brianjoseff
Joined 13 years ago
Joined 13 years ago
Do you have some examples?
We're building a sort of highly linkable (cell level) spreadsheet-type widget builder that is supposed to play nicely with existing workflows (instead of trying to force people to build out entire workflows like many of these new breed of "CRUD-replacer" low-code/no-code apps seem to want us to do). Might interest you!
I am not a Doctor observing patient populations, but I have lived and worked in East Palo Alto, CA for the last few years, which from my perspective, is a stark case study in all sorts of inequalities (For non-SV residents, East Palo Alto is a small historically socio-economically depressed city wedged between Palo Alto, Facebook, and Google. Zuck's house is a stone throw away from crack houses)
Anecdotally, what I have seen regarding poorer/uninsured people not utilizing health services involves all the things you have mentioned.
Non-emergency healthcare without insurance is pretty much out of the question. Even with insurance, co-pays can be prohibitively expensive. There are people I know living paycheck to paycheck with zero savings and like 50%+ of income going to housing expenses. Even a $50 unplanned-for copay is a painful blow.
Distance is also an issue for a population that may not have consistent access to a car--and the bus system takes too much time. If you are working a few jobs, it's nigh-impossible to take a random 1hr+ bus ride to a medical facility.
Education/knowledge is, unfortunately, also a huge issue. I have observed some astonishingly unhealthy habits that stem primarily from ignorance. Additionally, even navigating our health system requires some level of education, literacy, and time that often seems prohibitive for many in the population I have interacted with. And, with regards to distrust of the medical system, I have observed that as well. I have also seen this coupled with exploitative homeopathic "care" providers...which is doubly sad. These are more complex issues that I don't feel well-equipped to begin to speculate the underlying reasons for. Perhaps some of it is cultural. I am not sure if that is the primary story though.
Generalized ambient anxiety and depression is also, I believe, the more ultimate, albeit distal, cause here, rather these more proximate poverty mechanics. The emotional toll of living in poverty, primarily extreme _relative_ poverty (remember Zuck across the freeway and the swarms of Tesla commuting through your city on their way to high-paying tech jobs that are inaccessible to you) results in all sorts of extremely unhealthy compensatory behaviors. Heavy alcohol and drug use--even if just Marijuana, binge eating fast-food, violent communication styles that contribute to always-on fight or flight reactions, dangerous activities like racing cars or weaving bikes through traffic--perhaps done as some way to "feel something" or perhaps find identity in the only way available--acting out anti-social power displays as a way to reify self-worth contra a system that clearly treats them like shit on nearly all levels. And more.
Frankly, unequal access is both a moral failure and also, I believe, soon to be an instrumental failure for the strength of the United States. Having a large population of enfeebled, diseased people does not bode well for nice things we care about like innovation, improved quality of life, stability of our governance systems, or even things like the strength of our fighting force.
However you want to cut it, the issue of unequal health access is a shame.
Also has impressive numbers in other charts.
However, I think the author's deeper point still stands, despite his poor support for the argument.
Can we not agree that the _je ne sais quoi_ of humanness is threatened, on some level, by modernity?
It is a very difficult empirical case to make, as you have made clear with your totally acceptable critique of _Bowling Alone_.
But, in my view, supporting the claim that our "humanness" is under assault is not really where we should be focusing our energies here... It is much more interesting to discuss how we can preserve the "old good" things from our past, while somehow enabling ourselves to take advantage of the "new good" things unlocked by technological progress without being undone in the process.
I'm tired of all these jeremiads bewailing the loss of all that we hold dear, ripped from our grasp by inhuman techno-corporate-behemoths.
Not sure what the roadmap for a more productive discussion is--but perhaps first we must define exactly what it is we valued from our pre-industrial, supposedly unsullied past.
I agree with you that we must be very critical any rose-tinted "back in my day it was better" line of inquiry, but I do believe that there are things worth preserving. Another important question to answer is, why are those things valuable to us? Is it because they titillate our neurons in just the right way? Or is there something more there?
Then we need to figure out how to implement our technological progress in a way that fosters these values, rather than undermining them.
PS: above-mentioned link to Ladd's critique of _Bowling Alone_: https://www.csmonitor.com/1999/0301/p9s1.html
Hearing different perspectives, sharing interesting stories, and generally engaging in real human interaction are something I don't get enough of in my regular life, and Lyft has materially changed that. Of course unfortunate that I don't get enough of that outside of a transactional transportation arrangement, but it's real for me.
With your framing above, it was "everyone should be a homeowner" and "everyone should be educated"... well we did that. Reality conformed. Just at tremendous cost and risk.
The issues are of course way more complex than "# of ppl who own a home" and "# of ppl with a degree"
So the question, then, is how do we use instruments of governance to move complex systems in the direction we think we want.
This is complicated by, among other things: 1.) the fact that politicians are really just optimizing for "signaling" that they are fixing things rather than tangible results. 2.) long time horizons on these issues clashing with shorter time-horizons of political attention spans and our capacity to even reason about long-term things. etc...
Any recommended foundational texts to begin with?
Recommended learning trajectory to get to where this is understandable?
Very accessible set of case studies where algorithmic management of traditionally human-run bureaucratic processes is biased and destructive.