

The Healthcare Diff - pbw
http://www.kmeme.com/2010/03/healthcare-diff.html

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azm
Neat use of development tools to illustrate a point. But, to be quite blunt,
very naive in the best case and quite stupid in the worst case. We can "ship
early, iterate often" in software because quite often it doesn't cost much
(certainly a naive way of putting it) to do so. However that paradigm breaks
down even in software when dealing with things like enterprise software or say
medical device software or FDA approved software. Guess what would happen if
the large scale infrastructure construction industry went with this model?

Think about what it costs for an organization to adapt to a new set of
regulations. A boatload of new paperwork needs to be setup, ordered, printed
and distributed, after a thorough analysis of the regulations and a whole long
process to determine documentary requirements. If software or electronic
records are used, those need to be updated. The new set of rules need to be
communicated to a large number of participating health care providers with
appropriate document and/or software updates. Each of those things needs to be
audited and certified. Personnel have to be trained to understand and comply
to the new set of regulations and potentially certified. There would be a
period of enforcement where nobody will quite understand the limits and those
limits would be tested and the legal system would then clarify those
regulations.

And that is just the tip of the iceberg. In such cases the massive one-shot
refactor gives you way more bang for the buck than not.

~~~
chrischen
They should write the bill in a programming language instead of English. Then
it won't be so tough to interpret it. :)

~~~
kgrin
They do... what you see there in the "4,000 page" bill is legislative language
- pretty clear code for a lawyer or legislative aide. On the other hand, the
Congressional Research Service puts out some pretty good nonpartisan "plain-
language" bill summaries (and for anyone who asks "well why don't they just
use those the laws themselves", ask yourself "why don't you just write code in
English" - they both have the potential for ambiguity).

Incidentally, I put "4,000 page" in quotes because it's a pet peeve... if you
actually look at the text, it's in 24pt font and giant margins - makes it much
easier to read and mark up around a table, but in no way approximates the
amount of text people envision when you say "X-thousand pages".

~~~
chrischen
Yea but if you compile it, wouldn't it be faster than being interpreted? And
the interpretor is also a human brain, which is much more error prone than a
computer.

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jackowayed
The "trying multiple approaches" point he makes at the end exists in America,
to an extent. It's called federalism. There can be substantial, though not
absolute, differences between the laws of the states. Different states value
different things, so some will try things before the nation as a whole is
ready. If they work, the nation can look to their experiences and try to
implement a nationwide plan that has all of those benefits and avoids any
pitfalls they experienced.

Examples: women's suffrage, universal healthcare, medicinal marijuana even
though it's federally illegal, physician-assisted suicide for terminal
patients, probably tons more.

~~~
jacoblyles
One problem with this system in practice is that the federal government is
already so expansive in terms of regulation and tax burden that there is not
very much room left for states to experiment in.

California and Texas are very different states by some measures, but there are
no states without Social Security, No Child Left Behind, the FDA, the War on
Drugs or the Patriot Act, all things that I would prefer to do without.

~~~
diN0bot
i'm curious about your qualms with the FDA and what you'd like to replace it
with.

~~~
jacoblyles
FDA liberalization is not exactly a fringe position among economists. The
basic argument is that the FDA may kill more people than it saves and may
hamper medical innovation in the long run. It's hard to measure
counterfactuals, but you can measure the costs of FDA regulation which are
huge, about 80% of the cost of a new drug. So the benefits of the FDA would
also have to be huge to justify its existence.

The arguments are out there if you are curious. You can find people that argue
the position better than I can on a Hacker News comment thread.

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biotech
He tries to string together two different points:

1\. The language used for describing a change in a legislative document is
verbose and difficult to understand. A simple "diff" of the two documents
would be a substantial improvement

2\. Because a developer tool (diff) might be useful in one specific aspect of
legislation, other development methodologies might also be useful.
Specifically, the short time to release, fast iteration strategy should be
considered for legislation.

The author has a good point in #1. In this century, we should be using tools
that make our lives easier. Maybe not the exact diff tool, although that would
be an improvement - but any move away from a prose describing the changes down
to the last comma is probably a good move.

Point #2 fails to hold water in many respects. First, the particular utility
of a tool like diff has little implication of the end methodology that should
be used. Second, even if everyone decided that lawmaking _should_ be more like
software building, the "fast iteration" methodology is not necessarily the
correct choice. Just because that may be a good way of building web-based
software, if you are building software for a space-station, a medical device,
or a nuclear reactor, this is rarely the accepted practice. Perhaps law-making
is more like developing these forms of mission-critical software systems,
rather than web search software.

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tumult
Imagine the legislators running a distributed version-control system,
exchanging diffs, pull requests, etc., with each contribution able to be
logged and credited to an author. This whole thing is actually a merge of two
branches in the health care bill source. Of course, our legislation is not run
by intelligent people trying to get things done as efficiently as possible, so
it's not done this way. In fact, if you can imagine the complete opposite of
DVCS (or even regular monolithic VCS) that seems to be pretty close to what's
going on.

Difficult to know who authored exactly what. Nebulous states of various parts
of bills at various points in time. Opaque language designed to shift
potential blame in the future if something goes wrong. Vestigial formatting
rules, incomprehensible phrasing (to those who would equate law with plain
English) and a high level of redundancy.

Question for lawyers: if law (as in legal writing) is written as a sort of
code built up over time based on past rulings and with concrete (or semi-
concrete) meanings in terms of what effects it's supposed to have, why do we
not get any 'comments' in legislative law? For example, it makes sense for a
contract between two corporations to not have 'comments' to go along with the
'legal writing code' -- you're using the contract against someone else, so
it's their job to decipher what effects it will have (right?)

But legislation isn't supposed to be used as a competitive chokepoint between
two entities, it's supposed to be something that people who are affected by it
(in the case of medical insurance reform, everybody) can understand. Reading
legal writing to me seems like reading source code without comments, and you
just don't give source code without comments to someone asking to read your
code unless you have a grudge against them.

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TrevorBurnham
This is something I spend a lot of time thinking about. Law and computer code
are quite similar in many ways, yet innovations in software architecture and
tools barely affect the way laws are written. No matter how much
"transparency" we have, legal text itself remains incomprehensible. And though
online distribution has managed to catch on, lawmakers don't take advantage of
any of the affordances of the medium--diff being a prime example.

If only law could be written in Python...

~~~
amock
Is there a reason you picked Python? Python seems like a bad language for
comparison since so much of it is checked at runtime. It seems like Coq or
Agda would be a superior choice for writing laws in.

~~~
Raphael
Republican congressman can't get enough Coq.

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ezy
This assumes the goal was/is clarity. Unlike software, people have a lot to
gain from being unclear in this case.

~~~
scotty79
But that is gain at the cost of people suffering from lack of clarity.

You could say same things about lack of clarity as you can say about
corruption. It's huge potential gain for some people but horrible waste of
resources to every one.

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pvg
_Instead of arguing over the one true solution on the basis of hunches and
intuition_

We don't. Imperfect as much of proposed legislation is, it's also thoroughly
researched, argued over, picked apart, dissected, analyzed and so on. Often
with a partisan tilt. The system for coming up with legislation is quite
adversarial. But it's not based on 'hunches and intuition'.

 _we should implement more than one approach_

A little principle of 'equality before the law' might really get in the way
here.

The process of writing and designing software is a relatively new discipline
and one in which significant, high-impact insights are being made and will
continue to be made. Given these bright flashes of success, the temptation to
apply software methodology to entirely unrelated fields ranging from law to
personal relationships is very high. It's best resisted, since it's usually
stupid. At a minimum, before applying it, ask yourself 'how is this not like
software' rather than starting with 'how is this like software'.

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drawkbox
I like the diff idea for many things in government data.

But the real physical world has much higher costs, ask the hardware
manufacturer that makes a chip that is not bought. Software has much easier
iteration properties. Hardware and physical changes or slow changing
society/process changes are much much harder to iterate. It is like writing
code on punch cards or having to make the entire computer.

I think there is a fair amount of experimentation, trial and error and more in
healthcare mainly private but also public. What we are seeing in congress is
what we all deal with individually and as group, it is just freaking hard to
get teams to agree on even a direction on touchy subjects and the larger they
get the harder it is. Resistance to change and posturing prevents faster
change, mainly because of that error side of trial and error and large doses
of groupthink.

We can't easily roll back changes in law, process, society as you can in
software. But I agree it is so bad right now we have to do some changes to see
what happens.

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scotty79
Nice thing would be to have automatically checked assertions, constraints so
help spot interactions between law to be introduced with existing laws.

All that would require to parse language into what it actually means. So we
will probably have to wait for strong AI to see any significant improvement in
lawmaking.

But as author of this post postulates using readily available tools for
dealing with complex text documents today also would be nice.

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dvk
Except, in this case, trying out approaches and alternatives means treating
humans as the subjects of the experiment. Some may get degraded experience,
others may complain unnecessarily.

Furthermore, the problem in this particular instance there is a lack of
agreement on the objective metrics by which to measure and optimize. ($Cost,
%Insured, Access, Availability of Advanced Treatments, Eligibility for
Procedures, Choice of Providers, etc.)

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a-priori
The idea of experiment-driven law is an interesting one that should be
explored. I'm reminded of a TED talk I watched recently about "charter cities"
that have experimental legal and economic policies.

<http://www.ted.com/talks/paul_romer.html>

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dca
I was hoping he had hacked together some code to apply the diffs to the text
to make it more readable.

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Mz
My opinion (as someone who nearly died and has gotten a lot healthier):

The real problem is that study after study after study shows that diet and
lifestyle are major factors in health outcomes for every single major deadly
medical condition. But doctors are in the business of selling drugs and
surgeries. Telling people to eat right and live right isn't "sexy" (in the
advertising sense of that idea - basically exciting, attractive), it doesn't
win Nobel prizes, and it is highly unlikely to get you headlined as some
"hero" who is saving lives. (In fact, it seems to me that telling people to
live right is more in line with what most religions try to do than what most
doctors try to do. Of course, the problem with that is religion then has too
much baggage about "sin" and the like -- ie you are told in essence "You are
going to hell and morally bankrupt" rather than "That activity exposes you to
disease" or "It will clog your arteries".)

So they frame the problem as "healthcare", then work on bills about "medical
care" instead of actual healthcare, and basically miss the boat entirely. You
aren't really going to make the nation healthier by getting them better
designer drugs and manipulating who pays for what. You also aren't likely to
bring down costs that way. Most bills of that sort shift costs rather than
reducing them. Actually getting healthier is the only humane, effective means
to genuinely reduce healthcare costs. And getting healthier is mostly about
taking proper care of yourself to begin with rather than eating crap, not
being active, and then running to the doctor for a new pill for every new
symptom brought on by your bankrupt lifestyle.

Of course, that sh*t don't sell. (Yet. Maybe I will find a way around that
problem. :0 )

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gills

      git diff-and-fix-hubris-and-corruption-but-oh-wait-not-really government/legislation/intentional_obfuscator.rb
    
    ?

