There's more to the Cuban embargo than meets the eye. It is true that the Southern Florida Cuban exile community wields a disproportional amount of influence. Florida is almost equally divided between Democrats and Republicans, and is a big state in terms of electoral votes; so when a sizeable block like the Cuban exiles votes a certain way, it can tip the balance.
However, that is not the entire story. If we (US) were really that concerned about the lost property of the Cubans expelled by Castro, we would also look inward and ponder the fate of the British supporters kicked out in 1776; the KMT supporters kicked out by Mao; etc.
If we can trade with China, Russia, etc. then there's no reason we can't trade with Cuba. In fact, the opening of the borders with USSR is often listed as one of the key factors in bringing it down; so why not do the same with Cuba?
The US figure reflects very long careers; late retirements; investment in large teams of trauma specialists due to high war, car crash, and gunshot wound rates; a high percentage of women physicians working part time; and a high concentration of expensive specialists with no documentation that they improve outcomes and paid for by large federal government subsidies.
The actual amount of primary physician and general surgery time available to Americans is very low compared to other countries with similar numbers of doctors. Most countries also allow as many as half the cases administered by fully licensed doctors with 12-20 years of post-secondary schooling in the USA to be handled by nurses and pharmacists. Prescriptions for sniffles or heartburn, basic non-controlled medications, simple physical assessments, and vaccinations are handled by professionals the USA would consider nurses or pharmacists or unlicensed assistants in most first world countries. In the USA those jobs take the time of physicians.
And that is the top reason, among many other unrelated ones, that health care is so much more expensive in the USA. US doctors are fewer and have more responsibilities and thus must be paid extraordinarily to work very long hours and not retire at the usual ages or else some must go without care. It's not an accident; medical societies have blocked medical school expansion for decades until recently as the population grew.
Cuba, on the other hand, appears to be counting nurse practitioners as physicians. That's fine to do because they're highly qualified, but it makes the numbers not comparable across countries.
> It's not an accident; medical societies have blocked medical school expansion for decades until recently as the population grew.
Sort of. There are a lot of very common misconceptions around this.
The AAMC (not AMA!) limited the number of medical school students until about ten years ago, at which point they announced an explicit goal of expanding the number of graduates from medical school.
However, this doesn't mean anything in practice[0], because the bottleneck isn't the medical school graduates - it's the residency programs. As a medical school graduate, you have an MD, but you are not actually qualified to practice medicine. That requires usually four years of training (minimum), plus several more for various specialties.
These programs are costly to run, and so hospitals that offer residency programs are funded by the federal government to do so (through Medicare). The only way to expand the number of practicing physicians in the US is to skimp on quality during training (which nobody wants to do), or to increase funding through Medicare (which nobody wants to do.
> US doctors are fewer and have more responsibilities and thus must be paid extraordinarily to work very long hours and not retire at the usual ages
They also have to be paid a hefty amount to pay off massive debt. If you see an attending physician in his 30s (or even 40s), even if he's making a respectable amount of money, there's a good chance he still has a negative net worth. The level of debt of course varies by location, specialty, and quality of education, but it's rather misleading to look at an e.g. $200K/year income for a physician and compare that to the equivalent amount in the tech industry.
In this case, the bureaucracy eventually overcame institutional resistance of the wealthiest professional Americans to reform of a system that limited doctors and thus vastly expanded their incomes. I expect that same government and institutional bureaucracy to eventually increase significantly the residencies, but it will move in that typical slow motion of bureaucracy eventually doing good.
When it eventually adds to our production of new doctors, it will have a bigger impact than ten Obamacares or single payer plans or HIPAAs.
The debit of American medical students is as legendary as the vast incomes of doctors, both wildly out of proportion to the rest of the first world. Hazing practices during residency are also still crazy, though much reduced after glacial bureaucratic reforms.
I don't know if there's any better idea there than to hire and appoint good administrators to plan better. A violent revolution like the one in Cuba that built a better health care system seems too extreme.
Licensing practice is mostly at the state level (aside from certain DEA pharmacy regulations). States that promote licensing, liability, and practice regulations that encourage more pharmacists and nurse practitioners to practice more independently have much lower overall health care costs (also dental hygienists, opticians, &c).
Your pharmacist is part of a system that got your health care right this time.
yes, good points. It seems that Cuba has become something of a health resource for other countries in Latin America, where there is much less access to doctors (and NPs) than in Cuba. Middle-class people in those countries travel to Cuba for health care. At least that is picture I get when I've spoken to a bunch of people in the region over the past few years. I hear about a number of people travel to Cuba, others got to Chile, and almost no one can afford to go to US to get treated.
At the south of the continent, it is far more common to travel to Argentina, to get free health care. As Argentina has a large public health system, (that has been gradually loosing a lot of quality in the past 20 years) it's common that poor people from Bolivia, Chile and Paraguay travel and get attention for free in Argentina's public hospitals.
I highly recommend reading "Guide to the Perfect Latin American Idiot" which explain how dictatorships can pick a handful of indicators and elevate them to first-world levels while still making everybody's life miserable.
The indicators per se are not gamed. Instead, you select a few indicators like "Olympic medals", "life expectancy" (etc) and commit every resource of the country to them at all cost and without regard for everything else. The indicators you picked will show amazing and you can use them to justify your ideology. Pretty much like a SEO hack, they are hacking public opinion (looks like it worked on you).
Japan has a lot of welfare fraud which inflates their life expectancy numbers. It also has a fairly low level of income inequality relative to their per capita GDP which helps things. (AKA few poor people.) And to top it off universal healthcare which significantly increases a population’s life expectancy.
Edit: Arguably the high food prices reduce obesity which is really important.
> Arguably the high food prices reduce obesity which is really important
I don't think it's the food prices, because the cheapest foods tend to be the ones that lead to obesity (among other health problems). Fast food burgers and white bread are not expensive here in Japan, but fresh fruits and vegetables are.
I think there are many factors, but the pretty great universal health care system has to be a big one. As a working adult in Tokyo, I receive tons of preventative care and thorough annual check ups. It's cheap, and virtually all health care for my kids is completely free until they turn 15.
The lack of equal access to health care in the USA is almost certainly a reason that poor people die 5 years earlier than affluent people[1]. I would guess good access to health care is a big reason that Cuba does so well on that front, despite its obvious economic obstacles.
my experience in Japan is they eat more vegetables more often. I think this helps in so many ways. They also eat too much salt, smoke too much and probably work too many hours, but apparently the vegetables and great tea are doing something right.
You're focusing too much on Japan. Japan was just an example. This number that Cuba excels on has little relation to health. So what is the point that Cuba has this great number? It's just a number.
Canada, which has even fewer physicians, has a life expectancy only 2 years less than Japan.
Ehh, just pointing out that having more doctors is not that important from a public heath perspective. Plenty of people in the US for example only really see/need a doctor at birth for vaccinations and then suddenly die in there late 80's or early 90's. For much the same reasons that some people actually lived into there late 90's 2000+ years ago.
If nothing breaks there is little need to fix anything.
Comparing statistics from small, homogeneous populations to statistics from larger, heterogeneous populations is fraught with peril. Doubly so for metrics on education and health. (I like to call this the Scandinavian Fallacy)
As engineers we would never compare uptime statistics from a small, niche startup serving a couple thousand people to uptime statistics from, say, Google. Why do we immediately ignore these principles outside of engineering?
small, niche startups usually have poor uptime on their services. we commend them if they have a year up (hell, if they still exist after a year), but criticize Google for being down once every few years.
therefore, if you want to bring in the analogy of startups and Google, it should be even more impressive that small countries (viz. people in small countries, viz. Cuba) live longer than Google (viz. people in large countries, viz. United States).
No, because the specific topics at hand are not comparable (service uptime and, say, physicians per capita). The analogy was meant only to illustrate the fact that you cannot (should not) directly compare statistics from such different entities without attempting to control for the variables.
What does the heterogeneous populations of the US have to do with it? Maybe when it comes to life expectancy you're right, because genetics is a large factor in that. But when it comes to literacy rate and the proportion of physicians that's entirely down to government policy.
Do you really think the US couldn't beat Cuba on those metrics if they decided spending money on those topics was more important than spending money on the military?
I believe the point that is being made is that the US was designed from the outset with the idea that diverse factions compete against factions, and that was the only way such a large and varied democracy could work. See Federalist 10.
Citizens of the US have wildly varied views about what it means to be a good American, and we often have greater cohesion to groups such as race or state, etc. Just about the only thing we do agree upon is when there is an existential threat to the country, hence military growth over time.
Cuba or Norway have much less divided societies to govern, and Cuba's leadership is so small that it can focus on specific issues in a way US politics cannot.
Sure, that's a factor in US politics. I'm just saying that has nothing to do with having a heterogeneous population as the parent was claiming.
The parent was comparing the proportion of physicians in Cuba v.s. the US and claiming that the US couldn't match Cuba because of its heterogeneous population.
Now if you look at the WHO report on density of physicians[1] you see first-wold countries like Japan and Canada ranking below the US on the number of physicians per-capita.
I think numbers like these have a lot more to do with how the health care system is structured than the sort of population you have. E.g. maybe nurses in Japan and Canad have a bigger role in health care than the US.
Huh? I'm a big proponent of eliminating agrochemicals, but you've set up a huge straw man here: No one is arguing that agrochemicals are "necessary" in the sense that agriculture is impossible without it (indeed, millennia of experience prove otherwise). Rather, the rationale is that they allow us to increase productivity for the same input of acreage and man-hours.
I'm not saying that agrochemical proponents are right (I've heard that crop rotation is as good or better than synthetic fertilizers, though it's hard to argue against the labor efficiencies of huge tractors and lots of pest/herbicides), but the simple fact that agriculture is possible without agrochemicals doesn't disprove the argument that it might be better with them.
This article, while making good points, is written with a slant: to sell a book.
Broadly speaking, Marissa's big weakness is that she's a tad naive. She thinks too logically, and believes that if she has a system in place, it will be followed in spirit by logically-thinking people like herself. This may have worked in Google, because Google was heavily engineer-focused during its early years; but Yahoo is different: it's a (nearly) 20-year old company, with many people who are lifers. They have honed their skills at survival; and as one middle manager put it to me, "I've seen lots of CEOs; she'll also be gone, but I'll still be here". She can come up with the best laid plans; but the middle management will do what it thinks is in its best interest. And they look out for themselves, always.
One of the major reasons why she embarked on the acquihire spree was to do an end-run around these people. She knows that if she has to count on them, she won't get anything done.
This is also why she initiated the 'stack ranking' process. Her goal was noble: to weed out the underperformers. And yes, they did weed out a fair bit of deadwood. But the elephant in the room went untouched: the middle managers. There is no accountability for them! I've seen people join a manager's team and quit (or switch) within months; by any objective evaluation, he should have been fired a long time ago. And yet he survives, because he's been there a long time and knows how to play the game. I have also seen stellar performers quit because their manager was not willing to go to bat for them in the calibration meetings, so they always ended up with "achieves" (which is average, and forms the bulk (70%) of the ratings).
This article cherry picks mistakes; but who amongst us hasn't made a mistake? The HdC hiring was a big mistake, for sure. But once again: she was being naive, and thought he could deliver, when all he was doing was blowing smoke up her ass. She still can't get her mind wrapped around the smoke-and-mirrors that is sales, which is why Sales is still suffering. She needs a powerful, no-holds-barred Sales head, so she can go back to being a Product person.
People in HN can diss her all they want, but I was at a trade show, and half the outfits (startups) I talked to wanted to be bought out by Yahoo. Money talks; and right now she has gob loads of it that'll give her a lot of rope.
I was at Yahoo briefly (8 months, never again !) and middle management at Yahoo was absolutely the problem. A single SVP had 20 VPs and around a 100 Directors and Senior directors most of whom were lifers and 'career bureaucrats'. Less than 1% would be employable at another tech company.
The status quo at Yahoo before Marissa suits them just fine and they will always find ways to twist any effort from the top to their benefit.
QPRs are a classic example. It was intended to weed out under performers, but as the parent comment pointed out, the middle managers were the under performers. So they just made QPR evaluations into a secret, subjective process which they then used as a club to beat engineers who dared oppose them. Worked out pretty well for them, not so well for Yahoo. Anyone who was worth a damn found a new job pretty quickly.
But it happens at that level. You can't seriously expect anyone to go through life mistake-free. Look at Google's mistakes, for instance. How much money have they thrown after Google Glass?
If you hire someone that's a borderline con-man and lose $100 million dollars without making the most basic attempts of vetting him for the position, that's not an honest mistake.
Yahoo's problem is (and always has been for quite a while) bad middle-management. (See my earlier posts; like Punxsatawney Phil, I come out only on occasion). These middle MF'ers have been running the company into the ground with their lack of vision, petty infighting and sheer idiocy. This has led to MM and her cohorts to basically not trust the lower half of the company.
So the rank-and-file are paying the price for MM's inability to weed out the rotten layer of middle managers.
Instead of cracking down on the WFH crowd, she should crack down on middle managers.
1. Get rid of any manager who has less than 8 direct reports
2. Anyone of the level 'director' or above must justify their positions (there has been severe rank inflation in Yahoo in the past)
3. Anyone who has been at Yahoo for more than 2 years and in a position of authority must be forced to analyze why their property declined over that period, and what they could have done to avoid it. There is too much of 'shoot and scoot' at Yahoo: managers jump on any hot item, botch it up and then move on
From what I can tell as an outsider: Loeb thinks the company is valued at $18 - $20 range or possibly higher (thanks to its Asian assets). If he can drive down the price, he can load up some more.
Once he gets a significant voice in the company (via more board members), he will force them to sell their Asian assets, quickly driving up the price to the desired range. Having loaded up at around $15 and assuming it hits $20, you're looking at a quick 33% ROI. That's what hedge funds do; they don't usually invest for the long haul.
After reading this rant, I'm starting to think that all software companies become like this after a while. Extrapolating, I'm guessing Google has 2-3 years to go before they are ruined...
Yahoo has over 18,000 employees (and not 14,000). The extra 4,000+ are contractors. This is a scheme that the bureaucrats at Yahoo figured out pretty early: announce layoffs, and then bring the employees back as contractors. "win-win for everyone", they joke.
I really, really hate to see people get laid off; But this was a long time coming. As an ex-Yahoo, I hope they cut out the thick layer of bureacracy thats sucking the oxygen out of that place. Ever seen the algae that suffocates a pond? The middle managers there are like that algae. And then there the VPs: at last count Yahoo had over 200 VPs. Really, What do these fuckers do!?
If Yahoo can become more engineering-centric, it has a chance. If the middle managers (and VPs) win out, stick a fork in it; theres no hope.
>And then there the VPs: at last count Yahoo had over 200 VPs. Really, What do these fuckers do!?
These folks simply have goofy titles.
I used to have one of the world's largest banks (by AUM) as a client. They had over 200 "Vice Presidents" in one building, as it basically was their preferred title for "manager".
Bank VP is a different situation, most branches can not issues loans without a VP present- so there are many people with such title. There is standard and there no confusion that this is a high title in banking. Other titles like "Executive VP" are used to identify actual officers. That being said- I would still be interested in hearing if everybody at Yahoo is a director and/or a VP.
The managers always survived layoffs; the engineers, not so much. Has that changed now? probably current Yahoos can tell, but I imagine there a bit busy right now to post on HN.
I was curious too, and tracked it down to this. Only slightly more verbose than the quote!
But what experience and history teach is this, - that peoples and governments never have learned anything from history, or acted on principles deduced from it.
Excellent! Thanks. Interestingly, Hegel's argument is opposite to what the other quote says. The other quote implies that we could learn from history if we bothered, but we don't bother, so we never learn. At least that's how I read it. But Hegel's saying that people always try to learn from history and we should stop trying because it's impossible:
Rulers, Statesmen, Nations, are wont to be emphatically commended to the teaching which experience offers in history. But what experience and history teach is this, - that peoples and governments never have learned anything from history, or acted on principles deduced from it. Each period is involved in such peculiar circumstances, exhibits a condition of things so strictly idiosyncratic, that its conduct must be regulated by considerations connected with itself, and itself alone. Amid the pressure of great events, a general principle gives no help. It is useless to revert to similar circumstances in the Past.
During college I worked at a Midwestern regional supermarket, and they were employing similar tactics. No more full-time employees. Full-time implies benefits. Part-time employees will work the same amount for possibly even the same wage, but it costs the company a lot less.
However, that is not the entire story. If we (US) were really that concerned about the lost property of the Cubans expelled by Castro, we would also look inward and ponder the fate of the British supporters kicked out in 1776; the KMT supporters kicked out by Mao; etc.
If we can trade with China, Russia, etc. then there's no reason we can't trade with Cuba. In fact, the opening of the borders with USSR is often listed as one of the key factors in bringing it down; so why not do the same with Cuba?