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PaperclipPerfector  4mo ago (text post)   25651 thread views

Culture War Roundup for the week of January 1, 2024

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I have a new post up on my Substack today, which is expanded from a comment I wrote replying to @FarNearEverywhere's comment (for which they won one of their whopping five AAQCs for December - congrats!).

Why do I find the premise of this novel so risible? It’s not just that the possibility of the Irish far-right seizing power and transforming the country into a fascist dystopia is so laughably remote as to be almost fantastical - if it’s a “warning”, then it’s of about as much use as a warning about a Dáil made up of a coalition of pixies and unicorns. It’s not just that, like most successful Irish writers of the last decade, [Paul] Lynch is clearly something of an East Yank whose political concerns were imported wholesale from across the pond - I would find this novel’s premise exactly as contrived and indigestible were it set in the US or Canada (for reasons I’ll get into shortly). No - it’s that Lynch is writing about a hypothetical authoritarian Ireland brought into being by a far-right administration, while ignoring the warning signs of actual democratic backsliding and authoritarianism ringing loudly in his ears every day.

...

“Freezing the bank accounts of anyone even suspected of having donated to a political cause you dislike, without ever arresting them or charging them with a crime” is the kind of behaviour we’d rightly expect from a Central African dictator. But it wasn’t a far-right Canadian prime minister who did such a thing - it was the genocide-apologising, knee-taking Justin Trudeau, who attends Pride parades and offered the smarmy explanation “because it’s 2015” for his decision to appoint a gender-balanced cabinet. Trudeau is living proof, if any were required, that there’s no conflict between a socially progressive worldview and repressive, dictatorial tactics straight out of the Erdoğan playbook - the iron fist in the rainbow glove.

"Leftists are the real authoritarians" plays about as well as "Democrats are the real racists". It is axiomatic that the right is authoritarian and the left is fighting against that.

The thing about that novel is, that the recent expansion of police powers and giving them extra equipment, plus the public sentiment starting to crystallise around cracking down on 'hate speech' and thus giving the government more remit for censorship (even if it's not phrased that way) is happening under a slightly right-of-centre economically but liberal and very social progressive otherwise government, not the stereotypical GOP administration as would be the case for such a novel in the USA.

Leftists can be authoritarian too, see Cuba for instance (if the examples of the Soviet Union and China are going to be No True Scotsmanned as not really being left, or not really being authoritarian) or indeed the Sandinistas in Nicaragua and The Shining Path in Peru.

The mainstream left is generally sympathetic to Cuba ("Look how great their health care is, shame on the US for not having single payer") and was sympathetic to the Sandinistas (if only because Reagan opposed them).

I’ve always been blown away by the obsession with health care. Does the average person spend more than a few days interacting with health care pa?

In addition to the comments below, it's also worth noting that there is a massive disparity in how much people interact with medical institutions. Some people do have the misfortune of either personally having been struck by chronic conditions or having a close family member that has, but the more common situations are people that just eat themselves into it or medical their neuroses. About 15% of adults have diabetes, about 6% have sleep apnea, about 20% take some sort of psych meds, and so on. Sure, many of these things could be cured with diet and fitness changes, but for many people there is a culture of medicalization and it seems entirely normal to them that they are permanently dependent on medical institutions to remain alive and physiologically regulated. They can't control blood sugar, they can't sleep, they can't even focus on basic tasks without repeated visits to medical professionals and prescriptions for daily drugs.

If one’s a parent of small children or very aged, certainly.

I’m a parent of small kids. So we go to the pediatrician and it is very easy. No fuss. Don’t know why anyone would complain about that.

The people I know who are the loudest about health care all have Type 1 diabetes. That Wikipedia article says

Within the United States the number of people affected is estimated at one to three million.

so around 0.3-1% of the population. One I know says they very intentionally went the route of working for a big company to have a stable corporate job with health care because they've known since childhood that their choices were stable employment or death. The ones I know who didn't luck into such a stable career are pretty angry about it.

Women with significant period symptoms (which are fairly common, albeit not universal) also tend to care about health care to get access to the medication to manage their periods (aka birth control).

But also, catastrophic events resulting in high medical bills don't have to be all that common before a lot of people have a friend or acquaintance who had trouble with such a situation.

I know no one in the final category. My recollection from the literature is that bankruptcy due primarily to healthcare is very small (as opposed to bankruptcy that includes health care but where health care is not the primary factor).

With respect to the second category, I guess (maybe?). That’s putting aside that birth control per se is pretty shitty for women but also relatively cheap and affordable. I wouldn’t think again that birth control is a primary factor but who knows.

First one, yeah that seems legit (insulin is expensive).

That’s putting aside that birth control per se is pretty shitty for women but also relatively cheap and affordable.

You're probably thinking of birth control pills. Long-lasting birth control is both more effective and less shitty. And possibly actually cheaper, but the cost has to be paid up-front. An IUD is about $1000+ (but can last 7+ years), which isn't huge but can be a large expense for a young woman.

Per annum? Yes.

Schedule an appointment. Attend it only to get a referral for the thing you already knew you needed. Get a test ordered which has to be done across the county because reasons. Pay for all of these when you receive a bill months later, because the whole time, the provider and insurance are volleying back and forth on what will be covered and in what amount. If, during any step, you run into a bureaucratic hurdle, expect to spend an hour or two on the phone, because for some reason these companies all use voice-activated robot dialogue instead of a keypad or, God forbid, a website.

You can avoid most of this stuff if you’re young and healthy. America is not really either of those things, on average. Even the simplest brush with this system turns into a bureaucratic hassle. I understand the processes which led to this perverse setup. Wouldn’t it be nice if we could design it better?

Per annum. I get that it can sometimes be a hassle but that seems weird for relatively young people to base their seeming life or identity around, no?

How do you mean?

I think the normal level of engagement with the issue is something like “that guy says American healthcare sucks; my one experience with a chest x-ray concurs, so I guess I’ll vote for him.” If you want to get really spicy, share a meme or two about it on Twitter.

It's about a fifth of the US economy, if you're insured it involves monthly payments that will make up a significant portion of your paycheck or be significant deductions from it, if you're uninsured and poor you get regular paperwork from Medicaid that you have to fill or correctly or can end up in deep shit, and the reimbursement and deduction system drives a lot of other (often dumber) behaviors.

And if you have a pregnancy, or a serious illness, or a chronic illness, it gets a lot more in-your-face.

Yeah I guess the monthly payments are a pain in the ass. But so is FICA or Fed Income Tax, etc.

My wife and I have kids. Her heath care during pregnancy was fine. Wasn’t enough to orient our life around health care as a topic.

But assuming you fit the demographics of the average Motte reader, you likely have good to very good insurance no? That puts you in the upper bracket. How much did you end up paying for your wife's pregnancy care? How long did it take you to pay that off? Had she had to have been rushed to an out of network hospital, how would that have impacted your finances? What if her doctor was in network but the lab her doctor used was not?

I moved from the UK to the US so I have experienced both healthcare systems as an adult, and they both have their advantages and disadvantages, but the US one definitely requires more engagement, which isn't necessarily bad, but the more issues you have with executive function and planning the worse it gets. I can get a good chunk off my premiums by getting a yearly physical and then a yearly biometrics test, and by getting a prostate exam and by getting a dental exam and so on and so forth. For a planner like me with experience working through bureaucracies that works pretty well (though even for me the inability to know if a recent colonoscopy was going to be coded as routine or diagnostic in advance and therefore not knowing if was going to be out of pocket for around 600 dollars or 6,000 was literally a pain in the ass).

Treatment in the US is usually good and quicker than the NHS (though in rural or urban areas it can be comparable, it took me 6 months to get in with my PCP when I moved to a small town in the US, and it looks close to that now I have moved back to the city), but it does require much more engagement and does give you much more uncertainty about what is exactly going to be paid for or not. On balance I would say it is probably better, but it is also more stressful. It took 3 months before I knew for sure my bill was going to be 700 bucks, not 6,000.

We have an HSA. Just set up payment plan and used that. It didn’t impact our finances in any noticeable way.

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I think it's mostly a way to score points against the US and praise the European social democracies (+Canada) that leftists in the US tend to idealize.

Hypochondria was already widespread in progressive circles in 2019, but Covid practically made it into a heavenly virtue, to the point that many of the people reporting "long Covid" symptoms never actually contracted Covid in the first place. Progressives are also the faction most likely to endorse the idea that literally everyone in the world should be in therapy, which implies that anyone who isn't currently in therapy should interact with a healthcare professional anywhere from 12-52 days of the year more than they do at present.

That’s fair. I wasn’t thinking of therapy. I am literally anti therapy (generally think it does more harm than good).

A recent study demonstrated that getting vaccine boosters is correlated with Long Covid.

I was not surprised at all. In fact, this result is obvious once you have an accurate model of Long Covid. Boosters don't make it more likely for Covid to occur. However, people whose anxiety disorder masquerades as "Long Covid" are also more like to seek boosters.

A recent study demonstrated that getting vaccine boosters is correlated with Long Covid.

Can you cite the study you're referencing?

I won't pretend to be anywhere close to up-to-date on COVID literature, but the top pubmed result was this review:

the odds ratio of developing long covid with one dose of vaccine ranged from 0.22 to 1.03; with two doses, odds ratios were 0.25-1; with three doses, 0.16; and with any dose, 0.48-1.01...The high heterogeneity between studies precluded any meaningful meta-analysis.

Here you go: https://pubmed.ncbi.nlm.nih.gov/36538532/

My original synopsis was wrong. It was having 2 doses at all which was associated with Long Covid, although the much bigger risk was obviously having a severe case of the disease.

Note that this was only among people who tested positive for Covid and presumably sought medical treatment so it wouldn't capture the anxiety cases who may have never even contracted the illness.

I'll retract my original statement.

Does the average person spend more than a few days interacting with health care pa?

Not sure, but access to reasonable healthcare without bankruptcy or other life-destroying stuff is nice. In this case importance is not well measured by how much time is spend on interaction with them.

It is kind like I spend about 5h in total in my life interacting with military and consider armed forces to be quite important for my country to have (and large part is that I prefer to avoid interacting with military too much, especially Russian one).

Yes black swan events etc. But most people don’t orient their life around that (and for most people catastrophic coverage is feasible).

I guess I just don’t understand the extreme fixation on health care for people who frankly don’t use a lot of it.

"what happens if I break leg / get run over by bus / get cancer" is not some very unlikely black swan but something that happens to basically anyone.

You think a lot of people get run over by buses? Or for that matter you think a lot of healthy young people get cancer or even break a leg?

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So is "what if I get struck by lightning".

Now obviously it's more reasonable to worry about getting injured in the workplace/a bad car crash/whatever than by a lightning strike, but a lot of this runs afoul of "a huge increase over a trivial base...." and anyways most people don't know that the sticker price on the bill you get for medical treatment is not the final price.

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