1) Healthcare in the USA sucks because politics prevents you from remembering how insurance works. The most basic of basic financial calculations, the advantages of a large pool to absorb risk, vs smaller pools.

2) Education has different reasons for being problematic, and it’s not just in the USA. The USA has only caught up to the problems in the rest of the developing world, having never had to content with these problems before.

Is it me, or does it feel like developing software for BigCorp sucks for at least these reasons too?

That said, there's also the Baumol cost disease: in certain service industries, productivity increases are difficult to make (or even measure, really). We've tried to automate teaching and healthcare (&art!), but the results are mixed..

https://en.wikipedia.org/wiki/Baumol_effect

The new piece to this story and in stark contrast - my wife and I recently had a child and our pediatrician is genuinely fantastic. Friendly, helpful, and actively listens to our concerns. It frankly gives me hope that such physician-ing is still possible in today's system.

I don't know what it's going to take to get us back to a reasonable place, but I am frankly kind of hopeful for like some sort of AI note taker so that the doctor could be the human in the room again.

Seeing people standing around a classroom... hospital?... as amputees and weird shaped people in a space that's too large for them is very disquieting and distracting from the piece later on.

How about a quality patient care metric?

How about a metric which asks patients if they felt that the doctor could spend adequate time with them?

How about a metric that measures how long it takes from a phone call to see the doctor?

Ultimately, a lot of metric measuring management is not measuring what customers are asking for. They are only measuring BS that looks good to layers of management, with questionable value produced.

No wonder people have become cynical and unhappy. Our institutions have forgotten to serve the people they are taking money and time from.

Since health-care became a commodity, we lost touch about what it really is and what it can really do.

For people interested in this, I can recommend Tory Sutherland's book or interviews with him on YouTube. Tory is also consistently arguing that businesses and governments are too focused on metrics.

Follow the steps specified by a school, get the minimum marks specified, that means you have learnt the basic skill set needed by you to function in society. If you need to learn extra, there are other channels available.

Same thing with health care. A patient shows some numbers, treat those numbers. If something feels off, the doctor takes the call. That's why we still have human doctors and not AI.

Also, one major difference between education and health care, in education the customer is different from the one who pays. So the goals get differently from the start(make my kid the best mathematician-parent(paying), I want to be a footballer-kid). So who should the school listen to :)

probably a bad idea but it gets me to ponder long term measurements

I'm not so sure standardisation due to scaling is really as the cause of this. None of the problems the author points out are really novel observations; I've been hearing this sort of thing my entire adult life, 25 years now. So why doesn't anything change?

I suspect the cause is more a lack of trust in people, as well as a fear of things going wrong. Maybe that comes out of scaling: no one really knows what anyone is doing and everyone is a "stranger". So we have all these controls because we don't trust the nurses to nurse, the teachers to teach, etc.

I feel this matters because without identifying the cause, you're not going to find a solution, which is probably to think of ways to increase trust, and to increase societal acceptance that sometimes things go wrong and that's okay, because sometimes the cure is worse than the disease.

I'm not really sure how to go about that though – a big part of the problem are toxic media outlets that will abuse any incident to attack $disfavoured_politician without regard for truth or fairness. The incentives for politicians are pretty skewed.

I don't think that "self-directed learning pods" or "community-funded clinics" are really the path forward. It all sounds very nice, but you can't really run the entire country's system on this for a number of reasons. Sounds more of a libertarian pipe dream than anything else.

We live in a society, we are supposed to act civilized first, then throw AI tech solutions at problems. The problem is we do not act civilized, at least rich people and corps don't and rob society of basic funding. Look at food in schools big corps have regulatory capture and can put whatever shit in front of kids and get a stamp from the FDA. Unregulated hyper-concentration of wealth is going to look like and endless funnel to the richer classes and education won't get better even if you can throw some cheap ollama based tools at it.

Pretending that the issues in care are metrics and not stupid fee-for-service incentives (ignoring the myriad Rx issues and system failures) and an abject failure to improve the supply of providers is ridiculous nonsense.

Yeah, children now spend days looking at Youtube hip-hop videos, learning nothing.

> Rethink Metrics

In other words: "The victims of our 'non-education' approach crater on standardized tests. So we must destroy the standardized tests"

It’s one thing to suffer from a blinkered, reductive view of the world. It’s another thing to be proud of it.

Hmmm... I suspect this guy has some misguided picture of what the first principles are.

Last time I checked, the first principle of healthcare was "make sure as many wounded soldiers get back to the front line", and the first principle of healthcare was "don't let hordes of poor teenagers roam the streets and earn their booze and alcohol with pretty crime and prostitution by keeping them busy somewhere".