if insurance reimbursements to medical professionals weren't based on the government's Medicare reimbursements, and every doctor posted what he would charge for whatever service a patient needs (that transparency you mentioned). Patients could shop for the best price and/or what they determine is the best MD for their treatment.
Thanks for the graphene info. I did look it up, and it could be a revolutionary breakthrough for energy transmission. Superconductors are the holy grail, but I remember when the Tokamak was going to save the world. We can only hope.
Interesting that you would hypothesize that USA was prosperous due to high taxes!!?? My hypothesis is that all our competitors had just been destroyed by WWII!!
Actually, it was a number of factors. First, American labour built a wartime industrial base for a song- they were willing to take a bath on labour rates through sheer patriotism. Second, America had incredible branding in the post-war period- everybody wanted a little slice of American luxury consumerism, whether it was Coca Cola, American vinyl or a car built at a local Ford fabrication plant.
What the New Deal enthusiasts miss is that New Deal economics was tried virtually everywhere else in the post-war developed landscape and everywhere else it was tried it was a complete disaster, leading to decades of pseudosocialist economic stagnation.
People also look too much at physical infrastructure in the post-war period, and not enough at intellectual infrastructure. One of the reasons why Japan and Germany were resurgent during the post-war period, is that entirely new governments meant that they got to eliminate the massive waste and inefficiency which builds up in permanent administrative bureaucracies over time. It's also worth noting that because both didn't have the massive overheads of inefficient government, they were able to spend their taxpayer's money on things which are actually economically useful- like physical infrastructure.
The idea that postwar prosperity was the result of lack of foreign competitors is wrong. For a century before 1973 imports, averaged 4-5% of GDP (compared to 15% today). The postwar trade volume was about the same as the prewar one.
What did have a positive effect on prosperity was high tax rates that depressed financial returns to levels lower than the ROE on business investment. Hence business investment was favored, leading to strong growth. Back then retained profits were reinvested into business. today they are used for stock buybacks:
Access is controlled now. Every major healthcare corporation controls your access to specialists. I can’t even have my GP/PCP remove a mole now, which used to be routine. Medicare Advantage plans routinely block you from seeing specialists and getting care that your plan or your plan’s network doesn’t cover. (Don’t sign up for that, whatever you do!)
Really, now, I’d consider whether your point is even valid.
Hard agree. Although if I had to choose, I think eliminating the rent-seeking and skimming in healthcare would have much greater impact than single payer.
Have you read Frank Herbert's The Santaroga Barrier? It's a fascinating read, highly critical of the era's move towards mass marketing. The community depicted is a hilarious take on a conservative community on a hallucinogenic diet.
"Studies have shown a single payer Healthcare system would save 10s of thousands of lives a year and reduce bankruptcy by a huge amount.
But the rich might have to pay more taxes so it will never happen."
----------
It's wrong to blame only the rich for this situation. There are a huge number of stakeholders in any industry who want to maintain the status quo, because they have all the in's and out's figured out and are making money hand over fist.
Single payer would reduce the need for many, if not all insurance companies. MD's and hospitals would make less. Politicians would get less campaign donations from the medical industry. Pharma companies would have to sell their drugs for less, resulting in less revenues and bonuses.
With all these stakeholders who profit adequately now, they will fight to keep things the same. The prospects for an extension of Medicare to a younger age or single payer for all in the USA is low.
I'm personally on Medicare, so don't have a rabbit in this hunt. With a Medigap Supplement plan, I pay about $300/month for what is as close to unlimited medical that can be had in the USA. My only out of pocket is the now $225 Medicare annual Part B deductible and $20 co-pay for office visits. Can't beat this with a stick!
I'll tell you that when this subject comes due to an online article, such as in the NYT, that probably 90% of the people want single payer and everyone has horror stories to support the need. But you are fighting a dug-in enemy. You can demand all you want but it will be to no avail.
The only hope for moving to single payer is to make employer paid health insurance illegal. Then when everyone faced the reality of how much medical REALLY costs when you have to pay the whole bill yourself, many would join your foot stomping.
Agree with this. As a self-employed getting a K-1 for over ten years now, health care for a family is ridiculously expensive. No tears for me, but I wouldn't mind a single payer system even if it did mean higher taxes (I guess you pay either way?).
Me, too. Have you ever looked at the reimbursement rates? How doctors can make any money is beyond me, and goes a long way to explain why non-Medicare insurance rates and OOP costs are so friggin’ high.
MD's do just fine! Don't be shedding tears for them.
-------
The average doctor in the U.S. makes $350,000 a year. Why?
Analysis by Andrew Van Dam, Staff writer|
August 4, 2023
The average U.S. physician earns $350,000 a year. Top doctors pull in 10 times that.
When those simple data points were first presented in 2020, a small subset of physicians came unglued on the microblogging site formerly known as Twitter, slinging personal insults and at least one deeply unflattering photo illustration of an economist.
We couldn’t understand why. The figures are nigh-on unimpeachable. They come from a working paper, newly updated, that analyzes more than 10 million tax records from 965,000 physicians over 13 years. The talented economist-authors also went to extreme lengths to protect filers’ privacy, as is standard for this type of research.
By accounting for all streams of income, they revealed that doctors make more than anyone thought — and more than any other occupation we’ve measured. In the prime earning years of 40 to 55, the average physician made $405,000 in 2017 — almost all of it (94 percent) from wages. Doctors in the top 10 percent averaged $1.3 million. And those in the top 1 percent averaged an astounding $4 million, though most of that (85 percent) came from business income or capital gains.
In certain specialties, doctors see substantially more in their peak earning years: Neurosurgeons (about $920,000), orthopedic surgeons ($789,000) and radiation oncologists ($709,000) all did especially well for themselves. Specialty incomes cover 2005 to 2017 and are expressed in 2017 dollars.
Not all doctors breathe that rarefied air. Even in these peak years, family-practice physicians made around $230,000 a year. General practice ($225,000) and preventive-medicine ($224,000) doctors earned even less — though that’s still enough to put them at the top of the heap among all U.S. earners.
1. Organic farming and back-to-the-land are luxury goods. They are the result of progress, not a retreat from it. If we all tried to live like that, most of us would starve.
2. The paranoia of billionaires is not relevant to the value of technology in the rest of our lives.
3. Things are changing faster than people can keep up. Doesn't mean the change is bad or they won't catch up, though that's not certain as the economic value of sheer muscle declines.
4. Peace and quiet are luxury goods. As suburbs densify, people move on to the towns in pursuit of it.
5. Is it destroying lives, or is it just making destroyed lives easier to count? Working 12 hours a day in a coal mine with pick and shovel destroyed a lot of lives.
6. Generative AI is a fraud. It is a pastiche generator, and not a particularly good one. AI hype has always been about what it will do tomorrow, not what it does now. Tomorrow never comes.
7. Technology has always democratized commodities at the expense of quality and reduced margins. It is the same in every field. For most people, cheap beats great.
1. You don't know which tech is progress until you try it and see the results. We dump lots of tech if it does not improve our lives. Case in point: NFTs.
2. All new tech is disruptive and painful at first. The benefits emerge later after people adjust to the tech and tech adjust to the people. The old stuff always looks great; the new stuff always looks scary.
3. Again, short term pain, long term gain. The older tech looks rosy now, but it hurt then, just as the new stuff does today. That's the pattern going back centuries.
4. Not sure that the economists, technocrats, or politicians are fond of twitter. The problem is more that no one controls the discourse anymore.
5. During a gold rush, everybody heads for the hills. This too will pass.
6. All those things have been made available to everyone, rather than to the elite few, thanks to technology. Without it most of us would be crawling back to our hovels after 12 hours of work with no books or music in sight. Don't bite the hand that feeds.
7. That will require quite an upgrade to the wisdom or ordinary people, but we can hope.
Feeds whom? Makes me wonder if you're paying attention to the reality of the world around us. The old ways aren't working. It's trivial to confirm so many examples of this.
I hope I'm wrong. But I've lived through and seen a lot, and my money is on my own POV.
Feeds whom? Feeds far more people, both in absolute term and as a percentage than at any time in history. If you were to pay attention to the world as it was, you would know that until the middle of the 19th century, 50% of children died before the age of five. Whole villages could be wiped out by plague and famine. Poor people regularly died in ditches and on the streets. Maternal mortality was so high that raiding parties would kill all the men and old people and take the young women and children. They needed them to replace the women who had died in childbirth.
The old ways, as you call them, which would more properly be called the new ways, are working better than any previous ways that have been tired, and not by a little, but by a vast margin. Several ways have been proposed that claimed to be better still, but all of them have proved to be murderous failures. Is the world perfect? No. Is it immeasurably better than it was? Yes. Got a better idea? Okay, we'll listen, but do some studying first to make sure it has not been tried already. And make sure there is not some part of it that requires a fundamental change in human nature, because that is not going to happen. Good luck.
It's a fair question, thought I would question the quality of the statistics, since the shame associated with suicide has changed radically over that period, which could skew the numbers. Also, a loss of religious faith over the period could affect the numbers enormously, particularly where notions like meaningful and fulfilling are concerned. Still, the reduction in involuntary deaths dwarfs any increase in voluntary deaths. It's not a reason to go back.
That said, the question of meaningful and fulfilling is a legitimate one. An easier life is not necessarily a more meaningful one. If men find meaning in providing for and protecting their families, for instance, then they might find more meaning in a world of greater scarcity and violence where their strength and courage would be more needed. But at the same time, it is hard to imagine such a man wishing to go back to a time of greater scarcity and more danger, because that would be contrary to his instinct to provide for and protect his family. So I don't think a retreat solves that problem.
Plus, we have to remember that the carrying capacity of the Earth in 1750 was about one billion people, with premature death more common than the reverse. If we go back to the methods of 1750, before the industrial revolution, about seven billion or us are going to die, and I don't think you will find many volunteers.
So what are we to do? Try to find meaning and fulfillment in a safer and more secure world? I'm not pretending that I know what that will look like, though, most people do seem to be managing okay at the moment, even if the suicide rates are rising. I'd say a revival in religious observance, but I know that will be widely scorned. But people do adapt. Not all of us, and that is a tragedy. But as a species, we do adapt. And I don't think anyone wants to go back to 1750. Not, at least, if they have any clue what 1750 was like.
I think you nailed it here! In 2019, I was living in NYC. I hung out with a lot of Burning Man type techies. I barely cooked, let alone grew my own food. I didn't plan on having a family-- in fact, I lived like I'd be young forever. I avoided physical media due to the space limitations of NY apartments. I was glued to Facebook because I was wildly popular and always getting party invites on there.
Now, only 5 years later, I live in South Dakota, grow my own veggies, and buy stuff like raw milk from a local farmer. Sometimes an entire day goes by without me looking at my phone. I can go months without using Facebook. My boyfriend and I are moving quickly towards marriage and children. I collect things like books, CDs, and DVDs. I find out about local events from flyers in venues downtown.
After 2020/2021, you couldn't pay me enough to go back to NYC and use Facebook every day again.
We need to insist on the term "social progress," rather than progress. As John Dewey wrote in an essay defining "Progress" in 1916, "we have confused rapidity of change with [social] advance." 20 years later, Carl Becker wrote, “If progress means to go forward, [then] forward to what end, to the attainment of what object?” We still haven't answered that question a century later, instead blindly becoming devotees to "the religion of technology" (David F. Noble) under the umbrella of progress. This is an excellent and rare essay, not simply because I agree with it and progress rarely receives a critique, but because it takes leading indicators of "progress" and reveals the hollowness of the con and the hypocrisy within this unspoken technological ideology.
Well stated. This is a philosophical issue as well as a semantic one. Both need to be addressed, but our society has focused primarily on economics as the measure of progress. Not the financial or cultural well-being of individuals, as much as wealth or societal leaders.
The Carl Becker quote is spot on. Ironically, progress for progress’ sake is the platform for many movements supposed to make people feel better e.g. self-help, wellness. There’s no defined end, just infinite progress.
Brilliant—when we optimize for meaningless metrics, we get much worse than meaningless results. The culture at a large has pursued dopamine highs and short term gains with relentless efficiency for so long that the cracks are now, as you point out so eloquently, undeniable. It seems we've needed to touch the stove to learn what we actually want to value. I'm glad you see the next wave coming, and can't wait to read more.
Everything just seems Loopy if a person lives on social Media. Go outside & look around. Where is all this doom & Loopyness ? Mostly just peoople going about their business of the day.
Yeah, that was my view until recently, and I mainly still agree, but madness has leaked into real life. Plus the social media stuff is nested in a wider cultural context.
I read John Naisbitt’s book Megatrends in school 30+ years ago. The one concept that stuck with me through years is his concept of “high tech / high touch”—the idea that as technological capabilities grow at an exponential rate, people will crave more natural, “hands-on” experiences. The future was never going to be monochrome jump suits and minimalism—it’s seeking out our own human experiences in a largely artificial world. Organic farming, ax throwing, tiny houses, craft cocktails, etc—as less of our day-to-day professional work is tangible, the more we seek it out on our own.
Megatrends identified a great many trends that have come true in the 21st century. A well-written and researched book by a great thinker and observer. I recommend people now find a copy and read it to see how much has come to pass.
Let the good times roll....right off a cliff. Hey, Ted, I just moved to that sweet town Sebastopol you speak of. Residents are mostly white people in their golden years but I see a growing trend of gender and racially diverse young adults trying to make a go here. It's a microcosm of so called woke progress where the well-to-do do well. People who own property are either ultra-rich or bought years ago or inherited the land. Rentals are scare and expensive making the issue of homelessness and housing unsolvable. The official push for electric vehicles is outnumbered by the ownership of workhorse gas trucks and SUVs and most families have one or more of each. Local family businesses are promoting organic farming cooperatives and ranching but still the city supports 7 grocery stores. The fact that food banks and volunteer efforts abound is a testament to the generosity of the population. We're surrounded by a healthy network of state, county and city parks and open space year round due to our great weather. There is a definite community feel but the economic divide is palpable. The city council is running at a deficit. The fire department had to merge and depends heavily on volunteer firefighters. Most jobs are service oriented and pay poorly. My kids are grown so I don't know much about the school system here but the library just voted to put in surveillance cameras. Sigh.
I solved the issue of "too much progress" by moving to Ecuador which is 30 years behind the US and (dare I say) 50 years behind Germany, Norway and a few other countries. I'm hoping to be dead in 30 years but my psychic has told me otherwise.
I hate to sound flippant but somehow this reminded me of the old Bufferin advertising catchphrase: "Why trade a headache for a stomach ache?" The promise was that buffered aspirin would not upset your stomach. Even as a kid this stuck with me and as time passed I learned to regard new situations with the same balance - what's the profit here? Does it outweigh the potential loss? With Bufferin the unstated potential loss was the increased cost over generic aspirin.
The mate and I live on a farm in rural NC. We produce a lot of our food including meats cured with traditional methods - no nitrates. Only one or two trips to town a week. We can't say we planned it, we drifted into this after observing the soulless lifestyles of corporate careerists. We both had jobs at major educational institutions but after a couple decades of the lying, the back-stabbing, and the pitiless politics, we got out. We decided that trading our souls for a paycheck was a bad bargain.
So if there is a new awakening in American culture, I would welcome it. It would mean a few more friends in our community. Thanks for this wonderful essay, Ted!
Interesting questions but doesn't the answer for many of them boil down to, "it's good to have room for diversity, and people should not all be doing the same thing, but that doesn't mean you would want the counter-culture to become the culture." (and it's tough for me to say that because I like the counter-culture).
A world in which some people are growing apples and other people are building silicon valley is probably better than one in which everyone is growing apples (or everyone is learning to code).
The experience of being deeply invested in a creative field (in your case Jazz) is fantastic but it's also good that the world allow people the ability to easily have access to a little Jazz.
I feel like the world has changed in ways that make it more difficult to build an idiosyncratic life, but (a) I'm not sure you can blame that on "progress" without some strawmanning going on and (b) my perspective is shaped by the fact that my parents (and myself to a lesser degree) were able to build an idiosyncratic life, so I know what that path looks like, and I'm certainly underestimating the number of people who would not have been able to do that in, say, 1980, but can do so now.
[Edit]: I'd add that, in several cases you're comparing "consider an example of how the path less traveled succeeded" with "consider the average outcome from the conventional path." Which isn't an apples-to-apples (sorry) comparison. It's a good way to push back on the idea that the conventional path is the only one available, but it's stacking the deck.
Ivan Illich talked about two technological watersheds in things like medicine. The first is when exploding tech starts to radically improve our lives (e.g., vaccines, antibiotics). The second is when technological iatrogenics begin to impose net negative costs on humanity.
"Real wisdom on human flourishing is now more likely to come from the humanities, philosophy, and the spiritual realms than technocrats and politicians. By destroying these disciplines, we actually reduce our chances at genuine advancement."
I hope you are referring to the classical forms of these disciplines. In today's schools and universities these are no longer areas of disciplined logical thought, challenging discourse and self-learning. They are methods of indoctrination to ensure those at the top of the pyramid get to continue enforcing their vision of the idea of 'progress'.
I am a techie (72 year old physcist and engineering Ph.D. still working in the field) as well as a practicing techno-Amish. I use tech where it adds value to my life and don't where it does not. I had a large CD collection - I ripped it all to 256K MP3's 30+ years ago. I still listen to those recordings - which are now in my iPhone as well as on my computer. I have added to the collection, but it is enough for me - mostly classical, some ragtime, some folk, klezmer, strauss, .. But I don't listen to radio, podcasts, or watch TV, movies, and the like unless I absolutely have to (such as lectures or presentations). I resist giving the medium control over my time, I can control my reading, scanning, skip forward, go back, recheck, etc. I don't effectively have that with audio / video content.
I like the IP telephony apps. My wife spends hours a week talking to her mother and friends in Ukraine, which was very expensive in the telephone days. And they frequently do video calls, which was not available 30 years ago. Another advance. And I find texting to be very useful as it allows asynchronous communications.
But I have turned anti-social in a way, I am deluged in spam calls and e-mails and do not respond. I do computer security and assume that the calls / messages are malicious. A social-technical regression.
I largely restricted my kids media access / consumption when they were growing up - and very definitely got them hooked on reading. They do a moderate amount of video gaming now, but they are definitely readers - they walked off with my SF/Fantasy library when they moved out. Yes I let them watch, but I would meter access. At the time, VHS tapes and DVD's, which I could borrow from the library as well as rent.
I will probably start using the LLM's in the near future since the token count is getting large enough that I can feed in a large article or group of articles and then use it for summarizing / cross checking / rephrasing. LMM's will be used to increase my spam - thanks. But the spam / fake call level is already so high I have had to disregard unsolicited contacts. We will see if I can get a paranoid LLM Jeves agent to serve as a filter against the idiots, fools, and agents that are spaming me. My own guess that in my case, the AI/LLM will be an asset, but that many to most will find it a negative.
I like my plug-in prius hybrid. With my driving pattern, I am averaging 80+ mpg, which I will be able to afford even when I stop working. A nice technology. 50 years ago I was averaging 15 mpg. Pure electric is not for me - I can make Utah to see a daughter in a day's drive, 800+ miles, which I could not do in an electric vehicle giving charging times. - Significant advance.
I don't see that the social networking world adds significant value - and largely don't participate (I haven't updated my Linked-in profile in close to a decade and use it to check up on old contacts only).
Looking at the issues associated with social networks, I would judge them to be a regression as well.
Foodwise, we dropped out of the prepared food market. We do buy some pasta, frozen and fresh meat and vegetables, and canned / bottled tomatoes, olives, sardines, ... Beyond that, it is all cook from scratch. And we grow and can a lot ourselves. Stuff that is not up to our standard gets mixed in with the food for the chickens. Slower, but also cheaper than the prepared / processed food. And, it turns out, a lot healthier.
You don't have to live entirely in the public culture. You can't fully avoid it, but you can be rather out of phase with it. My daughter shocked her high school English class by reciting Kipling's IF as her favorite poem, it isn't taught anymore. The kids took my Kipling collection with them when they moved out.
My general advise is that if a product is or enables a status game, it is generally a regression and should be avoided until you can find a way of using it that is not part of the general status games. Outside of the status game issues, consider the costs and benefits and choose accordingly.
I've been asking myself the same questions since 2008, which is why I find myself here.
To your hypotheses:
1. I wish you'd submitted this piece and dared the editor to object. We must start putting anyone talking about progress on the spot: progress towards WHAT? Progress towards total emiseration of all but the 1%? Or progress towards a peaceful and healing planet where we honor the dignity of all life?
2. I see 2 & maybe 3 as related to Doctorow's enshittification theory, which extends waaay beyond platforms to almost anything Big Tech and VC/PE/Financial Mobs touch. (Capture required actors with by any means, acquire and kill off all competition, and finally, enshittify the product in order to extract every last available dollar for the rentier, something like a coke-addled caporegime desperately snorting the last bit from the cracks between the table leaves before they arrive to blow his head off.) (Now that they've successfully enshittified health care, will someone please come and blow their heads off? Please?)
On the rest, hard agree but with less optimism.
I worked for an AI company briefly and it still gives me nightmares. Generative AI sucks - now. No way could it write this post - now. It can't even come up with a decent joke - now. But that is highly likely to change. Big business can be shamed now, for the next short while, maybe, but it will keep trying until the outrage fades.
What happens when we rapidly move from a highly addictive digital world to one where any digital information is suspect? When communities either succumb to misinformation or make the shift to only believing what we can smell or touch? Are there artist and philosophers who can save us? How will more than a few thousand people hear any one of them if we can't trust anything digitally?
Last week my wife and I went to dinner with our eldest daughter and her husband. As soon as we sat down, they pulled out their phones and the effectively ended all conversation. Afterward, I asked my wife. why did they want to go to dinner with us?
What a thoughtful post! I'm not sure whether some or all of the questions are rhetorical, but I'll give answers, nonetheless.
1. Your mother rationally prioritized healthy eating. That's unfortunately a luxury for most.
2. Zillionaires spending money they don't need as an insurance policy against an apocalyptic event, however unlikely, is rational.
3. Health is better than ever for those who can afford it. There's a shameful ten year gap in life expectancy between the riches and poorest male 1%. That's an awful choice we as a country are making.
4. I suspect the move inland is relative value, i.e., still more house and space for your money inland than on the coast.
5. I think the evils of the smartphone were an unintended consequence. There are benefits as well to those who resist obsession.
6. We all want authenticity. To the extent AI interferes with authenticity, it will and should be shunned.
7. I'm 100% with you here. First album at the age of ten was Elton John "Don't Shoot Me, I'm Only the Piano Player." I played it over and over and communed with those songs.
I'm also 100% with you on your last three conclusions about values and wisdom of the humanities and personal and intimate interactions in real life in small groups. Nothing more precious or important to human flourishing.
My first CD (I was born in 1991) was Smah Mouth’s “All Star”, my mom told the cashier at Tower Records it was my first music purchase (I was in the 4th grade) and the cashier told me how his first music purchase was a Beach Boys cassette, that he wore out listening to.
Can’t get that experience from Spotify, but it’s the world my 1.5 year old son will live in.
same here, born 1989 and All Star was my first Tower Records purchase in San Jose
Dude I bought it at the Tower Records in Mountain View! Small world.
Hah no kidding! In high school I got heavy into metal and started making weekly runs to Rasputin and Streetlight records in Campbell. Many good memories seeking out new and used CD's back then, pretty wild to think how I only own a tiny fraction of the music I used to...
Also a fan of the Tower Records in San Jose (although born many more years ago!!).
Oth, he'll be able to listen to an immense amount of music and artists that he'd have no way of being aware of by going to the record store. And the reverse is also true bands are able to find their audience so much easier. However, I am concerned about who is the real economic beneficiary. It's important that the musicians benefit more than they presently do.
You could get him a cassette player…
It's not the cassette player itself that was special. It was the scarcity of music/choice that made owning your own music special.
Absolutely! Μixed tapes was amazing. Owing a hand held vinyl or cassette with favourites was the thing.
A useful and imperfect simplification may be that technology has mostly continued to do what it has done: expand the range of human choices. Most things are more accessible to more people than at any other point in human history. In the process, we're finding out how people handle that ability. The results are certainly mixed. As somebody who thinks we should prioritize the respect of human agency, I struggle to reason about what we should do about that -- if people want to stare at their phones instead of talk to their families, that sounds bad to *me*, but these seem to be the rules of freedom.
"if people want to stare at their phones instead of talk to their families, that sounds bad to *me*, but these seem to be the rules of freedom."
We shape the environment we live in (or well, companies, tech, laws, etc and us last of all, shape it for us) and the environment shapes us in return.
It's not some magical "rules of freedom" as if we're equally likely to chose among all options, and make a "totally detached from the world" free choice. The environment "we" created, influences us or even pushes as to certain choices more than others.
Quite literally: not only there's a huge cost if you don't make the choices your environment pushes you to - like the impact of not having a mobile phone or social media on your career, but there's also billion dollar industries working on ways to manipulate us with tech shennanigans ("dark patterns", habit tracking, etc.) and psychology (from messing with your social feed to make it more addictive, to investigating shelf placement or music playing in buying behavior in supermarkers).
True enough! This leads us to pursue the lowest hanging fruit, but not necessarily the healthiest. Control is ceded to folks in powerful but defensive positions, not positions that truly expand human experience (it's all the same). It's similar to "plausible deniability"; we know there are no real or enriching answers in this charade, but it allows the controlling to continue pushing their high cost/low benefit pseudo-solutions.
I agree that significant resources have been deployed to attract and maintain people's attention. Resisting these efforts is not trivial, but I don't think it's extremely difficult either. There is a thread of online discourse that shakes it fists at engagement-driven algorithms and dark patterns and then goes back to scrolling Twitter. The information is pretty available to participants in that discourse. Hardly anybody truly needs to use social media. Talking about phones as if breaking away from them requires some herculean effort seems counterproductive.
> Talking about phones as if breaking away from them requires some herculean effort seems counterproductive.
Well, shouldn't whether that's the case be determined by looking at the current situation? Which points to the opposite: that is kind of IS a herculean effort.
As you wrote: "There is a thread of online discourse that shakes it fists at engagement-driven algorithms and dark patterns and then goes back to scrolling Twitter."
Isn't this more evidence about how difficult it is (not just because of the psychological manipulations and dark patterns, but also because it piggybacks on millions of years of evolutionary instincts - kind of like our liking for sugar)?
I mean, as you write, even the people who have the info and are aware of it, and against it, stick back to it.
It doesn't have to be impossible to quit (social media and smartphones and the like) to be a problem. It's enough that it's more difficult than not quiting them, and thus a large number doesn't and wont.
Maybe an analogy to cigarettes can clarify. I think your argument is something like "social media and smartphones are like cigarettes, because they are designed to create addictions that are hard to break, and they are real addictions because the affected people want to stop but fail to do so". If that is true, the notion of choice weakens -- addicts aren't choosing, they're addicted.
Two things about this analogy seem suspect to me. First, I don't think social media and smartphones are as simply negative as cigarettes are. They aren't necessarily generating the itch they scratch. They can still live up to their old lofty goals of connecting people and enriching lives, if used carefully. I think this is part of why people stick with them -- some actual value is being provided, even as the discourse says the hip thing is to say it's all dystopian late-stage capitalism.
Second, I do think they are easier to quit than, say, cigarettes. Cigarettes are everywhere, and it is easy to slip back into a life where you smoke. In contrast, if you delete your Twitter/Facebook/Instagram, you pretty well detonate that part of your life. You could build it back up, but it would take a while. So there's a "make it pretty inconvenient to keep doing this" button that other addictions don't have. The infrequency with which that button gets used -- even addicts will flush their last pack or throw away their bongs or whatever, for a fresh start -- makes me question how people actually feel about what they're doing.
I'm not sure about the analogy between phones and cigarettes, but I definitely think a phone addiction is far harder to quit. Unlike cigarettes, phones are used by nearly everyone and welcome nearly everywhere. It's nearly impossible to navigate modern life without one.
I'm with you about staring at phones. The genie seems to have left the bottle.
From this survey,
https://sapienlabs.org/wp-content/uploads/2024/03/4th-Annual-Mental-State-of-the-World-Report.pdf
people's mental wellbeing is worse the earlier they have access to smartphones. It's as small a difference as 10-11 vs 14-15. It seems to be that since adolescence is the time when children start learning to interact and socialise as adults, if there is an obstacle at that time - whether abuse, social isolation, or smartphones - it hurts them badly. But by mid-late adolescence they will have developed enough social skills and personal resilience and sense of self that they will be fortified against the smartphone's more detrimental effects.
My first albums, once I woke up to their existence at the age of 13, were Dark Side of the Moon and Led Zeppelin 4, not long after they came out. Which both basically depth-charged my childhood 🤣
(Don’t can me from the group Ted, my first jazz album a year later was Sketches of Spain!)
Is point three US data? Shocking regardless…
It is.
"We all want authenticity. To the extent AI interferes with authenticity, it will and should be shunned."
Perhaps should be, but will? I don't think so. After all, is CGI shunned over models? Is plastic surgery shunned? Is television shunned over theatre? Are scripted stories shunned over improvised stories?
AI will be shunned not because it is unauthentic, but because it will remain autistic and retarded. Humans learn by interactions with other humans ("Mummy doesn't like it when you hit"), but AI is not permitted to do so, lest we humans turn the AI into a violent bigot; it can only passively absorb what's put out onto the internet, which increasingly is produced by AI. It's like locking an infant in a room with a television for its lifetime and having no human contact, and over time showing it nothing but other children watching TV.
We don't have an authentic culture anymore.
From the day we're born we're inundated with commercials from bigger and bigger corporations telling us what we need to be happy
And these recommendations are always what will make them richer, not make society richer.
The only reason the USA spends so much on health care is it benefits large corporate entities
And that is the only goal, not to extend lives, but to make money for people who already have too much of it.
Studies have shown a single payer Healthcare system would save 10s of thousands of lives a year and reduce bankruptcy by a huge amount.
But the rich might have to pay more taxes so it will never happen.
You can't have an entire society based on greed and rent seeking and expect it to be Shangri la.
Without the "only goal" you mention regarding health care I wouldn't be alive. The doctors who have used their amazing skills to keep me alive worked their asses off to be as good as the are using that "health care" have earned my respect and admiration. If the US had a single payer system I'd be dead, just ask the wealthy politicians from Canahda who've traveled to US hospitals (i.e. the Salk Institute). I've paid a lot in insurance, co-pays, etc., but I don't waste money on stupid things like $1000 "smart phones" either. And if you'd do a little research you'd find "the rich" pay the vast majority of the taxes in the US. But you won't. go ahead, take all of the US' billionaires' money and run the country for ninety days. Real numbers, not studies, are at odds with your claims.
Many many studies show the US spends the most money on health care and gets the worst outcomes of any western country
You can go believing fairy tales about the "free market" while wondering why everything is getting worse in this country
You do know that the tax rates for the very rich were over 90% in the 50s dont you?
Back during America's most prosperous era.
Actually the discrepancy isn’t due to the medical system. The Financial Times did a great analysis last year and most of the gap in life expectancy comes from non-healthcare sources: traffic accidents, drug abuse, gun deaths, and obesity and the related diseases primarily.
The survival rate for many diseases in the US is higher than in other countries--and once you already are in your 60s and 70s US life expectancy is about equal with other countries.
We have a lot of things we need to fix, including the very messed up employer-based health insurance system which is far from a market with all the many regulations, but the actual medical care you do receive in the US is world class.
You just need to go bankrupt because of a parasitic insurance industry that contributes nothing.
World class
You're obviously exempt from reality. In January 2009 I almost kicked the bucket and spent ten days in the hospital. My insurance deductible was $1000, and I was done for the year, no more money from me had to be spent on staying alive. Then, with the assistance of Harry Reid, Little o care was passed while the politicians who voted for it blamed "the health insurance lobby." In 2023 my insurance cost over $15K, I had to pay a $3500 "deductible," but wait, deductibles don't mean the same thing they did in 2009. I had to fork over $9K to meet my "out of pocket" expenses. So I'm out almost 50% of my take-home pay. Thanks to our stout leftist politicians Big Insurance's stocks have soared, hospitals have become corporatized, and the quality of care has diminished. Big Gubmint intervention (socialism) has never worked nearly as well as greedy free market capitalism, but you go ahead and keep telling yourself that it does.
Now I'm done talking about the misadventures of those who want to control my life. I generally don't mention politics in Ted's comment sections, but there are times when others do and I can't sit back and take their BS.
Parasitic and protected by government regulations.
There's an argument, which I would agree with, that "medicine" should include prevention as well as care. If not workplace deaths and so on, certainly physicians are in a position to address the circumstances which tend to lead to substance abuse and obesity.
Thanks for saving me time, I would have posted the same response.
To call the health care system “free market” is to misunderstand the meaning of the words. Our system is heavily regulated and highly cartelized. There are many reasons why our health care results are worse, drug and alcohol abuse, diabetes and obesity, violence and crime to name only a few.
If you want to make a strong argument for universal healthcare to Americans then the ideal system to pick is that of Australia. It's a publicly commissioned system which is almost entirely privately provided. If we contrast Australia with the UK then it's easy to see that Australia's system is measurably superior- roughly similar levels of public investment yet Australia manages seven times as many hospital beds, a much more thorough level of treatments and measurably better outcomes than any of the largely state-run alternatives, including Canada.
It's worth noting that America combines the worst aspects of state-run medicine and capitalism. It's better described as an oligopoly rather than free market, with crony capitalist barriers to entry ensuring that no medical services is commodified on the basis of price, quality or convenience. Australia is the best of both worlds- everybody gets treated and through a libertarian system of commissioning which means that dollars stretch far further in terms of treatment than in any other comparable system.
The main other positive countries are Switzerland and Sweden, the latter of which has been extending the range of the universal healthcare terrain by commission out treatments to the private sector since the early 2000s and reinvesting the savings in quality healthcare outcomes.
Here's a source which uses statistical measurement to compare outcomes in various high income countries.
https://www.commonwealthfund.org/publications/fund-reports/2021/aug/mirror-mirror-2021-reflecting-poorly
Interesting comment. I also find it interesting that, despite government's intervention, the US is still leading the world in new and advanced medical care. But, as a result of that intervention, that will likely not continue. Also, simple observation shows that true free market medical care can drive costs down. See the costs for two segments that health insurance won't cover: lasik and plastic surgery.
Stats on the UK pharma industry are quite informative on the subject of American innovation and success. The US produces somewhere between 65% and 70% of new pharma. Although the UK as a research venue accounts for 13% of new global pharma, this doesn't translate well into the UK pharma industry which is only an anaemic 2.3% to 2.6% of the global pharma market.
This points to two conclusions. First, that there is a distinct difference between innovation and monetising innovation (we Brits are great at the former, but terrible at the latter). Second, America has a special genius for monetising innovation- but it doesn't necessarily follow that America's crony capitalism towards pharma plays a substantial role in its success, if anything it makes new entrants like Vivek Ramaswamy's biotech company a rarity, through barriers to entry for startups- particularly with regard to the expense of drug trials.
I completely agree with you on the lasik and plastic surgery. A more libertarian approach to commissioning is definitely what the doctor ordered. In all probably the American market could become a lot more cost-effective and efficient through a simple statutory requirement for transparent medical markets, something like a medical exchange which allows users to search by region, procedure type and doctors rating in commissioning either their own healthcare, or via a third party commissioning specialist.
On the subject of monetising innovation, we really are terrible at in the UK. Globally, the financing for finding graphene applications totalled around $100 billion last time I checked. Sure, the UK managed to attract about $5 billion, but it was for nutty projects like everlasting trainer soles (something no manufacturer is ever going to want). Meanwhile, other investors are incorporating graphene into batteries and one Singapore-based project involves utilising graphene cables in geothermal (graphene cables have 100% conduction at lengths of up to a mile, with zero heat bleed- and also negate the need to frack to access the geothermal heat).
I think I'm going to take another look at graphene. It does appear as though useful types of graphene seem to have come down in price significantly since the last time I looked at it.
Holy cow, Batman, that was an amazing comment. I'm glad to see not all of the US' forebears are silly. I still have family friends across the pond from when my Dad was stationed at Upper Heyford from 68 to 70. They are magnificent people. I could spend hours discussing the things you mentioned, but I can't spend that much time away from work. I will touch on a few.
US pharma is in trouble because of its incestuous relationship with government. Big Pharma + Big Gubmint is a destructive equation and will not end well. See Wuflu vaccines.
You call it libertarian (correctly), I call it free market. Socialists' distortion of the effects of free market capitalism (not corporatism) benefit all who actually participate. In the medical services arena it would be best if insurance reimbursements to medical professionals weren't based on the government's Medicare reimbursements, and every doctor posted what he would charge for whatever service a patient needs (that transparency you mentioned). Patients could shop for the best price and/or what they determine is the best MD for their treatment.
Thanks for the graphene info. I did look it up, and it could be a revolutionary breakthrough for energy transmission. Superconductors are the holy grail, but I remember when the Tokamak was going to save the world. We can only hope.
Thanks again for you insightful commentary.
Excellent analysis, no doubt falling on deaf ears.
Interesting that you would hypothesize that USA was prosperous due to high taxes!!?? My hypothesis is that all our competitors had just been destroyed by WWII!!
Actually, it was a number of factors. First, American labour built a wartime industrial base for a song- they were willing to take a bath on labour rates through sheer patriotism. Second, America had incredible branding in the post-war period- everybody wanted a little slice of American luxury consumerism, whether it was Coca Cola, American vinyl or a car built at a local Ford fabrication plant.
What the New Deal enthusiasts miss is that New Deal economics was tried virtually everywhere else in the post-war developed landscape and everywhere else it was tried it was a complete disaster, leading to decades of pseudosocialist economic stagnation.
People also look too much at physical infrastructure in the post-war period, and not enough at intellectual infrastructure. One of the reasons why Japan and Germany were resurgent during the post-war period, is that entirely new governments meant that they got to eliminate the massive waste and inefficiency which builds up in permanent administrative bureaucracies over time. It's also worth noting that because both didn't have the massive overheads of inefficient government, they were able to spend their taxpayer's money on things which are actually economically useful- like physical infrastructure.
The idea that postwar prosperity was the result of lack of foreign competitors is wrong. For a century before 1973 imports, averaged 4-5% of GDP (compared to 15% today). The postwar trade volume was about the same as the prewar one.
What did have a positive effect on prosperity was high tax rates that depressed financial returns to levels lower than the ROE on business investment. Hence business investment was favored, leading to strong growth. Back then retained profits were reinvested into business. today they are used for stock buybacks:
https://substackcdn.com/image/fetch/f_auto,q_auto:good,fl_progressive:steep/https%3A%2F%2Fsubstack-post-media.s3.amazonaws.com%2Fpublic%2Fimages%2F256392ca-fa28-4b59-86d3-d93102c7a419_621x289.gif
Your user name tells me all I need to know about you
Many thanks for the compliment.
No matter what health system you choose there are pros/cons. In single payer access will be controlled and used to control costs.
Access is controlled now. Every major healthcare corporation controls your access to specialists. I can’t even have my GP/PCP remove a mole now, which used to be routine. Medicare Advantage plans routinely block you from seeing specialists and getting care that your plan or your plan’s network doesn’t cover. (Don’t sign up for that, whatever you do!)
Really, now, I’d consider whether your point is even valid.
Hard agree. Although if I had to choose, I think eliminating the rent-seeking and skimming in healthcare would have much greater impact than single payer.
I don’t trust single anything. When one person, group or entity controls something , it’s all over for anyone who doesn’t follow the party line.
Have you read Frank Herbert's The Santaroga Barrier? It's a fascinating read, highly critical of the era's move towards mass marketing. The community depicted is a hilarious take on a conservative community on a hallucinogenic diet.
"Studies have shown a single payer Healthcare system would save 10s of thousands of lives a year and reduce bankruptcy by a huge amount.
But the rich might have to pay more taxes so it will never happen."
----------
It's wrong to blame only the rich for this situation. There are a huge number of stakeholders in any industry who want to maintain the status quo, because they have all the in's and out's figured out and are making money hand over fist.
Single payer would reduce the need for many, if not all insurance companies. MD's and hospitals would make less. Politicians would get less campaign donations from the medical industry. Pharma companies would have to sell their drugs for less, resulting in less revenues and bonuses.
With all these stakeholders who profit adequately now, they will fight to keep things the same. The prospects for an extension of Medicare to a younger age or single payer for all in the USA is low.
I'm personally on Medicare, so don't have a rabbit in this hunt. With a Medigap Supplement plan, I pay about $300/month for what is as close to unlimited medical that can be had in the USA. My only out of pocket is the now $225 Medicare annual Part B deductible and $20 co-pay for office visits. Can't beat this with a stick!
I'll tell you that when this subject comes due to an online article, such as in the NYT, that probably 90% of the people want single payer and everyone has horror stories to support the need. But you are fighting a dug-in enemy. You can demand all you want but it will be to no avail.
The only hope for moving to single payer is to make employer paid health insurance illegal. Then when everyone faced the reality of how much medical REALLY costs when you have to pay the whole bill yourself, many would join your foot stomping.
Agree with this. As a self-employed getting a K-1 for over ten years now, health care for a family is ridiculously expensive. No tears for me, but I wouldn't mind a single payer system even if it did mean higher taxes (I guess you pay either way?).
Me, too. Have you ever looked at the reimbursement rates? How doctors can make any money is beyond me, and goes a long way to explain why non-Medicare insurance rates and OOP costs are so friggin’ high.
MD's do just fine! Don't be shedding tears for them.
-------
The average doctor in the U.S. makes $350,000 a year. Why?
Analysis by Andrew Van Dam, Staff writer|
August 4, 2023
The average U.S. physician earns $350,000 a year. Top doctors pull in 10 times that.
When those simple data points were first presented in 2020, a small subset of physicians came unglued on the microblogging site formerly known as Twitter, slinging personal insults and at least one deeply unflattering photo illustration of an economist.
We couldn’t understand why. The figures are nigh-on unimpeachable. They come from a working paper, newly updated, that analyzes more than 10 million tax records from 965,000 physicians over 13 years. The talented economist-authors also went to extreme lengths to protect filers’ privacy, as is standard for this type of research.
By accounting for all streams of income, they revealed that doctors make more than anyone thought — and more than any other occupation we’ve measured. In the prime earning years of 40 to 55, the average physician made $405,000 in 2017 — almost all of it (94 percent) from wages. Doctors in the top 10 percent averaged $1.3 million. And those in the top 1 percent averaged an astounding $4 million, though most of that (85 percent) came from business income or capital gains.
In certain specialties, doctors see substantially more in their peak earning years: Neurosurgeons (about $920,000), orthopedic surgeons ($789,000) and radiation oncologists ($709,000) all did especially well for themselves. Specialty incomes cover 2005 to 2017 and are expressed in 2017 dollars.
Not all doctors breathe that rarefied air. Even in these peak years, family-practice physicians made around $230,000 a year. General practice ($225,000) and preventive-medicine ($224,000) doctors earned even less — though that’s still enough to put them at the top of the heap among all U.S. earners.
...
https://www.washingtonpost.com/business/2023/08/04/doctor-pay-shortage/
1. Organic farming and back-to-the-land are luxury goods. They are the result of progress, not a retreat from it. If we all tried to live like that, most of us would starve.
2. The paranoia of billionaires is not relevant to the value of technology in the rest of our lives.
3. Things are changing faster than people can keep up. Doesn't mean the change is bad or they won't catch up, though that's not certain as the economic value of sheer muscle declines.
4. Peace and quiet are luxury goods. As suburbs densify, people move on to the towns in pursuit of it.
5. Is it destroying lives, or is it just making destroyed lives easier to count? Working 12 hours a day in a coal mine with pick and shovel destroyed a lot of lives.
6. Generative AI is a fraud. It is a pastiche generator, and not a particularly good one. AI hype has always been about what it will do tomorrow, not what it does now. Tomorrow never comes.
7. Technology has always democratized commodities at the expense of quality and reduced margins. It is the same in every field. For most people, cheap beats great.
1. You don't know which tech is progress until you try it and see the results. We dump lots of tech if it does not improve our lives. Case in point: NFTs.
2. All new tech is disruptive and painful at first. The benefits emerge later after people adjust to the tech and tech adjust to the people. The old stuff always looks great; the new stuff always looks scary.
3. Again, short term pain, long term gain. The older tech looks rosy now, but it hurt then, just as the new stuff does today. That's the pattern going back centuries.
4. Not sure that the economists, technocrats, or politicians are fond of twitter. The problem is more that no one controls the discourse anymore.
5. During a gold rush, everybody heads for the hills. This too will pass.
6. All those things have been made available to everyone, rather than to the elite few, thanks to technology. Without it most of us would be crawling back to our hovels after 12 hours of work with no books or music in sight. Don't bite the hand that feeds.
7. That will require quite an upgrade to the wisdom or ordinary people, but we can hope.
Your counter-arguments are excellent. Well thought-out and credible.
i live close to an Amish community - i see how they live-
MR baker you are a liar.
Confining myself to one observation:
"6. Don't bite the hand that feeds.."
Feeds whom? Makes me wonder if you're paying attention to the reality of the world around us. The old ways aren't working. It's trivial to confirm so many examples of this.
I hope I'm wrong. But I've lived through and seen a lot, and my money is on my own POV.
Feeds whom? Feeds far more people, both in absolute term and as a percentage than at any time in history. If you were to pay attention to the world as it was, you would know that until the middle of the 19th century, 50% of children died before the age of five. Whole villages could be wiped out by plague and famine. Poor people regularly died in ditches and on the streets. Maternal mortality was so high that raiding parties would kill all the men and old people and take the young women and children. They needed them to replace the women who had died in childbirth.
The old ways, as you call them, which would more properly be called the new ways, are working better than any previous ways that have been tired, and not by a little, but by a vast margin. Several ways have been proposed that claimed to be better still, but all of them have proved to be murderous failures. Is the world perfect? No. Is it immeasurably better than it was? Yes. Got a better idea? Okay, we'll listen, but do some studying first to make sure it has not been tried already. And make sure there is not some part of it that requires a fundamental change in human nature, because that is not going to happen. Good luck.
If human life is immeasurably (!) better then please explain why suicide rates have been increasing since the Industrial Revolution:
https://pubmed.ncbi.nlm.nih.gov/20519333/
You make several good points but they are all about material wellbeing. A meaningful and fulfilling life requires more.
It's a fair question, thought I would question the quality of the statistics, since the shame associated with suicide has changed radically over that period, which could skew the numbers. Also, a loss of religious faith over the period could affect the numbers enormously, particularly where notions like meaningful and fulfilling are concerned. Still, the reduction in involuntary deaths dwarfs any increase in voluntary deaths. It's not a reason to go back.
That said, the question of meaningful and fulfilling is a legitimate one. An easier life is not necessarily a more meaningful one. If men find meaning in providing for and protecting their families, for instance, then they might find more meaning in a world of greater scarcity and violence where their strength and courage would be more needed. But at the same time, it is hard to imagine such a man wishing to go back to a time of greater scarcity and more danger, because that would be contrary to his instinct to provide for and protect his family. So I don't think a retreat solves that problem.
Plus, we have to remember that the carrying capacity of the Earth in 1750 was about one billion people, with premature death more common than the reverse. If we go back to the methods of 1750, before the industrial revolution, about seven billion or us are going to die, and I don't think you will find many volunteers.
So what are we to do? Try to find meaning and fulfillment in a safer and more secure world? I'm not pretending that I know what that will look like, though, most people do seem to be managing okay at the moment, even if the suicide rates are rising. I'd say a revival in religious observance, but I know that will be widely scorned. But people do adapt. Not all of us, and that is a tragedy. But as a species, we do adapt. And I don't think anyone wants to go back to 1750. Not, at least, if they have any clue what 1750 was like.
I think you nailed it here! In 2019, I was living in NYC. I hung out with a lot of Burning Man type techies. I barely cooked, let alone grew my own food. I didn't plan on having a family-- in fact, I lived like I'd be young forever. I avoided physical media due to the space limitations of NY apartments. I was glued to Facebook because I was wildly popular and always getting party invites on there.
Now, only 5 years later, I live in South Dakota, grow my own veggies, and buy stuff like raw milk from a local farmer. Sometimes an entire day goes by without me looking at my phone. I can go months without using Facebook. My boyfriend and I are moving quickly towards marriage and children. I collect things like books, CDs, and DVDs. I find out about local events from flyers in venues downtown.
After 2020/2021, you couldn't pay me enough to go back to NYC and use Facebook every day again.
We need to insist on the term "social progress," rather than progress. As John Dewey wrote in an essay defining "Progress" in 1916, "we have confused rapidity of change with [social] advance." 20 years later, Carl Becker wrote, “If progress means to go forward, [then] forward to what end, to the attainment of what object?” We still haven't answered that question a century later, instead blindly becoming devotees to "the religion of technology" (David F. Noble) under the umbrella of progress. This is an excellent and rare essay, not simply because I agree with it and progress rarely receives a critique, but because it takes leading indicators of "progress" and reveals the hollowness of the con and the hypocrisy within this unspoken technological ideology.
Well stated. This is a philosophical issue as well as a semantic one. Both need to be addressed, but our society has focused primarily on economics as the measure of progress. Not the financial or cultural well-being of individuals, as much as wealth or societal leaders.
The Carl Becker quote is spot on. Ironically, progress for progress’ sake is the platform for many movements supposed to make people feel better e.g. self-help, wellness. There’s no defined end, just infinite progress.
Brilliant—when we optimize for meaningless metrics, we get much worse than meaningless results. The culture at a large has pursued dopamine highs and short term gains with relentless efficiency for so long that the cracks are now, as you point out so eloquently, undeniable. It seems we've needed to touch the stove to learn what we actually want to value. I'm glad you see the next wave coming, and can't wait to read more.
Yes too right about metrics and the most important things can't be measured. This is one reason why our societies gone a bit loopy!
Everything just seems Loopy if a person lives on social Media. Go outside & look around. Where is all this doom & Loopyness ? Mostly just peoople going about their business of the day.
But I can say: Too many people - too much noise.
Yeah, that was my view until recently, and I mainly still agree, but madness has leaked into real life. Plus the social media stuff is nested in a wider cultural context.
I read John Naisbitt’s book Megatrends in school 30+ years ago. The one concept that stuck with me through years is his concept of “high tech / high touch”—the idea that as technological capabilities grow at an exponential rate, people will crave more natural, “hands-on” experiences. The future was never going to be monochrome jump suits and minimalism—it’s seeking out our own human experiences in a largely artificial world. Organic farming, ax throwing, tiny houses, craft cocktails, etc—as less of our day-to-day professional work is tangible, the more we seek it out on our own.
Megatrends identified a great many trends that have come true in the 21st century. A well-written and researched book by a great thinker and observer. I recommend people now find a copy and read it to see how much has come to pass.
Let the good times roll....right off a cliff. Hey, Ted, I just moved to that sweet town Sebastopol you speak of. Residents are mostly white people in their golden years but I see a growing trend of gender and racially diverse young adults trying to make a go here. It's a microcosm of so called woke progress where the well-to-do do well. People who own property are either ultra-rich or bought years ago or inherited the land. Rentals are scare and expensive making the issue of homelessness and housing unsolvable. The official push for electric vehicles is outnumbered by the ownership of workhorse gas trucks and SUVs and most families have one or more of each. Local family businesses are promoting organic farming cooperatives and ranching but still the city supports 7 grocery stores. The fact that food banks and volunteer efforts abound is a testament to the generosity of the population. We're surrounded by a healthy network of state, county and city parks and open space year round due to our great weather. There is a definite community feel but the economic divide is palpable. The city council is running at a deficit. The fire department had to merge and depends heavily on volunteer firefighters. Most jobs are service oriented and pay poorly. My kids are grown so I don't know much about the school system here but the library just voted to put in surveillance cameras. Sigh.
I solved the issue of "too much progress" by moving to Ecuador which is 30 years behind the US and (dare I say) 50 years behind Germany, Norway and a few other countries. I'm hoping to be dead in 30 years but my psychic has told me otherwise.
I hate to sound flippant but somehow this reminded me of the old Bufferin advertising catchphrase: "Why trade a headache for a stomach ache?" The promise was that buffered aspirin would not upset your stomach. Even as a kid this stuck with me and as time passed I learned to regard new situations with the same balance - what's the profit here? Does it outweigh the potential loss? With Bufferin the unstated potential loss was the increased cost over generic aspirin.
The mate and I live on a farm in rural NC. We produce a lot of our food including meats cured with traditional methods - no nitrates. Only one or two trips to town a week. We can't say we planned it, we drifted into this after observing the soulless lifestyles of corporate careerists. We both had jobs at major educational institutions but after a couple decades of the lying, the back-stabbing, and the pitiless politics, we got out. We decided that trading our souls for a paycheck was a bad bargain.
So if there is a new awakening in American culture, I would welcome it. It would mean a few more friends in our community. Thanks for this wonderful essay, Ted!
Interesting questions but doesn't the answer for many of them boil down to, "it's good to have room for diversity, and people should not all be doing the same thing, but that doesn't mean you would want the counter-culture to become the culture." (and it's tough for me to say that because I like the counter-culture).
A world in which some people are growing apples and other people are building silicon valley is probably better than one in which everyone is growing apples (or everyone is learning to code).
The experience of being deeply invested in a creative field (in your case Jazz) is fantastic but it's also good that the world allow people the ability to easily have access to a little Jazz.
I feel like the world has changed in ways that make it more difficult to build an idiosyncratic life, but (a) I'm not sure you can blame that on "progress" without some strawmanning going on and (b) my perspective is shaped by the fact that my parents (and myself to a lesser degree) were able to build an idiosyncratic life, so I know what that path looks like, and I'm certainly underestimating the number of people who would not have been able to do that in, say, 1980, but can do so now.
[Edit]: I'd add that, in several cases you're comparing "consider an example of how the path less traveled succeeded" with "consider the average outcome from the conventional path." Which isn't an apples-to-apples (sorry) comparison. It's a good way to push back on the idea that the conventional path is the only one available, but it's stacking the deck.
Ivan Illich talked about two technological watersheds in things like medicine. The first is when exploding tech starts to radically improve our lives (e.g., vaccines, antibiotics). The second is when technological iatrogenics begin to impose net negative costs on humanity.
"Real wisdom on human flourishing is now more likely to come from the humanities, philosophy, and the spiritual realms than technocrats and politicians. By destroying these disciplines, we actually reduce our chances at genuine advancement."
I hope you are referring to the classical forms of these disciplines. In today's schools and universities these are no longer areas of disciplined logical thought, challenging discourse and self-learning. They are methods of indoctrination to ensure those at the top of the pyramid get to continue enforcing their vision of the idea of 'progress'.
Mere innovation is not the same thing as progress. Key point. The vast majority of innovation ends in failure.
I am a techie (72 year old physcist and engineering Ph.D. still working in the field) as well as a practicing techno-Amish. I use tech where it adds value to my life and don't where it does not. I had a large CD collection - I ripped it all to 256K MP3's 30+ years ago. I still listen to those recordings - which are now in my iPhone as well as on my computer. I have added to the collection, but it is enough for me - mostly classical, some ragtime, some folk, klezmer, strauss, .. But I don't listen to radio, podcasts, or watch TV, movies, and the like unless I absolutely have to (such as lectures or presentations). I resist giving the medium control over my time, I can control my reading, scanning, skip forward, go back, recheck, etc. I don't effectively have that with audio / video content.
I like the IP telephony apps. My wife spends hours a week talking to her mother and friends in Ukraine, which was very expensive in the telephone days. And they frequently do video calls, which was not available 30 years ago. Another advance. And I find texting to be very useful as it allows asynchronous communications.
But I have turned anti-social in a way, I am deluged in spam calls and e-mails and do not respond. I do computer security and assume that the calls / messages are malicious. A social-technical regression.
I largely restricted my kids media access / consumption when they were growing up - and very definitely got them hooked on reading. They do a moderate amount of video gaming now, but they are definitely readers - they walked off with my SF/Fantasy library when they moved out. Yes I let them watch, but I would meter access. At the time, VHS tapes and DVD's, which I could borrow from the library as well as rent.
I will probably start using the LLM's in the near future since the token count is getting large enough that I can feed in a large article or group of articles and then use it for summarizing / cross checking / rephrasing. LMM's will be used to increase my spam - thanks. But the spam / fake call level is already so high I have had to disregard unsolicited contacts. We will see if I can get a paranoid LLM Jeves agent to serve as a filter against the idiots, fools, and agents that are spaming me. My own guess that in my case, the AI/LLM will be an asset, but that many to most will find it a negative.
I like my plug-in prius hybrid. With my driving pattern, I am averaging 80+ mpg, which I will be able to afford even when I stop working. A nice technology. 50 years ago I was averaging 15 mpg. Pure electric is not for me - I can make Utah to see a daughter in a day's drive, 800+ miles, which I could not do in an electric vehicle giving charging times. - Significant advance.
I don't see that the social networking world adds significant value - and largely don't participate (I haven't updated my Linked-in profile in close to a decade and use it to check up on old contacts only).
Looking at the issues associated with social networks, I would judge them to be a regression as well.
Foodwise, we dropped out of the prepared food market. We do buy some pasta, frozen and fresh meat and vegetables, and canned / bottled tomatoes, olives, sardines, ... Beyond that, it is all cook from scratch. And we grow and can a lot ourselves. Stuff that is not up to our standard gets mixed in with the food for the chickens. Slower, but also cheaper than the prepared / processed food. And, it turns out, a lot healthier.
You don't have to live entirely in the public culture. You can't fully avoid it, but you can be rather out of phase with it. My daughter shocked her high school English class by reciting Kipling's IF as her favorite poem, it isn't taught anymore. The kids took my Kipling collection with them when they moved out.
My general advise is that if a product is or enables a status game, it is generally a regression and should be avoided until you can find a way of using it that is not part of the general status games. Outside of the status game issues, consider the costs and benefits and choose accordingly.
I've been asking myself the same questions since 2008, which is why I find myself here.
To your hypotheses:
1. I wish you'd submitted this piece and dared the editor to object. We must start putting anyone talking about progress on the spot: progress towards WHAT? Progress towards total emiseration of all but the 1%? Or progress towards a peaceful and healing planet where we honor the dignity of all life?
2. I see 2 & maybe 3 as related to Doctorow's enshittification theory, which extends waaay beyond platforms to almost anything Big Tech and VC/PE/Financial Mobs touch. (Capture required actors with by any means, acquire and kill off all competition, and finally, enshittify the product in order to extract every last available dollar for the rentier, something like a coke-addled caporegime desperately snorting the last bit from the cracks between the table leaves before they arrive to blow his head off.) (Now that they've successfully enshittified health care, will someone please come and blow their heads off? Please?)
On the rest, hard agree but with less optimism.
I worked for an AI company briefly and it still gives me nightmares. Generative AI sucks - now. No way could it write this post - now. It can't even come up with a decent joke - now. But that is highly likely to change. Big business can be shamed now, for the next short while, maybe, but it will keep trying until the outrage fades.
What happens when we rapidly move from a highly addictive digital world to one where any digital information is suspect? When communities either succumb to misinformation or make the shift to only believing what we can smell or touch? Are there artist and philosophers who can save us? How will more than a few thousand people hear any one of them if we can't trust anything digitally?
Re question #5: I’m reading Ted’s question about our damaging addiction to smartphones on my smartphone.
Last week my wife and I went to dinner with our eldest daughter and her husband. As soon as we sat down, they pulled out their phones and the effectively ended all conversation. Afterward, I asked my wife. why did they want to go to dinner with us?
Like people blogging about climate change in their cars in the gas line at Costco.
Not casting blame, just observing the fucking enormity of it all. I too live in a glass house.