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PaperclipPerfector  8mo ago (text post)   40032 thread views

Culture War Roundup for the week of February 24, 2025

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A pre-Lenten post that's been in the works for a while.

On April 10, 1947, a man named Rudolf Hoss went to confession, six days before his execution. Hardly a particularly unusual course of events, but Hoss had left the Catholic Church in his teens over an incident involving confession, joined the Nazi party, and would shortly therafter issue the following declaration:

My conscience compels me to make the following declaration. In the solitude of my prison cell I have come to the bitter recognition that I have sinned gravely against humanity. As Commandant of Auschwitz I was responsible for carrying out part of the cruel plans of the 'Third Reich' for human destruction. In so doing I have inflicted terrible wounds on humanity. I caused unspeakable suffering for the Polish people in particular. I am to pay for this with my life. May the Lord God forgive one day what I have done.

He was not the only war criminal to seek absolution following WWII. On the other side of the world, Yasuhiko Asaka would convert to Catholicism in 1951. While his connection to the imperial family would prevent his being charged for war crimes, he gave the order beginning the rape of Nanking. His immediate superior, general Matsui, who was executed for the crime, spent his retirement after the massacre promoting devotion to the Buddhist goddess of mercy and advocating for full independence for captured territories, and his last request was for his family to adopt a maid, presumably a large favor in postwar Japan.

On a lesser scale, I have spoken to missionary priests who talk movingly of impoverished third worlders walking hundreds of miles, often barefoot, to go to confession, often with no interest in the faith beyond it(especially in west Africa, it seems many had been baptized by Pentecostals but wished to confess transgressions rather than simply trust in the mercy of God- He may forgive, but does your ancestor spirit?). The early Spanish missionaries in Mexico noticed the same thing- Indians clamored for confession, they clamored for baptism, for release from their sins, but before the Guadalupe apparition had few interested in the practice of the faith.

The natural state of man is to fear retribution from the immaterial- will the ancestors punish me? Is the river angry with my conduct, will it flood? Have I cursed the whole village? How can I appease them? Will there be retribution on me, or maybe on my whole clan?

We have not moved past this. WEIRD Americans speak of Karma, of what comes around goes around, of 'garbage people getting what's coming'. It's been noted that the SJW brigade seems not to forgive; transgressions contaminate you, your works, your associates... forever. I don't know any SJWs so I have to take the motte's word for it.

Scott noted new atheism as a failed hamartialogy, but he focused mostly on the question of 'why do bad things happen to good people'- there's another aspect to hamartialogy, the question of 'how can I, as a person, move past my sins? How can I end the contamination?'. In Catholicism there's a simple answer- confess to a priest, do whatever penance he gives you. There might be purely natural consequences, like health problems from drug use, but the contamination is gone. As far as I know there is no other answer, anywhere, ever. Notice general Matsui, above, never seemed to regard himself as having atoned for the rape of Nanking- and he said, at the time:

I now realize that we have unknowingly wrought a most grievous effect on this city. When I think of the feelings and sentiments of many of my Chinese friends who have fled from Nanking and of the future of the two countries, I cannot but feel depressed. I am very lonely and can never get in a mood to rejoice about this victory ... I personally feel sorry for the tragedies to the people, but the Army must continue unless China repents. Now, in the winter, the season gives time to reflect. I offer my sympathy, with deep emotion, to a million innocent people."

Even if you are a secular materialist, the time to think about what you have done wrong is nigh. And it's the time to remember that guilt is real, very real. How does your society remove guilt? I suspect for many, the answer is 'it doesn't'. And removing guilt serves a vital and important function. We see it, so I am told, in the internecine warfare of SJWs over being too closely associated with wrongthinkers- without it you can't reintegrate into the community. We see it in the man weighed down with guilt over his past behavior, unable to move on. And I suppose we see it more controversially with the post-religious right, hanging a sword of damocles over the heads of converts from all sorts of degenerate behavior. Former abortion doctors and homosexuals are minor celebrities in Christian spaces; I suspect many of these people would have committed suicide without the ideas of Christian mercy.

We have not moved past this. WEIRD Americans speak of Karma, of what comes around goes around, of 'garbage people getting what's coming'. It's been noted that the SJW brigade seems not to forgive; transgressions contaminate you, your works, your associates... forever. I don't know any SJWs so I have to take the motte's word for it.

Counter-point: Dan Harmon committed sexual harassment, a real no-no sin, and gave a fairly heartfelt apology and was apparently forgiven and is now back to work. So it's not impossible.

I think part of the problem is more that SJW ethics are almost tailor-made for exploitation by narcissists and other bitter/status-seeking people disinclined towards forgiveness in the first place (and cancellation disproportionately affects people with enough status to become visible and thus provide an incentive to continually pick at), so it's hard to come up with a simple principle that accounts for all cases because someone can always defect and there are reasons to deny status even if one personally forgives.

And I suppose we see it more controversially with the post-religious right, hanging a sword of damocles over the heads of converts from all sorts of degenerate behavior.

A lot of this is likely because this is very online: converts are essentially acting as influencers, which gives good reason to gatekeep the usual positive reinforcement that comes with forgiveness.

If I see an aging instathot in a burqa I'm willing to accept she's a Muslim now (it's frowned upon to question that sort of thing without good reason), but there are good reasons to deny her prestige for wearing it. She clawed her way back to neutral, she's not a moral exemplar.

A lot of this is likely because this is very online: converts are essentially acting as influencers, which gives good reason to gatekeep the usual positive reinforcement that comes with forgiveness.

If I see an aging instathot in a burqa I'm willing to accept she's a Muslim now (it's frowned upon to question that sort of thing without good reason), but there are good reasons to deny her prestige for wearing it. She clawed her way back to neutral, she's not a moral exemplar.

I find people who are influencers/celebrities for a certain point of view and then flip flop on that, converting but maintaining their public profile to be reprehensible. If your publicly-endorsed perspective or behavior, the one that made you famous, was really so wrong, it calls into question the whole concept of your deserving any fame at all.

The appropriate response to so publicly being wrong is to state your intentions and then disappear. Run to the wilderness. Strike your breast. Fast in sackcloth and ashes. If your reasons for converting are about gaining the mercy of God, you will receive it; seek and ye shall find, and blessed are those who hunger and thirst for righteousness, for they will be filled. But if your reasons for conversion have to do with saving face or maintaining status, I have bad news for you:

Two men went up into the temple to pray, one a Pharisee and the other a tax collector. The Pharisee stood and prayed thus with himself, ‘God, I thank thee that I am not like other men, extortioners, unjust, adulterers, or even like this tax collector. I fast twice a week, I give tithes of all that I get.’ But the tax collector, standing far off, would not even lift up his eyes to heaven, but beat his breast, saying, ‘God, be merciful to me a sinner!’ I tell you, this man went down to his house justified rather than the other; for every one who exalts himself will be humbled, but he who humbles himself will be exalted. (Luke 18)

The appropriate response to so publicly being wrong is to state your intentions and then disappear. Run to the wilderness. Strike your breast. Fast in sackcloth and ashes.

And figures like dr Bernard Nathansen would be pointed to by many practicing Christians as a counter example.

If I see an aging instathot in a burqa I'm willing to accept she's a Muslim now (it's frowned upon to question that sort of thing without good reason), but there are good reasons to deny her prestige for wearing it. She clawed her way back to neutral, she's not a moral exemplar.

Yeah, I think this is part of the human condition, though, we are always more impressed by the convert than by the born believer, find it hard not to be. People find it flattering when someone changes to be like them and to agree with them, whereas someone who always did is less interesting.

Also in practice there tends to be a fair cost / friction in doing things like changing religions.

The more religious you and your community already are. For many it isn't as big a burden as it once universally was.

It's been noted that the SJW brigade seems not to forgive; transgressions contaminate you, your works, your associates... forever. I don't know any SJWs so I have to take the motte's word for it.

This isn't strictly true. The transgressions of an ally may be ignored for as long as that ally provides more value to the movement as an agent of it than as a victim of it. The second they have more to gain by cutting him down, he will be cut down. A great many male feminists and the like were "known" to be creeps, and it was even documented by places like kiwifarms for years, before their eventual public excoriations. Then all of a sudden one day it's "I always knew he was a scumbag" "I was afraid to speak up before" and so on as everyone joins in the public ritual of cancellation to snatch their personal shred of virtue from being part of the firing squad.

That's because this isn't only about morality and enforcement, it's also a status game. Tearing down an avatar of badthink elevates oneself; imagine a communist state in which firing squad members were both volunteers and exalted for their righteous service.

If you don't mind me necroposting a bit, can you give an example of a person who was discussed on KF pre-cancellation? I'd prefer not to have to wade through their material wholesale.

I'd strongly recommend taking a dive and reading up on random ecelebs sometime. The stuff they document is incredible.
Keffels(?) was one of the big "libs made him a saint and declared all evidence to the contrary Officially Hate Speech, then turned round and Knew All Along he was actually bad news and Highly Problematic"

You could also go to the various podcasts that plagiarize straight from the farms, like Jessie whatever.

If there is a hell, then Höss in the very lowest pit, and while nobody deserves to be in hell, I can hardly think of anyone who tried harder to deserve to be there. When the utilitarians break hell, his kind shall be the last to be freed.

The amount of utility loss Höss has caused is unfathomable. A comic book villain could rape and murder a five year old every day of his bloody life, and still the QALY loss of his lifetime would be less than what Höss and his team achieved in a month. He had every opportunity to regret his actions during his tenure of running the hell he had created on earth. If god wanted him to repent, then every cry of a child he murdered was a call to repent, and he ignored them all. He did not try to blow up the gas chambers, or take his own life, or even ask to be transferred to the front to serve Hitler without directly getting his hands dirty.

And then in a prison cell, he suddenly discovered that he had done grave wrong and asked god for forgiveness. Why did the Soviets even give him a priest? And if I had been his confessor, I would have told him that a million murders were a bit about my pay grade, but that I would be very happy to forgive him a dozen murders of his choice, and let him try the Nuremberg defense at the pearly gates for the others.

Of course, the evilness of giving comfort to Höss pales compared to what the Catholic Church did for other Nazis. The same Church which had barely lifted a finger to try to stop the genocides of Hitler was not only willing to forgive famous Nazis such as Adolf Eichmann or Joseph Mengele, they were willing to bet all their moral authority on helping them to escape worldly justice as well. Thanks to Christian forgiveness, Mengele, the Nazi doctor died in freedom in Argentina, and Eichmann only got his due because the Israeli were less forgiving than the Vatican.

Anything the Catholics did after the ratlines is small fries compared to the evil they did back then. I mean, if Christian forgiveness means smuggling mass murderers to Argentina, then it obviously also means shielding priest from worldly authorities and enabling them to continue to sexually abuse children. As long as they confess from time to time, a few raped kids will not prevent them from joining Höss in the Catholic conception of paradise.

And then in a prison cell, he suddenly discovered that he had done grave wrong and asked god for forgiveness.

Few convert for glorious reasons.

I find the idea of externally 'atoning' for your sins and/or expelling them in some way disturbing. If you do wrong and feel bad you deserve it. These emotions are yours now and you must carry them on with you. Trying to get away from this burden or attempting to ameliorate the pain through some self afflicting physical process is an act of rebellion against your own conscience. You are running away from pain your 'being' is telling you to feel. Paying a price for wrongdoing, for example a legal price, should not be seen as an excuse to free yourself from your deserved emotional turmoil.

Reading about pious pilgrims flagellating for faith, I'm reminded of people who speedrun video games. I feel sad when I see videos of them getting a new best time, springing out of their crusty chairs in a dimly lit room, screaming in elation: A new world record! Who knows how much effort, how many hours these folks spend on this completely insular and self driven compulsion to get the best time that is of no consequence to anything at all. But this perversion of effort and strife gets paraded around as an important accomplishment by similarly minded people.

Much like a sad teenager playing Super Mario for the millionth time, a pious pilgrim will do a real life barefoot desert speedrun. This is not an external exercise. It's completely internal. Completely useless and devoid of value beyond the perverted compulsion of the speedrunning pilgrim.

Reflection is important. Twisting and contorting your body to push yourself towards a better understanding of what life is for you can be noble and good. Struggle and strife for its own sake can also be good. But it has to be done for the sake of something actually 'real'. I think it's universally recognized that the only actually 'real' thing is having children and raising them. Anything else that is not working towards this goal is ultimately fake.

As an aside: To that extent you can pinpoint an ultimate 'gotcha' on the new religious right. As far as Christianity being a proxy for people successfully having children, it is obviously good. Beyond that, it's very little beyond philosophical speedrunning.

Much like a sad teenager playing Super Mario for the millionth time, a pious pilgrim will do a real life barefoot desert speedrun. This is not an external exercise. It's completely internal. Completely useless and devoid of value beyond the perverted compulsion of the speedrunning pilgrim.

Every religion has this kind of ‘speed running’ rules lawyerism. Many Buddhists believe that instead of chanting mantras you can just spin prayer wheels with them inscribed. In Bhutan, when I visited, the natives would hold them in rivers or running streams, or even let them float away, or build water wheel contraptions. If it spins a thousand times, that’s a thousand prayers, right? Far more efficient than saying them yourself.

If it happens in faiths as diverse as Buddhism and Christianity, I would expect that pre-Abrahamic European folkways / religions would have similar things. It’s just who we are.

I'm reminded of people who speedrun video games. I feel sad when I see videos of them getting a new best time, springing out of their crusty chairs in a dimly lit room, screaming in elation: A new world record! Who knows how much effort, how many hours these folks spend on this completely insular and self driven compulsion to get the best time that is of no consequence to anything at all. But this perversion of effort and strife gets paraded around as an important accomplishment by similarly minded people.

Couldn't you say the same of any art or hobby without a practical use, though?

Could you? I think most normal people have a very immediate and visceral understanding of the difference between a 'good' hobby and a 'bad' one.

For example, kayaking doesn't seem to have any immediate 'practical use', but I can tell you with full confidence that it's a much better hobby than playing Donkey Kong Racing on repeat.

One could probably write essays on why and argue at length through whatever wordgames possible back and forth, but I think most people share this fundamental understanding on the matter.

For example, kayaking doesn't seem to have any immediate 'practical use', but I can tell you with full confidence that it's a much better hobby than playing Donkey Kong Racing on repeat.

At this point many speedrunners are living off of it, so it's more like a career path.

I don't think there are that many who can realistically look at speedrunning as a career path. Especially not relative to how many participate in the activity. On top of that, many of those that are living off of it are living a sedentary isolated lifestyle where they have no responsibilities or costs that reach beyond their personal needs. Needs that usually don't reach beyond their bedrooms. Their 'living' doesn't cost all that much, and, sad to say, probably isn't worth all that much.

I'd also add that, relative to a 'good' hobby, you don't need an excuse like 'it makes me money' to confidently partake in it. You spend money on kayaking to go out on the water to paddle around and you still look far superior to someone who takes five hundred to a thousand dollars per month streaming their speedruns of Mario.

https://www.newyorker.com/magazine/2008/03/03/how-things-even-out

This comedy piece sort of encapsulates how I feel about karma. In the long run, things even out. Maybe a bunch of bad stuff is happening, but good things will happen eventually. Maybe innocent people are being punished now, but in the long run guilty people will get away with stuff, and innocent people will get away with stuff too, and the guilty people will be punished for other stuff, and every permutation thereof.

Except if the human race goes instinct, ofc. Then all bets about future karma are off, so to speak.

My impression of historical US-Euro relations is that while realpolitik was always an important component, there was a sense of shared ideology (liberal democracy) and cultural history that strengthened the bond relative to, say, US-Egyptian or US-Indonesian relations. We were the "free countries," we were the "Western nations," and until recently, we were "Christian nations." However, mass immigration, multiculturalism and its consequent curtailing of civil liberties, and militant secularism and progressivism seem to have severely weakened those identies in Europe and made room new identities to assert themselves.

I see US-Euro relations decaying to the more transactional relations that the U.S. has with culturally alien countries. European countries making noises about cozying up to China sounds bizarre when operating under the assumption that the old identities hold, but it actually makes sense if Europeans now simply view China and America as two ideologically-alien superpowers who offer different sets of incentives and obligations and who can be played off one another for benefit.

I think a lot of the outrage about "European ingratitude" from the American right is caused by right wingers failing to realize that European 2025 is not the Europe of 1950, or even 1990. Many Europeans seem to already view America as ideologically alien and thus view the relationship as totally transactional. It would be like expressing gratitude to your ISP for providing internet service after you sign a contract and pay your bill. Trump's more transactional approach aligns with this new reality, and so it's probably a good thing -- unless you're an American progressive, in which case, since you hold religious beliefs in common with European progressives, you probably view this development as needless division and infighting amongst enlightened nations that diverts time and energy away from pushing back the ever-encroaching forces of ignorance and oppression. That said, I sense a rift between American and European progressives as well, mostly in complaints from more traditional European socialists who see American "woke" progressivism as an irrelevant distraction from material problems and/or a form of American political and cultural imperialism. So perhaps even the bonds between progressives on either sides of the Atlantic are fraying and will not be strong enough to maintain a US-Euro relationship beyond the merely transactional.

This explanation is certainly too pat, and there's more nuance to be explored, but do you think this is more or less the direction in which things are heading?

I think there are some important insights here, but I'd like to speak to the European angle. In short, the bulk of the breakdown on the European side is due to Trump, or increasingly Trumpism as a movement, which seems tailor-made to alienate European elites. At a personal level, Trump is crass, vulgar, tasteless, and lacks the kind of general cultural and historical knowledge that would be a sine qua non for most European leaders. Vance makes things worse, adding a smug debate club arrogance to Trump's lack of regard for decorum and norms. I have two friends who were actually present at the Munich Security Conference last week, and both of them said Vance's address was the most shocking speech they'd seen in their respective diplomatic careers, both in terms of content, but also in terms of form: the complete lack of niceties, the most of all as what they perceived as its bilious anger and unpleasantness.

Even worse than the personal angle, though, is the political level. Trump simply doesn't play by the established rules of the Liberal International Order, and if there's one thing Europe loves it's rules and procedures. And as much as I can appreciate a good disruptor, Trump's diplomatic strategy seems less like Paul Graham and more like an unmedicated ADHD child in an airport lobby. One week it's tariffs on Mexico and Canada, the next it's annexing Panama, the next it's annexing Greenland, then Gaza, and then onto Ukraine. These ideas whizz by so seriously it's very unclear whether they're intended as literal policy proposals or some kind of semiotic ritual. Not to mention that the policies themselves are utterly bonkers, ill thought-out and ill considered. The Gaza plan in particular was just extraordinary in its inchoate madness. Adding all this together, to many of us Europeans, it looks like there's a void at the top of American leadership where elite human capital is supposed to go.

However, perhaps most of all, I think many Americans just don't realise how visceral and close and frightening the Ukraine war is for many people in Europe. To hear Americans talk about it, it may be as far away as Afghanistan or Iraq, but for many Europeans it's literally the next country over, we have Ukrainian refugees among us, and Russia is conducting assassinations and sabotage in our cities. The default assumption among most Europeans was that this was the obvious next conflict of the Free World against tyrants, and it was as much in America's interests to fight it as it was Europe's. This impression was bolstered by Biden's presidency, and despite Trump's bluster, I think most Europeans assumed he'd pursue broadly similar policies.

Instead, the events of the last two weeks have been the biggest shock to transatlantic relations since Suez, or perhaps even pre-WW2. Most left-wing Europeans didn't like America much to begin with (well, not as a political entity), but the usual transatlantic cheerleaders on the centre, right, and even hard right are in a state of absolute epistemic and existential shock. The idea that America would not just clamp down on aid for Ukraine but moot de facto switching sides was so far outside of their Overton Windows that they have no idea how to process what comes next. Suddenly, ideas that used to look like a bad videogame storyline - e.g., a realignment towards China - no longer seem totally impossible, but that's mainly because our model of the possibility space has collapsed, and until we can stitch it back together, almost anything seems possible.

I think you describe the European elite perspective accurately. The problem I have with the perspective is that it is all sizzle and no steak. Take Vance’s speech. He talked about the Euro problem with free speech. The European response was “we have free speech; you are allowed to say what you want provided it doesn’t offend the government’s sensibilities.” This of course vindicates Vance. Yet instead of tackling the substance and either disagreeing with Vance that free speech is good or doing some introspection, they complained about how shocking the speech was.

And honestly this all style no substance political idea has been endemic in western democracies for decades (including the US). The difference is that people like Vance are now focusing on the substance and it is difficult for European elites to hear because Vance is discussing uncomfortable truths.

I think Vance’s speech was more for Americans back home. As an “American back home” it was pretty epic and satisfying. Euros do need a wake up call. We are expected to contribute more than required to NATO, and the countries we are allied with don’t even support our most basic freedom of free speech? I’m not sure about that anymore…

But wasn’t it also for them? I see the European project dying in Europe. In fifty years do we expect Europe to act anything like Europe of fifty years prior?

No I truly believe euros think that “hate speech” doesn’t qualify for free speech protections and that insulting a politician is acceptably “hateful”.

I think it will keep getting worse and worse there until the euros completely freak out and swing towards ethno-nationalism, remilitarize and start WWIII. Doesn’t seem like they are good at moderating their political fads and always bring it too far in one direction

both of them said Vance's address was the most shocking speech they'd seen in their respective diplomatic careers

They are illiberal in a way shaped perfectly to block people like Vance or more traditional American Republicans from winning elections. Very selectively applied laws used to round up critics of leftists using police raids. A political Overton window enforced through state action and without any input from voters. Vance rightfully points out that Europe's true threats are just this sort of action.

The response is predictably shock, outrage and literal weeping.

I think many Americans just don't realise how visceral and close and frightening the Ukraine war is for many people in Europe

Europe buys Russian gas and contributes only the most meager and hesitant support for Ukraine. I notice the revealed preference here. "Apparently not very important."

A political Overton window enforced through state action and without any input from voters.

It's remarkable. The Europeans have somehow crafted a democracy that is immune from responding to the desires of the public.

For example, immigration.

Supermajorities in both France and Germany think immigration levels are too high. Perceptions of immigration have net negative ratings of 40-50%. And it's also one of the most important issues. Yet the leaders just keep ignoring the voters and doubling down on mass immigration.

Even "right-wing" parties seem completely unwilling to stem the tide.

The response is predictably shock, outrage and literal weeping.

The weeping was from the man talking about retiring, not about Vance's speech, FYI.

I saw the video. He addresses Vance's speech and immediately cries.

But yeah, also that is his farewell so maybe he was coincidentally weepy.

Oh dang I got suckered in by fake apologetics. Man it's so hard to trust anything today. Sigh.

I have two friends who were actually present at the Munich Security Conference last week, and both of them said Vance's address was the most shocking speech they'd seen in their respective diplomatic careers

The problem here is that I listened to that speech. There was nothing angry or unpleasant about it. In fact, it was one of the most refreshing public addresses I've seen in my memory. Is English your friends' second language? Do they have any understanding of American culture at all? Debate club? It was lightyears away from that - simple, direct language, delivered clearly. A real message from a politician instead of the same endless fucking vapid platitudes about democracy while jailing people for "hate speech".

I think many Americans just don't realise how visceral and close and frightening the Ukraine war is for many people in Europe.

Ok. Fine. Yes, it's far away. Let's pretend I haven't seen the visceral footage of men disemboweled, flayed alive, and burning in the fields of Ukraine. If it's so real, why can virtually no countries in Europe maintain their commitments to NATO spending? Is it perhaps because they're busy gloating about how morally superior their welfare state is while it's endlessly subsidized by the US of A?

I actually don't think Zelensky meant for this to pop off the way it did. It was uncomfortable to watch aggression and dominance toward a man who (to me) seems to be trying to keep his country and people from annihilation.

But I don't see how the established rules of the Lilberal International Order benefit the American taxpayer. I'm tired of watching my children's future being sold while being sneered at. If it takes someone as uncouth as Trump to man the Bailey while Vance stays in the Motte, then it is what it is.

Re Zelensky I have a different take. Marco Rubio complained recently that they had what they thought were agreements with Ukraine only for Zelensky to say something totally different to the media a couple of days later.

I think the Trump administration believed they had a framework with Ukraine to end the war — there would be a cease fire, and there would be a soft American guarantee via this rare earth deal but not a hard one.

Zelensky multiple times throughout the process indicated he wanted to with renewed support kick out Russia. When he responded to Vance’s criticism of Biden with saying we can’t do a cease fire with Putin because he will break his word Zelensky was confirming that he wasn’t agreeing with the framework that I think the Trump admin thought Ukraine agreed with hence Vance’s statement re litigating to the media (the same issue Rubio had).

So I think the Trump admin was simply pissed that they felt again Zelensky was welching on a private deal.

I also think the press conference proved to the Trump admin their fears are correct. Namely they are concerned Zelensky will armed with a guarantee try to provoke Russia into an altercation and then demand action by the Americans citing the guarantee in the hopes of regaining their lost territory. If you read Trump’s comments closet this is his concern.

And honestly given the history here, it isn’t unreasonable to believe Zelensky would try to antagonize Russia. The pre war boundaries of Ukraine weren’t natural. It was arbitrary lines drawn on a map with two peoples (more if you include the Hungarians). The Russian minority has faced persecution by the Kiev government and Ukrainian nationalists while at the same time Russia has helped to incite tensions. That is, no one has clean hands here. Zelensky focused on Russia’s untrustworthy actions (true) while ignoring Ukraine’s untrustworthy actions and historic goals re the Donbas and Crimea.

In short, Trump isn’t willing to give a security guarantee because he doesn’t trust either side here. But he was willing to more intertwine Ukrainian and US interests which creates some degree of strategic ambiguity that would help Ukraine without pre committing the US. And Trump realized that Zelensky isn’t really interested in that deal which I think they felt they had hammered out. And that pissed off Trump (who honestly does seem to want to end the war for both humanitarian reasons and economic ones).

It was arbitrary lines drawn on a map with two peoples (more if you include the Hungarians).

Three peoples. Galicians have never had their own state and they're big into Ukr nationalism, but they're not the same as central Ukrainians. Add Hungarians and Tatars and there probably isn't a way to make it not arbitrary.

If it's so real, why can virtually no countries in Europe maintain their commitments to NATO spending?

The "virtually no countries" is completely not true. The European defense spending have been rising rapidly even before Trump came to office. Only a handful of NATO members do not spend 2% GDP and the number of allies exceeding the limit crossed 23 in 2004. There are now a few countries that spend more than US without having global ambitions and open ocean navies.

While I always appreciate being corrected, you're arguing about a detail in my language about the countries themselves instead of NATO in aggregate. From your link:

If we take into account only the 23 EU member states that are also members of NATO, defence expenditure was 1.99% of their combined GDP in 2024 and is expected to be 2.04% in 2025.

So, put another way: Trump demanded they start pulling their weight 8 years ago, but they're still not hitting the 2% / GDP target, despite an active, major war in their neighborhood they supposedly care deeply about (?!?).

I think there are some important insights here, but I'd like to speak to the European angle

You're not speaking from the European angle, you're speaking from the European elite angle.

Sure, Trump is widely seen as a rube that's nothing new, but the only people Vance makes things worse for are the European elites. Our entire self-image is built on Americans being dumb rednecks who can't string a proper sentence together, and us being the enlightened ones. Trump can give a prophetic warning about dependence on Russia, and we'll laugh in his face because he's a simpleton, and we're obviously intellectually superior. Vance is a direct threat to that sense of superiority which is why, as TIRM pointed out, European politicians are breaking down in literal tears over his speech, but if you think the average European thinks he's worse than Trump, you're out of touch.

Approximately no one believes in "the established rules of the Liberal International Order". Most people eyes will glaze over, if you bring up the phrase. The war might be "visceral and close and frightening" to people bordering Russia, but quite frankly your bloodlust exceeds even that of the Ukrainian refugees' that I talked to.

You might be right that this is all a massive shock to the European elites who were relying on Americans acting a certain way, but I'd like for you to give some sort of argument for why Americans acting that way is either sustainable or desirable. Right now all we're getting is pearl clutching.

I actually think this might be good for Europe. The civilizational decay is really beginning to stink up the place, but there is nothing that focuses the mind quite like a genuine existential threat. Time to man up. Unfortunately, I didn't see much manning up on the faces of Europe's leaders during Vance's speech. I fear that in a few more years the indigenous peoples of Europe will increasingly rather take up arms against their governments than for them.

For all the European sabre-rattling, they are not actually worried by Russia, as evidenced by their weak military budgets and troop numbers. Russia is a rhetorical device not a real threat. They were barely able to conquer 20% of Ukraine.

But I agree that a sharp crisis is probably the only thing that saves Europe from permanent decline. The coming population replacement will leave a stronger mark on the history of the continent than any war or plague ever did.

What exactly is the way you see this benefitting Europe? Some sort of authoritarian magic where you 1. pump money into the military, 2. institute 3 years of Korean-style military service, 3. ????????, 4. experience great revitalization? There is not actually any existential threat to Europe from being dumped by the US, so any change would have to either be driven by delusion and/or resentment (towards Trump, Vance and everything they stand for). Resentment against Trump will surely not drive Europeans to make any policy change that looks like something he would want, and delusion is a crapshoot.

Not the OP, but I see it as benefitting Europe in the same way that "hitting bottom" might benefit an addict if it convinces them of the need to get clean.

Regaining the ability to defend themselves means that Europe will be free to pursue its own independent foreign policy without the nagging fear that if they step out of line they will be left out in the cold without America's guns to back them up. That could mean a more aggressive posture towards Russia, an economic realignment with China, maintaining Danish control over Greenland and its associated Arctic resources, restoring France's neo-colonial relationship with West Africa, or catching up to the US and China in dual-use technologies such as AI and rocketry. It's not that all of these things are impossible otherwise, but having a big stick provides a certain helpful sense of confidence akin to exercising and getting into shape on a personal level.

I think the “best case” scenario along those lines would be an extremely humiliating intervention in Ukraine that results in thousands of western casualties, more-than-Suez level political humiliation, and likely the collapse of the British, French, German, and possibly also low country and Italian governments depending on who was involved, followed by a period of great hardship, followed by reinvention out of desperation and a major pivot toward China.

Reading the comment sections in German papers during the past weeks, I am starting to genuinely feel a little afraid. The general population, or at least those who bother to comment under those articles, are positively hysterical, in a way that I imagine a deadbeat limerent live-in girl/boyfriend who refused to see the writing on the wall and wound up being dumped and dumped on the street with no plan B in short order would be. If it were an individual, this would be a point at which I'd call in a welfare check on them lest they harm themselves. Tropically, this would be due to emotional discombobulation or a line of thought like "He loved me, right? He still cares enough that he wouldn't just let me die, right?". Following this schema, I would not be surprised if they soon started floating a spontaneous deployment of European military, fueled by some vain hope that surely even Trump's US would turn around and step in before France/Poland/the UK goes in and outright loses (which is a distinct possibility, because I don't see immediately available European capabilities even just making up for US intel and Starlink if those are withdrawn, and a European mobilisation would surely be enough to convince even Putin to escalate at last). The comment sections would cheer right up until the point where they get draft letters themselves, and depending on what happens between now and then even beyond.

Of course, it could be that for all of Trump's seeming randomness, the whole plan was actually signed off by someone in the State Dept who went above and beyond on the "how can we make Europe contribute more" assignment and is now waiting for just that to happen.

However, perhaps most of all, I think many Americans just don't realise how visceral and close and frightening the Ukraine war is for many people in Europe.

Is it? My impression is that, even for most Europeans, the Ukraine war just isn't all that important. The real hot button issue seems to be immigration, or maybe just the economy in general. No one in Europe is massively raising defense spending, activating the draft, getting nuclear weapons, or calling for a pan-Europian army. I'd expect to see all of those things if they felt they were seriously on the edge of a Russian invasion. The only countries who are really acting like they're at war are the former Warsaw Pact countries like Poland and Bulgaria.

I guess we'll see if the new German government wants to massively increase military aid to Ukraine. If they do then, I'll be proven wrong. But I think they'll basically keep it to the same level it's at now.

No one in Europe is massively raising defense spending, activating the draft, getting nuclear weapons, or calling for a pan-Europian army.

Many countries in Europe have, in fact, hiked up defense spending massively, not only compared to 2021 but also compared to 2014, in other words the boost started already after Crimea. At least most of the EU countries in the chart now have defence spending that surpasses the 2% NATO guideline. Numerous politicians have called for a pan-European army throughout the years.

Well, this is subjective, but i wouldn't call 2.5% "massive." Massive would be 6% like what Russia spends. Massive enough to build up huge stocks of new ammunition, instead of using up all the old stuff in Ukraine and hoping that the war ends before supplies run out.

And, i know that politicians occasionally endorse the idea of a Europian army. But it just doesn't seem that serious to me. I cant imagine Britain or france wanting to join now, anyway. Meanwhile Austria still won't even join NATO

The most consistent thing about Trump, it seems to me, is how he plays into Russia's hands. I seriously wonder if we are seeing a real world Manchurian candidate.

  • -21

I don't understand where this sentiment comes from. When you look at actual effects on policy rather than rhetoric, Biden (or more accurately his handlers) seems to have been far more in Russia's pocket than Trump ever was.

See efforts to drive up energy prices (thus increasing russian revenue from ng exports), the DNC's much heralded policy of rapprochement (in contrast to Trump) prior to Feb 2022, and the onerous restrictions placed on the use of US supplied weapons in the first 2 years of the war.

Yeah, this level of Putin Posting always strikes me as a surefire sign that the person is not thinking logically. 2016-2020 notably did not include any Russian invasions/advancements. Trump consistently warned Germany and others against being reliant on Russian gas. Obama and Biden, on the other hand, saw large bites by the Russian military and could not marshal a response. They are part of the Green movement that has stymied European industry, and are big players in the various NGO movements that shipped millions of unassimilated Arabs into large cities in Europe.

If Trumps a manchurian what are they? Mao himself?

Apparently serious people are now talking about a "Trump-Putin alignment". You would think Trump were actively sending military aid to the Russian frontlines. Ironically, it's European nations who have done more to finance Russia's war because they're dependent on Russian energy. Anything less than complete unconditional and unlimited military aid for Ukraine is interpreted as actually allying against Ukraine and all of Europe.

Exactly.

We already saw a Manchurian candidate, and his name was Barack.

This breaks several rules, but mostly it's just a low effort snarl without evidence. You have a long string of these and have been skirting a permaban for a while now.

This comment itself is just middling bad and devoid of value, but your history recommends a timeout of anywhere from 3 days to forever. Your last few bans were 1-2 weeks, and you have multiple comments in the log saying "Permaban next time." The fact that we haven't done this yet is because we don't actually like to permaban people, especially when it's someone like you who, when exercising a modicum of self control, is capable of being a decent poster. On the other hand, we can only say "Knock this off or you're going to get permabanned" so many times before it becomes an empty threat.

I'm going to make this one 1 week. If I were in a less forgiving mood, it would have been 2 weeks, and if I had decided to make it permanent, no one would blink. So if you come back to spew more, you'd better be on point and make it worth it.

In Sweden we had a mass shooting where a man was kicked off welfare and then decided to kill 10 people at a welfare office before finishing himself. He screamed "not everyone should work" before letting off a few rounds. His energy seems to reflect the European attitude on paying for a military.

Currently the attitude in Sweden is beyond bizarre. John Bolton would be considered a tankie right now. Their, is just fanatical worship of the US military industrial complex combined view of any being in opposition to the US as a fundamentally evil. I have never before seen people justifying the invasion of Iraq and Vietnam at the scale happening now. The average Swede has been turned into a Dick Cheney, except they only see the world as good vs evil.

At the same time as they want complete and utter American domination of every corner of the world they are shitting all over Americans and talking about boycotts. To make matters worse, most people can't give any legitimacy to any other view point. There are true believers in the neo con project, people who are fundamentally evil and those who are brainwashed by Russians.

The attitude in the UK is similarly bizarre. The government, other blob parties, and supportive institutions have become foreign policy hardliners in a context where those same governments have, at every opportunity over the last 30 years, adopted policies that weaken the UK's ability to fight against a peer power. And I don't just mean in strict military budget terms here. They can increase the military budget right now and this won't improve the situation because the current circumstances make effective utilization of a larger military budget impossible. I mean policies like:

  • Outsourcing. Relying on foreign, China-centric supply chains for industry is silly.
  • Green energy. Tanks and jets don't run on batteries. Frack to Fuel Fighters.
  • Legally empowered NIMBYism. How are you going to build the factories and bases for all this?
  • Judicial power and rulings. Why build a munitions factory if you'll get sued over rare spiders? Why fight Russia if you'll get charged for shooting them?
  • Weapon Bans. Legal access to firearms would both mean more experienced citizens and a potentially stronger occupation resistance. Instead the government is floating bans for kitchen knives with pointed ends.
  • Nationalism. Nobody has found a way to make effective modern armies other than nationalism, and usually ethnic nationalism at that.
  • Lockdowns. Shrinking the economy over a cold does not win wars.
  • Immigration. This does not turn into military manpower. More British Muslims joined ISIS than are in the British Army.
  • Two-tier laws. Dispossession of the demographics most likely to serve in the military is a terrible idea.
  • Coffin dodgers subsidies. Why fund pensions or the NHS at the expense of the 20 and 30-somethings who are actually going to fight your war?

A UK that has a small military but is prepped and ready to re-arm and oppose Russia is a UK that looks very different from the UK we actually have. More importantly, it would be an image of the UK that our current government would despise. Cynically, the government isn't genuinely interested in defence, they just see sabre-rattling over this as a good way to go after domestic dissent.

The UK seems to be in a really horrible and sad spot. Personally I would leave. From banning encryption, kitchen knives, to spending the money from an outrageous tax system on bringing in Muslims who don’t care a lick about western society. The weather isn’t even pleasant!

Is this was happens in Europe though? You go from turbo hivemind cucked socialism and then going to swing aggressively right into strong ethno-nationalism and provoke WWIII? History would make that seem so

spending the money from an outrageous tax system

Taxes in the UK are higher than in some low-tax US states (although places like Texas have very high property taxes, while the UK has almost none, particularly on expensive homes), but the difference with high tax US places like NYC or SF is pretty minimal.

It does appear that UK taxes are only slightly higher than the US. The real extreme outliers are in continental Europe.

https://taxfoundation.org/data/all/global/tax-burden-on-labor-oecd-2024/

But there's a big difference. UK taxation effects lower income people. For example, in the UK, all income above about $60k is taxed at 40%. And VAT is 20%.

In the US, on the other hand, a gigantic proportion of tax revenue comes from high income individuals. About half of federal income tax is paid by people making more than $500,000/year.

The UK, having few high earners compared to the US, is forced to extract eye-watering tax rates from middle class people. The UK tax system is both less progressive than the US, and there are fewer rich people. So regular people get squeezed hard in a way they don't in the US.

Texas has very high sticker property taxes, but in practice established homeowners don't pay sticker price- there are a bevy of exemptions, and only people wealthy enough for second homes and landlords(and the low functioning, but most of those don't buy homes) have to pay the full amount for more than a year or two. Texas property taxes are still high but they aren't high enough to reach blue state levels of taxation.

I doubt that’s true when factoring in VAT.

That IRA court ruling is one of the most insane things I've ever seen. I'm not exactly an expert in The Troubles but... wow.

Indeed, and all the sabre rattling and criticism of what it claims is right-wing extremism by the current government must be understood in the context that this is also a government that not only funds extremism in support of it's supposed enemies, but is legally obligated to do so by it's own institutions.

Much of this is, however, just two-tier. A hypothetical opponent perceived as right-wing, like Russia, probably wouldn't be protected in this manner by our courts. But good luck defending Taiwan from Communists, to name one example.

More British Muslims joined ISIS than are in the British Army

Do you have a link for that?

The same bizarre situation is going on in entire Western Europe. People talking about the need to decouple from the US, so we can defend Taiwan?? I think we are living through one of those periods confusion in history that will be sandpapered by near-term historians in accordance with the developments that takes place by then, only for some guy to open some dusty archives in 70 years and realize "wait a minute actual people 2025 had wildly idiosyncratic ideas that didn't fit at all into the 2039 galactic federation council's ideological splits!!"

I think a lot of our international politics was controlled by the US establishment, and now that Trump is winding that down theres some weird reactions.

There's also the specter of US soft-blob money (USAID, State, etc.) money drying up so people scrambling for new grifts over to hard-blob (DoD, NATO, security services generally).

The same bizarre situation is going on in entire Western Europe. People talking about the need to decouple from the US, so we can defend Taiwan??

One of the British podcasters I listen to (I don't recall which off the top of my head — maybe Parvini?) characterized this as Starmer and European elites, in response to Trump trying to pull back the US from its global empire, trying to figure out how keep the GAE going without America.

I have heard people talking about wanting to set up a SWIFT-alternative to defend the liberal world order. They basically want to create a woke version of BRICS.

They see American unipolar order as dangerous, so they want to create an alternative one in order to save the ideology of the American liberal world order.

I think it was unrealistic to expect the bond forged between Americans and Western Europeans in the trenches between 1917 and 1945 and then reinforced by another half-century of preparing for WWIII together to endure forever, especially once those events fell out of living memory. Tanner Greer has begun a series of posts on this topic, in which he quotes a prescient speech by Robert Gates from 2011 and points out that for the first time nearly everyone holding the levers of American foreign policy is either too young to remember the Cold War as a formative political experience or was uninvolved in the institutions through which aspiring political and military leaders at the time forged personal and emotional connections with their European counterparts, ending with this exhortation:

It is no longer sufficient to argue that NATO, or a free Taiwan, or any of ten thousand other things, are good because they buttress American hegemony. That presupposes American hegemony is a thing worth preserving in the first place—a presupposition not shared by all in power. Our arguments must strike deeper.

These are days of dread possibility. Victory will not be had without contesting fundamentals.

To focus on just the Ukraine angle, today's Russia is not the Soviet Union. To the extent that it threatens anyone, it threatens the nations on its European periphery and not the United States. This change means that Europeans cannot realistically expect the same level of support they were receiving when the enemy was mightier and the danger greater. On paper, the economic disparity between European NATO and Russia indicates that they should be able to crush Moscow with one hand tied behind their backs even without American aid. Most of us know intuitively that it wouldn't be that easy, and explanations tend to converge on the idea that Europeans have become complacent and entitled, taking the fact that they can cower behind America's shield for granted and indulging in luxury beliefs that having a military or borders or a distinct national identity is icky and reeks of fascism. If the rug gets pulled out from under them in the form of military assistance or security guarantees, they will have one last chance to get off their asses and reclaim their place(s) among the great powers of the world, and if they can no longer muster the ambition to do that then they can go play Museum Fremen in their cathedrals and wait for some new, more vital culture to replace them.

Since no one has mentioned it yet, I will discuss my hobby horse and mention that because of mass immigration the American population is only a little more than half ethnically European and that share is rapidly falling. It's silly to expect that such a country will maintain such close ties with Europe when American demographics are rapidly shifting towards becoming a group of people who see Europe as the people who oppressed their ancestors with colonialism. The American right is probably going to continue its tendency towards isolationism while the American left will gradually become anti-Europe in a milder version of the way it has already become anti-Israel.

Most of the newer Americans are Hispanic, who are as likely to see Europeans as their colonial ancestors who brought civilization to the primitives as they are as historical oppressors.

Seriously the racial tensions in the US are mostly African-American v everyone else and inflamed by the blue tribe, not white v non-white.

Yeah. Racial discourse in the US is so ridiculous when it comes to Hispanics.

Imagine being a Mexican who is like 90% white and considered an oppressor, then moving to the US where you are all of a sudden "brown" and some sort of minority charity case.

We tend to lump Hispanics together but levels of European admixture are all over the place. Many will fully assimilate and become indistinguishable from the rest of the white population.

I have met Latin American legal immigrants who felt offended at the implication that they were non-whites needing help in the face of discrimination, similar to how I would react to being offered a spot in an affirmative action for trailer trash program.

In this house we welcome human garbage like yourself. How we can we help you get back on your feet poor soul?

Same reason I find it hard to believe how much CANZUK cope is going around right now. It's just not the same populations anymore.

I agree with the trajectory, but I disagree with your claim on what's causing it, at least from the American perspective. I think it has more to do with some combination of a geopolitical changing of the tides and the fairly obvious cultural suicide that Europe has allowed to occur with their mass immigration.

The mass immigration is a symptom not the cause.

Are you talking about developed countries' dwindling populations and their attempts at alleviating that problem?

Yes

We probably agree on what the cause is. My emphasis on their when talking about Europeans is due to the type of immigration rather than me casting any blame at them for trying to fix their impending demographic problem. In the U.S., much of our immigration comes from Latin America which is largely Christian, with cultural values that overlap with American society. Europe on the other hand has imported large numbers of immigrants from cultures with very different legal, religious, and social norms. Both the U.S. and Europe face this degenerative population disease, but Europe’s prescription has made assimilation much harder and fueled deeper cultural fragmentation.

Europeans seem to already view America as ideologically alien

All we do is have people who mock Green politicians dragged out of their homes by the police and then criminally punished. And for this Americans criticize us. I guess we have little in common. Might as well side with the Chinese communists who also drag people away for criticizing their betters. Maybe they're our real ideological brethren.

It's my loose perception that in foreign policy, the masses don't actually drive policy nearly as much as you'd think. Instead, it's all about "personnel is policy" at the diplomatic level (and to a lesser but still important extent, business level). Thus, it doesn't actually matter so much what the people of e.g. Zimbabwe think, it's about the diplomats and top leaders. Did a good chunk of them go to business school in Europe? Who runs in their friend circles? How are the business links? Questions like this, and including shared ideology/cultural history/philosophical affinity, are most impactful. Occasionally, this will also include military links, but again this is going to be often at the officer corps level at the lowest. To that extent, the actual "cultural alienness" of a foreign country's everyman doesn't matter.

If bonds are fraying then I view that as mostly downstream from State Department personnel changes under Trump 1.0 (and 2.0) as well as, honestly, Trump's trade policies, not some fundamental chasm in mindset... though some of it probably bleeds through even to the elites.

My pet lowbrow armchair sociological theory is: there is no drift apart, there is instead an incredibly high level of cultural, ideological, whatever coupling. When any bigger US issue du jour appears on an US-centric forum like this, it shows up here in Europe a bit later, usually as a malformed parody version of itself, often on high levels of public life and politics. As a prime exhibit, see our Finnish center-left party head doing an over the top cringy imitation after Obama got elected. Or in the pandemic times, in quick succession, we first got a condemnation of local antivaxxers protesting when the act of gathering in a crowd might spread the disease, followed by it being excellent to gather up in a crowd to protest in solidarity of BLM. Likewise the local anti-immigration right parties run very much on American import anti-woke memes. The US cultural influence somehow inflicts on us the animal spirits of whatever is going on over the Atlantic, no matter how out of place in the local circumstances or logically inconsistent with itself the result is, and we go helplessly along.

Because of this this coupling, we won't sound very friendly and grateful toward the US no matter what -- we run too much on material copied from the US, and the content of it is all wrong for that. The local population more influenced by US progressive thinking will have a lot of imported self-flagellating anti-American memes to chew on (sometimes weirdly idolizing Scandinavia so at least we're getting a healthy boost in national self-esteem out of it). The folks inspired by current Trumpish thinking from the US right maybe aren't that flavor of anti-American, but will also not be America First, but of course rather rah-rah Finland First or Portugal First or Poland First.

If America someday feels like really warming up the transatlantic relationship, it just needs to develop a mainstream cultural worldview by whose standards America is just fine, and which is universalist enough that if you make a garbled copy and search-replace the word 'America' with 'Belgium' it doesn't turn into 'Belgium is the greatest country in the world, every other country (such as America) is run by little girls'. We'll lap it up instantly. It doesn't have to be all the way universalist -- Biden's 'let's own the Russkies together' seemed to me to work to this purpose just fine while it lasted. Sadly it was also very easy for the US right to see that as a project of a self-interested Europe to fleece the US, I guess.

After you sign a contract and pay your bill

I think that's the issue though, no? The Europeans haven't paid their bill. The transactional approach is falling apart because there is no transaction - just one-sided behavior.

To abuse the metaphor, it would be like Local ISP was a local business that had been giving you low pricing because your kids went to the same school and to maintain market share in your town. But now, your town has grown into a large city. The company has been bought out by BigTelecom. Jimmy, the owner's nephew whom you used to call when your internet stopped working, has been replaced by "Johnny" located in Bangalore. And there's no chance of you switching to another ISP as you can't afford the fees to break the contract. So now Local ISP ("A BigTelecom corporation!") is raising rates, because while they still provide you with internet service, they no longer see you as a human being, just another KPI on a spreadsheet to fiddle with in the quest to maximize BigTelecom's profits.

No, there was a deal in place, and I'd say it was skewed in favor of the US, Europeans doing their part just fine. Now US wants to have and eat the cake both, because competition with Chyna is a daunting proposition without bold/desperate moves.

I think a lot of the outrage about "European ingratitude" from the American right is caused by right wingers failing to realize that European 2025 is not the Europe of 1950, or even 1990.

As I said downthread: a lot of the outrage about "European ingratitude" is caused by a) an imaginary Frenchman that lives rent-free in the heads of many red tribers b) taking a world that defers to American interests for granted.

To steal a turn of phrase, America is a country afflicted by "big country autism". Most Americans have no idea what other countries are like and mostly don't think (or care) about them. The average American voter has no real strong opinions on foreign policy beyond liking flashy, muscular actions because 'Murica. This has led to a half century of foreign policy that is, outside of a few big wars, mostly technocratic. I think the idea that American conservatives are outraged by some dissonance between their expectations of Europe and reality is faintly comical.

This explanation is certainly too pat, and there's more nuance to be explored, but do you think this is more or less the direction in which things are heading?

No. I think the central ideological divergence is within the United States, between Trumpian nationalists (who view European nations as unruly vassals who need fall in line and be grateful for whatever they get) and internationalists/atlanticists (who view European nations as strategic and ideological partners who need to led, not commanded). This is almost entirely an elite conflict, with voters either tuning out entirely or following the lead of their political leaders.

Within Europe, this mostly seems to come down to the question of what you think about the US' long term reliability, which is very much a developing situation. Right now, European nations cede at lot of de facto sovereignty to the US (e.g. on trade and foreign policy) in exchange for US security guarantees, but Trump's erratic, Russophilic behavior combined with the cultlike support he receives within his own party calls into question whether or not those guarantees will actually be matched. Right now the only NATO country to have invoked Article 5 is the United States and the current president has strongly hinted that he wouldn't reciprocate. Of course, given how erratic Trump is this could all change in a week. It's possible that assurances are being made behind the scenes that grandpa won't be allowed to do anything too disruptive (I wouldn't count on it though - per above, Trump is the party establishment).

They're not imaginary frenchmen living in our heads they are English and German elected officials on TV, I've also seen similar sentiments posted by several of our European users here. You can claim that these are not representative of the typical European's view, but they are not imaginary.

As @Dean observed last week there seems to be a refusal amongst the European powers to grapple with the reality of US-EU relations post Cold War. They seem to want the US to continue playing the role of world police and serve as thier mercenaries, but also seem to resent the idea that mercenaries have to get paid.

The position of the US military today feels somewhat analogous to that of a Cop in a blue city where the DA refuses to prosecute shoplifting and the local "elite" take pride in running interference for rioters. At some point the question becomes why would any sane, competent, moral person want that job?

This is the best reply in this thread I've read.

People like to wishcast world events as actually being about their pet causes. While I'd like to believe American reluctance is from Europe not taking the conflict seriously even after 3 years and being lapped in artillery shells sent by freaking North Korea, that's not actually the case.

The reality is that very few people care about foreign policy, while plenty of people care about culture and vibes and dunking on their outgroup. This means leaders get to effectively decide foreign policy, and the voters will mostly follow like sheep since they want to support their ingroup. I can practically guarantee that if Trump said we're now going big on booting Russia out of Ukraine by whatever means necessary, the Catturds of the right would flip (like they perennially do on Israel) and say jingoism is actually the best thing ever now -- "AMERICA IS BACK BABY". Really, the only thing you need to do to understand contemporary American politics is learn about negative partisanship. Learn about the frothing, searing hatred the two wings of the country have for each other, and everything else will follow naturally.

I also agree that America is a fundamentally untrustworthy ally. With the Legislative branch effectively defunct, the President has become more and more like an elected, absolute monarch. And you simply can't trust a country that's willing to elect a Mad King every so often.

Two case studies in government waste:

As you can likely imagine right now a lot of people in medicine are sharing tales and taking sides in the great DOGE debate. Two that popped up on my radar and stuck out to me:

  1. One of my medical school classmates is a psychiatrist at redacted city hospital. He has been informed that the state Medicaid will no longer pay for psychiatric emergency room visits if the patients do not go to their aftercare appointments within 30 days. They have been informed that they could lose their government funding if enough patients fail to do this.

Some problems: -As an emergency room most of their patients have no insurance or Medicare or Medicaid, meaning the facility often get paid less than cost. They only stay open at all because of their state grants.

-Many of the patients are drug addicts or malingering (because of homelessness for example). Every day you’ll hear something like “you’ve been here every day for the last three weeks” or “have you considered stopping using PCP? You always seem to fight with the police when you do” and “here’s your follow-up appointment, will you go? No? Fuck me? Okay thank you have a nice day.”

-Many of the patients who do actually have mental illness are in denial about it, or have some sort of limitation that prevents them from attending aftercare appointments.

-The “best” solution is probably to violate patient rights and involuntarily commit them to make someone else be on the hook for making sure they go to their aftercare.

-In the meantime, the hospital has hired several additional staff to manage some of the administrative complexities associated with this change (for example hammer calling the patients to remind them to come to the appointment). They have also hired night staff whose job is to sit in an office overnight purely to schedule appointments with an outpatient program (otherwise no patient could be discharged overnight because they wouldn’t have an appointment to go to…).

  1. One of the residents I mentor is about to do a rotation at the VA. This is pretty common for residents. His rotation starts in a few weeks. A few months ago, he got an email that included the instructions “it is imperative that you start your onboarding process for the VA right now otherwise your onboarding may not be finished by the time of your rotation” and “it is important that you not start your onboarding right now as it is too early to start onboarding and your onboarding may not be valid if you complete it too early.” This is not a joke or an exaggeration.

Anyway, he dutifully completed his requirements in a timely fashion (which were all pointless! Ex: what is the motto of the VA???). So, months later his rotation is starting soon. He begins the process of emailing the education team once every 2-4 business days. You have to email them multiple times before they respond. The conversation goes something like this over the course of multiple weeks, “I think I’ve completed my onboarding do I have to do anything else?” “no” “okay is my onboarding done” “no” “okay when can I pick up my ID card” “when your onboarding is done” “I thought my onboarding was done” “yes” “okay what I am waiting on” “nothing.” I have seen the emails; it really looks like this.

At this point his program tells him to CC the chief of medicine at the VA hospital, at which point the person responds with “okay we put in a ticket for this a month ago, your training is complete but your training is marked as incomplete.” A screenshot has been attached that shows the request and an automatic response that says something about high ticket volume and that they will get to it at some point. The chief of medicine replies “….does the trainee need to do anything?” (we are here).

The resident will be able to rotate but will not be able to do any work without computer access.

It’s worth noting that the VA is paying for this resident to be there, despite the fact he will in fact not be able to do anything. At his last VA rotation (yes they go through this for every resident every time) he was six weeks into an eight week rotation before he got access.

Widespread narcan use is surely one of the biggest disasters in the history of modern America.

Imagine if tomorrow, a new medicine called Dementiolab or whatever comes out. It doesn’t prevent or cure Dementia, it doesn’t even slow its progression while someone still has a personality and life to hold on to. But, at the second-to-very-last-stage of the disease, the “giant violent baby” phase, the nightmare phase, Dementiolab prolongs life by 10x, keeping patients alive for many years. American hospitals rush to prescribe this new treatment, after all it literally prolongs the lifespan of dementia patients by a huge amount.

But for insurers, the public purse, families of patients and (I would argue) the patients themselves, it would of course be a disaster. It even further fuels the drug market because when customers don’t die, they come back to buy another day.

Narcan is like this for hard drug addicts. For generations, addicts who got into a really bad way, the kind you can’t really recover from (in 99% of cases), just died. But in Narcan, we invented a Dementiolab, a means to keep people alive in a horrific condition, resurrected again and again to keep suffering, and to keep making everyone else’s life worse.

Humanity, decency, even empathy requires that we stop giving addicts Narcan. If a 7 year old accidentally ingests some fentanyl then sure, otherwise no.

I've mentioned before that Mexico allegedly limits naloxone supply. By "limits" I mean it doesn't allow US advocacy groups to mule across a bunch of drugs to clinics at will. AMLO also said a few things that was skeptical of harm reduction and Narcan's role in the opioid crisis. Not exactly prohibition, but legacy scheduling laws that haven't changed looks like something less than harm reduction.

Humanity, decency, even empathy requires that we stop giving addicts Narcan.

Narcan is the cheaper, easier solution to overdose treatment. A 20 year old EMT can administer it. Your little sister can administer it. Take Narcan out of the equation and EMS will still respond to overdose calls. They'll pick up junkies, apply whatever alternative medical attention they are able, then go and stick them in the ER.

Napkin math. Around 80,000 opiate overdose deaths in the US as of late. Pick one of the guesstimates, say the NSDUH surveys, on number of opiate users and decide to 2 million opiate addicts is fair enough. At 82,000 deaths a year we get an annual mortality rate of ~4%. To me, this suggests addicts are actually pretty good at not dying from drugs given the drugs are as potent, addictive, and dangerous as ever. If we want to be extra generous with the numbers (decidedly not generous to addicts) then what do you think happens when Narcan is removed as a treatment? My guess would be the annual mortality rate of addicts rises by 2 percentage points for a time. Possibly less. What do we solve with such policy?

You suggest we stop treating overdoses with the best, relatively cheap treatments we have available. Enabling drug use is bad so we should remove tools that enable drug use. Medicine is one such tool, because it enables an addict to live longer to do more drugs. You do not suggest we don't provide medical treatment at all. If we wave the magic wand and blink Narcan out of existence we still the same stressors in the system. EMS arrives, does all the not-Narcan treatments, keeps someone alive if they can, and drives them to the ER. Some greater number of addicts are dead on arrival, but the rest receive the same or possibly greater treatment.

As I've gotten older I find myself more sympathetic to moral hazards. If the cost to widely available, easy to use treatments such as Narcan nasal spray is a 60% increase in opiate deaths (50k in 2015, now 82k) then, yeah you may have a point. The obvious incentives fire up my neurons, too. That said, in writing this post I did not find a study or review that gives Narcan substantial responsibility for the rise opiate use (now plateauing) and deaths. Even if we remain skeptical of harm reduction as an industry, lobbying group, and advocacy movement-- of the motivations of researchers in the field -- Narcan is so widely used there ought to be some. It's an old drug that was subject to innovation in response to increasing opiate use.

Wand waving Narcan does not look like compassion or tough love to me. Withholding the best medicine available doesn't sound decent to me. Tough love is giving someone Narcan, then immediately throwing them in the back of a paddy wagon to some farm in California to get clean and clear wildfire brush as punishment. Zero tolerance prison might work as well, but the cost of addicts taking up space in prison is fairly high. Withholding emergency medical treatment is a half-measure against a population that is filled with friends and family. Psycho Joe on the corner who demands medical attention twice a month is but a slice of the drug addict pie.

Tough love is giving someone Narcan, then immediately throwing them in the back of a paddy wagon to some farm in California to get clean and clear wildfire brush as punishment.

That's two things. They'll get separated, so they get the Narcan but not the punishment.

That said, in writing this post I did not find a study or review that gives Narcan substantial responsibility for the rise opiate use (now plateauing) and deaths

Here's one that made the rounds a few years ago: The Effects of Naloxone Access Laws on Opioid Abuse, Mortality, and Crime

In this paper, we use the staggered timing of state-level naloxone access laws as a natural experiment to measure the effects of broadening access to this lifesaving drug. We find that broadened access led to more opioid-related emergency room visits and more opioid-related theft, with no net measurable reduction in opioid-related mortality

Author's website has some additional commentary and appendices. Most interesting is the regional analysis where their estimates are that naloxone access led to a 14% increase in opioid-related mortality in the Midwest in particular (in the West and Northeast: insignificant decrease in mortality; South: insignificant increase). They give two explanations:

  • In the West, black tar heroin is more commonly used. In the Midwest, powder heroin. Black tar heroin doesn't mix easily with fentanyl which removes one avenue by which drug users could engage in riskier behavior in response to narcan access.
  • In the West and Northeast, drug treatment programs are more accessible:

We find suggestive evidence that greater availability of drug treatment may be important. That is, broadening naloxone access increases mortality more in places where less drug treatment is available. This makes sense if we think that the primary goal of naloxone is to give individuals a chance to get treatment for their addiction — if there is no treatment available, then perhaps it’s unsurprising if naloxone does more harm than good.

Their main policy recommendation is to expand drug treatment programs and find ways to ensure people get help post-overdose. Your paddy-wagon idea might have legs.

Thanks, register as Seen. Felt like they should be some push-back in this direction somewhere.

I can't take a major gander today but will come back. Curious how they control for all the gunk and if they look internationally at all. Estonia was a yuge fentanyl place for a time, but they went at the issue hard as I recall -- law enforcement wise -- and its OD rates got better. Canada, like the US, is bad and I assume has similar maximal harm reduction approaches.

In the West, black tar heroin is more commonly used. In the Midwest, powder heroin. Black tar heroin doesn't mix easily with fentanyl which removes one avenue by which drug users could engage in riskier behavior in response to Narcan access.

This is interesting and makes sense.

Their main policy recommendation is to expand drug treatment programs and find ways to ensure people get help post-overdose. Your paddy-wagon idea might have legs.

This is what people always say though, hehe. I commiserate with the people tired of hearing it as things progressively get worse. Sounds rather uncontroversial to say that involuntary commitment will save some number of souls. This doesn't have to be attached to naloxone prohibition.

You're assuming that everyone who ODs is a hopeless junkie, and that all hopeless junkies are incapable of being anything other than bums. Pretty much every jazz musician who came up in the late 40s and early 50s was a heroin addict, and some were truly hopeless. Yet a good deal of them were extraordinarily productive. Same with any number of rock musicians who OD'd. Same with my brother's neighbor, who had a good job and had been to treatment but fell of the wagon and OD'd because she no longer had the tolerance for her old dose. My friend's ex-husband overdosed in a gas station bathroom despite having a good job and leading an otherwise normal life. You can't paint everyone who has a serious drug habit with a broad brush and say that there's no hope for recovery and that their lives have no value.

Yes, obviously many great musicians have been drug addicts. The frontman of my favorite band, a man whose music has brought much joy to my life, is a former heroin addict. I don’t know if he ever OD’d to the point of needing Narcan, but if he did, I’m glad they saved him!

However, such individuals represent only a very small percentage of total hard drug addicts. More importantly, they are important enough to a large amount of people — and are paid accordingly — such that they have a support system and financial cushion. In other words, if they OD and the police and EMTs show up to save them, they can pay for the Narcan themselves out-of-pocket, or else have someone else pay on their behalf. If they want to pursue a personal habit which is not only expensive but also extremely dangerous, they better have some money saved away for just such an occasion. I’m sure Jimmy Page and Kurt Cobain could have afforded it.

They can pay for it on credit, of course, and if the expense is too onerous, they can appeal to their fans to crowd-fund the payment of the subsequent debt. If the fans aren’t willing to bankroll it, I guess that particular musician was not generating enough fan enthusiasm to be worth saving. And if they can’t pay the debt, they go to debtors’ prison, which we also need to reintroduce.

It's not that every drug addict is a great musician as much as it is that more than you think are perfectly capable of being productive. Naloxone is trivially inexpensive; I don't think that letting someone die over a perceived inability to pay a small sum is any way for a civilized society to operate. This isn't like cancer treatment.

And if they can’t pay the debt, they go to debtors’ prison, which we also need to reintroduce.

No, we don't. There's a reason we abolished these in the 1800s and established a bankruptcy code. Hell, for how much it costs to imprison someone, we'd better off just having the state pay the debt in all but the most serious cases. The only thing we really have that's comparable to debtor's prison in Pennsylvania is jailing people for failure to pay child support, and this isn't taken lightly. Basically, it's threatened repeatedly, but only against people who obviously have the ability to pay and are just refusing to do so. I used to practice bankruptcy, and believe me, these people are trying to pay. They've usually put themselves in a much worse spot than they could have been in if they had filed earlier. Fraud is rare, and it's rarer still to find a bankruptcy attorney who would file a case in which fraud was evident.

Under EMTALA this would be explicitly illegal.

Given that he's advocating the return of debtor's prisons, I don't think he cares too much about EMTALA.

There is in fact a reason for EMTALA- people experiencing severe medical emergencies are often unable to confirm that they will be able to pay the bill not because of inability to pay the bill, but because of the severe medical emergency.

Lots of people are ok with letting the poor die. Far fewer are ok with letting the unlucky die from being mistaken for poor.

But what percentage of cases are even remotely functional, let alone high functioning? If we’re saving people who are somewhat functioning, it might make sense, but if we’re saving people who will dig through trash cans and sleep in the streets and can’t afford medical care, we aren’t saving people, just prolonging the suffering stage.

Well that's the question isn't it? What percentage of addicts do you think have to be functional before it's worth spending $25 worth of Narcan on them?

You can't separate them. The benefits to society from saving the more functional addicts are a karmic reward for being a society that regards human lives as worth effort to save even if they don't benefit society.

https://www.usatoday.com/pages/interactives/seven-days-of-heroin-epidemic-cincinnati/

8:35 p.m.

The police officers and medics find the man on the floor of the Speedway bathroom on West Main Street in Newark, sprawled next to the toilet, head under the sink.

They’ve tried spraying naloxone into his nostrils, but it’s had no effect. He’s not breathing. They’re running out of time.

One of the medics takes a drill out of his bag and turns it on. It whirs like a dental drill as he pushes it into the man’s shin bone, trying to create a more direct path for the naloxone to enter the bloodstream.

The medics install a stent and start pushing in doses of the life-saving drug.

The man rouses and tries to stand.

“Lay down, buddy. You overdosed,” a medic says. “We just brought you back to life.”

Later, at the hospital, the man hops off the gurney and runs outside, the stent still embedded in his leg.

Narcan is a wonder drug that brings ODing opiate addicts back to life. So of course there are frequent fliers who keep ODing and being revived.

Some localities have limited how many publicly-funded narcan doses cops will give to someone. Which is an eventual death sentence for an addict.

So yes, this wonder drug stretches out the terminal phase of an addict's life.

I am skeptical of any plan that involves causing large numbers of people to die on the basis that the world would be better off without them. What if it isn't? You would have just caused a bunch of deaths for no reason.

It'd be pretty embarrassing if you wiped out all the heroin addicts, then a few months later someone came out with a new AI-devised wonderdrug that can cure all addictions with a single pill.

Advances in medical technology twist the knife for families that have lost loved ones no matter what you do. Some people hold out for a miracle. Some people just receive fresh new horrors to endure daily. I pulled my dad off life support a few years before a cure for him was discovered. Not sure there would have been much of him left though had I waited it out. Sometimes the merciful thing is to let people go.

We've been making the mistake of enabling drug addicts for a very long time, and IMO it's more than fair to err on the different side for a while before we determine that we need the addicts after all.

then a few months later someone came out with a new AI-devised wonderdrug that can cure all addictions with a single pill.

As long as we're proposing fantasies, let's counter with a similarly-absurd nightmare: all the heroin addicts on their umpteenth narcan turn into 28 Days Later rage zombies, and you could've avoided the apocalypse if you'd just let them die of their previous overdoses instead. Embarrassing!

Hey, we’re talking about opioids, not PCP!

causing large numbers of people to die

Your framing of the problem is wrong.
In a suicide, the fault for the death ultimately lies with the one who pulls the trigger.

Overdose deaths are suicides.

It'd be pretty embarrassing if [all the heroin addicts killed themselves], then a few months later someone came out with a new AI-devised wonderdrug that can cure all addictions with a single pill.

That was their choice to make, and an isolated demand for rigor: if we actually cared about this for human beings more generally, cryopreservation would be a much larger industry.

Overdose deaths are suicides.

Philosophy question: to what extent do we as people owe each other to stop suicide attempts? Discuss.

On one hand, we've put up nets and installed phones and nationwide hotlines and circulated narcan. On the other, some Western states have legalized euthanasia for increasingly minor medical issues. To me, the former feels reasonable (although I find OPs argument about narcan to be at least darkly intriguing), and the latter feels like it starts reasonably but quickly slides down the slippery slope. I know some moral codes (Catholicism, for one) are blanket-opposed to aiding suicide.

I'm interested to hear other opinions on where the line should be.

I think euthanasia should be legal. I think there should be quite a lot of oversight of the process, but I'm not against governments doing cost-benefit analyses of who gets care.

By revealed preferences, it's impossible to care infinitely about a given life. If that wasn't the case, then the entire global economic output would be spent on the first kid who showed up with terminal cancer. Not even those who claim that Life Is Priceless act like that's true. The Pope isn't selling his mobile to save one more starving child in Africa. Even the Dalai Lama has personal possessions, and expensive ones.

Once you accept that (and no population on earth could function without doing so) , all that remains is figuring out how much society implicitly or explicitly values life and making it legible. Yes, it sucks. But we're not gods with unlimited resources.

(If you wish to spend your own funds on your care, then I have no objection to you spending as much as you can afford, your money, your choice. But if you're spending my money, through taxes..)

I also think that anyone who can prove they possess capacity (in the medicolegal sense) should have the right to end their lives.

I'd be open to that being a difficult process, you'd need doctors to sign you off as sane and not suffering from a disease that impairs judgement (and can be cured).

No, I avoid tautology by not claiming that just wanting to die is sufficient grounds to be diagnosed with a mental illness and hence lack capacity. I think there are philosophical reasons that are consistent with wanting to die, for reasons other than depression.

(Severe depression that is resistant to all treatment is, IMO, a terminal illness)*

I hold this position despite being severely depressed, with occasional suicidal ideation. I recognize that I don't want to be depressed or suicidal, and want that part of me excised. I'm quite confident I would never act on that (and doctors know how to make it quick, painless, and irreversible), and if my disease somehow overwhelmed my true volition, I would want to be saved.

I think that unless someone has formally applied for a Suicide License, the default presumption should be that something is wrong with them, and they don't actually want it. This allows us to try and save people who jump off bridges or take paracetamol after a bad breakup. I differ from most people in that I would accept people wanting to die for more considered reasons.

Of course, in the Real World, my hands are tied by laws and code of conducts that physicians must agree to if they want to stay out of jail and in their job. But that's my stance on the matter.

*I haven't exhausted all options, far from it. I even expect that we'll have a generalized cure for depression in my lifetime. I still am not comfortable with telling someone with depression so bad life has lost meaning that they must hold out in hopes of a cure, suffering all the way.

"Safe, lethal legal, and rare." I've been fooled by this before.

That is to say, I believe you and believe your earnestness, but I just cannot conceive of how you would stop cultural slide on this without a solid Chesterton fence.

I'm a radical transhumanist who aspires to live forever, and wants that for everyone else. I can't think of any conclusive argument that proves beyond reasonable doubt that such measures won't be taken to a place that's not palatable for me, and I really wish I had them.

I just think it's worth a shot, even as a small pilot program.

Even if this never happens, I wouldn't lose sleep over it. I think that the kind of person who was that intent on dying would find a way, you don't have to be a doctor to figure out ways to kill yourself. It just makes it easier to achieve without leaving a mess.

Clayton Atraeus managed it, and he was down to two arms and a head.

I hold this position despite being severely depressed, with occasional suicidal ideation. I recognize that I don't want to be depressed or suicidal, and want that part of me excised. I'm quite confident I would never act on that (and doctors know how to make it quick, painless, and irreversible), and if my disease somehow overwhelmed my true volition, I would want to be saved.

But how confident are you that you would never act on that if you had been raised in a society that not only tolerates suicide but excuses and justifies it? In the depths of despair, when the abyss swallows your vision and knowing that doctors could do it quickly, easily and painlessly, then are you confident you would never go through with it?

Quite confident. If my heterodox views are any indication, I'm not someone particularly susceptible to conformity or peer pressure. How many people do you think were born and raised in my circumstances and turned out the way I did? I defy neat classification.

If society was unchanged in terms of medical technology and overall technological progress, but actively encouraged suicide, I still don't think I'd opt for it. I'd demand that every possible treatment be tried first, then possibly ask for a legal document put in place that debarred me from applying for a lengthy period of time, no matter the cause. I'd spend the rest of my life hoping for a cure, and wouldn't give up until I was dying of other causes. If I really wanted to die, I already have more opportunities than I can count (not that the average person doesn't, bridges and busses aren't rare objects).

Do note that I would prefer that even if euthanasia on demand was an option, that there were multiple safe-guards in place to minimize impulse decisions. That would include medical review for reversible causes, counseling with therapists paid a bonus for every patient they talk out of it (to align incentives), and a wait time of a few months. If at any point someone has second thoughts, the wait time gets pushed back another few months.

Hell, keep it a secret under NDA that the first time they put you in the suicide pod, it's actually a drill. If you start screaming and want to be let out, that's when they tell you and swear you to secrecy. Even during the real thing, leave a big red button that would stop the process, if it's a lethal drug, have a bottle of antidote by their side when they're given it.

There was an incredibly poignant video of an elderly francophone lady taking her euthanasia meds for a terminal illness. She was lucid and in absolute control, and speaking till she went to sleep and never woke up. That's what I want the average person who takes this route to look like.

At that point, I'd be content that we're looking at people with incurable illnesses who can't be talked out of their intent. My confidence in an eventual cure for almost all disease isn't so strong that I would demand people hold out for it, that's their choice to make. My choice, at every point in the 10+ years I've been depressed, is to live for a better future.

Those are good measures, although like pusher_robot I would expect them to scope creep a lot. Rules or laws with any ambiguity seem to inevitably fall victim to the death of a thousand cuts. We've already seen euthanasia for a depressed 29 year old in the Netherlands.

But I'm not so worried about patients requesting assisted suicide as I am about the people with access to buses and bridges who suffer in silence and don't have educated medical professionals to help them. It's not really peer pressure, I'm talking more about a society where the emotional valence of suicide is not negative and how that will impact the depressed in general. A world where the water we breathe says 'suicide is an option actually' instead of 'suicide is a tragedy'. I am strong enough in this world to not submit to despair, but I don't know if I would be strong enough in that world. Not when that black dog has me and suicide seems like the only chance for something resembling relief.

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I think euthanasia should be legal

I think importing doctors from poor countries gives you doctors with lower than average amounts of empathy. Seeing human misery up close creates calloused human beings.

I'd be ok with writing a 30 day high dose script of dilaudid that a terminal patient could take all at once to kill themselves with, but the physical act of administering that lethal dose is where I draw the line. If they need help let the family do it.

I hope euthanasia never becomes legal here because I wouldn't like that in my job description and I wouldn't like to interact professionally with anybody who is ok with that. I wouldn't want to work alongside a high-kill-count sniper or kamikaze-drone operator either.

I think importing doctors from poor countries gives you doctors with lower than average amounts of empathy.

I think I've got plenty of empathy, or at least the average as doctors go. That being said, while empathy is always nice to have in a doctor, I'd personally prefer one that was incredibly competent at addressing your problems even if they weren't tearing up over your plight.

Seeing human misery up close creates calloused human beings.

Would you say that a doctor who volunteers for the MSF has lower empathy because of their experience with crushing poverty and disease? Probably not, though I'm happy to note there are selection effects involved. What about one that grew up in an inner-city ghetto but was bright enough to enter med school? Is that a bad thing?

I've seen crushing poverty, and when I volunteered to transfer to one of the largest hospitals in my home country (to work for free), I saw things that emotionally wrecked me. As the essay notes, you either harden your heart or exsanguinate.

It didn't make me a worse doctor, quite the contrary. I went out of my way to help people, and still do.

Suicide is a form of murder: self-murder. We make efforts to stop murders, we should make efforts to stop suicide. Overall, society must signal disapproval of suicide. Cultures that honor or otherwise approve (even the implied approval of not bothering to do anything about it) fall into failure modes that our current society doesn't, without much obvious benefit. See Imperial Japan, for instance, which continued fighting long past the point where there was no hope of victory because their culture venerated honorable death over defeat. It did their society active harm. Their suicide rate remained high up until around 2010, when it began to drop and has continued to drop until today, where the suicide rate is actually a little less than the United States (it went from a high of 25.6 per 100K people in 2003 to around 12.2 today, compared to the US's 14.5).

Why did suicide rates drop so significantly in Japan? Well, in 2007 the government released a nine-step plan to lower suicide rates. Since then they funded suicide prevent services, suicide toll lines, mental health screenings for postpartum mothers, counseling services for depression, and in 2021 created a Ministry of Loneliness whose job is to reduce social isolation. In other words, when the Japanese government tried to make a societal effort towards preventing suicide, suicide rates dropped.

Which is good, because Japan needs every citizen it can get. Population is still dropping, and everyone who kills themselves can no longer contribute to society nor create and raise society's next generation.

Which is good, because Japan needs every citizen it can get. Population is still dropping, and everyone who kills themselves can no longer contribute to society nor create and raise society's next generation.

Those people don't owe Japan their lives. Maybe if Japan wants them to contribute to society or create and raise society's next generation, it can make doing those things seem better than literal oblivion.

Kind of seems that that is exactly what they are doing: providing mental health services, attempting to find ways to reduce social isolation, trying to change social norms so that literal oblivion does not look like such a nice choice in comparison to social disgrace, etc.

No, they're trying to convince them not to choose oblivion despite not actually changing the conditions. That is, they're trying to get some marginal people from "life sucks so bad I'd rather be dead" to "life sucks almost bad enough I'd rather be dead", not generally improving conditions.

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People owe the societies they live in, actually. If you want to go live in the woods with wolves and bears for neighbors then more power too you, that’s the condition for opting out.

People owe the societies they live in, actually.

No. Communistsitarians tend to think this because it allows them to demand infinite sacrifice for zero benefit, but the social contract is continually and constantly renegotiated.

In this case, society isn't holding up its end of the bargain- the "owes its members a future that's at least as good as it was before" part- and as a result, the individuals that make up society will under-deliver in TFR until it starts delivering.

Why is living in the woods a valid way to opt out, but killing yourself isn't?

If the world owes you nothing, you owe nothing to the world.

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Giving someone a service they never asked for, then claiming they owe you for it, is a classic scam. And this isn't the 16th century. There is nowhere you can run that a government won't find you. They own everything.

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I think it’s probably good to help create a minimum effort threshold for suicide; things like putting railings on bridges and nets on high buildings make it so that individuals struck by an acute but fleeting suicidal urge are protected from doing something they’d almost immediately regret.

The people accessing medically-assisted suicide, or using other high-effort methods of suicide requiring persistent and focused intent, are probably people who genuinely are better off dead. Not every human life is destined to last until a peaceful death in old age. Not every person is psychologically constituted in a way that’s resilient to all of the various tribulations that life throws at us. I probably wouldn’t personally pull the trigger or inject the deadly solution myself if one of those people asked me, but I’m fine with professionals existing who are willing and able to do so.

As for hard drug addicts, my impression is that only a small percentage of junkies are the sorts of people who’d be very valuable contributors to society if we managed to fix their addictions. Drugs are not taking our best, in other words. I’m aware that there are some unknown number of totally normal middle-class individuals who got hooked on opiates because they were led astray by unscrupulous doctors overprescribing them; my impression is that this represents only a very small percentage of addicts, and that their numbers are being inflated by a populist coalition determined to treat impoverished white Americans as hypoagentic victims.

Junkies killing themselves, whether through overdoses or other means, is overwhelmingly a boon to society, and I think almost zero effort should be taken to prevent them from doing so.

If overdose deaths are suicides, then they're accidental suicides. The proper term for an accidental suicide is "fatal accident". Normally, when someone suffers a serious accident but survives, we give them medical attention to try to keep them alive.

I actually don't have a problem with suicide, provided it's intentional and done right. I think the authorities should make you wait a few weeks to confirm you're really sure you want to die, then shoot you up with lots of fun but deadly drugs.

What I do have a problem with is denying lifesaving treatment to people on the (unproven!) basis that they're a drain on society.

If you choose to repeatedly engage in an activity that you know has a high risk of death, that's just suicide with plausible deniability. I don't consider someone who loses a game of Russian roulette to have suffered a "fatal accident".

No, mere thrill-seeking is not "suicide with plausible deniability" nor is engaging in dangerous activities with more tangible rewards (e.g. tower-climbing as a job). Probably most addicts aren't trying to kill themselves either, they're just chasing a high. But since they aren't sharing the reward with the rest of us, I don't see why we should socialize the risk either.

I would distinguish activities that have a tangible, elevated risk of death from ones that have a risk of death high enough that the odds of dying in repeated acts over time approaches 1. Riding a motorcycle or smoking is risky, but someone who does those things, even their whole life, is not likely to die from them even though they might. Consuming recreational doses of street narcotics is something that, if you do it frequenlty enough, is very likely to kill you sooner or later.

I believe your distinction is arbitrary. And in any case I suspect the actual value of the thing you're trying to compute (probability of dying from the drugs instead of something else) is not something available, or even well-defined.

It’s not that the world would be better without them. It’s that you’re simply delaying the inevitable while increasing the suffering of the individual. Drug addicts suffer a lot, they have serious diseases, they’re often homeless, they have to scrounge for food in trash cans, they can be covered in sores. At some point, I think you end up keeping someone living that life alive because it’s good for you, rather than good for them specifically.

It'd be pretty embarrassing if you wiped out all the heroin addicts, then a few months later someone came out with a new AI-devised wonderdrug that can cure all addictions with a single pill.

Ozempic already seems to do this. What if we just forced addicts to go on Ozempic?

It unfortunately doesn't do that. Source: am on Ozempic, but I still have to fight tooth and nail to keep my sugar addiction under control. It does make you get full faster, but the cravings are just as strong as ever.

Huh. More proof of my personal theory that different people react differently to the same drug.

(I just got on Semaglutide for a number of reasons, and the difference is astounding.)

Man, I envy you. I really was hoping it would have good effects for me in terms of making it take less willpower to not binge on sweets, but no such luck I'm afraid. Obviously it still does me good in terms of blood sugar control, but I didn't get the fringe benefits I was hoping for.

Amazing.

I've only been on it for a short time so far, but I've already gotten to the point where I can literally forget to eat. The effects have been so beneficial overall I'm kinda waiting for the other shoe to drop.

Wild. The effect it had on me is making me find sugar kind of gross. I consistently add only one teaspoon to coffee from now on whereas I used to always add two. Additionally I used to take my kids to a coffee shop in the mornings for some goodies a few times a week and now everything in there seems gross. I haven't had a thing from there since starting Semaglutide for weight loss.

It hasn't affected my interest in alcohol though. I can still have a beer or two with dinner, though alcohol never had a grip on me.

When it comes to snacking I find my behavior changed. I can lay in bed now at night and think "hmm I'm feeling a bit hungry. there's some delicious vanilla yogurt in the fridge. I should go have some. go on, go have some" and ... the actual urge to get up and do this is just gone. The abstract thought of pleasure around snacking is still there but the dopamine boost to get me to jump out of bed is missing.

This seems like it could have profound positive effects on addiction, but it's kind of weird how selective it is.

Don’t copious amounts of diet soda help?

Diet soda doesn't taste like sugar. It tastes like a nasty off-sweet thing, maybe some sort of byproduct of sugar production.

Everybody has a different response to medicine, and food. Some people metabolize certain medications well or poorly. Some people get a good response from Ozempic for all kinds of shit, some don't

Some people think Cilantro tastes like soap and we know exactly why.

Personally I am not offended at all by diet soda but I do know plenty of people who are. It does work for some people!

Not really? I've been able to replace regular Coke with Coke zero, even before Ozempic. But it tastes kinda nasty by itself, so I only drink it with food (as food masks the bad taste). I wouldn't really have much luck using it to fulfill cravings for sweets.

There's preliminary evidence that Ozempic helps with addictions, but it's far from conclusively established, and won't be for another year or three.

Ahh interesting. Yeah and there is a lot of hype around it rn.

If were "cause to die" only in the extended consequentialist sense, then Im not sure theres much reason for this skepticism.

Principally I don't really have a bone to pick with you here, and many others are discussing the implications. However, still loads of addicts die all the time from overdose. Narcan prevents very few deaths, as you need to have it available, someone who uses it, and then having them actually contact 911 so they can get a second dose is not very common. Dementia is a progressive incurable disease, drugs aren't and the 99% number needs a lot of qualifying by you. Also there are alternatives to Narcan. E.g. intubation. We actually do this with specific overdoses of carfentanil. If a machine can breath for you, it doesn't matter if you're fucked up on opioids. Its the same — effectively — as Narcan.

While I certainly have little sympathy for hard drug addicts who don’t try to quit- I think repeat offenders of drug use laws should be executed- I don’t know how much difference narcan makes. These people live outside, exposed to the elements, not eating regularly, using substances that fuck up their hearts and breathing and nerves, passing STD’s back and forth and getting in fights. They are not long for this world even with narcan.

Absent certain diseases the human body is extremely resilient and adapted to not eating for long periods, to the cold and the elements (across the world), to getting into fights, to unhygienic environments and so on. The homeless addicts live in poor conditions for us, but conditions not particularly worse than those many humans historically lived for 50+ years in. The drugs complicate it, but that’s where Narcan comes in.

These people get certain diseases a lot, though.

I’ll also point out that while humans are resilient, only to a point- and individuals often aren’t. Drug addicts are taking high fatality rates even with life-saving medical care being administered to them regularly. Scurvy is on the uptick, I’m surprised these encampments haven’t already seen typhus outbreaks, and they get lots of STD’s.

Plus, historically normal people had far better nutrition and slept in better shelter than these types do; peasants a thousand years ago had a roof and ate whole grains.

Edit: the response above me points to a 4% annual mortality rate among addicts. This is already quite high, considering most addicts are young.

What prevents a helpful billionaire from buying out Narcan and jacking up the price 100x?

Doesn't help the billionaire in daily life, probably not profitable, terrible optics?

-The “best” solution is probably to violate patient rights and involuntarily commit them to make someone else be on the hook for making sure they go to their aftercare.

We have gotten to an odd place where people can nonchalantly talk about fighting police weekly and utilizing millions of dollars of public resources as "rights". This seems like yet another example of why the left and Democrats are so alienated from "the working class", as far as such a thing exists. Relaying a story like this to an Amazon delivery guy, a stay at home mom of 3+, a legal secretary, or a midlevel real estate agent and they'd very likely be seething with rage, thinking about how they just got a $3000 bill from a hospital because their kid had an asthma attack, which came just after finished paying off the bill for their other kid's birth.

Why didn't they just pretend to be homeless again? That is the question they ask. Why is the violent drug user getting better treatment from the state?

We have gotten to an odd place where people can nonchalantly talk about fighting police weekly and utilizing millions of dollars of public resources as "rights".

Get on our level. British Columbia got into a bit of a kerfuffle when it tried to ban people from injecting drugs in playgrounds. Apparently it would cause "irreparable harm" if they had to shoot up elsewhere, so the BC Supreme Court filed an injunction against that amendment.

(They eventually got it banned, eight months after their first attempt. Having Health Canada do it instead of the BC government was the secret sauce to make it stick, because it matters which government is violating the Canadian Charter of Rights and Freedoms, or something.)

Well, you've got to give them points for intellectual consistency and being willing to bite bullets! If a the Parks department wants to do something to improve general community wellbeing and make parks enjoyable for normal people, we have to think carefully about the rights of junkies to shoot up in parks. If the Health department says that it's about health, there is absolutely nothing that will counterbalance that and they have an arbitrary level of power to dictate who goes where when.

If the Health department says that it's about health, there is absolutely nothing that will counterbalance that

In Canada, as with the rest of the Western world, 3 Goddesses are worshipped: Safety, Equality, and Consent.

The Parks department's approach contradicted Equality, so what they wanted was bad and denied.

But the Health department are Safety's priests, so what they wanted was good and applied.

I think this anecdote shows there is an interesting debate to be had about the role of "science" in governance. When the court defers to "experts" opaquely like this, it subverts the intentional democratic structure of government. As someone who has had "scientist" in their job title before, I'm actually of mixed feelings about this. It might feel better if we pushed for science literacy on the courts, or maybe just published the science and let The People decide what to do with it.

I think the misunderstanding, IMO is that "science" is, as-designed, value neutral. It should inform political decisions, not make them directly.

Although maybe this was a question of federalism? Certain powers in the US are reserved for states or feds (regulating alcohol sales vs. international trade). But that doesn't seem like what happened in Canada here.

Why didn't they just pretend to be homeless again? That is the question they ask. Why is the violent drug user getting better treatment from the state?

That drug addicted hobo is theoretically liable for the cost of his treatment. Obviously he won’t pay it, the hospital knows he won’t, the government knows he won’t, but it’s illegal to consider that up front so they don’t. Instead he receives treatment and the hospital doesn’t bother trying to collect because it’s a waste of time.

So why collect from anyone who isn't a millionaire?

Because most people have insurance, and the rest will make partial payments.

The few eccentric middle class people who don’t have health insurance know the game and will probably negotiate the bill, but not refuse.

One of the other posters hit on this but basically in most states people have a right to be not forced into treatment (of any kind, not just psychiatric) as long as they are not actively suicidal or homicidal (gross oversimplification the laws around this are very state specific and complicated).

Drugs don't count for this. We can't force someone to take their diabetes medication. We can't force someone to go to a psychiatrist (again with above caveats).

This is generally good despite the edge cases.

Its not forcing anyone. The hospital has a clear need to have a minimum treatment program of 30 days. You can accept that program or not

If a patient comes into the emergency department the options are (loosely) you discharge or admit them.

People are allowed to go home even if doing so may result in death or bad outcomes. We typically calling this leaving AMA (against medical advice). Common reasons for this are illness disrupting decision making, denial, and needs (like drug use, or I have a flight to catch, or I gotta go to work).

If people in the hospital think a patients decision making is impaired (for instance: dementia, medical illness resulting in confusion so they can't make a decisions with full thought) they can do a capacity assessment. This usually involves calling psychiatry for help but you don't need to. If the patient understands the ramifications of their decision (oversimplification again) they get to go home and die or have their frostbitten fingers fall off or do too much heroin.

A sub category of this is psychiatric extremity.

If a patient comes to the ED and has a psychiatric history or has psychiatric symptoms then psychiatry needs to see them and say they are safe to go home. Some critical thought should be used to determine if psychiatry is actually needed but for various reasons (including the ED being overworked, midlevels, and liability concerns) no critical thought is used.

For instance "I'm sorry I said I wanted to die, but I had fallen off of a dump truck and could see all the bones in my legs going the wrong direction and it was very painful" "or I came here because I was looking for a therapist" now generate a need for an outpatient follow-up appointment. Also "I have no psychiatric problems but I was confused because I have early onset dementia" and "I came here because prison lore is that I don't have to go to jail if you guys say I have psychiatric problems" or "no I'm fine, that was some good heroin, let me out so I can go get more before they run out." None of these people necessarily need a psychiatrist, the ED psychiatrist's job is to determine if they do and if they are safe to go home.

Now they are required to see someone (supposedly, I don't know the legislative details), wasting everyone's time.

The other primary option is admission. If the patient is a threat to themselves, others, and in some states property (with a lot of at times hazy and at times specific clarification on what all of that means) then they can be involuntarily committed. You can also just ask the patient if they want to stay, which depending on resource availability may involve admitting someone who really doesn't need it. All kinds of complications fall out here, for instance some patient's say they want to be admitted but are admitted involuntarily any way.

In past times the U.S. was very free with involuntarily admitting people, very resistant to actually discharging people (from the ED and from the psychiatric hospital) and abused people in various ways, our current legal framework exists to protect against those abuses, some of which were very very serious (gang rape of patients at state hospital for example).

The downside of reforms was that homeless people who are too mentally ill to function or chronically treatment non-compliant are allowed to wander the street.

You may not care about those people, but we also used to accidentally catch people who really weren't mentally ill or were definitely safe to be at home. Not making this mistake is harder than you think because its very common for people with no mental illness, mild mental illness, and severe mental illness to all say the same things (especially when someone is taking the medication only because they are locked in a state hospital and will stop as soon as they leave and start murdering again).

Its not about caring/not caring about these people. Its about not elevating them above everyone and everything else

It's not that simple. It's not always clear who is who. Some frequent flyers are coming back because they don't want to go to the shelter. Some are coming back because the ED keeps not treating them because they think the problem is mental illness and they never did a basic work up...

It may be helpful to model this similarly to however you feel about the legal system, letting guilty go free and so on.

The legal system doesn't involve people coming into my house, stealing tens of thousands of dollars, and then the next time they are at the front door I am supposed to let them back in. In fact, most of the more sane jurisdictions allow for pretrial detention of something as serious as a burglary or theft by deception.

The problem is the state blatantly violating freedom of contract by forcing these victims to treat these menaces, and then trying to fudge away the actual cost of the insane policy by smuggling it through various re-distributive schemes as opposed to a budgetary line item.

$100 billion for ER visits from meth heads and heroin addicts is less defensible then "we can't have people dying in the streets (ignore this massive cost we've hidden with subterfuge)"

The problem isn't necessarily your idea (although I'm sure some would take issue with it), the issue is the implementation. How do you decide? Some people with chronic medical illness look like a mental health patient, some mental health patients try repeatedly to get medical care and get ignored... when the issue is "live or die" you have to get things absolutely right.

We have gotten to an odd place where people can nonchalantly talk about fighting police weekly and utilizing millions of dollars of public resources as "rights".

I think OP is referring to the 'negative' rights, such as 'not being involuntarily committed unless a danger to oneself or others'. (Mr Have-you-considered-stopping would fall under that exception; Ms Here's-your-follow-up-appointment wouldn't.)

That's a nonsensical frame. The hospital is already being forced to interact with him. They should at least have the tiny freedom of determining the length and course of the imposition

Dysfunctional social policies cause/exasperate problems.

Problems are incompetently addressed with system bloat.

System bloat starts weighing the functional parts of society down.

Functional society members want bloat cut down.

Dysfunctional social policy advocates say system bloat cannot be cut down, citing: Who will address the problems?

The correct way to contextualize this predicament is through hate and sympathetic horror. Government waste is just a symptom.

The correct way to contextualize this predicament is through hate and sympathetic horror. Government waste is just a symptom.

Can you expand on this? I don't follow.

He's not speaking clearly, but basically gesturing at the classes of people he thinks are responsible and advocating we Do Something about them and their enablers, using abstruse language.

the classes of people he thinks are responsible

Turbulent priests?

You should immerse yourself in the horror that is being facilitated, sympathize with the victims and hate the root cause

I do find myself occasionally wondering if the local abandoned Walmart (shoplifting killed it) might be a fine place for a novel nonprofit to set up an indoor tent city for the local homeless, with security guards and nurses on staff, a doctor dropping by every day for prescriptions, and the in-store pharmacy restored to full functionality. The big outdoor parking lot might be additional space for the hardier hobos willing to rough it.

Actual quote from my last time talking to a patient in the ED:

"A shelter, why the fuck would I go to a shelter doc? It's fucking filled with homeless people, besides they won't let me get high on crack!"

In order to fix the problem you need to be willing to violate some people's rights and to discriminate, the former is something that you do sometimes see flexibility on in the left but the later...

abandoned Walmart (shoplifting killed it)

That’s impressive. It is difficult to kill a Walmart.

I don't know about the US, but the toughest stores here are dollar stores. I don't think I've ever seen one die.

I’ve seen dollar stores die. It’s gas station convenience stores(in local parlance- ‘corner stores’) that won’t die.

Near where I used to live we had an intersection where three corners were gas stations and the other corner was a 7-11, no gas.

It's a four lane divided road. The gas stations on the far side of the intersection, where one could take a right after passing through the intersection, and then take another right to continue on the same route, have always had the same branding and ownership.

The one gas station that was on the near side, where you'd have to exit and be immediately at the stop light, would change ownership every couple of years, and eventually failed completely.

Traffic gets very backed up in this area, and I'm guessing people didn't want to deal with re-entering with a line of cars that wouldn't be kind enough to let them in. Just a few seconds further would take you to a station where eventually traffic would get blocked by a red and you could re-enter without depending on the kindness of strangers.

That property sat unused for about a decade, reportedly because of the great expense involved in neutralizing the underground gas tanks to meet environmental standards.

eventually traffic would get blocked by a red

Fun fact: One of the downsides of roundabouts is that they do not provide these breaks in traffic, so they can cause problems downstream.

They can also cause problems upstream:

(Assumes driving on the right / CCW flow through the roundabout.) If you have a roundabout with heavy traffic flow from, say, the South entrance to the West exit, you can get perpetual backups for traffic coming from the East.

And then you have to do goofy stuff like "traffic-metering signals", which turn the roundabout back into an old-fashioned traffic circle…

I’ve heard the trick is to make sure you have an area of effect anti-regeneration ward.

Last time I saw it done, breaking a mirror worked.

Does a section of the city commonly called “the warzone” and officially termed “The International District” count as “an area of effect anti-regeneration ward”?

Not sure but it does sound like it would at least disrupt worker drones trying to cast healing spells. A tactic worth trying when faced with such enemy!

Why would they go there? Homeless who will accept not doing drugs or fighting already have shelters.

It’s worth noting that the VA is paying for this resident to be there, despite the fact he will in fact not be able to do anything.

As always, American doctors have it better. In the UK, the spectrum of duties for psychiatry residents includes pigeon-control.

Now, I can easily see a British trainee ending up stuck on a placement because they haven't been signed-off to do the work, but the extent of the dysfunction would include not being paid for that month.

Reading that link was interesting and disturbing but wasn't totally worth it until I made it to this comment.

You might as well be feared, if you can't be loved, and there's little love lost for resident doctors on NHS wards.

You might get a kick out of reading this Very Serious case presentation in the BMJ:

https://pmc.ncbi.nlm.nih.gov/articles/PMC7839907/

LOL this is amazing. Reads like a fiction story. This is so fun omg.

And not even the Christmas BMJ. I had high hopes after seeing it came out on the 25th, but wrong month.

https://www.bmj.com/content/363/bmj.k5094

For non BMJ:

https://pmc.ncbi.nlm.nih.gov/articles/PMC4773691/

The original Christmas BMJ parachute metanalysis that the linked 2018 paper is satirising is also a classic of the genre, although now unfortunately paywalled. Magic internet points to anyone who has a pirate link.

I do enjoy that the one I linked has a correction haha.

I thought this was the med reg's job in the UK?

Is this scope creep?!?!

You call the med reg when you want a pigeon removed from the ward. You call the psych reg when you want the pigeon removed from existence.

(With your username, you're best off avoiding the UK like the plague.)

I remember when Canary Wharf (the secondary London financial district with the skyscrapers, for Americans who don't know) hired a falconer for pigeon control duties. If you decapitate or shoot them you have to kill an awful lot of them before the problem is solved, but pigeons have an innate fear of sparrowhawks and after the first bird-on-bird nomming incident les autres are effectively encouraged.

That said, if you hang around Trafalgar Square you will probably still be fed illegally by tourists.

That said, if you hang around Trafalgar Square you will probably still be fed illegally by tourists.

And here I was thinking the London banding didn't nearly account for additional cost of living, I appreciate the culinary advice!

Unfortunately that offer is only good for pigeons.

Good enough for me!

Edit: Replied to wrong comment.

Did you mean to reply to someone else? I am very deliberately not taking a stance on that side of things.

Oh yeah my comment was for 2rafa thanks for letting me know I fat fingered it.

What is a VA?

If you are asking this question you are likely not from the U.S., so some details:

The VA is the U.S.'s primary "socialized" medicine - health care for veterans.

It's been criticized for having amazingly poor care (what's the difference between a VA nurse and a bullet? A bullet can only kill one person), being more of a job program than a health system, at the same time some people love it (everyone involved understands the veteran experience).

It's a huge system with a ton of rot that is essentially a preview of what would happen with single payor in the U.S.

It's been criticized for having amazingly poor care (what's the difference between a VA nurse and a bullet? A bullet can only kill one person), being more of a job program than a health system, at the same time some people love it (everyone involved understands the veteran experience).

One important thing to consider with the VA is that its level of care is pretty consistent over the entire country. It is "amazingly poor care" relative to many comparable institutions in some urban areas with high quality clinics and hospitals, but amazingly good care relative to what is available privately in many rural communities.

Much as I hate defending the VA I should say that the care can actually be very good at times. Inpatient medical care? Almost always awful. Outpatient care? Some of the clinics are actually excellent. PTSD treatment? Some of those programs are clearly best in the world in class.

Much of this had to do with the specific specialties and staff. Many people at the VA work at a slow pace because they want to be lazy and can get away with it, but some use that slow pace to do things like spending more time with patients which means satisfaction and care can sometimes be better.

Most of us train at the VA at some point though and the VA training experience is comically poor.

My grandmother used to work as an Occupational Therapist at the VA. They were way ahead of most of the rest of the country with a lot of the things she was doing. And, say what you will about the quality of care, the free van trip to the VA for those who needed it was a literal lifesaver.

I'm a member of a VFW and the VA is popular enough that we have people who assist veterans in applying for VA benefits. I don't doubt that media reports of incompetence are accurate, but the impression I get is that this is largely dependent on the hospital and the doctor. I'd certainly prefer the VA over any of the smaller rural hospitals and over most of the suburban regional hospitals.

It's popular because the financial benefits are great: for many (maybe even most) veterans the care they get through the VA system is either free or close to it. And the VA Community Care Network program means that for outpatient stuff you can actually get seen by a non-VA doctor and the VA wills still pay the whole bill (there are hoops you have to jump through, but a lot of people are motivated to jump if it means they don't have to pay a cent of their healthcare bills).

Context

Commented somewhere else but there are things to like about the VA, I suspect that part of the issue is that the part where it is weakest (inpatient care) is the part most patients know the least and where its hardest to tell when your care is ass.

It's a huge system with a ton of rot that is essentially a preview of what would happen with single payor in the U.S.

The VA isn't just a single-payer system - it's a "fully socialised" - i.e. single-payer, single-provider system. Among 1st-world countries, only the UK, Denmark and (for the publicly-subsidised part of their system) Singapore do this. Medicare is a single-payer, multiple-provider system as are the national healthcare systems (also called Medicare) in Canada and Australia. Canada goes further and bans most self-paid top-up care, something very few countries do (and in particular the UK and Australia don't).

All serious proposals I have seen for single-payer healthcare in the US are basically Medicare for all. We know what that looks like (Canada or Australia) - it offers a much better patient experience, at a much higher cost to the taxpayer, than the UK NHS.

Department of Veterans' Affairs

The VA is a government run hospital system which provides free treatment to veterans, at very low standards. Veterans certainly use it, but it’s most popular among those who are either desperate or who have issues that won’t kill you if someone f’s them up.


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