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PaperclipPerfector  11mo ago (text post)   32578 thread views

Culture War Roundup for the week of December 9, 2024

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If she doesn't enjoy it, she should stop. But I don't see any fundamental problem with such virtuosic feats of sex. It's a bit weird in the same sense that hot dog eating contests are weird, but if the people involved were happy about it I wouldn't see any problem.

She might be able to find a fairly normal husband if she wants to, sure, and again I don't see any problem with it as long as both people are happy. A pussy doesn't develop magical destructive powers just because 100 dicks were inside of it in one day.

Also, I don't see why a trigger warning would be necessary. We regularly discuss things like wars, genocide, rape, and capital punishment on this site, so sex is pretty far down on the list of what should really trigger anyone who enjoys this place.

but if the people involved were happy about it I wouldn't see any problem.

Is this your only criteria? It isn't. Because if it were, you would have no problem with people becoming addicted to drugs and other substances.

Furthermore, let's get into temporal preferences and shifts in self-perspective over time. Maybe this woman can convince herself that she's "happy" with it for some amount of time. I'd argue, given the clip shared, that that amount of time was, at most, the time between the end of this sexual act and when that clip was filmed. Regret may have been forestalled, and it then arrives on camera.

(Interesting aside: this has a bizarre connection to false/not-false rape allegations. Two people are "happy about it" in the moment. The next day, one of them wakes up feeling less "happy about it" and files the allegation. A complex and high stakes legal process then ensues wherein both parties try to somehow prove how they felt about what at which times).

People are often flawed at judging what is good for them and what makes them truly happy. To combat this, we try to develop systems of normative thinking to assist. Some people call this morals, ethics, virtues etc.

Show me the moral/ethical/virtue system that says "Sex with 100 strangers in an hour" is permissible. Aside from moral relativism, out and out hedonism, or nihilism, it doesn't exist.

Show me the moral/ethical/virtue system that says "Sex with 100 strangers in an hour" is permissible. Aside from moral relativism, out and out hedonism, or nihilism, it doesn't exist.

To the extent that it's a moral system in addition to a political one, it's called liberalism.

You know what, fair. Thank you.

I'll pivot and, then, say that liberalism is a fantastic moral and political system for speedrunning towards the destruction of human integrity and the destruction of individual dignity. If such a path leads to such desolation, of what use is the path?

Wouldn't the counter-argument be that, prior to the invention of liberalism, Europe was constantly tearing itself apart in holy wars? I doubt many of the people whose lives were constantly being disrupted as a result felt terribly dignified about the whole matter.

I'm not saying that "I'd rather be dead than compromise my integrity and dignity" is an incoherent or obviously ridiculous statement - there really are certain principles I hold which I would rather die than violate, or certain experiences which I find the idea of going through so humiliating that I would rather die than experience them. But I would like to be reassured that whatever you're proposing as an alternative to liberalism wouldn't immediately lead to hundreds of years of civil war and the immediate cessation of all meaningful human progress and economic development.

Wouldn't the counter-argument be that, prior to the invention of liberalism, Europe was constantly tearing itself apart in holy wars?

Other than the Thirty Years War (1618-1648), what other "holy wars" do you have in mind, such that "Europe was constantly tearing itself apart"?

https://en.wikipedia.org/wiki/European_wars_of_religion

So, the smaller post-Reformation conflicts leading up to the Thirty Years War?

What about the many, many centuries before the Reformation? Europe wasn't exactly "tearing itself apart in holy wars" then, now was it? It still looks to me like Europe has spent a minority of the last couple millennia in "holy wars" — certainly not enough time to deserve the term "constantly."

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Liberalism has been around a few centuries and hasn't led to desolation yet. I'd rather not get off the path or take doommongering too seriously.

So out and out hedonism it is.

Ironically I do think that there are systems of ethics that have a coherent claim to not just allow this behavior but make it virtuous. But nobody actually cares about weird sex positive pagans anymore.

I don't think liberalism is interchangeable with hedonism. My one-sentence gloss of hedonism is "do whatever you find pleasurable", which quickly spirals into libertine degeneracy. My one-sentence gloss of liberalism is "do whatever you want as long you aren't infringing on anyone else's rights", which quickly spirals into endless debates about distributed effects and externalities and "but how does this affect you personally" and so on. But to a first approximation, I fail to see how this adult woman having sex with a hundred consenting adult men directly infringes on anyone else's rights.

do whatever you want as long you aren't infringing on anyone else's rights

Bounded or not by pragmatic guidelines, the ultimate goal is indeed to realize whim and desire with no examination as to whether that is proper.

What OP surely means by a "moral system" is such an examination. Ethics of any kind.

If the answer to "what is to be done" is "realize desire", then it is hedonism.

Indeed the only reason for the limitation you point to is that in violating someone's rights you are preventing them from realizing their desire also. What are we then to believe if not that this is just hedonism, if of a pragmatic nature.

I fail to see how this adult woman having sex with a hundred consenting adult men directly infringes on anyone else's rights

It does not, but that's the contention: that there is more to ethics than consent.

Why would liberals have to allow this? Locke, for example, absolutely thought the government could punish sexual immorality. I'm not familiar enough with his work to know whether there's any inconsistencies there, but it seems like, as a matter of fact, most liberal societies thought banning that sort of thing was fine.

They wouldn't have to. In another comment I wrote:

My one-sentence gloss of liberalism is "do whatever you want as long you aren't infringing on anyone else's rights", which quickly spirals into endless debates about distributed effects and externalities and "but how does this affect you personally" and so on.

It's perfectly consistent of Locke to think "what some other person believes about the ontological character of the communion wafer does not affect you personally, so let them do as they please; but the normalisation of sodomy, adultery and promiscuity absolutely do have distributed negative effects on society, and so should be forbidden and socially stigmatised". Whereas a more modern liberal generally takes the attitude of "people are entitled to their own opinions" and "what consenting adults do in the privacy of their own home is none of the government's business, and by extension none of society's business".

I don't have a good answer as to which interpretation of liberalism is better or more conducive to human flourishing. "As long as you aren't infringing on anyone else's rights" permits a lot of degrees of freedom to permit certain things and forbid others.

I am a pretty moral person. I have a strong moral code. I am generally nice to others. I try to help people. I think that things like murder and rape are fundamentally wrong in an absolute way. And I have absolutely no problem with someone having sex with 100 strangers in an hour. The idea that there would be a moral issue about it strikes me as somewhat absurd.

As for drugs, I would prefer that people not get addicted to them, but there is no moral dimension about it for me.

I'm not trying to speak for 100Proof by replying, just my opinion here.

  1. Moral systems exist in part to guide people to optimal choices as people are often poor judges of what makes themselves and others happiest.
  2. It is possible to morally wrong yourself (as the primary victim). This is wrong like it would be a moral wrong to allow yourself to weigh 600 pounds.

Allowing oneself to weigh 600 pounds undoubtedly hurts one. Having sex with 100 people in a day does not undoubtedly hurt one.

That's debatable. But your comment makes me wonder if there were any sort of screening of these men for STIs, beyond simply "Hey do you have any?" I somehow doubt it.

Why doubt that? Requiring a ticket to ride is pretty standard procedure.

For whom? I feel like a girl advertising for sex wanting only a photo of your face and you holding up an email address (or whatever it was) is not particularly cautious. I could be wrong, of course.

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I am a pretty moral person. I have a strong moral code. I am generally nice to others. I try to help people. I think that things like murder and rape are fundamentally wrong in an absolute way.

A self-referential argument from authority is a hell of way to make a point.

As for drugs, I would prefer that people not get addicted to them, but there is no moral dimension about it for me.

What, then, does have a "moral dimension" for you? Are you saying that many things in life are not only inherently ammoral, but immune to morality?

Well, I already said that I think murder and rape are fundamentally wrong in an absolutely way, so certainly those have a moral dimension for me. But promiscuity doesn't.

Also, I'm not trying to argue from authority, I'm just pointing out that I'm not a moral relativist or a nihilist, and I may or may not be a hedonist depending on how you define hedonism, yet I don't see any moral issue with promiscuity.

Because if it were, you would have no problem with people becoming addicted to drugs and other substances.

I have no problem with people becoming addicted to drugs and other substances. I'm not saying it's a good idea, but I have no problem with it because it's none of my business how they choose to live their lives.

because it's none of my business how they choose to live their lives.

Please meet Daniel Penny, another person who didn't care how others choose to live their lives until he really, really cared.

I mean this is such a naive response. Of course no one should care how another person lives their own private life. But we live in a society. We interact with one another. If your horribly addicted to drugs, you might choose to "involve" yourself in my life in a drastic way.

Perhaps you'll say, "oh, sure, you can beat the crap out of an addict if they accost you" - but the median position in society is that we shouldn't let people become addicted (to at least the illegal substances) so that we can avoid the far more costly "beat up the zombies" method of social regulation.

Blind/naive libertarianism is just such a poor way of even approach the world. Complex system interact with one another. Unintended consequences are real. People's quality of life extends beyond the walls of their apartments.

A person becoming addicted to drugs to the point that he starts to be violent to people or overuse the healthcare system is a social problem because, well, he starts to be violent to people or overuse the healthcare system. A person choosing to have sex with 100 men in one day in a safe manner causes no harm to others that I can think of. I guess you can put forward complicated theories that boil down to some kind of magically contagious social rot, but I neither find having sex with 100 people in a day to be rotten nor am I convinced that its contagious nature is much of a problem.

A person choosing to have sex with 100 men in one day in a safe manner causes no harm to others that I can think of.

It causes harm to the self. That's the whole point. This was a bad decision by the lady in question and it was a bad decision that should be easy to avoid.

Again, utilitarianism and/or libertarianism congratulate themselves by saying "we have a hard line up against harming others" conveniently leaving out that all "others" are "selves" depending on reference point. While I definitely don't think the power of the State should be employed to inhibit people from doing things that may or may not be harmful to themselves, I do believe that a useful moral system must necessarily state that there are some actions and motivations that are harmful to the self (and do not offset this with noble and/or virtuous self-sacrifice ) and ought to be avoided for moral reasons ... not just in service of a self-preservation instinct.

Would you say it's immoral for someone to intentionally burn themselves so they could get a cool scar? What about smashing their own (non shared) things in a fit of rage?

What about smashing their own (non shared) things in a fit of rage?

Do they correctly dispose of the smashed bits afterwards? Did they do the smashing when I don't have to see or hear them and they aren't inconveniencing anyone?

Would you say it's immoral for someone to intentionally burn themselves so they could get a cool scar?

Is the scar in a visible part of the body? Will it be deleterious to their health now or in the future?

It causes harm to the self if you're the kind of person who is harmed by having sex with 100 people in a day, in which case you shouldn't do it. If you're the kind of person who isn't harmed by it, your argument doesn't apply.

What if they took a drug that caused 100% of users to violently assault the next person they see? What about 50% or 10%?

Because other people using drugs does actually affect you in most cases. Whether it's something relatively small like having to step around hobo puke on the sidewalk, or something more direct like a junkie biting your face off because they're high on bath salts.

I think this response is beautiful. This was the standard response of the laissez-faire economist and the social liberal pre-2024. It has dominated western politics and was basically the default position of anyone who drank water, breathed air, and wanted to not be fucked with. Leave well enough alone, what I do is my business. You don't have a right to tell me what to do, and I don't have a right to tell anyone what to do.

I also think that this response is very dated. Partly as a result of the way the internet systematically crushed the vast majority of social barriers to information, partly because of the wilful detonation of social structures and institutions (What if people are excluded? Well, then everyone needs to be excluded! Wait, why'd they let that in? Screw this, I'm outta here!).

There is a fantasy of man as an island that has never gone away.

It is still possible, for some, to a limited extent. For the rest of us, who don't hunt, kill and butcher our own meat, make our own clothing, craft our own domiciles and generate our own electrical power, we have to engage with society in some way. But that breaks the fantasy. We wish to think of ourselves as alone, fully in control of our own destinies, that society loses more from us not participating in it than we lose by not participating in society.

I think we're past that. Isolated as we are, we are all easy pickings for those who've managed to coordinate meanness. I think that's also why people have such poor reactions to this poor creature who has sold her body to a crowd for attention. They are concerned with great ideas, like the collapse of pair bonding, stable male-female relationships, and what this signals for both sides of the fence, as well as the governments that rule them. Maybe some of them are concerned for her mental well-being, who knows. It's a tug of war between those who see society as something to be preserved, shaped in a way that benefits them, or at least in a way that doesn't make their lives actively worse, and those who couldn't give a hundred fucks about society.

We do not care for the crackhead. What he does with crack is his business. But we do not live near him either.

Does it seem to you that her lack of enjoyment surprised her?

Does her apparent lack of enjoyment surprise you?

Well, that's why I said "if she doesn't enjoy it". Surely some people do. Aella for example.

That doesn't really answer either of the questions. Sure, I can imagine that some people genuinely would enjoy it, for some definitions of "enjoy".

The Rationalists had a phrase I admired, "I notice I am confused". They realized confusion was useful, and an opportunity to seek deeper understanding. For those who hold that sex is harmless entertainment, this seems like it ought to be confusing. Why did she expect to enjoy doing this, and why didn't she enjoy it?

And this is the thing, really. Back in the 90s, the sexual revolution was unassailable, because those of us arguing against it were killjoy puritan tyrants who just wanted to spoil everyone's fun. So we were pushed out of the way, and it was declared that anything went. And that's well and good, but it turns out that there do indeed appear to be consequences, and those consequences do indeed appear to be woeful in at least some cases, and the side that won the fight has no room for either the consequences or their woefulness in its model. The license they argued for is observably making people wretched, and the only move available to them appears to be to play dumb.

@Primaprimaprima - I never had time for replies to the art discussion, but IIRC your position was that art cuts, takes away from you, is incisive, yes? Was this art, in your view? Do you think her choices have made her life better?

Back in the 90s, the sexual revolution was unassailable, because those of us arguing against it

Am I mixing you up with someone else, because I thought you'd always been a liberal until... 2008ish?

I was raised a Conservative Christian. I ditched the Conservativism in 2002/2003, and the Christianity around 2004, and went atheist and deep blue on pretty much everything but guns; I actually left the country for Canada under Bush because I was deep into blue tribe conspiracy theories about 9/11 and stolen elections, among other things. I came back to the states in the Obama years, but stayed deep blue. When the Feminist blast-wave hit my position in ~2013 IIRC, I was initially very concerned and highly engaged and all gung-ho for Social Justice. It took a couple months of actually paying attention for that bubble to pop.

"SOCIAL JUSTICE NOW!"

"Social Justice is vitally important, but some misguided people are doing it wrong, they need to stop that!"

"They aren't stopping, they need to be stopped, guys this isn't the way"

"Wait, why are all the people around me cheering the bad people on and shouting at me, this is crazy, what the fuck is going on"

"Either I'm going crazy, or 90% of my social class has gone abruptly crazy, and I can't tell which"

"Nope, it's them. They're betraying True Liberalism, which we must fight for."

That played out over about three or so months, and I came across Slate Star Codex while trying to figure out what the fuck was going on. I started limping my way back to Christianity around then, but still identified as deep Blue for another couple years, thinking that Social Justice was just a temporary aberration which could be rolled back or corrected. I spent a long time arguing against the Zunger thesis and in favor of Scott's niceness, community and civilization, until eventually I realized that I was losing those arguments because Scott was wrong and Zunger was straightforwardly correct. That destroyed what was left of my allegiance to Blue Tribe, and I've been moving Red ever since.

Thanks, I had no idea about the Early Life part, and only remembered your post-bush moving-to-canada stories.

You've been writing for a long time, is there any chance you still have like 2005 era blog comments? It would be really interesting to see old-you's perspective on events I hardly remember.

For those who hold that sex is harmless entertainment, this seems like it ought to be confusing. Why did she expect to enjoy doing this, and why didn't she enjoy it?

I mean, little kids think they'll enjoy eating 100 cakes, but there's quick diminishing returns for many pleasures. I would venture a guess that psychologically, having sex twice in a single day is pretty doable, and probably still enjoyable.

I don't think there's anything special about sex as a pleasure that makes doing it 100 times much more onerous by the end. It's just like trying to force yourself to drink 20 shots of vodka, or smoking 200 cigarettes in a day. Pleasures just don't scale that way.

I would venture a guess that psychologically, having sex twice in a single day is pretty doable, and probably still enjoyable.

When I was much younger, having sex several times a day -- with the same woman -- was very enjoyable for both parties. However, I think even then, 100 times would have been physically painful.

It's just like trying to force yourself to drink 20 shots of vodka, or smoking 200 cigarettes in a day. Pleasures just don't scale that way.

I notice that your choice of examples have deleterious effects on the recipient of said "pleasure" that could range in severity up to including death.

Was this art, in your view?

There's nothing intrinsic to the content or the surrounding circumstances that prevents it from being art.

I don't really have a strict criteria for separating art from non-art. It's not a problem that I consider to be very important. Probably some criteria of intentionality would be useful (so one can distinguish between say, a random urinal at your office and Duchamp's Fountain) and I don't know if the requisite intentionality was present in Philips's case. Neither the content of her act itself nor her reaction to it afterwards really help or hurt the case for it being art.

Do you think her choices have made her life better?

Depends on how much and what kind of attention she's getting. In the short term, I wouldn't be surprised if it was better, because the news coverage will drive traffic to her OF.

In the long term, she may have to deal with reputational damage if she tries to go into something other than porn. But I don't view that as particularly just, so it feels weird to describe it as "her choices making her life worse". That feels akin to the woke mob canceling someone for wrongthink and then asking them "do you think your choice to engage in wrongthink made your life better or worse". The "consequences" of the original choice would have been perfectly manageable if not for the wilful external interference.

As a parallel comment already stated, there is not actually anything confusing about instances of people not enjoying something that they claim is enjoyable. There are people who overeat, people who are fed up with doing daily quests in live-action games, people who drive for 8 hours to go to an amusement park and spend their whole time there bored, people who align their whole lives to enter a profession and then are miserable from the realities of it, and even people who go halfways across the world to visit a city and break down from disappointment; yet, nobody generally takes those things as evidence that food/games/amusement parks/professional commitment/international travel need to be made exceptional and/or taboo again.

The Rationalists had a phrase I admired, "I notice I am confused". They realized confusion was useful, and an opportunity to seek deeper understanding. For those who hold that sex is harmless entertainment, this seems like it ought to be confusing. Why did she expect to enjoy doing this, and why didn't she enjoy it?

This sounds like you are confused (about the lack of visible confusion from "those who hold that sex is harmless entertainment"). What do you think could be possible reasons for this lack?

Every time someone goes viral having a bad experience from sex, conservatives like clockwork parachute in to run victory laps wearing their best told-you-so face, as if the case for the sexual revolution rested on an argument that nobody can ever possibly not enjoy sex. Have you ever seen this persuade someone - not in the way where someone already agreeing pretends to be persuaded, or someone who is in the process of joining your tribe taking notes on the ideological package they are supposed to download, but someone who actually isn't with you and isn't about to be performing a very specific update to their worldview regarding whether the sexual revolution was a good thing?

If you watch the documentary she's pretty clear her lack of enjoyment at the end is because she feels bad that some of the guys didn't have a good time, not any regret about the act itself.

I haven't watched it yet, but this sounds like weapons-grade copium.

Put yourself in her position for a second. Actually, forget about putting yourself in her position, imagine doing the same thing as a man. If you have to have sex with a hundred women, it becomes nothing but a feat of physical endurance no matter how hot they are, and no matter whether or not you thought it was a sexy fantasy beforehand. I'll have a hard time believing you'll have any concern for anyone past participant #5, let alone for them having a good time. If you break down crying and cite your concern for others as the reason, the chances of me believing you are zero.

EDIT: I have now watched the documentary, and can confirm that it was total weapons-grade copium.

It surprises me that people put so much weight on her lack of enjoyment. If you asked me ahead of time if even the most sex positive person would enjoy a continuous eight hour marathon sex session, I'd say of course not, based on how physically demanding it would be if nothing else. It's also not unusual for people who are physically exhausted to become emotional.

Lots of people also have unrealistic fantasies that they derive more pleasure from the thought of than the practice. Presumably people are actually enjoying the sense of thrill when contemplating something taboo. It's also typical for people to be unaware of their own psychology in this way.

If she doesn't enjoy it, she should stop. But I don't see any fundamental problem with such virtuosic feats of sex.

The fundamental problem is "should we let people do things that will likely fuck them up even if they think it won't, should we discourage them or should we preempt their attempts". Raskolnikov thought he was an overman who was above the petty morality of the masses. The he chopped down a couple of people and this fucked him up.

Sure, this Lily Philips was the only victim of her stunt and traditional liberalism strongly insists people should not be stopped if that's the outcome. But one may argue that we can minimize total harm by discouraging others from repeating her mistake, even if constantly bringing up Lily Philips as a negative example hurts her more than collectively agreeing to memory hole this incident.

Do religious people actually genuinely believe that those who willingly perform such stunts are capable of having all their sins washed away?

I'm copying this from other comments because you removed it. I don't think this was in bad faith at all, it's a very good question.

And yes. But the form of Christianity I believe in also holds that, while God forgives all things because of genuine repentance, he doesn't remove the natural consequences of sin, and he doesn't remove the requirement for intense, even painful, spiritual growth and purification after partaking in sin. In this sense, yes, some sins are worse than others, and more sins are worse than fewer sins.

The closest person to Lily in the Christian tradition is probably St. Mary of Egypt, who was a prostitute who often refused payment for her services because she just loved sex, and even went on a pilgrimage to try and bang pilgrims. According to the hagiography, she tried to enter a church and could not, and was struck with remorse, pledging to become an aescetic if God would forgive her. After receiving absolution, she fled into the desert and lived as a hermit.

I don't see it in your comment -- did this woman repent? Did she publicly say that she's ashamed of her actions and she believes God has given her grace to overcome them? Has she been baptized? If not, will she?

If yes, my response to her is the same as to Russell Brand: I trust in God to judge you spiritually, but to earn my temporal respect you must prove your amendment over a long period of time, and that starts with shutting up.

Stop trying to be a celebrity. Don't go on shows to talk about how great your conversion is and how much of a degenerate you were and how much of a good Christian you are now -- just stop. Go into the desert. Become an aescetic. For someone whose sins are so public and attention-seeking, repentance must inevitably involve privacy and humility. And that path may be painful, involving great sacrifice -- it may indeed include religious vows someday. But no one said the Christian life was easy, least of all the man nailed to the cross.

When St. Paul became a Christian, he did not immediately set out to preach to the world, but fled to Arabia for three years. If your goal is truly to make yourself right with God, and not to win the favor of men, you should treasure this opportunity as a pearl of great price. Christianity is not a get-out-of-consequences-free-card, but the Way that leads to life.

But if your goal is merely to resurrect your temporal reputation and not to resurrect your soul, then you will be numbered among the goats and there can be no redemption for you.

Are Christians morally obligated to forgive someone if God has forgiven them? Like, let's say this woman appears to convert to Christianity and repent meaningfully and by all appearances it seems 100% genuine. Am I supposed to treat her like she's a completely fresh, clean bowl of cheerios? Would it be wrong of me to refuse to marry/date her because of her past?

Would you marry/date a bowl of corn flakes? Or fruit loops, I don't mean to assume.

It would be wrong of you, according to the Christianity I was raised with, to insist upon that decision even in the face of genuine remorse. If you got to know this woman and had long deeply spiritual conversations with her and came to the conclusion that she was genuinely sorry for it and still refused to date her for that reason, that would not be Christian.

But like @urquan says, only God can truly judge you, because only God and you know what is truly in your heart. On top of that, no one will be judged before judgement day and no one knows when that will be. In our predicament we can only evaluate the evidence - has she stopped doing it, does she visibly feel bad about it, and so on. It would be acceptable if you didn't believe she was truly sorry after getting to know her, although it would still be necessary to be polite to her.

To roll in what @mrvanillasky asked about the guy nuking the planet and then repenting, yes God would forgive that guy, because he would know that guy was legit, because he can see his thoughts and because it was part of his plan. The idea of nuking the planet and then being truly remorseful about it seems strictly impossible to me though - how do you even conceptualise the death and suffering of 10 billion people?

It would be wrong of you, according to the Christianity I was raised with, to insist upon that decision even in the face of genuine remorse. If you got to know this woman and had long deeply spiritual conversations with her and came to the conclusion that she was genuinely sorry for it and still refused to date her for that reason, that would not be Christian.

Repentance is not the same as healing. If she's so psychologically scarred that she'll never be able to function as a wife there's no reason I'd consider marrying her in the first place, whether she's 'really' sorry or not. We're not expected to marry a woman unless she occurs to us as good to marry. There are many reasons that someone with her history is less likely to be a good wife.

whether she's 'really' sorry or not.

Can I ask what you mean by quoting really there? Because I'll tell you what I assume - you don't believe she's really sorry* and there actually isn't anything short of the clouds opening up and a ray of sunshine beaming "no dude she is totes for real" into your head that would change your mind. It is that thought pattern that is unchristian as I understand the faith. I didn't say you were expected to marry her, I said if you maintained the belief that she was a soiled bowl of cheerios you point blank refuse to date after getting to know her and embracing the concept of forgiveness you would be in the wrong.

One of the first steps in embracing the concept of forgiveness is accepting how much of a fuck up you are. It changes your worldview, as does getting to know someone, especially on a spiritual level. Still, only God can judge, if after all those deep and meaningfuls and tears and sleepless nights you still believed she wasn't really remorseful, it would be acceptable to refuse to date her. (But I would bet some people in your community would believe you didn't 'really' forgive her.)

Deciding up front that a woman is a roastie who could never truly accept Jesus because she's banged too many dudes you see, is a similar sin to banging a hundred dudes then saying sorry because then you have to be forgiven. You are trying to put one over on God. God doesn't expect you to get everything right, or even anything right, but he expects you to try and to think it through.

*For clarity, I don't think this Lily is genuinely remorseful, it sounds like she's getting ready to bang another thousand guys? She would have a very high bar to vault to convince me she was sincere. I would talk to her and give her a chance to change my mind though.

Can I ask what you mean by quoting really there? Because I'll tell you what I assume - you don't believe she's really sorry* and there actually isn't anything short of the clouds opening up and a ray of sunshine beaming "no dude she is totes for real" into your head that would change your mind. It is that thought pattern that is unchristian as I understand the faith.

I mean there's a solid chance she's not really sorry, yes. This is how people work. Hopefully we both understand this? Seems like you do.

But the part where you've apparently randomly concluded that I've already decided she's lying and it would be nearly impossible to change my mind is kind of crazy. No idea where you're getting that.

Yes I understand how people work. That's why, when someone angrily implies I'm being a naive simp for suggesting forgiving this woman to the point that you can view her as another person deserving of love, reads an obligation to marry her in a post that explicitly says the opposite and adds a pre-arranged excuse to get him out of viewing her as marriage material, I assume he has already made up his mind.

Maybe you just meant to signal your strong disbelief currently and you would be happy to marry her if you got to know her and discovered she wasn't too psychologically scarred? I apologise if that is the case. Where would you get married? How many kids would you have together and what would you name the first one if it was a girl?

You know, rather than respond point by point I'll just let you know that I wasn't angry in the slightest, but it's also true that I'm not interested in the conversation any more.

More comments

Are Christians morally obligated to forgive someone if God has forgiven them?

What would I forgive her for? She has done me no wrong. She may have sinned against God and her own body; she can forgive her own conscience and God can forgive her sins. I cannot forgive her sins even if I wanted to.

Are Christians morally obligated to forgive someone if God has forgiven them?

One must, it is true, forgive one's enemies-- but not before they have been hanged

Are Christians morally obligated to forgive someone if God has forgiven them? ... Would it be wrong of me to refuse to marry/date her because of her past?

You would have to forgive her her sins. That doesn't entail pretending that her past experiences won't impact her future relationships. So the answer depends on your motives, but generally no, it's not wrong.

Yes, Christian’s are obligated to forgive this woman. No, Christian’s are not obligated to be willing to marry this woman post conversion.

Would it be wrong of me to refuse to marry/date her because of her past?

No. But it also wouldn't be wrong for you to choose to marry her. You wouldn't be sinning in marrying her. Which is already an important distinction, and an important advancement over most other views of morality historically and presently.

My own personal view, is that deal breakers, while tempting, are bad to have too many of, and really bad to try to enforce on others. Because finding a good partner is hard enough as it is. I know good Christian girls who married their sweetheart from Liberty University, or married a girl they only courted with chaperones, who wound up in miserable, failed, dangerous, or otherwise terrible marriages. Given the importance of finding a good spouse, and the difficulty of doing so, it would seem foolish to throw someone away if you genuinely thought they'd make you happy over one thing.

This, of course, is all big talk on my part, as I already married the perfect woman.

Am I supposed to treat her like she's a completely fresh, clean bowl of cheerios?

Depends, are you getting straight-married or gay-married to her?

Because she seems the type to still want (or rather, need) a straight marriage, and at this point I think she’d have a hard time with both, because the betrayal in a straight marriage is not being a virgin, but the betrayal in a gay marriage is not being fucking trustworthy enough not to want to fall back into needing those straight marriage privileges for the relationship to be viable (because she can’t provide them now as well as she used to).

Are Christians morally obligated to forgive someone if God has forgiven them?

For one thing, it's hard to know if God has forgiven them when all you've got is a public claim of religious conversion. But the second part is that there's nothing for you to forgive here: the sin was against herself, and against the men she involved in it, and against God, not against you.

But if someone has directly sinned against you and comes to you with deep remorse combined with restorative action, then the number of times you should forgive them is seventy times seven.

Am I supposed to treat her like she's a completely fresh, clean bowl of cheerios? Would it be wrong of me to refuse to marry/date her because of her past?

No, not at all.

Like I said, forgiveness is different from the natural consequences of your actions. If someone along these lines expresses genuine remorse and is part of, say, your local church community, while showing evidence of repentance (which involves actions as well as words), then you should treat them with the respect owed to someone in the community. That means not spreading gossip or being harsh or critical, it means loving them as you love yourself. (Some acts rise to the level of crimes, of course, and that's a different situation: Christian repentance doesn't erase the consequences of sin, like prison sentences.) But this is dependent upon true absolution and penitence, which in ancient Christianity could sometimes involve years of formal ostracization (i.e. temporary excommunication). This is a "be nice until you can coordinate meanness" situation. It's God, through the ordained ministry, that gets to make these decisions, not you or me.

But that doesn't mean you can't make a judgment about their behavior in terms of your temporal choices or choices that entangle you with them, like choosing not to marry them because you believe their particular inclinations might make them a poor spouse. You're under no obligation to marry anyone in particular, and choosing not to date/marry someone is not equivalent to social ostracization (one of my disagreements with trans activists). The natural consequence of poor sexual behavior is poor sexual prospects, and God doesn't remove those unless he has a particular plan for you -- which, of course, he might.

Christians are called to be innocent as doves but wise as serpents, to forgive and have compassion but also to be judicious and not naive.

There was a short thread discussing this issue while ago.

The short version is that Christians are obligated to act with charity and love to all people. However, that does not mean Christians shouldn't condemn the sins people have committed and treat them out harshly out of love (love is willing the good of the other - the good of the other may require some 'tough love'). This includes accepting there may be temporal consequences for sin (penance is built around this concept, but also consequences outside of penance). Additionally, there is a significant degree of prudential judgement Christians should excerise when it comes to determining genuine conversion or not. After all, Jesus warns against 'wolves in sheep's clothing' and false prophets more than once. False prophets easily extends to those who claim to have had an encounter with Christ (i.e. a conversion).

I’m a Hindu

Do Hindus even believe in the concept of forgiveness at all? Isn’t your whole thing that souls get reincarnated forever and get a better or worse deal based on how evil they were in a previous life?

Christians believe that if you are genuinely repentant that you are forgiven. In fact perhaps the only unforgivable sin is believing that you couldn’t be forgiven.

and get a better or worse deal based on how evil they were in a previous life?

I thought that was a recent Western invention and Hindus don't actually think that you are earning Good Boy points and Bad Lad demerits and being rewarded or punished suitably in the next incarnation.

Edit: Don't trust whitey, at least not about Hinduism.

"recent" is relative, but from the Upanishads:

'He's made of this. He's made of that.' What a man turns out to be depends on how he acts and on how he conducts himself. If his actions are good, he will turn into something good. If his actions are bad, he will turn into something bad. A man turns into something good by good action and into something bad by bad action. And so people say: 'A person here consists simply of desire.' A man resolves in accordance with his desire, acts in accordance with his resolve, and turns out to be in accordance with his action.

I've heard college educated white Americans confidently assert my above-mentioned statement.

Turns out they were wrong.

I guess I'm fascinated by the logistics of the whole thing. The article says that each guy got 5 minutes for the 100-man run. That's right around 8.3 hours or so of sex. Were there breaks to eat? Use the restroom? Seems like that would be essential. Or maybe you fast beforehand? For 1000 men, assuming you want to keep the same time, you're looking at 30 seconds per guy. That's not a lot of time! Makes sense to have them disrobe first but I wonder if getting/maintaining an erection will be a problem. Standing in a line of naked guys for 30 seconds of sex is probably not the most arousing thing. Wonder how you find a venue that is big enough for a purpose like this.

Lily and her friends have done similar things before but I cannot find any of it since any mention of her name brings up thousands of links about what she did this week.

For many search engines you can add something like "before:" to get results that are before a particular date. Ex. doing a search on StartPage for "Trump before:2020" gets me news articles about Trump from before the year 2020.

The cherry on this cake is that she can get married to a fairly normal guy tomorrow because Riley Reid, another adult entertainer did this too.

I feel like I'm supposed to read this as sardonic, but why? Is there something bad or wrong about the fact she could marry a normal guy?

ETA:

I watched that whole fucking documentary and I'm glad I did because if you watch the whole thing she's very clear the reason she's crying and emotional is because some of the guys tried to guilt her about not making them orgasm or not feeling they got their 5 minutes worth, not because she feels some kind of shame or remorse for having sex with so many guys.

Is there something bad or wrong about the fact she could marry a normal guy?

Of course there is. In essence she would be cheating the social contract. She would be tricking some poor sap into bailing her out of the socially agreed upon consequences of her actions. It benefits everyone to enforce harsh social penalties on promiscuous women and this would be undermining that valuable rule.

Socially agreed upon by who? I certainly don't agree. What is the benefit to me of this woman having difficulty finding a husband?

Even if the poor sap is okay with it, many men are quite dissatisfied with taking a high bc woman as a wife. They may do it anyway because they want a wife badly enough. Therefore, these men would benefit from a high bc being disincentivized.

Ok. Then those men are free to not to marry a woman who has had a lot of partners. I am confident there are a lot of normal guys who do not care how many previous partners their partner has had.

A hasty google disagrees with you

Although I will admit this is an internet survey with n of 188. So, probably not super robust findings.

Edit 1

More evidence saying men do penalize past promiscuity, this time using prostitutes.

This one is interesting because of their proxy mechanism.

I'm gonna need some help. What's the chain from "there's a negative correlation between time as a prostitute and earnings among Indonesian prostitutes" to "there are not a lot of normal guys who would marry Lily Phillips."

I am confident there are a lot of normal guys who do not care how many previous partners their partner has had.

That's what you said.

Both of my sources cast quite a bit of doubt on your assertion.

More comments

While I am confident that having had 3 previous partners instead of two does not prevent a woman from settling down, a triple digit body count is a difference of sufficient degree to constitute a difference in kind.

Many men - including many of these men who desire chastity in mates - are quite dissatisfied if they cannot get laid regularly or at least rack up a reasonable body count for themselves in their youth.

"If you want to marry a virgin, you should leave a few of them around!"

You can make this argument about anything. Many men would prefer an educated wife, therefore they would benefit from society shaming women who choose not to pursue an education. Does that mean women who do not pursue an education are "cheating the social contract?"

the socially agreed upon consequences

Some people fantasize that such consensus views exist. They then act cheated when someone mitigates or entirely avoids negative consequences. As though cosmic justice has been subverted.

Because those used to exist when we had a functional society, and people can't resign themselves to believe that we live in a free for all hellscape with no rules where selling your body online is a consequence free way to bypass decades of toil.

People facing up to the reality of what that means would look a lot more radical than people whining about whores on X. Historically speaking.

I mean, aren't there plenty of old stories about sluts getting away with it and becoming respected members of the community? The biblical prostitute Rahab got picked up as a model of "hospitality, mercy, faith, patience and repentance."

While helping the Israelites deal with their enemies is a good way to "earn" her redemption, that still sets a precedent that loose women can become part of the common fold.

There sure are, but they're all within the context of a culture that heavily shuns the behavior in the first place.

Jesus' treatment of Magdalene isn't meant to to suggest that whoring is without consequence, but rather that divine mercy is available even to such people. You still have to bear the consequences of sin in this world.

People facing up to the reality of what that means would look a lot more radical than people whining about whores on X. Historically speaking.

What sort of historical examples do you have in mind here?

Quite literally any pre-modern understanding of your Abrahamic religion of choice. Ask your local Muslim cleric how he feels this behavior should be condemned if you want a taste of what that means.

People would like to think that Sharia and other such traditions are some completely unnecessary barbarism when really it's a series of solutions to real problems that became obsolete when the problems stopped occurring. Reintroduce the problem and you'll reintroduce the need for solutions.

The cherry on this cake is that she can get married to a fairly normal guy tomorrow because Riley Reid, another adult entertainer did this too.

Fairly high status men marry whores all the time. Nancy Reagan, Miranda Kerr, Meghan Markle. Even Melania was an Eastern European model in NYC in the late ‘90s lol, and that was a pretty sordid business. Men say they care, and in a vacuum they do, but in real life I think less than they’re willing to admit.

Female promiscuity is completely harmless, as this stunt again proves. If you assume a linear no-threshold model of harm and she does fine after hundreds of men, likely ending up married to some banker or politician, then obviously sleeping with only a football team can’t possibly be harmful at all, the equivalent of one banana of radioactivity.

It’s extremely difficult to prove causation even if there was correlation here.

It could be modernity, or the million other things that have changed, it could even be the other way around: in the 60s, 70s and 80s promiscuity was celebrated and people had more sex, now with these sexual hangups, we see the rise in sexlessness.

Personally I think the lack of sex is more due to quality porn and entertainment and general ‘lack of needing others’. Men don’t need women to fulfill their sexual urges, women don’t need men to provide for them anymore, it’s way less boring to stay alone in your room than it used to be, and so on.

The Rise of The Incels sounds like a fantasy, whatever instability there is in the west does not come from incels, who seem more pacified with each porn-induced orgasm, a well-known soporific. By contrast, you imply the islamic world’s sexual restrictiveness has made it stable? I would dispute that.

Everything else aside, I just don’t like infringing on individual liberties, consenting adults and all that. I don’t think there was someone I forgot to ask.

Most dudes are unattractive to be begin with which is why we have more female ancestors than male.

That's really not the reason, it's the massacre of patrilineal groups through the ages. The vast majority of men reproduced. But if it was true, I guess we'd all be Ken's sons while women would be descended from hags, so we'd win the intersexual beauty contest easy (but who would be the judges?).

You seem to be saying most men are so ugly we need to force women to date them, which is funny, and a little insulting. Those poor women lol. I’d be merciful and let her choose celibacy if it came to that.

Any Faang engineer can get married, given effort and low standards. Actually, that goes for almost anyone.

The Redpill view of attractiveness is imo very confused. Let’s say that women only cared about status, and men about looks. That still leaves two hierarchies of people with corresponding attractiveness, and nothing fundamentally different in the attractiveness model of the sexes. You say women can sense men’s status, but men can rank women on looks just as easily. And men all prefer a better-looking girlfriend, does that make them hypergamous? If half the men are too low status to be attractive, then half the women are too ugly to be attractive.

The main difference you identify is that most men would accept an offer of casual sex from most women anytime, while women only accept the offer from george clooney sometimes. This says more about the sexes relative enjoyment of casual sex than attractiveness.

I think desire for marriage is a lot more balanced between the sexes. You brought up that indian ‘divorce rape’ case (btw, I know the manosphere uses it, but it’s a terrible name. It comes off as a cheap attempt to ‘equalize’(‘you rape us we rape you’ – but of course most men don’t rape anyone so they don’t deserve this ‘retaliation’, plus rape is illegal, while this uses the legal system to fuck men over, so it’s more like the opposite, etc), and on that subject we agree.

Which leads to my question: let’s say promoting female chastity really does increase marriages … Why do men want the kind of headache that lead to that guy’s suicide anyway? I suggest that before we think of stopping our female overlords from fucking george Clooney, we stop giving them the legal right to steal all their husbands money and send them to prison.

Promiscuity is probably harmful psychologically, but just as there are plenty of alcoholic men who can nevertheless find an attractive wife, there are plenty of very promiscuous women who - despite having engaged in activity that is probably harmful to their mental health - marry well, as those examples show.

A man would rather a virgin than a harlot, but the beautiful promiscuous woman rarely has issue finding suitable men, if she wants.

But can those alcoholics down a hundred bottles in a night? Any harm from promiscuity, if it exists, is comparatively tiny, harder to find and subject to more ifs.

But can those alcoholics down a hundred bottles in a night?

A hundred bottles in a night, and a hundred men in a day, are extremes for both. But apparently André the Giant could drink that much yes.

online trad redpill mra types always pretend that high status people marry whores regularly.

? No they don't. They say 'betas' marry them after high status 'alphas' 'pumped' them. Through the transitive property of the woman, this makes the 'beta' the 'alpha's bitch (imagine the woman in a sandwich where they all face the same way), reinforcing the sexual hierarchy they obsess over.

I think he forgot a “don’t”, otherwise the sentence doesn’t make sense.

Fairly high status men marry whores all the time. Nancy Reagan, Miranda Kerr, Meghan Markle. Even Melania

How many of them were central examples of whores? How many of them have acknowledged that they regularly had had sex with people that weren't their romantic partners for money?

There were enough rumors about all of them in society circles that the men in question (and their friends) presumably knew exactly what the record was.

I think men care a bit less about whether a woman is a whore when he marries her, but more if she will end up whoring out after the marriage, and maybe more importantly if she carries the reputation of a whore or has been able to keep things discreet.

Status and deniability matter. It theoretically makes no difference but "supermodel" reads differently than "Onlyfans model".

Did Miranda Kerr get into something tawdry with a fat Malaysian scammer for what could only be the financial benefits? Maybe. But it's not on tape, she denies it and the guy was apparently a weird introvert who apparently really did do things like pay for women to flaunt and then wouldn't even talk to them. Harry...I think is legitimately dumb enough to not believe anything but video until it was too late.

I think a man like Kerr's is not in this woman's future but she probably will get married to a fairly normal guy (assuming she has some creepsense and filters out people who like this stuff). She made it as hard as possible for that guy though.

Do religious people actually genuinely believe that those who willingly perform such stunts are capable of having all their sins washed away?

"Religious people" is a big group but I'll speak for Christians at least: yes, we do. Christian teaching is crystal clear that God will forgive any and all who repent of their sins, and that we all are equally in need of this mercy no matter what we have done. The girl who bangs 1000 dudes in one day is no worse, in God's eyes, than the sweet old grandma who snapped at her grandson in a moment of frustration.

Doesn't this strike you as bizarre?

Forget about the whore - Kony embraces God and he's alright? The thug who murders someone's whole family sincerely converts and is forgiven - but the victim goes to hell because she can't let go of her hatred for this bastard?

Real justice systems don't work this way, there is no unlimited forgiveness and for very good reason. I feel confident that the vast majority of Christians in history did not truly believe this, their threshold for unforgivable sinning was much lower.

I don't think they truly believed this, but then again I find it hard to believe most Christians in general truly believe. It does seem, however, to be in character for a social technology that optimizes for maximum converts and maximum adherence to their practice. Come to us, literally any and all, and you will receive everything in the afterlife as long as you do what we say, no matter the past.

Irredeemable sinners would be a failure of such a system, as they have no more incentive to obey.

I don't think they truly believed this, but then again I find it hard to believe most Christians in general truly believe.

Frankly, that seems to me to be a failure of imagination on your part. Most people believe their religion, regardless of what it is.

It's not that difficult to believe, because it's all conceptual and doesn't cash out anywhere - no-one can point to someone in heaven (or hell) that they think shouldn't be there, so there's never a challenge to the belief system.

Before I try to address your post, it's important to note that some of the answers here are going to vary a lot based on denomination. The basic doctrine of "repent for sins, get forgiven" is the same across every denomination, but once you get into the details things vary. So just bear in mind that on some of the things I'm saying there isn't a monolithic Christian viewpoint. I'm giving you the Catholic viewpoint.

Forget about the whore - Kony embraces God and he's alright? The thug who murders someone's whole family sincerely converts and is forgiven - but the victim goes to hell because she can't let go of her hatred for this bastard?

There are a few misconceptions here. First, hell is not a punishment for acts we have committed. Hell is what happens when you have chosen being apart from God during this life - once you die, you get what you wanted and are separated from him in the afterlife. It is miserable not because God wishes to punish people, but because he is the source of all good things. So by separating yourself from him, you wind up in a place where you can only experience bad things. But as CS Lewis memorably put it, the gates of hell are locked from the inside.

Second, Catholics believe that after you die (if you are going to end up in heaven) you will go through a period of purgation as the stain of sins you committed is erased (through means we can only guess at, but it's generally believed it will be painful). Yes, God forgives you for your sins, but they still happened and they still have consequences for you. And based on the exact sins you committed, you will suffer a varying amount as your soul is purified.

Third, all people are equally flawed compared to God (because they are being compared to a perfect standard), but not all sins are ones which mean you will go to hell. Remember, that hell is really about choosing sin over God and not a punishment, so only some sins are so serious that they constitute a break in your relationship with God. The example Bishop Barron gives (which I found helpful) is to use the analogy of a person who does something inconsiderate toward a friend. Some things are minor and weaken the relationship, but don't destroy it. But some things are so serious that the friendship is dead afterwards because of the level of disregard shown.

So to go back to your example of a murderer and the family of one of his victims. The murderer will not be in hell, because he repented and God is merciful. But he will very likely have to suffer the consequences of his sin in purgatory. Meanwhile, the family member will probably also not go to hell, because her hatred is not a mortal sin. She will also have to suffer the consequences of that sin in purgatory, but they will probably be less than what the other person suffers because the sin was not as serious.

Real justice systems don't work this way, there is no unlimited forgiveness and for very good reason.

God is not running a justice system with the various factors that they need to take into account. Like I said, hell is about your relationship with God and not punishment for sins.

I feel confident that the vast majority of Christians in history did not truly believe this

It's official church teaching and has been since the very beginning. That doesn't mean that the actual people truly believed it, but the doctrine is very clear on this point.

This is a good answer, though I'll just add that the current view of hell you describe is very much the post Vatican II (ie from the 60s onwards) position. Prior to that there was a lot more focus on the concept of hell as punishment and torment etc.

There is also some debate amongst modern theologians about the nature of hell, as the idea that it's meant to be both eternal and due entirely to the self-rejection of God can be difficult to square, though this is certainty the current Catholic position.

Yeah, and purgatory was normally considered as involving punishment too.

Forget about the whore - Kony embraces God and he's alright?

Part of repentance is confession and taking responsibility for what you've done. If Kony is truly repentant, he should confess his crimes, make restitution to his victims, turn himself in to the authorities and submit to punishment willingly.

Forget about the whore - Kony embraces God and he's alright?

In the next life, if his conversion is genuine and he repents for his past sins etc. Doesn't mean he'll escape consequences (legal or otherwise) in this life.

The thug who murders someone's whole family sincerely converts and is forgiven - but the victim goes to hell because she can't let go of her hatred for this bastard?

Forgiving others (which doesn't necessarily mean trusting them or anything else like that) is one of the hardest commandments to follow, but it was given by the mouth of Christ Himself:

"Then came Peter to him, and said, Lord, how oft shall my brother sin against me, and I forgive him? till seven times? Jesus saith unto him, I say not unto thee, Until seven times: but, Until seventy times seven."

In my specific subset of Christianity (Mormon) it's even more strict:

"Nevertheless, he has sinned; but verily I say unto you, I, the Lord, forgive sins unto those who confess their sins before me and ask forgiveness, who have not sinned unto death. My disciples, in days of old, sought occasion against one another and forgave not one another in their hearts; and for this evil they were afflicted and sorely chastened. Wherefore, I say unto you, that ye ought to forgive one another; for he that forgiveth not his brother his trespasses standeth condemned before the Lord; for there remaineth in him the greater sin."

That Christians have been imperfect and unable to consistently live up to the requirements set by Christ doesn't make it somehow not Christian doctrine. We're imperfect, which is one of the reasons the atoning sacrifice of Jesus Christ was required in the first place. We're going to mess these things up, over and over again, but that doesn't mean they aren't things we keep striving for.

My semi-educated guess as a non-Christian is that they would draw a distinction between divine forgiveness and temporal forgiveness. “Kony embraces God and he’s alright” is the wrong framing: he may be forgiven by God (though of course we humans can never truly know that), but we are under no obligation to forgive him for his heinous acts as a matter of Earthly law. At least not forgive him immediately and unconditionally.

See also: rendering unto Caesar

The state may absolutely still put that thug to death, or whatever other punishment.

Yes, the hatred is sufficient to merit hell. This is not unusual or weird in Christianity. Essentially everything we do merits hell. We are only saved through Christ's work. If the victim is not united with Christ, then, sure, improperly proportioned hatred for the thug suffices to damn.

I think merely by paying this at any sort of attention at all you are creating the market for this material.

No one here subs to onlyfans

Actually true. This is why the Cathedral and PMC would do anything to shut us down. This is the last refuge of Western Men that Refuse to be Broken.

Edit: Also a good idea for a question for my Motte user survey

I don’t think there’s a huge moral difference between having sex with 100 men in a day (which is admittedly unusual) and 100 men in a year (which is comparatively common). In both cases you’re treating sex as a trivial thing.

The number of people one sleeps with has no moral dimension as far as I can tell. A doctor who saves people's lives and sleeps with dozens of people a month is morally better than a celibate or monogamous murderer.

That works only as long as 10 righteous people are still left in Sodom.

Note that Genesis does not specify exactly what sins the people of Sodom had committed.

However, the book of Ezekiel, chapter 16, verse 49, describes it as:

Behold, this was the iniquity of thy sister Sodom, pride, fulness of bread, and abundance of idleness was in her and in her daughters, neither did she strengthen the hand of the poor and needy.

The Talmud further expands on Sodom's mis-deeds; they generally involve either callousness towards the poor or hostility to foreigners.

This is a really strange take, since in Genesis the men of Sodom immediately try to rape the angels that are sent to Lot to warn him to get out. Genesis hardly leaves you wandering what could have been so bad about these people that they were condemned.

No, this take is entirely consistent with the actual context of the time. The emphasis on the crime being due to homosexuality is the more modern reinterpretation.

Other ancient texts such as the Talmud and the Midrash go into significantly more detail about the sins of Sodom, and they revolve entirely around lack of hospitality, cruelty, and miserliness.

The biblical story of Sodom makes sense in this context when you understand that threats of rape were commonly used to ward off intruders. As just one example, in Roman culture the god Priapus (also depicted with an enormously exaggerated phallus) was frequently used as a 'no-entry' symbol at the entrance to properties, with the implied (or in many cases with humorous inscriptions) that any trespassers would be subject to sexual violence.

It's actually a great case study in how easy it is to misinterpret stories out of other cultures - something that as you say can seem entirely obvious can have very different meanings to the people and cultures of the time.

Either I am misunderstanding Blueberry's comment which started this digression, or you and Celestial-body-NOS are. Neither Blueberry nor I at any point said that homosexuality was the sole reason for the sinfulness attributed to the people of Sodom.

I fully agree that lack of hospitality was a major component. What I disagreed with was this statement:

Note that Genesis does not specify exactly what sins the people of Sodom had committed.

I claim this gives a false impression of the account in Genesis which includes a striking account of the wickedness of that people.

Side note: the case for homosexuality not being a major component of Sodom's wickedness is pretty weak. First: homosexuality is only spoken of in the Old Testament in this and one other similar narrative passage (Judges 20) describing exceptionally wicked peoples, and in prohibitions which call it an abomination.

Second: The Ezekiel passage does indeed ascribe miserliness and idleness to the Sodomites in verse 49, but it also continues in verse 50:

And they were haughty and committed abomination before Me; therefore I took them away as I saw fit.

Third: The New Testament in Jude summarizes the sin of Sodom and Gomorrah as "giving themselves over to sexual immorality".

the men of Sodom immediately try to rape the angels

Because the angels were foreigners. The men of Sodom were not motivated by desire for the angels; they sought to degrade them, for having the temerity to exist as foreigners. (Some interpretations speculate that the mob wanted to interrogate the angels, 'knowing' them in a more literal sense.)

Lot's offer of his daughters was not a contrast between same-sex and opposite-sex attraction, but an attempt to protect his guests by whatever means he could think of. (Sacred hospitality was considered very important in the Ancient Mediterranean; cf. the Classical myth of Philemon and Baucis, in which Jupiter and Mercury visit a village incognito and are turned away by everyone except the titular couple, who invite them into their small home, resulting in the village being turned into a pond and the inhabitants into fish, the house of Philemon and Baucis being turned into an ornate temple, and the granting of their request that they would die at the same time as each other, at which time they were turned into trees [an oak and a linden].)

which is comparatively common

Citation needed.

No citation needed. Sleeping with 100 people in a year is a strict superset of sleeping with 100 people in a day. Also… common sense.

Well, duh. I got the impression that doglatine was making a stronger claim than that though.

Do religious people actually genuinely believe that those who willingly perform such stunts are capable of having all their sins washed away?

If you have to ask, you fundamentally do not understand Christianity, or its concept of repentance or grace. You appear to be using a model where forgiveness is for lesser sins, but too much sin means that this forgiveness is overwhelmed. In the first place, there are no lesser or greater sins; all sins are alike in that they all involve rejection of God, his nature and his creation. In the second place, what prevents forgiveness from working is not the amount of sins committed, but rather the refusal of the sinner to repent, leading eventually, one way or another, to an inability to repent.

If you have to ask, you fundamentally do not understand Christianity. [...] You appear to be using a model where forgiveness is for lesser sins, but too much sin means that this forgiveness is overwhelmed. In the first place, there are no lesser or greater sins

Also, from @SubstantialFrivolity: The girl who bangs 1000 dudes in one day is no worse, in God's eyes, than the sweet old grandma who snapped at her grandson in a moment of frustration.

It's hard to say uniformly "what Christians believe" about sin and hell because of denominational drift. The Catholic church certainly teaches different levels of eternal punishment exist for different degrees of unrepented sin. (And, correspondingly, different levels of virtue in life grant different amounts of glory in heaven.)

So yes, it's a mess. Even the most agreed-upon doctrines, such as that any sinner can repent and be saved; find dissent in at least a few churches, such as Calvinists with their TULIP.

(While I'm here, another denominational difference: a Catholic would say that Lily Philips loses eternal punishment for sleeping with 100 men by repenting, but the damage to her soul still requires purification, which can be accomplished in this life or after death. Eastern Orthodox Christians have a similar idea, but they have 'purification after death' rather than purgatory, and it varies in the particulars.)

It's true that there's a ton of denominational drift, but I don't think you can find a central example of Christianity that claims to be able to observe this specific carnal sin, and conclude that the sinner is therefore straightforwardly damned without hope of redemption. I'm pretty sure even the Calvinists would claim that it's at least theoretically possible that this girl might be one of the elect, that despite her recent behavior she'll be saved by God.

What about the sin against the holy spirit?

Hence "this specific carnal sin", ie banging a hundred dudes in one day. Interpretations of "The sin against the Holy Spirit" vary wildly, but I've never heard of a version that claims this specific obscenity would qualify.

As a Calvinist, it's the case that:

For everyone, if they were to repent, would be saved. Not everyone will in fact repent, but only those whom God predestines.

This isn't unique to the Calvinists, though. You'll see the same thing here among the more predestination-leaning Roman Catholics (like those following Thomas Aquinas) or Lutherans (like Luther or Walther, but not like Gerhard, if I remember correctly).

(Also, the TULIP acronym isn't ideal, especially in that the L is considerably more optional within the Reformed tradition than the other four. But it's a popular characterization, and frequently used by those within.)

You'll see the same thing here among the more predestination-leaning Roman Catholics (like those following Thomas Aquinas)

Predestination-leaning Roman Catholics are just "Roman Catholics". God perfectly foresees the free choices men make within time, and thus has perfect knowledge of who will be saved. This, in the Catholic view, does not infringe on the agency of the sinner in responding to/failing to respond to grace. Some people see this as a logical contradiction: "If God already knows I'll steal cream from the office fridge on Tuesday, how do I have a free choice?" But the teaching makes good sense to me, as God exists outside of time; an easier way to conceptualize it might be to imagine that we made choices at the beginning of time, but are now experiencing them linearly.

Which leads to the core difference:

For everyone, if they were to repent, would be saved. Not everyone will in fact repent, but only those whom God predestines.

Per Total Depravity and Irresistible Grace, the very choice to repent is motivated purely by God, and the choice not to repent is likewise compelled by God. Agency does not exist. The sinner who will not repent was never free to repent, and the elect who repents was never free not to repent. The universe is a clockwork contraption devised for a glorious divine drama.

If God designed it that way, Lily Philips could never not sleep with 100 men, nor repent for sleeping with 100 men. It was all a plan, scripted by God, for God's greater glory.

I do not see the calivinist view as inherently ridiculous (or even monstrous, as people often describe it), but it is a real difference from other denominations.

Predestination-leaning Roman Catholics are just "Roman Catholics".

Sure, but there's a difference as to what extent God's will is seen as posterior vs. prior to the decision, right?

I know there were big controversies between Jesuits and Dominicans at some point, and the Franciscans had still another position, I believe.

the very choice to repent is motivated purely by God

Yes, it does depend upon God giving us a new heart, etc. etc.

and the choice not to repent is likewise compelled by God.

Well, not in the same way. It's not a direct action on the part of God; it's the inevitable result of our fallen state barring divine grace.

Agency does not exist.

Sure it does. We're just, in our fallen states, bad agents, at least in the respects relevant in these instances.

The sinner who will not repent was never free to repent, and the elect who repents was never free not to repent.

This depends pretty heavily on what you mean by free.

The universe is a clockwork contraption devised for a glorious divine drama.

Well, I'm not necessarily committed to that. I'd be fine with, for example, direct action by God in determining how quantum states collapse each time. I'm not actually endorsing that position specifically, but I have no problem with it. But sure, I have no problem with a deterministic world, and it is for God's glory. Just don't use determinism as a grounds to minimize it.

If God designed it that way, Lily Philips could never not sleep with 100 men, nor repent for sleeping with 100 men. It was all a plan, scripted by God, for God's greater glory.

Depending on what you mean by "could," sure. But surely you also would agree that conditional on God's knowing that Lily Philips would sleep with 100 men, that would necessarily happen? And not only knowledge, but as part of God's decrees in ordering the world—his will, not just his knowledge? I mean, Molinists would affirm that, not just Thomists, correct?

I do not see the calivinist view as inherently ridiculous (or even monstrous, as people often describe it), but it is a real difference from other denominations.

Are you aware of the Dominican-Jesuit debate? Do things like "physical premotion" mean anything to you? (Note that I am not sufficiently knowledgeable on these myself.) Are you aware that the esteemed Thomas Aquinas is thoroughly on the more strongly predestinarian side of these himself?

Even the most agreed-upon doctrines, such as that any sinner can repent and be saved; find dissent in at least a few churches, such as Calvinists with their TULIP.

This is not really true. It's true in the same sense as it would be true to say "material determinists claim that there certain orderings of a deck of cards that can never be created." Some orderings of the cards will never be created, and since material determinism says that the entire course of the universe is already set, in a sense that's equivalent to saying that there are some orderings which "can never" be created. But for all practical purposes it would be a misleading way to phrase it.

The same applies to Calvinism. Calvinists teach that everything which will come to pass has been foreordained by God from eternity. This means that those who are foreordained not to be saved, "can never" be saved. But it's not due to anything special in the person nor susceptible to our analysis ahead of time. Certainly it is not a Calvinist doctrine that certain sinful acts allow us to know here and now someone's predestined fate.

It's pretty normal in Christianity to admit of degrees of guilt. See, for example, when Jesus wishes woe upon Capernaum, saying that it will be more tolerable for Sodom and Gomorrah than for them. See also how some kings of Israel are praised but caveated, whereas others are outright condemned, because the first class forbid pagan gods but allowed worship of God in the high places, whereas the worse kings allowed pagan worship.

You'll also see some people saying that the sin that's committed has effects on willingness to repent, but I'm not really knowledgeable of that.

Here's an interesting question that occurs to me, inspired by this post:

Is promiscuity worse when it's public or when it's private?

I'm inclined to think that we reached a social consensus that public promiscuity is worse than private promiscuity. ("As long as they keep it in the privacy of their own bedroom", laws against obscenity, etc.) But I'm also inclined to think that that social consensus is wrong. Yes, there are special types of damage done by public promiscuity - "normalization", corruption of bystanders, etc. But there are also special types of damage done by private promiscuity, and I'm inclined to say that they are much worse.

Everyone here can laugh it up about the men who'll marry these open prostitutes. But, y'know - at least they'll know what they're getting. It's not exactly a viable secret to keep. This doesn't seem, to me, nearly as corrosive to the social fabric as the general social expectation that even normie religious women will have some sexual history that they don't need to disclose to their husband.

My instinct is that it is actually better and less sexually immoral for a woman to be a clownish slut and publicly document a farcical orgy centered on herself than it is for her to act chaste and traditional but have a single one-night-stand she never tells another soul about. It is better to unconsciously offer oneself up as a cautionary tale about rough living than it is to consciously erode the trust between the sexes. I do not find that the cases like Aella blackpill me nearly as much as women in explicitly Christian/conservative contexts who accidentally let on that their morals are looser than they realize. It's like the difference people point to between Donald Trump, who's repulsive, but openly so, and a more classically dishonest politician.

A car's value plummets as soon as it's driven off the lot. Provided, I have no interest (in this metaphor) in purchasing a used car - but I have no quarrel with used car dealers, per se. It's about the integrity of the thing.

This doesn't seem, to me, nearly as corrosive to the social fabric as the general social expectation that even normie religious women will have some sexual history that they don't need to disclose to their husband.

I thought hiding that was the point, though.

Normie religious/straight marriage laws and rules are all about managing competing interests, are optimal if you assume you don't actually have love up front, and help keep the marriage together should the desire in learning how to love not be equal among partners. They work even better if/when the woman is not economically useful.

But modern society turns this into a trap for the men in the relationship! If you ask with the tacit statement that you'll be offended by your future wife "having cheated on you before the relationship even begins, what a sinful broad", what do you think your wife going to say? It's the spear counterpart of unintentionally selecting for assholes, where what you're doing here is excluding women who aren't intending to lie to you (which are the ones you actually want... right? Or maybe not; I wouldn't know- is the 'virgin experience' really an emergent property of virginity?).

From a biological standpoint, I want to minimize the chance I end up raising another man's child (if I'm going to put effort into kids I want them to actually be mine). I think I have a better chance of doing that by emphasizing "my wife feels safe telling me things", but my biology hasn't yet resisted me for dating a non-virgin and people tell me this occurs magically, so...

Another analogy that occurs to me is the dsyfunctionally adversarial relationship between employers and applicants. An expectation emerges among the applicants that it's acceptable to lie while applying for a job. The employers tacitly accept this; they don't punish the dishonesty, and instead act dishonestly themselves, asking for qualifications that are impossible or at least implausible, reinforcing the emerging norm that it's acceptable for the applicants to lie. And so it becomes quite difficult indeed to determine if the applicant is actually qualified for the job. The people have collectively failed. Thanks, Moloch. (There are other factors at play there, of course.)

But modern society turns this into a trap for the men in the relationship! If you ask with the tacit statement that you'll be offended by your future wife "having cheated on you before the relationship even begins, what a sinful broad", what do you think your wife going to say?

I thought I already explained this in the previous post, but perhaps I wasn't clear enough. I'm uninterested in nonvirgins as partners, but the moral offense to me comes in when someone tries to pull one over on me. My whole point here is that I'm not cursing the women who honestly filter themselves out for me, as I consider this more honorable than trying to subvert the filter. That can't mean that having a filter is itself wrong; that's an absurd modernist notion, like saying that hiring decisions shouldn't take ability to do the job into account. If you put up a sign that says "looking for qualified drivers" and you get a bunch of qualified drivers and a bunch of liars, then sure, the people who didn't show up because they weren't willing to lie about their ability to drive are far more virtuous than the liars, but that doesn't mean that you should hire them to drive; it means that you should try to figure out which of your applicants are telling the truth.

I see your point, but to extend the metaphor further, I feel like a man who marries a woman without knowing her full sexual history is a bit like a man who buys a used car without giving the tyres so much as a cursory kick - caveat emptor and due diligence has to kick in somewhere. Of course people can lie and keep secrets, but if you know someone well enough to consider marrying them it should be fairly obvious that there's something they're keeping from you, unless they're a truly consummate (so to speak) liar.

Everyone here can laugh it up about the men who'll marry these open prostitutes. But, y'know - at least they'll know what they're getting.

On the other hand, many pornstars have a fairly brief career under a stage name and then retire and go into teaching or something. There's a recurring scandal when a primary school discovers that one of their teachers used to be a porn star and fires her (e.g.). For obvious reasons, the porn industry is keen on insulating porn actors from the social consequences of pursuing a career in the industry: some guy compiled a database of porn actors and their real names (so that men could find out if their girlfriend had ever done porn before they popped the question), and Bang Bros bought it for the express purpose of shutting it down.

Perhaps this "one and done" approach is less viable in the OnlyFans era, but still, I have to assume that a significant proportion of "content creators" are performing under stage names. Many even film their videos in such a way that their faces aren't visible.

To make this argument work, you have to consider the problem with private promiscuity to be just that it's a lack of honesty. Then it's only that to the extent those involved placed some idiosyncratic value on avoiding the act. Many people have such standards (such as religious diet restrictions) which outsiders don't have much reason to care about.

On the other hand, if there's some intrinsic reason promiscuity is bad, women who do it publicly aren't only doing the same thing but honest. They're suspect because its publicity creates an added inappropriate relation, now with a public who shouldn't be involved at all, above the men involved.

None of this is to say you should be tolerant of the presentable slattern either...but treating it as just a matter of hypocrisy demeans the issue.

I can understand people having a brief dalliance with extreme behavior and learning a sharp lesson. But...when you get to the point where you're competing with Aella in how terms of how many people came in the fluffer you must have had multiple hints that you aren't built like that?

And if you want to do the crying wojak thing instead of pulling back I have little sympathy.

Do religious people actually genuinely believe that those who willingly perform such stunts are capable of having all their sins washed away?

My reading of my society's trad Muslim faith* is that we formally leave room for the notion that this person is redeemable. Allah only knows who's in heaven and all.

But the sort of credulity shown by online simps who immediately welcome any convert who even touches Christianity would not be acceptable. No one sane would assume that they could just reach her with one verse, nor trust her if she just said she converted. She would simply have to suffer a bit of a social death. Being visibly observant (easier to tell than with other faiths) while suffering social opprobrium seems like a minimal requirement to signal true commitment.

* I guess we can say "conservative". I don't want to imagine the really trad sharia punishment.

Edited for meme accuracy.

There are at least a couple of Hadiths where a prostitute is forgiven iirc.

Trigger warning - this is related to pornographic material

Not to be rude, and off topic, and I'm sure this has been discussed to death, but I just dont get trigger warnings. Why is "trigger warning: [your trigger here].........[your trigger]" less triggering than [your trigger]? I get "nsfw" on a hyperlink that is risqué or etc., but it is never used this way and pro tw is justified pretty different anyways. But is triggering even a real thing? Is the idea that someone is just so porn addled that they cant even see the words "onlyfans model" lest they just start jerk jerk jerking? Every time I have seen it used, the writer will not cover something (allegedly) traumatic in an callous and likely triggering way. But obviously holocaust_rape_groyper will be covering that topic maximally toxic and awfully and they will not be warning the reader it might trigger them, so what does it even do? It just seems so empty and performative. Especially on a forum to discuss controversial things.

Its not really "nsfw" vs "trigger warning", its the context in which it is used. I see "nsfw" used almost exclusively in the context of warning what a hyperlink connects to - something porographic, or gore, or something that would literally run into a workplace IT web filter. "Don't click this if you want to avoid getting on a workplace IT naughty list", not "don't read this if you are especially offended by topic X". I can also understand its use in the context of a content warning for children, to not have them exposed to something that parents would not want them to be yet.

While I do think you are in good faith, and you're using "trigger warning" in good faith, I don't think the entire concept of "trigger warning" is in good faith. Those that want such warnings want their issue to be elevated to a special and sacred status. That whatever they are offended and traumatized by deserves a ritual acknowledgment before it can be discussed.

When you adopt this language it is accepting this insane frame: that good faith words can be harmful, and that we ought to change our thoughts and behavior to avoid that harm.

Adding a trigger warning to whatever I want to say is legitimizing their frame and enabling their neuroticism.

This is probably my biggest issue with Scott, he argues very well and logically and convincingly within a frame. But the frame is fundamentally wrong. See his writing on this:

I like trigger warnings. Trigger warnings aren’t censorship; they’re the opposite of censorship. Censorship says “Read what we tell you”. The opposite of censorship is “Read whatever you want”. The philosophy of censorship is “We know what is best for you to read”. The philosophy opposite censorship is “You are an adult and can make your own decisions about what to read”.

Censorship does not just say "Read what we tell you." It also says "Write what we tell you and how we tell you." It says "Think how we tell you." The words can be trauma and violence frame is unworkable, there are a near infinite amount of things to be offended about. Arguments should stand and fall on their own merits, their own internal merits, not those of some moral superstructure.

They say that “Confronting triggers, not avoiding them, is the best way to overcome PTSD”. They point out that “exposure therapy” is the best treatment for trauma survivors, including rape victims. And that this involves reliving the trauma and exposing yourself to traumatic stimuli, exactly what trigger warnings are intended to prevent. All this is true. But I feel like they are missing a very important point.

YOU DO NOT GIVE PSYCHOTHERAPY TO PEOPLE WITHOUT THEIR CONSENT.

Because this is where it leads. Someone claiming that not censoring yourself is somehow psychotherapy. As if we need an MD to adjudicate acceptable arguments. Reject the moral superstructure. Don't let people impose it on you and us by being neurotic.

https://slatestarcodex.com/2014/05/30/the-wonderful-thing-about-triggers/

I agree people don't tend to do it here, but in general these days I mostly see people use "content note" instead of "trigger warning" to specify topics that the reader might not want to read without implying that it's specifically about triggers, which are often too random and personal to tag. For instance, I see a lot of posts on Mastodon (which has explicit support for warnings so a post with warnings shows only the warning until you click on it to unfold the full post) with the warning field mentioning "us pol" because enough people on social media don't want to hear about US politics. Additionally, social media generally has a way to filter on keywords (either explicit warnings or just anywhere in the text), so including a straightforward warning can be a way to hope you hit a keyword filter so people who don't want to read something never see it.

But also, it's definitely possible to reference undesired content without describing it in detail. "Gore" or "abusive relationship" gets the point across well enough warn someone without eliciting the response they might have to the actual content. And depending on the warning and the person, it may be sufficient to know it's coming / maybe a part they might want to skim over.

a cum infested e celeb.

I suppose if this revolting term applies to anyone it applies to the girl in question. I'd like to think, however, that we'd avoid such wording (I originally thought this was a quote but I see it's your term.) Why? Because it's pointless and smacks of a chodey kind of schadenfreude.

Because it's pointless and smacks of a chodey kind of schadenfreude.

I dunno, I think "the only thing valuable about certain women is their bodies, and so if they're not saving them to sell to a man in exchange for resources this is a massive problem and it means the men won't want to buy, which has implications for family formation for those women; also DAE think sex with men is Bad and Evil?" is certainly a worldview.

Of course, you have to actually unpack that rather than just saying it to be obnoxious.

The circuitous way you're making your point is flying by me. I don't agree with the quoted worldview, but I'm also not saying practicalromantic has that view.

despite breaking down on camera?

What, you even think that reaction is genuine?

I don't; I think that's trying to cover oneself with the female privilege to be hurt by sex ("dissociation") for the camera when prompted/given the opportunity (and a good number of women will, as that's their social role). She is well-practiced in acting, obviously. It's just sex, and discovering you're putting swine before pearls and feeling terrible about it isn't unique to professional women- this has probably happened at least once to every human being.

But it sure does gets the expected reaction from a bunch of white-knighting simps, the glory of which those brain-dead Christian men are falling over themselves trying to cover themselves with- they're doing literally the same thing she just did, for the same reasons. (Ever wonder what the straight spear counterpart to 'cumslut' is? Well, now you know.)

The cherry on this cake is that she can get married to a fairly normal guy tomorrow because Riley Reid, another adult entertainer did this too.

Fuck 1000 guys, or have a fake poor-me mental breakdown? I'd consider the latter much more difficult to accept, where the former is more just a health risk (I don't want cold sores, sorry).

I think she's 100 percent honest there.

Then why be actively planning to still have it both ways? Brain damage from (what is described as) the ionizing cancer-causing XXX-rays those sex acts emitted?

Being used as just a piece of stupid meat/treated as if I’m only in it for myself existentially annoys me, in my experience, but it’s more that than it is any particulars doing the damage.

(Of course, if you know you’ll need straight marriage and sell your meal ticket to it…)

Here's a weird and kind of dumb article about the stunt that I didn't like very much. Every writer has their blind spots, the topics where their ordinary rigour fails them and they fall victim to the motivated reasoning and logical fallacies they're so careful to avoid on other occasions. Scott's are trans stuff, any and all criticisms of EA, any and all criticisms of polyamory, and anything feminist-coded (and he's only fessed up to the latter); Freddie's are trans stuff and HBD. Mary's is porn and the sex industry. If a factual claim casts the porn industry and/or sex industry in a negative light, she'll believe it, regardless of how implausible it is or how incongruent it is with the other factual claims she's endorsed which are critical of the porn or sex industries.

Here she goes on a bit of a ramble, looking for some way that she can make out that Philips is the victim here, suggesting a bunch of hypotheses in which Philips might be the victim (if you squint) without really committing to any of them, consistently putting the word "consent" in scare quotes. Philips fell victim to audience capture against her will! Philips was possessed by the digital egregore! Philips was slutty before she started her OnlyFans - hey, did you know that a lot of women who are slutty are trauma victims?? isn't that interesting??

Weak stuff all round, far from her best work.

Who's Freddie btw?

Freddie deBoer.

Thanks for the article though, I had no clue who mary was.

As I said it's not her best work. I wanted to share some of her better articles, but reviewing her Substack it seems she's paywalled some of her articles which were once visible to free subscribers. Annoying.

I feel like you are implying two different questions. There is the religious question of does this person deserve forgiveness, and I donno. Not my call.

Sort of entrapped in that question is, does this person deserve to pretend they never did these things and live a "normal" life. To which I'd have to say any man that tries to wife her is out of his damned mind. But she could easily just not tell guys she was competing to be the UK's biggest attention seeking whore. Some guys might know, some might not. Were she to turn over a new leaf and find a church, she'd probably just run roughshod over some poor schmuck there.

Not an expert, but in a religious context, she belongs in a nunnery, and not out there ruining some poor man's life, along with whatever children they have. The BPD and narcissism inherent in that sort of attention seeking is incurable, even if the "sins" are absolved.

Since ‘nunnery’ was an Elizabethan euphemism for ’brothel’, you couldn’t be more right.

Do religious people actually genuinely believe that those who willingly perform such stunts are capable of having all their sins washed away?

Sure, if she repents and puts her faith in Jesus Christ. Believers' righteousness is not based in what we have done, but in what Christ has done for us. God forgives much direr sins than that.

The cherry on this cake is that she can get married to a fairly normal guy tomorrow because riley reid, another adult entertainer did this too.

Maybe. Christianity doesn't draw an automatic line from forgiven to ideal wife material, to be clear.

Didn't Chuck Palahniuk write about that?

In case you wanted my opinion on this, I don't even consider this sex anymore. I don't know what you call it. Comparing this to being a slut is like comparing the hot dog speed eating contest to an occasional cheat day at McDonalds.

To quote a cynic tweet comment:

I’m sleeping with 100 men. Pay attention to me!
Oh I slept with 100 men, pay more attention and feel bad for me
I’m sleeping with 1000 men! Pay all the attention to me!

It is all an act and performance to advertise her OF.

Tate Brothers asked their followers to go undercover in her gangbang and literally preach the gospel to a cum infested e celeb.

Absolutely insane levels of grift given their source of wealth and fame.

You shouldn't be aware of any of these people.

On physician salaries:

This topic comes up from time to time and is more in the news now for obvious reasons.

Here I will point out that cutting physician salaries does little to address the healthcare cost crisis and also argue that the salaries are deserved.

Obviously yes, I am a physician and don’t want my salary to get cut, but nobody wants that to happen to them, how would you feel if people on the internet were saying you were over-compensated and demanding you take a 50% pay cut?

It’s also worth noting that everybody in the U.S. is compensated well (too well?). That includes within healthcare (see: nurses) but also outside of it. We make good money here; it’s one of the reasons so many of the successful elsewhere want to come to America.

-Okay how much of healthcare spending is doctor’s salaries?

About 8%. If you cut physician salaries by half you get 4% savings. That’s not a little but it is also not a lot.

-Can we do this?

Sure, you could, maybe, but you’ll introduce new problems, people will retire or leave the field, shortages will get even worse, and so on. Depending on how you did it, certain critical fields like surgery would vanish overnight. OB care would be financially impossible to provide (due to incredibly high malpractice burden (can be 150k per year). You can’t spend your entire salary on malpractice insurance and other expenses.

-Okay, but how are physician salaries trending, are you making more than you used to?

Doctors have been getting year after year real wage cuts for 20-30 years. Everyone else’s (in healthcare) salaries have been going up. Percentage of healthcare spending on physician salaries is going down. So, if you really want us to get paid less just wait. Our salary shrinks every year and the portion of the pie we are taking shrinks too.

-Alright, again. So, does cutting physician salaries help?

No not really, we aren’t a large enough slice of the pie and you’d cause a shit ton of new problems. We’ve already seen this a bit. More people are working part time, quitting, dropping out of residency, graduating from medical school and not doing medicine, not providing certain types of services or working in certain locations. That’s with a modest decline in salary and things like an increase in administrative burden and a decline in respect. This would shoot up if you dramatically cut salaries.

-Okay but let us just import a ton of foreign doctors.

Again, 8%. It’s not going to help that much. However, it’s worth keeping mind that a lot of what pisses people off about healthcare gets worse with foreign doctors. Yes, I believe that foreign doctors have worse training and experience than American doctors. People here seem to not like that argument, but we don’t need it. Foreign doctors are almost always coming from third world countries, not Western Europe. People hate when their doctor barely speaks English, spends little time with them, and acts like a cultural alien. All of those things are what cheaper foreign labor brings to the table. Patients in the 90s and 00s heavily pushed better customer service in medicine. It’s made things more expensive but has resulted in better customer service. Walk that back and make things cheaper if you are okay with worse customer service we can do that without breaking everything else.

-Okay DW what’s the most histrionic thing you can say on this topic, just for fun.

If you cut MD salaries by half, I think healthcare costs would actually increase. You’d see a decline in certain types of care which is unexpensive, preventative, and annoying for us to do. Example: nearly every single endocrinologist would stop practicing and go back to doing hospital medicine (they already make less than hospitalists, often to the tune of 150k and have already completed the training for that). All those unmanaged conditions would end up costing more in the long run. You’d also see an increase in “well fuck you, I’m going to be shady now in order to make this worth it.” And you’d see a huge increase in low value – high expense defensive medicine since protecting your salary becomes even more important. A more modest boiling the frog approach is already in use, and involves far too little money to solve the problem.

Switching gears.

-Okay give me some numbers.

It’s hard to tell for a variety of reasons but the number going around right now is an average of 350k (it may actually closer to 300k and we are seeing a complicated post-COVID mirage). That’s a big number but this is a situation where the median and average diverge a lot. Pediatricians often make between 180k-200k. Family medicine makes more than that but not a lot more. Those are a huge percentage of the overall jobs. Yeah, neurosurgeons can make 5-10 times that, but there aren’t a lot of them, and they work close to 24/7, they still make the average weird. A lot of “rich” doctors are a small number of people in a complicated specialty working egregious hours and not really enjoying the money. At one point the neurosurgery divorce rate was over 120%. The median physician has much more reasonable compensation. They also used to make a lot more, the mental framing of this for some is anchored around 90s compensation which just isn’t true anyway. Doctors work a lot. People who run entire departments, manage millions of dollars in research grants, or own patents and other companies are sometimes presented in these numbers.

-That’s still too much.

Okay let us talk tradeoffs. Some things to keep in mind. Doctors don’t typically make money until after they turn 30. Up till that point physicians can often live in more or less in poverty (want to live next to your hospital in the nicest part of a major city on 60k? Good luck). Once you start making money you can start paying off your 500+ thousand dollars in loans. Delightful. Up until that point you have no flexibility. You can’t leave your job or your life is over. You can’t choose where you live. If you get fired your life is over. If your boss is abusive, you say nothing. Probably most importantly, you can’t get back time. Money and time are probably most useful in your 20s. Our peers are meeting partners, going on vacation, clubbing. We are working 24-hour shifts. That’s a huge cost.

-Boring. You chose this.

Fair. But if you want American to keep choosing this you have to be aware, otherwise it ends up like the other jobs that nobody in this country wants to do.

-Okay fine, like is it even that bad of a job though?

Yes. Consider that many doctors are functionally working 2-3 full time jobs worth of work.

-Okay hold up, yeah you work 80 hours in residency but not as an attending and certainly not 120 hours.

Okay, okay lemme explain. Yes, some people are working 80 hours a week (or a lot more) as an adult. However, you are more often doing things like working 60 hours a week, but that is including things like nights, weekends, and Holidays. How many jobs involve regularly working Christmas, or three weeks in a row without a day off, or 24+ hours in a row? Any job with hourly wage and overtime is going to add up to 2 times the base salary really quick under those conditions.

Also, unlike most blue-collar labor (which is laden with mandatory and very real breaks) or white-collar labor (which involves a lot of downtime), most doctors are working nearly 100% of the time while working.

That may sound unfathomable to you, and to some extent varies specialty by specialty but can be very close to literally true. On days when I’m in the hospital for three or meals I’m lucky if I sit down and eat for one of them. Usually if I’m lucky I’m just cramming a protein bar in my face. Trainees always go “what the fuck when do you eat. Or drink. Or pee.” We usually don’t. Surgeons are notorious for regularly giving themselves mild kidney injuries because of dehydration.

Almost nobody I know who isn’t a physician has worked a 24-hour shift. Most people I know have never worked 8 hours in a row for real with no breaks, certainly not for weeks and weeks in a row. Your year-end scramble or Go-Live or tax season is our baseline, and often we are doing it for 24+ hours at age 55.

Once you break this down to hourly wage the numbers get much more reasonable.

-Hold up you work 24 hours in a row with no breaks? Is that real? Isn’t that unsafe?

Yes, at around hour 18 you become disoriented to the point where it’s not safe to drive anymore. Yes, this schedule ends up actually making a lot of sense somehow. Yes we sometimes work more than that, at any given time in a hospital there’s probably someone working a single shift longer than some of the nurses whole work-week.

-Okay but like, outside of the sheer hours it is not that bad right?

Well lack of breaks is part of that. Plenty of other stuff though. Perks are non-existent these days. Most places got rid of the physician lounge and parking lots, which mostly exist to make us faster and more efficient so not the best move in the world. Keep in mind that the chair in my office is maybe older than I am, and most places I work my personal laptop screen is bigger than the screen I’m doing my work on. Most corporate jobs are comfortable. Medicine is not. Little things like that add up and are part of why a lot of us get lured into the general workforce. For some reason I pay for parking.

Also, the job is intrinsically hard. Treat us like kings and pay us millions of dollars a year…and you are still dealing with death and entitled and demanding people all day. You can get sued and lose all your money, your job, or more likely just be miserable for five to ten years while the case gets sorted out in your favor. Most jobs if you make an inattentive mistake, you say oh shit and fix it, or somebody loses some money. Doctor fucks up and somebody dies, and you make thousands of decisions each day where if you lose that focus…

Alcoholism, drug abuse, and depression rates are high. As are suicide rates.

Sidebar: most white-collar work does not involve dealing with the dregs of society. This occasionally makes useful for for instance talking about the practicalities of the criminal underclass but is absolutely stressful.

-Okay but like, not everything is clinical work, right?

Well yes, to some extent that is part of the problem. An increase in charting and administrative work has made healthcare more expensive and restricted supply and quality since I spend less time with and working on patients. Writing bullshit notes does not increase my job satisfaction.

However, there are good other parts – leadership roles, research, teaching. Most doctors are clinical care providers, mentors and educators, and team leaders and managers all at the same time. With the demands of all of those things.

-That’s a lot of shit, anything else you want to unload?

Yeah, there’s other stuff that makes being a doctor be expensive. Board examinations and licensing can cost tens of thousands of dollars. If you get caught smoking weed you could end up losing your job and have to pay hundreds of thousands to get it back for some god forsaken reason. Everyone wants to siphon off of us because they know where the money is. This is also why NPs don’t get sued despite having less training and more bad outcomes. Less money involved.

You constantly get expensive retraining, tests and learning for the rest of your career also. Medicine changes all the time and we are required to stay up to date.

-Okay but like if I’m in the hospital I don’t see you at all what the fuck are you doing?

Operating. Teaching. Calling the lab. Writing notes. Seeing other patients. In committee meetings. I swear we are working you just aren’t seeing it, and a lot of what we do isn’t direct clinical medicine.

-Thank you for coming to my TED talk.

No not really, we aren’t a large enough slice of the pie and you’d cause a shit ton of new problems. We’ve already seen this a bit. More people are working part time, quitting, dropping out of residency, graduating from medical school and not doing medicine, not providing certain types of services or working in certain locations. That’s with a modest decline in salary and things like an increase in administrative burden and a decline in respect. This would shoot up if you dramatically cut salaries.

Yeah, this is the eternal threat, right? But ok, what are these people going to do? How many jobs in America are there that pay as much as medicine and aren’t ’top of the corporate pile after a 40 year career’ type jobs?

Very, very few.

A few jobs in big tech. A few jobs in front office high finance. A few jobs in big law. A relative handful in (other) professional services.

None of those professions have medicine-tier job security. All of them (save maybe big tech) have very long hours. All of them are ultra-competitive.

Doctors on the internet always seem to assume they could be investment bankers or deepmind engineers instead, but I don’t think they could. The truth is that medicine is a lot less competitive and more midwit than most of these jobs. Plus, most of these jobs have an extreme up-or-out career progression that medicine just doesn’t have. Of a thousand junior investment bankers at Goldman Sachs who already passed an application process with a 1% acceptance rate, how many become managing directors or seniors in PE? Maybe thirty or forty. Most end up failing out into comfortable PMC professions, often paid less than many medical specialties and again still with far, far less job security.

Plus, there’s status. Nobody in modern American society has higher status than doctors, not billionaires and certainly not bankers, lawyers or engineers. That also has value - socially and for one’s own ego - that can’t be measured solely in pecuniary terms.

Even if medicine paid half as much there would still be doctors. There are still huge numbers of bright eyed, intelligent college students with elite credentials who want to be journalists.

I know you hate that argument so I very specifically didn't make it this time.

Based off your historical unwillingness to update your understanding of anesthesia compensation and work duties I don't think we are going to have a fruitful discussion on the doctor skills/role and work alternatives side of things.

By the way, and I truly am sorry if you’ve gotten that impression, I have a great deal of respect for doctors. I think you do a great job, and I think you should be well-paid for it. And and, I think doctors’ pay is only one part of the issue with the US system’s immense inefficiencies, of which a great deal can be laid at the feet of Congress, insurance companies (not out of ‘evil’ or even the profit motive, but just because of the perverse regulatory and incentive environment they’ve been out in), the way big pharma is funded and to some extent the tragedy of the commons.

My only real ‘thought’ on doctor pay is that we should have more doctors. Let’s train them, let’s import them (from native english-speaking countries with decent standards, like our peers in the anglosphere), let’s do whatever it takes to increase residency spaces. And let’s make residency easier, let’s limit medical liability to bring down the ridiculous cost of malpractice insurance, let’s make medicine an undergraduate course like it is elsewhere so doctors don’t have to waste four years and more money going into debt.

But yes, ultimately, let’s work to bring down some salary costs. Is that so unreasonable?

let’s import them (from native english-speaking countries with decent standards, like our peers in the anglosphere)

Do these people want to come? I'm not sure they do.

Other stuff.

Usually when this conversation comes up what happens is that I say something like "sure increase supply just don't compromise quality" and then someone says "being a doctor is easy, there aren't really quality differences or problems" I recall this argument from you in the past but if you don't endorse it now no problem, but ultimately most supply increasing options involve compromising quality in some way. Americans are mostly uninterested in decreasing quality, but if we decide that's on the table then we have a lot more tools available to solve some of these problems without touching supply at all.

Also, right now we seem to be in a situation where shortages are pronounced enough that the market can absorb a much higher number of physicians without bringing salaries down. In fact we likely need to increase salaries (specifically: one of the biggest problems right now is that people will refuse to work in red states or rural areas, these jobs already offer higher salaries, sometimes as much as twice as much, but in some cases that's not enough).

We already have some evidence that salaries are too low for some needs, taking salaries down further is liable to make those issues first (and again does little to decrease the overall healthcare costs).

Do these people want to come? I'm not sure they do.

From the UK? I assure you they do.

Why don't they then?

I wasn't able to find a good single source of truth but medical students can do it (which Scott did(ish)) if they are interested. It's harder than it would be a for a U.S. grad but likely much much easier than an Indian medical school grad.

The BMA website implies that some "adult" (saying it this way because I can never remember the British terms) doctors may be able to come over without any specific retraining but does not provide details.

Training is probably somewhat worse in the UK but not enough that I'd have any complaints about anyone coming over (although this would obviously be bad for the UK).

You need to redo your residency if you want to become a US doctor even if you are a consultant with 15 years of experience in the UK. That is enough of a barrier that prevents people from coming over, never mind the extremely onerous visa requirements the US imposes on foreign professionals of every trade and type.

The official stance of the BMA per their website is:

"Doctors who are already on the UK specialist register may be able to apply for partial exemption from the residency programme requirement. To check if you are eligible, you should contact the relevant specialty board in the US."

My guess is that the answer is not yes or no but "it depends."

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The one I'm married to wanted to in 2014/15. She passed the USMLE had her ECFMG certificate, recent clinical experience in a western European native English speaking country and didn't require visa sponsorship as the spouse of a US citizen, applied to a variety of programs and failed to match, not even any interviews. ☹️

I appreciate the N!

Most of the countries that seem to match into residency in the US seem to have pretty well developed infrastructure to help explain what to do, outside of that its hard to know what locations are programs are realistic. It's a brutal process even for US MD grads.

:/

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Do these people want to come? I'm not sure they do.

From my experience talking to Anglosphere doctors, you would instantly collapse British, Canadian, South African, and probably Australian/New Zealand healthcare if you opened up the American medical system. (Don't laugh about the South Africans, they turn out some incredible doctors.) The big issue I've heard from them is less about the objective difficulty of getting US certified, and more that you're sacrificing even more years of your youth on a particularly pointless altar.

I 100% believe they want to come here for South African (I actually had supervisor at one point who was South African, he was incredible). Australian, and NZ healthcare actually pays comparable to the U.S. to the point where we have people going there. I'm sure if you opened it up you'd get a mix in both directions. Canada is already pretty open to transfer with the U.S. is my understanding with some jobs making the same some making less, some making more.

Britain is the odd one. Granted redoing say IM/FM/Peds/EM residency here is only three years and be a huge life gain. They don't seem to sign up for it. Most of the time I see this online it's associated with a bunch of anti-Americanism.

It isn't just "three years" - it's "three years of hell", and if you are doing it for the second time to tick a bureaucratic box, it's unedifying hell. People who are already upper-middle class don't put themselves through just to double their salary. You either need to offer enough upside potential to take the winners out of the upper-middle class (startup founders, finance jobs) or something that speaks to the soul.

Also those are the specialties that are at the bottom of the food chain in the US in a way they are not in the UK, so they are the ones where the benefit of moving is least. NHS GPs who want to graft can make as much money as successful surgeons.

I was initially going to say something about this not being be that bad in those specialties and then realized my understanding of what is too much work is now pretty much forever broken.

And yeah it's bad, but it's instructive. I am amenable to the idea that every hour of US and UK training are roughly equivalent, but if US trained physicians are getting that many more hours of training it really does a decent amount to justify the need to retrain to US standards. Yes those hours rapidly have diminishing returns, but I find most foreign doctors are willing to admit that training is better and more thorough here (in part because of stupid oddities of our system, in part because we have more resources than everywhere else, or our population is less healthy, or just sheer weight of hours).

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Do these people want to come? I'm not sure they do.

I would be interested to hear @self_made_human respond to this, if willing.

Doctors from the Anglosphere?

Yes. At least some parts of it.

For example, British doctors are massively disgruntled, and a significant portion of them are trying to leave the country, though as always, the majority of people anywhere don't really want to emigrate. When Brits run, it's usually easier to go to Australia or New Zealand, where wages are markedly higher, work life balance is better, and their credentials are recognized as equivalent with little faffing around. Some opt for Canada.

Aus/NZ doctors are largely content, and only a small number want to move, and when they do the US is their goal most of the time.

If licensing regimes like the USMLE were relaxed for these specific countries, I doubt you wouldn't see a 2-5x efflux, comparable to the boost in salary they'd see, even if the working hours are worse.

Hell, I'd go if I could, I opted for the UK because I didn't have a better choice for long and painful reasons. Depending on how the job market looks in 3-6 years and if the barriers go, I could well be tempted in the future.

I'd say doctors from these countries are competent, especially native ones, I've certainly been nothing but impressed. They make do with shit wages and a QOL that is worse in many ways because of the UK being a stagnant country, but they're sticking around both because of inertia and because the US isn't easy to go to. They're seeing their own wages stagnate, and face stiff competition from international medical graduates (like yours truly, I have to look out for my own interests), training is unnecessarily long and painful, and many don't need more than a nudge to reconsider.

Thanks! I guess for context I considered you as "part of the Anglosphere", although there are different degrees of centrality to that concept. I remember you had a couple (interesting, IMHO) posts a while back about how difficult the US regime would have made transferring your education credentials.

I'd imagine most people here would consider the "Anglosphere" to be the Commonwealth countries plus the US, I doubt India would come to mind for them. While we have a gazillion English speakers, it's not strictly the language of the majority! I would hope that I qualify for honorary membership nonetheless haha.

I'm uniquely screwed when it comes to practising in the US, I won't elaborate since you seem to recall my moaning before, but even in an ideal world, I'd be looking at the USMLE and 3 years of residency. I haven't heard of anyone actually getting those requirements waived if they're a credentialed specialist elsewhere, but that could be my ignorance as opposed to me denying @Throwaway05 's claims. It's not a formalized route at any rate.

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IF the US wanted to poach British doctors, you could get about half of them (including some of the ones who are currently heading to Australia). Please don't. I love my family, and several of them are dependent on healthcare to stay alive.

Same! When I see this online it's mostly people bitching about the U.S. being terrible but I'm sure that's not representative of how people actually feel.

specifically: one of the biggest problems right now is that people will refuse to work in red states or rural areas, these jobs already offer higher salaries, sometimes as much as twice as much, but in some cases that's not enough

Is this a ‘flyover’ issue that clears up for Miami, or is this progressive lying about Texas laws again?

A good half of it is medical people being hysterical idiots about "right wing legislation." Dumb shit for sure.

The other half is people refusing to work in rural Mississippi or whatever because they are educated, selected to be blue tribe, and want to actually have fun when they finally have the money and ability to actually choose where they live.

Stop being woke AF and this will self correct to some extent.

The other half is people refusing to work in rural Mississippi or whatever because they are educated, selected to be blue tribe, and want to actually have fun when they finally have the money and ability to actually choose where they live.

A lake house and a boat and a housekeeper(because getting paid $300k+ in Mississippi makes domestic labor cheap) isn't enough of a draw?

No, running theory is that the people in the pipeline currently are simply too culturally blue and want to avail themselves of big city resources when they finally have the ability to do so.

Given how many people leave residency single there is also the reality of finding a partner, and since most people want a class/wealth/intelligence equal and being a doctor isn't really a draw anymore, they go where the other young professionals are (and stay).

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Paging @self_made_human

I believe he’s one doc who wants to come! And I would have him. Hell maybe I’ll even marry him to get him over here.

Heh, it's a dream alright. If you're willing to marry me, I'll promise to be the sub ;)

LOL you better. I couldn’t handle being with a doctor who’s also a dom. Sounds intense.

There are still huge numbers of bright eyed, intelligent college students with elite credentials who want to be journalists.

Journalism is a non-central case because there's a very large non-monetary compensation in the form of influence/power.

Most journalists even at the NYT don’t have very much influence/power.

It's highly nontrivial to get "very much" influence/power, and the main ways involve quite a bit of luck. Journalism reliably gets some, can get quite a bit, and while it's tricky to get "very much" strictly as a journalist, journalism -> politics isn't unheard of.

Great post, although I think the word "salary" might be doing too much work.

I would argue that 250k-300k for a internal medicine doctor is very reasonable, as is the 1 million dollar a year that the top neurosurgeon gets.

But payments to doctors can be more than salaries. As we all know, seeing patients pays very poorly. But procedures and tests pay very well. The orthopedist who owns an MRI machine has a license to print money. He many only draw a "salary" of 200,000 while clearing over a million in profit.

Other specialties which involve procedures seem to pay an abnormally high amount as well, including anesthesiologists, radiologists, and dermatologists. The ease of these specialities compared with the outsize salaries make them some of the more competitive residencies. But is society better off having our most talented young people chasing these specialties? No, of course not. Some even argue that most anesthesiology could be done by a non-MD.

Rather than cut salaries, which I agree would be a bad idea, we need to fix the problem of outsized payments to doctors. We can do that in a market-based way.

  1. Create more med schools and residency programs to increase the supply of doctors. If the AMA doesn't play ball, remove their involvement.

  2. Reduce the regulation that leads MD's to do things that non-MD's can do.

  3. Price transparency for procedures. I need to know exactly how much that ultrasound will cost, and I need to be able to shop around. Same for prescription drugs, which doctors often proscribe completely blind to how much they cost.

If you are a doctor making 250k a year seeing patients, no one is coming for your salary. At least I hope not. You deserve it. But doctors (in aggregate) do bear a large amount of responsibility for the cost explosion we are seeing.

Some even argue that most anesthesiology could be done by a non-MD.

Jesus Christ please no haha.

The rest of your comment.

Physician ownership is dead in most specialties, nearly everybody is employed now. There are some people who still own things now but the majority of people get paid salary with some element of bonus that is RVU based (eat what you kill type stuff). It did not use to be this way, and I won't argue that era had some excess, but it is dead now.

Procedural work does pay more and there are problems with that, but it is generally much harder (on an hours worked basis if nothing else) and as a result we have much less of a problem with rationing of surgery than most countries.

There's also a lot less of these people - there's 35 times as many (Family Med/IM/EM/Peds) doctors as dermatologists.

Skim 100k-200k off of the dermatologist and you do fuck all for total healthcare costs.

Decrease doctor salaries and increase doctor supply and you'll have doctors refuse to do out of title work and demand to work a normal day. If you half doctor salary and double the number of doctors you haven't done much. Every doc is doing 2-3 people worth of work and they do it because the money is good, money stops being good and then they stop...

I'm burnt out on the price transparency issues because of other conversations on this board but keep in mind that a lot of this already exists. Check out GoodRX.com Most doctors will use these tools nowadays when they can (lots of EMRs automatically tell you the drug cost for instance) but if given the choice of a drug that costs X or 10X they are going to choose 10X 10/10 times if they think its going to reduce the risk of a lawsuit.

I'm burnt out on the price transparency issues because of other conversations on this board but keep in mind that a lot of this already exists.

Maybe you don't see it as an MD, but price transparency really doesn't exist to your average patient. You go in, you get your thing, and then you get a shocking, incomprehensible bill somewhere between 2 weeks to 2 years later. Sure, part of this is insurance. A lot of it isn't.

Providers will happily charge you $1000 for a routine test if you don't have insurance and then I guess you're supposed to like call them up and negotiate. In the real world, that's just not going to happen.

Yeah, savvy customers will find a way to reduce costs. You can ask the doctor what blood test they want, go on ultalabtests.com (highly recommend), get your tests results for incredibly cheap and without having to wait in line, then print them out and give them to your doctor (or, shudder, fax them in). Maybe the system will tolerate this. But they are not set up for it, and it will be a ridiculous burden on the patient, who will have to fight his doctor and clueless staff every step of the way.

Drugs are a little easier to save on, but face much of the same burden on the patient to proactively battle to save money. And since something like 80-90% of health care is paid for someone who is NOT the patient, there is little incentive anyway.

On a personal note, I don't think you should fear reform. As an average doctor making 250k, you have nothing to worry about. The system needs you more than you need it. And maybe we can even find a way to reduce the bullshit that doctors have to deal with. But not everything always has to be the way it is now forever. The $5 trillion we spend every year is clearly going somewhere. The people who take surplus profits from the system are not exactly going to stand up and advertise themselves.

price transparency really doesn't exist to your average patient.

I mean price transparency doesn't really exist for most things.

Two major problems:

  1. Physician's are employed now and are therefore generally not in charge of anything when it comes to billing. This adds an extra layer of abstraction and problems. You correctly identify useless clueless staff as part of the problem and as the doc I generally have other stuff I need to be focusing on.

  2. Most of the total types of costs are unreasonable or impossible to have useful price transparency on. The average patient may almost entirely interact through the medical system (just off the top of my head) through the window of just drug prices, professional fees, and lab tests/imaging. That's certainly plenty but it might just be 3/100 total things we deal with, and those three are a lower percentage of my actual workload than you might think. Two of the three are totally reasonable and many places will actually have better price transparency if you ask for it but if you try and pass legislation and include the other 97 it becomes an exploding fucking mess.

Meds (well, outpatient ones) and testing (well...outpatient again) are generally reasonably self-contained and it would be sensible to try and get it done at a cheaper place. Hospital based care? Procedures outside of very careful ASCs? Useless. Lots of things get sneaky though - the ultrasound is cheap, but who is going to read it? Is it going to get done automatically and a hidden professional charge or not covered by your insurance charge? Easy to mislead patients if you are unethical or by accident. Then people get mad and demand legislation which makes it even more complicated and confusing.

Professional fees also get super weird. I'm going to give a made up number for opsec reasons. If you come to see me and offer to cash pay my employer may or may not be okay with that. If they are it's going to be be a fairly reasonable number. Let's say 100 dollars for an hour long initial appointment (psychiatry shut the fuck up and stay out of this). If you are paying with insurance there is no number. None. It doesn't translate to anything directly, and if I have no cash fee schedule you can't even squint and go "it's 100 right?" No, it's a billing code, it doesn't relate to what's "fair" or what is "cost" it is all negotiation. State Medicaid pays me 20 bucks an hour for that billing code. We still take state medicaid even though that's less than the cost to run the front desk because my hospital gets a grant from the state government. Private insurance pays me between 40 and 140 dollars for that billing code depending on the insurance. If they decide to cover it. They may decide that on Tuesdays I must include the word "sneeze" in my note, and since I didn't no money for me (well, for my employer). Medicare pays 40 dollars and doesn't ask any questions normally but a few times a year they show up in my office and decide that half the charts need to include the word "mega-ultra-sneeze" since I didn't they are going to take back all of the money they paid me and fine the shit out of everyone.

That's just one way this is done, the more famous one is that my professional fees are 100 dollars but my employer charges 1,000 dollars and puts that on the bill and then the insurer pays between 15 and 200 dollars.

Sidebar: I don't recommend ordering yourself lab tests without physician involvement, it's easy to fall afoul of pretest probability and sensitivity/specificity issues. A big one I see right now is college age people will order themselves STD testing because they don't want to ask their doctor cause awk. Eh kinda harmless. Except these places will add on HSV, which you are not supposed to do (per AAFP) because a positive test result causes a ton of misery but only has a 50% change of being a true positive and there isn't any option for follow-up confirmation testing.

I just want to add, I mostly think your comment chain here is rad, even if I had a slight disagree, but there’s absolutely zero price transparency in medicine.

Zero.

I’m 40 and even tho I don’t go to the Dr a lot … there has never, ever been price transparency. In anything remotely close to medicine, for myself or anyone else I know.

That’s not your fault.

But not defaulting to the obviousness of a lack of price transparency is driving me up a wall.

Ultimately the lack of price transparency is not something that should be relevant to patients, you functionally need insurance in the US and every having to do with payment outside of your insurance fees is a total nonsense dance between various entities. If your ultrasound costs 300 dollars or 350 dollars shouldn't be relevant if you are paying 0, 5, or 20 for the thing.

It's certainly annoying not to know stuff if you are a curious person, but I'm not really sure it is ever relevant.

The problem is for example, me going for a colonoscopy, I contacted my insurance company to ask how much would be covered. They said if my doctor coded it as preventative (i.e. I was just being screened due to my age) it would be essentially entirely covered, however if it was because the doctor was trying to find a diagnosis it would be 50% co-pay. So I asked well how much would that be, and they said depends on your doctor and their facility but somewhere between 3 and 10,000 dollars, perhaps more.

Now the problem is I was having symptoms, which is why my GP referred me to a GE (the only GE I can get into see inside 3 months in the area as it happens) in the first place. So I ask the GE how they are going to code it and he says, no idea, you'll have to ask the front desk staff who do my billing. So I ask them and they say, depends on what the doctor puts in his notes. If he mentions pre-existing symptoms we'll code it as exploratory. So I ask how much that will cost and they say, we have no idea, so I ask how much does it usually cost OOP on average and they mumble around a lot and eventually say 2-4000 dollars.

So I get the colonoscopy because I am feeling pretty bad, and I get diagnosed with ulcerative colitis, they code it as exploratory and I end up having to pay about 4 and half grand out of pocket (most of which as it happened went to the facility and the anesthetist and the lab that analyzed the removed polyps and tissue, it appears). Now luckily I can afford that, because I am a responsible person with a decent paying job. But I asked my doctor what would have been different if it was just a routine screening and he said nothing at all. He would still have checked polyps in the lab, he would still have done everything he did, except I wouldn't have had to pay more than 50 bucks. And of course he is recommending I get a colonoscopy every 6 months because I am at elevated risk of bowel cancer. Now my GE doctor says he does 5 or 6 colonoscopies a day. It is essentially the main thing he does, and my insurance company is the biggest in the state. There has to be a better way than telling me, well it can be somewhere between zero and unknown but probably between zero and 10K, for a procedure which is pretty well defined.

Thank you for providing a good example, last pile on about this nobody gave me anything to work with. I'm assuming in this case that your plan is a high deductible one and once that runs out you no longer pay co-insurance right? (If not... I didn't think that was legal anymore?).

My mental model of the deductibles is that if anything remotely complicated happens you'll burn them instantly but it appears that isn't the expectation for most people. Probably because in hospital medicine if you so much as sniff a patient they've been charged an arm and a leg but our population on this board is mostly young people who aren't utilizing medicine too much with related expectations.

That said 25% your doctor is being lazy asshole for not trying to work with you, but 75% he's employed and not in charge which is pretty common these days. He can write his note however the hell he wants but the backend people are just going to do something else. He doesn't want to promise you anything because you'll take it at face value (because doctor!) but then somebody he never talks to in a building he's never been to changes some shit and you go form 0 to thousands of dollars.

Your story smells a little more lazy asshole doctor and I'm sorry that happened to you, during my training most of the attendings I worked with would try and save patients time and money, even when a little tiny bit fraud was involved to make that happen. I tried and remember that and encourage the people I train to remember that. I don't do any fraud though. Obviously.

Asking the doctor to know what somebody else is going to do (in this case, sometimes it's for knowledge he doesn't have) isn't super reasonable but that's a lot of this stuff at times.

The whole system is arranged around insurance plans where this kinda stuff never really applies but it hurts those in edge cases.

Also your plan sounds shitty.

Also also: shit. UC sucks. Follow the screening recs they give you. Seriously.

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Reminds me of "How to Do Health Care Right" by The Dreaded Jim:

My wife was advised to get a colonoscopy. We shopped around, got a reasonable price at a doctor with a good reputation, negotiated with the insurance company, did all the stuff one does in an environment which actually has prices. Then after the colonoscopy was done, the hospital pulled a huge list of stupendously expensive charges out of their ass, most of which were obviously ridiculous or completely made up out of thin air, just trying it on to see what they could get away with, and all of which were charges we had definitely not agreed to, nor consented to in any way, formal or informal, written or unwritten. They just were not used to doing stuff on the basis that one has a definite price, and that the price one charges affects demand for one’s services. The concept seemed alien and incomprehensible to them. Mentally, they were socialists.

In Singapore, they advertise prices.

Some years later, I had the following conversations with various US health care providers. I recorded the conversations:

Conversation with Stanford Hospital:

Me

My wife needs a colonoscopy: Could you give me a price on it?

Stanford Hospital: (businesslike tone)

Twenty five hundred to thirty five hundred.

Me

You do this all the time. Can’t you give me a specific price?

Stanford Hospital: (cooler tone)

Sorry

Me

Is $3500 the all up, all included price to both myself and my insurance?

Stanford Hospital: (businesslike tone)

It only includes the doctors fee, and does not include any additional services

Me

So after I have this done, any number of people could then charge me any fee they like in addition to the thirty five hundred?

Stanford Hospital: (distinctly chilly tone)

I am afraid so.

O’Connor Hospital

Me

My wife needs a colonoscopy: Could you give me a price on it.

O’Connor Hospital

Do you have a primary physician?

Me

Yes, my primary physician has advised this procedure, but it seems expensive. I am looking for a price.

O’Connor Hospital (outraged and indignant)

We don’t give out prices!

Mercy General Hospital

Me

I am looking for a price on a colonoscopy.

Mercy General Hospital hangs up without a word.

Saint Joseph’s medical center of Stockton:

I am transferred to financial counselling, who transferred me to “Estimates” The estimating lady appreciated my problem and made sympathetic noises.

She then asks me for a CPT code. I then research what CPT codes are, and discover that an operation can result in any CPT, and any number of CPTs. I discover that no matter what CPT I give, it is unlikely to be correct or sufficient, that additional CPTs can show up any time. A CPT would only be useful if it was possible to know in advance what CPTs would result from a colonoscopy, but the CPTs are only decided after the colonoscopy, usually long after the colonoscopy.

I'm not really sure it is ever relevant. [emphasis added]

You really cannot be serious. You do not get to decide that it is never relevant. There are many many many stories of it being relevant (some on the storied pages of the Times). You may be in a narrow slice of a specialty where it happens to be rarely relevant, but across the entire swath of healthcare services, with the entire swath of different patients, with different insurance terms and different financial situations, it's going to be relevant often enough. At times, you've even admitted that it "is viable for some services". It beggars belief that you can say with a straight face that you think it is never relevant.

I don’t find the doctor to have any less price transparency than the mechanic?

The mechanic will have a plan for what he is going to do (e.g., "I'm going to replace your CV joint."). He will then assemble an estimate for how much that is likely to cost. He will probably even break down that estimate in terms of parts and labor. He might even provide you options for different brands of parts at different price points.

Everyone involved knows that there is some uncertainty in that estimate. They might get in there and discover that something else needs to be done, too. Usually, at that point, they will reformulate their plan, potentially with multiple options, assemble similar price estimates for those options, then contact the customer, try to explain the situation (knowing that there is an inherent knowledge gap), and ask which of the options the customer would like to take. I did this as a job long ago. There are some sketchy mechanics out there, for sure. But if you want to succeed, especially in a market where being sketchy will become 'known', you need to be very proactive in your communication with your customers, including on pricing information.

Doctors take the same exact sort of uncertainty in their work as a gospel truth that the price is "fundamentally unknowable"... and so, they just refuse to tell you. If you really press them, sometimes they'll do it, but sometimes, they just won't (and sometimes, they'll lie to you and make something up; there are sketchy mechanics everywhere). They certainly don't provide anything comparable to what the 25th percentile auto shop provides on a routine basis.

Perhaps you were thinking of a slightly different concept, that they're similar in that there is a significant information asymmetry. Customers don't necessarily know if the mechanic's plan is motivated by the car really needing whatever it is, whether it's barely justifiable and mostly a scam to increase billing, or whatever else. Similarly, patients don't always know that sort of thing with doctors; they could also be concerned that a doctor is practicing defensive medicine rather than thinking about the patient's pocketbook and giving them only what they really need. These questions are probably near impossible to estimate; I would like to believe that doctors are actually equal to or better than mechanics (the median doctor is almost certainly better than the 25th percentile mechanic if I had to guess, unlike with price transparency). In both cases, the most common solutions are to just diversify your sources of knowledge. I gave an example of how diverse those sources of knowledge can be here, but an extremely common suggestion in both domains is to just get a second opinion.

Again, I don't find it difficult to get healthcare providers to give me pricing information. I go to lower-rent(often bilingual) healthcare providers in a blue collar part of a red state, so maybe it's just different sorts of clinics.

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It doesn't translate to anything directly, and if I have no cash fee schedule you can't even squint and go "it's 100 right?" No, it's a billing code, it doesn't relate to what's "fair" or what is "cost" it is all negotiation. State Medicaid pays me 20 bucks an hour for that billing code. We still take state medicaid even though that's less than the cost to run the front desk because my hospital gets a grant from the state government. Private insurance pays me between 40 and 140 dollars for that billing code depending on the insurance.

Good news, since you pointed out that physicians are employed now and aren't in charge of anything! Your employer signed agreements for all those things, so your employer has all of those numbers. Your employer also knows which category the patient falls in (they took the patient's insurance information when they came in the door), so they know which number was negotiated for that patient. This is a solved problem with a computer even in an auto parts store in [current year]. It's a solved problem in every other industry. I've very occasionally had medical providers look it up for me; I have even seen what was on the screen on their computer; it's a solved problem.

In the real world, that's just not going to happen

Why not? My hysterical aunt managed it, basically on her own. I’m sure that people who aren’t in the 95th percentile of neurosis will have an easier time:

Some even argue that most anesthesiology could be done by a non-MD.

I recommend these people as the first to be sedated by non-MD’s.

Okay, I’ll bite. Why does it take 11 years to train an anesthesiologist and why are they so precious they need to make 400k a year?

To my uninformed eyes it seems like a relatively easy technical skill that could be learned in much less time and without such a rigorous filter.

What’s the delta between in a 90th percentile anesthesiologist and a 10th percentile one in terms of patient QALY over their career. It feels more like a systems problem, in that if the system is set up correctly then skill doesn’t matter too much. And if the skill of the anesthesiologist does come into play it’s because things are already pear shaped. Kind like commercial airline pilots.

Could less skilled technicians + remote monitoring lead to even better outcomes than today?

I’m probably wrong but it’s not obvious why.

The explanation that convinced me was essentially "removing all senses from a human for a specific time and then giving them back without irreversible damage is hard, especially since humans have a very wide range of medicine tolerances and reactions".

If I had to write code, with no syntax highlight, no test cases, in subtly different environments every time, and a single compiler error might kill someone, I'd definitely want some training.

Gas is a lot like being a pilot and flight attendant in that you receive a lot of training for things that aren't often happening and that the average person doesn't see or notice. Job looks easy when things are going smooth. Every time you do something you do a lot of preparation and planning that seems to happen automagically to outsiders.

Unlike aviation, the plane tries to crash repeatedly and active actual plane crashes happen a few times a week. Fundamentally you are fighting to keep the patient alive while the surgeon tries to kill the patient. Think about things like open heart surgery. Even something as simple as an open gallbladder involves radically changing the patient's physiology. Bad outcomes get blamed on you and are your fault.

Surgery isn't everything gas does though.

Imagine you are working a 24 hour shift overnight, it's 4am and you are sitting in a break room watching jeopardy reruns and eating shitty chips from a bag, your pager goes off. You have 90 seconds to get to the trauma bay, where you find a patient has got hit in the face with a sledgehammer. His anatomy looks a cheeseburger put in a food processor and pulsed. You have to keep the guy alive long enough to put a tube down this throat, get fluids and blood running, and get the guy to the OR where another doc and the surgical team repairs the guy's face in an 16 hour surgery.

Ten minutes later you are back to eating chips and watching jeopardy.

OB, psych, and gas have serious tempo issues which more resemble the military and police and are not for everyone.

Consider that many doctors are functionally working 2-3 full time jobs worth of work.

Okay, but the only reason this is the case is because the doctor cartel limits the number of residency slots to keep physicians in demand and well paid. You don't like your hours, but at the same time, you are against increasing supply: you don't want to bring in foreign doctors (doesn't have to be third world, American doctors earn way more than NHS doctors) and you don't want more American doctors because it will eat into your salary. You've painted yourself into a corner here, unless you have a clever idea for demand destruction.

This is no longer the case (your citation is from 1965) and is a non-sequitur anyway.

If you cut doctor salaries in half and double the number of doctors, you have improved physician lifestyle at the expense of compensation but not changed costs at all.

If you cut doctor salaries in half and double the number of doctors, you have improved physician lifestyle at the expense of compensation but not changed costs at all.

This is only true if you also cut the hours doctors work.

If you were working 24 hour shifts, weekends, and holidays - and then someone decided to cut your pay in half. Would you keep working period? Probably not. Would you entertain those hours? Zero chance.

Nurses typically work 3 12s or 4 10s and in some cases make six figures and we already have a nursing shortage problem because they don't like the schedule (because clinical work can suck and nights, weekends, and holidays also suck).

I wouldnt work 24 hour shifts in the first place, and I'd be pissed if I found out that a doctor who was seeing me and potentially making huge decisions or recommendations about my health was 23 hours into a shift.

Anyways, average seems to be somewhere in the 50s of hours per week. Increasing the amount of doctors such that they no longer have to work stupid hours seems like a no brainer, I would easily take a ~30% pay cut to go from 55 hours to 40 and not have 24 hour shifts. No idea why doctors wouldnt either.

https://www.statista.com/statistics/1385440/physicians-work-hours-united-states/

Attending physician work life definitely lands more in the 40-60 range "on average." Surgical specalities can still end up in the 60-80 hour range as an adult.

As a resident 60-80 is more common with 80 being the "max" allowed but many places go over that. Neurosurgeons may end up working 100-120 hour weeks more often than not for like seven fucking years.

The devil is in the details though. Most medical jobs require someone to cover weekends, nights, and holidays. How that shakes out is pretty variable but you can be an attending with a relatively normal 60 hour work week.....but a few times a month you work 24s. Maybe you do trauma at a midsized trauma center. If it's Tuesday you actually sleep through the night. If it's Friday you are working 24 hours in a row. That is ass at age 27. At age 55 it is catastrophic.

pissed if I found out that a doctor who was seeing me...

Um.....about that.

If you go to a university hospital (you should if you have the choice) you WILL be cared for by a resident who hasn't slept in a day. If you get a surgery done the person operating on you might be on hour 28 and gotten 4 hours of sleep the night before that long ass shift.

Edit: these days theres a good number of women in medicine who decide to work part time for a pay cut. It is a thing but given how time consuming and expensive it is to train someone it's usually unwise.

If you get a surgery done the person operating on you might be on hour 28 and gotten 4 hours of sleep the night before that long ass shift.

I'm from the UK, where a typical long shift for a doctor is 13 hours, so I cant really tell if this is an exaggeration.

But if this is true, holy shit. That is absolutely outrageous. how can you with a straight face protest that doctors are so desperately committed patient wellbeing, while accepting a 28 hour long surgery shift? There's no other way to describe it - that's dangerous. You, above all, should know what the science tells us about decreasing performance with fatigue. Any airline pilot that accepted a shift even close to that would lose their license.

The 36 hour shifts are an exaggeration (well, more specifically in some specialties it happens in others it doesn't).

24s are the standard.

To briefly summarize residents are called residents because they lived in the hospital, back in the day when that made sense - the social technology existed to support it (everyone had supportive wives who would still be there after and bring them food) and the medical technology was limited (yeah you lived in the hospital but most overnight work was "shit hope he is still alive in the morning), also the inventor of residency was a massive coke head and we didn't figure that out until later.

Now it is a bit more complicated. Bad outcomes happen, see https://en.wikipedia.org/wiki/Libby_Zion_Law

But 24s are often more popular than the alternative. Often the alternative is something like working 16 hours a day 7 days a week. No or less days off. After a 24 you get home between 6am-12pm and get to sleep until the next day. Or run errands while fucked on sleep deprivation.

The problem is that you need 24/7 365 coverage and that's complicated to do and expensive, residents take the burden.

Importantly our regulatory entities have a bunch of research showing that working 24+ hours is better for patients than handing off to a new team. Things get missed. Your drunk (on lack of sleep) doctor is more reliable than a new doctor that doesn't know you.

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Sometimes there's just no other option. An airline can simply delay the flight until a new pilot is available, but you can't always delay a surgery like that, and there might not be any other surgeons available. We have a massive shortage of doctors because of the dumb med school/residency system.

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This is no longer the case (your citation is from 1965) and is a non-sequitur anyway.

The dynamics today are largely the same.

If you cut doctor salaries in half and double the number of doctors, you have improved physician lifestyle at the expense of compensation but not changed costs at all.

I acknowledge that physician salaries are only a small part of healthcare spending.

However, your opposition to additional doctors seems to obviously conflict with your complaints about working conditions. How can physician working conditions be improved without additional physicians?

The dynamics today are largely the same.

Negative, the AMA has spent the last few decades arguing for an expansion of supply not a restriction, nearly ten percent of residency slots are unfilled every year, and alternate funding for residency spots has been a part of the landscape for a long time.

This meme hasn't been accurate for ages but is very pervasive.

Considering the AMA controls accreditation for medical schools, there's no good reason for slots to go unfilled against their will. Let a thousand med schools bloom.

There is also an excess of medical students applying for spots each year (primarily driven by shitty Caribbean schools and foreign applicants). Even a small number U.S. MDs and DOs go unmatched each year.

We have an excess of supply in the form of medical students and residency spots but for both the excess is of insufficient quality.

@Throwaway05 says that the doctor cartel limiting the number of residency slots is an urban legend. I'll live it to him/her to provide details.

Partially addressed with this user down thread.

This is the data he offered to support his claim the last time. I pointed out that Figures 1, 3, and Table 5 might tell a different story to some folks. This time, he apparently didn't use this citation to support his claim; he only picked out the one statistic from it that sounds like it supports his position, preventing others from seeing the rest of the context.

I generally see the smarty pants contrarian "reduce MD salaries" suggestion paired with a proposal to change the training pipeline, notably by going straight to med school instead of making it a postgraduate program (which I gather is how things work in much of the rest of the Western world.). I don't know whether other countries run their residencies like the US does but presumably worth looking into as well.

Removing the undergrad requirement would be nice for American doctors, who wouldn't have to spend an extra 4 years and $200,000 for literally no reason, but it wouldn't do anything to help patients. That's because the real bottleneck on the number of doctors is the residency requirement, not the medical degree. To increase the supply of doctors, need to either shorten residency or increase the number of residency slots.

I've talked elsewhere about the whole residency and medical school slot thing. The residency length thing is a very complicated discussion.

I do want to point out there are some advantages to the U.S. system of 4+4 years. Yes lots of places do 4 or 6 years, but the ability to go through undergrad first gives you a few advantages:

-You actually have a college experience/fun. That's important!

-You are absolutely sure this is what you want. Really fucking important.

-Better balanced people - less medical school robots.

-Opens the door for career changers, who are some of the best doctors.

Abolishing pre-med and pre-law does not close the door for career-changers, though. People can still do 4+4 if they want.

How would that work though? You "go back to college" instead of medical school - all the students are 18 instead of 22-26 and you do the curriculum designed with 18 year old maturity. I'm sure some people would still do it but that the amount would absolutely tank.

People do that all the time. People enter undergrad after enlisting in the military, or working a few years, all the time. People take a degree part time, nights and weekends, while working. It's not crazy.

I don't think career changers exist at all in Europe/elsewhere in the world. If you have information to the contrary please share.

Uh, my understanding is that the continental Euro education system is completely different and most students are locked in to a particular set of postsecondary education(often sharply limited) by their mid-teens at the latest. Applying directly to medical school, or applying to medical school with a two year degree in biology or chemistry, shouldn't necessarily bring the entire Prussian education system with it.

Now that being said, while I assuredly do not think that making doctors get bachelor's degrees before applying to med school does anything useful, we do not live in a society where med school applicants will stop getting bachelor's degrees if it's not technically required anyways.

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What are you talking about? Why does it matter whether people change medical careers in Europe when people change careers in America all the time despite needing a new degree?

If doctors don't change careers in Europe that would tell us more about Europe and it's education system and career choices than it would about how it would go in America, right?

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People "go back to college" all the time, what are you talking about? You think people wouldn't career change into medicine if it was only a 4 year thing because the curriculum being designed for 18 year olds would make it, what, too easy? Your messages in this entire thread are alien but this takes the cake.

I am not saying I don't support switching from the American model to what we do in Europe. I'm saying that you'd see a plummeting in career change applicants. Medical school isn't very much like (current) undergrad.

For example: medical education is always consolidated programs not a la carte, right now that's mildly aggravating to biochem majors who have to redo a small amount. A European model would involve redoing a lot of coursework very consistently.

I don't think career changers exist at all in Europe/elsewhere in the world.

Medical school students who start at 18 in other countries still have a “college experience”, they’re still on campus, can still party, join clubs, whatever, they’re just doing a more intense course.

I mean preclinical years are an undergraduate class every 1-2 weeks. That pace cuts out a lot of traditional college activity. Once clinicals start you aren't on campus anymore and don't have time for fun. I'm sure this isn't the case in Europe but you can't change the work culture that easily (nor the geography which is a big piece of it).

Sure people talking about increasing the supply of physicians and therefore driving costs down, but that only matters if reducing physician salaries does anything useful. It's not a large enough slice of the pie.

So where’s all the money going?

Whenever someone has a proposal for healthcare reform, the response is “actually that’s not the main driver of costs”. The money’s not going to insurers, their profit margins are slim enough as it is. It’s not going to doctors, they only make up 8% of the pie. So who’s actually getting paid? The money can’t be disappearing into thin air.

Not trying to do a gotcha here. I’m genuinely uninformed on this topic and willing to hear you out.

A bunch of it is going to insurers. Profit margins are thin but if expenses are high from inflated salaries and the gross amount of money is hundreds of billions of dollars that adds up.

Clinical staff add value, most of the other salaries involved are siphoning value. Hospital and healthcare admin staff has ballooned. Practice managers. Billing staff. HIM staff. Midlevel mangers etc etc.

The system has a lot of room to be more lean but as with academia it's just expanded into an inefficient mess.

Many of the people who get paid unnecessarily essentially have the job of fighting other people who get paid unnecessarily (ex: hospital billing staff warring with insurance).

Comparatively little goes to insurers. On top of that insurers are obligated to pay out 80% of premiums.

This article has been litigated elsewhere so I won't belabor the point, but it's very easy to use loop holes for this sort of stuff. Non-profits do it all the time. Oh yes we didn't make any profit, but all the executives and their nephews have massive salaries...weird that.

(the insurance companies can likely be run a lot more lean).

Not really.

if UnitedHealth Group decided to donate every single dollar of its profit to buying Americans more health care, it would only be able to pay for about 9.3% more health care than it’s already paying for. If it donated all of its executives’ salaries to the effort, it would not be much more than that.

In any case, insurers are obligated to pay out a percentage of premiums, not profits, so the accounting tricks you described are not relevant. Indeed, UHC paid out 83% of premiums in the year shown. Since the most anyone could expect from them is to pay out 100% (and they obviously can't pay that much), there is clearly not a lot of room to maneuver.

Hmmmm, what's the explanation/incentive for their wildly shittier business practices then? They must be making money somewhere off of the sky high denial rates, no?

They make money off of denied claims, but the strategy can only go so far without falling afoul of ACA profit caps. They certainly aren't incentivized to pay out much more than 80%, it's just that even with high denial rates they can hit that target due to the difference in what they pay providers vs what they charge customers.

I mean I didn't realize it was premiums and not profits that's a my b, but there has to be some explanation for why their behavior is so much more obnoxious than providers and way their denial rate and so on is so different (30% more I think?)

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Following up on this, some of the comments on the Noah Opinion article suggest that Hollywood style accounting tricks are involved but I didn't see enough in terms of details to really buy that.

I mean, to start with, 8% is not nothing. And I think it’s quite reasonable to pay doctors like doctors, for the record. But there’s also everyone else’s salaries(hello, nurses), there’s admin expenses and capital costs, there’s profits for the hospital and the drug companies, there’s a bunch of healthcare that just doesn’t get paid for, etc. There’s no one culprit with a smoking gun.

Yes you’re important

Yes you work hard

Yes you should be well compensated

…

Yes there’s too many barriers to being a Dr … especially just a family practice type

Yes there’s not enough Drs because of the artificial barriers that you ‘ you ‘ put in place

This is your fault / the fault of the institutions that made you

I don’t want several hundred thousand Indian doctors … I want several hundred thousand American doctors with slightly lowered standards

Yeah this is the fault of the doctors. Also, as @2rafa said, they are absolutely overpaid. Very few professionals make anywhere near doctor salaries, and they have incredible status to boot. Doctors are basically the priests of our society.

I say we gut the doctor’s system and open the floodgates to immigrants. High time they earned their salaries. I don’t like doctors for personal reasons anyway, they are far too confident when they shouldn’t be.

and they have incredible status to boot

I don't think this is true anymore. Anti-doctor viewpoints are super common right now. The left and the right hate us. Corporate media blames us for cost overruns. We aren't independent anymore. Patients murder us and it doesn't make the news. We get threatened all the time at work and the police and the hospital both shrug, even in places where there are specific laws against that.

Look at the tone here. Sure I'm not a perfect communicator but every time I try and refute lies about the AMA I get buried in downvotes, the "doctor bad" and "doctor is the problem" memes are rampant, and that extends to general society.

Not saying it isn't true, just saying that people absolutely feel that way.

For a practical example - you used to be able to get laid or find a partner b/c you were a doctor. Doesn't really work any more.

Fwiw, I appreciate your posts, but don't fret too much about downvotes, that way lies madness. As much as we wish people would vote according to how well an argument is articulated, whether they agree with it or not, I believe most people still use it as an "I agree/disagree" button, and a substantial fraction vote in a reflexively tribal manner.

That being said, while I believe you that being a doctor is difficult and not as rewarding (financially or emotionally) as it might once have been, it's still really hard to convince me that being one of the 4% or so sucks as much as you imply. We could probably do all sorts of reforms that would improve doctor QAL, but some of those would also reduce doctor remuneration, and for some reason doctors seem to prefer the high barriers to entry and what amounts to years of grueling hazing before you're in the money.

I don't think the hostility you describe is some new wave of anti-doctor sentiment. It's a general breakdown in social norms making it more dangerous to be a bus driver or airline attendant or a counter person at McDonalds too. Most hostility about the health care industry is not directed at doctors. It's the hospitals, the front offices, and the insurance companies. And probably nurses take the brunt of patient hostility more than doctors.

I don't think I disagree with any individual thing you said there - downvotes aren't representative and shouldn't be over analyzed, the job and pay are worth it (but less so than the past), people are meaner and angrier in person (to say nothing of online) these days, and so on.

That said - the excess of disagreeableness and decline of respect for institutions and expertise is real (everywhere and sometimes deserved). It's extremely noticeable in our jobs though, because most of life and health takes place outside of the hospital so we can easily see when people don't listen (and come back or die) or make a mess during their stay/visit.

Our oldest can tell us how different it was in Ye Olden Days, or if we work in settings with radically different populations we can see the gap (Vets).

These days we see more and more patients doing things like walking away from treatable cancer to ending up terminal on homeopathic arsenic from someone who is legit licensed in Oregon because that's a thing they do. While I'm not immune to slinging mud at times...people yelling at me on the internet scratches the fundamental same itch writ small.

What bothers me a little more is when people don't realize the decline, especially when it is the respectable types, because of course that hurts more.

Yes I want to be respected (who doesn't?) but it's so intrinsic to the job for us. Yeah its kinda funny when I whinge about it being harder to pick up women as a doctor, but patients shooting their doctors (real but rare), people demanding things that are dangerous to themselves and others like antibiotics for a virus (common as all hell and a problem but individually small potatoes) to the expansion of midlevels because people don't realize how much worse they are (metastasizing everywhere and I'm tired of seeing my patients and friends end up with bad outcomes from it)...these things are real and bringing my end of things closer to collapse.

Like much of everyone's current ills I don't know what the solution is, but I will get on the soapbox and mumble a bit.

And on traditional and all together saltier note, since I was a young intern on call at one point in the distant past: yes nurses get it worse from patients but they totally deserve it.

Indians who would make up the bulk of these are well known for being modest, competent and not over overconfident.

It was more a line against importing doctors rather than fixing our own issues

I found many doctors to be dull. They clearly “learned” a lot of material but they don’t seem to have any interesting thoughts or creativity. Maybe the medical field selects for those kinds of people.

-Okay how much of healthcare spending is doctor’s salaries?

About 8%. If you cut physician salaries by half you get 4% savings. That’s not a little but it is also not a lot.

Obvious question - is this the total income paid to doctors or just the salaries of salaried doctors? The fraction of doctors who are salaried is increasing over time, but most of the doctors who are allegedly overpaid are not salaried - they are surgeons being paid a fee-per-procedure, or owner-partners in physician-owned clinics.

Here's a source:

https://siepr.stanford.edu/news/just-how-much-do-physicians-earn-and-why

Thanks. So modulo a relatively minor argument about capital gains when retiring doctors sell their practices, this is total physician earnings and not just salaries.

That does indeed point to "overpaid doctors" not being the problem.

Yeah it's a pretty sticky meme but it just isn't true.

Same with the "AMA cartel restricts supply!!!!" argument.

You can still claim that doctors are overpaid, but that overpay if present is not the cause of costs.

Keep on snarkily dismissing it rather than refuting it.

There is a surplus of medical students and residency slots every year. AMA lobbies for increased supply of providers.

You can verify these for yourself if you'd like.

Great! Abolish the match. All the trainees are down. I'm down. I'm not sure it's a good idea but I'm down.

That's also not the problem (the problem is that programs with unmatched slots would rather have nobody than the available candidates in SOAP/candidates available in SOAP would rather take a year off than go to those programs). Also all kinds of slots exist in a gray area outside the match.

But by all means abolish the match. Institutional memory for why it exists is low enough that people are willing to give it a shot.

-Okay how much of healthcare spending is doctor’s salaries?

About 8%. If you cut physician salaries by half you get 4% savings. That’s not a little but it is also not a lot.

This seems like a super-important number. I'd like to see the rest of healthcare broken out this way. Who, ultimately, are the people getting paid? Health insurance has a profit margin of 3.4%. So, stylizing a little, if I put $1 into the healthcare system, I have:

  • $0.08 goes to doctors via salary and benefits
  • $0.03 goes to teachers, engineers, and other retail investors via dividends
  • Remaining $0.89 goes to [???]

All the breakdowns I see look at institutions; but institutions are just placeholders. When we say "Drug Companies" got paid $1M, is that $800k in researcher salaries, $100k in admin, and $100k in marketer salaries? Or is that $500k in corporate dividends, $100k in researcher salaries, and $400k in marketer salaries?

The difference matters a lot, since - like you're saying - cutting healthcare means that someone is going to stop getting paid for work they're currently doing. And who it is / how much they're getting paid now matters a lot.

I've never seen it broken out in a way that granular but I expect a bunch of it would be line items like "secretary to assistant infection control nurse" and you'd be like "who the fuck is that and what do they do" to which my response would be "well I don't know who that person is, but I know the infection control nurse is the person who goes around cancelling all of our tests that will show that the patient got a hospital acquired infection" (through nobody's fault) because the government doesn't like when we have those.

The sheer number of admin and regulatory compliance people who don't really do anything has massively ballooned.

It's very much like universities.

but I know the infection control nurse is the person who goes around cancelling all of our tests that will show that the patient got a hospital acquired infection" (through nobody's fault) because the government doesn't like when we have those.

First thought: How is this a thing?

Second thought: Oh yeah, economics. Of course this is a thing.

Third thought: Can we shoot these people instead?

Fourth thought: It totally was somebody’s fault. I realize that meticulous clinical hygiene is hard. People will still die if you screw it up.

OH LET ME TELL YOU ABOUT WELLNESS MODULES.

Problem: Our resident physicians keep killing themselves.

Solution: Make them come in at 6am on their day off to spend 2 hours filling out un-skippable e-learning trainings reminding them that they should sleep. The person who worked a 24 hour shift over night and is being prevented from going home starts screaming incoherently. Then the hospital hires a "chief wellness officer" at executive pay scale who comes up with more wellness modules. If you are lucky they throw the residents a pizza party while they are working and the nurses eat their pizza.

Sorry one of the other comments made me think about wellness modules.

"well I don't know who that person is, but I know the infection control nurse is the person who goes around cancelling all of our tests that will show that the patient got a hospital acquired infection" (through nobody's fault)

"this is the person who goes around committing what amounts to fraud because we don't want to get caught having caused an infection" (which is totally our fault, they got it while they were in our care). What do you think this sort of a thing sounds like to other people?

I mean it's nuts and physicians hate it.

They do generally have paper thin justifications to avoid it being outright fraud but it is stupid and everyone outside of administration acknowledges that.

It's also a classic "juke the stats" type government/regulation outcome.

Medicine faces the same problem that computer programming has, I think: it’s a prestige job, with a high salary, and has therefore attracted strivers.

Strivers are great at taking tests, going to meetings, taking photos, networking, self promotion, speaking, etc. and are sometimes okay at the underlying skill, but to them the underlying skill is an afterthought.

I think this is why I’m frustrated at doctor pay. I want the type of autists that are obsessed with being good doctors, and I’m happy to pay them $1M+ a year (what some of the doctors I’m friends with make), but I want to filter out the strivers. How do we do this?

Interestingly, this is similar to the problem Google has faced WRT search. They defined how they measured a good page, and then everybody just adhered to that. The actual underlying quality went to near-zero, and they just overfit to the test.

The way to filter out strivers is extreme classism of the old-school sort. Gate professions by last name, by prep school, by who your father is friends with and you keep the scummy, first-generation strivers with their bad manners and grubby hands out.

This system is actually ideal. It doesn’t preclude class movement, it just requires that it be a multi-generational project. By the time new money is accepted into the striver jobs, the kids are as accustomed to success and fat and lazy from it as everyone else.

What you are describing sounds quite a bit worse, though, doesn't it? Maybe "I don't care about becoming high class through becoming a doctor because I'm already high class so it doesn't matter"? Hmm.

Basically I don't want these jobs to be prestigious, I want to filter for the people who are interested in the work, and look at the class-effects as secondary.

The idea is that the only people socially qualified to be doctors don’t have to strive or get a prestigious job because they’re upper class already, but they do it anyway because they want to.

I know someone who inherited enough money that he never HAD to work a day in his life, but he became a rather overworked agricultural vet because he wanted to.

By the time new money is accepted into the striver jobs, the kids are as accustomed to success and fat and lazy from it as everyone else.

Do you have a general presentation of the model here? What I see around me is a lot of people trying to prevent their kids from getting fat and lazy.

The physician pipeline is a whole separate problem that is infested with culture war (DEI and AA) and pre-culture war (autists bad, I want better customer service and English speakers!!!) bullshit.

If you throw out the customer service angle, then to some extent you want psychopathic hard workers AND autists. The supply of people who are both is limited.

Walking back all of the box checking side of things is also hard. These days autists get furious at mandatory wellness modules and other asinine useless horseshit and burn out. Banning that stuff is hard and box checkers are much better at dealing with it.

Iatrogenesis might become a leading cause of mortality

Is this a reference to the blatantly fallacious "medical errors" study?

You do realize that people in healthcare deal with the frustration of the job because they want to help people and are therefore constantly doing quality improvement projects and establishing metrics and other ways of tracking and addressing bad outcomes right? It's one of the major drivers of cost.

So you don't think doctors are spending a ton of time and energy trying to improve patient care?

So if it's not your salary that's at fault, and it's not the medical cartel's restriction of the supply of doctors that is at fault, and it's not the insurance companies because they're legally required to pay out such a large portion of their revenue, whose fault is it? All I see in this thread is a bunch of deflecting and blame shifting but without one concrete indication from you as to what the actual problem is that needs to be solved. When you've attempted to shift the blame to other elements of the healthcare system, other commenters have replied with evidence to the contrary that seems to surprise you. So who is at fault?

I mean its cost disease. Ex: excess regulatory burden that does nothing helpful.

Same as in everywhere else in the economy with the cost overruns.

You're only tossing that out now that other commentors poked holes in your other attempted explanations. You may as well blame the tooth fairy. If you genuinely thought that you would have opened with it, and you'd have some concrete ideas about what regulations are in the way. Your profession by and large does not give a fuck about the human aspect of medicine or the cost to individuals, and this wildly out of touch crypost from you is full of evidence of it. Luigi's only mistake is he didn't get the surgeon who ruined his back too.

Your profession by and large does not give a fuck about the human aspect of medicine or the cost to individuals, and this wildly out of touch crypost from you is full of evidence of it. Luigi's only mistake is he didn't get the surgeon who ruined his back too.

Think about what you just said here.

"I wish the assassin had killed a doctor too" "doctors don't care about people."

Does that really seem reasonable, or fair? Doctors should be murdered for routine complications or things that just don't work?

Please refrain from attacking others as insincere. The generalized rage isn’t particularly constructive, either.

Bureaucratic institutions, if given access to funding are going to proliferate indefinitely.

Parkinson's laws are undefeated. Famously predicted RN with more admirals than ships.

Came true in '90s. These days, there's more army general in the British Army than there are tanks in it. Probably more generals than big artillery pieces too.

My friend Fred says that median real wages for doctors have been going up since 2000 at least. Although $2700/week seems pretty low. What's your source for the claim that they're going down?

Anyway, I don't think we should cut doctors' salaries as such. We should allow more people to become doctors and let the market sort it out.

Yeah that's clearly not accurate data given how far the number is off from the average 300-350 yearly salary range. Zero idea where it's coming from.

The simplest elevator pitch for decline in physician salaries is that medicare reimbursement has been cut every year for 20+ years (something like ~30 percent down from 2000 I think). At the same time inflation has happened. While pay isn't always directly driven by Medicare, private insurance often pegs itself off of Medicare rates.

An alternative is that the raw numbers haven't really gone up for many years (although COVID changed this) but inflation has gone up by a lot.

The numbers are divided by CPI, "Index Dec 1999=100". Multiplying by 175 gets to $245,700/year in 2024 dollars. It's also a median; the mean would be higher.

Hmmm. Something still seems off, I'm not sure I can square that with the pay checks I know about. Also not sure that surgical specialities are doing well enough to raise the average by 100k (given the smaller numbers of them).

Maybe they are including residents in the numbers and its fucking it up somehow? They are technically doctors and actually have had pay gains because at some point living in downtown SF on 50k became completely impossible.

I wonder if there has been a flattening of wages since now doctors are effectively all employees and few are owners.

Can I ask what motivates you to be a doctor? Is it that if you don't rage out and quit by the time you enter your 40s you can start expecting a really sweet lifestyle, if you properly monetize your certifications and experience?

I feel a little guilty that I never went to college and liked computers instead and was clearing $500k/year and retired in my 30s. But at least when a doctor has a garage full of sports cars society nods and says "oh yeah well he's a doctor that's why" whereas I have to do shit like live a low key life and give to EA so I don't trigger class rage.

All the doctors like that are DINCs, from a prior time (aka the 90s), or from one of the well paying specialties. 300k a year starting in your 30s with 500k in debt isn't enough to make you rich until late in the game if you intend to put 2-3 kids through college and so on, if ever. Sure you can push state school or not pay but if you went through it you want to protect your kids from dealing with it.

These days the doctors are on the receiving end of class rage though, everyone is mad at us on both the left and the right, thinks our job is easy and easily automated, and wants us to make less money. Thus my long ass rant.

That said I do it because I want to help people and I like teaching. It's also interesting as hell. Medicine is hard because it is much poorer define than most knowledge work which means there is a lot of room to learn and research and for your job to stay interesting over the course of your career.

These days the doctors are on the receiving end of class rage though, everyone is mad at us on both the left and the right, thinks our job is easy and easily automated, and wants us to make less money. Thus my long ass rant.

It is pretty astounding to hear that health spending occupies an increasingly larger share of GDP yet doctor compensation is worsening.

That said I do it because I want to help people and I like teaching. It's also interesting as hell. Medicine is hard because it is much poorer define than most knowledge work which means there is a lot of room to learn and research and for your job to stay interesting over the course of your career.

I obviously don't know anything but from the outside it does seem like one of those things where the more you learn and the faster you think on your feet the more good you can do. When, you know, the cases aren't boring and you have to remind the patient yet again that they don't get better unless they actually take the meds as prescribed.

It is pretty astounding to hear that health spending occupies an increasingly larger share of GDP yet doctor compensation is worsening.

I think this should be pretty intuitive if you think about government and academic spending. More administrators and more middle managers are rampant everywhere and drive up costs. Market activity is somewhat protective against this, but healthcare has too much going on that doesn't resemble a market.

...faster you think on your feet the more good you can do...

One of the remaining perks that hasn't eroded is that you bring in the revenue for the hospital. Even an IM doc brings in 4-5 times their salary in revenue to the hospital. This gives some independence, should we choose to use it (we often don't because residency beats that out of us). You want me to fill out a yearly HIPAA training. Fuck off, fire me if you want. You won't.

This patient is having an emotional breakdown and really needs it? I'm skipping my mandatory meeting and spending time with the patient and their family.

Moments like that matter a lot.

Also, if you are smart and motivated you can discover entire new ways of helping people, stay on the bleeding edge, redefine what the standard of care is...and so on.

Even bad patients can be rewarding when you finally help them to the ah-ha moment.

Good stuff is out there.

The supply of doctors in the US is artificially constrained which means you can increase the supply of doctors while lowering salaries.

Up until that point you have no flexibility. You can’t leave your job or your life is over. You can’t choose where you live. If you get fired your life is over.

Why can't you change jobs? Every doctor in my family has done so at least once. Don't many doctors work for themselves at their own clinics?

The supply of doctors in the US is artificially constrained which means you can increase the supply of doctors while lowering salaries.

Putting aside whether this is true or not the whole point of my post is that it doesn't matter since doctor salaries aren't the problem.

Why can't you change jobs? Every doctor in my family has done so at least once. Don't many doctors work for themselves at their own clinics?

You can't change your job or choose where you live during residency (and to a less extent medical school). 7-11+ years.

Putting aside whether this is true or not the whole point of my post is that it doesn't matter since doctor salaries aren't the problem.

I don't see how they're not part fo the problem. If they increased the supply of doctors, they'd be cheaper and healthcare costs would go down.

I don't see how they're not part fo the problem. If they increased the supply of doctors, they'd be cheaper and healthcare costs would go down.

A realistic salary cut brings down healthcare spending by 2%. That's barely anything. Bring administrative spending down to 1980 levels and you probably save something like 25%.

-Okay, but how are physician salaries trending, are you making more than you used to?

Doctors have been getting year after year real wage cuts for 20-30 years. Everyone else’s (in healthcare) salaries have been going up. Percentage of healthcare spending on physician salaries is going down. So, if you really want us to get paid less just wait. Our salary shrinks every year and the portion of the pie we are taking shrinks too.

Alex Tabarrok wrote an article in 2019 that showed this is simply incorrect. Real physician wages tripled over the past several decades, and are doing far better in terms of wage growth than many other professions. Maybe he's doing something weird with the numbers here, but you didn't post any numbers, just an assertion.

Please supply the data if you can because nothing about that makes sense. Medicare cuts to physician reimbursements are well known, several specialties are frequently sub 200k which isn't really consistent with any form of keeping up with inflation.

I don't know this writer but I think it's pretty reasonable to conclude it's likely an anti-physician agenda post given this: if physician pay is one of the biggest factors behind healthcare costs (as they say), why is it such a small percentage of healthcare costs and they don't even mention what the percentage is or note if its increased or decreased over time?

I think it is reasonable to have significant suspicions after noticing that.


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