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I think C is highly defensible, as long as you think about how each of the outcomes affect the people involved in feeding the system. Though maybe that becomes B in fact because those are incentives.
I would argue that it depends. Taken literally, you could not distinguish a hospital aiming to save a fixed fraction of cancer patients and one who tries to save as many of them as possible, given other constraints. An advocate of (C) should default to the fixed fraction model, because it avoids having to ascribe intent to people (which might not even be directly tied to direct financial incentives of individual actors) and the alternative requires a lot of assumptions on what fraction of cancer patients can be saved at a given tech level.
And it is clear that this leads to wrong predictions about what would happen if the hospital got some new tech which saved an additional ten percent. (C) would predict that the survival rate would not increase, because the fixed rate is the goal. Perhaps the doctors all stop working Friday afternoon to compensate, instead, people preferring free time to work is a well supported finding.
My (B) like model of the hospital can take into account the fundamental motivations of people who work in health care as well as the outcomes and direct incentives of the actors. It is much more complex and relies on a lot of assumptions, but I would argue that it is likely to outperform (C) models.
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To make C defensible I think you have to at least define "outcomes" as "the differences between the state of the world with the system and the counterfactual state of the world without the system" (call this (C1)), whereas it often instead seems to be implicitly defined as "the state of the world with the system" (call this (C2)).
Consider the claim that "the relevant Iranian intelligence agency does not have the purpose of avoiding Israeli infiltration", to use the example above. Under (C1) this would be a claim that Iranian intelligence is actually not reducing Israeli infiltration at all (almost certainly false in this case, but it would be very interesting if it were true), and under (C2) this would just be a claim that some Israeli infiltration still happens despite efforts to reduce it (almost certainly true, but not very interesting).
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C is highly defensible, but it's far more common for D to masquerade as C. Not even necessarily intentionally/in bad faith - people have their personal hobby horses they fixate on and most of the systems they're complaining about are very complex.
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