Compared to doctors in Germany, doctors in the US spend a lot more of their time dealing with billing issues. If you ask the average person about whether it’s a problem that US doctors spend so much time on billing issues instead of patient care, if they are a bit informed about how the system works, they will likely tell you that the would prefer that the system works in a way where doctors have to spend less time on billing issues.
After the first Trump administration passed a law allowing drugs without FDA approval being given out under compassionate care, the FDA didn’t like it. They communicated that in a way that got the drug companies not to give out drugs under compassionate care. I think you can call that fear of government violence.
I think there’s probably plenty of things that go on in healthcare setting because someone says: “This doesn’t really make sense, but if we don’t do it we get problems with government regulation. And of course a bunch of other agents like insurance companies or malpractice lawyers that add complexity.”
I think you’re still talking about something different from government workers taking bribes and working with the mob. The Department of Making It Hard to Approve Drugs making it hard to approve drugs because they, like a majority of citizens in this country, think it should be hard to approve drugs is a problem but not the same problem as corruption.
The public is too uneducated to know better. Even many in the FDA are too uneducated to know better because they are insufficiently interdisciplinary.
The question is: how should the handful of smart and good people react to this state of affairs?
I say: high level operatives within medical bureaucracies should understand the price theory of economics, the germ theory of disease, and have a working definition of jurisprudentialintegrity. If asked to do evil, they should educate in a face saving way, then disagree pointedly if that doesn’t work, then remonstrate, and, at length, they should resign and blow a whistle.
Narrowly, if they weren’t just good bureaucrats but good medical bureaucrats, and they understood Koch’s Postulates and the real telos of public health systems, they would understand that Racism is not a disease with transmissible causative infectious agent that can be grown in a petrie dish and then physically put into a person to cause the person to “become Racist” somehow… and so they would never say things like “racism is a public health crisis”.
Regarding the correct name for the mobsters that BAD bureaucrats might eventually go to work for (until law enforcement properly cleans up a group of bad actors, investigating, prosecuting, and convicting some people people (who should generally get the presumption of innocence (at least by non-investigators, and non-DAs, prior to a procedurally correct conviction))) “a mobster” will often be called something like “the CEO of the City’s Sanitation Company who some allege has ties to organized crime” or some such. De facto.
Ideally, “oligarch” might be better than “mobster” since it intrinsically connotes venality (the pursuit of money for personal uses up to or past lines of propriety) and indicates the properness of “a general sense of suspicion by default” by normal people. Very few people are oligarchs, and oligarchs are weirdly powerful.
I think that a properly ordered society would contain some oligarchs, but only as one small part of a free society, with free markets, where the accumulation of personal wealth in hypothetically morally valid ways is a presumptive goal for the society. “The pursuit of happiness” and “the common wealth” are positive goods, and oligarchs are winning at that (insofar as wealth can cause happiness, which seems to be the case).
There can be good oligarchs (who commit no major fraud while vigorously pursuing validly selfish private benefit), and bad oligarchs (who violate just laws and/or coherent morality as they accumulate enormous wealth)… but also, having outright oligarchs run an essential bureaucracy (whose internal procedures inherently require jurisprudentialintegrity in its day to day administration) would sort of obviously be insane.
Yay for good oligarchs! But boo for bad oligarchs! And boo to the idea of appointing or electing any oligarchs as judges or public benefit administrators or bureaucrats who are funded by taxes (and often empowered to investigate and prosecute criminals).
If asked to do evil, they should educate in a face saving way,… Broadly, they have a duty to correct the public, and elected officials, and anyone who is actually wrong… or at least they have a duty to not enthusiastically conform to the public’s stupid, and self-harming, and commercial-propaganda-based opinions
If asked to do evil, they should do evil. Because I don’t trust the judgment of bureaucrats to decide what is evil, and we’d be better off with them following what elected officials tell them to do and not deciding to become a shadow government that slow walks everything they don’t like. This is where you get the deep state from.
You yourself mentioned claiming that racism is a public health problem. But consider how “evil” goes with racism. Failure to do something about racism is evil—in fact to some people it’s one of the worst evils possible. Calling racism a public health problem is an example of bureaucrats seeing evil and deciding that they just have to fight the evil by any means necessary.
If a officer (serving as a trusted component in a coherent social machine serving an important telos) doesn’t resign when their deontics are violated, then why the fuck were they even trusted with such power in the first place? Someone has to be the grownup. You can’t have “nothing but idiots and children” if you want good things to happen, on purpose, at scale, with high efficiency. The worst possible outcome is for actively bad things to happen, on purpose, at scale, with high efficiency.
I could write a long response, about “conventional morality that runs on vibes and makes sense to consumers of governance” vs “post-conventional morality that runs on logic and is necessary for producers of governance” but the succinct response is: you left out the MOST IMPORTANT PART of the instructions, which was to resign if the early steps of Saying No To Evil don’t work.
Given the context here (you voted to 0 so far, and me prone to writing too much) I’ve DMed you with a few more words, that might be specifically helpful <3
The Department of Making It Hard to Approve Drugs making it hard to approve drugs because they, like a majority of citizens in this country, think it should be hard to approve drugs is a problem but not the same problem as corruption.
That’s not what I said.
Punishing companies for using explicitly legally available methods to give out drugs according to compassionate use is not the same thing as generally making it easy or hard to approve drugs.
The FDA did try to coerce companies not to do what congress and the president wanted companies to do by passing the compassionate use exception. That’s distinct from the general question of whether drugs should be hard or easy to approve. It’s not working with the mob, but it’s an agency intentionally working against the democratically legitimized institutions of congress and the presidency.
Compared to doctors in Germany, doctors in the US spend a lot more of their time dealing with billing issues. If you ask the average person about whether it’s a problem that US doctors spend so much time on billing issues instead of patient care, if they are a bit informed about how the system works, they will likely tell you that the would prefer that the system works in a way where doctors have to spend less time on billing issues.
After the first Trump administration passed a law allowing drugs without FDA approval being given out under compassionate care, the FDA didn’t like it. They communicated that in a way that got the drug companies not to give out drugs under compassionate care. I think you can call that fear of government violence.
I think there’s probably plenty of things that go on in healthcare setting because someone says: “This doesn’t really make sense, but if we don’t do it we get problems with government regulation. And of course a bunch of other agents like insurance companies or malpractice lawyers that add complexity.”
I think you’re still talking about something different from government workers taking bribes and working with the mob. The Department of Making It Hard to Approve Drugs making it hard to approve drugs because they, like a majority of citizens in this country, think it should be hard to approve drugs is a problem but not the same problem as corruption.
The public is too uneducated to know better. Even many in the FDA are too uneducated to know better because they are insufficiently interdisciplinary.
The question is: how should the handful of smart and good people react to this state of affairs?
I say: high level operatives within medical bureaucracies should understand the price theory of economics, the germ theory of disease, and have a working definition of jurisprudential integrity. If asked to do evil, they should educate in a face saving way, then disagree pointedly if that doesn’t work, then remonstrate, and, at length, they should resign and blow a whistle.
Broadly, they have a duty to correct the public, and elected officials, and anyone who is actually wrong… or at least they have a duty to not enthusiastically conform to the public’s stupid, and self-harming, and commercial-propaganda-based opinions in a totally blind and stupid way, and the opposite of their duty would involve going to work, later, for the mobsters, as political lobbyists for those mobsters.
Narrowly, if they weren’t just good bureaucrats but good medical bureaucrats, and they understood Koch’s Postulates and the real telos of public health systems, they would understand that Racism is not a disease with transmissible causative infectious agent that can be grown in a petrie dish and then physically put into a person to cause the person to “become Racist” somehow… and so they would never say things like “racism is a public health crisis”.
Regarding the correct name for the mobsters that BAD bureaucrats might eventually go to work for (until law enforcement properly cleans up a group of bad actors, investigating, prosecuting, and convicting some people people (who should generally get the presumption of innocence (at least by non-investigators, and non-DAs, prior to a procedurally correct conviction))) “a mobster” will often be called something like “the CEO of the City’s Sanitation Company who some allege has ties to organized crime” or some such. De facto.
Ideally, “oligarch” might be better than “mobster” since it intrinsically connotes venality (the pursuit of money for personal uses up to or past lines of propriety) and indicates the properness of “a general sense of suspicion by default” by normal people. Very few people are oligarchs, and oligarchs are weirdly powerful.
I think that a properly ordered society would contain some oligarchs, but only as one small part of a free society, with free markets, where the accumulation of personal wealth in hypothetically morally valid ways is a presumptive goal for the society. “The pursuit of happiness” and “the common wealth” are positive goods, and oligarchs are winning at that (insofar as wealth can cause happiness, which seems to be the case).
There can be good oligarchs (who commit no major fraud while vigorously pursuing validly selfish private benefit), and bad oligarchs (who violate just laws and/or coherent morality as they accumulate enormous wealth)… but also, having outright oligarchs run an essential bureaucracy (whose internal procedures inherently require jurisprudential integrity in its day to day administration) would sort of obviously be insane.
Yay for good oligarchs! But boo for bad oligarchs! And boo to the idea of appointing or electing any oligarchs as judges or public benefit administrators or bureaucrats who are funded by taxes (and often empowered to investigate and prosecute criminals).
If asked to do evil, they should do evil. Because I don’t trust the judgment of bureaucrats to decide what is evil, and we’d be better off with them following what elected officials tell them to do and not deciding to become a shadow government that slow walks everything they don’t like. This is where you get the deep state from.
You yourself mentioned claiming that racism is a public health problem. But consider how “evil” goes with racism. Failure to do something about racism is evil—in fact to some people it’s one of the worst evils possible. Calling racism a public health problem is an example of bureaucrats seeing evil and deciding that they just have to fight the evil by any means necessary.
If a officer (serving as a trusted component in a coherent social machine serving an important telos) doesn’t resign when their deontics are violated, then why the fuck were they even trusted with such power in the first place? Someone has to be the grownup. You can’t have “nothing but idiots and children” if you want good things to happen, on purpose, at scale, with high efficiency. The worst possible outcome is for actively bad things to happen, on purpose, at scale, with high efficiency.
I could write a long response, about “conventional morality that runs on vibes and makes sense to consumers of governance” vs “post-conventional morality that runs on logic and is necessary for producers of governance” but the succinct response is: you left out the MOST IMPORTANT PART of the instructions, which was to resign if the early steps of Saying No To Evil don’t work.
Given the context here (you voted to 0 so far, and me prone to writing too much) I’ve DMed you with a few more words, that might be specifically helpful <3
That’s not what I said.
Punishing companies for using explicitly legally available methods to give out drugs according to compassionate use is not the same thing as generally making it easy or hard to approve drugs.
The FDA did try to coerce companies not to do what congress and the president wanted companies to do by passing the compassionate use exception. That’s distinct from the general question of whether drugs should be hard or easy to approve. It’s not working with the mob, but it’s an agency intentionally working against the democratically legitimized institutions of congress and the presidency.