This jewelry stays in place via needles lodged in your skin!
No no no no no no no no no.
The integrity of my sleep has been forever compromised.
Luckily it's still conceptual, not real.
Uh, earrings stay in place via needles lodged in your skin.
You've just destroyed MAE's life.
Not mentioned in the first article: that the AMA and medical schools keep the supply of doctors artificially low. From this follow both the high salaries and the burnout, not to mention little things like difficulty for people accessing care.
5: He claims:
. But the reason primary care is on the ropes is not because of too limited primary care residency training positions, as is currently thought in Congress. It's because doctors are leaving medicine: A 2012 Urban Institute study of primary physicians found that 52% of those over 50 planned to leave practice within five years.
I have no actual idea.
The burnout thing doesn't seem counterintuitive at all. In fact I'd argue it's stereotypical in the UK. That said, this argument is not as persuasive as the author seems to think:
But the reason primary care is on the ropes is not because of too limited primary care residency training positions, as is currently thought in Congress. It's because doctors are leaving medicine: A 2012 Urban Institute study of primary physicians found that 52% of those over 50 planned to leave practice within five years.
Many older people in a well paid profession are considering retirement shock! Also, is this proportion increasing? Is 52% of docs over 50 more or less than five years worth of med school students?
3: No, earrings stay in place against skin lining a hole which you created once, a long time ago.
Anyhow, my friend used to line his neck with staples occasionally, maybe that's more what you had in mind.
Much better. I was also thinking of facial studs.
And earrings don't have those long, pointy needles that look like they're straight out of some cyberpunk dystopia.
Plus, they don't go into the base of your neck, right next to your fucking spine.
Here is my friend's page about the neck staples.
... possibly MAE shouldn't look at it?
A quote from 12:
Anyways, I just loved the ideas of staples in me. I almost wanted to get staples instead of stitches, but decided to get both!
He's hilarious. Brilliant guy, too.
I'm with MAE on this one. I can't even contemplate getting a tattoo.
I know a bunch of doctors who have left patient-based medicine to do things in the pharma industry (like medical writing or trial oversight) that pay far less but are much less stressful and life-consuming.
Not (just) because of the needles, but because of the little bits of ink left in your skin. Also, I'm too bourgeois.
My friend's page about tongue splitting is also super informative.
14: I had a suspicious spot on my arm punch biopsied a few days ago. Having a plug of apomeat removed was kinda gross but still interesting.
I can't handle injury talk, but body modification and surgical procedures I'm mostly okay with. It's the element of surprise that squicks me out. Although I can't handle those surgery shows. Those are gross. But I can read about it.
15: Most of the doctors I know do quite a bit of research (which is how I know them), but they all see patients at least one day a week.
6: my bad, I did miss that. But like Ginger Yellow I find it unpersuasive (bordering on disingenuous). People leaving a profession shouldn't be a problem if people are allowed to enter it. Also, it's not just about primary care.
I agree that it's a pretty silly claim to talk about physicians leaving in droves, but limit your statistics to those nearing retirement age.
I can't handle those surgery shows.
Oddly enough, I have no problem with those. I'm fine watching people getting carved up with knives and shit. For me, the squick is all about those long, thin needles.
Depends on where you are. I have physician friends who aren't libertarian at all. A lot of pediatricians seem pretty liberal and interested in work/family balance stuff as well as policy related to chrilden's health.
Yeah, most of my friends do at least some research.
Why can't the primary shortage be as a result of more than one thing? I think there aren't enough people going in AND too many people are leaving. Why are people dissatisfied with primary care (either when considering whether to go into the field or to leave it)? Poor reimbursement relative to other specialties and a method which reimburses quantity of visits over quality of care and does not pay for time spent coordinating care or telephonic communication.
Job dissatisfaction doesn't preclude there being a shortage of training slots.
A friend of mine is a burnt-out physician. He was griping about the tedium of managing people's non-life-threatening chronic conditions in a podunk New England town. Now that I think about it, that sounds like the setup for a situation comedy.
A friend of mine is a burnt-out physician. He was griping about the tedium of managing people's non-life-threatening chronic conditions in a podunk New England town. Now that I think about it, that sounds like the setup for a situation comedy.
Swap Alaska for New England and it was one. Well, a comic drama anyway.
GY the US term of art is "dramedy", if you would.
Are you sure that doesn't belong in the whisky thread?
I was thinking more along the lines of Newhart, except with Bob Newhart as a doctor. "This is my brother Daryl, this is my other brother Daryl, and we've got foot fungus."
Or maybe I was just really young. Last night I watched an episode of Magnum and it wasn't nearly as good as I remembered it. Stupid Netflix recommendations.
I think part of physicians' dissatisfaction is entitlement - we defer to them a lot less readily these days, and whether it's via insurance, their employers, or government, more and more pressure has steadily been coming from above for them to minutely record and account for their actions. Which is a good thing in broad strokes, and they'll just have to get used to not making the rules themselves, but I hope it can be made less mind-numbing for them. And that crap like this gets stopped.
26. Ricky Gervais' Derek is about the staff of an old folks' home. Sweet, sometimes funny. There was a previous BBC comedy similarly set that was pretty good, but I can't remember the name. ABout residents rather than staff.
My friends who are doctors (hospital and GPs) love the doctoring part of their jobs, but are ground down by all the admin and management parts. C's doctor friends are all academics, so have rather different and very varied lives, which probably helps with the not burning-out.
On the other hand, doctors probably get to deduct stuff like this as a business expense, so it isn't like there aren't some serious fringe benefits.
Full feature listing. At $1125, it's a steal.
36: It's the small touches like a carrying case for the genitalia that really justify the price.
A foam decubitis ulcer is included!
Other Features: Grandma Chase also comes with a tracheostomy, a rectum that accepts rectal thermometers or water enemas, and an ostomy stoma.
"Primary care physician" is a pretty big bucket. There are people in private practice who are willing to game the system (legally) who can work long but not crazy hours and make $3 even 400,000 per year. There are also people working in urban clinics for the underserved who often moonlight to make ends meet. Everything about their lives is different except that they went through the same training.
That said, there are some problems that crop up a lot of places: the administrative work can be a huge hassle, and physicians are slowly becoming wage slaves, which means that they're expected to see x number of patients and bill for y amount of stuff, while keeping patients in z band of health, and their compensation is directly tied to hitting those targets, often with perverse incentives to not see or not treat the more ill. That's not true everywhere, but it's becoming true in more and more places, and given that most primary care docs actually give a shit about their patients, that leads to a lot of frustration.
(It's also true that primary care docs make less than most other docs, but I haven't heard any complain about the pay--it's not like they didn't know what they were getting into. My wife complains that some specialists make so much, but she thinks they (and she) should make less.)
And that crap like this gets stopped.
There was an interesting peer-reviewed study from a while back that showed a perverse consequence of the pressures on ER physicians to admit. When severe trauma cases show up at a community hospital ER, they are statistically more likely to be sent to a nearby level one trauma center (the appropriate site of care) if they are uninsured. The commercially insured patients are more likely to be admitted to the adjacent hospital, where the chance of adverse outcomes is vastly higher. It's a rare case where the uninsured get better care than the well-insured.
I think part of physicians' dissatisfaction is entitlement - we defer to them a lot less readily these days, and whether it's via insurance, their employers, or government, more and more pressure has steadily been coming from above for them to minutely record and account for their actions.
Physicians have some legitimate gripes about electronic health records, but I guarantee you if could magically make the bugs and hassles disappear, most of the resisters would still hate the EHR, because it makes their performance transparent in a way they have never had to experience before. A lot of doctors cling to an artisanal conception of quality of care. Their conviction may be sincere, but it has the welcome effect of extending maximum autonomy to the physician and protecting them from every external judgement except the occasional malpractice suit. To produce quality care at an affordable price, you need statistical quality control. And you can't do statistical quality control without data.
I remember back in the 80's the radical economist Stephen Marglin lecturing a bunch of students at the University of the Ruling Class about the dynamics of workplace control and autonomy. He ended the lecture with this [paraphrased, of course]: "Now I know a lot of you are sitting there thinking you don't have to worry about any this, because you're going to be highly paid professionals like lawyers and doctors, and you're going to have autonomy. Mark my words, future doctors: before your careers are over, you will be controlled like assembly line workers. Ask not for whom the bell tolls, it tolls for you."
To produce quality care at an affordable price, you need statistical quality control. And you can't do statistical quality control without data.
As the school reform movement demonstrates, it is not always the case that people obsessed with "metrics" are particularly interested in quality outcomes. The metrics have a way of becoming ends in themselves.
True, but you really have trouble trying to claim science and avoid metrics.
Anyway, "Did you remember to check for possible drug interactions?" is just as much a metric as "Did you get the patient out of your office in less than 5 minutes?"
44: I'm as conscious of Goodhart's Law as the next guy, probably more so, and I recognize that the standard population health and care quality metrics are highly imperfect. But they are meaningfully correlated with outcomes we want. If your hospital isn't giving patients aspirin at the onset of a heart attack, you're practicing medicine wrong, and it doesn't matter a damn that medicine is as much art as science. Also, if we are going to transform the healthcare system from one that spends a king's ransom on treating sickness but scarcely a farthing for keeping people healthy, we will need to manage to certain metrics.
I wonder what happened to the guy who played Larry whose brothers were Darryl and Darryl. Not massive stardom, I would guess. Speak, o internet! Huh, looks like he's done well as a character actor, True Blood and stuff. I have a hunch Newhart is not something that holds up.
Or what moby hick said in 46.
I thought the current trend was for patients to be kept lounging around hospitals for days in some sort of administrative limbo because there was a disincentive to formally admit them.
Maybe I'm thinking of the stats on readmission? Where if you admit a patient, then they're in the system and you want to give them a chance to go home and come back? I really can't remember what it was. Or maybe these were re-admits, and they were hoping to get them back out the door without counting them towards the statistics?
A lot of doctors cling to an artisanal conception of quality of care.
One of the great things about the NYT-style-section reported trend towards "boutique physicians" is that it puts this distinction right out on the table. Your dream doctor-job is the one where you sit in a big relaxing office, being your own boss, and a low-stress stream of clients showers you in cash and prestige? Uh, me too! Maybe someday you'll quit your [I]regular doctor[/I] job and become a boutique doctor. But right now you're a regular doctor.
I thought the current trend was for patients to be kept lounging around hospitals for days in some sort of administrative limbo because there was a disincentive to formally admit them.
There are more "observation stays", including long ones, these days, but that doesn't affect the care you get so much as what kind of bill you get later. (A lot of people are only discovering after the fact that they weren't an inpatient; a bill that died in the CA legislature this year would have required hospitals to use "outpatient" in all the signage for units with observation patients.) There's not really a disincentive to admit - Medicare pays hospitals more for inpatient stays - but IIUC Medicare has tightened up criteria for what severity is worth an inpatient payment, and there's a lot of hospital/DC squabbling underway over it.
More broadly, in the inpatient service world, since Medicare's move to DRGs in the eighties the incentive has been to discharge faster because you get paid based on condition, not length of stay. And now there's also a Medicare penalty for excessive readmissions - not sure what that's doing in terms of quality of care, but readmissions are indeed going down.
8: the word you are looking for is "fistula".
You're welcome.
"Fistula" is not just a river in Poland.
Sticking to primary care physicians -- which I tend to think of as solo practitioners (as mine is), though this may be wrong -- I wish I could remember where I read a recent article by a PCP explaining that reductions in insurance payouts were leading to his needing to spend no more than 15 minutes with any given patient .. which was causing him to refer patients to specialists, when in fact he might could well be able to address the patient's complaint himself, would that he had the time. He mentioned that if he bordered on spending too much time with a patient, his office manager would page him to Hurry up.
The gist of the piece was that he felt he was increasing the cost of health care by referring to specialists all the time.
Oh good lord, very simple, a NYT piece from a couple of weeks ago.
I thought a fistula was one of the more awful complications from L&D.
55: A lot of the newer ones are not solo practitioners. As the ACA pushes an emphasis on primary care and ACOs, hospitals are getting into the primary care game. Many new graduates are salaried employees. And some of the starting salaries have gone up as high as $200k.
I have to admit, if a doctor spent more than 15 minutes with me, I'd start to be afraid I was dying or something.
Solo practitioners are pretty damn rare around here.
Because hairy palms make it hard to don latex gloves.
58: So I gather. I dread the day that my PCP decides to retire, so that I have to find a new one.
33: I think part of physicians' dissatisfaction is entitlement - we defer to them a lot less readily these days
On an entirely different tack: I defer to physicians much less these days because I've been steered wrong so often lately. My mother, an R.N., always told me in strong terms that I had to take control of my own health care, and wow was she right.
Solo practitioners are awesome. I phone the office for an appointment, I say, "Hi, Ellen, this is [me]", she says, "Hi, how are you, it's been a while since we've seen you."
A couple of years ago I said "Um, I had a tiny tick on my leg which I removed yesterday, and today it has a target-like circle around it," and Ellen said, "Come right in. Now." Awesome.
59: My doctor hung around with me for 40 minutes while my nose was bleeding. She was going to get a nurse to wait with me, because she had to see other patients, but luckily the ambulance people came.
At the Harvard teaching hospitals, the psychiatrists book 30 minutes. At a community clinic it would probably be 15 minutes though.
46: Anyway, "Did you remember to check for possible drug interactions?" is just as much a metric as "Did you get the patient out of your office in less than 5 minutes?"
I disagree with this. Checking for drug interactions or giving aspirin at the onset of a heart attack are things I would characterize as "best practices" or "standard of care" rather than "metrics".
Also, for both of those examples there is strong evidence that doing them will improve patient outcomes. As far as I know, there is no evidence that 5 minutes (or 15 minutes, or whatever) is the optimal amount of time to spend with a patient in order to get the best results.
I'm not sure that tech support call centers in New Delhi are the ideal model on which to base our health care system.
I don't think you're disagreeing with me at all about anything but the definition of "metric". I just mean something that could be data.
I just mean something that could be data.
OK, that's different from what I am thinking of. I guess I tend to mentally translate "metrics" into "perverse incentives".
To produce quality care at an affordable price, you need statistical quality control. And you can't do statistical quality control without data.
You can't do anything without data, amirite? What strikes me as slightly odd about the drive for electronic health records is the implication that prior to their advent, the medical community had no idea what it was doing, and that is surely incorrect. I don't dispute, of course, that the medical establishment has been primarily treating symptoms rather than engaging in prevention or considering the whole body, but: are electronic health records going to change that? I'm not sure.
Those who know more about this than I: enlighten me.
I think 33 is exactly right. There are significant worries about the various for-profit elements of the medical system (because they invariably seem to end up drawing that profit from screwing people over). But there's also a lot of resistance from medical doctors to the idea of being held accountable for things (or just feeling like they're being supervised).
This isn't entirely surprising, really: autonomy is probably the most central part of feeling like a professional. (Professors seem to do a lot of complaining about similar stuff though, generally, a lot more reasonably given what Universities think success looks like. At least with medical doctors there are some parts of "success" that everyone agrees on and that are readily quantifiable.) And when people's lives are involved there's a very reasonable reluctance (on their part) to even think about the chances that you could be making serious mistakes on a regular basis, even if we know that, in fact, they are making serious mistakes on a regular basis.
But as often as not they end up opposing things like going through standard checklists before surgery, which is absurd*. I particularly enjoyed the fact that at the end of the test 20% still opposed their use, but 93% said that if they had surgery they'd want their surgeon to be using one. Even generously speaking that's a good 13% who thought it was effective at preventing serious medical complications, but didn't like the idea of having to do it themselves. Part of their resistance to electronic medical records is almost certainly the burden of having to learn a new system (and the dangers of having to do this while using it to treat patients), but I think part of it is that increasing the extent to which other people can look over their shoulders and (when it happens) prove that they've made serious mistakes a lot more easily. (I think this is especially true given how many places are setting up systems to make those electronic records immediately/easily accessible to patients through the internet, rather than making them go through various hoops to pay for copies of their medical records. It's how I found out that a doctor I was seeing was giving me a different set of treatments than he'd told me he was performing in order to treat a condition I neither had nor had been diagnosed with, and was writing down positive results that I hadn't reported in my file.)
*Not directly stated but insane fact implicit in that article: surgeons weren't going through checklists to make sure they had what they needed. In other words, they were treating this with less care than when they went grocery shopping.
(I think this is especially true given how many places are setting up systems to make those electronic records immediately/easily accessible to patients through the internet, rather than making them go through various hoops to pay for copies of their medical records.
Have I complained that my OB has a prominently placed sign saying it will cost $25 for them to send your records elsewhere?
Elsewhere includes to Jupiter. That would be a bargain.
69.last: Find a surgeon who eats take out every night. Also, the nicer the watch, the less likely they are to leave it inside you.
And if they do anyway you get a really nice watch for free. Well, depending on whether your insurance pays for the surgery to take it out.
69: It's how I found out that a doctor I was seeing was giving me a different set of treatments than he'd told me he was performing in order to treat a condition I neither had nor had been diagnosed with, and was writing down positive results that I hadn't reported in my file.
This is rather startling.
It occurs to me that I was a coauthor on a paper about the implementation of electronic medical records. Also, ten of the first twenty hits in PubMed for my last name an initials are me and not fake-me.
I sometimes feel like I should send the fake-mes an email asking them to change their middle name to keep things neater.
It's mostly just one guy and he's at the University of Birmingham. I'm not even sure that's a real place. It doesn't appear on any list of schools in Alabama.
I guess in fairness, the treatments were very similar (the same drug, but in slightly different places). And if I had (had/been diagnosed) with what he was writing in my chart it might have been a no-difference difference.
The frustrating part for me was that when the first treatments (that I thought I was getting throughout) worked, and the second didn't at all (these are the different ones) he probably should have double checked the records instead of reassuring me they were the same and then giving me a higher dose (which ended up making the problem worse rather than better). Also he probably shouldn't have written that the second set had a strong positive effect, but who knows what he was up to at that point.
It wasn't a great experience though, especially since the referring physician also misdiagnosed me, as a result of ignoring what were pretty obviously relevant parts of my medical history. By ignoring I mean, "ignoring me when I interrupted him to point them out" and and by pretty obviously relevant I mean "symptom x showed up right at the time I started taking a drug known to cause symptom x along with related side effects y and z which also showed up at the same time".
The point in 69 about professionals hating tracking seems right. I mean, I hate recording my time, and if I had a mandatory checklist of 40 things to remember before a deposition or whatever it would probably be pretty useful, but I would definitely resent it.
Especially, I bet, if it was at the really-basic-dumb-stuff level like:
(1) Do you know what case this is? (Y/N)
(2) Do you have a pen handy? (Y/N)
(3) Are there any questions you intend to ask? (Y/N)
(4) Do you know what those questions are? (Y/N)
...etc.
From my impression at least that's about the level involved in the checklists they were giving surgeons (or at least some of them were).
How many sponges did you put inside the patient? How many did you take out? (In an ideal world, these two numbers are equal.)
I guess it's a question of where "instituting best practices that have been shown to improve outcomes" ends and "Taylorization of skilled labor" begins.
My feeling is that the default attitude toward calls for Taylorizing skilled labor should be one of deep suspicion, both of the likelihood that it will deliver the claimed benefits and of the motives of those calling for it (not casting aspersions on the motives of anyone in this thread, of course).
69.last: people actually use grocery lists? Whoa.
(In an ideal world, these two numbers are equal.)
"Where the fuck did that extra sponge come from???"
Two sponge enter, one sponge leaves.
TWO SPONGE ENTER, ONE SPONGE LEAVES
83: yes, in my dotage, I rely upon them.
From my impression at least that's about the level involved in the checklists they were giving surgeons (or at least some of them were).
The thing is, really consequential medical errors occur with terrible frequency because of glossing over the simple stuff, because I'm a big shot surgeon and I don't have time to verify that this this Mr. Nigel Jones DOB 07/11/1963 who's getting his meniscus repaired and not Mr. Nigel Jones DOB 11/07/1936, who is having his foot amputated because of complications of diabetes. It's akin to the issue knecht mentioned in the other thread with safety culture in industrial plants: if you don't take it to an extreme that looks faintly ridiculous to the commonsense observer, you're not doing it right.
Checking for drug interactions or giving aspirin at the onset of a heart attack are things I would characterize as "best practices" or "standard of care" rather than "metrics".
Others have addressed this already, but there is no practical way to enforce a standard of care if you don't collect data to track it. Literally every pediatrician knows that you shouldn't prescribe antibiotics for colds and flu, yet many of them do (the CDC estimates that 30-50% of antibiotic prescriptions deviate from evidence-based guidelines). It wasn't until CMS started tracking appropriate antibiotic use and imposing penalties that health systems (apart from some commendable exceptions) started to change their behavior.
I'm not sure that tech support call centers in New Delhi are the ideal model on which to base our health care system.
If you prefer, think of it as running a Lexus factory. You want cars with zero defects? You use statistical quality control and continuous improvement. You want a high performing healthcare system? You use evidence-based medicine and, yes, metrics.
he felt he was increasing the cost of health care by referring to specialists all the time
Parsi, this is in fact one of the fundamental flaws of the system: the systematic undercompensation of PCPs relative to specialists, and the fact that physicians generally are compensated by volume of procedures. The only sustainable solution IMO is some form of capitation with quality measures, which comes with its own set of perverse incentives (and pretty much implies the end of the solo practitioner PCP).
Interestingly, in the financial sector, if a system is set up whereby you get more money and prestige if you do the job badly or dishonestly, and risk losing your bonus or being sanctioned by your boss if you do things properly, people don't tend to say "oh what a terrible system undermining your professional judgement with these perverse incentives". They say " you are a terrible bastard looking out for yourself and now you need to be severely punished ". I've often wondered why hospitals who leave patients in corridors to game their NHS performance metrics, or teachers who " teach to the test " don't get treated like LIBOR submitters, and I have warned a couple of mates who were in the process of juicing the universities Research Assessment Exercise that "I had to do it or I would have got less money and prestige" doesn't always sound so good when said out loud to a public inquiry.
Are the LIBOR submitters getting any punishment? And if so, I assume the next twenty groups that are rigging the system are passing undetected.
Oh definitely. Lots of lifetime bans from the industry (with no such niceties as due process of course), and likely criminal charges to come when the inquiries are finished.
Meanwhile a friend of mine recently heard that the FCA has decided that there was no evidence on which to charge him, even by the very reduced regulatory standard of evidence, with being a member of an insider dealing ring. When he asked which office he should go to to get his reputation (and four years of missed earnings while they were making up their minds) back, they indicated there was no such office. People say that blue collar criminals get treated much worse than bankers but it's not necessarily true
Given what the banking industry, especially the mortgage-lending portion of it, has just done to the whole economy, I'm still more upset out what is legal than that somebody might have been wrongly accused of doing something illegal. Your mileage may vary on your island.
91: The only sustainable solution IMO is some form of capitation with quality measures, which comes with its own set of perverse incentives (and pretty much implies the end of the solo practitioner PCP).
I'm afraid the issues involved here are over my head. Having read a bit about capitation just now, I certainly get the concept; what are the perverse incentives? This is new territory for me.
People say that blue collar criminals get treated much worse than bankers but it's not necessarily true
I'm pretty sure that not only does the same sort of thing happen to blue collar not-actually-criminals-or-at-least-not-provably but that there are far nastier versions of the same sort of thing, e.g., actual arrests, "resisting arrest" charges, time spent in jail, or civil asset forfeiture. I mean, maybe those things happened to your friend as well but it's typically not the case.
As far as the perverse incentives go, I think people tend to be a lot more suspicious of the idea that the financial sector is promoting the public good in any way at all, or that the underhanded-incentive-gaming that goes on rebounds in any benefit to anyone other than the people doing it. The not entirely convincing argument for hospitals (and researchers) at least tends to go "doing this sneaky and questionable thing that has non-optimal results is necessary to get more money which we use to keep people from dying (but not in the exact we'd do if the incentives worked better)." Similarly people are a lot more likely to go along with the idea that some doctors are better than others and spending more to get them to your hospital/keep them there is worth it than they are for mortgage brokers, even though it's not always true on an individual level. Researchers can appeal to using the money to do research, but I think people are a lot less likely to sympathize there. And the banking industry has even more trouble because everyone figured out what they were using that additional money/prestige/etc. to do a few years ago.
Oh my fucking God the whining of bankers. The system made me do it! Where will I possibly find the resources to fend off these improper regulatory charges!
There is one area where per visit checklists bother me (as opposed to checklists about general health screenings): caring for the sickest disabled people.
In my experience, the people who are most successful with either physically or mentally disabled individuals invest oodles and oodles of time into relationship building and gaining the trust of the people they are treating. By doing that, they are able to understand things like how the individual is actually using the steroid cream and substitute Eucerin instead. They have to develop trust, but when they do they can avoid ED visits.
And I'm talking hours--like 2.5 hours to do half of an initial assessment. You just have to build in a lot of extra time, and a lot of what you're doing is not easily quantified.
A lot of standardized assessments and shared-decision making models freak these people the fuck out.
Trauma victims too. Getting someone who has been sexually abused to the dentist is a herculean task--even if they have a serious cardiac history and could die from infection. Having a PCP, e.g., an NP, accompany someone to that appointment can be huge. It doesn't fit into any of the standardized metrics.
We can and should work on measuring it, but it's hard.
70: I don't think they're supposed to do that if it's going to another doctor. If you request them for yourself you may have to pay. By the page.
Oh my fucking God the whining of bankers large corporate content distributors. The system made me do it financially ruin those people with thousands of questionably sourced lawsuits! Where will I possibly find the resources to fend off these improper regulatory charges prevent the enjoyment of my intellectual property without my permission in a way that may or may not have some impact on my business plan!
This is why there's an analogy ban isn't it...
Fuck off, I don't think I've ever whined about routine corporate lawbreaking by fraudsters on a "the system made me do it" theory. The whining, if at all, was about the actual collapse of an industry.
Given what the banking industry, especially the mortgage-lending portion of it, has just done to the whole economy, I'm still more upset out what is legal than that somebody might have been wrongly accused of doing something illegal. Your mileage may vary on your island.
Given what people on websites, especially the child pornography portion of them, have done to defenceless babies...
98: right, intellectual property lawyer boy isn't really interested in hearing about people being frivolously prosecuted, why am I not surprised. Go fuck yourself, asshole.
I'm not sure why you think that your rank bullshit about oppressed bankers is supposed to impress or persuade anyone -- maybe you think that this is an audience of academics not actually familiar with the relevant rules, prosecutions, or current system? The astounding LACK of enforcement and prosecution of the banking industry is one of the most disgusting residues of the financial crisis, unfortunately easily explained by political capture, and if you're defending a post-2008 lack of banker prosecutions you're a right wing shithead defending the powerful, full stop.
I mean, personally I believe in protecting the rights of creators of culture to earn money from their works, and don't believe in cyberlibertarian bullshit to the contrary. But if I was in charge of "optimum social good," I'd adopt the platform of the EFF as national law in exchange for actual regulation/prosecution of the financial industry, which at least in the US is a complete fucking joke. Oh hello FINRA arbitration! How are you, ridiculously lowball SEC settlement with denial of wrongdoing? How about you, extraordinarily industry-compliant Supreme Court?
104 isn't even an accurate analogy unless I greatly misunderstand what is legal in the UK.
Bringing up the LIBOR scandal in this context is really especially egregious.
I mean, personally I believe in protecting the rights of creators of culture to earn money from their works
I love it when you start talking like Frank Luntz.
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To try to distract from the argument (and because it would feel even more off-topic in the Israel thread), I just happened to watch this video for a 1996 George Clinton single, and it seems like an interesting antecedent for Janelle Monae's work. It's presents images of a science fiction dystopia in which funk music is contraband. In particular, it was impossible not to think of Monae when they bring a female android to life with funk music. Sadly George Clinton does not wear a tuxedo.
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That just lead me to watching Janelle Monae perform two songs at the White House. Both are excellent and the contrast between her energy and the audience is funny.
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If you have to go up against the wall during the revolution, going behind Frank Luntz isn't a bad idea.
The video in 111 also has some nice Metropolis references.
I wonder if there's some way to get a fight between intellectual property lawyers and investment bankers generally, in a context where there might be legitimate harm done and between the genuinely nasty/corrupt parts of each group, as opposed to between decent people in blog comments.
"Hey Intellectual Ventures! Yesterday I heard Bain Capital say you were a bunch of child molesters. Is that true?"
capitation with quality measures, which comes with its own set of perverse incentives
Indeed. A friend probably just went through a few extra stages of cancer because he was undertreated in a capitated system. Doctors should be salaried with bonuses paid based on specialty-appropriate criteria. But a lot of doctors are greedy fucks, so don't expect them to go along.
That said, on EMR, consider that a lot of the resistance is simply generational. Many doctors have been doing things one way for decades, and are being asked to changed. Crucially, being a doctor is a job that, until now, hasn't required people to use computers, so you've got not-young computer illiterates being asked to adopt (often clumsy) software as a central part of their job. In my experience, younger doctors like EMR. Our pediatrician spends at least half our appointments geekily telling my wife about the macros he's built in their EMR system.
creators of culture
This is in no way a taking sides with the bankers against the lawyers, but you should probably slap yourself for typing those words.
Ok. "Recording artists, authors of books, and people who create, act in, and produce movies should have some ability to sell their works so as to make money aside from government funding and/or the patronage of rich people, assuming that we're going to maintain capitalism for everyone else." Radical proprietarianism!
117, 118: "Creators of culture" is a pretty horrible phrase.
"Creators of culture" is bad enough that just for that I'm going to download a bootlegged cam of Teenage Mutant Ninja Turtles and watch it, Halford. Just for that.
Talk about a self-punishing crime.
107
The "creators of culture" in our society turn out to be, in the eyes of the law, the giant corporations that own the copyrights (and patents), not the actual creators.
Living on stale pizza in underground sewers is precisely what cyberlibertarians want for artists. The turtles are named after Renaissance artisits like Rafael, Michaelangelo, etc for a reason. In a sense, you're watching the future that you're simultaneously creating through theft.
115: I was going to suggest the creation of a new class of assets, Collateral Intellectual Property Obligations, which aggregate large portfolios of low yield copyrights and patents, and then slice them up for resale in ratings agency assessed tiers. But then I realized that Intellectual Ventures basically is that already. And I can't see banks having any problem with it.
So whatever the opposite of that is.
Oh, Hollywood's been successful at losing banks' money* for a long time. Unfortunately, as with all such things, the middlemen tend to do fine and it's the poor saps the studios and bankers work together to sucker who get fucked.
*a tiny amount of their money, unfortunately in the copyright lawyers v banker battle, the other side is about 8 billion times more powerful.
To be clear, I was objecting to the use of the phrase "creators of culture" because it sounds like corporate, marketing-speak, not because I begrudge artists money. I make no comment on the merits of the IP debate.
Also to be clear I did NOT want to start another IP debate. I just wanted to insult Dsquared.
Well that's all right then. All in good fun, eh?
How many sponges did you put inside the patient? How many did you take out? (In an ideal world, these two numbers are equal.)
In the wonderful and deeply cynical "Cardiac Arrest", there was an operating theatre scene...
"Well, that's about it. Swab count correct, nurse?"
"Yes, Mr Docherty."
"Hmm. Good. Well, if you'd been as careful the first time we wouldn't have had to open the poor fellow up again today. By the way, I presume you remember that the swab count should have been one higher this time, to include the one we took... oh. Oh dear."
(Anaesthetist sinks head into hands)
104, though an analogy, makes a good point. It's unjust to condemn the entire industry for dodgy mortgage-lending and mortgage-securitisation practices - after all, this was just a small part of the financial sector.
Nor, for the same reason, is it just to condemn the entire industry for defrauding millions of their retail customers by selling them flawed or unnecessary PPI. Or pushing their customers into flawed packaged accounts. Or flogging small businesses over-complicated rate hedging products. Or conspiring to rig benchmark rates in the precious metals, energy, forex and interbank lending markets. Or insider trading. Or conspiring with genocidal governments to evade UN sanctions. Or laundering billions of dollars in drug money for the Mexican cartels. Or assisting in illegal tax-evasion schemes. Or bribing government officials. Or targeting the relatives of recently-deceased borrowers and trying to bamboozle them into co-signing for responsibility for their debts.
Look, the point I'm trying to make here is that there are lots of bankers out there who have never had any involvement in defrauding the public, undermining the financial system, obtaining money by deception, bribing government officials, conspiring in tax evasion, drug running, sanctions busting, or genocide. Lots and lots!
115: I was going to suggest the creation of a new class of assets, Collateral Intellectual Property Obligations, which aggregate large portfolios of low yield copyrights and patents, and then slice them up for resale in ratings agency assessed tiers
Meet Bowie bonds, first issued in 1997.
The default attitude toward calls for Taylorizing skilled labor should be one of deep suspicion
The problem here is that one man's embedded, undefinable artisanal skill is another man's obscurantist bullshit, and still another's unexamined privilege. Medicine, especially, is the absolutely classic example of a profession whose claims to scientific status are often entirely unfounded, self serving, and riddled with sexism/racism/authoritarianism/any damn ism.
right, intellectual property lawyer boy isn't really interested in hearing about people being frivolously prosecuted, why am I not surprised.
Maybe you could actually come up with a single example of someone in the financial sector being frivolously prosecuted?
You know, people always complain about frivolous prosecution, but do we really want our prosecutors to be joyless scolds? Why shouldn't they get to cut loose, live a little? Life is a waterslide, Martha Coakley. Life is a waterslide.
I am sitting on a small, inflated tube.
Different from the tubes we are sitting on now, I hope.
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Speaking of people being compensated for creating works of art, is anyone else now more tempted by the idea of subscribing to this thing?
The drinking games alone would be potentially deadly worth it.
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Jezebel continues to suck. Other than dropping an "in," Palin makes perfect sense there, even if her mockery is inane.
Maybe you could actually come up with a single example of someone in the financial sector being frivolously prosecuted?
Maybe you could read the comment you're responding to maybe a bit? My friend, Cl/ive Rob/erts, who recently had the charges against him dropped after four years of SFO time and effort came up not just with no criminal charges, but literally with nothing; he was guilty of having clients and talking to them on the telephone and it took the authorities four years to admit that being on someone's speed dial isn't actually evidence of criminality. Of course, my business and my friend's has nothing to do with subprime lending or the financial crisis, but I have long since given up on any hope of the ever so wise and virtuous people of the internet being interested in finding out anything about what they're talking about.
And further to 132, is it your journalist's glass house or your army glass house from which you are throwing those stones?
Perhaps that was a little unnecessarily tetchy. So I'll just restate my point that if someone's worried "more about what's legal than what gets prosecuted" then it might be worth considering, on topic, the doctors' licencing cartel and the pharmaceutical patent system. Between them, those two put away a TARP's worth of expense to the US taxpayer every couple of years, and cause avoidable pain, suffering and death to (at a conservative estimate) tends of thousands of people in doing so.
And in a world where bankers have had their time, journalists have had their time, MPs have had theirs, light entertainers have had theirs and so on, I think everyone who wants to use "ha you work in finance" as a killer comeback really ought to be wondering whether John 8:7 is relevant to them. I'm certainly not sure that surgeons should presume that it will always be the case that they can literally put other people's limbs at risk through poor practice and think that the debate is always going to be about Taylorisation of professional skills.
133: Indeed, though that seems a critically harsh assessment of Bowie, vs more hypothetical Slade Bonds.
Not the medicine doesn't have some problems, but it's hard not to notice that people on average live a great deal longer than they used to before doctors were licensed and there were any pharmaceuticals to patent. I'm not saying that banking hasn't been a benefit to much of society in many ways. But over the past few decades the banking industry in the U.S. has actively and successful lobbied for a much looser environment in which to operate. I take it as fairly obvious that these actions imposed costs on nearly everybody while the benefits of the actions were very narrowly distributed.
Of course, if the other thread is right, I basically killed a guy to please ogged.
145 plays into the error that dsquared identifies when he refers to "everyone who wants to use 'ha you work in finance' as a killer comeback."
In fact, banking and finance have been huge boons to humanity. As has intellectual property law, for that matter.
But if you're manipulating Libor, you're a crook, and all the tu quoque in the world ain't gonna change that.
147 last is certainly right, but Dsquared's more ridiculous claim was that prosecutions and/or regulatory investigations in the financial sector have been particularly high-handed, excessive, or abusive in recent years -- even more so than the problems faced by "blue collar" criminals (!). Now, it's true I know nothing of the UK, but I have a reasonably decent knowledge of the criminal, regulatory, and civil lawsuits affecting the industry in the US. It is very difficult to get anything charged, and the charging decision will often come only following negotiations between the target and prosecutors/regulators. The relevant criminal or regulatory violations (primarily fraud) are extremely tough to prove, because it's generally speaking extremely easy to cover up wrongdoing with just a little bit of caution and creation of room for plausible deniability. The current system excuses a veritable ocean of bad or questionable behavior. And prosecutors are generally extremely risk-averse, tending to go after easy-to-prove violations by small fry over anything affecting the big fish.
Once you're outside the realm of state action, and trying to use private law to stop industry abuse, it's often worse, since claims are subject to arbitration in front of FINRA, which is effectively industry controlled. The head of Obama's SEC was the former head of FINRA. The industry professionals who are prosecuted are, almost uniformly, well represented to a standard that no other set of criminal or regulatory targets, except maybe in the oil industry, could ever conceivably dream of. It's somewhere between laughable and offensive to say that the climate for the finance industry is anything whatsoever like that affecting ordinary, non-financial crime.
And yet, even with the foregoing being true, there are a stunning number of post-2008 scandals that are so egregious that they've come to light, of which the LIBOR scandal (mentioned by Dsquared as excusable!) is probably the biggest. That alone should tell you something about the state of current regulation. I don't think there's any reasonable doubt but that the industry engages in massive self-dealing that ultimately hurts many of its customers, but more importantly the public and the economy as a whole.
Now, it's possible that the regulatory environment is different in the UK. But everything I've ever heard has suggested to me that, if anything, it's substantially more lax than in the US and it is even easier for bankers to get away with self-dealing and activity that either is (or should be) criminal.
This is a decent generalist place to start reading about the issue.
But if you're manipulating Libor, you're a crook,
This is my point. Everyone in finance agrees with this. The chief executive of Barclay's said so, then got sacked, then the next chief executive of Barclay's also said so. I said so myself.
Meanwhile, the AMA helped to do for single-payer healthcare (it is not just the banks which have lobbyists) and continues to artificially restrict the supply of doctors, and people don't seem to want to understand that this is just as corrupt as spoofing a LIBOR quote and orders of magnitude more harmful; the benefits to the incumbent doctors are also highly concentrated.
The point of tu quoque is not to excuse people who don't deserve the excuses; it's to point out that the same treatment people are currently handing out to "bankers" is likely to be on its way to everyone else's sector in their turn, at which point everyone is going to want sensible distinctions between guilty and innocent actors to be made, so why not get into the habit now.
Instead, we're at the point where people are happily telling me that they don't care if my mate had his livelihood taken away for nothing because "bankers" while simultaneously admitting that doctors occasionally chop the wrong leg off and "culture creators" occasionally harass people to death, but you shouldn't get too up tight about that, because they're working in a system where they might find it inconvenient to do otherwise.
But if you're manipulating Libor, you're a crook,
This is my point. Everyone in finance agrees with this. The chief executive of Barclay's said so, then got sacked, then the next chief executive of Barclay's also said so. I said so myself.
Meanwhile, the AMA helped to do for single-payer healthcare (it is not just the banks which have lobbyists) and continues to artificially restrict the supply of doctors, and people don't seem to want to understand that this is just as corrupt as spoofing a LIBOR quote and orders of magnitude more harmful; the benefits to the incumbent doctors are also highly concentrated.
The point of tu quoque is not to excuse people who don't deserve the excuses; it's to point out that the same treatment people are currently handing out to "bankers" is likely to be on its way to everyone else's sector in their turn, at which point everyone is going to want sensible distinctions between guilty and innocent actors to be made, so why not get into the habit now.
Instead, we're at the point where people are happily telling me that they don't care if my mate had his livelihood taken away for nothing because "bankers" while simultaneously admitting that doctors occasionally chop the wrong leg off and "culture creators" occasionally harass people to death, but you shouldn't get too up tight about that, because they're working in a system where they might find it inconvenient to do otherwise.
the LIBOR scandal (mentioned by Dsquared as excusable!)
I'd be interested in what ambiguous wording caused you to read this so totally, diametrically incorrectly.
I don't know anything about your friend's case, but "investigated for a few years and then not punished when an investigation for which there was a plausible basis didn't reveal anything" doesn't really seem like the world's greatest due process violation. Maybe it was more tragic than that! But you're not just arguing about an individual case, you're trying to make a sympathy plea about overregulation or overcriminalization in the financial services industry which is (at least in the US) complete and utter bullshit -- there is no crisis of either overregulation or overcriminalization of the financial industry and anyone who is telling you that there is is a liar and selling you a bill of goods.
Ummmm I'm going to have to press you on this because you did specifically mention the LIBOR scandal and you did say is said it was excusable. You can of course understand why that's not something I can allow to float around the internet without clarification, so please could you point me to the words you interpreted as me saying that?
If you're arguing that banking should be nationalized, I withdraw my objection.
But you're not just arguing about an individual case, you're trying to make a sympathy plea about overregulation or overcriminalization in the financial services industry
I also don't recognise this at all but I really want to get this LIBOR thing squared away first.
I'm perfectly willing to believe that the financial industry in the United States is under regulated and under criminalized, and that the FCA ruins the lives of innocent people.
I read "I've often wondered why hospitals who leave patients in corridors to game their NHS performance metrics, or teachers who "teach to the test " don't get treated like LIBOR submitters" to mean that you favored treating the LIBOR submitters roughly like teachers who teach to the test. This seemed a particularly likely interpretation given the line "People say that blue collar criminals get treated much worse than bankers but it's not necessarily true," which strikes me as ludicrously false.
However, if in fact you believe that the LIBOR scandal was a crime and the LIBOR submitters and their bosses were actually criminals, then I'll happily agree that I misunderstood you on the LIBOR issue, though 154 still seems a little needlessly pompous. No one cares what I have to say about you here!
People say that blue collar criminals get treated much worse than bankers but it's not necessarily true
I won't speak for Halford, but I thought you were flirting with making such a case here, though I read your "not necessarily" charitably. That said, having spent a full night that one time arguing with you about due process -- and seriously, shame on me for putting myself in the position of defending John Yoo's rights in any way, shape, or form -- I want no part of this discussion. Also, for what it's worth, I'm sorry that your friend got dealt such a shitty hand.
I think the word you might have been looking for is "sorry".
160 -- are you fucking kidding me? Are you vying for my crown of most immature commenter? How old are you?
"White collar sociopaths unite" is certainly a novel rallying cry.
I started to make a very inappropriate joke and then stopped myself. Chilling effect!
160 to 158 obviously. I suppose in context, I should also raise a "sorry" to Ari in respect of some of my more angry responses in the discussion referenced in 159; my only excuse is that I was angry. I don't think either of us are likely to change our minds on the underlying issue so I'll respect your wish not to resurrect it despite temptation.
I thought it was fairly obvious that leaving someone untreated in an emergency ward to game a target is a very serious evil but there you go. And I only ever brought up Cliv/e's case because h-g asked me whether people ever got prosecuted. To which the answer is "yes, all the time, but usually through regulatory processes which have been designed to be massively more prosecutor friendly than the courts, and which are used in preference to them for that reason". I'm in favour of this as it is the only way to get miscreants punished without unreasonable cost but it does their up some horrible injustices from time to time.
Promise me you guys will keep this up long enough for me to pop some popcorn.
Equating Libor scamming or leaving a patient untreated with "teaching to the test" seems like an unfortunate choice of words, if nothing else.
But doctors who engage in horrible practice like leaving patients to die in hallways are in fact subject to criminal investigations, regulatory sanction (losing your license, where you most definitely don't get all the protections of a criminal trial), and certainly civil tort sanctions in the US. And, so are some teachers gaming tests, e.g. this RICO prosecution. The idea that the financial industry is some kind of uniquely egregiously hounded-by-the-government profession just doesn't hold water and is worth reacting against -- again, sticking strictly to the US, which is all I know, I'd say it's less strictly regulated and with less severe sanctions than either teachers or doctors.
Really? I also don't see the practice of screwing up a child's education in order to game your own performance metrics as a trivial offence. This is kind of my point, everyone has a blind spot for fiddles and rorts that haven't had their LIBOR moment yet. It's an irregular verb.
I do my best within a dysfunctional system
You respond understandably to perverse incentives
He is a crook.
People tend to be a bit more sympathetic when the upside is keeping a small raise to a middle class salary than a seven figure bonus or more.
166: you certainly don't owe me an apology. I was, more than anything else, sticking up for my co-blogger. But by way of doing that, I ended up defending John Woo in some weird way, and there's just no excuse for that. Anyway, it was a long time ago and it happened on the internet, so it's nothing to worry about at all. I'm sorry for having brought it up. I just didn't want you to think I was piling on without acknowledging that bit of history.
I guess I should know the formal name for the argumentative fallacy where you try to excuse/minimize objectively bad behavior familiar to you by pointing to other, largely unrelated flaws in the system as a whole and then asking if we really shouldn't be condemning the system as a whole? I think of it as the Deltas on Trial defense and it certainly works well for trolling purposes sometimes.
Which suggests most people don't follow sound economic reasoning. Obviously, the bigger the temptation the less the blame for falling for it.
171: As long as we're declaring a moratorium on making distinctions, let's throw mafia hit men in there, too. Libor conspirators and teachers who are overly obedient are just like mafia hit men - just people responding to perverse incentives. Let's not get fussy over which things are legal, or try to parse degrees of immorality.
The scene really does work pretty well as an argumentative template here:
Otter: Ladies and gentlemen, I'll be brief. The issue here is not whether we broke a few rules, or took a few liberties with our female party guests - we did. [winks at Dean Wormer] But you can't hold a whole fraternity responsible for the behavior of a few, sick twisted individuals. For if you do, then shouldn't we blame the whole fraternity system? And if the whole fraternity system is guilty, then isn't this an indictment of our educational institutions in general? I put it to you, Greg - isn't this an indictment of our entire American society? Well, you can do whatever you want to us, but we're not going to sit here and listen to you badmouth the United States of America. Gentlemen!
Sorry, heebie. I'll do better now.
You're a fucking cunt, dsquared. Same with you, halford. And Moby Hick makes matzoh with the blood of Gaza's children.
I don't know the name for the argumentative fallacy of misunderstanding an ambiguous paragraph, then having it cleared up then just ploughing on as if this had no consequences for the point you had based on the misreading, but at least now I know who to name it after.
I ended up defending John Woo in some weird way
A) So racist.
B) Look, Broken Arrow wasn't great but I'd say he redeemed himself with Face/Off.
What? Broken Arrow was better than Face/Off and neither was very good.
177: the distinction is between "people who are crooks" and "people who are not crooks". Literally dozens of people in all sorts of industries face incentives whereby it would be easier and more profitable to cheat, and yet don't. I'm one of them. So's my brother the surgeon and so is my kids' teacher. All the assholes who work the system to help themselves are making things difficult for the good people, just like Mafia hitmen make life difficult for Sicilian workers.
So yes, Mafia hitmen, LIBOR fakers, cheating teachers and dishonest ER staff have one big thing in common; the property of being crooks. You can parse degrees of immorality (and harm; Madoff was much more dishonest, but much less harmful than the LIBOR fraudsters) in the sentencing phase
And also to 177, the distinction we seem to be making at present is "bankers=crooks, even if they're innocent / teachers and doctors= not crooks, even if they do crooked things / journalists and politicians, to be decided on a case by case basis depending on attractiveness of overall electoral stance". Which I think makes less sense than my proposal.
Is Mozillo innocent? Fuld?
There's a bureaucracy custom built to dissipate responsibility and lobbying to weaken regulatory authority. Good to know that it's black and white regardless.
You keep talking about comparing harms, but I don't see you addressing the potential benefit to society or any reasonably large portion thereof. And I think that is a key difference. Most people can see the societal gain in a system of emergency rooms or schools and understand that there will be people working in these systems who do bad things but that the system is necessary. There are entire sectors in the banking industry (e.g. pay-day lending, derivatives, sub-prime mortgage lending) where it looks very much like all the gains are concentrated into a very small group and all the costs are spread out to nearly everybody. You don't have that situation with teachers or ER workers. The closest thing to it in medicine is a pharma sales rep and in that case, much of the rest of medical industry has been pushing to limit that.
187 to 183/4 and VW, because of the world-control thing.
183 -- I agree almost entirely with 183 (I'd say scope of harm and immorality of the offense also matters to the crime/violation charged, not just to the sentencing/punishment, but that's a quibble). At least you're not in full-on Animal House Argument mode in that comment.
The only problem is that you seem to feel that somehow crooks are being charged excessively in the financial industry, and not in others, which is wrong, or that prosecutors/regulators are overzealous in the financial services industry but not in other areas, which is wrong on both points. At least, given 183, I can't figure out any other way to read 92 and 94 and 184. There is in fact no overzealous campaign that exists to punish all bankers as guilty no matter what and excuse all doctors and teachers as innocent no matter what. It's much closer to the truth to say that there are lots of bankers who are guilty as fuck who are sadly not being prosecuted, investigated, or regulated. I'd say that lack of prosecution/punishment is a much bigger problem in the financial services industry than in the medical industry or the teaching profession.
(Actually, in context, 92 and 94 made even less sense, because people immediately above (91, 80, 78, etc.) were talking about things like doctors using checklists to avoid completely innocent, routine mistakes to improve standards of care, and then you seemed to analogize things like failure to use checklists to the LIBOR scandal, which sure seems like a category error, but I guess we're past all that now, unless it matters for INCREDIBLY CAREFUL PARSING of comments).
Since we're decided to bury the analogy ban on this, let me make my own analogy. Banking is like coal mining and power generation. The problem of outright theft, like Enron, is one thing, but there is a separate issue with the very high level of negative externalities assuming perfectly legal behavior on the part of the industry.
I also wonder if "teaching to the test" means something much more literal in the uk. otherwise, wtf?
I'm pretty Dsquared has a limited defence of certain kinds of short term loans aimed at poor people.
184: You aren't wrong, but the issue with crooked bankers via a vis , say teachers is two-fold: the industry is one of those that attracts the crooked, and they are highly leveraged in their crookedness.
That said, I agree it should be sorted out proportionally in the courts. The practical problem with this is, if you want to get serious about proportionality then heads will roll. If you give some poor schmuck 5-10 years in max security for stealing a few cars, then when a rich schmuck goes down for stealing 20 million they really have to be looking at 25 years in max security or you are just screwing about.
See that happening? Fwiw I don't think either of the above should spend that sort of time I that sort of environment, but that's a separate issue.
I'm saying it "LEE-ver-age" in my mind. Because Britain.
Maybe in the UK there actually is now post-2008 social shunning of bankers for 190-like reasons, and that explains this persecution complex? That would be kind of awesome if it were true, but I doubt it is.
And I only ever brought up Cliv/e's case because h-g asked me whether people ever got prosecuted. To which the answer is "yes, all the time, but usually through regulatory processes which have been designed to be massively more prosecutor friendly than the courts, and which are used in preference to them for that reason".
But this was an example of someone who was not, in fact, prosecuted! He was investigated, but then the charges were dropped. (This is like the "pub fight in which no one was actually punched" thing, isn't it.) If you are a known associate of someone who has committed a crime, then you are likely to attract the attention of the police, and this really doesn't count as unjust persecution.
But if you're manipulating Libor, you're a crook,
This is my point. Everyone in finance agrees with this.
I hope so. But that really wasn't the case a few years ago when fifteen different banks were rigging Libor (and various other rates) - at a time when, by their own admission (in things like the Salz review), every major bank had huge cultural problems to do with risk-taking and regulatory compliance. Now, maybe that's all changed now. Maybe once all the bankers were warlikegreedy and mean, but that couldn't happen again. If so, then it's changed impressively quickly.
the same treatment people are currently handing out to "bankers" is likely to be on its way to everyone else's sector in their turn
This, I think, is related: the idea that banking doesn't actually have any worse cultural problems than any other industry. That isn't what the banks themselves are saying, and it isn't what the regulators are saying.
Relevant to 187, in things like medicine you actually have demonstrable improvements in outcomes since the 1970s. Banking, not so much. Paul Volcker can say something like "the only worthwhile financial innovation of the last twenty years was the ATM" and not get immediately ridiculed. There's no other industry in which you could make that kind of statement - or in which you could make a solid argument that the industry's now less efficient and less valuable to society than it was in 1912.
Maybe in the UK there actually is now post-2008 social shunning of bankers for 190-like reasons, and that explains this persecution complex? That would be kind of awesome if it were true, but I doubt it is.
It's somewhat true. I wouldn't go so far as broad-based social shunning, although there is a lot more banker bashing in polite discourse, whether in the media or otherwise, than in the US (and than pre-crisis). And you certainly don't have anything like the sycophantism on display when Dimon testified to Congress on the Whale losses. There's basically no major UK bank (remember, there are only five or six major banks to begin with) which hasn't either been nationalised or implicated in a major scandal so, building society sector aside, there's nobody benefitting from a "well, we're not as bad as those guys" effect. And from a regulatory perspective, there has definitely been a much stronger shift in enforcement policy and practice, and in rule-setting*, than I perceive in the US, but from a much lower base. Without particularly endorsing dsquared's comments, there's definitely a sense that the FCA and the FSA before it are playing catch-up and prosecuting everything they can, with the result that some of their enforcements have been overturned by the Upper Tribunal. But not many.
* Most of the rule-setting aggressiveness has passed, I think, but for a while post-crisis the UK had much tougher rules on, for example, resolution and liquidity than the rest of Europe.
building society sector aside, there's nobody benefitting from a "well, we're not as bad as those guys" effect
Even the Co-operative Bank, which should really have been profiting from its (justified) image as an ethical, well-run, honest sort of bank, fell foul of the decision to pick an inexperienced, incompetent meth head as chief executive. (Paul Flowers, former Methodist preacher, now known as "the crystal Methodist".)
There's basically no major UK bank (remember, there are only five or six major banks to begin with) which hasn't either been nationalised or implicated in a major scandal
Mind you, this is sort of true in the US as well, isn't it? Off the top of my head, Bank of America had the mortgage scams, JP Morgan had the London Whale, Citi had the Magnetar business. Goldman Sachs had the Abacus fine. Wells Fargo was deceitfully reselling mortgages, I think? etc... there aren't any that spring to mind as being clean.
Mind you, this is sort of true in the US as well, isn't it? Off the top of my head, Bank of America had the mortgage scams, JP Morgan had the London Whale, Citi had the Magnetar business. Goldman Sachs had the Abacus fine. Wells Fargo was deceitfully reselling mortgages, I think? etc... there aren't any that spring to mind as being clean.
Yes and no. For a start, the very biggest banks make up a much smaller share of the market in the US than in the UK (though bigger than before the crisis), so while "Wall Street" has few entirely clean names, plenty of people never deal with those firms directly. Also, I'd argue that the Whale was more of a cock-up than a scandal in a public opprobrium sense (though it would have been different if JPM were RBS) . There were definitely policy, control and disclosure failures around the Whale, but there's a meaningful qualitative difference, at least as far as social shunning goes, between cocking up a portfolio hedge on spectacular scale and, say, illegally hiding money laundering or rigging Libor to make profits on derivatives and/or mask your financial weakness. Dimon's name is not mud but Diamond's is, whether or not that's justified.
Well, Fred Goodwin's house was vandalised and he's had it removed from Google Street View if that helps?
201: It's not. I really shouldn't say this given my job, but he's The Worst.
201: OK, fair points, especially the first one about market share.
203: You mean Dimon's name isn't mud, and should be because he is The Worst?
Also, Thorn is coming dangerously close to blowing her real identity (Janet Yellen).
203: You mean Dimon's name isn't mud, and should be because he is The Worst?
I'm just saying that despite the Whale (and other stuff like the RMBS settlement), he's still running the bank and treated in some quarters like a god. Diamond is not.
206: yes, I got that - I just wasn't sure what Thorn's comment meant.
199.last: British journalism has had its issues, but at least it still can make a pun.
204: I mean it's not justified that his name is not mud, yes. Apparently you worked that out, as you did the rest of my no-longer-secret identity.
Aha, thought so.
Dimon is still at JPM, but maybe not for much longer, what with the throat cancer.
An underlying issue in this thread involves the rankings of different professions along two axes: Public loathing and proportionally appropriate public loathing.
The public loathing ranking for professions discussed in this thread:
1. Mob killer
2. Politician
3. Financial professional
4. Lawyer/journalist (tie)
6. Teacher
7. Military
8. Physician
And, as it happens, the public gets this basically right because this ranking also represents the appropriate level of generalized loathing that should be aimed at each profession.
For members of the military, "just following orders" is a legitimate defense in a way that it is not for other professions, and the public recognizes this. Physicians, while under-policed and over-licensed, are as a rule tremendously dedicated to the performance of a helping profession.
The Mendoza respectability line here is between teachers, who are practitioners of a fundamentally honorable profession, and lawyers/journalists.
Respectable journalists and lawyers are rightly tarred by association with their less scrupulous colleagues. There are many despicable acts that are entirely consistent with professional legal and journalistic practice, whereas teachers who cheat and doctors who hurt patients are correctly understood to be acting outside professional norms.
Financial professionals are like journalists and lawyers, but worse because their primary professional imperative is self-enrichment. The profession is full of conspiracies like Libor that are generally accepted practice, until they suddenly aren't. The only available defense is tu quoque: We are all fallen, and thus hypocrites if we cast stones. Had you chosen to be a financial professional or a mob hitman, you'd have done the same thing.
I just wanted to make that explicit, since it seemed to actually be the topic under discussion.
You're welcome.
The profession is full of conspiracies like Libor that are generally accepted practice, until they suddenly aren't.
To be clear, it wasn't generally accepted until it wasn't in a "We all prescribed thalidomide until we learned about the birth defects" sense. It was widespread among the Libor setters, and clearly encouraged/turned a blind eye too by their immediate and not so immediate superiors. And the legal/regulatory environment (or lack thereof) around benchmarks let them get away with it for a while. But it wasn't generally accepted in the market. The banks didn't admit it until they were investigated. It was rumoured to be happening by disgruntled participants and then reported on as something dodgy going on more or less contemporaneously (as in the active rigging phase continued well after the first press reports).
Lawyers have such a range of contemptibility, from low-income tenants rights advocate to "prestigious Wall Street firm -- helping the real scandal be what's legal -- since 1887." But at least we're used to being hated and don't whine about it. The combination of the rough basic truth of 197, that is the outsized compensation for years for vanishingly little social good in return, should, at a minimum, make finance types understand why the general public may have a dim view of them as a profession.
But even with the negative stereotyping it's still not true that they are prosecuted/regulated/policed at excessive rates, instead exactly the opposite is true.
It was widespread among the Libor setters, and clearly encouraged ...
To me, the relevant distinction here is between the practice of a corrupt individual or organization and the practice of a corrupted profession. Madoff was a crook, and Michelle Rhee ran a crooked organization, but Libor wasn't about any of the individuals and organizations involved; it was about everybody in that business (and yeah, everybody regulating it).
Moreover, Libor scamming is far from the only finance practice that fits that description.
But at least we're used to being hated and don't whine about it
Right. This is what pulls lawyers up into a tie with journalists, who are rightly regarded as a whiny, sanctimonious lot.
D-squared: And I only ever brought up Cliv/e's case because h-g asked me whether people ever got prosecuted. To which the answer is "yes, all the time, but usually through regulatory processes which have been designed to be massively more prosecutor friendly than the courts, and which are used in preference to them for that reason".
Ajay: But this was an example of someone who was not, in fact, prosecuted! He was investigated, but then the charges were dropped. (This is like the "pub fight in which no one was actually punched" thing, isn't it.) If you are a known associate of someone who has committed a crime, then you are likely to attract the attention of the police, and this really doesn't count as unjust persecution.
D-squared really does have, not exactly a point, but something valid to say here. I'm not a financial regulator, and not actually any kind of a regulator, but I defend regulatory agencies after the fact, particularly agencies that regulate licensed professions. And you can lose your license on not very much evidence, at least in NYS. The standard for what you need to support an administrative determination here is "substantial evidence", which is less than a preponderance of the evidence -- that is, when a court reviews an administrative determination, the court lets the determination stand even if, on the evidence presented, the court thinks it's more likely than not that the agency is wrong, if there's some respectable amount of evidence in favor of the agency's determination.
I don't actually think this is a bad thing: being in a licensed profession is a privilege, and if the regulatory agency has lost confidence in your honesty/reliability based on at least some evidence, I think the interest in protecting the public overrides the damage to the professional who loses their license. And mostly, the administrative determinations I see seem well founded to me. But there is the occasional one where I find myself thinking "Wow, that guy's business was just destroyed, and my personal reaction to the evidence the agency relied on was that it was fairly sketchy." Cases like that are going to happen in an actively regulated area, and I don't think there's any way to avoid it without underregulation, but they do create real hardship.
(None of this should suggest that I think that bankers are more actively regulated than any other profession, or that they're more actively regulated than they should be. Just that d-squared's anecdote does describe a pattern of genuine hardship that is going to hit some people in regulated areas.)
216 is a good point. And this is going to become much more relevant in the UK because the financial regulator, the FCA, has just announced it's going to massively expand the scope of its licensing/approval regime to cover pretty much everyone who works in banks except the security guards, the cleaners and the kid in the print room.
The standard for what you need to support an administrative determination here is "substantial evidence", which is less than a preponderance of the evidence -- that is, when a court reviews an administrative determination, the court lets the determination stand even if, on the evidence presented, the court thinks it's more likely than not that the agency is wrong, if there's some respectable amount of evidence in favor of the agency's determination.
The UK standard for market abuse enforcement is (or rather has been - there are changes in motion right now) the balance of probabilities.
the kid in the print room
But he can steal all the banknotes.
219: that's OK, it counts as quantitative easing.
What if he draws a mustache on Jane Austen.
Technical point, but LB is talking about the standard of review for the reviewing court. The administrative body still finds by a preponderance of the evidence, the reviewing court is then largely bound to the administrative body on a substantial evidence standard.
Anyhow, that's an interesting question in the abstract but not very relevant to financial industry regulation in the US (many professionals aren't licensed, for those who are the licensing body is industry controlled and kind of a joke. Of course injustice can happen in any individual case but it's not even close to a societal problem. And I understood the story of DSquared's friend to be that the administrative body brought no charge, but the reputational harm of the investigation hurt his livelihood.
And I understood the story of DSquared's friend to be that the administrative body brought no charge, but the reputational harm of the investigation hurt his livelihood.
I think that's right, but again, that can be a very significant injury. You could probably find someone in a position like d-squared's friend where I would both think that the investigating authority had done absolutely nothing wrong, but I would be powerfully sympathetic to the friend as having been severely injured without any strong evidence of wrongdoing.
The administrative body still finds by a preponderance of the evidence, the reviewing court is then largely bound to the administrative body on a substantial evidence standard.
This is right in substance, but you wouldn't put it in those words in NYS. Obviously, the finder of fact isn't going to make a determination that they think is wrong, which is meaningfully equivalent to 'a preponderance of the evidence'. But there's no stage at which anyone would look at a determination and question whether a preponderance of the evidence standard had been correctly applied -- there's no context where you'd use those words or that standard.
Well, we'd have to know more a lot more detail to know what happened. It sounded like there was plausible evidence that the guy might have been part of an insider trading ring, but then the administrative body investigated and concluded that this wasn't the case, and didn't pursue the matter. Doesn't prima facie sound like a huge injustice on the part of the regulators, though it's obviously unfortunate if you're totally innocent but it looks like you might be plausibly connected to an insider trading ring.
225 to 223 -- and I should say it sounds like we agree. I have no problem with personal sympathy, just with using the example to suggest that the wrongful persecution of the bankers is upon us.
Here's an article I found on the prosecution, which certainly doesn't make it sound like some kind of overaggressive governmental overreach. But who knows without more detail.
Technical point, but LB is talking about the standard of review for the reviewing court.
Yes, it's the same here. The balance of probabilities test is used by the Upper Tribunal when reviewing FCA enforcement decisions.
