In practice, India’s workers have had less success than their Western peers; India is much more unequal than the West at a similar stage of development.
Imo they're kind of the same picture; India has worse economic conditions by inequality and most metrics because it had a more successful labor movement, at least in terms of getting the capitalist class to bend to their demands, which were mostly against the kind of mechanization that made other countries' textile industries take off. But that's a separate argument.
Even when worker conditions were at their lowest and labor at its most militant in the west, strike activity still doesn't come close to what we see in India - the Swing riots in the UK and the Coal Wars in the US are tiny disturbances in comparison to India's mass culture of wildcat strikes. But we can even leave that aside; I've said before here that I don't have a strong opinion on immigration and am generally skeptical of the skeptics. I don't actually think immigrants from India or wherever would be more difficult to manage, at least the latest immigrant-critical work seems to show favorable impact from Indian immigration in the end.
But by the same token, I doubt anyone can credibly claim the opposite, that the native British population would be harder to manage than foreigners. If we're talking about the present year I assume relatively modern comparisons are more applicable than the broader millennium - which I agree was pretty darn violent in Europe - but in the 2020s it would be unheard of for 20% of Britain to go on strike, or even for most countries at the same level of development as India.
Soriek
11mo ago
Given that likelihood to have kids increases the poorer you are, I assumed you would be against the implications of this kind of policy, though correct me if I've misjudged.
Soriek
11mo ago
My reaction as well from the same background. If i read the coverage right he held that chokehold for two minutes, which is crazy. It only takes a few seconds to knock someone out like that. Anyone trained enough to know the hand position would know that from experience.
Soriek
11mo ago
Yeah fair to say. I don’t think i have a strong objection to the policy myself.
Soriek
11mo ago
You don’t have to spend a lifetime doing bjj, the rear naked choke is a move taught to beginners. The way it’s taught involves practicing it on other people, you see an instantaneous reaction from the other person the moment you apply pressure. It’s essentially impossible to learn the move without understanding what it does.
This is not to say I feel no sympathy for people defending themselves against a crazy person on the train, being a commuter myself, but the idea that someone could rear naked choke another person for two minutes and be surprised it was lethal is not realistic. The question is whether lethal force was warranted in the situation.
Soriek
11mo ago
No, you practice it live too. We have children do this, I’d be shocked if actual marines don’t as well.
Soriek
11mo ago
Imo we could definitely use more firsthand Africa posts. Or at least I like to read them.
Soriek
11mo ago
It doesn't look like has the choke on perfectly in the first part, though we can't really see it the second minute.
At this stage, I don't think we have sufficient evidence to reach a conclusion regarding whether reasonable people would have believed that the threat had ended.
I agree, and as per my earlier comment I don't even have an opinion on whether he was unwarranted in using lethal force in the situation. My objection is to the idea that any trained person wouldn't understand that the rear naked choke isn't meant to restrain someone, it has deadly potential if held continuously. From his use of the move and his leg wrap around the guy's legs he clearly has training.
Soriek
11mo ago
I honestly really don't think that's true, when you practice this live it's totally normal to see people pass out if they're stubborn or don't tap out quickly enough. Even if you just watch the sport you'll see this happen regularly.
Soriek
11mo ago
No, you spar, where you're trying to attack another person who is resisting you and trying to attack you. This is a very far cry from "having other people play along," and you regularly see people pass out from using this move in sparring, making it extremely unlikely that anyone would be familiar with it and not understand what it does.
I've said several times in this thread I don't have a stance on whether his response was right or wrong, at least until more info comes out, because if someone attacks you in real life sometimes lethal force is warranted. What I question is that he wasn't aware that this move had lethal implications, it's genuinely really clear to anyone who's used it. The "how would people react in an uncontrolled situation vs a controlled situation?" isn't the question here, it's "how would someone's bloodflow react to this move in an uncontrolled vs controlled situation?", to which the answer is "the same".
Soriek
11mo ago
From your above comment you did judo? How often are rear naked chokes used? I thought pushing down on the back head as part of a choke was fully banned in judo tbh. I've seen people go out more times than I can count in bjj and have come close to passing out myself.
But the guys in the 2-Gun Action Challenges understand that guns are lethal even without actually being shot, and someone who has trained or sparred in bjj would understand the implications of a rear naked choke hold.
Soriek
11mo ago
I mean, he probably convened a meeting of ethics professors, focus grouped the results a bit, got a supreme court ruling and a blessing from the pope before confronting the maniac.
Pretty unnecessary response imo.
I don’t especially care about this incident anymore than I care about any of the other daily killings in NYC, but even maintaining the same hold without putting the one hand behind the head (which is what causes the downward pressure on the bloodflow) would have been both easier and less lethal. Not even saying he should have done that in the situation if the guy was violent, but if all he wanted to do was restrain him (as opposed to knock him out and dip) then almost any way of holding someone other than the really specific RNC position is less lethal.
Soriek
11mo ago
Yeah I was gonna say actually knocking him out and withdrawing quickly could have made sense, if the guy was attacking him at least. If you can’t land it perfectly just applying sustained pressure to the throat for a long time is dicier though. And if the guy doesn’t turn out to have attacked anyone, you can’t just knock someone out for being really awful to be around.
This is either wildly wrong or extremely pedantic.
…it isn’t though? Fitting your hand behind the back of somebody’s head and pushing down isn’t a natural, easy-to-fall-into movement - you might have to literally force your hand up in between their body and yours while they’re struggling - and that move is specifically what causes the blood flow to cut off. Almost every other form of back control doesn’t have that immediate risk because the RNC isn’t back control, it’s a submission. Even just take the same hand and use it to pin his arm to his body and you have a movement both less dangerous and more natural for beginners, whereas as the RNC isn’t something people know intuitively without being taught.
As for your comment about lethality, in every conversation I’d had about this event, including my comment above, I’ve very explicitly said I’m not condemning the use of lethal force, which may have literally been necessary if the guy was attacking him or somebody else on the train. I’m disagreeing with the people who are for some reason arguing that choking someone out for a long ass time doesn’t have obviously lethal potential. And if it turns out the guy wasn’t attacking anyone, for better or for worse you don’t get to knock people out just for being awful.
Soriek
11mo ago
I‘m fine with people carrying and using guns, tasers, and pepper spray in self defense. Not that these are valid comparisons, the latter two are pretty obviously less likely to result in a dead guy than choking.
Strange how there are exactly zero responsible and reasonable uses of force, at least after the fact if something goes badly and someone dies.
Maybe you think you’re responding to someone other than the guy who’s said like five times that lethal force could be valid in this situation.
From that position? You lock your bicep on one side of the neck and forearm on the other, then pin that hand to your other upper arm to keep it locked. Then take your other hand and push down on the back of the head and it’ll cut off bloodflow, causing someone to go unconscious. It looks like this all together.
Soriek
11mo ago
Yeah it has actually, sort of meant to do a follow up post and never really got around to it but I've definitely been enjoying it more. @OracleOutlook's suggestion to use the Phil Dragesh audiobook was a gamechanger. I usually read history and my goal is kind of just processing information as efficiently as possiblec, which isn't so well suited here. By taking away my ability to control the speed of reading I was able to get more of an immersive experience. I feel like that's also helped me appreciate the other elements people like yourself mentioned, like all the worldbuilding and references to the world being fallen from ancient greatness.
I've also just been enjoying the Two Towers more. The Fellowship felt like a lot of build up but I've read Book III now and it feels like the plot is progressing and more action is happening. My friend sent me the ACOUP series getting into the weeds of the battles which also helped me appreciate how much background effort went into making the world belieavable/functional.
Soriek
11mo ago
I'll definitely be checking out the Simarillion then! Good to hear it's rewarding because I'm pretty sure I signed up for it by accident along with the others when I joined the Book Club - I honestly hadn't realized Tolkien had written anything else.
Consolidated Markets in Healthcare
In the old place we talked about doing regular analysis of emerging legislation / happenings on the Hill, so this piece is in that spirit. Yesterday the Ways and Means Health Subcommittee had a hearing on “Why Health Care is Unaffordable: Anticompetitive and Consolidated Markets.” This isn’t a major hearing or anything, it’s just a topic I’m interested in so I thought I’d share it here.
If you’ve never watched Congressional hearings I actually recommend it. When I started I was surprised how generally intelligent and reasonable most Congressmen appear, even the ones who act like clowns on social media, how much they tend to ask the kind of questions you would want them to ask, how often Republicans and Democrats actually agree. The panelists are listed below, hyper linked with their written testimonies. Q and A is in the video.
Dr. Barak Richman, Professor, Duke Law School
The Honorable Glen Mulready, Commissioner, Oklahoma Insurance Department
Mr. Joe Moose, Owner, Moose Pharmacy
Mr. Frederick Isasi, Executive Director, Families USA
Dr. Benjamin N. Rome, M.D., M.P.H., Instructor in Medicine, Harvard Medical School
It probably needs no introduction how borked the US healthcare system is, but a few stats from the hearing: according to the Kaiser Foundation 30% of Americans say they didn’t pick up pharmaceuticals because of cost, almost half of all Americans must forego broader medical care due to cost, and over 40% of Americans live with medical debt. Other countries often pay half or less of what we do.
Panelists attribute this to anti-competitive practices coming from consolidation in three interconnected markets: pharmacy benefit managers, pharmaceutical manufacturers, and hospitals.
PBMs
Pharmacy Benefit Managers, or PBMs, are middlemen companies that represent a bunch of healthcare customers collectively in negotiations with pharmaceutical companies. On net PBMs are believed to decrease drugs costs, but there is no way for PBM customers to see what prices were negotiated, and frequently rebates aren't passed onto consumers. In Ohio for instance PBMs passed on the full difference of what they paid pharmacies to Medicaid managed plans, and in Delaware PBMs overcharged the State by $24.5 million. The latter practice is called “spread pricing” and has become increasingly common as PBMs buy up pharmacies themselves.
Currently three PBMs - CVS Health, Cigna, and United Health Group - control 80% of the market, with zero pay transparency.
Pharmaceutical Companies:
Often drug prices are pretty arbitrary themselves because brand name drugs make up 75-80% of costs, and patenting laws allow pharma companies to raise those prices as high as the market can bear. One panelist cites that in 2015 over $40 million was spent on drugs that big pharma held excessive patents on, and that the top 12 drugs have over 120 patents for 38 extra years of exclusivity.
Clearly some degree of patent protection is reasonable, but I’m not sure why i.e. the 12 year biologic patent period Trump created offered anything better than the previous 8 year period. Also, see one of my favorite old Scott posts, “Busiprone Shortage in Healthcaristan,” for stories of Sanofi protecting nominally off-patent Insulin by issuing 74 patents for the biological processes to create insulin - not to use these processes themselves but just to prevent any competitor from ever using them.
The Inflation Reduction Act changed Medicare’s ability to negotiate prices somewhat, but pharma companies still get their market exclusivity and even then Medicare can only negotiate the 20 highest cost drugs. Giving Medicare greater ability to directly negotiate prices would likely help quite a bit; this is the model practiced in much of the world and by the US Veterans Administration, which also pays about half of what everyone else does.
For context though, pharmaceutical prices are, shockingly, only about 8.9% of healthcare spending...
Hospitals
...with physicians and hospitals making up over 50%. The hospital panelist thought it was funny the PBM folks were complaining about there only being three major market players. Most hospitals don’t even have one competitor!
According to Representative Claudia Tenny from New York, from 1983 to 2014 the percentage of physicians practicing alone has fallen by half, while the rate of physicians joining practices of 25 or more people has quadrupled. Often when hospitals acquire these physicians they charge high facility fees for seeing doctors “off-campus,” even though the services are the same. The very fact that hospitals can get away with doing this only further encourages consolidation, because they know they can mark up prices for any new acquisitions. Representative Kevin Hern from Oklahoma proposed in the hearing a bill that would supposedly combat this practice.
Hospitals typically make physicians sign non-competitive clauses, meaning they can’t leave and work for a competitor, even in areas as large as the entire state. From 2007-2014 hospital prices increased twice as fast as inpatient physician’ salaries and four times faster than outpatient physician’ salaries.
Often hospitals also lobby State Legislatures for monopolist laws. Nineteen state have Certificate of Public Advantage laws allowing hospitals to evade anti-trust laws and merge in already-concentrated markets. Another Thirty-five states (and DC) have Certificate of Need Laws forcing providers to obtain regulatory permission before they “offer new services, expand facilities, or invest in technology”. These laws act as huge regulatory barriers to entry for small competitors trying to challenge major hospital systems, and the DOJ and FTC have long condemned them for their anticompetitive nature.
Interested to hear people’s thoughts and would love if we could get a regular thing going.
I don't have an opinion on the broader thesis, but I'm not sure this checks out, unless actual revolutions are the only stat we care about. The largest share of Britain's yearly immigrants come from India, which is famed for its labor unrest. Scroll to page 35 of Susan Wolcott's study on textile strikes to see "days lost per worker" in the Bombay Presidency simply blowing the UK's numbers out of the water, "nearly ten times as high". I'm not sure of any comparable study for the modern day, but during the height of the farmer protests something like a fifth of India went on strike and drove an otherwise electorally dominant party to walk back one of their major legislative commitments.
I don't know much about labor relations in Pakistan and Nigeria, but when I google their countries plus the word "strike" there seems to be an active aviation workers strike in Nigeria along with a University professor strike last year, and recent strikes in Pakistan from garment workers and gas distributors. Both countries are also pretty notable for general unrest, secessionist provinces, etc.
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