This weekly roundup thread is intended for all culture war posts. 'Culture war' is vaguely defined, but it basically means controversial issues that fall along set tribal lines. Arguments over culture war issues generate a lot of heat and little light, and few deeply entrenched people ever change their minds. This thread is for voicing opinions and analyzing the state of the discussion while trying to optimize for light over heat.
Optimistically, we think that engaging with people you disagree with is worth your time, and so is being nice! Pessimistically, there are many dynamics that can lead discussions on Culture War topics to become unproductive. There's a human tendency to divide along tribal lines, praising your ingroup and vilifying your outgroup - and if you think you find it easy to criticize your ingroup, then it may be that your outgroup is not who you think it is. Extremists with opposing positions can feed off each other, highlighting each other's worst points to justify their own angry rhetoric, which becomes in turn a new example of bad behavior for the other side to highlight.
We would like to avoid these negative dynamics. Accordingly, we ask that you do not use this thread for waging the Culture War. Examples of waging the Culture War:
-
Shaming.
-
Attempting to 'build consensus' or enforce ideological conformity.
-
Making sweeping generalizations to vilify a group you dislike.
-
Recruiting for a cause.
-
Posting links that could be summarized as 'Boo outgroup!' Basically, if your content is 'Can you believe what Those People did this week?' then you should either refrain from posting, or do some very patient work to contextualize and/or steel-man the relevant viewpoint.
In general, you should argue to understand, not to win. This thread is not territory to be claimed by one group or another; indeed, the aim is to have many different viewpoints represented here. Thus, we also ask that you follow some guidelines:
-
Speak plainly. Avoid sarcasm and mockery. When disagreeing with someone, state your objections explicitly.
-
Be as precise and charitable as you can. Don't paraphrase unflatteringly.
-
Don't imply that someone said something they did not say, even if you think it follows from what they said.
-
Write like everyone is reading and you want them to be included in the discussion.
On an ad hoc basis, the mods will try to compile a list of the best posts/comments from the previous week, posted in Quality Contribution threads and archived at /r/TheThread. You may nominate a comment for this list by clicking on 'report' at the bottom of the post and typing 'Actually a quality contribution' as the report reason.
Jump in the discussion.
No email address required.
Notes -
My point that it's an oversimplication to describe federal spending as "just subsidizing a good that has a restricted supply because of over regulation." Just as easily a lack of funding can be the root cause of a dearth of supply.
Administrative excess should be culled everywhere, but I'm unconvinced that "the rest of [the budget] is bloat". From this graph on their budget it looks like a reasonable 5-10% is administration while the overwhelming majority is compensation for services, 50% for hospital care, 25% for physician services, and the remainder broken between prescription drugs, and smaller categories like equipment and nursing homes.
I'm unconvinced the future is bleak either. The largest growing category in spending has been prescription drugs and the IRA should arrest that trend substantially. You've likely also read the recent headlines that our projections have wildly overestimated growth in Medicare spending, which has leveled off significantly per beneficiary for the past decade.
Administrative waste is bad but isn't the core problem here. The problem is that the government restricts the supply of people allowed to practice medicine through regulations and then provides subsidies to purchase healthcare so that people buy more of it than they otherwise would. New players are legally barred from entering the market to raise the supply so the subsidies go straight into the pockets of the providers. It's like when the government provides section 8 housing vouchers but at the same time makes it illegal to build new housing via zoning restrictions or environmental regulations. You can't subsidize your way out of a cartel.
And the fact is that we're just not getting a good return on investment. We spend more on healthcare than anywhere else in the world but life expectancy is declining. Paying a trillion dollars a year so people with alzheimer's can linger in the nursing home for another year is just a bad way to spend money.
This is like saying the government restricts the supply of tanks or something. There's no regulation artificially restraining something that would be in more abundance on the free market, the subsidy just isn't big enough. There is no law restricting resident doctors, which hospitals can have as many of as they want, there just isn't extra public funding to have more of them, so hospitals make up funding shortfalls out of pocket, from state governments, or philanthropy. Cutting government would ofc result in less residency slots, not more.
There are lots of regulations that genuinely do restrict the supply of medicine via laws that shield hospitals from anti-trust and prevent new competitors from emerging. But these are mostly on the state level. Even the lengths of residencies themselves are usually required by state-level licensing rules. If there's anything federal scale that's as significant as CON/COPA laws, I'm more than interested to hear about it though, that's why I asked.
The entire edifice of credentialing and licensing is built on government regulations that the AMA lobbied for. I can travel to India for a surgery but if an Indian doctor moves here he can't perform the operation without jumping through the AMA's hoops to give one example. I get that these are at the state level but since there are more or less similar requirements in every state I don't see that it matters all that much.
It matters because if your plan is that we should cut spending because costs are inflated by supply restrictions, but you have no plan or authority to address those supply restrictions, then you're in a worse place than before. @guesswho put it much more succinctly than I could.
More options
Context Copy link
More options
Context Copy link
Access to medication is gated behind prescriptions. Even if you know exactly what is wrong with you and exactly what medicine you need, you have to go to a doctor to access it. I guess this is more inflating demand rather that restricting supply, but the result is the same
More options
Context Copy link
More options
Context Copy link
More options
Context Copy link
More options
Context Copy link