…if we're around someone who's "higher" than us on a dimension that matters (e.g., wealth, looks, personality), the degree to which we feel good or bad about it depends (in whole or part!) on whether we feel we have what it takes to get where they are.   
      
      
        
        
      
      
      
     
  
  
    
  
  
    
    
    
    
      
        …what one considers fair or equitable is partly based on whether a person’s allotment is deserved - that is, earned by virtue of personal qualities or actions. Deservingness isn't just about what a person is or does, though. It's also about the broader social and economic context: the rules of the game that dictate which qualities or actions are rewarded.   
      
      
        
        
      
      
      
     
  
  
    
  
  
    
    
    
    
      
        I care about outcomes, not motivation. Greed is good as long as greed delivers.  
      
      
        
        
      
      
      
     
  
  
    
  
  
    
    
    
    
      
        But the California system uses a rigid, top-down approach that disincentivizes labor-saving innovations in nursing care. That's because California hospitals would still be stuck with the same minimum RN:patient ratios even if ways were found to reduce time spent on some nursing tasks (e.g., documentation).    
      
      
        
        
      
      
      
     
  
  
    
  
  
    
    
    
    
      
        It looks like job stress has gone up a bit over the years, while work hours and satisfaction with work load and level of RN staff levels haven't changed much since the implementation of AB 394. Kinda disappointing when you think of the added expense of all those extra RNs and RN hours. This is not at all to say that nurses haven't benefited from the implementation of strict staffing ratios. It just doesn't look like the benefit has been all that great. And then you've got to ask if it's worth it. Because there are costs to these extra costs.
      
      
        
        
      
      
      
     
  
  
    
  
  
    
    
    
    
      
        “The basic takeaway from the analysis was that there is variation in quality from hospital to hospital, but that variation it is not correlated with for-profit status.” Maybe For-Profit Hospitals Aren't So Bad, Harvard.edu Blog  
      
      
        
        
      
      
      
     
  
  
    
  
  
    
    
    
    
      
        US healthcare spending is almost twice that of the other developed countries. Pharmaceuticals and medical goods (e.g., medical supplies and devices) are a relatively small part of that difference. If we knocked off, say, $200 a year in drugs and medical goods, we'd hardly make a dent in overall US healthcare spending – which is approaching a per capita average of $10,000 a year.   
      
      
        
        
      
      
      
     
  
  
    
  
  
    
    
    
    
      
        First we've got to get a handle on what the US actually spends on healthcare. According to the  Centers for Medicare & Medicaid Services (National Health Expenditures 2016 Highlights - CMS.gov), US healthcare spending reached $3.3 trillion in 2016, or $10,348 per person. That represents 17.9% of the gross domestic product (GDP).   For comparison, the “Comparable Rich Country” average for healthcare spending was $5169 per person in 2016 (10-12% of GDP, depending on the specific country).  
      
      
        
        
      
      
      
     
  
  
    
  
  
    
    
    
    
      
        Problems are problems because they conflict with desired outcomes.  Exploring a problem space may start with the desired outcome (universal but affordable health care!) or with a "problem-alert": the sense that something is wrong.  Part of exploring a problem space is refining, clarifying, or figuring out what the desired outcome is. Part of that process is refining, clarifying, or figuring out what the actual problem is.  
      
      
        
        
      
      
      
     
  
  
    
  
  
    
    
    
    
      
        There are things I care about… I want the biosphere to survive, relatively intact. I want every human to have a home… The list goes on. There's no way to justify the list. No first principles that can withstand scrutiny.  
      
      
        
        
      
      
      
     
  
  
    
  
  
    
    
    
    
      
        ...ideologues tend to exaggerate societal problems, the better to justify their Big Solution. Big Solutions need to be justified when they require painful sacrifice (the darkness before the dawn), as they often do. That pain had better be worth it. Hence: Big Solutions need Big Problems. 
      
      
        
        
      
      
      
     
  
  
    
  
  
    
    
    
    
      
        Even when we think we're doing the right thing as an "end-in-itself", there is an implicit assumption that the world will turn out better (at least in the "long term") if we simply focused on the action itself, consequences be damned. Basically, it's a heuristic that resolves a lot of ethical dilemmas. We need heuristics because life is complicated; we can't think through everything. 
      
      
        
        
      
      
      
     
  
  
    
  
  
    
    
    
    
      
        On second thought, all research is desire-driven. Because behavior is necessarily goal-driven and you don't have goals without wanting something to happen and wanting is desire and doing science is a behavior. But some desires are more conducive to scientific progress than others. Like the desire for reality not to make fools of us. 
      
      
        
        
      
      
      
     
  
  
    
  
  
    
    
    
    
      
        Suppression of alternative points of view is immoral, because it prevents movement towards a better understanding of the truth. Species evolve through competing variations within changing environments. Nothing works for long (except for crocodiles). 
      
      
        
        
      
      
      
     
  
  
    
  
  
    
    
    
    
      
        A moral emotion wants something to happen. What if the things it wants to happen are in a zero-sum relationship with each other? More of this means less of that and both this and that are Moral Goods. But you can’t have the optimal amount of both. You gotta choose! (And keep choosing, because time doesn't stop and stuff keeps happening).
      
      
        
        
      
      
      
     
  
  
    
  
  
    
    
    
    
      
        ...you insist on seeing things as binaries rather than continua. Either this or that, e.g., save the environment or help business; serve the rich or help the poor. 
      
      
        
        
      
      
      
     
  
  
    
  
  
    
    
    
    
      
        ...feminism helped some women advance to positions supervising men, which in the bad ol' days was rarely tolerated, whether at fast food restaurants or accounting firms.
      
      
        
        
      
      
      
     
  
  
    
  
  
    
    
    
    
      
        Moderates are often considered weak versions of the Real Thing - people who lack strong convictions, who don't want to rock the boat. 
      
      
        
        
      
      
      
     
  
  
    
  
  
    
    
    
    
      
        ...they’re better at constructing elaborate ideologies around their dumb ideas and more likely to achieve positions of power, allowing them to impose these dumb ideas on others. See, for instance...
      
      
        
        
      
      
      
     
  
  
    
  
  
    
    
    
    
      
        Unfortunately, in this era of media fragmentation we see the exact opposite with groups collecting themselves into silos while simultaneously insulting anyone who doesn’t hew to their exact world-view. A Chemist in Langley Posted on April 29, 2017