An epistemic concundrum

Tyler Cowen links to an interesting thread I had seen on Twitter, Here’s what it’s like when your kids get sick in Québec right now – a long thread.  Click through to the distressing thread.  This is an epistemic challenge.  Everyone everywhere complains about the terrible health service they receive.  And in some cases it is almost certainly true that the complaint is fully warranted.  But how can one know with any confidence.   

Even in a relative constant and contained environment you get massive disagreements about basic facts.  On Next Door a few weeks ago in my neighborhood, someone posted about some bad experience in a local hospital and asked for recommendations about which other hospitals in the area provided better service.

The discussion was fascinating in that it was voluminous, heated, and contradictory.  Ten people were in love with Hospital X and ten hated it, both groups offering detailed examples of excellent or disastrous service.  Same for Hospital Y and Hospital Z.

Everyone seems, as far as a healthcare is concerned, to be either the unfortunate victim or the lucky beneficiary.  

It is of course necessarily true that across a random population of users, there will be variability in service provision but this bi-modal distribution of hatred and adulation makes it difficult to interpret whether the opinions being expressed are in any meaningful way related to the actual quality of service being provided.

I come across enough concerning accounts to believe that in Canada and the UK, and possibly also in Australia, that the national health systems might be in some spiral of dysfunction.  How and why remaining unclear.

Maybe in some other countries as well but not nearly as clearly.  

And maybe none of them are in distress.  

It is simply difficult to objectively and empirically conclude much that is meaningful about these critical but immensely complex aggregation of systems and how they actually achieve public health and/or provide public health service adequate and appropriate to their consumers.