2rafa
3hr ago
If you’re Maduro and think you’re going to be deposed, that’s when you resign, leave the crown for the next guy, and sail off into comfortable exile in Russia / China / Cuba / Brazil etc. Agreeing to some elaborate scheme where you spend the rest of your life in jail seems like a bad idea.
2rafa
5hr ago
or, on the other hand, it might be that the Mormons in the CIA are just vastly more competent than the rest of the government.
2rafa
7hr ago
Maduro captured and in US custody. Absolutely unhinged but also, one has to say, immensely impressive move.
2rafa
7hr ago
It’s more complex than that, Fuentes actually defended the Monroe doctrine and was ambivalent to sympathetic to attacking Venezuela a few months ago.
2rafa
20hr ago
No, it’s different. Public school teachers are paid relatively averagely given years in the workforce and levels of education; a few make $130k but that’s a small minority in the highest paying districts in the country. They are paid toward the bottom of the most common ‘public service professions’ pay scale (cops, nurses, local government workers), especially in red states. In blue states, particularly rich ones in big cities with very high private sector salaries where the ‘we support underpaid teachers’ sentiment is most common they are paid slightly better, but so are the NYPD and nurses who work in Manhattan.
Meanwhile, while Americans have a lot of respect for doctors, I’ve never heard the sentiment that they’re underpaid except from doctors. They might say underpaid ‘compared to’ dislikes groups like CEOs and bankers, but that is more about the latter than the former. “No, I believe my anaesthesiologist should make $900k a year instead of $600k - hell why not a million?” just isn’t really the kind of thing people are saying or thinking.
2rafa
23hr ago
That’s nothing new. The BMA (British Medical Association) was the most aggressive and chief lobbyist against the formation of the NHS in the 1940s. Doctors hate single payer because it drives down physician pay. That is precisely a reason to do it.
2rafa
23hr ago
The US doesn’t really have a party system like other democracies. There is no Democratic or Republican Party as an actual organization with a Leader and a membership base that pays $100 a year to be a card-carrying Republican and a committee of leaders that picks all the candidates running for every seat. That’s in many ways a good thing, and the result of a popular vote based primary system with open party affiliation, but it also means that the parties are amorphous. Even the National Committees are weird quasi-governmental service operations that manage conventions and assist with fundraising and advertising, they’re not leadership bodies the same way most other countries’ political parties have them, and their managers are neither the leaders of the movement nor have any actual political power if the ‘party’ has a majority in both chambers and/or the presidency.
That context explains why grassroots politics in the US is mostly driven by organizations dedicated to specific policy goals like Pro Life or Pro Choice or anti-ICE or PETA or the NIMBYs or the YIMBYs by whatever name. Around election time huge PAC funding allows paid organizers to fund both volunteered and paid campaigns that operate the way that canvassers to in more traditional party systems, but the ‘social club’ style party all year, every year, is less of an American thing.
When it's single payer it's not really negotiating any more. It's lobbying... and corruption.
If I’m an American citizen (only) and want to become a diplomat or a military submarine captain or a central banker, I pretty much have to work for the government. Making it so that if you want to be a doctor, you (mostly) have to work for the government is no different.
The common pattern with such monopolies is the union or association negotiates not with the government itself but the politicians.
The politicians in single payer systems often stand up against paying doctors more because they know that if they do they have to pay all public sector workers more, and that means their own fiscal priorities often become unaffordable. The incentives aren’t perfect but they’re better than the current system where responsibility is diffused.
This won't occur with things like drug development because those companies are very unpopular; they can offer money but won't have enough to offer in terms of votes compared to the populist who says he's going to fix the prices of new drugs.
There are ways around it. The big drug makers have forced the UK to pay more by threatening to move well-paid pharma jobs offshore for example. Governments fund tens of billions of dollars in medical research, private universities do too. I’m unconvinced there will some collapse in new drug development if single payer happens, the global system might just become more fair instead of the American taxpayer paying for a disproportionate share of medical innovation.
2rafa
1d ago
I just don’t think this applies to a lot of historic conflict since the advent of civilization. When you’re an man in some European country some time in the last thousand years and one year the King and his council decide that you’re at war with this random other European country because of competition over control for the Caribbean or something happening in the Spanish Netherlands (you’ve never met anyone from there) and then thirty years later the next king decides that actually you’re now allies with the people you fought against and your son needs to go off and fight the people you were allies with, this isn’t some deeply visceral intertribal conflict against blood enemies. This is politics. Until the modern period most people didn’t even have what we’d call a modern, nationalist conception of the state or loyalty to it.
For 200 years, immigrant groups have plundered America, destroying everything the Anglo Saxon founding fathers have created. That much is obviously and entirely true. But it also left the descendants of the Irish who destroyed the peaceful, English eastern seaboard, the New England of gentlemen’s clubs and old Boston, long forgotten, the ‘swarthy’ Scandinavians (according to Ben Franklin who settled the Midwest, the Italians and Poles and whoever else poorly placed to frame their own civilizational conflict against later groups of migrants.
2rafa
1d ago
Single payer has a very ugly aspect to it that you see when you are exposed to it a lot. There's a good book written by an Indian about it in England (forget the name). I've seen people come to ER and get a bed because their wife was in. Complain of some general stomach pain. Unable to elicit any signs. Probably the current system has this as well. It's just a very ugly thing when you make something free for common good and the underclass abuse it in ways that make you want to put them on the moon.
Sure, although as mentioned, the underclass already have this in the US since they don’t pay for anything. If anything, the extreme bed pressure on the NHS means they’re more likely to turn away someone with no medical issues who just wants a bed.
For normal hypochondriacs and elderly people with nothing better to do but some money, implementing an ER fee is still completely possible in a single payer system (it’s just that England doesn’t have one). It would not affect the true underclass but would affect a lot of abuse which is by people who have some money but just nothing better to do.
2rafa
1d ago
One option could be to have a ‘premium’ package on a critical care / serious illness model for working age people where they get access to priority care, better hospitals and treatment if, say, aged 18 to 65 and seriously ill, and then a standard package for people above and below that age paid for by the state.
2rafa
1d ago
Surely these programs have net worth caps far too low to be able to generate $7k a year. I looked it up and some seem to have a primary home exemption, but securities I doubt are included.
Single payer makes sense
Relative to GDP and median income, British doctors and nurses are paid like shit. This is objectively good for the taxpayer and user of healthcare services. The NHS is worse than the US system, but this is likely more because Britain is much poorer than America than that it spends a much lower proportion of GDP on healthcare (both are true). The fact that it works at all, most of the time, is kind of great. US annual healthcare spending per capita is 300%, in dollar terms, of UK annual healthcare spending. The British spend $5000 per year per capita, the Americans spend $15,000. There is no major difference in life expectancy. A few niche cancers have higher mortality in Britain, but for most people, most of the time, the outcome difference is marginal and reflects a comparatively lower economic baseline and therefore budget than it does some inherent problem with single payer.
In addition, British doctors can emigrate to places that pay more, whereas the US under a single payer system would probably still have the highest medicine pay of any major country, it just wouldn’t be so much higher because one central employer could negotiate centrally (not just for pay, of course, but also for things like drug costs where the Brits pay far less for the same drugs than Americans do). I’ve been to the ER here on a couple of occasions, in both it was no worse than the US equivalent. If an American doctor currently making $600k had their pay cut to $300k, there’s still pretty much no other Western country they could move to where they would be paid much more, even in Australia most doctors don’t make that (450k AUD) and Australia isn’t big enough to absorb that demand anyway.
Every American who has ever used (or been forced to use) an anaesthesiologist making $600k is a pay pig for the AMA cartel. You can take the top 10% of nurse practitioners by IQ and train them to do this in a year. Even nurses make like $150k now in a lot of places. And the entire insurance system is a middleman grift, with zero incentives (due to both the nature of the business, the pricing power of hospital systems and doctors, and bad legislation) to rein in costs. Everything just gets passed on with an extra cut until ultimately the taxpayer foots a big proportion of the bill. In the American system, the solution is always increasing prices because that is all that can happen.
Three intertwined factors explain American healthcare costs, none of which have anything to do with great care. Extremely high physician salaries, high drug prices, and the entire bureaucratic insurance apparatus.
The first issue is part of a problem you also see in other professions like accounting and law, although medicine is by far the most egregious case, which you could call something like “professional capture”. In this case, a profession dominated by moderately intelligent people (say 2 standard deviations above the average) runs circles around legislators, regulators, administrators and others around the median to its advantage. In a single payer system where say 90% of hospitals are owned by the government, the government decides how much doctors get paid. You can do some private work for the super rich on the side, but outside of specialties like plastic surgery that isn’t going to pay the bills. Otherwise, you take the pay the state gives you, or you go somewhere else (which, as discussed, wouldn’t be an option for all but a tiny minority of American doctors). Since medicine is so overpaid relative to most other PMC professions, halving doctor pay like this would bring down costs by perhaps 5% with no disadvantage (even at half pay the average doctor would still make more than the average accountant or lawyer).
The second problem is a reality of the insurance and network system. For experimental/research treatments, patients can whine and complain about experimental therapies not covered, which generates bad press for the insurers, which forces them to cover some horrific experimental procedure that costs $10m and prolongs little Timmy’s life by 2 additional horrific months. In the UK, when this topic comes up at the water cooler, most people will defend the NHS’ QALY system because they rightfully understand the direct relationship between their tax money and this kind of bullshit waste. In America, where the consumer is distanced from this spending, far more people will argue that insurers are “greedy” whenever they don’t spend “whatever it takes”. Instead of seeing themselves as the losers, they see Big Business as the loser, because the average person cannot grasp even the most banal plumbing of the economic system. For mainstream treatments, big pharma has leverage over providers and insurers who are often local, and so can’t drive down prices. If you don’t sell to the NHS, you aren’t going to sell your drug in England (outside, again, of perhaps a handful of tiny private hospitals in London). In America, you don’t face that stark choice; there is no pressure to negotiate, and of course even Biden’s lifting of the prohibition on Medicare (the only entity large enough) negotiating drug prices seems to be being heavily diluted.
The inherent reality of insurance as applied to healthcare doesn’t make sense. Most people’s houses never burn to the ground. Most mail is never lost. Most people don’t die before they retire. Most ships don’t sink. Insurance works in these cases to pool risk. If every ship sinks some of the time, if everyone’s house burns down a few times in their life, insurance is bad model for handling these inevitabilities - a communal (eg church, guild, industry, whatever) or state-based scheme is economically preferable. The insurance bureaucracy (which extends far beyond the insurers themselves) has already been covered elsewhere, but a combination of the model’s inherent weaknesses and terrible regulation is responsible for significant upward pressure on all healthcare costs. Margins don’t have to be high (and they aren’t) for this to be the case, the process just needs to be labor and other cost intensive (and it is). In fact, with margins strictly limited, profitability is driven only by higher total insurer revenue, again incentivizing higher prices without any incentives for productivity growth.
As I’ve argued here before, if you are a middle class or above taxpayer in America, you should be fighting for single payer. Why? Because the dregs, the scum, the homeless, the degenerates, the old and sick who never contributed much, the welfare queens and trailer trash and lifelong can-never-works already get free single payer at the point of use and forever. They already have this. Only you, the pay pig, has to pay, get into medical debt, deal with endless bureaucracy. The homeless guy who ODs again or has some horrific needle induced injury walks in, gets his free stay under whatever name he chooses, costs YOU your share of the $150,000 bill (after all, the doctors and nurses and drug companies still get paid all the same) and leaves. No consequence.
Since the American people are too taken by pathological empathy to do something about that (does this make healthcare the ultimate example of anarcho-tyranny?), you may as well at least get the same deal for yourself.
2rafa
4d ago
Scamming and stealing is definitely fun in and of itself for a lot of people. It’s why some bored housewives with money shoplift trivial value merchandise they can easily afford is a thing. Every few years here in England there is a story about some wealthy City banker using fake (or no) tickets on a commuter train and getting caught for years of fare evasion. Sure, even for the moderately wealthy that’s thousands of dollars, but it’s not about the money, it’s about the thrill. On Extreme Couponing many of the participants had money and treated it as a hobby.
However, the reason why the Somalis in Minnesota are stealing billions from the government instead of playing Fortnite isn’t just because they want to. It’s because they can, and the system isn’t really set up to catch them. They exist outside the complex web of North Western European social interaction which exists everywhere above the lowest dregs of that region’s indigenous underclass (Marius Hoiby types), and in which you would probably face some social shame or tut-tutting for ripping the government off for billions (interestingly I think this instinct is less developed in England, where the native working class have a reputation for cheating the state, both at the bottom on welfare (“benefits”) and at the top (see Michelle Mone’s PPE case)).
Northwestern Europe, especially the nordics, and so especially Minnesota, were just uniquely high trust. Singapore is also a very rich, safe and peaceful country with high quality of life, but because the state expects that whatever incentives they offer will be ruthlessly exploited by the very intelligent and cunning populace this is factored into planning. If someone is making tens of millions in China by exploiting a government program then someone in the government is corruptly in on it and local CCP management on a regional / sector level is either getting paid to look away or is being cut in. In Minnesota, I doubt there are any Jorgensens or Lunds who have made a billion off of this scam, they just let it happen.
2rafa
7d ago
Half of congress in the 80s had literally fought Japan in the Second World War, anti-Japanese hostility was far from purely economic.
China was at best a secondary antagonist in the Cold War (and no longer after 1972). Korea is little remembered, before the memory of almost all living Americans and the present state of North Korea means that most people have no idea of how involved the PLA was. So the last ‘real war’ that was USA vs China was what, the Boxer Rebellion?
It could change if Xi panics and decides to abandon the slow game for Taiwan (which would be surprising) by staging the most audacious possible invasion involving a first strike at American bases, but even in the event of a ground invasion (unlikely) I consider that relatively unlikely.
Some grand global game of competition in which AMERICA NUMBA ONE just doesn’t really exist in the minds of most Americans in the way it does for the Chinese or even for, say, the French. American identity is tied to more amorphous things that don’t really have anything to do with global affairs like the Wild West and country music. A Dane or Swiss will gladly lecture you on why Denmark or Switzerland is the best country on earth (both would be mostly correct). Americans don’t really do that except in a very tongue in cheek Team America World Police way and even that is mostly limited to the middle class.
Italians abroad will talk about Ferrari and Columbus and pasta. Americans abroad don’t really lecture anyone about Google and Microsoft and Chevron. It’s not shame in the German way, but it’s not really pride either; global economic and cultural hegemony just isn’t central to American self-conception.
2rafa
7d ago
The problem with meritocracy is that it’s pointless.
If you want meritocracy, just administer a single IQ test to every child at 10 years old and distribute every accolade and job based upon that and whatever protected characteristics you want to prioritize (‘Other Backward Castes’, ‘Pardo’, ‘gender diversity’, ‘URM’, ‘BAME’, whatever) and you will be more efficient than the entire wretched body of meritocracy - not just in America - but in even more degenerate systems like those of South Korea, India and elsewhere.
The whole making kids study for 7 hours after school to pass bullshit tests isn’t meritocracy, it isn’t education, it doesn’t make for a successful society. It’s pure ideology. It doesn’t serve the objective of allocating power, resources or status in any way, since along whatever lines you want, you can do it more efficiently in another way.
Well, except one line.
Imagine your children are second or third generation immigrants. You are wealthy. Pure meritocracy will see your children (due to IQ reversion to mean) likely outcompeted by others - either immigrants or natives. Pure status hierarchy, legacy, families with centuries of history and deep social ties to those who run the august intellectual bodies that are the leading universities will outcompete you. Looks and charisma will also largely favor the beautiful, tall, etc, which probably isn’t your kids.
So what is one to do?
Build a ridiculous status system that specifically prioritizes an absurd and unreasonable level of parental investment. Monetarily yes, but also in terms of time, your children’s and yours. Make the kids suffer, so that parents from nicer cultures that care more about kids choose not to push them through the ridiculous pantomime. Poor families won’t have the knowledge, time or money to compete with you. Very rich ones won’t care to. And the future is yours.
One of the unique realities of both British and American imperialism is that Empire was and is not central to the national identity of either people.
British Imperial identity was, as many historians have relatively well argued, invented wholesale in the last thirty years of Empire. In fact, the greatest and only real grand celebrations of Empire occurred between 1918 and the Second World War, when Britain’s relative global power had been in decline for more than fifty years. At the true height of Empire in the mid-19th century, identity was more English than Imperial, and international competition was more focused on the French than anyone else (even as the opium wars raged, as the scramble for Africa slowly began, as British money surged into South and Central America, as settlement in Australia grew rapidly etc etc etc). Pomp and ceremony in the colonies, even India, was very limited until the 1920s.
Similarly, in America, most American identity has nothing to do with America’s global power or prestige. America is much larger and more geographically diverse than England, unlike that country it doesn’t really even need to trade with its regional peers. Unlike those final days of the British Empire, most American media doesn’t really reference American imperialism. Most stories are set solely domestically, while even most international ones treat the rest of the world the way a pre-imperial American might have a century and a half ago, with a certain distance, a foreignness from petty domestic conflict (see Indiana Jones versus James Bond, for example). Most Americans have no major opinions on foreign policy.
America is often called a reluctant hegemon. I disagree, it’s an incidental one. The empire is not important to the American psyche, to American identity. I won’t comment on the Russian or Soviet empires, but I get the feeling they may have meant more to their inhabitants, at least some of them, than the American Empire does. In part, this is reflected in the fact that even most Americans consider the wars in which America participates done either for moral reasons or self-interested ones. Economists say that American hegemony makes the world safe for profitable American companies, but most of these still make the vast majority of their revenue in-country. I think, on balance, this is like an Englishman in 1910 extolling the virtuous export of Britannic Civilisation, namely a very nice just-so story to explain how things came to be so.
This is true even for more politically aware, heterodox thinkers. People will say America goes to war for powerful banana companies, for oil, for revenge, because of the Jews, because of some leader’s personal grudge. An earnest interest in world domination and American political hegemony is considered laughable, even if it’s mentioned in a PNAC leaflet everybody treats it as a ruse. Nobody believes in it. “America’s mission is to export liberal democracy to the world”. No, I don’t think even Hillary Clinton believes that.
But America can cope spiritually with the collapse of its global power better than most other historical empires for one reason. Because an invasion of the homeland is so unlikely, and because the domestic market is so large, and because they have so many resources, Americans can simply stop caring about the outside world if the news gets worse.
It’s the rest of the world that will be less lucky, and which will experience radically more upheaval. The Chinese will need to solidify their offer for new vassal nations though, because currently it isn’t particularly compelling, and they have a quality around them that seems to make a lot of enemies, which means their hegemony might be resisted more than the present arrangement.
2rafa
8d ago
Software is special because the previous wave of applicants didn’t just need the H1B, they also needed whatever local cartel was required. The bar and going to law school in America and the fact the law is a verbal heavy field strongly preference native speakers raised in the US. The AMA locks foreign doctors out of any desirable residency places (which it mandates for almost all foreign doctors). Engineering has various local licensing requirements, and a lot of federal stuff requires you to be a citizen anyway. Meanwhile, sales, consulting, finance and a lot of other professional service jobs have a strong sales/relationship component which again makes it harder for Indians and Chinese applying from overseas.
Software engineering was unique in that it didn’t really require social skills, doesn’t usually require client interaction, paid well enough to get the visa, didn’t have a domestic licensing cartel and could be taught as a technical skill in foreign universities and schools.
2rafa
8d ago
Amusingly, this will only make it easier for smart Indians to import their countrymen. It’s just that instead of Infosys it will be some motel owner in Iowa who figures out that there’s a local shortage of massage therapists or health administrators or insurance salesmen or machinery operators or vegetable traders or whatever is both in demand and locally deemed hard to hire for and sets up a business that brings over people who did a bullshit 3 month fake degree in whatever it is from an amendable university in his hometown.
The only thing that would really fix the program (other than scrapping it) is to limit no more than 10% of visas to a single country.
2rafa
8d ago
Quite a sweet story, Love Actually indeed (it’s interesting that there isn’t a comma in the actual movie, maybe because both “love, actually, is all around us” and “love actually is all around us” are grammatically correct? I’m no English lecturer).
Anybody is capable of cheating in the right circumstances, and so the first duty of the maritally faithful is to avoid those situations. But just like the propensity to get drunk various from person to person, with people who can have have four or five drinks and cut themselves off without a second thought and people who cannot have a sip of alcohol without a one hundred percent chance of blacking out, propensity to cheat varies too, especially in middle ground situations that are neither “my spouse is the only non-geriatric adult of the opposite sex I interact with in any real capacity, ever” nor “I regularly get drunk and do MDMA with a group of hot beautiful people I’m attracted to who all want to have sex with me”.
Because since at least 1991 the US has been technically and geopolitically capable of invading Cuba and overthrowing the communists there without provoking a global crisis and hasn’t done so.
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