from Hacker News

Education and Healthcare Suck for the Same Reasons

by ChaitanyaSai on 12/1/24, 4:13 AM with 115 comments

• by intended on 12/1/24, 7:27 AM

  0) Metrics sure as heck aren’t the issue, because we already have metrics which tell us what to do. There are entire basic fields of economics, sociology and math which have told us how to order these industries to get better outcomes. Since the Scottish widows fund.

  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.

• by gsf_emergency on 12/1/24, 5:03 AM

  >"The way forward lies in open-source initiatives, crowdfunded projects, and collaborative efforts that prioritize human outcomes over institutional metrics."

  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

• by donatj on 12/1/24, 5:04 AM

  I have talked about it here a couple times before but my last couple doctors have generally spent more time typing than talking to me. They've become more stenographer than physician. I have lamented how the need for record keeping has seemingly interfered with actual … listening and empathy. They're just typing away on the computer, and I have even had one Google my symptoms and pull up WebMD.

  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.

• by tptacek on 12/1/24, 5:09 AM

  I wish singleminded focus on measurable outcomes was the problem we have with US healthcare.

• by whaaaaat on 12/1/24, 6:04 AM

  The giant, terrible, AI generated header image isn't doing anything to support the page. IMO, either hire an artist for a sketch or remove the image.

  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.

• by __MatrixMan__ on 12/1/24, 5:12 AM

  I think a lot of these harms could be mitigated by involving practitioners in metric selection. Let the staff pick a metric to focus on this quarter. Next quarter pick a different one. It's optimizing for the same number for ages which leads to the myopia, so lets find a balance re: how fresh we keep them.

• by debacle on 12/1/24, 5:25 AM

  I was being very nitpicky about the ideas shared here before I remembered that BetterSchooling is not a US institution, and so is not talking about US problems. In the US, only the title mostly applies.

• by nine_zeros on 12/1/24, 5:31 AM

  How about a quality and happy customer metric?

  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.

• by hehbot on 12/1/24, 5:25 AM

  The article isn't wrong, but mostly reads as one big truism. Until we have an actionable alternative to metrics-based systems, they are here to stay.

• by Jhyrachy on 12/1/24, 1:13 PM

  I'm a surgeon; healthcare sucks because people have unrealistic expectation of what it's actually possible and politicians have no interests in defending healthcare workers but they actually double down bashing on them every chance they get.

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

• by anothernewdude on 12/1/24, 5:50 AM

  Because private alternatives exist, and therefore the wealthy and powerful have no reason to make public education or healthcare work. (Except for long-sighted views that they seem to lack, possibly because their education is also pretty bad.)

• by huijzer on 12/1/24, 10:57 AM

  > The Tyranny of Metrics

  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.

• by zharknado on 12/1/24, 5:25 AM

  Fwiw early childhood education (pre-k) is a slam dunk, one of the highest ROÍ investments a society can make in its people. Yes it can be studied longitudinally and it does make a marked difference.

• by entropyneur on 12/1/24, 9:32 AM

  Not really. Education sucks because it doesn't scale. Every single child needs to be educated and educating them takes thousands (or tens of thousands) of hours of teacher work. Meanwhile an average person probably requires only tens of hours of doctor work in teir lifetime. Imagine doctors having to treat people by a roomful (even if they were pre-sorted by vaguely similar diagnosis). That would suck indeed.

• by nutanc on 12/1/24, 8:32 AM

  I think it all boils down to goals. If we need a standard health care and standard education, we will need standardization. If we need to handle special personal cases, we need special treatment. Things can be improved, but frankly I am amazed at how process oriented our education and health care has become.

  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 :)

• by throwaway14356 on 12/1/24, 6:07 AM

  didn't give it much thought but couldn't you eventually run schools and universities on a percentage of student income tax (and remove all other sources) combined with a periodic questionnaire (for life) how [?????] one thinks their education was.

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

• by arp242 on 12/1/24, 8:42 AM

  > Both healthcare and education faced similar pressures in the 20th century. As knowledge expanded exponentially, systems needed to scale up to serve more people. The solution? Standardization. Create protocols, establish benchmarks, develop universal procedures. It worked – sort of.

  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.

• by rsoto2 on 12/1/24, 5:14 AM

  There's always some dumb "futuristic" education/health solution when countless of countries do it better than the USA in both of these and they didn't have some big tech douchebag running the show. FUND education. Elect people that care about community and education not profits and reducing taxes for the rich(majority of both Rs and Ds)

  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.

• by jmye on 12/1/24, 5:39 PM

  I’m so tired of people who don’t know anything about healthcare opining confidently about 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.

• by low_tech_love on 12/1/24, 7:30 AM

  Honest question: do you think this article would be worse off without that horrendous image at the start? In other words, was it necessary for the author to add a horror-movie drawing of a hellish hospital within a distorted reality full of misshapen demons in order to make their point?

• by cyberax on 12/1/24, 5:31 AM

  > Take ApniPathshala, for instance – they're creating learning pods where children can engage in truly self-directed learning

  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"

• by sorrythanks on 12/1/24, 11:32 AM

  kill all quants

• by shermantanktop on 12/1/24, 5:06 AM

  If I never hear a manager utter “if you can’t measure it, you can’t manage it” again, it’ll be too soon.

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

• by aboardRat4 on 12/1/24, 8:26 AM

  >Return to First Principles We must reconnect with the fundamental purpose of these institutions.

  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".