In reading Economic media one hears a lot about "American exceptionalism". The context is usually some author bemoaning why the rest of the world should be like America. It rankles me a bit.
It is not that we in the United States don't have much to be grateful for. Despite the often crass dysfunction of our politics and hyper chattiness of our media, we have freedoms difficult to obtain in many parts of the world, we have many of the most dynamic businesses and our overall standard of living, although it has slipped a little bit, is still one of the worlds highest, and is certainly the highest for a country of our size and population.
What rankles me is that usually the people touting "American Exceptionalism" do so in support of their notion that if people work hard they will be successful, so all the poor folks of the world (and the US) need to do is just work hard and they will be successful. Certainly success without hard work is difficult. But who works harder than slaves? Who works harder than garment workers making pennies a day in Bangladesh? Who works harder than the migrant farm workers traveling from low wage job to low wage job.
What separates us from the rest of the world is the extraordinary head start we gained when our ancestors populated a continent depopulated by the diseases they brought with us, and by our ability to push aside native populations with overwhelming technical superiority and use the oceans that insulate our continent from opposition or aggression from the old world that match our technical development.
For 200 years we spread across the country, the government giving free land to any citizen willing to live on the land and improve it. We have had it so easy. We never experienced the situation where there is not enough land to feed our population. We never experienced having most of the population dependant upon landlords who owned all the land and forced us to work for what they chose to pay us. As a result we have never been seriously tempted by the desperation that drove revolution in France or Russia or China. Then within the last 100 years virtually all of the Eastern Hemisphere suffered massive damage and dislocation from World Wars that, while they cost us some money and the lives of many young men, left our infrastructure and homeland largely untouched.
What I hear when someone start using the term "American exceptionalism" is usually a combination of arrogance and complacency. The context always seems to suggest we are special people, smarter and more hard working, than all those less successful people than the world. It is usually in the context of disdain for social safety nets - they are a nuisance at best and probably un-American. That pundits and leaders of big Corporations that have scrambled to the top of their field must be wiser than the rest of us so we should do what they think is best.
Its only a phrase, but to me, when someone starts talking about 'American Exceptionalism" I am immediately suspicious the persons view of the world is infected by the complacency of personal success, and their notions of what we need to do for a stable, free and prosperous society are probably more likely to lead us down the road toward a society that is just an updated version of feudalism.
Sunday, May 11, 2014
Wednesday, May 7, 2014
Why do Organizations Become Bureacracy's
The most valuable organizations are begun to solve a problem.
Ideally governments organize agencies to solve perceived problems.
Ideally businesses are created because the organizer percieves a need in society and moves to fill that need.
In reality some organizations solve nothing other than the organizers desire to extract money from others to his benefit.
However, even the most valuable organizations, organized for all the right reasons, tend to gradually decay into inefficient bureacracy's.
Decaying government organizations take up space and suck up money while providing little benefit.
Decaying business entities either die or find new ways to extract money from customers, or government that provide no real benefit to society.
Here are some things I think are true:
The longer an organization exists the more resistant it becomes to new ideas. This is a reflection of a fact nueroscience is validating that people become more resistant to change as they get older, unless they conciously work at rethinking their beliefs, or some event occurs that causes massive emotional trauma that relates directly to what they do in the organization. The more successful an organization becomes, the more likely it is to allow that success to validate and harden ideas of what the organization should do.
New people who are hired into existing organizations tend to be hired, not for their problem solving ability, but for their rote learning ability - their ability to adopt the existing procedures they learn as new hires. New hires that are problem solvers will self select themselves out of the company after a time to go find a place that allows them to solve problems. But the rote learners are comfortable with the company. So over time the company roster fills from the bottom up with rote learners who may be uncomfortable with trying out new ideas, or who are more focused on their own position in the company than the success of the company.
Ideally governments organize agencies to solve perceived problems.
Ideally businesses are created because the organizer percieves a need in society and moves to fill that need.
In reality some organizations solve nothing other than the organizers desire to extract money from others to his benefit.
However, even the most valuable organizations, organized for all the right reasons, tend to gradually decay into inefficient bureacracy's.
Decaying government organizations take up space and suck up money while providing little benefit.
Decaying business entities either die or find new ways to extract money from customers, or government that provide no real benefit to society.
Here are some things I think are true:
The longer an organization exists the more resistant it becomes to new ideas. This is a reflection of a fact nueroscience is validating that people become more resistant to change as they get older, unless they conciously work at rethinking their beliefs, or some event occurs that causes massive emotional trauma that relates directly to what they do in the organization. The more successful an organization becomes, the more likely it is to allow that success to validate and harden ideas of what the organization should do.
New people who are hired into existing organizations tend to be hired, not for their problem solving ability, but for their rote learning ability - their ability to adopt the existing procedures they learn as new hires. New hires that are problem solvers will self select themselves out of the company after a time to go find a place that allows them to solve problems. But the rote learners are comfortable with the company. So over time the company roster fills from the bottom up with rote learners who may be uncomfortable with trying out new ideas, or who are more focused on their own position in the company than the success of the company.
Friday, May 2, 2014
Money and Politics - Koch Brothers
The large part of the stratagey of the Democrats for the coming mid-term elections seems to be to focus on the Koch brothers, the Texas billionaires who are pouring tens of millions of dollars into funding various conservative causes.
The Democrats argue that vast sums of money coming from a few candidates undermines democracy, particularly when coupled with the Supreme Court decision that Corporate campaign contributions cannot be regulated by Congress.
Republicans (and the Republican dominated Supreme Court) argue this is a freedom issue. People who work hard to gather wealth should be able to use their money to advance their political goals in a free society.
There is some validity to both positions of course. But both positions also mask fundamentally wrong principals.
The Democratic position, that rich folk should be banned from spending beyond certain minimal limits (or that longtime liberal notion that Government should finance campaigns) has a couple of serious policy flaws:
1. It unquestionably undermines the freedom of rich folk. It is in essence discrimination by government against a class of citizens (the folks who value money above all else),
2. It also is the lazy solution that has characterized totalitarian thinking down through history. If you don't like something, or want to increase your power at the expense of others, limit their ability to participate in politics.
On the other hand, the Republican position focusing on individual freedom ignores a fundamental requirement of a functioning democracy. Honesty. Rich folk who want to support various political causes have a dizzying array of ways to hide where the money is coming from. The can use corporations they control. Or set up shell corporations and run the money through a whole string of them to hide where the money is coming from. They can set up organizations with names designed to suggest they are supporting exactly the opposite of what they are in fact trying to accomplish.
In an ideal world, we should ban an organization that is created under an authorization of government granting special priviliges, such as Corporations, from contributing funds to politics, but we should not ban individuals from contributing as much as they want to political causes, as long as contributions are publicly disclosed in a timely manner.
For those of us who are not rich our power to counter money from rich folk depends on our willingness to factor who gave that money, and why they are doing it, into our decision making when we go to vote. If we do our homework rich folks money should not be able to sell us on something we don't really want.
In an ideal world.
The Democrats argue that vast sums of money coming from a few candidates undermines democracy, particularly when coupled with the Supreme Court decision that Corporate campaign contributions cannot be regulated by Congress.
Republicans (and the Republican dominated Supreme Court) argue this is a freedom issue. People who work hard to gather wealth should be able to use their money to advance their political goals in a free society.
There is some validity to both positions of course. But both positions also mask fundamentally wrong principals.
The Democratic position, that rich folk should be banned from spending beyond certain minimal limits (or that longtime liberal notion that Government should finance campaigns) has a couple of serious policy flaws:
1. It unquestionably undermines the freedom of rich folk. It is in essence discrimination by government against a class of citizens (the folks who value money above all else),
2. It also is the lazy solution that has characterized totalitarian thinking down through history. If you don't like something, or want to increase your power at the expense of others, limit their ability to participate in politics.
On the other hand, the Republican position focusing on individual freedom ignores a fundamental requirement of a functioning democracy. Honesty. Rich folk who want to support various political causes have a dizzying array of ways to hide where the money is coming from. The can use corporations they control. Or set up shell corporations and run the money through a whole string of them to hide where the money is coming from. They can set up organizations with names designed to suggest they are supporting exactly the opposite of what they are in fact trying to accomplish.
In an ideal world, we should ban an organization that is created under an authorization of government granting special priviliges, such as Corporations, from contributing funds to politics, but we should not ban individuals from contributing as much as they want to political causes, as long as contributions are publicly disclosed in a timely manner.
For those of us who are not rich our power to counter money from rich folk depends on our willingness to factor who gave that money, and why they are doing it, into our decision making when we go to vote. If we do our homework rich folks money should not be able to sell us on something we don't really want.
In an ideal world.
Wednesday, April 30, 2014
Finite and Infinate Assets
One of the oddities about the Federal system of taxation is the way it treats assets that are fundementally different exactly the same.
Stocks are an infinite asset. They are created at the whim of people with something of value they want to sell. Although a person can in theory lock up the stock of some particular company, there is always an opportunity for some new person with an idea for something else to sell, or another version of the same item to create their own company and sell interests in that company. Free market theories work pretty well with stocks, even though the people whose power is based on ownership of companies will always have a tendency to seek monopolies to undermine market forces. We have had laws on the books for a hundred years to deal with monopolies, and although from time to time the laws get undermined for period of time when the public isn't paying attention, in the longer term we are pretty good at dealing with monopolies.
Land, on the other hand, is a finite asset. There is only so much of it. In the United States that fact has received very little attention because we arrived on what we viewed as an empty continent (ignoring the native populations). Government policy was to give land away to whoever wanted to move onto it and improve it. But there is not much land left for the Government to give away, and as the population of the United States continues to grow land is becoming monopolized in a different way. Land is becoming more expensive in comparison to individual incomes. In the most economically successful cities the average family already can't afford to buy a home despite extremely low interest rates. When interest rates start going up it is going to aggravate the problem, since the loan the average family will qualify for will be even lower. (The source of the next big housing downturn). For the last half a decade a bigger and bigger percentage of single family homes have been bought up by speculators, often with cash, who turn around and rent them to the folks who, in prior decades would have bought a home. Bare land on the margins of town is being snapped up by development companies with cash.
Much of the war and uproar in the last 2 millenia, and most memorably the revolutions in China and Russia early in the last century that led to a century marked by tens of millions of people being exterminated, were a direct result of ordinary people being shut out of access to land - they lived at the mercy of the landlords. That disparity in wealth distribution gave the wealthy disproportionate influence that contributed to a string of wars over the centuries by powerful people seeking to expand their power using rootless, powerless, young men as cannon fodder.
Why do we allow people to speculate in land cheaply through our low capital gains taxes and big exemptions? We are a long way from being a Feudal society, but it seems to me we are drifting in that direction.
Because Stocks are an infinite asset low capital gains rates on stocks are not a big problem. We can argue about the fairness of working folks paying higher taxes on their income than folks just selling stock, or collecting dividends or rents, but collapses in the value of those kinds of investments don't threaten the fundamental stability of society. The Great Depression and the Great Recession weren't caused by the stock market crash, it was the accompanying crash in the housing markets that had been destabilized by tax laws that encouraged speculation in real property that crippled the country. (Legislation pushed through by Republican Congress's in 1919 and 1995 created the impetus for speculation that resulted in housing market crashes about a decade later)
After the Great Depression Congress recognized the harm speculators in real estate could do. They didn't ban speculation, but they created a distinction between taxation on speculation in the real estate market and people buying homes to live in. Everyone was entitled to a tax sheltered haven for their their own home, and people trading up to bigger homes as their family grew, or down to smaller homes as they went into retirement were able to do so largely without a tax burden.
If we really want to bring back stability to our economic system for the future, we need to recreate that distinction. Don't provide a big tax break to speculators and create a tax haven for everyone to own a piece of property of their own. The housing market is a different animal than the stock market, we shouldn't treat them both as equal in terms of opportunities for speculation.
Stocks are an infinite asset. They are created at the whim of people with something of value they want to sell. Although a person can in theory lock up the stock of some particular company, there is always an opportunity for some new person with an idea for something else to sell, or another version of the same item to create their own company and sell interests in that company. Free market theories work pretty well with stocks, even though the people whose power is based on ownership of companies will always have a tendency to seek monopolies to undermine market forces. We have had laws on the books for a hundred years to deal with monopolies, and although from time to time the laws get undermined for period of time when the public isn't paying attention, in the longer term we are pretty good at dealing with monopolies.
Land, on the other hand, is a finite asset. There is only so much of it. In the United States that fact has received very little attention because we arrived on what we viewed as an empty continent (ignoring the native populations). Government policy was to give land away to whoever wanted to move onto it and improve it. But there is not much land left for the Government to give away, and as the population of the United States continues to grow land is becoming monopolized in a different way. Land is becoming more expensive in comparison to individual incomes. In the most economically successful cities the average family already can't afford to buy a home despite extremely low interest rates. When interest rates start going up it is going to aggravate the problem, since the loan the average family will qualify for will be even lower. (The source of the next big housing downturn). For the last half a decade a bigger and bigger percentage of single family homes have been bought up by speculators, often with cash, who turn around and rent them to the folks who, in prior decades would have bought a home. Bare land on the margins of town is being snapped up by development companies with cash.
Much of the war and uproar in the last 2 millenia, and most memorably the revolutions in China and Russia early in the last century that led to a century marked by tens of millions of people being exterminated, were a direct result of ordinary people being shut out of access to land - they lived at the mercy of the landlords. That disparity in wealth distribution gave the wealthy disproportionate influence that contributed to a string of wars over the centuries by powerful people seeking to expand their power using rootless, powerless, young men as cannon fodder.
Why do we allow people to speculate in land cheaply through our low capital gains taxes and big exemptions? We are a long way from being a Feudal society, but it seems to me we are drifting in that direction.
Because Stocks are an infinite asset low capital gains rates on stocks are not a big problem. We can argue about the fairness of working folks paying higher taxes on their income than folks just selling stock, or collecting dividends or rents, but collapses in the value of those kinds of investments don't threaten the fundamental stability of society. The Great Depression and the Great Recession weren't caused by the stock market crash, it was the accompanying crash in the housing markets that had been destabilized by tax laws that encouraged speculation in real property that crippled the country. (Legislation pushed through by Republican Congress's in 1919 and 1995 created the impetus for speculation that resulted in housing market crashes about a decade later)
After the Great Depression Congress recognized the harm speculators in real estate could do. They didn't ban speculation, but they created a distinction between taxation on speculation in the real estate market and people buying homes to live in. Everyone was entitled to a tax sheltered haven for their their own home, and people trading up to bigger homes as their family grew, or down to smaller homes as they went into retirement were able to do so largely without a tax burden.
If we really want to bring back stability to our economic system for the future, we need to recreate that distinction. Don't provide a big tax break to speculators and create a tax haven for everyone to own a piece of property of their own. The housing market is a different animal than the stock market, we shouldn't treat them both as equal in terms of opportunities for speculation.
Monday, April 21, 2014
Adam Smith Probably Didn't See This Coming
One of the hallmarks of modern stock markets is that the power of management has eclipsed the ability of investors to control them. CEO's make mind numbingly large salaries, even at companies whose performance is decidedly mediocre.
The reason seems to be because stock markets have become so liquid that investors have no commitment to a particular company. Boards of Directors are filled with folks from management of other companies who benefit from the general inflation in management salaries, so the notion of board oversight on salary has proved to be a fantasy. Capital Gains tax rates are so low it is not worth challenging management, you just aim to buy stock cheap and sell it when you have a gain and move on to some other stock.
A side effect of the current situation that is more of a problem for society is that companies do less planning and investment for the long term, hire fewer people, and generally focus all their attention on doing whatever is necessary to keep their stock price as high as possible, right now. Layoff's that reduce overhead are often the quickest and easiest way to keep your bottom line looking good.
How do we bring investor control back into the equation? How do we motivate companies to take a more long term view? To focus on making the company more valuable in the long term? What if you had to hold a stock for 10 years to get truly low Capital Gains tax rates? Would that bring investor control back?
Or do we care if capital doesn't control companies very well? What if we just go back to the punitively high taxes that applied to the very wealthy from 1950 through 1980 and use the tax revenue generated to make sure everyone can afford a good education that won't cripple them with debt?
If management pays themselves exorbitant salaries, a big chunk will go the Uncle Sam to be used for scholarships, or a more generous GI Bill. So at least we will maintain a society based on achievement rather than continuing the gradual slide we are currently in toward a class based society, where rich kids always have opportunity and only the very best of the rest will be able to rise to the level of achievement they aspire to.
The reason seems to be because stock markets have become so liquid that investors have no commitment to a particular company. Boards of Directors are filled with folks from management of other companies who benefit from the general inflation in management salaries, so the notion of board oversight on salary has proved to be a fantasy. Capital Gains tax rates are so low it is not worth challenging management, you just aim to buy stock cheap and sell it when you have a gain and move on to some other stock.
A side effect of the current situation that is more of a problem for society is that companies do less planning and investment for the long term, hire fewer people, and generally focus all their attention on doing whatever is necessary to keep their stock price as high as possible, right now. Layoff's that reduce overhead are often the quickest and easiest way to keep your bottom line looking good.
How do we bring investor control back into the equation? How do we motivate companies to take a more long term view? To focus on making the company more valuable in the long term? What if you had to hold a stock for 10 years to get truly low Capital Gains tax rates? Would that bring investor control back?
Or do we care if capital doesn't control companies very well? What if we just go back to the punitively high taxes that applied to the very wealthy from 1950 through 1980 and use the tax revenue generated to make sure everyone can afford a good education that won't cripple them with debt?
If management pays themselves exorbitant salaries, a big chunk will go the Uncle Sam to be used for scholarships, or a more generous GI Bill. So at least we will maintain a society based on achievement rather than continuing the gradual slide we are currently in toward a class based society, where rich kids always have opportunity and only the very best of the rest will be able to rise to the level of achievement they aspire to.
Wednesday, March 12, 2014
Syria & Ukraine - Thoughts on Tribalism
Tribalism is in our nature. Our default emotional inclination is to distrust that with which we are unfamiliar. When humanity was living in isolated small groups, with no technology, subject to the whims of the environment, that inclination was necessary for survival. When your tribe is barely surviving a stranger is a threat on many levels. They may deprive your tribe of the resources you need to survive, or just outright kill you. So whatever tribe recognizes the threat first and eliminates the strangers survives.
As humanity evolved that instinct evolved into forms of institutionalized discrimination against those who are different from us.
Beginning a couple hundred years ago our ability to manipulate our environment began to make, for more and more people, the notion of scrimping for survival a thing of the past. Here in 2013 we have the technology to feed everyone, to house everyone, to cloth everyone.
But our thinking lags behind our technology. Even in the United States, where Tribalism was not well entrenched to begin with, and has been continually weakened by the influx of immigrants seeking to put that all behind them, we are only now finally getting to the point where Government, in word and deed, does not discriminate against people based on broad categorizations of personal characteristics. Although our founding principal was that we are all created equal and entitled to equal treatment under the law, we had to fight a Civil War in which millions of citizens died and then amend the Constitution to clarify that the principal actually applied to all persons. WW I and WW II both exploded out of tribalism, the sincere belief by some that other ethnic or religious groups were subhuman in some way.
To this day, 150 years after the Civil War, we in the US are still trying to clarify that "all" means "all". Most of the world is moving, slowly, the same direction as the United States, particularly in Democratic states. The exception is the Middle East. The crossroads of the world has such a long history of conflict between competing groups that many folks there evidently have not yet even begun to realize we all do better through respect and cooperation.
Syria is the bleeding wound in Middle East that is exacerbating regional tribalism. In some sense, like our Civil War, it may be a necessary and painful process that we cannot insulate the people of the region from. But in our Civil War, we were largely left to sort it our ourselves. In Syria that is not the case. Russia and Iran, two purported democracies where powerful groups "who know best" have a monopoly on the democratic process, have been supporting the Syrian Government, whose power is based in Tribalism and patronage, for decades and continue to protect and support the regime. Various other regional power brokers support one or another group of dissidents hoping to influence the outcome.
Now Russia is moving in the same direction in Ukraine.
So the stark choice for the US is whether we try to counter the influence of external power brokers to level the playing field so the people of Syria make the choice they will live with, and learn from, in the future, at the risk of sparking wider conflict? Or do we stand by and let the folks with a tribal agenda prevent the people of Syria and Ukraine from living and learning from their mistakes.
As humanity evolved that instinct evolved into forms of institutionalized discrimination against those who are different from us.
Beginning a couple hundred years ago our ability to manipulate our environment began to make, for more and more people, the notion of scrimping for survival a thing of the past. Here in 2013 we have the technology to feed everyone, to house everyone, to cloth everyone.
But our thinking lags behind our technology. Even in the United States, where Tribalism was not well entrenched to begin with, and has been continually weakened by the influx of immigrants seeking to put that all behind them, we are only now finally getting to the point where Government, in word and deed, does not discriminate against people based on broad categorizations of personal characteristics. Although our founding principal was that we are all created equal and entitled to equal treatment under the law, we had to fight a Civil War in which millions of citizens died and then amend the Constitution to clarify that the principal actually applied to all persons. WW I and WW II both exploded out of tribalism, the sincere belief by some that other ethnic or religious groups were subhuman in some way.
To this day, 150 years after the Civil War, we in the US are still trying to clarify that "all" means "all". Most of the world is moving, slowly, the same direction as the United States, particularly in Democratic states. The exception is the Middle East. The crossroads of the world has such a long history of conflict between competing groups that many folks there evidently have not yet even begun to realize we all do better through respect and cooperation.
Syria is the bleeding wound in Middle East that is exacerbating regional tribalism. In some sense, like our Civil War, it may be a necessary and painful process that we cannot insulate the people of the region from. But in our Civil War, we were largely left to sort it our ourselves. In Syria that is not the case. Russia and Iran, two purported democracies where powerful groups "who know best" have a monopoly on the democratic process, have been supporting the Syrian Government, whose power is based in Tribalism and patronage, for decades and continue to protect and support the regime. Various other regional power brokers support one or another group of dissidents hoping to influence the outcome.
Now Russia is moving in the same direction in Ukraine.
So the stark choice for the US is whether we try to counter the influence of external power brokers to level the playing field so the people of Syria make the choice they will live with, and learn from, in the future, at the risk of sparking wider conflict? Or do we stand by and let the folks with a tribal agenda prevent the people of Syria and Ukraine from living and learning from their mistakes.
Sunday, March 9, 2014
On Chosing Your Own Doctor
The notion of choosing your own Doctor has become a big controversy since Obamacare was passed. Everyone is for it, the controversy is all about accusing others of not allowing people to choose their own doctor, implying (usually) that if you don't get to choose your own doctor you will end up dead. It is silly.
Over the years I have from time to time been hired to do research that relates to he competence of doctors. Here are some basic truths I have learned.
1. The competence of Doctors is controlled by Doctors (in California by the Medical Board)
2. Medical Science is full of gray areas, competing ideas, different views of treatment.
3. In our privacy obsessed society it is very difficult to get information about the competency of a particular doctor, particularly doctors operating in a small or solo practice.
Put these three facts together and you have created the situation we have - where Doctors who are supposed to monitor doctors are extremely unwilling to judge another doctor to be incompetent. Even when a patient dies at the doctors hands, other doctors are inclined to bend over backwards to give the doctor the benefit of the doubt.
As a result horribly incompetent doctors, doctors who have committed major mal-practice multiple times, including killing people with their mistakes, sometimes continue being doctors for many years, continue having patients and getting referrals.
Who goes to these Doctors? Who sends them referrals? People (including other doctors) like you and me who judge them as we judge other people we meet. Are they likable. Well-spoken. Friendly. Do they sound like they know what they are talking about.
There is no way for a lay person to know if their Doctor is bad, mediocre or good. Given the gray areas in the medical field, even fellow doctors who work with the doctor may have a hard time distinguishing good from mediocre.
As far as I can see there is only one way to make sure you don't get a really bad Doctor. Use a big corporate entity for your medical care, who pays the malpractice insurance for all it's doctors. We all know no corporation is going to tolerate an employee who costs them lots of money.
Over the years I have from time to time been hired to do research that relates to he competence of doctors. Here are some basic truths I have learned.
1. The competence of Doctors is controlled by Doctors (in California by the Medical Board)
2. Medical Science is full of gray areas, competing ideas, different views of treatment.
3. In our privacy obsessed society it is very difficult to get information about the competency of a particular doctor, particularly doctors operating in a small or solo practice.
Put these three facts together and you have created the situation we have - where Doctors who are supposed to monitor doctors are extremely unwilling to judge another doctor to be incompetent. Even when a patient dies at the doctors hands, other doctors are inclined to bend over backwards to give the doctor the benefit of the doubt.
As a result horribly incompetent doctors, doctors who have committed major mal-practice multiple times, including killing people with their mistakes, sometimes continue being doctors for many years, continue having patients and getting referrals.
Who goes to these Doctors? Who sends them referrals? People (including other doctors) like you and me who judge them as we judge other people we meet. Are they likable. Well-spoken. Friendly. Do they sound like they know what they are talking about.
There is no way for a lay person to know if their Doctor is bad, mediocre or good. Given the gray areas in the medical field, even fellow doctors who work with the doctor may have a hard time distinguishing good from mediocre.
As far as I can see there is only one way to make sure you don't get a really bad Doctor. Use a big corporate entity for your medical care, who pays the malpractice insurance for all it's doctors. We all know no corporation is going to tolerate an employee who costs them lots of money.
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