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Noel Reid's avatar

well done, as always, thanks Roger

Edithatogo's avatar

" A good diagnosis points to a treatment. The Commission has measured something other than the disease and prescribed more visits. "

Funny, so topical. The irony of that specific metaphor, is that NZ Parliament parties appear to be effectively prescribing more visits, but doing very little to address supply, creating demand for a service which doesn't exist with no insights let alone plans on how to help. By focusing on monitoring rather than eliminating the regulatory barriers holding back new entrants, they’ve trapped Kiwi markets in a loop: more bureaucracy to treat the side effects of bureaucracy.

There is a specific and pointed example in both Australia and New Zealand healthcare: people are concerned about autism (https://rareinsights.substack.com/p/can-we-ever-know-how-many-autistic):

- The actual concern from parents/clinicians are to be able to access assessment and supports (e.g. schooling, respite care, etc.).

- The concern for autistic adults is typically discrimination / social inclusion.

But, Governments have heard, "let's help diagnose autism". And there's lots of people with an opinion, including many well-meaning clinicians who offer premium autism assessment services in private and may have a little cognitive dissonance around statement and management of interest. Policymakers are given ye old, "more with less", and try to figure out how to have high impact at low cost, often without understanding the domain let alone the specific issue, let alone the economic mechanisms available to them to influence. So, they've almost universally said (with one very notable exception, Peter Malinauskas, who is a very smart man dressed up as a street hustler), "why don't we screen for it more".

So policymakers fund more screening. It's typically in schools and early childhood (services like Plunket). And so more people are suspected to have autism, more people screen positive, the index of suspicion rises, and further converts latent into realised demand. Screen positive people are referred to health services, who have received no investment to handle increased referrrals. Funny thing is, a number of these policymakers are noted to have said things like, "The problem with healthcare is health managers", ignoring that they were often warned of the consequences but thought they knew better.

Peeps are referred to disability services who say, "we can't treat them until they're diagnosed". Then hobbiest policymakers come along and say, "let's help diagnose autism", and decide to introduce more screening... And so it goes.

Health is simply the language of my response, but it's analogous because whether one sits on the right and uses the language of business, or one sits on the left and uses the language of national provision of human services, these are complex systems where the problems typically have clear albeit dynamic causal models for which experts exist.

LLMs may well be a very useful policy governance tool to prevent the boom-and-bust of "truthy" policy design and political, but not understanding the causal mechanisms for complex, impactful and very expensive problems, means that more screening and monitoring will simply tell you more of what you already know, not how to address the issues.

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