fmac
Ask me about bike lanes
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User ID: 3415
fmac
Ask me about bike lanes
3mo ago
Education strikes me as fairly similar. It's kind of a monopoly good (oligopoly good?), demand is fairly inelastic, as a service it is incredibly hard to quantify cost vs benefits ahead of time and suss out who's the best at providing the service.
I'm generally pretty ideologically unbound, whatever system is shown to work the best is the system I want implemented. So yeah, implement European educational institutions, I think that western school board bureaucracy is an uninhibited nightmare so I'm all for getting rid of as many of them as possible. Korean/Japanese/Chinese ones seem fucking awful though, they make smart kids but I'm not sure if it's worth the hit to human wellbeing.
My uninformed opinion is that a ton of the USA's education woes are the fault of American parents, which is downstream of American inequality/poverty. But I have nothing to back that up aside from vibes.
fmac
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3mo ago
Yeah exactly. Healthcare systems fundamentally cannot play nice with market mechanics because people get unhappy when the market mechanics cause people to die.
So privatized healthcare seems to end up being an awful chimera hybrid of the worst of both worlds.
fmac
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3mo ago
Thanks for the link, yeah makes sense. I was just making things up that felt plausible.
fmac
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3mo ago
Are those systems actually that good?
They are better than the USA, which is the key benchmark. Canada is much more similar than Western Europe and also has historically out-performed the USA, although our healthcare system is getting fucked on pretty hard right now so idk how the stats match up post-COVID.
Can we make that happen here?
Unlikely currently, although given the USA is finally starting to (slowly) go pretty YIMBY on building a state-by-state basis, the USA does have a pretty blessed capacity to drive change in a way other countries do not.
we spend a lot of money on illegal immigrants
This is one of the factors tanking Canada's healthcare system, although they're not illegal, just extremely net negative on "tax contributions - cost to society"
have a maximal amount of cost disease
Strike me as a good argument to cut out the middlemen, as they need more expensive salaries
we are more unhealthy
This is hard, no easy solutions here (Ozempic as a condition of Medicaid if you're obese?)
we subsidize the rest of the world's medical research
I'm torn on this, if the USA also captures most of the world's pharma profits than this is a net gain no? No idea how the math works out there though.
we are more independently minded
This is true but hilarious. Americans are violently against "taxes to pay for healthcare" but are completely fine with "employer subsidized insurance premiums that mean they get less cash in hand in exchange for access to healthcare" which is functionally just taxes but with more middlemen??!!?! And poor people I guess get less services versus single-payer, but then everyone subsidizes them anyway via higher medical bills to offset all the non-payments from the aforementioned poor people.
medical malpractice is a huge drain
This is by far the easiest problem here to solve. Just legislate limits in damages or applicable suits. Although you will say "but will anyone actually do that" and the answer is "probably not" given it hasn't happened.
we don't have death panels and rationing
Are death panels real anywhere? I also feel like prices/medical bankruptcy (66% of all USA bankruptcy filings) are kind of analogous? If you can't afford chemo you sell everything you have until you run out of money to pay for it and die. Also you absolutely do have rationing, it's just in the form of prices versus bureaucratic limits. It can be debated which type of rationing is better, but the human demand for healthcare is infinite, supply never will be.
you can get care fast if you can afford it & the best care is in the USA
Profoundly true
Even putting aside those things good luck changing our system to resemble other's once reality comes into play (for instance forcing people onto plans).
Unfortunately profoundly true, I'm pretty black-pilled on western nations being able to pro-actively change anything until it explodes in their faces and they are forced too, at great cost.
In some ways I guess the USA's system is more survivable in that way. I can't really see it ever imploding, it'll just get shittier and shittier to get care from as all the costs/frictions drag on it. Unfortunately, I can see Canada's healthcare system imploding if it continues to be as mis-managed as it seems to be.
fmac
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3mo ago
the government should cover ozempic
Given how much obesity costs the US healthcare system/economy, this might be a positive EV move.
fmac
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3mo ago
If you’re 21, you probably don’t need much besides the catastrophic health care package. You are not likely to get sick, and thus you can skip the rest. If you’re 45 you might want more coverage for drugs or doctor visits or whatever else you think you need.
But now you've concentrated the risk pool for the >45 year olds. If the 21 year olds can't bring the average risk of the insurance premiums down, the premiums for coverage that isn't "you got hit by a car" are going to be insane.
Almost every collective welfare system in a government is predicated on extracting value from the young(er) and working to the old(er) [and very young] non-working.
fmac
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3mo ago
yes you can absolutely up end the system and make it way better than what we have now, but when has that ever happened successfully?
Basically every other western nation manages to spend equivalent or less amounts of healthcare than the USA, and has equivalent or better outcomes. So yes, basically everyone else's system is better than the USA status quo.
fmac
Ask me about bike lanes
3mo ago
that isn't just single-payer across the board
Why avoid this when every single proposed solution seems like replacing the current inefficient massive headache with yet another inefficient massive headache?
Single payer also has tons of issues, but when your healthcare system also involves a massive extra layer of insurance bureaucracy (and knock-on bureaucracy requirements for hospitals, etc. to interact with the insurance bureaucracy) and value capture (every dollar of insurance profit is a dollar not spent on making humans healthier) it seems like you're doomed to fail.
I'm open to examples of healthcare systems that do a great job of juggling this (Germany and Switzerland?) but it seems to me that you fundamentally must make trade-offs in a healthcare system. It is also too important and chaotic to leave to market mechanisms, for reasons like: no one who needs an ER is going to shop around for the best/cheapest/highest utility to them ER, people who can't pay for healthcare get treated anyway and then hospitals can't collect and have to charge everyone else more, etc.
To my amateur observations, it seems like you can:
You can have a collective/single payer healthcare system that tries to take care of everyone, and is constrained by resource availability/requires you to pay taxes that mean people you don't like get healthcare.
or
You can have a privatized healthcare system that siphons a ton of value/resources into insurance profits/bureaucracy and thus deprives the actual humans who need medical care of the medical care they need. It also functionally requires you to pay taxes that mean people you don't like get healthcare in the form of insurance premiums and meme-tier prices because hospitals have to eat the cost of people with no money still getting healthcare (yet another way that healthcare breaks market mechanisms, because hospitals don't like when people die, they treat people first and ask for payment after).
I would be a lot more sympathetic to the USA's current healthcare system if it managed to be either cheaper than it's peers, or more effective, but it is somehow both more expensive and worse.
fmac
Ask me about bike lanes
3mo ago
From the POV of a missile the carrier is essentially stationary, whatever direction it moves is irrelevant.
In terminal phases sure, but if the carrier is making a hard turn to move itself to a place where they suspect the missile won't be, I can see it. The carrier can do evasive maneuvers in the minutes between the missile being detected and the missile being anywhere near the carrier.
fmac
Ask me about bike lanes
3mo ago
I've never used anything but FancyZones and HOLY SHIT it is amazing.
Although I just jumped to Windows 11 and it's FancyZones-lite native feature is pretty good too.
fmac
Ask me about bike lanes
3mo ago
futility of enforcement
I actually think enforcement for this is incredibly easy.
I live in downtown Toronto, I have a dog. My neighborhood is overrun with dogs as it's all mid/late 20s yuppies in condos that are too small for kids.
There was a park that became an unofficial dog off-leash park while the nearby dog park was renovated for a year. Once the dog park opened people didn't stop going to the "unofficial" one. Eventually, by-law officers started doing occasional driveby's, and would attempt to ticket people. I have no idea if they actually ticketed anyone, but it had a profound chilling effect on people using that park as an offleash area.
And they half-assed it! Just hire more by-law officers and have them circulate. The evidence is clear, people do NOT respond to the severity of punishment, anyone breaking rules breaks them without worrying about the consequences as they think they wont get caught. What changes behavior is the assessed risk % of getting caught. So increase enforcement in a visible way, and watch people adapt.
The problem is, that requires taking action and doing things, and western governments at all levels are profoundly allergic to doing things.
This is a side note, but I actually had an incredibly sad related moment last winter. My girlfriend, dog, and I were walking through a park that has a skating rink. The Zamboni had created a snow mountain beside it. I have incredibly fond memories of playing on these as a kid. It was surrounded by other optimal parent age young adults like us, all letting their dogs play on the snow mountain. There were no children in sight anywhere in the park (it was morning, to be fair). Our dog had a great time running around it, but holy fuck was it sad seeing such a visual representation of the collapse in our societies fertility.
fmac
Ask me about bike lanes
3mo ago
I predict that they will accept a couple of the cheaper, more fig-leaf recommendations and ignore the rest, maintaining a status quo
A great way to predict most western government actions these days
fmac
Ask me about bike lanes
3mo ago
It is possible that fatal overdoses are reduced, which would allow the individual in question to overdose in the future again.
This strikes me as profoundly true.
It is possible that SIS increases the number of people who get addicted to drugs
I can see this being true, but can also see it not being true. Unsure.
I would also caution in believing that the three items in your list can exist simultaneously - although there is no physical reason that they cannot, there are political reasons they will not, and that is much harder to change.
They almost certainly will not exist. Voters hate paying for things. I hope we get institutionalization though, I am seeing the tides of public opinion shift on these as everyone gets sick of addicts ruining downtowns/parks/transit.
fmac
Ask me about bike lanes
3mo ago
I agree. SIS reduce overdoses, but don't make anyone stop doing drugs. And people who implement SIS also refuse to make people stop doing drugs.
We should have SIS, voluntary rehab, and institutions for those who can't stop themselves
fmac
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3mo ago
I think it's pretty clear they reduce overdoses and the waste of paramedic/hospital resources.
It's also incredibly clear that alone they do nothing to actually fix anything. They're a Band-Aid for symptom management as we treat the underlying issue. Problem is, we don't bother to treat any of the underlying issues.
fmac
Ask me about bike lanes
3mo ago
Safe injection sites
They reduce overdoses and time wasted by paramedics/hospitals treating the same 100 people over and over again.
They clearly don't make less people use drugs.
Their biggest issue imo, is that the Venn diagram of people who implement SIS and people who also implement the more draconian measures for the un-savable drug addicts are two different circles. And then the awful addicts are left to ruin it for everyone.
fmac
Ask me about bike lanes
3mo ago
Ahhh
That's an interesting concept. Any good examples? Why do you think the model of "the customer is a rational economic agent who buys the best things for themselves" has fallen apart recently? What changed in the marketing world to allow companies to leverage marketing to make up for sub-par products?
fmac
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3mo ago
I'm not saying he isn't a socialist.
I'm saying "Socialism at the federal level mostly means endlessly , whereas socialism at the state + local level mostly means ."
Is not a very accurate way to describe socialism.
To add a similar thought, "bloating the elder care apparatus" is pretty much a bi-partisan issue in the West.
Going further, "bribing connected nonprofits and unions to provide various crappy services that don't really work" is very true for liberals, and so is the opposite "bribing connected companies to provide various crappy services that don't really work" for the conservative side.
fmac
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3mo ago
Brandon Johnson in Chicago
I've been meaning to read up on him. Sounds like he's a total fucking disaster.
My general vibe is Chicago has been on a pretty good hot streak of terrible mayors.
fmac
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3mo ago
He's at least said for the grocery stores that if they don't work they don't work, and he'll walk away
They won't work, so we'll see if he actually walks away
fmac
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3mo ago
"socialism" = "liberal policies I dislike, the more I dislike them, the more socialist they are"
"Far right" = "conservative groups I dislike, the more I dislike them, the more far right they are"
"Neoliberalism" = "things about capitalism I dislike, the more I dislike them, the more neoliberal they are"
Western political discourse is stupid and getting stupider, because we are becoming stupider
Super fair point.
This is kind of a large "but" given how much of a nightmare healthcare costs are to those who can't afford/have shitty insurance, but I do happily agree that the upper bound of USA healthcare quality is incredible, it's just a matter of having extended access to it...
Brother tell me about it. So far all my experiences (I do a lot of dangerous sports, so I've been to the ER far more than I would like) have been speedy and great, but I live in downtown Toronto and have a great family doctor, so I am pretty lucky in that way. My friends/their parents all have overall good experiences/timelines as well, but again, we're all educated white collar workers who live nearby to the largest agglomeration of healthcare resources in the nation.
The news stories and stats I see though.... Jesus Christ it's grim.
As my parents (and me! yikes!) get older I do find myself wondering if I should familiarize myself with USA v Canada "healthcare arbitrage". If I can get one of my parents an MRI in 1 week for $5,000 vs in 9 months for free when time is directly proportional to better outcomes, that's $5,000 I'd spend in a heartbeat.
Funnily enough, as MRI is the only example I actually know of for "things its worth going to the USA for". The one time I got an MRI, for in retrospect was a slightly frivolous diagnostic rule-out, I was scheduled for one a week after my ENT appointment. Although I am assuming that is Toronto-privilege, I bet if I was in Halifax that would not have been as fast.
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