Saturday, August 9, 2014

Do Quora users actually have brains at all?

Right now I'm somewhat ashamed to admit it, but I have an account on Quora. Every week (or so--I don't pay very close attention) they send me an email digest of popular questions and answers. It might be an exaggeration (but if so, only a fairly small one) to say I was shocked by the question and answer that were most highly featured in their most recent email.

The question was: "Why do Americans seem to be so scared of a European/Canadian style of healthcare system?" The top-voted answer (at least as I read this) is: "In a word - fear" (yes, I cut and pasted that--if you think I must be making this up, I'd consider that entirely forgivable). Now, it's true that the author does go into more about detail about what he thinks drives that fear, but "fear" is what he gives as the actual answer. So, "Why do Americans seem to be so scared" is answered with "fear", and (at least as I write this) that has received literally thousands of up-votes.

Unfortunately, the "answer" goes downhill from there. The author (a "Dan Munro", who gives an unsupported claim of "knows some healthcare stuff"). He gives four supposed reasons for his claim of "fear":

  1. A false assumption (with big political support) that a system based on universal coverage is the same thing as a single payer system.
  2. A fear of "rationing" - which was set ablaze by Sarah Palin and her cavalier remarks about "death panels."
  3. An attitude and culture of what's loosely known as American Exceptionalism.
  4. A fierce independence that has a really dark side (which he goes on to explain as an attitude that when/if anybody "fails", it's considered their own fault).

To put it simply, I've yet to see any real support for any of these. The only one that seems to have even the slightest basis in reality is the second. It us true that a few (Sarah Palin being the most obvious) have tried to generate fear on this basis. It may even be true that it has succeeded in at least some tiny number of cases. The vast majority of people who oppose (further) government regulation of healthcare, however, seem to find it nearly laughable.

The most ridiculous, by far, is the claim of "American Exceptionalism". While frequently advanced (relative to an almost surprising range of subjects), this seems to be a pure straw-man at least with respect to this question. I have quite literally never heard anybody dismiss an argument on the basis that "it came from Canada, Europe, or outside the US in general, and we can't possibly learn anything from 'them'." At least in my experience, it simply doesn't happen. I obviously can't possibly know exactly what every single person in the US believes or feels, but I've yet to see or hear anything that gives even the slightest shred of support for this particular belief.

He then goes on to quote some of the usual statistics about how much of the US GDP is spent on healthcare, and a study about deaths from preventable medical errors in US hospitals.

Unfortunately, the numbers he quotes (210,000 to 440,000 annually) seem to be open to a great deal of question. Depending on which study you prefer to trust, the number is might be as low as 32,500 annually (and no other study I can find gives a number any higher than about 100,000 annually). Despite this, the largest number he can find is quoted as if it were an absolute fact that's not open to any question at all.

Worse, however, is a much simpler fact: he makes no attempt at comparing this result to the numbers for other countries, and (perhaps worst of all) he makes absolutely no attempt at telling us how the change(s) he apparently advocates would improve this in any way. So, even if we assume he's gotten the factual part right, we have absolutely *no* reason to believe any particular plan will improve it in any way.

Although I can't claim to speak for the US in general (or anybody else at all) in this regard, that leads directly toward a large part of the reason I have personally found it impossible to generate any enthusiasm for the plans that have been advanced to change healthcare in the US.

The usual argument seems to run something like this. The advocate starts by pointing to US citizens paying far more than others for healthcare, and having shorter average life spans. He then uses that to support his claim that we need to pass some particular health care plan he supports.

Unfortunately, nobody making such arguments seems to (even try to) "connecting the dots" to show exactly how or why *their* plan will improve the problems they ascribe to the current system. Virtually none can provide any real breakdown of US healthcare costs vs. costs elsewhere, to indicate exactly what is driving the higher costs in the US. Absolutely none (that I've seen) takes any next step toward showing how their plan will fix those problems.

When I've participated in a discussion, it usually runs like this:
Them: Our current system is broken. We need to pass bill X to fix it.
Me: What will X fix, and how will it fix it?
Them: Didn't you listen? It's really broken!
Me: Okay. What will X fix and how will it fix it?
Them: I'm telling you, it's seriously broken!
Me: Yes, I hear that. Now, can you tell me what X will fix and how it will fix it?
Them: [usually starting to get pretty loud by now] Damn it! What will it take to get it through your head that it's broken? Are you a complete idiot?

This seems to go on about as long as I'm willing to participate. I've yet to hear a single advocate of a single system actually answer a single real question about what it will fix, how it will fix it, what costs will be reduced, how much they will be reduced, etc. No matter how often you ask, even about relatively simple details of any proposed program, nobody seems to have a single answer about what they think it will accomplish, not to mention providing any reason for me to believe that it really will accomplish that.

If you'll forgive a (mildly) medically-oriented metaphor, Quora seems to be infected with a similar culture. Questions pre-suppose a given answer (in this case, that resistance to changes in health-care stems from fear rather than things like lack of information). This is certainly far from the only answer that seems to do little beyond echoing back the question, with only straw man arguments to support it, then a rather disjointed attempt at denigrating what the author dislikes, without even an attempt at claiming that his "solution" would really fix the supposed problem(s) he cites, not to mention actually providing anything similar to real evidence that of improvement.

So yes, although Quora users undoubtedly do have brains, it certainly appears to me that failure to actually put them to use is somewhere between common and rampant.

Considering questions more specifically about health care: I, for one, am fairly open to the possibility of reforming how healthcare is run in the US. So far, however, I've yet to hear anybody advance a coherent, understandable argument in favor of any proposed plan. Most simply seem convinced that the current system is *so* badly broken that absolutely any change would have to be an improvement. Even the slightest study of history, however, indicates that there is no such thing as a situation so bad that it really can't get worse.


  1. "The only one that seems to have even the slightest basis in reality is the second." : D They do not need to:


    Good reading on SO too. Thanks!

  2. Jerry, really, they have to pass it to know whats in it? Didn't you know that? Sorry, a little dark humor about our seriously criminally corrupt government.