fmac
Ask me about bike lanes
No bio...
User ID: 3415
fmac
Ask me about bike lanes
1yr 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
Ask me about bike lanes
1yr 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
1yr 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
1yr 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
1yr 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
1yr 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
1yr 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
1yr 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
1yr 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
Ask me about bike lanes
1yr 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
1yr 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
1yr 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
Ask me about bike lanes
1yr 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
Ask me about bike lanes
1yr 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
Ask me about bike lanes
1yr 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
Ask me about bike lanes
1yr 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
fmac
Ask me about bike lanes
1yr ago
Socialism at the federal level mostly means endlessly bloating the elder care apparatus, whereas socialism at the state + local level mostly means bribing connected nonprofits and unions to provide various crappy services that don't really work.
Neither of these things have anything to do with the ownership of the means of production.
I feel like we've fallen into the trap of using "socialism" as a shorthand for "stupid liberal policy I hate" in the same way the "far right" now means "conservative people with ideas I really dislike"
fmac
Ask me about bike lanes
1yr ago
I agree with you regarding your critiques of socialism, but
The problem with socialisms are two - people are selfish and tragedy of the commons.
This describes a huge % of issues the capitalist West is currently failing to deal with too
fmac
Ask me about bike lanes
1yr ago
Which problems are you referring to here?
Because the big NYC ones are:
Housing, which is entirely the fault of local voters using government to prevent more building. I blame the voters for this, not the politicians responding to their voters (selfish) wishes.
Public safety, voters hate all functional solutions to drugs/homeless because they feel "gross" (bleeding heart libtards hate enforcement, delusional rightoids hate proven solutions like SIS, no one wants to pay for more rehab centers).
Traffic/transit efficacy. See the huge backlash to congestion pricing, despite it being an economically sound and obviously beneficial policy. Also note that absolutely no one wants to give the MTA money despite it falling apart all the time (because preventative maintenance is expensive and boring). Admittedly it does seem like the MTA admin is a bit of a shitshow, so I guess we can blame government for that one. Although I've worked for large oligopolistic corporations and their admin was also an inefficient shitshow.
More broadly, in every western nation absolutely every citizen wants more gibs, and absolutely none of them want to pay more taxes to fund the gibs. So they mortgage the future instead.
I find it hard to blame government for all of this, as any politician who actually tried to take action to fix any of this would immediately lose their next election.
fmac
Ask me about bike lanes
1yr ago
I mean vs Ukranian civilians relative to population size for both countries.
So per 1,000 people in each country, there ~30 Gazan civilian deaths per capita for each Ukranian civilian death.
Given how much obesity costs the US healthcare system/economy, this might be a positive EV move.
More options
Context Copy link