Soriek
7hr ago
The problem is that the government restricts the supply of people allowed to practice medicine through regulations
This is like saying the government restricts the supply of tanks or something. There's no regulation artificially restraining something that would be in more abundance on the free market, the subsidy just isn't big enough. There is no law restricting resident doctors, which hospitals can have as many of as they want, there just isn't extra public funding to have more of them, so hospitals make up funding shortfalls out of pocket, from state governments, or philanthropy. Cutting government would ofc result in less residency slots, not more.
There are lots of regulations that genuinely do restrict the supply of medicine via laws that shield hospitals from anti-trust and prevent new competitors from emerging. But these are mostly on the state level. Even the lengths of residencies themselves are usually required by state-level licensing rules. If there's anything federal scale that's as significant as CON/COPA laws, I'm more than interested to hear about it though, that's why I asked.
Soriek
8hr ago
It should be noted this was long after PP funds were banned from being used for abortions, so moderate Republicans got smeared with trying to cut funding from all the other services PP provided to some several million low-income women. And then as now, Democrats had the Senate so there was a limit to how conservative any viable budget could be.
Soriek
9hr ago
My point that it's an oversimplication to describe federal spending as "just subsidizing a good that has a restricted supply because of over regulation." Just as easily a lack of funding can be the root cause of a dearth of supply.
Administrative excess should be culled everywhere, but I'm unconvinced that "the rest of [the budget] is bloat". From this graph on their budget (from the conservative AEI) it looks like a reasonable 5-10% is administration while the overwhelming majority is compensation for services, 50% for hospital care, 25% for physician services, and the remainder broken between prescription drugs, and smaller categories like equipment and nursing homes.
I'm unconvinced the future is bleak either. The largest growing category in spending has been prescription drugs and the IRA should arrest that trend substantially. You've likely also read the recent headlines that our projections have wildly overestimated growth in Medicare spending, which has leveled off significantly per beneficiary for the past decade.
Soriek
9hr ago
If you haven't read it already you might like Tanner Greer's "How I Taught the Iliad to Chinese Teenagers". It's long but I think a cool example of introducing an ancient epic to a culture where it's not part of their own canon:
Over the last few years a debate has been raging among both educators and classicists regarding what place, if any, the “classics” should have in modern education, for what purpose they should be taught, and how best to teach them. I come to this debate from an unusual perspective: someone tasked with getting zonked-out Chinese teenagers to care about a book most of them assume they could never possibly finish.
Chinese students live in a social world that is quite alien to the culture wars that divide the Anglosphere and which underlay many of the debates we have about how to teach the classics. They don’t have a dog in that fight. Because of this I found teaching them to be a clarifying experience. Those who defend and those who attack the classics tend to focus their fire on the role the classics play, for good or ill, as the foundation stone of Western high culture. This context is entirely irrelevant to the Chinese teenager. The Western tradition is not their tradition. They have no special reason to adore or revile it. They must approach a work like the Iliad on its own terms and for its own sake. If it means anything to them, it is as a human story, not a Western one.
Why, my Chinese students asked, will we read this? Because you need to prepare for American university classes, I replied. But more importantly: because this book might just change your life! I said this without apology or awkwardness. I believed it! Ultimately, if a great work of history and literature does not have the potential to change a student’s life, to shape their character or transform their worldview, there is no point in teaching it! Most students believe this themselves. They can tell whether you believe the books you are assigning are that important. If you do not believe the works you are assigning matter, students will not think they matter either. I presented the Iliad as a meditation on universal problems of the human condition. My students read it as such.
Soriek
9hr ago
I'm all for cutting unhelpful regulations, but which federal regulation would substantially reduce healthcare costs? The largest increases in costs have been from physicians and hospitals becoming increasingly consolidated monopolies, and this has much less to do with federal law than state-level rent seeking.
Soriek
10hr ago
One of the reasons supply is restricted within medical care is because MMS helps fund residency slots and have historically capped their funding at '96 levels, keeping supply of doctors lower than it could be. Only in 2022 have we started to fix this and raise the residency slot funding. Cutting MMS funding would be moving backwards on doctor supply.
Most of the rest of the supply restrictions are state level like Con and COPA laws. Cutting MMS funding won't do anything to fix those problems.
What do you mean? The Democrats helped the Republicans keep the government funded, which is what the majority of the GOP wanted. This is completely separate from an agreement for the Democrats to support a Speaker from the opposite party. McCarthy, like Boehner before him, would certainly never expect that without specific negotiations (which he's said he won't do, at least so far) and no minority party would grant it without significant concessions.
I believe this would also be the first time in US history the House will have removed a Speaker with a motion to vacate.
I was looking it up and I guess this is only the third time a motion to vacate ever happened in history. The last time was kind of similar to this, the right flank, led by Mark Meadows, rebelling against John Boehner in 2015. It was unsuccessful but he ended up resigning anyway.
The first time was in 1910 and the Speaker filed a Motion to Vacate against himself. Basically he was daring unruly representatives to challenge him publicly, and ultimately they fell in line. Couldn't be farther from our present situation.
Soriek
1d ago
She's qualified in many ways. She is also 77 though, it would be nice not to keep going down the path of ancient politicians, especially in a seat that was so recently a laughing stock over its holder's clear dementia. Newsom had also said several weeks ago it wouldn't be Lee because she's already running in the race. Most likely he doesn't want to pick one of the actual viable candidates like her, Porter, or Schiff, because he auomatically risks making an enemy out of the other two
Soriek
1d ago
Do you have an opinion of PiS's track record on the economy? I know you mentioned you were more sympathetic to Konfederacja's more libertarian policies and my understand is PiS is pretty state interventionist pro-welfare, but Poland's growth seems to be a success story so I'd be interested to hear what you thought.
Soriek
1d ago
What are the odds the government will walk back the austerity if resistance from unions and other protestors is high enough (or at least give the unions more of a seat at the table)? Do you agree with them some austerity is necessary for Finland's fiscal situation? I assume no, but you pointed out that the previous Administration may actually have bundled the healthcare reform.
Soriek
1d ago
Thanks for the added context, I appreciate it. Culturally how did it reach the point that a group known for kidnappings and bombings became fairly accepted across society? Even Perón condemned them back in the day right? I get the Kirchnerists are motivated to whitewash them / tap their history of struggle for legitimacy, but they still only represent about half the country, and Macri would do stuff like taking photoshoots honoring their victims.
Soriek
4d ago
And by extreme clown I am not putting it lightly ("Under Hitler's rule there was greater freedom in Poland because seatbelts were not mandatory" is a representative example).
Yeaahh that's pretty dang rough. What odds do you give them or KO of ending up in a coalition with PiS? Would that change the ways things are currently run significantly?
Soriek
4d ago
This is not a standard we normally apply to deciding whether a country is an ally or a puppet.
Is the UK equal to its ally Portugal? Is France equal to its ally Romania? Turkey and Azerbaijan? The rest of NATO and Turkey? Nigeria and Sierra Leone? Do the latter countries normally decide their political actions based on what the former countries want, even if it goes against their interests? This is what it means to be a client state.
Soriek
4d ago
Imo this is an oversimplified way to understand America’s relationships with other countries, which do things we don’t like all the time, ie Egypt, Afghanistan, Israel, Ethiopia, Iraq, & Syria, are all in the top ten states we give funding to. A world where America was genuinely attempting to control most of the countries we consider allies would look very different than ours.
Soriek
4d ago
I think what @Dean said, plus that their President Ruto has made a priority of fostering good will with the west. He's been notably anti-Putin among African leaders, makes regular visits to Europe / the US, and thumbs his nose at BRICS. Presumably he also doesn't want overly much attention on his own autocratic impulses. It's not really a matter of the US picking up a new client state though, we've mostly historically been friendly with Kenya - last year we donated over 3 times what we're giving them for this intervention - but I don't think calling our relationship a client state would really be accurate either.
Soriek
4d ago
Thanks for the added context. Is PiS the party you consider catastrophically bad or one of their competitors? What's your take on their overall tenure in power?
Literally the only reason this is being done is because people are too concerned about the "optics" of a military force consisting of predominantly white or Latin soldiers laying down the law in uber-black Haiti
Not at all, the US was pushing Canada to intervene for a long time. It's more that intervening in the world's most dangerous country is a pretty bad job that no one wants to take. There's a very good reason Caricom hasn't done anything at all, despite most of their members being majority black and this kind of situation being one of the reasons the organization exists to coordinate for. America doesn't care overly much about the optics here or we wouldn't be encouraging a country with weekly headlines about police brutality to do the job, they're literally just the only place that volunteered.
Soriek
5d ago
I certainly believe you that Mendeloff is exagerrating his claims, his line about the lowest feasible level just seemed minor to me compared to his + the other interviewed subjects' main argument about ever-increasing procedural requirements.
Definitely interested in the idea that the procedural requirements are less of a time burden than the data digging required by overambitious regulatory targets - though can those really be separated? It seems like a ton of the procedural load is specifically around data collection and review.
Where do you access the timeline / breakdown of how the time was used for the Benzene process? I couldn't seem to find it in the EHP writeup.
Soriek
6d ago
Thanks for your reply, sorry for the delay, I've been pretty wrapped up
I'm not entirely sure where this quote's coming from -- it's not present in Mendeloff's better-known "Regulatory Reform and OSHA Policy" nor his current RAND page
All the quotes are from that Environmental Law Institute piece, I didn't want to keep citing it because I honestly hadn't realized we didn't have character limits anymore.
Thanks for the added legal context on where OSHA's restrictions really are/aren't. IANAL but my one quibble is that the ruling that they don't have to do cost/benefit analysis is from 1981, and since then we had Clinton's EO in 1993 that I think does require them to do that. At least, it's a thing they're clearly spending time doing, whether or not it guides their regulatory decisions the way it should.
More importantly, does any of this refute the broader argument about all the added layers of procedural and analytic requirements that all three of the people interviewed cited? This seems like a separate measure from where their authority actually ends that would add a time burden rather than a legal burden. Even the feasibility studies, whether or not their actual threshold is reasonable, presumably signify months of mandated paperwork. From OSHA's quick overview on the website:
Once OSHA has developed plans to propose, amend or revoke a standard, it publishes these intentions in the Federal Register as a "Notice of Proposed Rulemaking," or often as an earlier "Advance Notice of Proposed Rulemaking." Prior to publication of proposed and final major rules OSHA consults with OMB under procedures established by Executive Order. OSHA consults with small business on proposed rules which significantly affect them through a panel with participation by the Small Business Administration and OMB, as required by theSmall Business Regulatory Enforcement and Fairness Act (SBREFA.)
An "Advance Notice" is used, when necessary, to solicit information that can be used in drafting a proposal. The Notice of Proposed Rulemaking will include the terms of the new rule and provide a specific time (at least 30 days from the date of publication, usually 60 days or more) for the public to respond.
Interested parties who submit written arguments and pertinent evidence may request a public hearing on the proposal when none has been announced in the notice. When such a hearing is requested, OSHA will schedule one, and will publish, in advance, the time and place for it in the Federal Register.
After the close of the comment period and public hearing, if one is held, OSHA must publish in the Federal Register the full, final text of any standard amended or adopted and the date it becomes effective, along with an explanation of the standard and the reasons for implementing it. OSHA may also publish a determination that no standard or amendment needs to be issued.
It certainly sounds pretty time consuming. In 2012 the GAO also wrote a report that seems to find the same thing titled "Multiple Challenges Lengthen OSHA’s Standard Setting". The exerpt below is probably unnecessarily long but just to give a flavor of all the mud they have to wade through:
Experts and agency officials indicated that the increased number of procedural requirements affects standard-setting time frames because of the complex requirements for OSHA to demonstrate the need for standards. Experts and agency officials named a variety of statutes and executive orders that have imposed an increasing number of procedural requirements on OSHA since 1980.
The process for developing and issuing standards is complex and directed by multiple procedural requirements. According to Labor staff, agency consideration of a new standard can be the result of information OSHA receives from stakeholder petitions; occupational safety and health entities, such as the National Institute for Occupational Safety and Health (NIOSH) and the U.S. Chemical Safety and Hazard Investigation Board; OSHA’s enforcement efforts; or staff research (see fig. 3). To publicly signal OSHA’s intent to pursue development of a new safety or health standard, OSHA typically publishes a Request for Information or an Advance Notice of Proposed Rulemaking on the topic in the Federal Register. In this report, we refer to these events as “initiation.” OSHA also signals the beginning of standard-setting efforts by placing the issue on its regulatory agenda.
The process for developing OSHA standards varies, but the typical process involves multiple steps. After OSHA initiates a standard-setting effort, staff typically schedule meetings with stakeholders—employer groups, worker groups, and other interested parties—to solicit feedback and discuss issues related to the potential standard, including its potential cost to employers.
Concurrently with these meetings, OSHA staff and contractors perform technological and economic feasibility analyses using data gathered by visiting worksites in industries that will be affected by the potential standard. These analyses are necessary because the Supreme Court has held that the OSH Act requires that standards be both technologically and economically feasible. In addition, courts have held that OSHA must evaluate economic and technological feasibility on an industry-by-industry basis, which requires that the agency research all applications of the hazard being regulated, as well as the expected cost for mitigating exposure to that hazard, in every industry. For the technological feasibility analysis, staff identify the controls required by the standard and determine if each of them is technologically feasible for employers to implement. Agency officials told us this is an enormous undertaking because, for example, sometimes there are no sources of information on the applications of various chemicals or technologies. According to OSHA officials, this also requires visits to multiple worksites, and because these visits are generally conducted on a voluntary basis rather than under OSHA’s inspection authority, OSHA staff or its contractors can only visit worksites where the employer allows the visit.
Collaboration with NIOSH has, at times, helped facilitate these site visits. For example, OSHA officials told us that their staff worked closely with NIOSH staff in developing the technological feasibility analyses or risk assessments for standards on butadiene, methylene chloride, hexavalent chromium, silica, and diacetyl. When OSHA performs the economic feasibility analysis, it concludes that a standard is economically feasible if the affected industry or industries will maintain long-term profitability and competitiveness.29 To do this, staff and contractors, by analyzing information they collect when visiting worksites, must assess the extent to which employers in the affected industries can afford to implement the required controls. In addition to the site visits, OSHA staff sometimes conducts industry-wide surveys to determine baseline practices and collect other relevant information needed for the technological and economic feasibility analyses. According to OSHA officials, the process of developing a survey and having it approved by OMB takes a minimum of 1 year.
In addition to the feasibility analyses, OSHA staff generally must also conduct economic analyses. First, OSHA must assess the costs and benefits of significant standards as required by Executive Order 12866.31 Second, under the Small Business Regulatory Enforcement Fairness Act of 1996, if OSHA determines that a potential standard would have a significant economic impact on a substantial number of small entities, such as businesses, it is one of three federal agencies that must initiate a panel process that seeks and considers input from representatives of the affected small businesses. The small business panel process takes several months of work that many other federal regulatory agencies do not have to complete in order to issue regulations. Agency officials told us they want to consult with small businesses, but that the provisions laid out in the requirement make it too formal a process and are duplicative of the public hearings they hold after publishing the proposed rule. Finally, according to OMB guidelines, if a potential standard is projected to have an economic impact of more than $500 million, OSHA must initiate a peer review of the underlying scientific analyses.33
After completing the above steps, OSHA submits the preamble and text of the potential standard to OMB for review. OSHA then publishes a Notice of Proposed Rulemaking in the Federal Register to alert the public that OSHA intends to issue a new final standard and to invite interested parties to comment on the proposed standard. Although OSHA is only required under the OSH Act hold public hearings upon request, as a general practice, officials told us that OSHA holds such hearings and has issued regulations governing its hearing procedures. GAO has reported that, while regulatory agencies are generally subject to a number of rulemaking requirements, many rules do not trigger certain requirements.
Notably, an administrative law judge presides over the hearings, and stakeholders have the opportunity to submit evidence to support their views on specific provisions of the proposed standards. The administrative law judge may also permit cross-examination by stakeholders or OSHA attorneys to bolster or challenge testimony presented during the hearing. Finally, stakeholders can submit data and other written documents subsequent to the hearing that OSHA must consider when crafting the final standard.
Yadda yadda.
It's... probably worth pointing out that a little over a dozen states have separately-funded OSHA-approved State Plans doing their enforcement.
Very good point tbh.
I should be clear I don't really have a dog in the fight, just didn't want people to have the impression that the fight was particularly about abortion.
Out of curiosity I looked at Planned Parenthood's 2021-22 report; sex ed seems to be small compared to the medical services category ($49,200,00 vs $1,052,000 on page 33). I think a lot of the medical services are offered under affiliates but if it's funded through the same source or receives patients from the same centralized pipeline I guess same difference.
The breakdown of medical services is on page 29, for some reason the total is a little smaller here ($9,117,154):
STI Testing & Treatment: $4,411,825
Contraceptive Services: $2,348,275
Cancer Screenings & Prevention: $470,419
Other Reproductive Health Services (Pregnancy Tests, Prenatal Services, Miscarriage Care): $1,110,247
Abortion Services: $374,155
Other Services (Family Practice Services, Adoption Services, Urinary Tract Infections Treatments): $402,233
Probably a lot of this stuff conservatives consider elective, and cultural conservatives maybe object to contraceptives, but I'm not even sure how substantial that opposition is. Pew suggests only 4% of Americans think contraception is morally wrong and even for Catholics the number is only 13%. I imagine opposition is less to specific services and more just a holistic dislike of Planned Parenthood as an organization for that very public backing of abortion. Personally though I'm kinda surprised what a small portion goes to abortion.
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