If we're going to talk about how to "scale care" and how not to, then Buurtzorg has to be mentioned[0][1]. It's a Dutch home-care company that was started by nurses who basically got frustrated that managers got in the way of them doing their job. It operates by having a flat organization working with small teams of highly trained nurses, and trusting them to make the right decisions. The result is a low-cost provider of high-quality health-care.
So when the author says care "doesn't scale", they obviously mean "you need a one-to-one ratio of caretakers", which I fully agree with. But what they're also accidentally doing in the process is explaining why creating bigger teams with bigger hierarchies and structures does not appear to increase the efficiency of care.
Some projects do need big teams with hierarchies - even in healthcare. Effectively responding to a pandemic comes to mind. I suspect it's when the core problem to tackle most naturally breaks down like a tree - a hierarchy then mirrors the way the problem breaks down. For some projects, like general homecare, the efficiency sweet spot is a flat structure of autonomous individual teams, because it doesn't scale beyond those teams anyway.
And just like the author concludes, I find that there's something comforting about that.
Thanks for elaborating further what we mean by "scaling".
Couldn't it be said that when organization acquire ranks, it is to solve coordination problems that arise with scale but that in this case, there isn't much that is solved by more organization ?
There's also a different kind of coordination problem.
The incentives of an organization - or at least of a corporation - are to make money and to continue to exist and to enrich and empower the people who control it. But employees' incentives are usually pretty different. Nurses usually get into nursing because they, at least to some extent, want to help people. Engineers get into engineering because they, at least to some extent, want to build something really good. Teachers get into teaching because they want kids to learn. And so on.
If you're the principal of a school, and your goal is for a teacher to teach, you don't have a coordination problem. Most teachers want to do that. But if your goal is for teachers to maximize standardized test scores, or to minimize the number of frustrated parent calls, etc, you do have a coordination problem, because your goals are misaligned with your employees'.
If you're the CEO of a tech company, and your goal is for your engineers to build good software, you don't have a coordination problem. Your engineers want to do that. But if your goal is to maximize conversions, or to ship faster, or to raise money, etc., you do have a coordination problem.
If you run a hospital, and your goal is for your nurses to care for patients, you don't have a coordination problem. But if your goal is to maximize profits, then you do.
It's usually these kinds of coordination problems that managers are, effectively, in charge of enforcing. Their job is not to help individual employees achieve individual employees' collective goals, it's to make employees feel (sometimes truthfully) like their goals are aligned with the organizational goals, or to use the threat of loss of income or work to force them into line.
This is not true, I can confidently say, most of the time. Engineers generally want to build software they think is a good trade off between fulfilling the spec and not being too hard to build.
This does not generally translate to good software. It’s not a detriment of character or anything like that. They’re just lazy like most people are
Classically people got into software engineering because they liked writing code and they needed a way to pay the bills. Plenty of retired software engineers still code because it is part of who they are.
Most software engineers especially now are definitively not plucky kids who just love computers. They are in it entirely for the money. It's a completely different kind of person, the motivation comes from a completely different place.
A company should be able to build working software even without good engineers. Just like how TCP can deliver ordered packets over unreliable connections - you change the processes and systems to do it. Of course, you give up some things - such as speed and agility in that case.
For most people, a job is a job. It's not something they want to dedicate their life to - that's for artists and craftsman, and not many people are of that ilk in the modern day.
When I graduated (2006) it was still mostly that way, a few kids in it for the money tried to get a CS degree and failed out and changed majors.
Most of the people I've had the pleasure of working with have a love for the craft.
Sadly I understand that with how messed to the economy is now days, making a good living in a US costal city doing anything else but software is rather unrealistic...
I'm generalizing, obviously, but I think most engineers would rather not build horribly tech-debt-y things all else equal. Yes, there are some business-minded engineers, but just looking at my own data set of job seekers, people seeking code quality far outnumber people seeking rapid product iteration.
If you're focused on teaching, building or caring instead of test scores, conversions and profits, you're going to lose customers and opportunities.
Parents choose schools with better test scores, not schools with better teaching. Customers use products with better conversions; this is literally what the word "conversions" means.
If you focus on making your employees happy instead of making your customers happy, you'll quickly find that your employees have no more customers to serve. You will be outcompeted by other companies in the great rat race.
This is why most of the companies we have now are the way they are. It's not because all CEOs are evil, it's because the non-evil ones can't survive.
> Parents choose schools with better test scores, not schools with better teaching.
Only because other signals don't exist.
Parents know test scores don't correlate perfectly with learning, but what other metric do they have to judge by?
There are some schools with a stellar reputation for learning, and they get to charge an obscene premium. Amongst private schools, the ones with the best word of mouth reputation get to charge a lot more!
Yeah, my post was not intended to be a value judgment.
Personally, I think it's somewhere in between. Yes, some degree of "actually make things people want" is an essential component of a business...but I think the amount of "required evil" is usually overblown.
If markets were so ruthlessly competitive that no one could afford to be not-evil, no one would be making a profit. Every company would be barely surviving and profits would be minimal. The fact that profits exist - indeed, are much greater than they have been in the past - means that markets are NOT that ruthlessly competitive, at least not between actors with comparable access to capital resources.
Every dollar of profit a company makes is a dollar they could afford not to make and still survive. And given that the feasibility curve of profits <> level of evil is likely pretty convex, choosing not to make $1 likely pays out many dollars of not-being-evil externalities.
The goal of "getting money" is what is the problem here. For what? To do nice things with it? Can't you do nice things in the first place? If we could agree on more than money as exchange among us, working on/in humanities would not be such a grind. The idea of "you take care of this, I take care of that" is completely lost.
That sounds about right. If you watched the video then you also will notice that the further up the management chain we go, the more abstract the goals become compared to the most concrete ones that the nurses are dealing with. One could say that if most care work starts and ends with those concrete individualized issues, the cost of handling (or worse, prioritizing) abstract goals is far greater than the benefits that they add.
Compare that to the pandemic response example I gave: that is the kind of challenge where there are concrete problems at individual, city-wide, national and international scale to tackle, and they're all interconnected too. So plenty of those coordination problems you mentioned.
Your reply seems focused on size, but this line caught my attention:
>trusting them to make the right decisions.
I'm wondering if trust isn't the real issue. For example, wouldn't a large high-trust organization be able to provide good care? Or is there something intrinsic to scale (e.g. diffusion of responsibility) that makes "high-trust" and "large organization" incompatible?
My mom is a (retired) preschool teacher. By the end of her career, she was working for a school affiliated with a large chain, and maybe 1/3 of her time was spent on filling out all the paperwork required by management. That was time she absolutely was not spending with the kids.
My dad is a (retired) doctor. Similar story there. His hospital ultimately ended up associated with a regional health care network, and the paperwork load ultimately got so bad that they ended up having to hire additional staff dedicated to help the actual health care providers fill out all the paperwork so that they could spend more time actually providing health care.
I switched primary care providers over this a few years back. I had a great doctor, but her practice got bought up by one organization, which then got bought up by another, and over time working with her office became a huge bureaucratic quagmire. I switched to a different clinic that's still local (although also chain with multiple locations), and everything's easier again.
The same thing happens at my own job, software. The bigger a company I'm at, the more of my job consists of filling out paperwork about the work I'm doing, rather than doing the actual work.
>The same thing happens at my own job, software. The bigger a company I'm at, the more of my job consists of filling out paperwork about the work I'm doing, rather than doing the actual work.
There's some irony here considering software has been promising for decades to help businesses scale information sharing.
Oh, it has. The scale at which we share information has never been greater.
Concrete example:
15, 20 years ago when we tracked user stories, the status of the sprint, etc., with sticky notes on a wall. We didn't have to record a lot of information on them because they only needed to track status at a high level. Details were communicated through conversations. That did mean that a lot of that information was tribal knowledge, but that was actually fine, because it was of ephemeral value, anyway. Once the work was done, we'd throw the sticky notes in the trash can and forget the tribal knowledge. Reporting out happened at a much higher level. We'd report status of projects in broad strokes by saying what big-picture features were done and what ones were in progress. We'd fill operations in on the changes by telling them how the behavior of the system was changing, and then let them ask questions.
Nowadays, we put it all in Jira. Jira tickets are extremely detailed. Jira tickets live forever. Jira tickets have workflow rules and templates and policies that must be complied with. Jira rules make you think about how to express what you're doing in this cookie cutter template, even when the template doesn't fit what you're actually doing. Jira boards generate reports and dashboards that tell outside stakeholders what's happening in terms of tickets and force them to ask for help understanding what it means, almost like you're giving them a list of parameters for Bézier curves when what they really wanted was a picture. Jira tickets have cross-referencing features, which creates a need to do all the manual data entry to cross-reference things. Jira tickets can be referenced from commits and pull requests, which means that understanding what changed now means clicking through all these piles of forever-information and reading all that extra documentation just to understand what "resolves ISSUE-25374" means when a simple "Fix divide-by-zero when shopping cart is empty" in the commit log would have done nicely. etc.
We communicate so much more these days. Because we can, because we have all this communication technology to facilitate all that extra communication. What we forgot is that, while computers can process information at an ever faster pace, the information processing hardware inside our skulls has remained largely unchanged.
I think that highlights the issue I'm poking at. "Good communication" doesn't just mean a firehose of information at your fingertips. It means getting the right amount of information at the right time. Developing systems like the latter is much harder than the former, but they both get the same sales pitch.
This is also where I really dislike a lot of this more recent push toward automating communication.
One person deciding what needs to be said, to whom, and when, can have a LOT of leverage in the productivity department, by reducing the time that tens or even hundreds or thousands of other people lose to coping with the fire hose.
Microsoft Copilot has been yet another downgrade in this department. Since it got adopted at my job, I've seen a lot of human-written 3-sentence updates get replaced with 3-page Copilot-generated summaries that take 10 minutes to digest instead of 10 seconds.
At my company we are aggressively rolling out policies to forbid the use of AI. I'm one of the bigger folks behind it. I just see no benefits. I have no desire to debug AI generated code, I have no desire to read pages and pages of AI generated fluff, I have no desire to look at AI generated images. Either put the work in or don't.
If you use AI like a quick answer machine, or quick example machine, they all outdo Google by a large margin.
The friction between moving between, and knitting different systems and languages together that I don't use frequently enough to be fluent, has been lowered by an order of magnitude or two. Due to small knowledge gaps getting filled the instant I need them to be.
The same with getting a basic understanding (or a basic idea) about almost anything.
My AI log documents many stupid questions. I have no inhibitions. It is a joy.
> If you use AI like a quick answer machine, or quick example machine, they all outdo Google by a large margin.
I mean, A) hallucinations still happen, and B) Google sucks anyway. I don't know of anyone at the company still using Google because we're largely an engineering outfit and all were aware as Google's search features slid into uselessness.
I find that the code I get from Copilot Chat frequently fails to do exactly what I asked, but it almost always at least hits on the portions of a library that I need to use to solve the problem, and gets me to that result much more quickly than most other ways of searching do these days.
Hallucinations (or more correctly labelled, confabulation) is a property of human beings as well. We fill in memories because they are not precise, sometimes inaccurately.
More to the point, once you know that, having a search engine for ideas that can flexibly discuss them is a tremendous and unprecedented boon.
A new tool, many (many) times better than Google ever was for many ordinary, sometimes extraordinary tasks. I don't understand the new gigantic carafe of water is half full viewpoint. Yes, it isn't perfect!? It is still incredibly useful.
> Hallucinations (or more correctly labelled, confabulation) is a property of human beings as well.
Yeah and if, when I asked a coworker about a thing, he replied with flagrantly wrong bullshit and then doubled-down when criticized, I wouldn't ask him anything after that either.
I will say I have warmed to GitHub Copilot's chat feature. It's a great way to look up information and get answers to straightforward questions. It feels similarly productive to how well just Googling for information was back in the 2010s, before Google went full content farm.
We can’t. Paperwork exists to be able to transfer knowledge and liability. It isn’t meant for you and it is mostly cost for your company. It’s for lawyers, insurers, investigators, auditors, your future replacement, etc.
Ha, no instead we're going to eventually have to have AI workers getting AI salaries and to spend on AI products. Then the AI governments and eventually AI wars...
Related: every few years someone posts "Paperwork Explosion"[0] again, and people here rediscover that there's nothing new under the sun.
> In 1967, Henson was contracted by IBM to make a film extolling the virtues of their new technology, the MT/ST, a primitive word processor. The film would explore how the MT/ST would help control the massive amount of documents generated by a typical business office. Paperwork Explosion, produced in October 1967, is a quick-cut montage of images and words illustrating the intensity and pace of modern business. Henson collaborated with Raymond Scott on the electronic sound track.
Usually the discussion quickly converges on how automation in administration is a prime example of the Jevons Paradox[2] in action.
Well, Buurtzorg is a large organization, it's just that it does not have a large hierarchy. I suspect you're really asking "high-trust" and "large hierarchy". In that case there's plenty of causes to point at. I'll just give a few of the top of my head
First, note any organization that breaks into different departments (hierarchical or not), at least partially does so to let each department "abstract" away the other ones - if you don't have to worry about issues outside of your responsibility, you can focus more on yours. That is actually a form of trust.
In the case of a hierarchy however, that means that each layer abstracts away the layers above and below, and since going up multiple levels in the hierarchy happens indirectly, the further away, the more abstract things become. So that often needs some kind of structure to regain the trust that is lost by dealing with abstract departments - leading to bureaucracy.
On top of that, usually more power resides higher up the hierarchy. That means that without explicit structures to compensate for this, people lower in the hierarchy lack individual leverage to protect themselves against bad decisions made higher up, that may not even be malicious or intentional but just a consequence of the aforementioned abstraction.
Of course, most structures that are created to fix this typically are also abstract procedures, meaning they barely help with our instinctual "I cannot attach a face to this" type of distrust. Bureaucracy can create leverage, but rarely creates trust. Which also explains that quite often, talking to someone in person can make such a difference in being allowed to "go ahead" or not. Because it can provide a more "natural" sense of trust that bureaucracy is supposed to provide but barely does.
Not OP, but orgs that scale usually rely on metrics. It's metrics that are easier to measure, not the one that measure system performance (i.e. lines of code written per day, points closed per sprint) that get selected. Then management lampoon workers for not meeting those metrics (they need to prove their doing something, and can't lose control), regardless of how the system is performing. So trust erodes.
I honestly think most orgs would leap forward considerably (with some pain) by doing a severe reduction in middle management, basically making them prove why they are actually providing value, and removing them if they aren't.
Tons and tons of middle managers do absolutely FUCK ALL in terms of delivering product, meeting goals, and serving customers.
I generally dislike middle-management as much as the next IC, but I think these types of arguments tend to ignore latent or low-probability risks.
You see this all the time in discussions about quality or safety metrics. By definition, if those teams are doing a good job you won't see many quality or safety issues, which leads people to believe they are doing "FUCK ALL" and provide little benefit. Only in hindsight, after a low-probability but high risk event happens, does getting rid of them seem like a bad idea.
You’ve never worked in middle management, have you? Just because they do largely ‘soft stuff’, mediating between different departments, teams and layers of the organisation, and (hopefully) running interference so that their team can focus unimpeded on the actual fun part of the job, doesn’t render their contribution null and void.
I’ve dealt with bad upper management, bad project management, bad clients, bad suppliers, but only rarely bad middle management. (And no, I’ve never worked in middle management although at times I’ve been some of the other categories above. :P )
Most healthcare organizations in the US are profit-oriented, sometimes to the detriment of the patients. That is why we have large, unwieldy organizations surrounding the very few people that actually do hands-on healthcare. There’s also the issue of liability – it can be pretty litigious in the US, and companies are frequently wanting to limit their liability, which means having the paperwork to back up their decisions. Unfortunately, it also means they have to restrict their decision-making to a very small matrix.
>Most healthcare organizations in the US are profit-oriented
According to the American Hospital Association, less that 20% are for-profit [1]. I'm sure all are extremely budget-conscious, but that's not the same as being profit-driven.
It seems to me that the US optimizes for quality to the detriment of cost and, more recently, access.
But also be aware that non-profit does not mean non-profit-oriented. Just that any profit goes to executives [1] instead of toward community/charity services [2].
I think there’s an error in conflating “not for profit” with “charity”. You could provide all care at cost and have zero charity care. That d doesn’t imply all “profit” goes to executives, but rather to keep reimbursed or charged costs lower.
1. Thanks for the nuanced view. I agree that zero charity care doesn't necessarily mean greedy execs.
2. In my mind keeping costs lower is a form of charity. Especially with something as frequently difficult to understand as health care costs.
3. Executives do deserve to make a fair amount for their skills and effort. I'm not sure myself what salary I consider it fair pay vs taking greedy advantage of not-for-profit status.
On your last point: I think it's useful to think in multipliers and desired outcomes.
Do you want the best doctors involved in care for patients and training juniors, or do you want them to spend time jockeying for a position in the hierarchy because that's a plausible but also the only way to 2x their income?
This doesn't fully answer the question, of course, but it suggests that large pay disparities are extremely wasteful for society as a whole.
I couldn't find the 20% in your reference, but is it talking specifically about hospitals? I can believe that only 20% of hospitals are for-profit. But, if I do a maps search for all 'healthcare organizations' within 10 miles, the vast majority are for-profit.
Also, of the groups of ambitious hustlers that I know nearby, many are looking to get into running healthcare clinics because there's so much profit to be made.
Don’t be fooled by the “non-profit” label. Many are as greedy as for-profit hospitals, except that the money goes to execs and their friends instead of shareholders.
Legally an organisation is usually exposed in relation to its scale, even if the misconduct was limited to one employee trusted to carry out work independently, the penalty will likely be related to the total size of the company.
The second is if you're scale is large enough that you are considering a significant portion of the employees with some skill in a region, you have a harder time selecting for anything other than "holds a qualification" during hiring. This leads to all sorts of policy to prevent someone with qualifications but less integrity causing issues.
I don’t think it’s that they are incompatible by definition. I think the large organization is a result of low-trust.
A trust-breaking event occurs, so a new form gets added, a compliance process is created with a new team monitoring, etc. etc. Have enough of those and you eventually get your typical, modern healthcare bureaucracy today.
I live in Switzerland and my girlfriend has been working as a doctor (surgery), and it has mostly to do with the politics that come with hierarchy. As in nearly all companies, hierarchy allows politics and favourism to enter the playing field which will attract people that do not act in the primary interest a service should have: ergo, patients.
For example you have leading doctors who prefer not to look at patients, even tho they belong to them (from a specialization point of view), as they are "cumbersome" cases. That often leads to them "ignoring" it for some time until someone else takes over, or completely delegating it to non-fit persons.
It's a huge pain for me to heard this every day, because it literally sucks out any desire to work as a doctor from my girlfriend. At the same time, it's infuriating: we pay a lot each year, and with every year more, for services like this. If I was to ever win lottery, I'd use that money to make my own hospital without all of this crap.
The other companies are also shortstaffed, all healthcare is at the moment, and the bureaucracy layers just keeps humming along ... Buurtzorg is however cheaper, and since you cannot scale the actual care that counts.
Yes, and the actual nurses also have more job satisfaction and their patients are happier too, so the quality also improves. The main explanation given for that is that compared to solutions that require a lot of time spent on administrative work, these nurses get to focus on the actual care work, and have more personal time with the patients, meaning a bond of trust can be established. Which is also an important aspect in the scaling trade-off I'd say.
Imagine if we had an openly adoptable Buurtzorg model along side open source software used for adminstration. With the power resting with the carers the non-care admin work could be collectively automated through the open source model.
I'm actually working on the software part of that, in the UK. It isn't open source yet (mostly because we can't afford the level of comfort we need about data security, given that this is very sensitive data) but that remains the intention.
But even with open-source software, there will still be the issue of how highly regulated the care industry is. There are significant variations even within the UK, and indeed, there are even inconsistencies between inspectors of the same regulator.
But below the level at which regulation kicks in, care work is—for some people—the most rewarding (not financially!) type of work and arguably will be one of the last professions to be replaced by AI (though there is plenty of work on robots).
Honestly sounds like that's Conway's law, but in reverse. Instead of a project's setup mirroring it's organization, the organization mirrors what they see as the ideal project setup. That's something that I wish more teams were willing to recognize as the best approach; Conway's law isn't necessarily something to be worked around, it's a tool.
Doesn't scale compared to what, though? Because if the comparison point is the more typical modern care-work organization where tasks are divided into a fine-grained categories of "high skill" and "low skill" work, outsourcing the "low skill" tasks to the low-trained workers as an attempt to save costs, then Buurtzorg shows that that approach is not a net savings.
Because Buurtzorg has been shown to have lower costs and higher job satisfaction than its competitors, and the reasons are quite obvious too: the hierarchical outsourcing solution adds extra communiciation costs, administration costs, and similar organizational overhead. On top of that patients are in a situation where they see many different unfamiliar care workers briefly, meaning they do not get to form a bond of trust with any one of them. That is a pretty heavy costs that I don't even know how to categorize.
> There was some pain in that realization. So many of my utopian dreams—what if we could live in a society where everyone can get the food, the housing, the healthcare, the opportunities for growth that they deserve—come from a place of wishing that we could live in a world where people are cared for.
I'd like to offer some comfort to the author on this score. Food, housing, healthcare broadly... while these are all aspects of being "cared for" by society, they aren't all care in the individual sense you describe. The food system is different from homecooked meals; the housing economy is different from the handsome breakfast nook your family DIYed into their home. We can build systems which scale and make it possible and economical for individual care to happen.
> The food system is different from homecooked meals
This is a good point, and everything I've heard from parents says that it's parents, not children, who identify home-cooked meals with care. Children notoriously prefer prepackaged industrially processed food over whole foods prepared with care and love. In order to feel cared for, all children need is to trust that the person caring for them will make sure they get enough food when they need it. Food quality has nutritional consequences down the line, and at some point a child that is fed pancakes every day will gain the ability to look back and regret how they were raised, but it doesn't prevent a child from feeling cared for in the moment.
During fine dining, a meal may consist of small portions that even when added up together total less calories than a large bag of theater popcorn which many people are quite capable of going through.
No one will argue that the popcorn taste "better".
Simply put the popcorn is less satiating but more addictive to eat.
Meanwhile the fine dining meal, if done well, will be incredibly satiating and not leave one wanting for more.
Hyper-palitability is a thing. There are foods that are hard to stop eating (e.g. potato chips), and that do not fill people up no matter the caloric content.
Starbucks frappes are another example. They can easily have over 1000 calories, barely be satiating, and yet people desire them again and again.
I hope no one claims frappes or potato chips are the best tasting foods in the world. But they are both addictive as hell to consume.
That’s something I hate about other people. They just type out comments. I prefer to trigger the control centers of my brain to cause movement of my peripheral actuators to depress buttons on a purpose built device to compose textual information for transfer across the Internet.
if you'll forgive my prior snark, some people successfully involve the children in the cooking. When this is done, the children seem to prefer the home-cooked because they are part of the cooking and they are part of the feeding/providing to others.
Don't underestimate the human desire to provide value to the tribe, it runs deep in the evolutionary make-up.
Speaking as someone who successfully involves their toddler in the kitchen: regardless of her great joy in being alllowed to participate and contribute (which you are completely right about), my daughter would still much rather prepare spaghetti for dinner than veggies.
Also, in some kind of weird benign parentification[0] twist, she now loves to feed me food, even if (or more like especially if) she doesn't like it.
So having fun with cooking food seems quite decoupled from her desire to eat it.
Pretty sure no amount of participation in cooking can make children start liking food with specific tastes, like eggplants or celery. If they like it - great! I they don't like it, but parents do - well, _that_ kind of home-cooked food will never be liked.
(Unless you process them so much, and add so many spices, that they no longer have any original taste.. but by that point they are at "pre-packaged" level of cooking)
> Children notoriously prefer prepackaged industrially processed food over whole foods prepared with care and love.
In most cases, this is probably due to the care givers training their children to prefer that kind of food because they don't make many home cooked meals.
I don't even know if it's true, though. When I was a kid, the best food in the world were the home made meals my grandmother made, especially on the holidays. Remember as a teenager telling my Grandma her meals were better than any restaurant I had ever eaten at, and meaning it in all sincerity.
Something to keep in mind is that industrial food usually has a lot of sugar and other additivies added to make it taste as good as possible. . Companies literally spend billions of dollars figuring this stuff out, of course the home made meal can't compete.
Could you please stop posting flamewar- and ideological-battle-style comments to HN? Your account has been doing it repeatedly, unfortunately, and it's not what HN is for.
Children notoriously prefer consistent meals over diverse ones, home cooked or not. The issue with serving blueberries for example is that each blueberry is different. My mother home-cooked for me a boiled egg and rice porridge every morning, and it was that consistency that associated me with care.
Yes. And child psychologists will tell you that babies and children crave consistency, variety is not their thing. In fact, one of the reasons we as parents (adults) expose them to variety is so they develop an understanding of how to cope with inconsistencies. And it's always a careful balance, small amount of variety but mostly consistency.
And I can tell you most little kids love hard boiled eggs which I suspect is because they are incredibly consistent in texture and taste, unspoiled by some cook seasoning them or cooking them differently.
Often, it's the act of preparing the meal by hand rather than pressing a button on their hypothetical Food-o-matic that makes the biggest impact. We can certainly scale the provision of needs otherwise. I agree with the author on their assertions about what it means to care and actually connect with people.
I'm not talking about food preparation, but food systems. E.g. look up the concept of a food desert. Preparing a meal by hand is one thing; having access to quality affordable ingredients is another. A food desert is what you get when the system that would enable care is deficient.
And even in a "food oasis" with adequate quality, yes, if you yourself cannot prepare a meal, or have nobody to do that for you, that's a failure of a different kind.
I tend to consider food deserts just cheap/fast transportation or personal mobility deserts seeing as they tend to "lack" a whole bunch of other things in addition to food. They lack these things not because people can't get them, but because the cost in time or money of going whatever distance one needs to go to get them makes it not worth it. Food doesn't ship well or keep well in individual use volumes so it is particularly impacted.
Although it’s theoretically possible and theoretically economical for individual care ‘to happen’, it doesn’t in practice for the housing economy. If anything it’s decreasing year by year on average.
Especially when you look at construction quality, the average quality of say new built condos in any major city has gone way way down since the 90s.
Of course on average condo designs have on average gotten fancier with quirkier architecture, and building codes have gotten more complex, so maybe it’s not due to builders caring way less, but the end result is shoddy work either way.
Edit: And the average home buyer has no method of separating out all these confounding factors, so it boils down to a single congealed mess.
About housing: I have a few ideas as to why, weirdly none of which overlap with yours.
1) I think part of it is due to our ability to fine-tune the limits. Before, if a company wanted to pass an inspection, they had to be really confident. There were going to be some expenses that in theory they could have avoided if they were better capable of measuring where the line between 'safe' and 'unsafe' was. The end result was buildings that were more safe than strictly required. But now we can get closer to the line, and so buildings are engineered at the edge of safety.
2) Of course, survival bias plays a role here. Who remembers all the crappy buildings that just vanished? It's the same reason we look at old toasters or mixers or what-have-you and say things were so much better-made in the past - all the crappy cheap toasters, mixers, and houses are gone now.
3) Also, as extreme weather has happened more frequently, areas all over are seeing weather different than what they were designed for. Given that the average temperature in Oregon in July (the hottest month of the year) was typically around 65 degrees Fahrenheit[1]. For the past few years it has generally hovered in the upper 60s. The hottest temperature ever recorded in Oregon before 2021 was 107 degrees Fahrenheit[2], and typically there were one or two days a year that crossed one hundred degrees -- occasionally five, more often none. In 2021, it hit 116 degrees. Since 2021, there has not yet been a year without 4 or more days over a hundred. And, of course, this pattern is repeated all over the world. Houses are being built for one set of extremes and averages and getting another.
1 is in large part a reflection of idiot proofing everything. Every party's judgement gets reduced down to some some quantitative stuff like wire gauges, stud spacing, etc, that even idiots with poor judgement can reliably assess. Instead of failures because people do shoddy work we instead get failures where people are dumbly building things they know won't last because it's easier to just let things be crappy than to try to get permission to deviate from the plan. Basically decision making authority is being abstracted away from the people who have actual context. This limits the screw-ups from people doing work below the minimum at the expense of preventing anyone from who would have done something better than the minimum from doing so.
Heh, I know somebody that was really annoyed their builder wouldn't install conduit since it wasn't in the code or something and their gripe was "but its better than code".
Maybe it doesn't in America. Nor here in Australia. Some European cities are showing that better is in fact possible by strongly supporting co-operative housing sectors which are better for residents. But that would break the American taboo against government intervening usefully in private markets for human rights (in this case, shelter).
Anyway, my advice to the author was that systems can enable care at scale. Not to say that our current systems do.
Edit: to be more explicit, I'm suggesting that some approaches to the housing sector in some parts of Europe amount to care that scales; society and governments have decided that housing is a right, and have enacted policies to approach that situation. Conversely, a "we don't care" approach also scales very well with the opposite outcome.
‘Society and governments’ can also ‘decide’ that the Sun is revolving around the Earth… so decisions and policies on paper cannot be fully credible by themselves…
What is the actual tangible evidence that the aforementioned issues are avoided?
Yes I did take a slightly different tangent than your build quality argument. I don't actually know whether there's been studies done about that. You've inspired me to go find out.
>We’re pretty limited when it comes to care. In any given moment, you can only really care deeply and individually for one person.
Absolutely. Society tends to assume that people are interchangeable units and that 'care' is a commodity which can be dispensed evenly as if from an industrial nozzle in a food factory. So we have 'care homes', 'daycare', 'care packages'. We are enjoined to be more 'caring'.
But the reality is that love, which is what we're really talking about, is dyadic.
i.e. between two individuals. That's how it works and how it effects its magic.
A patchwork of dyadic connections is what we may hope for and build.
Yes, it points to how hard & expensive any government attempt to backstop the traditional parental model of care actually is.
The earlier the intervention the better.. and consistency is also incredible important. But you can spend incredible amounts of money just to get a slightly worse outcome than what was going to happen on its own. As a wealthy society we must do something to help those in need, especially children who are in the situation of no fault of their own. But it's not clear our current methods work.
You can also generalize this problem to the healthcare industry as a whole. Costs go up much faster than the rest of the basket of goods & services citizens pay for, and they don't understand why.
The underlying reason is that - care doesn't scale. You are essentially (directly or indirectly) paying for someone's (doctor, nurse, etc) time. We have not gotten much better at making care more time efficient in the field, and in many cases it has gotten worse (more paperwork/electronic record entry time/etc). Everything else we buy is the product of using automation to replace labor, making labor more efficient, or making labor cheaper (offshoring / simplifying so less training is needed / etc).
> >We’re pretty limited when it comes to care. In any given moment, you can only really care deeply and individually for one person.
The evidence very strongly points the other way, IMHO:
Almost all people care deeply and individually about many others, starting with their families - spouse and children are a clear and I think irrefutable example of deep caring and love for multiple people. And for most, also siblings, parents, grandparents, and some or even many other relatives.
And outside of family is friends, co-workers, etc. Many healthcare workers care deeply (depending on the meaning) about their patients. Fundamental human empathy enables us, if we choose, to see people as individuals and care about them, even people we meet briefly on the street. I've learned to do it and I'm not superhuman.
Obviously we know people experience these things. Why is it important - to what ideology and why - to insist empathy and love is so limited.
I'm not claiming that we can only love one person, it's just that the nature of love is unique to each dyadic relationship; they're not commensurable.
Yes, I may show empathy and respect to strangers, patients or clients, trying hard to deal with them fairly and conscientiously. Well said.
But this only operates in the short term.
It doesn't mean I can love them all, or at all, or love them equally, or anything like that. That would be meaningless. We don't know what love is exactly, but it does seem to include a sustained form of attention. It provides a space in which the other person can grow.
Such attention is always specific, by its nature; it latches onto a subject, something recognised yet new in the other. It can't be served out like soup. Yet increasingly businesses, bureaucracies and government pretend that it can!
Thank you for responding! I appreciate your thoughts and that someone else is thinking about these things - me too.
As you imply, I agree that much of what we say depends on our definitions of 'love', which is undefineable. To the degree it involves time (for attention), well obviously time is limited and therefore love would be limited. But I think that's a distraction, a rationalization, a tool to win a debate but not our intent.
Love at its core is about empathy, compassion, and that social emotion called love; time is a unavoidable factor but isn't necessary - love without time would still be Love (maybe moreso). I once thought Love was limited. I was trying to come to terms with the fear and trauma of evil in the world and to protect myself from it; and much more I was trying to come to terms with the lack of love I received in my past, and to justify or rationalize the lack of love I then currently gave or was involved in.
...
As I grew, I learned some things: I learned that I was avoiding a deeply painful reality - that some very important people treated me badly, I was injured by it, and that was never going to change. For me, to rationalize the limitations of love was an attempt to justify what they did, as bizarre as that sounds, so I could believe they did love me - you see, the injuries were just the natural course of things and my fault, my shameful weakness, vulnerability and resulting needs. Neglect is worse than abuse; nothing is worse than feeling meaningless (that's why people try to befriend their abusers).
Then I learned that love is much greater. I learned from someone who loved me, who showed me.
And the rationalization trapped me - it trapped me in the limitations of those who abused and neglected me. If love was much greater than what they did then they didn't love me, I was nothing (or not much) to them, and then that empty space - that feeling of meaninglessness - and the injuries are very real and cannot be undone. I can't go back and make them love me, or make them love me now.
I had a choice: I could stay in that trap, within those limitations, or move beyond them and face the pain and emptiness. Like the coming of age stories - I could stay in my small town, in the bosom of those relationships and (imagined) love; or having a much greater vision than them, I could leave for the wide world, the big city, and accept the isolation of leaving my roots behind. And then they would never understand me again, and would certainly reject me because of it.
...
That's the choice of many of us and I can just tell you my story: I went for it. I chose to accept love not only as much greater than those people in my life, but as unlimited - I was going to try for the best possible result, knowing it might fall short.
It hasn't fallen short, amazingly. IME, it's unlimited. I can love, I believe you can love, without limit. Most powerfully, I can love myself. I can love deeply in an instant, in prospect, people who've harmed me, and those close to me no matter what they do. I'm not joking or exaggerating, though few will believe me.
It's not a fairy tale; life is very hard. The pain and trauma from my past remain, though I handle them much better. Those people from my past do reject me, actively at times. Other people and the world still do horrible things; they beat you down again and again; it feels awful, sometimes terrifying. I do bad things too, of course. Life is very hard no matter what you do - do you have a solution where those things don't happen? There's no pain? Have the emotional walls actually worked? Now I can get my bearings and rise up much stronger and better; there's an undercurrent, though sometimes faint or overwhelmed, of almost magical joy. I never feel defeated beyond the immediate experience:
One key for me is perceiving that many people, unfortunately ~97% of them it seems, don't know this secret. They do horrible things and act badly because they are, very understandably, scared, traumatized, and don't understand there is unlimited love for them and in them. The answer is not to fight them for survival, but to love them, to show them. Some think you must be a fool - in terms of their survival perspective, you are doing crazy things; in that survival game, acting with love can make you vulnerable; you may get knocked down. But that will happen at times anyway and, in my experience, people see and sense the love and very rarely, in my experience, fight you. Most of all, people follow you if you lead genuinely; if you lead with aggression and defensiveness, they'll adopt a defensive posture and fight you; lead with love and they will love.
...
Long ago I read many 'great books' - Shakespeare, Aristotle, Confucius, religious texts, etc. Recently I re-read the Gospels, the first four books of Christianity's New Testament. I'd read them back then and my memory is that on a philosophical level - ignoring the supernatural aspects here at HN - they seemed confusing and bizarre, another obscure religious text centered around submission to a supernatural king - grovel and they'll forgive you anything!
With no expectations I reread the Gospels and discovered something shocking: This lesson that changed my life today, someone knew 2,000 years ago! That's what the Gospels are about, for me; the faith in Jesus is necessary, by its internal reasoning, because that is faith in love's power (arguably; I'm not a theologist and others have their beliefs). I refer you to them not for the religious aspects, but because obviously they express these ideas very well - an influential, very popular book for 2,000 years.
Thank you mrmooss, good luck with your ongoing journey. In my experience we are hurt most when we return evil for evil, which is something that evil tries hard to get us to do.
Regarding the gospels, yes, and to my original point, in John's gospel there is "the disciple whom Jesus loved", implying that Jesus didn't love them all equally.
There was a story on HN a while ago that I can't seem to remember the title of.
It was something along the lines of "The optimal amount of slack in an organization is not zero", or something like that.
The argument was that, since it's impossible to plan for every eventuality, you need a certain amount of slack capacity in order to retain some flexibility.
And that by always using 100% capacity, we end up dysfunctional.
I think the same is true for our personal lives.
But the endless treadmill of self-optimization, side-hustles and ever more commitments leaves us unable to cope.
I think it referred to the classic efficiency vs latency tradeoff. Like when emergency vehicles are always on standby, which is inefficient, but allows them to roll out without delay. Conversely privatised rail lines squeeze out every ounce of capacity from the infrastructure resulting in delays when something, anything goes even slightly wrong.
I use this extensively when planning activities with my children. It's a fun challenge because they're both too young to tell the time, much less read, which are constraints one does not normally encounter in their work life.
I agree efficiency vs latency, but it's also "exploit vs explore" balance, work/life balance and more, leaving time for research, exploration, shooting the sh*t, decorating the office, buying christmas gifts at lunchtime, helping out co-workers etc.
I think "slack" is a much more general concept than efficiency vs latency. The slack itself allows low-latency response to emergencies but the activities that fill the slack time can be valuable in ways that often aren't legible to the org hierarchy.
It was the same problem for JIT supply chains falling apart during COVID.
It's very hard to sell slack to management and so in "well run organizations" it ends up trending towards zero. And then everyone is surprised at the resulting catastrophes.
It's pretty simple no, the model that is reasonable and antifragile is within our grasp, a model that includes degrees of error more than it reifies hewing towards 0 carrying costs. It's more the good will and good faith across the board to use that known simple math, as sneaky monkey minds in our midst see that if they defect they can win some edge in the short term (and again, a better model shows the true utility and total harmed effect) and then it's a race to the bottom and a world of basically the prisoners dilemma. Making that thinking anathema in human culture should be the focus. I don't know that a grass roots effort could out-compete existing networks of power and influence, nor that a total reset of players is possible either.
It's aligning the incentives of top management with the slightly longer term outcomes. If stock grants are based on this quarter's performance, "slack" seems much less important.
Exactly, if you get rewarded for the 5% improvements annually but are out before the once-a-decade near death experiences.. you end up with more Intels, GMs, Boeings, etc.
I can't help you with the title, but with another paragraph from that story, should you want to find it.
Paraphrasing from memory:
> When you are in a major Chinese city you may street sweepers sitting on the side walk chitchatting. The first thing you may think of it as waste that could be eliminated. But it also acts as a buffer.
hey, I hear you. Modern America is full of voices demanding you give them care/attention.
Every.
Single.
Thing.
It is overwhelming. See following comments on the need for slack/margin in capacity. Well, we also need it in emotional demands. Yet every commercially-moderated interaction in our society seems to be optimizing for making us care more about it, because that increases their revenue.
This is why I recently fell in love with libraries. It is one of the few places where ads/manipulation to part you from your money is extremely limited and the demands are so chill.
"Want to borrow a book? Ok."
"Don't want to? Ok. Whatevs."
And even analysis paralysis is overcome with: "Why not both! Borrow two whole books!"
I really resent how our collective attention has been so commoditized. Advertising lies at the core of so many of our problems, and I'm not sure how we can come back.
This is ultimately a dichotomy between having the family unit or "the state" as the central point of governance. Many totalitarian regimes looked at newborns as "belonging to the state". The result is a unified mass person who dresses, thinks and acts in predictable ways.
The more power, personal connection and influence parents have over their children, the more diverse society will become.
> Have you ever been there and met the uniform mass persons?
I was born in Eastern Europe in a society headed in this direction. I observed its transformation after the fall of the Berlin Wall.
You felt the overarching power of the state from as early as the kindergarten. Signs of individuality were suppressed and all children were supposed to do things "the right way". When such an institution decided that a child "systematically misbehaves", it was able to take the child away from its parents in another orphanage-like institution that was supposed to teach them good socialist manners. Eventually some of them would end up seriously harassed, physically-ill and sent to an anonymous grave in the backyard of that institution.
I grew up in the USSR, and in the kindergarten, our teacher actually tried to convince us that the correct 5 year old kid's answer to the question, "which person do you love the most?" ought to be Lenin, and not e.g. "mom".
That said, in practice, the quality of indoctrination was extremely variable for the same reason why it was variable for everything else - most people weren't really buying into it themselves, and so even if they were in a position where they were expected to indoctrinate, they did the bare minimum that was demanded of them, which usually wasn't very convincing. I didn't get to witness it as an adult, but according to my mother, by the time you were old enough for Komsomol, very few still had their rose-tinted glasses on.
"Care" doesn't scale. You can't just replace "the family" with some industrialized system of raising children and get the same results. Not being able to scale "care" and make it more efficient is almost tautological, really.
> Besides, what countries are you talking about?
North Korea? Former Soviet Union?
At the very least appearance of conformity was ruthlessly enforced and even private conversations were infiltrated to detect dissent.
Totalitarian regimes often uphold traditional values like family as a means of control, promoting unity and loyalty to the state-yet they’ll redefine these values whenever it suits their ideology.
That's not really true. Marxism-Leninism famously sought to abolish the family and the Soviet union performed quite a few experiments in communal rearing of children in it's early years.
The reason why totalitarian regimes end up promoting traditional values relations is that to them the only imperative superior to ideology is survival.
There is a reason the Soviet Union backed off from it's repression of religion in the middle of WW2.
> the only imperative superior to ideology is survival
I think it's more that well-meaning ideologues are easily replaced by self-serving pragmatists in post-revolutionary turmoil. There were plenty of Marxists in Russia vying for power, in the early days. Lenin didn't win based on ideological purity; he won based on political strength. And say what you will about Lenin—he did have beliefs and he did have a real ideology. Stalin only cared about Stalin, and he claimed to believe whatever was convenient for him in the moment.
Early Soviet Union did try to reshape family, but it went back on it eventually, seeing the value of the conservative family model in building social cohesion and loyalty.
Expressed differently: they tried to abolish the family, found that doing so created more problems then they solved, and backed off in order to avoid tearing their country apart.
They discovered that in some things doing nothing is better than doing something, but Westerners of all political stripes (both for or against authoritarianism) chronically make the mistake of assuming that everything that a totalitarian state does is done with some grand plan in mind rather than them just flailing about to find a centralized policy that kinda-sorta works.
Your comment reminds me a lot of modern speculation about China's grand plans. Sometimes a government chooses not to touch something because they learned from bad experience that they'll break it if they do, not because they're playing 4D chess manipulating it behind the scenes.
Bolsheviks were absolutely pushing quite radical ideas on sex, rekationships and family in the early 20s e.g. Kollontai with her Glass of water theory.
> 1918 Code on Marriage, the Family and Guardianship
> One year after the Bolsheviks took power, they ratified the 1918 Code on Marriage, the Family and Guardianship. The revolutionary jurists, led by Alexander Goikhbarg, adhered to the revolutionary principals of Marx, Engels, and Lenin when drafting the codes. Goikhbarg considered the nuclear family unit to be a necessary but transitive social arrangement that would quickly be phased out by the growing communal resources of the state and would eventually "wither away". The jurists intended for the code to provide a temporary legal framework to maintain protections for women and children until a system of total communal support could be established.
Not really, just the notion that trying to abolish family is somehow the hallmark of totalitarianism doesn’t seem like sound reasoning, and indeed it isn’t confirmed by historical examples.
I would argue that the main reason why USSR changed so spectacularly circa WW2 is because Stalin was personally very socially conservative in many ways. It wasn't just religion during WW2 - the country reverted to traditional gender roles in general in many ways, banned abortion, made homosexuality illegal again etc. Most of the early extreme experiments that really didn't work out were already long abandoned by then.
Our principal exports, all labelled and packed,
At the ends of the earth are delivered intact:
Our soap or our salmon can travel in tins
Between the two poles and as like as two pins;
So that Lancashire merchants whenever they like
Can water the beer of a man in Klondike
Or poison the meat of a man in Bombay;
And that is the meaning of Empire Day.
Songs of Education: II. Geography by G. K. Chesterton
You’re describing the extremes on a spectrum, but you only go to one of the extremes, which exposes your bias.
And it’s a false dichotomy to begin with, since shifting more care work towards society doesn’t equate to a path toward totalitarianism. You’re conflating socialism with totalitarianism. Understandable, but misguided.
Frankly, your whole premise is based on a capitalist narrative that keeps workers in their place because individual care work is so inefficient—it drains energy that could otherwise be channeled into organizing worker councils to balance out the power now disproportionately held by banks, IT corporations, political parties, and the military-industrial complex.
I’m aware that I may come across as an arrogant prick in this comment. I wish I had more time to craft a friendlier response with more sources and explanation, but I simply don’t. I need to work to feed my children and their mother, but anyway, here’s a reading list for anyone who’s interested:
"Capitalist Realism: Is There No Alternative?" by Mark Fisher - Fisher discusses how capitalism has permeated every aspect of life, including care work, and critiques the idea that alternatives like socialism lead to totalitarianism.
"Workers of the World: Essays Toward a New History of the Working Class" by Philip A. H. G. D. Van der Linden - This collection explores the historical context of labor movements and the importance of organizing against disproportionate power structures.
"The Care Crisis: What’s Wrong with Care and How to Fix It" by the Institute of Public Policy Research - This report outlines the societal implications of care work and its impact on worker organization.
"Wages for Housework" by Silvia Federici - Federici argues for the recognition and compensation of domestic labor, linking it to broader struggles against capitalist exploitation.
The whole point is scaling "care work" is almost oxymoronic. Care is only quality care when there are a small number of carers per those being cared for. To make it "efficient" is to turn children, the addicted, the disabled, and the elderly into cattle.
> "Wages for Housework" by Silvia Federici - Federici argues for the recognition and compensation of domestic labor, linking it to broader struggles against capitalist exploitation.
This reveals one of the poorly hid secrets of progressive ideology. Progressives LOVE Capitalism and want to spread it to encompass every human interaction. Caring for your own home, your own children, anything someone might do for a friend or a loved one MUST be turned into a financial transaction with an explicit contract.
> This reveals one of the poorly hid secrets of progressive ideology. Progressives LOVE Capitalism and want to spread it to encompass every human interaction
this is one of the fascinating consequences of "capitalist realism". often people who attempt to criticize the system end up describing a form of capitalism that they would prefer to participate in. picturing a world that isn't the one you know is really difficult. questioning everything is a painful and slow process.
I didn’t advocate for "scaling" care work in any way. The point is that care work needs adequate support and funding—not efficiency measures to turn it into a production line. Right now, schools and childcare services are chronically underfunded, with too few teachers and caregivers for the number of children needing attention. Meanwhile, parents with limited support systems work full-time just to make ends meet, only to watch a large portion of their income go straight to childcare costs.
The conservative approach you’re defending offloads all responsibility to the individual and the nuclear family, which means that in reality, women often end up trapped in unpaid care roles, increasingly dependent on their spouses' income. That’s not freedom, nor does it offer any dignity or choice; it’s a conservative agenda dressed up as “individual responsibility,” which only entrenches inequality and dependence within families.
And let’s address this twisted notion that anyone who wants state-funded support for care services somehow thinks of people as "cattle." It's laughable—except it’s also insulting. So, to put it bluntly: go fuck yourself for even suggesting that. Care, when adequately supported and dignified, recognizes people’s humanity rather than ignoring it.
As for the accusation that progressives want to monetize and commodify every human relationship, look at who benefits from the status quo. Conservatives would rather sacrifice people’s well-being to "traditional values," while keeping corporate interests safe from any pressure to reinvest in the society they profit from. I don’t see any corporate executives or capitalists hesitating to send their own kids off to private schools and exclusive care, expecting other people’s children to manage with nothing.
So let’s be clear: asking for social investments in care isn’t “capitalist.” It’s about making sure people aren’t left to fend for themselves, and about affording everyone—children, the elderly, those with disabilities, and the rest of us—a dignified life. And if that offends the conservative agenda, then good.
Then I'm completely lost on how it is relevant to an article that specifically mentions the care of orphans as its central example for how care does not scale.
I think the idea is that many totalitarian systems treat every child as an orphan, in some cases taking them physically away from their parents and then have people look after the children as a job. Hence the comparable situation.
And, of course, all such systems I've ever read about do not care about the practical limitation of 1 caretaker per 1 child. I believe youth services in the Netherlands, for example, has 1 caretaker (effectively available to the child) per 15 children, or 7 or 8 if they're trouble. Does this work? No, of course not. They don't care. The kids grow up caring for nobody, probably because effectively nobody cares for them. One person watching 15 children can only hope to prevent disasters, if that, they cannot provide decent attention to children. By the standards of this article, there's probably 2 people who work in the same "group". If there's a third one, they will be shared between at least to groups. So 2 to 2.5 per 15 children ... comes to one parent figure per 7 children, which is a third to a fourth of the care children would receive in even a huge family, and much less than in a small family.
> I think the idea is that many totalitarian systems treat every child as an orphan
This idea is just wrong. Wrong isn't strong enough, it's conterfactual. At most some of them treated female bodies as owned by the state. I do not remember any example of totalitarian society where a child of a political opposant would be treated the same as any military child. Maybe Salazar? But even then, it was so corporate-aligned I doubt children from owners were treated the same as children from workers at anytime.
Whats much more important, empathy doesn't scale. Care can be established. But no one will ever know about its quality. I know what I am talking about, I visited a k12 school for the blind, and have a mentally unstable mother. Nobody ever asked me if I am happy/content at home. They all assumed my mother is doing her best. My life only started when I managed to escape from every kind of care. Institutionalized care is the worst, because its lacking empathy the most...
> you could probably ... subtract a social worker, as a cost-saving measure.
Anyone who has scheduled 24x7 work knows that you need 4+ people:
24 hrs * 7 days/wk = 168 hrs/wk
So that's 4 shifts of 42 hours each. Caregiving is difficult, very draining work, so 3 shifts of 56 hours isn't going to work (even if that's feasible for any job), and especially over the long term. Then people get sick, take vacations, have family emergencies, etc., so you need additional people available too.
So, maybe interesting in the context of "creating scalable structures of aid and care", one of the big points I think that makes scaling hard is how much complexity gets pushed onto a central administrator. You have societies like certain Basque communities (see https://scholarship.claremont.edu/cgi/viewcontent.cgi?articl... ) where households are literally arranged in circular patterns, and there are obligations of care and service between you and your "first neighbor", "second neighbor", and so on, chains of dependencies moving clockwise and counterclockwise through the circle, allowing a potentially very large structure that still allows you to mostly interact with a small number of "near neighbors".
Quoting directly from the article:
"THE GIVING OF BREAD
Until the 1960’s, a fundamental circular exchange was the giving of blessed bread. Each household regards its neighbor to the right as its first neighbor
(The directions right and left are as viewed from the center of the circle so that right is clockwise and left is counterclockwise.)
The giving of bread took place weekly and was thought of as being given from first neighbor to first neighbor. That is, each Sunday a woman from one particular household, call it H_i, bought two loaves of bread to the church where it was blessed and partially used in a church ritual. Then, before sunset, a portion of the bread was given by H_i to her first neighbor, namely to H_{i+ 1}. The following week H_{i+1} was the bread-giver and H_{i+2} the bread-receiver. Thus, the giving (and receiving) of bread moved around the circle serially, taking about two years to complete one cycle of about 100 households. While each household was both a giver and receiver of bread, this mode differs from simple reciprocity; only if there were a total of two households would H_i and H_{i+1} directly reciprocate as each other’s first neighbor."
Not only does care not scale, but the fact that other fields do scale is one of the sources of "cost disease" [0]. If software engineering is thousands of times more scalable than teaching, caring for children, injured or elderly people then all of those other jobs will need to pay more to prevent everyone quitting to become a software developer.
I think one of the most important purposes of technology, if not the most important one, is turning the things that don't scale into those that do.
Fundamentally, technology increases how much change a single person can achieve in the world.
The steam engine made production and transportation scalable. The printing press, radio, television and the internet did that to information sharing and knowledge preservation. The telegraph, telephone and internet did that to person-to-person communication. Writing and the computer did that to knowledge work. The record player, the radio and the internet did that to music listening. If you start noticing this pattern, you eventually notice it everywhere.
To predict where technology goes next, I think it's important to look at what can't be scaled just yet. Customer interaction, childcare, healthcare and physical product delivery are obvious examples, though there are probably many more.
It's not like we don't know how to do these things. We have machines (human brains) that clearly know how to do them, we just don't yet understand how to make similar machines ourselves, just like we didn't understand how to make machines that would be better muscles or better horses. This is not like e.g. faster-than-light transportation, where we don't even know whether it can be done at all.
I think it's worth thinking about how a wourld where those things could be scaled would look like. Individual instruction for each child, exactly fitting their needs and abilities, is an obvious consequence, so is much better care for those who can't currently afford a (good) specialist doctor.
This has been well-known for ages and is a major subject of feminist studies. Care jobs are mostly feminine, and don't scale, and this dichotomy plays a big role in the overall wage gap.
There's a million examples of tech utopianists walking head-first into ideas and even entire disciplines they previously dismissed as irrelevant or outdated.
Working well with a three one ratio does not scream scaling to me.
The when you have more need than care workers it falls apart, with no way to scale it besides hiring more out of a pool that may not exist at the price you were paying the previous ones.
If you think in terms of supply and demand, if they are already have the curves met, additional demand is going to scale more than linearly because you need more people at a higher pay.
If it's 10, 20, 30, this doesn't work. This is the entire point, that care work does not scale like manufacturing or farming or software or entertainment or...
I disagree. Frustration wouldn't come from having to care for 10-30 people, but from inadequate systems that would fail to facilitate effective care for this many people simultaneously.
Id bet if there was a reliable and effective means for 1 person to take care of 10-30 people, it wouldn't be a problem.
In summary, imho, the problem here isn't capacity to emotionally care for this many people, but means of taking care. I think the problem is we don't collectively invest enough resources (both material and cognitive) to figure out how to do something like this well.
Which is quite remarkable, because up until less than a century ago when women “entered the workforce” virtually every woman who had ever lived somehow managed to care for her 3+ children.
Incidentally, large families do scale sublinearly with respect to the parents. The reason why is that even with merely natural spacing by the time they have a fourth child, the oldest is in a position to provide significant assistance. Every mother with a large family that I’ve spoken to confirms that the difficulty peaks with the third child and then plateaus.
It is remarkable. I have one child, and it is by far the hardest thing I've ever done - far harder than any job I've had. It doesn't help that both parents are working full time. Maybe parenting has changed recently and we are too hands-on, but I can't imagine having 2, much less 3+ running around. Even if one of us stops working to raise the kids full time, it's way more taxing, physically and mentally, than working a white collar job and paying for child care.
I recall before we lived in nuclear families [somewhat recent phenomenon] communal raising was commonplace. Grandparents, aunts, uncles, neigbours, etc. would come help.
It is not from the benevolence of the butcher, the brewer, or the baker, that we expect our dinner, but from their regard to their own interest. We address ourselves, not to their humanity but to their self-love, and never talk to them of our own necessities but of their advantages. Nobody but a beggar chuses to depend chiefly upon the benevolence of his fellow-citizens. -- Adam Smith
Care doesn't scale but self-interest scales efficiently. The baker who gets up at 3 am generally does so because she cares about her close circle of loved ones, far more than the world at large. In this sense care and self interest are not in tension but amplify by constructive interference.
But those 3am bakers are being exterminated by at scale corporate chains, no? Generalizes to just about anything that could reasonably be described using "artisanal". Social atomization inexorably spreads, and after thinking about it pretty hard for many years of travel putting eyeballs on "artisanal" processes I don't see any possibility of any other outcome. So we enjoy what is left.
To complete the thought, the baker example is explicitly in opposition to OP's point. In the economy we exist in, a 3am artisan baker does so explicitly out of a care for craft and community.
Yes. Precisely so. As it happens, we've been friends with a "3am baker" for decades. We do not envy her life, but we do intensely enjoy her taste. Delighted to pay double for it.
I would argue that the killing of small businesses that care by chains that don't is that the vast majority of consumers are in a position where making even such choices as paying twice as much for a donut are luxuries. Salaries have been stagnant forever, with a boost during COVID but was then immediately undone with price gouging on the part of tons of essential-to-life industries. And do not come at me with inflation, it has been demonstrated, numerous times and is continuing to be demonstrated, as nothing more than profit seeking. Inflation was a factor, yes. Greedy bastard corporations were another, IMO much larger, factor.
The pandemic as a whole stomped the gas on an already running process of money being trapped in the hands of the uber rich, and if none of it is coming back down, then the amount of money everyone has to spend necessarily shrinks too. And this is not my usual pinko-commie-scum ass set of thoughts. This is a well understood principle that many economists have been banging on about for years now, because even those who believe capitalism is the best system, though I disagree with them on much, also understand that if all the damn money goes to the rich and stays there then the entire party ends REAL quick and probably violently.
The 3am baker currently exists because the people who benefit the most from the exploitation of labor have the extra money to buy artisan products. My great grandfather had a bakery. He and my great grandmother would bake their product and my grandfather and his brothers would deliver the product to local businesses and homes.
And then corporate breadmakers came in and made it impossible to compete from a price standpoint. Quality disappeared, and variety was subsequently crushed. The only people keeping his businesses open for a while were those who had fortunes that existed from owning a ton of land. They still wanted their oval loaves and fresh french bread and muffins.
Essentially most consumers just didn't care about quality and preferred the lower price over the higher quality product. That seems like normal consumer choice. The people didn't get poorer all of a sudden when the corporate breadmakers came along - the people simply decided they would prefer to get an inferior product at a lower price.
The reality is most people don't want to spend more money for higher quality goods. Or, if they do, it's on a limited set of goods based on personal preference.
I see another comment like this one, so here I will respond to both. I've known quite a lot of rich people, all vastly richer than ourselves. As for us, we are so rich we don't think we can financially justify spending more on cars than my 23 yo pickup and my wife's 8 yo Prius. Our house in an astoundingly banal suburb is worth ~$300K. We can't afford to retire to a cool US city. I find it hilarious that SWEs posting on HN think paying $8 for a loaf of great bread means you are "rich".
As for those rich people, they generally have atrocious taste. They will drop big bucks on high priced wine, or more generally, restaurants. They stay at resorts on vacation and fly business class. We do go to Paris, and stay in a cheap AirBnB out in the 19th, and we fly steerage. We make most of our meals in the AirBnB, and... wait for it... eat food out of artisan vendors. I don't think we've ever spent more than $150 for a restaurant meal in the EU and most of the time it is less than $50. Those rich people we know would neverever spend the time to go to a great bakery. Why would they? That would take time mingling with the plebes, and
who cares? Bread is bread. Impossible to play the status game on that.
The problem with the economics of artisan products is that the number of people, income immaterial, who would go out of their way to spend more on an apex product is, economically speaking, a set of measure zero. Low bid rules our world. This is the reason that at scale corporate chains produce the shit that they do, because that shit industrial product is lower cost and nearly everyone prefers that.
Ever stop to think that the fancy restaurants they're going to are using these artisan bakers? The vast majority of high-end restaurants are not baking their own bread or doing their own pastries. They're outsourcing them because of the sheer amount of space you need to do that sort of specialized work.
I don't think that's right, but I could be wrong here as I have no data.
The problem I see is volume. Once an "artisan" baker is running an operation scaled up to likely more than one restaurant, how do they remain artisan? Why doesn't Baumol's cost disease apply?
True-ish. But try talking to some old folks, about the vastly reduced scale of such volunteer work since (say) the 1950's. That "voluntary unpaid" stuff would include religious organizations, civic groups, housewives, ...
America's in-person group membership plummeted across the decades[0], but I don't know about overall volunteerism. It may just come in different forms. Anecdotally, here in NYC volunteer orgs are stuffed to the gills; spots to clean my local park fill up in days, finding any weekend activity on NY Cares can be hard.
More concrete data are hard to find, AmeriCorps' only started in '02. We can look at volunteer rates across demographics[1] but it's likely true that volunteer hours drop off with age.
[0] see: Bowling Alone (needs a post-COVID update, though)
It seems to me that capitalism discourages that behavior. If the system is setup to be transactional, and you can't rely on others reciprocating altruism if you need it; then it seems like engaging in altruism would be for suckers.
True-ish. But in older-fashioned communities - long-term stable, extended families usually present, participation in many altruistic groups and activities are established norms, everybody's noses not buried in web browsers and smart phones - there's this thing called "social capital". And, as a generality, it's at least as important as the monetary kind.
True-ish. But when you say 'older-fashioned communities' I have a feeling you are speaking through nostalgia or a rose-tinted view of an idealized past. Can you name some of these older-fashioned communities that exist today, and how they are different from the ones you are contrasting them to?
capitalism is so that strangers with no reason to cooperate can via the market. It should have nothing to say about you network or closer relations and how you interact. Altruism has a large place in life but in general it is directed to friends and family then your larger social groups.
Nit: That's not the defining property of capitalism. The defining property of capitalism is that the means of production are privately owned, as opposed to e.g. market socialism.
That's not true, and only seems true because of highly selective examples.
Money can force people to work, out of the necessity of survival. What it buys is reliability. You can force a toilet cleaner to come to work day after day, and the toilets stay clean.
But human progress, social progress, economic growth, does not solely come from people grinding through their jobs. It comes from people 'giving it their all', look at the great scientists, Newton, Von Nuemann, all the people at bell labs etc. These people create titanic economic value in their wake, and they are motivated by passion, which heavily mixes altruism with self interest.
Indeed, the 'developed economies' are precisely the ones that also allow 'care' to scale, that's why we have social welfare, that's why we have free education.
Its that 'Care' doesn't scale, its that its impossible to centrally monitor and control. People in the third world work harder than the first world, and are 10% as rich, because no one in their societies care.
Public schools are notoriously uncaring. It's expensive private schools which can afford to have small class sizes, so the teachers can develop personal relationships with the students. "Care" in this context isn't just "doing something for someone's benefit"; it requires a caretaker's undivided attention, which is why it doesn't scale.
The quality floor of "reliable" work produced solely by economic self-interest is also quite vulnerable to misaligned incentives.
If you don't provide the right balance of economic incentives for quality, the rational economic answer becomes "quiet quitting", and quality plummets. And maintaining that balance of incentives is also someone's job, which needs the right economic incentives to be done well, so it's turtles all the way down (or up).
In practice, it's an unstable, patchwork combination of care and economic incentives that keeps real-life institutions in working order.
> People in the third world work harder than the first world, and are 10% as rich, because no one in their societies care.
typically they "care wrong" and the first world comes in and dismantles everything to keep raw resource prices at a price point that they like. advanced third world economies are a threat to first world prosperity.
I feel like you missed the point completely. Did you read the article at all? The social workers in the article are also professionals working for a paycheck. The operative difference is that a baker produces bread: If they can produce (say) 100 loaves for 100 people in a day, you have a 1:100 producer:consumer ratio, and with a bigger oven you could probably double that. Conversely, a social worker cares for children at close to a 1:1 rate, with one worker per child, and you can't do much better than that. Regardless of a social worker's motivations, their productivity is limited by the fact that they are doing the labour of caring.
>In this sense care and self interest are not in tension but amplify by constructive interference.
Perhaps in a well designed system, but if self-interest can be derived at a cost to the collective good, that also scales rather efficiently and without such a wholesome outcome.
Just want to add that so many freshman-level thinkers who are fond of this idea forget that democratically enacted regulation and oversight also count as self interest.
Capitalism is a fantastic solution to the problem of biological wants and physical limitations.
But that does not really change the issue that you need about 1:1 caregiver per child. It just means you get them much more effectively than any other system.
"The story, then, is everywhere. It is the founding myth of our system of economic relations. It is so deeply established in common sense, even in places like Madagascar, that most people on earth couldn’t imagine any other way that money possibly could have come about. The problem is there’s no evidence that it ever happened, and an enormous amount of evidence suggesting that it did not.”
Its wild to me how often people conflate "human nature" and culture. People who share a cultural background with Adam Smith may very well be accustomed to this self-interest-first way of seeing the world. People who would struggle to see other people's life ways as valid, because there's very little value in other people's perspectives. Especially if they involve practices that undermine profitability.
People do depend a lot on the benevolence of the butcher and the brewer and the baker, because while regulation and inspections and laws and so on are there to stop out and out sociopaths from killing people in pursuit of profits, a lot of people that do their jobs are doing it because they think their job provides some value to the community at large, and they try to do it in a way that doesn't harm people.
I'm having a hard time translating her points regarding how infrastructure serves and cares for the basic human physical needs (e.g water, clean air etc) and how it can serve social needs like child care or elder care.
Care is not something that is magically performed by the state or money.
At some point someone has to physically wash and feed the elderly in the retirement homes.
If past governments or cultural environments messed up demographics, states might end up with a significant fraction (Germany already has 22% aged 65+) of the population in need of that care, which requires another significant share of the population to just do that instead of producing actual stuff.
This will either get ugly in one way or another or we will need scalable tech solutions.
I don't think anyone's talking about forcing, or slavery.
Foreign workers are improving their lot (and that of their families back home). In a world where they don't have the same economic opportunities in their home countries, and the locals don't want to do those "shit jobs", it's a win win.
Even talking about shit jobs is pejorative. Foreign workers don't just pick fruit, they're also essential talent in healthcare and other critical areas.
Why is that? Do you think shit jobs don't exist? You think wiping other old people's asses is NOT a shit job? Are you lining up for these kinds of jobs yourself or did you work and study hard to not have to do them because you knew those jobs are shit and are usually given to the lowest underclass class of people who don't have better options due to various factors?
> Foreign workers don't just pick fruit
I never said such thing. The thread I replied was about importing workers for elderly care.
You're trying to project some things I didn't say onto me.
They're promised path to citizenship and an ok money. Then they discover that they work for an agency that takes away big chunk of their money. They can not change the employer since they'll be deported etc. etc. And the worst part is that at the end they still have to leave the country.
Actually... they kinda can? If they don't work, they get deported back. Also they are in debt to the agency that got them here. It's a hair above modern slavery the way it currently works, especially in EU countries with more... lax standards than Germany.
lol, nice joke, how many illegals has Germany for example deported? Deporting people in the EU is a huge hassle and the source countries often don't want to cooperate in taking back people. You'll have to murder someone to actually get the authorities in the EU go through the hassle of deporting you, but refusing to work shit jobs isn't enough to get you deported, just have your welfare access cut off.
Plus they can also claim asylum once they get here to escape their slave drivers and not get deported.
>especially in EU countries with more... lax standards than Germany
Germany already has lax standards on that regard. Many there are raking in huge profits by bringing in these vulnerable workers and having them work in terrible conditions.
> lol, how many illegals has Germany for example deported? Deporting people in the EU is a huge hassle and the source countries often don't want to cooperate in taking back people.
> Plus they can also claim asylum once they get here to escape their slave employers and not get deported.
You are confusing two groups of people. One group consists of illegal migrants, usually from MENA countries that claim asylum and are a hassle to deport back.
Migrant workers usually come from southeast Asia (India, Nepal, Philippines..) and there is no problem sending them back because those countries are considered safe. Also they got families back home, their motivation is not really to stay here long term but to earn a decent amount of money (from their perspective). And despite sometimes poor treatment and shitty jobs, EU is a much better place to work than gulf countries.
No, I read what you wrote and I meant what I said. Let me explain again: people are willing to do anything, even jobs they dislike, just to get a visa. That doesn't mean they'll want keep doing that shitty job once they get the visa and can start looking for workarounds. Otherwise there wouldn't be a shortage of staff in those sectors if all workers would stick around for long.
well, except for the fact that, as the article states, it doesn't scale. Or rather, it scales poorly: the quality of care provided by a nation state is going to differ in degree and quality compared to the 1:1 care that humans probably need (and certainly traumatised humans).
I'm not sure this comes as a surprise to anyone except for those who have had no interaction with state-provided social services. I'd also say that a level of care that does not reach to that 1:1 standard is still appreciably better than no care, which may be what one might otherwise receive.
The open question is can we work out better, decentralized ways of providing support that take advantage of the new social technologies that we've developed since the construction of the modern state and its welfare services in the late 19th and 20th centuries.
Care doesn't scale, but a lot of activities around care should be scalable. A caregiver can be helped so they can spend as little time as possible on auxiliary tasks like admin or logistics.
I don't think there is any contradiction here. Government care can work, but it simply cannot benefit from economies of scale. Gonna need to double the income tax to pay for elders that have been abandoned by their children.
He means that they messed up by investing in their children and providing them a good life instead of putting everything in an index fund. They didn't realize the rug pull they were about to eat.
Just because the government does something, doesn't mean it has to be centralised. Eventually the care has to be given from one human to another human. On the other hand, it shouldn't matter where you live to receive care or how good the care is.
And the week in which private companies will be able to provide this, is the same week which has two Tuesdays.
Doing it by a state does not make it magically scale in any way shape or form. You still need something like one-to-one or one-to-a-few for care work to be effective. Trying to provide it through the government does absolutely nothing to change this fact.
The state is ideally suited to manufacture public goods, more efficiently than private enterprise.
That means armies, judiciaries, policing municipalities, governance amongst others.
They address issues like management of the commons.
This does not translate into scaled care - care for orphans (from the article) still needs large numbers of skilled manpower, which is in short supply across the world.
These services are also often underfunded, since they are not really a first class citizen for voters.
Voters today, are also deeply targeted by emotional campaigns and identity campaigns, since that is the current political state of the art.
The state can be efficient, but some things don’t scale unless they are also resourced correctly.
Such services will also be amongst the first to cut, since “X will render it obsolete”, is a promise as old as time, and aren’t directly tied to overall societal survival.
Compared to something like defense / emergency funding
My argument is, that care is a public good. There will never be a situation in which care can fund itself. To fund care is a political decision and when the decision is made to to not fund it or leave to a market or private enterprises it will fail, because private enterprises need something which will eventually scale.
> The state is ideally suited to manufacture public goods, more efficiently
The government does not provide a more efficient military or education. It compels individuals to pay for something which is in the collective good, but not their personal interest.
Economists argue markets are efficient because of the incentive structure they place on actors. There is a plethora of writing about government inefficiencies due to not having these. It the most distilled form: they are insulated from both positive and negative consequences of behaving efficiently.
Due to this, government entities have a unique set of traits, but efficiency tends to not be one of them. But who cares? Efficiency isn't always the goal. When it comes to making laws, efficiency isn't the goal, long term values are more important.
The post office was created with full knowledge that it would be a net loss, but it was felt to be institutionally important to have universal access to communication across the nation. Now that this is an antiquated method of communication, and there is a market for the remaining services, it is mostly an inefficient make-work program for a well organized voting block.
Now you I can imagine all the distopian problems of a private military, but I'm going to guess efficiency is not one of those (The US Gov believe Blackwater saves them money, btw).
I'm surprised the article and non of the comments I've seen in this thread mention effective altruism, which in the framing of the article is an attempt to scale caring in some sense.
The article helped me realize why so many people in the startup/tech/software engineering scene are drawn to effective altruism, it's a way to scale helping humanity in the best way possible. The effective altruism argument is that it's more productive to by mosquito nets in Africa than to volunteer at a food shelter because buying mosquito nets will save more lives.
But this article helps explain why I don't personally feel drawn to or buy into effective altruism. Because caring doesn't scale, you can only really care about a handful of people close to you. And to me that altruism feels better and seems like it goes further than donating money to help more people that I can't truly care for.
Mosquito nets are oft being used as fishing nets. Since 1) the loopholes of malaria nets are much smaller than manually knotted ones (thus also killing baby fish) and 2) the impregnation chemicals kill riverbottom insects (thereby disrupting the foodchain), this has lead to a massive killing of fish. Instead of fixing malaria, this has instead led to aggrevated hunger crises in some places.
I think most people's problem with "effective altruism" is rather that some of its more prominent adherents end up defining "helping humanity" in very weird and rather counter-intuitive ways. Like that whole argument that we basically should care more about future humans than present ones because there's a lot more future ones.
I agree that's most people's problem, but it's now mine. I've tried to think about effective altruism from first principals. For me, I can rationally understand effective altruism and why it's attractive. I even believe people that follow it (and actually do good) may in some sense be "better" people than me. But it none the less rubs me the wrong way and I can't follow it, so I've tried to understand why.
A lot of what makes society and politics so hard comes from the fact that humans have among the most demanding offspring of any living creature. This starts with pregnancy and birth which is a life threatening medical condition with a high mortality rate without modern medicine. We can’t reproduce and raise our children without dedicating gigantic amounts of energy to it, causing an inherent tension between the need to do so and the desires of both individuals and entities like corporations and states that want claim to that labor.
If we laid eggs and our young were viable more quickly our politics would be orders of magnitude simpler. It would basically be the politics of twenty somethings, but for everyone.
On the plus side, it’s probably why we have among the longest life spans of any land mammal. Grandparents helped with child rearing, so societies with longevity probably did a better job raising children.
That is partly true due to biology. But it's partially culturally inflicted.
In previous decades kids were allowed to do much more unsupervised. And the pressure to prepare for high stakes college admissions from early ages was much less extreme.
In the Talmud, Sanhedrin 37a says "Anyone who saves a life is as if he saved an entire world." and anyone who destroys a life is considered to have destroyed an entire world.
In this sense care does scale in long timelines. When pregnant women go hungry, predispositions towards obesity remain in the epigenome even after several generations[0]. As a trivial example, in Les Miserables, the criminal Valjean can only become a hero because he is forgiven completely and totally by one man. It may sound ridiculous but surely life is also ridiculous.
I disagree. There's plenty of historical and present evidence of people who cared deeply for a collective of people (country, village, town, group, family).
There have been people who would risk their lives, and in some cases commit suicide in various capacities, for their country and people. There are people who go to world's most unstable places just to help people there.
A more concrete example, one of many, would be María Santos Gorrostieta Salazar[1], who had a total of 4 assassination attempts against her, with the final one eventually getting her killed, as a result of fighting organised crime. You can't tell me this person didn't care deeply for her people and country.
I think the possible cause for indifference today, especially in developed countries, is because people can afford to be indifferent with little consequence to their quality of life. You can go about your life only caring about your most immediate circle, and things will still be relatively comfortable. I speculate that it's the matter of having no need to go beyond your comfort zone apart from moral ideals. Even then, people are just fine living with a slight discomfort of not living up to their ideals, or straight up re-evaluating and adjusting them like in this post.
The article defines care "scarcity" rather narrowly, almost tautologically
> In any given moment, you can only really care deeply and individually for one person
Yes, but there are many moments in a day / one's life, and care is needed and appreciated at various levels of "deepness". Further, how much care (and what type) is needed depends enormously on what society has managed to scale with the right organizational patterns etc.
So in the end the question is: how much of this type of exclusive (and scarce) caring capacity does society really need? Mathematically, there are 8 billion exemplars of the species roaming the planet and 1:1 caring takes care (pun) of the 4 billion.
Well, everyone's a kid for the first few years of their life, and children require a lot of care. The elderly require care. The unwell require care. Everyone wants care some of the time.
We do have cultural institutions to do much of this work. Parents care for kids. Adults care for aging parents. Romantic partnerships exist so that people can reciprocally care for each other. Still, we have to fill in the gaps for kids without parents, seniors without kids, and sick people. The demand for therapy and sex work proves that people will pay a lot of money to be cared for, even when they don't need it to survive.
> So in the end the question is: how much of this type of exclusive (and scarce) caring capacity does society really need?
The comment comes from reading the article, then wondering how can societies make things scale? We make things scale by delegating our concerns to people who know and care more about specific outcomes, and helping them to make the differences that are required. Scale comes from people learning that things around them matter and that they are responsible for making them good.
In that case i'll ask for a clarificaiton on the link. From the article it seemed quite a clear cut case about activity types that dont scale.
Outsourcing the responsibility doesn't mean it scale, which seems contradicted by what you are saying. People learning that things matter and that they are responsible, doesn't change this does it?
The article noted that, when you care for someone, you give of yourself and your attention and you cannot spread this to a significant number of people. If you outsource the activity, then whoever you outsource it to has to pay attention in the same way. But the world is full of people that were cared for, and mostly quite well. So in that sense, care scales.
I am only really suggesting that scalable care schemes might be those that help people to support those they already have a connection with, and that organisation/coordination be managed on that level.
What exactly is the evidence, and how is it not exactly centralisation? All the advances in care that I can think of (those that actually unburden more humans from having to give their life to care) are brought to us by some sort of centralisation.
No. Centralization isn't needed to scale, it's just needed to exploit scale. Exploitation has become so commonplace it's replaced everything as the primary "desirable metric". I'm writing this comment on a platform founded on the idea of exploitation being a desirable metric.
Try giving everyone housing without centralized production of things like nails, screws, siding electrical wire...
Decentralizization is fine sometimes, but a single huge nail factory is going to beat thousands backyard forges in (average/95th percentile) quality and especially in prices.
This isn't true though. Neither in theory nor in practice. A broad set of individual product quality has consistently declined throughout the industrial era - not least, infamously, one of your own examples: nails.
Many products have increased in quality due to factors unrelated to centralised production: new scientific research, intensive r&d, internal standardisation efforts - but centralised production tends instead to produce demonstrable reductions in individual quality. We're living in an age of unprecedented consumer waste due to this phenomenon. Planned obsolescence is a relatively recent term (& while it may not be real in terms of being intentional it's definitely true in terms of increases in obsolescence-rates).
Are you suggesting there is no provider of high quality nails at industrial scale?
That’s ridiculous. Many people just prefer to pay for cheap nails because they are good enough for the application, and that’s a good thing because this option did not previously exist. But the high end still exists and is higher quality than ever.
Capitalism has problems, but providing low complexity commodity improvements at scale and quality is not one of them.
> Are you suggesting there is no provider of high quality nails at industrial scale?
Nails was one of the examples cited by the gp, which I found funny since there is one famous example of nails being lower quality by definition as a result of centralisation. That example isn't the case for all nails (nor for all the gps examples), but it is still an excellent, if isolated, example: cut nails. Most carpentry nails you buy today are wire nails. I don't know if it's possible to buy cut nails today from any large factories, but broadly speaking, manufacture of cut nails does not scale. The switch to wire was a detail of the manufacturing processes, not of consumer demand (nor quality assurance). Cut nails are still considered superior today.
If you look at antique diagrams of nails available for purchase, you'll see 20 or 30 varieties, all with very distinctly different designs. Those designs have converged on a single design for all applications, not because it's a better design, but purely because it's a design that scales for manufacture. Flaws in the design are compensated for via material choice & worker skill.
There's likely thousands of such cases in industry.
This an empirical argument about nails. Are you just saying that to emphasize your confidence?
> cut nails
I just googled and there are literally dozens of brands of this product.
Even so this preference appears to be a niche opinion of artisan woodworkers, not a failure mode of furniture and construction.
> The switch to wire was a detail of the manufacturing processes, not of consumer demand
Yes it is. They wanted to pay less for nails and the cheaper manufacturing served that need. If it mattered they would pay more.
> but purely because it's a design that scales for manufacture.
In other words, people like to reminisce about hand made goods. But when it comes to paying for them, they usually prefer the ones that work well at a fraction of the cost.
You can’t claim that intricate items with fine details are not manufacturable at scale (see the iPhone?). So your cause and effect are backwards. Manufacturing did not dictate old methods became less prevelant. Consumers did.
And once again, your claim that higher quality ones don’t exist is wrong too. I guarantee we can find a supplier of many varieties of decorative nails. They are just more expensive.
> Are you just saying that to emphasize your confidence? [...] people like to reminisce about hand made goods. [...] I guarantee we can find a supplier of many varieties of decorative nails
A nested HN thread is likely not the best place to go into great detail on the precise practicalities of trade work, & I know I can't expect any given commenter to become an expert in a possibly niche topic just to engage in discussion, but this level of dismissiveness is a little difficult to reckon with. Nobody is buying nails for their "decorative" qualities - they get embedded in materials. They're not a visual feature.
Decorative was my word to summarize your “catalog if 30 styles of nails”
> but this level of dismissiveness is a little difficult to reckon with
Let me summarize the key economic points that I feel have been dismissed:
- any kind of nail you want, you can buy right now.
- You can also buy nails of higher quality than anything that’s existed in preindustrial time
- popularity of which kind of nail is driven by demand
Whether it's a conscious strategy or an implicit outcome, planned obsolescence wouldn't be viable without centralisation. Centralisation is a tool of capitalism to achieve its goals.
Sure, it's not required to build _some_ houses, but it's required for scale.
Backyard forges are OK if you have few hundred million people, most of them in farming, with most families living in a house with a a single room. But you cannot build New York on without large factories.
I'd argue that centralization allows a scale that otherwise wouldn't have been possible, but at the cost of added fragility and externalized costs.
We produce way more corn in the US today than we could without a centralized industry, but we do so by subsidizing the hell out of an industry that is driven only by how much volume of corn is produced. Nutritional quality of the food produced is ignored, damage to the land is ignored, damage to the broader environment is ignored, etc.
We grow a small amount of corn on our land. We absolutely don't have as high or consistent yields as an industrial farm, but we also don't spray any poisons on the land and if the soil health was being negatively impacted we would know it pretty darn fast. Rain water from the corn patch runs down into the pond our cows drink from, another reason we wouldn't use poisons on the land. All of these are considerations one will likely make at a smaller scale that just won't happen with a centralized system driven by one or two primary goals (currently that's just money).
I was mainly thinking of care when I wrote this, but I think there is generally a trade off between centralisation and increases in efficiency, in some part given by standardisation, and increased fragility as more comes to depend on fewer things that aren’t a complete fit for what you are trying to do, or that might fail.
yeah centralization is a proxy for trust and stability, it adds some friction on the edge to give you that benefit
i also think that ultimately no single system is best and that regular renegotiation about the amount of central vs decentral is key (something we should help people be better at)
“Care Doesn’t Scale” is a fractal type of truth which essentially describes life but also is a steadfast warning of the underlying state of healthcare in general.
Holistic 100% care doesn’t exist - even for the rich.
The only way to get optimal care is to pay for it with study. Even the richest in the world don’t necessarily get the best care because care is a function of the present life situation of the practitioner - something no one can control 100% of the time.
What is reassuring is that through a little study - you can refine the care provided by most nurses and doctors using your own curiosity at the point of interaction.
Surprisingly the mistakes committed by nurses and doctors on somewhat healthy patients are easily fixed with some sembalance of attention.
Study the first 2 years of med school. It’s not hard but does take time. And then ask the pertinent quesitons during your time with the doctor. Understand the diagnosis and how they came to it - it’s mostly simple and straight forward.
80% of the massive mistakes by doctors and nurses are fixable this way. Thats $800B … 800 billion dollars - with a little study.
This reminds me of Clay Christensen's talk: How Will You Measure Your Life?[0] He compares how most people define success by how high up the hierarchy they get, against the individual effort of making a positive impact on the people around you.
> Software engineering as a field is made up of people who are very conscious of missed opportunities for scale […]
It amuses me to read these articles because it’s so airy and nebulous that there is all this text that doesn’t say much. I pretend it’s another pg article instead to humour myself further.
HN is perpetually being played by the storytelling of some minor event that the author saw - people taking care of orphaned children by some rotating number of adults - and is reaching conclusions “care doesn’t scale” as if to educate us. It’s like a TED talk, only even less structured. So all I’m reading is vain, egotistical puffery. There isn’t really anything here other than the author thinking they can bring the tablets to us, the blind unwashed masses. It’s not only software engineers who do this so I won’t say it’s a trait unique to them in any way, though I see software engineers trying to make grandiose life statements more often than not.
Scale vs care/love is a false dichotomy, and each word encompasses many phenomena.
Years ago, a neighbor in Los Angeles went to social services and was diagnosed with schizophrenia and given some meds.
I knew what he was going thru, and I was young and rebellious, so I told him to skip the meds and take some time with good friends. In 2 months, the symptoms were gone. I can't remember the name of the meds but the side effects were awful.
On the other hand, in my mid 30s I started to appreciate all the little details around infrastructure and design in various countries, and I often get the feeling of "being loved" by workers I've never met because the way it works is so nice or because it protected me in some way I didn't think of.
I do pretty “small scale” work that has a fairly outsized impact on folks.
The app I released in January, currently has a bit over 600 users. I get one or two a day (plus, the odd scammer). It may accelerate, in the future, but the demographic is small. There’s only so many people that can use it.
I tested with 12,000 fake users. I suspect we won’t ever see half that. To many folks here, 12K is a rounding error.
But the ones that do use the app, get a top-shelf experience.
On another note, I have family that used to run a group home for kids that were made wards of the state (many terrible stories). He’s really good with kids, but he’s been an EE for the last couple of decades. Running the group home was very stressful, and emotionally wrenching, so the engineering was a cakewalk.
I think in the future, descendants of today's LLM models and some future version of Tesla's Optimus could create a paradigm shift in how care is given.
I'm hopeful that when I get old, and inevitably come to need some help with living, that such a solution will be available.
> I would like the option to die painlessly before I end up needing a robot to change my diaper.
My dad has Parkinson's and needs a human to change his diaper. If he had the option of a robot, I bet he'd take it. Not a painless die now option, though. As I write, where he is it's 8 o'clock in the morning and he's watching an old Larry David and eating an ice cream cone while my mom gets ready for them to go to breakfast.
That’s the idea of an option. Great if it works for him, but having spent a lot of time with Pieter Hintjens (of AMQP and ZeroMQ fame) before he chose the time of his own passing from recurrent cancer, the notion that this is not allowed in order to appease religious zealots is simply barbaric.
I think this is a gross and psychopathic vision of the future.
Tell your grandmother that you're going to automate away her need for human connection. What a terrible indignity. I hate my industry.
Psychopathic? I think that's a ridiculous statement. No-one said anything about automating any human connection. I can tell you that my wife is a full time carer for her parents, and though she does it willingly and with love, it exerts a great toll on her, both physically, and mentally. So if we're going to far-too-easily use words like "psychopathic" - I could just as well say that ignoring that cost is psychopathic. Knowing what her role as a carer has cost her in terms of quality of life, I would never want to subject my children to the same. That is entirely different to maintaining human connection with older relatives.
> No-one said anything about automating any human connection
Maybe I was inferring the wrong thing, and if so I apologize, but the context of this comment was invoking LLMs and humanoid robots in a discussion about how "care doesn't scale". Like of course automation and technology should do things to make the lives of the elderly easier, but I would not classify any action done by a machine as "care". My dishwasher is a great convenience, but I would never classify my relationship with it as one of "caring".
> Knowing what her role as a carer has cost her in terms of quality of life, I would never want to subject my children to the same
Of course that's a problem. The answer though, IMO, is creating a society where we value elder care more, and have more programs to provide human support and connection to the elderly. I strongly feel like this isn't something which we can or should automate away.
Perhaps it is a question of the different meanings the word care can take. Care in its normal everyday usage is indeed a natural human emotion, however this was not the subject of my post.
"Carers", are people who perform functions for people unable to do them themselves. Whether they "care" or not for their charges is not directly relevant (though often they are relatives, and certainly do care for, and love the people they are helping very much). Not always though - consider a "care home", which is essentially a dumping ground for the old and inconveniently frail. Having seen the inside of a few such places, I very much do not want to end up in one.
Enter the Robots, and technologies such as the LLM. In my imagination, a robot equipped with some facility with language, could act as an assistant for an elderly person, allowing them to maintain their independence for much longer without a human carer. This is not a replacement for human connection with their loved ones, but it is a replacement for putting them in a care home, or having ones own children spend part of their lives unable to have a job, or a normal social life, due to complex care requirements of some relative.
For what its worth, I doubt we disagree too much, I think it was a misunderstanding. However I'm interest to hear your thoughts.
> For what its worth, I doubt we disagree too much, I think it was a misunderstanding
I think so as well-- I'm glad you replied.
We certainly agree on the problem of bad care homes. We've all seen and heard the horror stories, and it's really unacceptable what's going on at a lot of these places. The question is, would unscrupulous care homes buy a robot and re-task workers with providing more social care to residents, or would they simply lay off the workers?
For a pretty large chunk of the population, care workers are the only source of regular human interactions. As such, I would make the argument that the necessity for these tasks to be completed by a human is, in many cases, a feature, not a bug.
Let's then hope that the LLM solution is FOSS so that relatives and the one being cared for can be in control of the service and avoid enshittification.
> Scale isn’t bad, at least not necessarily. Industrial is perfectly capable of being better than custom. Sometimes the YouTube video is more helpful than the private tutor.
This is not true; consider the argument that there is always a loss of quality in scaling. Industrial maybe better than average custom, but is always worse than best customs. Broadcast lecture is almost always worse than a tutor whose discourse is customised to student's current knowledge. (The word guru (literally, one who leads towards light) is wrongly translated to teacher, for which the word in sanskrit is shikshak.)
I agree the average tutor is better than the average lecturer. But if I watch a YouTube lecture, then I might have access to the best lecturer in the world, or at least a 99%ile lecturer, e.g 3blue1brown. This only works because of the scale -- it wouldn't be possible for millions to get access to tutors this good 1 on 1.
but can you argue with them for an indeterminate period of time in earnest dialogue until the idea goes CLICK inside your head? You cannot, and so the value is much lessened because that critical access isn’t present.
Do you always need that kind of prolonged argument whenever you learn a new concept?
> Sometimes the YouTube video is more helpful than the private tutor.
University lectures work like that. First the general lecture, which has 300 students and is not interactive. Then the tutorial, where students who want extra help can consult individually with a TA. Attendance for tutorials was typically much lower in my experience, because a lot of students thought the lecture was plenty and wanted to spend the time on something else.
Except the argument is university lecture (classroom structure) doesn't work. A personal tutor might be able to teach a concept to all their students, whereas not everyone in a classroom passes. Your argument about sufficiency can be made about books and is not relevant here.
> A personal tutor might be able to teach a concept to all their students, whereas not everyone in a classroom passes.
Why are you convinced that personal tutors are so much more effective? I'd expect the average student to be slightly better-served by having a personal tutor, but not by much. After all, personal guidance is available from TAs when necessary—my point is that it typically isn't necessary.
I don’t think that holds for everything. Industrial 3nm chips are probably better than whatever you would get if people tried to DIY this. Lots of things get better with scale: materials, precision machinery, process efficiency, power generation.
But there’s also plenty of things that don’t work this way. Care is one of the most extreme things that does not.
I think the argument is that someone with the knowledge to make 3nm chips could probably know how to make some very cool yet very expensive chips, but since they target a lot of people they probably make choices that would satisfy more people but maybe not as well
Q: How many Silicon Valley software engineers does it take to change a lightbulb?
A: They will refuse to change the lightbulb, claiming it "doesn't scale" unless the "lightbulb problem" is fixed globally ;)
In seriousness, enjoyed this article and it's a wise realization. I think the world would be a better place if more people take the time to be a good person to the people around them, rather than focusing so much on big picture issues.
I agree with your central point, but in my estimation, the entire world minus a very small percentage point only work on or care about small, short term solutions to problems.
And that is fine. Engineers are not social & feelers with high individual level empathy scores. So let them/us build large scaleable solutions with the individual 1-to-1 personal interaction removed.
I think article may overlook the power of a great idea.
What seems like common sense to us, may be a gap in the knowledge of someone else.
When we help fill in those gaps, people will naturally help others when they see those gaps.
When approached with love, curiosity and a seeking of understanding, we enable others to help themselves.
This is where great ideas scale quickly & naturally, because once we're aware of a better solution - why would you do it any other way?
This is a pretty big realization and one that resonates strongly with me. As an engineer, parenting can be frustrating, of course for the usual reasons, but also because you realize there’s really no way to “hack” it.
I feel like we as a society need to acknowledge that this probably applies to childcare, teaching, health and elder care to a large extent. That no matter how much private sector ingenuity you apply to some field, there is a hard upper bound to how much efficiency you can achieve. Cost savings basically just require making hard choices about who gets what.
I think some of the healthcare changes during my lifetime have increased efficiency and been fine (maybe even good) for patients.
I used to have my vitals taken by the doctor. Now, that’s a nurse. Used to get vaccine shots from the doctor, now a nurse. I feel like docs used to do blood draws, now a nurse. All of that is good, IMO. Doctors may not like the 20 minute blocks, but overall I can get the same care at a lower total cost and the nurses are probably better at the job they do twice as frequently than the doctor whose head might be somewhere else during the “boring parts”.
I suspect aspects of this apply to teaching (why does every calc teacher need to give the lecture? Why not have the top 1% of them in that skill record lectures with excellent production quality/editing and have students watch those?)
Yes, there are upper bounds, but I think even +50% or +100% might be possible with minimal (or in the calc case, negative) losses. Those efficiencies can really matter when someone else has to pay the bill.
I question your teaching comment. Sitting there and receiving a lecture is a rather small part of learning (varies per student). For the rest of it you're going to find that class size is by far the biggest determiner of success.
I wonder how the best teacher in the world teaching 5 classes of 40 would stack up against 200 people chosen at random from a pool who had already passed that class working 1:1 for 1 hr per day. Probably the ideal case is somewhere in the middle, but the point is that it's allocation of the teacher's time, and not production quality, that's the bottleneck when it comes to scaling teaching.
I meant to expand that to clarify that other aspects (supporting students as they work to apply the lectured material) would/must be done 1:1 in person, but the core lecture can/should be delivered by those with particular skills in that area and that we could apply extra effort to editing/production value.
My son's calc class is taught via watch the lectures online/at-home and then apply them in class and at-home via exercises. The only difference from what I proposed is that the same teacher pre-recorded the lectures, which seems to a practical solution but not an inherently necessary constraint (and there are likely thousands of calc teachers making average quality such videos).
But absolutely a personalized teacher must be available 1:1 for at least part of the overall process.
>I used to have my vitals taken by the doctor. Now, that’s a nurse. Used to get vaccine shots from the doctor, now a nurse. I feel like docs used to do blood draws, now a nurse. All of that is good, IMO. Doctors may not like the 20 minute blocks, but overall I can get the same care at a lower total cost and the nurses are probably better at the job they do twice as frequently than the doctor whose head might be somewhere else during the “boring parts”.
The statistical you is paying statistically much more than the historical equivalent. The situation is far more complex than that. There's a million variables here. Changes in services rendered, changes in outcomes, relative wage differences, more parties taking a cut of any given transaction, more "make work" prior to rending specialized care, etc, etc.
Outcomes are better than they were 40yr ago but is that because of the changes or despite them?
> Used to get vaccine shots from the doctor, now a nurse. I feel like docs used to do blood draws, now a nurse.
Weren't these always done by nurses? The doctor would do the determination of what you get, but nurse being the one executing these is something that was here for decades.
No, it's saying that _in any moment_ you can only focus deeply on, and thus care for, one other person. And if you have to care for multiple people, then you have to shift your focus moment to moment.
As a parent, can confirm. To give an example, it's really hard to hold and comfort two crying kids at the same time. When the toddlers are melting, they really want your whole attention and don't want to share it. If they're melting because they got in a fight with each other, it really takes an adult per toddler to help calm them.
That doesn't mean I can't love and care deeply for both kids, it just means you can only implement that caring with one at a time.
I think he's generalizing the point a bit and not all situations are like that. But it's close enough to accurate to be valid. Care doesn't scale.
> With four kids, the kids can feel like kids; if there were forty kids, they’d probably feel like they were cattle.
The point of the article is that you’ll never achieve economies of scale (10, 100, 1000x) for situations that require individualized attention, no matter how much engineering effort you put into it.
I don't think it's implying that at all. Whether or not you agree with the statement, it's referring to a specific moment. Most parents will have many moments with their children.
No, because normal healthy children do not require 24/7 care, even as newborns.
Children in care do, partly because of the circumstances that led to them being in care, but mostly because the State in general is not willing to accept the same risk profile as individual parents.
I think it comes down to the many meaning of the word "care" in English. The state is certainly willing to accept way greater risk than the individual parent, in many circumstances. If we take something like daycare, which I presume is included in "care", then it's typically four children per adult until the age of 4, in schools it goes down to 20+ children per one adult, where at home it might be more than two adults per child (but also less obviously).
The risk profile is different, if you have a newborn in hospital, then that child may have their parent present at all times, plus staff, but it might also be one or two nurses and an on-call doctor for any number of babies. In some sense the potential risk is greater, but it's also more professionally measured.
>The state is certainly willing to accept way greater risk than the individual parent, in many circumstances.
I don't think that's true.
> If we take something like daycare, which I presume is included in "care", then it's typically four children per adult until the age of 4, in schools it goes down to 20+ children per one adult, where at home it might be more than two adults per child (but also less obviously).
That's a much lower care ratio than parents accepted before regulation, so I think you're arguing against your own point here.
Those ratios are heavily debated in Denmark for being absolutely terrible. Parents have been complaining for years that the ratio of especially children for 4 to 6 are awful (typically 7 children per adult).
They might be a improvement in other countries, but they are considered a move in the wrong direction here, because they are worse than previously.
I wonder if education/teaching is fundamentally inseparable from, at least to a serious degree, caring. Every single teacher who impacted my life seems to have cared for me. Maybe not. I have learned a lot on my own too. It would be interesting to see the minimum amount of care needed for a successful education; that would directly increase how scalable education can be.
Humans can have hundreds if not thousands of human-to-human (or human-intermediary-human) interactions a day.
Caring for those kids when they need it - a sibling comment also mentions education/ideas - leads to adults that hopefully have thousands upon thousands of better interactions in future. Better for them AND better for the other humans in the society they live in.
What most don't understand is that the economy IS us caring for each other. When you go to a restaurant when you are hungry, or a store to get what you need, or a hospital when you get sick, you are getting care. Virtually most people are taking care of other people. And yes it doesn't scale because it takes all of us to care for each other.
> What most don't understand is that the economy IS us caring for each other.
But when those businesses we seek care from scale, the system is no longer closed.
A portion of the care I give or receive is siphoned off and sent to shareholders or a wealth business owner. When caring happens through capitalism, a portion of our care is depleted with every transaction.
It's an interesting conflict. As the businesses scales, small losses which would be acceptable in a smaller operation will scale as well. Maybe a mistake people make as they scale is being too quick to give up the extra couple french fries.
Regarding caring for children, for much of the 20th century it was common for women to have half a dozen children or more. The children got less attention from their parents than a single child would, and younger children got some care from the older ones. Most turned out OK.
This should be a crucial realization for anyone out there trying to establish worthwhile intimacy with friends or anyone else as an adult. If you use the idea of scaling in a more abstract sense, you don't get to relentlessly pursue your personal career ambitions AND come out with substantial personal intimate relationships for free. It takes deliberate time and attention to cultivate a worthwhile connection with someone, whether it's your kids, or your parents, or your friends, and that's going to come from the few hours you get after work or on the weekend, or it just simply won't.
This is already very apparent to anyone who still has friends and family back home, wherever you went to school or went to grade school. If when you visit, you tell everyone you're available, you're going to give everyone a small scheduled fraction of time and then hurry yourself off somewhere else, making no more than a shallow appearance. But if you only tell the people you know you can for sure spend a good uninterrupted chunk of time with, then it'll be wildly better
Another non scaling field is making houses ready for the energy transition. Here in the Netherlands there is a lot of uncertainty and distrust which requires an almost one-on-one approach for each (owned) house. Only powerful neighborhood initiatives can do this and do well.
Yes - to me the OP means solving issues ahead of time.... create the vaccine 1x or treat the virus causing the issue millions of times.
I have spent enough of this year injured due to my own adventure sport aggressive mis steps. I was MUCH less productive during this period than before or now due to injury.
Had I not needed to deal with that, is the most productive self and that has a exponential effect society.
Interesting maybe, but also one that lacks sources. It is entirely possible that this passed by me and I just didn't catch the thing mentioned in the blog post. But, I also can't find much in the way of any reference to it online. Not even a hint using various search terms and combinations as mentioned in the blog post.
It very much gives the impression of it being a story made up as a vehicle for the main point they are trying to make.
Things that scale can have a big multiplier, so to say. The problem is, more often than anticipated, that multiplier, rather than being large, ends up being considerably less than one.
Whereas work that doesn't scale always has a multiplier of 1, so its always useful.
I have what I think it's a very good article on the economy of care - making exactly this point and others, but it's in the dungeon of peer review for more than one year. And the reviewers do not even answer my emails.
Depends on what you mean by "care for". Calling your parents a few times a week to make sure they're doing OK and dropping by on the weekend doesn't take too much time and effort. But as people get older they need more and more care. Caring for one person with dementia or other similar problems that comes with aging is for all intents and purposes a full time job.
And eventually if you can't afford to become unemployed to do it or pay full time caregivers, you need to move them to some kind of care home where there is minor scaling effect. Being housed together, the residents can share caregivers since most do not need continuous help.
A common arrangement is a board and care home with about 4 residents and 2 caregivers who work mostly non-overlapping shifts, and one sleeps onsite to (hopefully) be able to handle overnight care needs.
A larger place can scale a bit better. E.g. 10-20 residents can have 5-10 staff on various shifts. But some staff could be cooks or handle cleaning while others focus more on the residents' needs. And at this level of staffing, they can manage to have an overnight shift with someone who remains awake to keep an eye on things, as well as probably having other(s) sleep onsite to be on call to help with bigger events.
I agree with you, but I read the article as saying you can't care deeply about more than one person at literally the same instant. Your attention is directed to one or the other.
But I think even that's not literally true e.g. the social worker could make dinner for all four kids at once. And probably converse with all four of them while doing it!
But, I think I agree with the broader point that care doesn't scale, even if it does scale slightly greater than 1.
Horizontal, not vertical scaling is what you need here.
Even the college-socialists, at least when they're talking about climate change, realize that the best we can do individually is save a few bags of CO_2 here and there, but if everyone in the world did this then we'd have a fighting chance.
Or consider the charity ads with lines like "if everyone reading this poster donated the cost of a cup of coffee a week ..."
We can care deeply for one person, or perhaps two or four. We can look out for a couple of coworkers. We can cultivate 5 or so deep and meaningful friendships. If everyone did this then we'd have improved the world a lot, at scale.
healthy society only work if most people are virtuous and take care of themselves and their families. The cost to care for the neglected and broken isn't sustainably if its more than a tiny percentage of the population.
4 people taking care of 4 kids 24/7 in 24 hour shifts. From article:
> To get that individualized care, though, they had four social workers and four children. One-to-one. [...] But you couldn’t stray that far from one-to-one without changing the nature of the experience, without industrializing it to the point that individual care is lost.
I don't think you need the ratio of worker:child to be 1:1 in order to provide 1:1 care.
The alternative might be 20 social workers taking care of a group of 20 kids. It's the same ratio of workers to kids, since no 1 worker will get to deeply know individuals in the group.
I agree 1:1 is confusing and not totally accurate but it's fine for illustrating the point.
Well 1-1 care for any given child at an average of 25% of the time. Which for social work is probably better than most alternatives, yet not as good as having a parent per one or two kids.
Anyway, I don't mean to nit pick. Everyone has to know their limits, and I'm sad to admit that I found I can barely handle two kids with two adults. And families managing 5+ kids strike me as over natural+healthy limits, unless they've a large extended family (who have capacity to help).
There are 4 workers taking turns looking after 4 kids. So while at any given time 1 worker is looking after 4 kids, you need 4 workers to cover all the shifts. Thus one-to-one
That's a very odd framing. So it works out to one worker per one shift/day? Wouldn't that be true if there were 10 or 20 kids yet still 1 worker per shift?
It muddies the point, because having 1 worker at a time (watching 4 kids) isn't really 1-to-1. And doing 24h shifts means kids have a different caretaker quite often, which complicates conflict resolution and other things that may span days.
Regardless, it's probably the best they can do and likely far better than orphanages with 20+ kids per adult. So the core message about scaling does stand. Even if the ratio described is actually worse and less scalable.
> Adults often come to see small-scale solutions to major problems as childish. Yeah, you could make a couple of sandwiches for the hungry—but there are billions of people who need better access to food. Maybe your effort is better spent working on solutions that can scale.
Much of this essay is baffling to me.
From 2022 to 2023 the fed funds rate was jacked up. The aim of doing this was to, among other things, drive up unemployment, so that more working class people working in supermarkets and the like would become unemployed, and to increase food scarcity for their families. The rate rise affects us as well, with tech hiring somewhat dead since late 2022.
Looking abroad - the International Criminal Court charged Netanyahu, Israel fires on and invades UN bases in Lebanon, Israeli television broadcasts Israeli soldiers raping in Sde Teiman (go look on YouTube for the footage) as rabbis and Knesset MPs swarm to defend them. Gazan children starve as European countries block weapons being sent to Israel. In the US, Biden sends troops abroad and Israel weapons to further the slaughtering, which has spread to the West Bank, Yemen, Syria, Iran and Lebanon. Also, the US vetoes at the UNSC effectively help block Gazan children being fed as they starve. Kamala Harris backs Biden and vows to continue arming and funding Netanyhu doing this, and Trump is even more belligerent. So Americans elected the person enabling this and over 98% who vote will vote for a candidate doing this.
It is not a lack of care or attention to Gazan children, Americans, or 98% of those who vote are paying attention to Gazan children and are trying to starve them - or at least are willing to trade a specific tax cut or whatnot to enable their starvation.
There's nothing about lack of individual or scaled care - the vast majority of Americans work for the opposite - to continue the famine.
Going back to the point of scale - the <2% of people not voting for candidates arming Israel and continuing the Gazan famine are working together as a mass movement and at scale and many for, as the essay mentioned, "socialism", because this <2% has to coordinate and work together against the 98% who are actively pursuing the famine in Gaza, or who are neutral about it and willing to trade support for it for a tax cut and such.
Gazan children don't starve because Americans don't pay individual or scaled attention to Gazan children. They starve because 98% of Americans will vote for someone who works to starve them. It is what the vast majority of Americans are and what America is. And works for domains outside Gaza - like unemployment and the fed funds rate mentioned.
So when the author says care "doesn't scale", they obviously mean "you need a one-to-one ratio of caretakers", which I fully agree with. But what they're also accidentally doing in the process is explaining why creating bigger teams with bigger hierarchies and structures does not appear to increase the efficiency of care.
Some projects do need big teams with hierarchies - even in healthcare. Effectively responding to a pandemic comes to mind. I suspect it's when the core problem to tackle most naturally breaks down like a tree - a hierarchy then mirrors the way the problem breaks down. For some projects, like general homecare, the efficiency sweet spot is a flat structure of autonomous individual teams, because it doesn't scale beyond those teams anyway.
And just like the author concludes, I find that there's something comforting about that.
[0] https://en.wikipedia.org/wiki/Buurtzorg_Nederland
[1] https://www.youtube.com/watch?v=SSoWtXvqsgg