From: sbharris@ix.netcom.com (Steve Harris  sbharris@ROMAN9.netcom.com)
Newsgroups: sci.physics,talk.politics.misc,sci.med.pharmacy,sci.med,
	alt.fan.rush-limbaugh
Subject: Re: . 2.7 Million Morons
Date: 7 Dec 2003 16:56:57 -0800
Message-ID: <79cf0a8.0312071656.366425d@posting.google.com>

nulldev00@aol.com (Edward Green) wrote in message
news:<2a0cceff.0312061630.1404cf33@posting.google.com>...

> Unrelated note: I had this idea last week, in one of my, ahem, few
> idle moments at work:  given "high unemployment", which the US seems
> to be enjoying (Europe too?), this means (brace yourself for the depth
> of my conclusion) -- _many people are out of work_!
>
> Ok.
>
> If you follow me this far on my flight of fancy, you may also agree
> that of this cohort of the workless, many again have _skills_ and are
> out of work.  Now, take some skills, mix 'em about, and what have you
> got?  I'll tell you!
>
> Value, value, value!
>
> Alright, it's not quite that easy, but maybe you begin to see my
> point: given an army of the idle but not starving we have an
> underutilized pool of value for _something_.  So, being
> entreprenuerial, one someone enlists this idle labor -- poof -- value
> out of nothing!  You take some value, give some back to workers no
> longer idle, everyone goes home happy.
>
> If only it were that simple: I guess I've just described in a nutshell
> the idea of venture capital -- given some plausible idea to convert
> underutilized labor and resources into surplus value, one convinces
> someone with money to lend to lend you enough to get things started.
> But this is hard, and lenders are reluctant to lend in bad economic
> climate, which we predicated our predicament on.  Yet there is that
> idle labor -- if only there were some way to get the idle to
> _themselves_ invest a portion of their time, maybe even find some
> distressed physical resources ...
>
> Ok!  I've got it!  We employ the unemployed to be rag-pickers on
> commission!


COMMENT:

Ed, I see by your last sentence that you see the problem.

Of cousre your idea of harnessing un-used brain power of unemployed
people is rather like the SETI project's idea of harnessing all the
unused processing power of PC's that otherwise goes to waste as they
sit there running screensavers instead of crunching numbers. It's a
great idea, except how do run it on anything but a volunteer basis?
There's no problem billing or paying for time, but there's a real
problem in billing more for quality time, especially if the customer
(see actual real market) is not the one paying the bill.

Specifically, as in most of medicine, if the government or some other
third party insurer pays the bill, then in order to bill for quality
thinking, the person doing it has to prove they've been *doing*
quality thinking. Which means they have to submit to somebody a lot
smarter than they are, as a sort of thinking-output manager, who
judges their thinking work product, and decides who much to pays
accordingly. And how does society decide how much to pay THAT guy? At
the top of this, we get to insurance company suits, fed agency
staffers, politicians, and finally the Amurican voter.  These are the
real brains?  Say what? It's a horribly recursive problem which has no
solution when you get to the upper reaches of mental performance. Peer
review only works when one's "peers" are blinded, and have no vested
interest at all in whether you get the money or not. Which is not the
system we have, don't you know.

I will tell you a not-unrelated story:

Once up on a time, there was once a young man who was going to be a
medicinal chemist, and make new drugs to cure diseases. But soon, it
occurred to him that if the did that, with the FDA being the sort of
thing it is, he'd eventually just be a slave for some monster
pharmaceutical company, which would use his effort and he'd never see
any of the profits from any really good ideas. So he sought advice
from the career councilors, and they said approximately the following:

"Why, anybody can make a good living. That's a very mediocre
commodity. Every pusillanimous creature that crawls on the Earth or
slinks through slimy seas makes a living. Back where I come from, we
have universities, seats of great learning, where men go to become
great thinkers. And when they come out, they make good livings with no
more brains than you have. But they have one thing you haven't got: a
medical diploma."

"Well, then, I have to get me one of them dang things, then" decides
the young man.

So he gets one. And after he has it, he looks at various ways that
physicians make their livings, and notices that some of them were
doing much better than others financially. So once again, he seeks the
advice of the powers that be. And is told approximately:

"Why, anybody can be a doctor. That's a very mediocre commodity. Back
where I come from, we have many medical schools, seats of great
learning, where men go to become doctors. And when they come out, they
make a lot of money and with no more brains or degrees than you have.
But they have one thing you haven't got: a billable procedure."

"You mean like surgeons taking out gallbladders?" asked the young man.

"Yes, but much more." he is told.  Also cardiologists sticking
catheters in people's hearts. And gastroenterologists putting tubes
down their throats, and up their behinds. And radiologists sticking
them into complicated and expensive scanners and also putting various
catheters into them. Did you know surgeons are the richest doctors of
all, and that radiologists make almost as much as surgeons? It's all
in what you can bill for."

"But what about diagnosis and thinking?" asks the young man. If you do
a good job of that, you can save a lot of billable procedures and a
lot of money. I've learned that much in medical school"

"So what? The patients aren't paying for these things, and they rather
like them. Nobody likes to be told to wait a few months and whatever
they have will probably go away on its own, no matter what they do.
It's scary and powerful being put into a complicated machine; there's
a lot of magic there. And you know people--- if somebody isn't probing
one of their orifices, people don't feel anybody cares about them.
Even space aliens have to toe the line."

"But people do pay for these things eventually, one way or another."
objects the young man. "The system's going broke! Surely the
government sees that the way to save money is more thinking and fewer
procedures.  Er, don't they?"

"My son," they say gently to the young man, "it is unfortunate that
doctors' salaries are only 20 cents of the medical dollar. The
remainder goes for hospitals and procedures. And if you subtract the
salaries of doctors doing procedures, and instead just look at the
salaries of those thinking about better medical care, you're down to a
few percent of total medical spending. Don't you think this disparity
may have some influence on the politics of the issue?"

"No!" objects the young man. "Medicine is a noble profession. There is
no way they would let profits interfere with the best interests of the
people they treat!"

"As you will"

"All right, what about oncologists", says the young man, not growing
desperate. "THEY think and think a lot about cancer, and the
government pays them to do it, don't they?"

"Not enough to make a living," the young man is told. "Oncologists
make a lot of their living on mark-ups on chemotherapeutic drugs,
which the government allows them to do. Giving chemotherapy is their
procedure. Most of their patients are elderly, and if oncologists had
to get by on what Medicare pays them to just think about the best way
to treat cancer, they'd go broke."

"You're wrong!" the young man says.  But later, after looking into the
matter, he returns sadly.

"Okay, you're right about oncologists. And I suppose you're going to
tell me that the profit on chemotherapy influences oncologists on
whether or not to use chemotherapy."

"Perish the thought!  Of course not! Medicine is a noble profession.
There is no way they would let profits interfere with the best
interests of "

"Okay, stop with the satire."

After much of this kind of thing, eventually the young man experiences
a bit of zen enlightenment, and goes away.

But, he stays in medicine, and eventually learns to make a living
without probing people, although he is still required occasionally to
deal drugs (though not as much as pediatricians). And he refuses to
stop thinking, and even offers some of these thoughts free to the
public, occasionally. But long ago he's stopped imagining he's going
to make a living in medicine by just thinking. There's no market for
it.

--Steven Scissorhands