Employees who decline genetic testing could face penalties under proposed bill(washingtonpost.com)
washingtonpost.com
Employees who decline genetic testing could face penalties under proposed bill
https://www.washingtonpost.com/news/to-your-health/wp/2017/03/11/employees-who-decline-genetic-testing-could-face-penalities-under-proposed-bill/
168 comments
Compare with https://www.thestar.com/news/canada/2017/03/08/genetic-testi...
I'm sorry to all Americans who may read this and get ruffled, but what the actual fuck is wrong with your political landscape and attitudes towards workers rights? Why don't you have unions? Why do Americans seem to hate unions? Why don't you have an active political party representing workers? Why don't you have an active movement to prevent your employer from becoming overseer of your entire life? All I see day in and day out from America is employers and capitalists finding another way to fuck the workers and there is not one iota of widespread organised resistance to this (or any of your other disgusting work legislation like "at will employment" or your complete desire to shoot yourselves in the foot with univ.healthcare) at all.
Seriously what is the problem with your country that you've managed to manoeuvre yourselves as employees into a position where you are totally unable to counter the repeated and ceaseless violation of your ability to live with some sort of security and expectation of privacy against your employer. Your country is amazing, your people are lovely. But your politics and attitudes towards work, workers and their rights is abhorrent and disgusting.
The thought of legislation like this arising in my country (Australia), where your employer is given free range to look into your genetic privacy is just unfathomable to me, and if it did happen there would be widespread protests organised by unions and political parties representing workers rights. Truly the attitude of seemingly the majority of Americans towards themselves and workers rights is gross, and frankly quite sad. You will only ever stop these sorts of gross violations of workers rights with even bargaining power between employee and employer, and there is only one way to achieve that (workers unionising)
Seriously what is the problem with your country that you've managed to manoeuvre yourselves as employees into a position where you are totally unable to counter the repeated and ceaseless violation of your ability to live with some sort of security and expectation of privacy against your employer. Your country is amazing, your people are lovely. But your politics and attitudes towards work, workers and their rights is abhorrent and disgusting.
The thought of legislation like this arising in my country (Australia), where your employer is given free range to look into your genetic privacy is just unfathomable to me, and if it did happen there would be widespread protests organised by unions and political parties representing workers rights. Truly the attitude of seemingly the majority of Americans towards themselves and workers rights is gross, and frankly quite sad. You will only ever stop these sorts of gross violations of workers rights with even bargaining power between employee and employer, and there is only one way to achieve that (workers unionising)
I hesitate to throw out this quote because it may come across as a "hot take" but I think that John Steinbeck said it best:
"Socialism never took root in America because the poor see themselves not as an exploited proletariat but as temporarily embarrassed millionaires."
Another quote I've heard is that "extremists become more extreme, not less, as problems come closer to solutions."
"Socialism" and "extremists" don't really apply but the sentiments do. Unions sprang up in the United States as a counterweight to outright and absolute worker abuse. Things we--those resident in the U.S.--now take as "absolute," like child labor laws and the 40-hour workweek, were earned as a result of those early struggles.
We've had it really good here for really long, comparatively, so I think that a lot of people see these kinds of abuses as "won't happen to me"-ism so they're not interested in sacrificing even a little to ensure that the abuses happen to virtually[0] no one.
Going back to unions, a lot of people I know--in the IT industry, obviously--flatly refuse to recognize that a union could be a good thing because jobs, salaries, and opportunities are all plentiful. We're not "abused" because employers know that we can just hop jobs and recover. (Never mind things like the gaming industry or the "crunch" period or, say, Uber.) Because of the illusion of choice, unions aren't valued. (I say "illusion" because witness what happened in the doldrums of the early 2000s. When every employer, or even a bunch of large employers, pull back at the same time, there is no choice.)
For others, things like unions or some form of collective action or even just "group health care run by the government" are seen as impinging on the basic rights to shoot--metaphor intentionally chosen--our own feet off however we like, consequences be damned because other countries are just wrong and the United States is a Special Snowflake.
Or something like that but maybe with a little less bite.
0 - I say virtually because people will always find a way to take advantage of others but there's a lot to be said for pushing to prevent that as much as possible. America doesn't seem to do that very much.
"Socialism never took root in America because the poor see themselves not as an exploited proletariat but as temporarily embarrassed millionaires."
Another quote I've heard is that "extremists become more extreme, not less, as problems come closer to solutions."
"Socialism" and "extremists" don't really apply but the sentiments do. Unions sprang up in the United States as a counterweight to outright and absolute worker abuse. Things we--those resident in the U.S.--now take as "absolute," like child labor laws and the 40-hour workweek, were earned as a result of those early struggles.
We've had it really good here for really long, comparatively, so I think that a lot of people see these kinds of abuses as "won't happen to me"-ism so they're not interested in sacrificing even a little to ensure that the abuses happen to virtually[0] no one.
Going back to unions, a lot of people I know--in the IT industry, obviously--flatly refuse to recognize that a union could be a good thing because jobs, salaries, and opportunities are all plentiful. We're not "abused" because employers know that we can just hop jobs and recover. (Never mind things like the gaming industry or the "crunch" period or, say, Uber.) Because of the illusion of choice, unions aren't valued. (I say "illusion" because witness what happened in the doldrums of the early 2000s. When every employer, or even a bunch of large employers, pull back at the same time, there is no choice.)
For others, things like unions or some form of collective action or even just "group health care run by the government" are seen as impinging on the basic rights to shoot--metaphor intentionally chosen--our own feet off however we like, consequences be damned because other countries are just wrong and the United States is a Special Snowflake.
Or something like that but maybe with a little less bite.
0 - I say virtually because people will always find a way to take advantage of others but there's a lot to be said for pushing to prevent that as much as possible. America doesn't seem to do that very much.
> a lot of people I know--in the IT industry, obviously--flatly refuse to recognize that a union could be a good thing
Usually this includes knee-jerk arguments against dues, mandated wages/salary, and other aspects of existing/older unions. It seems like many people implicit assume that a union must involve a list a of traditional practices.
A union can be what you want it to be. If you don't want it to cover something, then leave it out. Charter the union to only address the specific problems that need to be addressed. Maybe limit "crunch" periods to healthy lengths of time near an actual product release? Maybe include a specific deterrent against extreme problems like collusion to fix salaries while otherwise ignoring salary completely?
As for dues and management costs, isn't that the kind of problem that is easy with modern computers and telecommunication? How much management is even needed for an IT union? In the past dues were needed to hire people to do the paperwork, send out notices, etc. Today, that work is a weekend Ruby On Rails project. After a specific purpose union is setup, are dues even necessary?
Usually this includes knee-jerk arguments against dues, mandated wages/salary, and other aspects of existing/older unions. It seems like many people implicit assume that a union must involve a list a of traditional practices.
A union can be what you want it to be. If you don't want it to cover something, then leave it out. Charter the union to only address the specific problems that need to be addressed. Maybe limit "crunch" periods to healthy lengths of time near an actual product release? Maybe include a specific deterrent against extreme problems like collusion to fix salaries while otherwise ignoring salary completely?
As for dues and management costs, isn't that the kind of problem that is easy with modern computers and telecommunication? How much management is even needed for an IT union? In the past dues were needed to hire people to do the paperwork, send out notices, etc. Today, that work is a weekend Ruby On Rails project. After a specific purpose union is setup, are dues even necessary?
It seems like many people implicit assume that a union must involve a list a of traditional practices.
It's not an assumption that it must, it's a recognition that very likely, it will. Organizations aren't created in a vacuum, they require bringing in others, and if you're starting an union, you'll attract people who are already predisposed to all the ideas of what makes up a union, and you'll attract offers of help from existing unions, which will try to co-opt you. And there's no valid reason to believe that you'll be able to control that process. Finally, once that it created, it's not just a matter of distancing yourself; once a union grows, it affects every worker, even non-unionized - in some cases, even banning them outright from working.
So it's not surprising that workers which still have it pretty good aren't interest in opening that can of worms, and you must have a better reason to convince them why it won't be one.
It's not an assumption that it must, it's a recognition that very likely, it will. Organizations aren't created in a vacuum, they require bringing in others, and if you're starting an union, you'll attract people who are already predisposed to all the ideas of what makes up a union, and you'll attract offers of help from existing unions, which will try to co-opt you. And there's no valid reason to believe that you'll be able to control that process. Finally, once that it created, it's not just a matter of distancing yourself; once a union grows, it affects every worker, even non-unionized - in some cases, even banning them outright from working.
So it's not surprising that workers which still have it pretty good aren't interest in opening that can of worms, and you must have a better reason to convince them why it won't be one.
> It's not an assumption that it must, it's a recognition that very likely, it will.
To add to everything you just said, the NLRA sets very rigid rules regarding how unions can form and how employees and employers can interact with them. So you can't just charter it however you want and assume all the problems are solved - the NLRA imposes a number of requirements and protections for the union (not the members, but the union itself as a corporate structure) which way be at odds with the employees.
As a result, once a union forms, it's very difficult (practically) for its members to deunionize, even if a majority of the membership opposes the union representing them.
So people are very hesitant to go down a road which is essentially seen as a one-way street, except as a last resort.
To add to everything you just said, the NLRA sets very rigid rules regarding how unions can form and how employees and employers can interact with them. So you can't just charter it however you want and assume all the problems are solved - the NLRA imposes a number of requirements and protections for the union (not the members, but the union itself as a corporate structure) which way be at odds with the employees.
As a result, once a union forms, it's very difficult (practically) for its members to deunionize, even if a majority of the membership opposes the union representing them.
So people are very hesitant to go down a road which is essentially seen as a one-way street, except as a last resort.
> no valid reason to believe that you'll be able to control that process
People aren't interested in small-scale organizing for specific purposes because strong, traditional unions are too popular? Why aren't the same people you claim will "control [the] process" making a union now?
Yes, just like every other type of organization, a union - or business - can evolve beyond it's original purpose. There are no guarantees in most collective actions. However, arguments that assume an inevitable strong union in industries where unions are very unpopular do not seem to be based in reality.
> you must have a better reason to convince them why it won't be one
The tech industry has been very successful at inventing new types of organizations over the last several decades. The "gig economy" and Bitcoin/Etherium are obvious examples. Silicon Valley is popular because of how easy it is to invent new businesses. Sometimes this creativity extends to new ways to fund startups. A lot of the tech itself revolves around new types of social interaction.
I find it very hard to believe that unions - or collective bargaining in general - are somehow immune from "disruption" and creative reinterpretation.
People aren't interested in small-scale organizing for specific purposes because strong, traditional unions are too popular? Why aren't the same people you claim will "control [the] process" making a union now?
Yes, just like every other type of organization, a union - or business - can evolve beyond it's original purpose. There are no guarantees in most collective actions. However, arguments that assume an inevitable strong union in industries where unions are very unpopular do not seem to be based in reality.
> you must have a better reason to convince them why it won't be one
The tech industry has been very successful at inventing new types of organizations over the last several decades. The "gig economy" and Bitcoin/Etherium are obvious examples. Silicon Valley is popular because of how easy it is to invent new businesses. Sometimes this creativity extends to new ways to fund startups. A lot of the tech itself revolves around new types of social interaction.
I find it very hard to believe that unions - or collective bargaining in general - are somehow immune from "disruption" and creative reinterpretation.
Look, we weren't discussing whether unions were good or bad; we were discussing why people don't believe it's in their best interest to form or join one. I'm telling you why I think you are mistaken about their motivations, not that you are mistaken in your belief that a union would in fact be a positive thing for tech workers.
SAP in Germany was getting union representation just when I was doing an internship there about 10 year ago. The move wasn't popular with employees.
Why was that? Unionized engineers in Germany (like in the automotive industry) are the highest paid and get the most benefits. Why would they be against it, given that if you don't enjoy red tape, you probably won't work at SAP to begin with?
I was only an intern. The food was good, but the work was boring.
German law says that union representatives can get an almost equal say in company matters. SAP had a vote, most people were against union representation, but by German law any nine (9!) employees in favour in the whole company is enough. So SAP got some people from IG Metal (ostensibly a metal workers union!) on their board.
Most of my coworkers saw the union representatives as busy-bodies who were interested in political power rather than real work. People had higher opinions of management than of them.
To get a bit more general:
It does help that programmers are broadly in wide demand, and can mostly get a new job at a drop off a hat. So instead of forming a cartel and `fighting' for their rights, they can just vote with their feet.
Same as what people do to make sure they get quality groceries: go shop at a different venue. If unemployment ever gets low enough, the general population would be elevated into a similar exalted position for their jobs.
> [...] given that if you don't enjoy red tape, you probably won't work at SAP to begin with?
It's a decent company. If you can put up with Java, they are OK to work for.
(That doesn't mean that I enjoy using their products. In that regard they are the opposite of the video game industry: I'd rather play a computer game, but I'd also rather work for SAP than finish a game in a death march.)
German law says that union representatives can get an almost equal say in company matters. SAP had a vote, most people were against union representation, but by German law any nine (9!) employees in favour in the whole company is enough. So SAP got some people from IG Metal (ostensibly a metal workers union!) on their board.
Most of my coworkers saw the union representatives as busy-bodies who were interested in political power rather than real work. People had higher opinions of management than of them.
To get a bit more general:
It does help that programmers are broadly in wide demand, and can mostly get a new job at a drop off a hat. So instead of forming a cartel and `fighting' for their rights, they can just vote with their feet.
Same as what people do to make sure they get quality groceries: go shop at a different venue. If unemployment ever gets low enough, the general population would be elevated into a similar exalted position for their jobs.
> [...] given that if you don't enjoy red tape, you probably won't work at SAP to begin with?
It's a decent company. If you can put up with Java, they are OK to work for.
(That doesn't mean that I enjoy using their products. In that regard they are the opposite of the video game industry: I'd rather play a computer game, but I'd also rather work for SAP than finish a game in a death march.)
Electrical and mechanical engineers are in high demand too, and afaik they don't complain too much about their strong unions. And I know SAP is a decent company.
Anyway the comparison with the situation in the US is a bit pointless. More than unions, they need basic workers' rights.
Anyway the comparison with the situation in the US is a bit pointless. More than unions, they need basic workers' rights.
The US has enough poisonous unions. (The German and Scandinavian ones tend to be more bearable on the whole.)
The US has a lot of problems, but what makes you think they need more workers' rights? A saner tax system would be a good start---so that eg health insurance and employment can decouple. (Right now, their employer provided health insurance is subsidized, so individuals are rationally stuck with that model.)
The US has a lot of problems, but what makes you think they need more workers' rights? A saner tax system would be a good start---so that eg health insurance and employment can decouple. (Right now, their employer provided health insurance is subsidized, so individuals are rationally stuck with that model.)
Besides health insurance: retirement pensions, short-term/long-term disability/incapacity, unemployment benefits, reasonable notice periods and severance pay, parental leave, ... all these things are a given in Germany and in most 1st world countries.
All those benefits have to be paid for. (And the US does have quite a lot of people on long term disability benefits.)
Restrictions on firing just make companies less likely to hire.
People can negotiate reasonable notice periods, and parental leave, severance pay etc, if they rather want that than more money every month. (But that negotiation / demand only works if the economy is humming along fine. So that is way more important.)
Germany and the US could both become more like Singapore. That would be a step forward.
I find it a very weird streak in Germany that they have a lot of mandatory `insurance' that mixes up some actual insurance aspects with welfare and redistribution. I think it would be cleaner to separate these two aspects.
(And Germans do have quite a high appetite for redistribution via their taxation and benefit systems, and vote accordingly. Nothing wrong with that preference in a democracy.)
I am more sympathetic to the nordic countries that marry their social safety nets with reasonable free economies.
And I'd really like to see a country try and rely on Land Value Taxes instead of taxing labour and capital. An LVT can raise an enormous amount of revenue without any deadweight losses to the economy. So you could run a lavish welfare state, and have a dynamic economy without a large wedge between gross and net pay for workers.
Henry George in America was a major proponent of these. In Germany Silvio Gesell wrote some interesting books a hundred years ago.
Restrictions on firing just make companies less likely to hire.
People can negotiate reasonable notice periods, and parental leave, severance pay etc, if they rather want that than more money every month. (But that negotiation / demand only works if the economy is humming along fine. So that is way more important.)
Germany and the US could both become more like Singapore. That would be a step forward.
I find it a very weird streak in Germany that they have a lot of mandatory `insurance' that mixes up some actual insurance aspects with welfare and redistribution. I think it would be cleaner to separate these two aspects.
(And Germans do have quite a high appetite for redistribution via their taxation and benefit systems, and vote accordingly. Nothing wrong with that preference in a democracy.)
I am more sympathetic to the nordic countries that marry their social safety nets with reasonable free economies.
And I'd really like to see a country try and rely on Land Value Taxes instead of taxing labour and capital. An LVT can raise an enormous amount of revenue without any deadweight losses to the economy. So you could run a lavish welfare state, and have a dynamic economy without a large wedge between gross and net pay for workers.
Henry George in America was a major proponent of these. In Germany Silvio Gesell wrote some interesting books a hundred years ago.
> People can negotiate reasonable notice periods, and parental leave, severance pay etc, if they rather want that than more money every month. (But that negotiation / demand only works if the economy is humming along fine. So that is way more important.)
Vulnerable workers aren't in a position to negotiate anything.
Vulnerable workers aren't in a position to negotiate anything.
Yes, hence my qualification that it's important the economy be booming.
Alas, government protection doesn't help that much: just like you see greedy landlords in the US haze people who are paying below market rates in rent controlled apartments, you see bosses quietly make people's lives hell in some jobs in Germany.
Alas, government protection doesn't help that much: just like you see greedy landlords in the US haze people who are paying below market rates in rent controlled apartments, you see bosses quietly make people's lives hell in some jobs in Germany.
> But your politics and attitudes towards work, workers and their rights is abhorrent and disgusting.
Because the government providing anything for you is seen as a form of welfare or regulation that "kills jobs."
Never mind that any senior in the US benefits hugely from Social Security and Medicare, making any proposed reform of those programs nearly political suicide. Just look at efforts to raise the retirement age if you think I'm kidding.
So, not to sound like a whiney millennial, but the older generation already has programs which are quite socialist. However some Americans have still been duped into believing the "American dream" applies to them (it probably did if you were male and white in the 1950s) and thus anything that helps other people is "socialism" or "government overreach"
Nevermind that the Republicans will happily reach into bedrooms (abortion) and bathrooms (transgender rights) to affect people's life.
It's a complete farce to watch this unfolding in the US from Canada. Yeah, our healthcare isn't perfect, I don't think anyone said it was, but I don't have to worry about bankruptcy if I go to the hospital. Nor do I have to worry about politicians fucking me over w.r.t. healthcare.
Because the government providing anything for you is seen as a form of welfare or regulation that "kills jobs."
Never mind that any senior in the US benefits hugely from Social Security and Medicare, making any proposed reform of those programs nearly political suicide. Just look at efforts to raise the retirement age if you think I'm kidding.
So, not to sound like a whiney millennial, but the older generation already has programs which are quite socialist. However some Americans have still been duped into believing the "American dream" applies to them (it probably did if you were male and white in the 1950s) and thus anything that helps other people is "socialism" or "government overreach"
Nevermind that the Republicans will happily reach into bedrooms (abortion) and bathrooms (transgender rights) to affect people's life.
It's a complete farce to watch this unfolding in the US from Canada. Yeah, our healthcare isn't perfect, I don't think anyone said it was, but I don't have to worry about bankruptcy if I go to the hospital. Nor do I have to worry about politicians fucking me over w.r.t. healthcare.
As an American, I believe the fundamental reason you don't see widespread organized resistance against lack of universal healthcare and employer benefiting work legislation is due to the absolute lack of social programs.
Americans cannot organize because of the lack of universal healthcare and work legislation such as "at will employment." Doing such would risk one's job and healthcare. There is no recourse once one is unemployed in the US, especially if one does not have a significant amount of money saved. The government and corporations have our back against the wall.
Americans cannot organize because of the lack of universal healthcare and work legislation such as "at will employment." Doing such would risk one's job and healthcare. There is no recourse once one is unemployed in the US, especially if one does not have a significant amount of money saved. The government and corporations have our back against the wall.
Corporate and elite interests get away with this because of the propaganda of 'American exceptionalism' - people are brainwashed into thinking that we have it so much better that other countries, so don't complain. The news media is a powerful tool of control. Not watching any news at all on TV would yield a more accurate world view, that is, the news is a negative information source.
goombastic(2)
If two consenting adults want to make a agreement that includes exchange of their own genetic information, I really don't see the issue.
There are plenty of employers that don't require genetic information. If you don't want to give your genetic information to your employer it's simple, don't work there. Companies that can't hire employees go out of business. This is a self correction 'problem'. We don't need legislation here. Legislation almost always fails edge cases and is not needed for self correcting issues.
There are plenty of employers that don't require genetic information. If you don't want to give your genetic information to your employer it's simple, don't work there. Companies that can't hire employees go out of business. This is a self correction 'problem'. We don't need legislation here. Legislation almost always fails edge cases and is not needed for self correcting issues.
> If two consenting adults want to make a agreement that includes exchange of their own genetic information, I really don't see the issue.
The problem is one of bargaining power: Consent must be given freely – but in cases where one party in an exchange has a lot more bargaining power, the other party often will agree to something because of fear of retribution or a threat of force. Example: If an employee is told by the boss he or she will be fired if they do not have sex right now, any consent in that scenario is not given freely, but under duress.
The problem is one of bargaining power: Consent must be given freely – but in cases where one party in an exchange has a lot more bargaining power, the other party often will agree to something because of fear of retribution or a threat of force. Example: If an employee is told by the boss he or she will be fired if they do not have sex right now, any consent in that scenario is not given freely, but under duress.
The boss is threatening to abuse their power if they do not have sex. An employee can sue the boss for violating the contract.
> but in cases where one party in an exchange has a lot more bargaining power, the other party often will agree to something because of fear of retribution or a threat of force.
You seem to be implying this is bad thing but it makes sense that a company (could be thousands of people) should have more bargaining power than an employee (1 person). What is the threat of force here? That is illegal. What is the retribution here if an employee chooses a different employer because the employee wants to decline testing?
> but in cases where one party in an exchange has a lot more bargaining power, the other party often will agree to something because of fear of retribution or a threat of force.
You seem to be implying this is bad thing but it makes sense that a company (could be thousands of people) should have more bargaining power than an employee (1 person). What is the threat of force here? That is illegal. What is the retribution here if an employee chooses a different employer because the employee wants to decline testing?
what happens when all insurance plans make this a hard requirement, and you effectively can not be employed, or insured without it.
Don't think it will happen? Try to get internet access, or medical insurance without agreeing to mandatory binding arbitration (that is, signing away your ability to sue).
Don't think it will happen? Try to get internet access, or medical insurance without agreeing to mandatory binding arbitration (that is, signing away your ability to sue).
If it happens, then that's what employees/customers want. It's similar to democracy.
I do not want to force something on other people.
I do not want to force something on other people.
The other problem is that it is impossible to contract to give solely _your own_ genetic information: your DNA necessarily informs on your relatives in a predictable, probabilistic manner. Should they be informed that a third party can reasonably infer salient features of their genome? Should they have to consent?
If this law is passed, every insurance company will jack their rates up to make participation in wellness plans all but a requirement for those in the bottom 98%. Your employer will not have a choice of non-GATTACA health plans.
Absolutely insane policy.
This is severely fucked. Wellness programs do little or no good but do allow employers to offer incentives for participation. This on the other hand is GATTACA level fuckery. GINA took many years to be put in place; now the proposal put forward will potentially cause people to lose health coverage or their job based on things they cannot control. Potentially their kids, too, since these idiotic "wellness" programs are administered by poorly regulated third parties.
This is very, very bad stuff.
This is very, very bad stuff.
To be fair, kids born today are pretty fucked for so many reasons. In a way, this kind of dystopian future is averted when you consider the rate of accelerating ocean warming, permafrost melting, etc. It seems likely that all problems short of that which is going to end us, sort of gets subsumed.
All of these social problems are in the context of a failing ecosystem that is being increasingly overtaxed. So... the kids never had a chance.
All of these social problems are in the context of a failing ecosystem that is being increasingly overtaxed. So... the kids never had a chance.
Is there any credible research that climate change is going to "end us"?
By "end us" I mean end our civilization... extinction is unlikely.
In that case, my question still stands.
I'm asking because I frequently see this kind of climate change alarmism on forums (it's the end of civilization, billions will die, etc) but my sense from an admittedly cursory reading of the estimates is that the dangers of climate change are likely to be an epic refugee crisis from coastal flooding, famine, and war. Hundreds of millions will die, and many more will see a substantial decrease in quality of life for generations.
So, horrible. But I think it's wrong to say that it represents the end of civilization. For one thing, like most things, the consequences of climate change will be felt very unequally. The richest countries of the world are likely to see a much smaller impact in terms of famine and death.
Granted, no one knows for sure, but as someone who is NOT skeptical of the cause and effects of climate change, I am somewhat skeptical that in 100 years it'll be as bad as many internet chicken little types seem to think.
I probably sound more dogmatic than I am though, so please do share some research and change my view :)
I'm asking because I frequently see this kind of climate change alarmism on forums (it's the end of civilization, billions will die, etc) but my sense from an admittedly cursory reading of the estimates is that the dangers of climate change are likely to be an epic refugee crisis from coastal flooding, famine, and war. Hundreds of millions will die, and many more will see a substantial decrease in quality of life for generations.
So, horrible. But I think it's wrong to say that it represents the end of civilization. For one thing, like most things, the consequences of climate change will be felt very unequally. The richest countries of the world are likely to see a much smaller impact in terms of famine and death.
Granted, no one knows for sure, but as someone who is NOT skeptical of the cause and effects of climate change, I am somewhat skeptical that in 100 years it'll be as bad as many internet chicken little types seem to think.
I probably sound more dogmatic than I am though, so please do share some research and change my view :)
So over the next 85 years we're expecting a rise of 2-10m based on current warming with the low end hoping that we maintain only 2c by the end of the century, which currently seems unlikely. Follow the link at the bottom and ask yourself what the US is going to do without Florida, or how much the dams across the Golden Gate (and Houston, New York, DC, Shanghai, London) are going to cost to prevent the inundation of Sacramento and the destruction of California farming.
We're ignoring poor places like Bangladesh with a population of 200Mil (or Indonesia with 1Bil), which will likely be largely depopulated.
I'm now going to past text I used in an earlier comment: _Florida is porous. You can build walls but they don't do much. The water will rise to cover the entire peninsula. Long before that tides and storm surge will destroy all of the surface roads to coastal cities. I personally wouldn't lend money there for longer than 30years._ http://geology.com/sea-level-rise/florida.shtml
We're ignoring poor places like Bangladesh with a population of 200Mil (or Indonesia with 1Bil), which will likely be largely depopulated.
I'm now going to past text I used in an earlier comment: _Florida is porous. You can build walls but they don't do much. The water will rise to cover the entire peninsula. Long before that tides and storm surge will destroy all of the surface roads to coastal cities. I personally wouldn't lend money there for longer than 30years._ http://geology.com/sea-level-rise/florida.shtml
I also don't think that global warming will end civilization for the same reasons as you. However, a refuge crisis, wars over food and water and hundreds of millions dead will be a heavy blow that might set us back for a long time. There is little money for colonizing Mars when you have to spend it all for killing revolutionaries.
Agreed. This is not an argument for not taking climate change seriously and doing all we reasonably can.
It'll also be pretty hard to colonize Mars when SpaceX and Florida no longer exist.
I would just say in response to your post: the start of Syria's troubles are considered by some to begin with an unseasonable and sustained drought.
That's one country's population sudden injection into the rich Western world you consider to be facing limited fallout, and we've witnessed the results and the reactions.
I don't think most people can picture the real effects of sustained and mass migration, even if you're fortunate enough to enjoy the perks of Western life.
That's one country's population sudden injection into the rich Western world you consider to be facing limited fallout, and we've witnessed the results and the reactions.
I don't think most people can picture the real effects of sustained and mass migration, even if you're fortunate enough to enjoy the perks of Western life.
I agree, but look at the backlash in Europe and the US. Does it seem likely that a 10x increase in the turmoil that caused Syria will result in more migrants and refugees to western countries? I highly doubt it.
Unfortunately, I think it highly likely that rich western democracies will turn their backs on developing nations and their tens of millions of refugees. North America, Japan, Australia, and NZ are particularly well suited for this geographically, but Europe will isolate itself as much as possible as well.
Unfortunately, I think it highly likely that rich western democracies will turn their backs on developing nations and their tens of millions of refugees. North America, Japan, Australia, and NZ are particularly well suited for this geographically, but Europe will isolate itself as much as possible as well.
I think you're going to find that as huge parts of Africa and the Middle East cease to be capable of supporting the large number of people who live there, you will see migration like never before. You think people fleeing from absolute misery are going to care that their welcome will be less than warm?
For now it's a relative trickle, but given time and a lack of care and you'll see floods. As you say, look at the backlash... imagine what a 10x or 100x backlash will look like. Now remember that we all have nuclear weapons on a hair trigger.
For now it's a relative trickle, but given time and a lack of care and you'll see floods. As you say, look at the backlash... imagine what a 10x or 100x backlash will look like. Now remember that we all have nuclear weapons on a hair trigger.
The ability to isolate yourself comes with its own costs. Turning away refugees is one thing; but what happens when people are sufficiently desperate that they will be willing to take up arms to secure a place under the sun for themselves and their kin?
...And then, after slaughtering those people and years of insularity, nationalism, and populism... what's going to be left, but for those insular nations to fight over remaining resources?
I can't see a nuclear nation shrugging and saying, "Well I guess we're conquered! Here are the keys..."
I can't see a nuclear nation shrugging and saying, "Well I guess we're conquered! Here are the keys..."
Of course not. But do understand that we're talking about large scale warfare here. Even if you're willing to set moral issues aside, it's not going to be cheap. Those who want to isolate their countries from "third world problems" are going to pay for it in cold hard cash. Thus, even they cannot truly claim to be unaffected.
Using a nuke to fight off a tide of refugees is like bringing a grenade to a fist fight. Do you think the people who are already here are going to tolerate the wholesale slaughter of their family members who are trying to rejoin them? What about all of their friends? No. If we don't find some way to rescue everybody we will be torn apart by civil war.
Using a nuke to fight off a tide of refugees is like bringing a grenade to a fist fight.
Yeah, or firebombing a defeated nation. Who would do such a thing? Oh right... humanity.
Yeah, or firebombing a defeated nation. Who would do such a thing? Oh right... humanity.
Sounds like a good argument to not let even one of them in.
You must must've missed the part where I mentioned that they are already here. They are us.
We aren't going to be able to pull up the ladder. People will try, though, and it will get very ugly, very fast.
We aren't going to be able to pull up the ladder. People will try, though, and it will get very ugly, very fast.
Average temperature rises, icecaps melt, sea levels rise, shores recede. Think about where most of the global tech and financial infrastructure currently is.
edit: Apparently I didn't read your comment; you understand that the coasts will be lost. Not only do the more sparsely populated inland regions not have the infrastructure to take in the coast dwellers, but the core instruments of modern civilization will literally be underwater.
edit: Apparently I didn't read your comment; you understand that the coasts will be lost. Not only do the more sparsely populated inland regions not have the infrastructure to take in the coast dwellers, but the core instruments of modern civilization will literally be underwater.
The question is how accurate are the estimates?
Estimating in a complex system where one problem triggers another, cascading with feedback loops, is a messy business.
So the outcome could be either far more or far less dire than we think.
As you put it, know one knows for sure. So it's prudent to assume the worst.
Estimating in a complex system where one problem triggers another, cascading with feedback loops, is a messy business.
So the outcome could be either far more or far less dire than we think.
As you put it, know one knows for sure. So it's prudent to assume the worst.
Thank you. I would personally be beyond thrilled if I ended up being, "That cranky bastard who always brought up environmental and social doom." I would feel pretty foolish however, if I bet on that outcome, and just hoped for it to materialize.
You think given the way things are going today, civilization as we know it will survive this?
> an epic refugee crisis from coastal flooding, famine, and war. Hundreds of millions will die, and many more will see a substantial decrease in quality of life for generations.
> an epic refugee crisis from coastal flooding, famine, and war. Hundreds of millions will die, and many more will see a substantial decrease in quality of life for generations.
You phrase this as a rhetorical question, as if it's obvious that given "the way things are going today", of course we won't survive.
I don't really know what you're referring to. On a century-long scale, what is "going on today" that is so abnormally terrible?
I don't really know what you're referring to. On a century-long scale, what is "going on today" that is so abnormally terrible?
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In a world with mandatory genetic testing, genetic engineering in order to "give your child the best possible start" will definitely ring true.
I wonder what traits we'll program for? Intelligence, maybe, but that's tough to manage and I'd guess that without a complete understanding you'd get a lot of madness. Physical traits will be easier to select for, especially gross ones like size and overall strength. Selecting out congenital illness would be another step.
If you could though, if you had a clear understanding of how Trait A and cluster of genes/epigenetic factors Z were related... then what traits would be valued? Some would want attractive, intelligent offspring. After a while though, I wonder if people would really want that?
If you're the kind of person who wants to control the development of your kid's moral/religious/political/etc. views (and lots of people do) then you're not going to get what you want out of that. You might want to select for traits that are just... like you.
If you could though, if you had a clear understanding of how Trait A and cluster of genes/epigenetic factors Z were related... then what traits would be valued? Some would want attractive, intelligent offspring. After a while though, I wonder if people would really want that?
If you're the kind of person who wants to control the development of your kid's moral/religious/political/etc. views (and lots of people do) then you're not going to get what you want out of that. You might want to select for traits that are just... like you.
> I wonder what traits we'll program for? Intelligence, maybe, but that's tough to manage and I'd guess that without a complete understanding you'd get a lot of madness.
That's an understatement that belies human laziness. The real predictor of success, almost no matter how you define success, is about the effort you put in. Good genetics is usually a micro-optimization on effort expended. But if you ever told people that they were genetically Destined™ or Guaranteed™ to succeed, that's precisely what will cause them to discredit effort, sit back on their laurels, and wait for the not-so-inevitable money to start rolling in. When it doesn't, their failure will breed resentment and conflict.
> I wonder if people would really want that?
People want to be at the intersection of attractive and unique. Attractive is more or less easy to control for - genes for attractive figures, full heads of hair, clear skin, no disabilities. Unique is far more difficult, and would only get more difficult if sizable pluralities or majorities of parents started to select on the same Recommended™ or Best Choice™ genes, and generations start to look like cookie cutter clones of each other. Most probably, you'd end up with some classic tragedy of the commons, and the government would have to step in to regulate what would end up being a finite resource (being genetically unique, with a genetic monoculture being especially dangerous considering the Darwinian requirement for genetic diversity to promote survival) if the market's natural price pressures didn't self-correct. And if you think the rich and powerful will allow the government to allow anybody but their children to have the beauty and desirable qualities which will keep them at the head of their parents' empires, well, I have a history book on feudalism to sell you.
That's an understatement that belies human laziness. The real predictor of success, almost no matter how you define success, is about the effort you put in. Good genetics is usually a micro-optimization on effort expended. But if you ever told people that they were genetically Destined™ or Guaranteed™ to succeed, that's precisely what will cause them to discredit effort, sit back on their laurels, and wait for the not-so-inevitable money to start rolling in. When it doesn't, their failure will breed resentment and conflict.
> I wonder if people would really want that?
People want to be at the intersection of attractive and unique. Attractive is more or less easy to control for - genes for attractive figures, full heads of hair, clear skin, no disabilities. Unique is far more difficult, and would only get more difficult if sizable pluralities or majorities of parents started to select on the same Recommended™ or Best Choice™ genes, and generations start to look like cookie cutter clones of each other. Most probably, you'd end up with some classic tragedy of the commons, and the government would have to step in to regulate what would end up being a finite resource (being genetically unique, with a genetic monoculture being especially dangerous considering the Darwinian requirement for genetic diversity to promote survival) if the market's natural price pressures didn't self-correct. And if you think the rich and powerful will allow the government to allow anybody but their children to have the beauty and desirable qualities which will keep them at the head of their parents' empires, well, I have a history book on feudalism to sell you.
> The real predictor of success, almost no matter how you define success, is about the effort you put in.
That, and how well you choose your parents. Unless you honestly believe black people just didn't try hard enough to be president for the first 230 or so years of the USA's existence.
Christ these Horatio Alger "just so" stories are ridiculous. And if we repeal GINA, it'll make it that much harder for people to escape their supposed "destiny". Genetics interacting with environment makes us who we are. I'm of the opinion that the latter is more important, and I hold a doctorate in statistical genetics so this is not purely an off-the-cuff opinion. It may or may not be right in a specific case (evidence >> eminence, credentials are at best a proxy for expertise) but it happens to agree with yours, if you think about it.
The amount of grit you develop is going to be a function in large part of your childhood (or other major environmental influences; in the field, "environment" is shorthand for "everything that isn't genetics"). So locking in an ignorance of its importance is just astoundingly stupid. If we want a sclerotic European aristocracy or a caste system in America, this is the way to get it.
And of course the rich and powerful will do anything to perpetuate their position. On average, however, the American dynasty half-life is 3-4 generations. Compare that to Europe and I think we know which better favors social mobility.
That, and how well you choose your parents. Unless you honestly believe black people just didn't try hard enough to be president for the first 230 or so years of the USA's existence.
Christ these Horatio Alger "just so" stories are ridiculous. And if we repeal GINA, it'll make it that much harder for people to escape their supposed "destiny". Genetics interacting with environment makes us who we are. I'm of the opinion that the latter is more important, and I hold a doctorate in statistical genetics so this is not purely an off-the-cuff opinion. It may or may not be right in a specific case (evidence >> eminence, credentials are at best a proxy for expertise) but it happens to agree with yours, if you think about it.
The amount of grit you develop is going to be a function in large part of your childhood (or other major environmental influences; in the field, "environment" is shorthand for "everything that isn't genetics"). So locking in an ignorance of its importance is just astoundingly stupid. If we want a sclerotic European aristocracy or a caste system in America, this is the way to get it.
And of course the rich and powerful will do anything to perpetuate their position. On average, however, the American dynasty half-life is 3-4 generations. Compare that to Europe and I think we know which better favors social mobility.
Health, physical attractiveness and intelligence are the obvious ones. We already know many genes that are associated with cancer and other illnesses, so screening for those and discarding embryos could already be done with today's technology. I suspect eye, hair and skin color aren't very difficult either. Seeing how popular skin bleaching products are I could see many parents paying money for lighter offspring. Intelligence is more difficult as you already said, but as we get better at reading the genetic code, that'll become possible as well. If this kind of genetic engineering became legal and socially accepted, there surely would be a lot of money for researching these kinds of things.
...But physical attractiveness has some serious variability, even within culture. I agree though, that some things like lighter skin in many parts of the world would be a likely big seller.
So? Parents choose what they find attractive.
Right. Like genital mutilation, or foot binding, or neck-stretching...
Except that you could do it at a genetic level. People, like Pugs and Pomeranians, because that's how we do things. We'll create fashions and fuck around before we figure out the fine details.
"Oh Mandy is so lovely and pale, so thin and tall! What a pity she slobbers and can't breath very well."
Even worse, lets imagine...
Uganda bans "Gay genes"
Parts of the world now produce girls who are naturally born "pre-mutilated", or maybe you bypass that and just make them unable to experience sexual pleasure.
Maybe people would finally get their dream, and have a child who would stay a child for a very long time.
Then you have the people with a plan... the "best golfer" or "best football player" stuff, but now genetically loaded before conception. Todd Marinovich, but even more intense.
Just take all of the insane, controlling shit that people do, and now give them as much control (and as much fallibility) as you can imagine over our own genes.
Except that you could do it at a genetic level. People, like Pugs and Pomeranians, because that's how we do things. We'll create fashions and fuck around before we figure out the fine details.
"Oh Mandy is so lovely and pale, so thin and tall! What a pity she slobbers and can't breath very well."
Even worse, lets imagine...
Uganda bans "Gay genes"
Parts of the world now produce girls who are naturally born "pre-mutilated", or maybe you bypass that and just make them unable to experience sexual pleasure.
Maybe people would finally get their dream, and have a child who would stay a child for a very long time.
Then you have the people with a plan... the "best golfer" or "best football player" stuff, but now genetically loaded before conception. Todd Marinovich, but even more intense.
Just take all of the insane, controlling shit that people do, and now give them as much control (and as much fallibility) as you can imagine over our own genes.
What parents will want will be informed by the environment around them.
For example, when parents perceive the economy to be closer to zero sum, with clear "winners and losers", they tend to push their children more to get every edge they can in credentialing and jockeying for the best position for financial security (read: Tiger Moms).
Hard to say what said environment will be in the future when more tools are available.
For example, when parents perceive the economy to be closer to zero sum, with clear "winners and losers", they tend to push their children more to get every edge they can in credentialing and jockeying for the best position for financial security (read: Tiger Moms).
Hard to say what said environment will be in the future when more tools are available.
Then maybe you want a kid who doesn't sleep much, has a high drive, and low empathy. That assumes you want success uber alle though, what if you want your kid to believe that handling poisonous snakes is the key to salvation, or something like that?
Then you might need to breed a very different kind of mind.
Then you might need to breed a very different kind of mind.
Well exactly. Hence its hard to say what we'll desire given that we don't really know what things will be like.
Who knows, pale skin may sadly be more desirable than ever before if things continue their current course. :(
Who knows, pale skin may sadly be more desirable than ever before if things continue their current course. :(
It's weird to think about... people already try to look like particular types so much with just makeup, clothing, and surgery. As you say, it might be that we get some weird genetic monocultures for a while.
Then of course, maybe they'll all die off. Breeding is a tricky business, as any farmer or botanist will tell you, and at least there you're taking it slowly.
Then of course, maybe they'll all die off. Breeding is a tricky business, as any farmer or botanist will tell you, and at least there you're taking it slowly.
At some level I think to myself "first they came for the druggies and I was too young to say anything, just pissed in a cup like everyone else, then they came for smokers and I didn't say anything, then they. . . ."
Where is this all going and in what combination of futures does it turn out well?
Where is this all going and in what combination of futures does it turn out well?
Recent discussion with 87 comments: https://news.ycombinator.com/item?id=13843364
I would have never imagined it would come to this. Now I'm reading about it and can't believe what I'm seeing. This is worrisome on a whole new level.
We need to get some people to the nascar track, put the foam hats on folks, it's time to start yelling fire! This is Republican policy taxing your family unless you give your family's bloodline to the corporation.
Insurance company: Looks like you might have an elevated risk of heart attack. Your premium will be half your paycheck. Sorry about the bad luck, buddy. God bless and send our love to your defective children.
Insurance company: Looks like you might have an elevated risk of heart attack. Your premium will be half your paycheck. Sorry about the bad luck, buddy. God bless and send our love to your defective children.
We've got to separate healthcare from employers before this goes to far. Companies have no business in your health and we still tie health insurance to employment as a legacy error not a benefit. Many problems arise from healthcare provided from the job such as ageism, culling the sick, making it harder to change jobs or start companies, and losing healthcare as you change jobs, not to mention helping the fixed price / backroom market that is healthcare. We'll never fix anything until we unbind healthcare from employers and make it more consumer focused independently (single payer or completely independent/private).
We don't get any other personal insurance from work. We need to outlaw allowing companies to facilitate the healthcare plans and go fully independent like all other insurance (auto, home, life etc). Benefits can be paid in extra money not false benefits that lead to invasions of privacy.
Why would you want your company knowing anything about your health? We supposedly live in a free society but then work at mini feudal/sharecropper empires with dictators and barely any say in what is acceptable.
We don't get any other personal insurance from work. We need to outlaw allowing companies to facilitate the healthcare plans and go fully independent like all other insurance (auto, home, life etc). Benefits can be paid in extra money not false benefits that lead to invasions of privacy.
Why would you want your company knowing anything about your health? We supposedly live in a free society but then work at mini feudal/sharecropper empires with dictators and barely any say in what is acceptable.
The history behind our current nonsensical scheme started with FDR capping wages during the great depression, which spurred companies to offer "perks" like healthcare to recruit talent. An example of one market intervention leading to another, and another, ad nauseam.
Totally agree that insurance should be decoupled from corporations. The way the "market" is regulated hampers people from working independently or starting small businesses because it's so damn expensive for individuals to pay for healthcare themselves.
Totally agree that insurance should be decoupled from corporations. The way the "market" is regulated hampers people from working independently or starting small businesses because it's so damn expensive for individuals to pay for healthcare themselves.
The specifics of the American healthcare system aside, what leads you to believe that the problem is regulation? By essentially any metric, state provided (single-payer) healthcare is the best-known solution to the healthcare problem. Why is there any reason to believe that there's too much state intervention as opposed to, say, too little?
I think they meant the kinds of regulation, not the fact of regulation itself. In fact, it wouldn't surprise me if American healthcare had more regulation than the average European country.
Singapore works fairly well. They have an interesting system; but it's not strictly single-payer.
> By essentially any metric, state provided (single-payer) healthcare is the best-known solution to the healthcare problem.
Except things like, you know, quality of care or satisfaction.
Single-payer healthcare beats the American implementation, which is not a high bar to clear.
There's a reason medical tourism to Mexico and India is so prevalent. Totally deregulated private doctors seem to kick the ass of state healthcare (in quality and wait times) and American healthcare (in cost). I wouldn't want to get, say, complicated brain surgery in Mexico; in that case, the tens of thousands of dollars premium you would pay, uninsured, for US care is probably worth it. But for routine medicine (dental care, minor surgery, etc.) it's medical tourism all the way. For certain kinds of medicine, people will even make medical visits to the US from socialized countries like Canada or France.
Except things like, you know, quality of care or satisfaction.
Single-payer healthcare beats the American implementation, which is not a high bar to clear.
There's a reason medical tourism to Mexico and India is so prevalent. Totally deregulated private doctors seem to kick the ass of state healthcare (in quality and wait times) and American healthcare (in cost). I wouldn't want to get, say, complicated brain surgery in Mexico; in that case, the tens of thousands of dollars premium you would pay, uninsured, for US care is probably worth it. But for routine medicine (dental care, minor surgery, etc.) it's medical tourism all the way. For certain kinds of medicine, people will even make medical visits to the US from socialized countries like Canada or France.
> There's a reason medical tourism to Mexico and India is so prevalent
Yes, and it's because labor is cheaper in these countries than in yours, because their standard of living is lower, and therefore living costs are cheaper.
So it's cheaper for you, because you come from a country with a higher standard of living, and your income is much higher than average in those countries. So for you, their prices are cheap. But for the locals, they're definitely not cheap.
If you switch to a completely private system in US, those doctors will want to be paid US wages, not Mexican or Indian wages. And then you'll find the cost of their services much less affordable.
> For certain kinds of medicine, people will even make medical visits to the US from socialized countries like Canada or France.
There was an actual study on Canadians coming to US for healthcare. The scope of it is vastly overblown, and the reasons are very different from what people often assume they are.
http://content.healthaffairs.org/content/21/3/19.full.html
Yes, and it's because labor is cheaper in these countries than in yours, because their standard of living is lower, and therefore living costs are cheaper.
So it's cheaper for you, because you come from a country with a higher standard of living, and your income is much higher than average in those countries. So for you, their prices are cheap. But for the locals, they're definitely not cheap.
If you switch to a completely private system in US, those doctors will want to be paid US wages, not Mexican or Indian wages. And then you'll find the cost of their services much less affordable.
> For certain kinds of medicine, people will even make medical visits to the US from socialized countries like Canada or France.
There was an actual study on Canadians coming to US for healthcare. The scope of it is vastly overblown, and the reasons are very different from what people often assume they are.
http://content.healthaffairs.org/content/21/3/19.full.html
Nope, this is clearly wrong. Cost of labor and standard of living alone can't account for the cost difference. Average net-adjusted household disposable income is (per OECD) only 3x higher in the US than Mexico. GDPPC is 5x higher. Medical care in the US is drastically more expensive than these numbers would suggest. Claiming "it's because Mexico is poor" is a lazy argument that falls apart very quickly.
> doctors will want to be paid US wages, not Mexican or Indian wages. And then you'll find the cost of their services much less affordable.
Doctors already get paid US wages. Not really sure what you were thinking when you wrote that.
You're also wrong on two counts here; one, the primary cost sinks in the US that they don't have in Mexico are increased regulatory costs (meaning huge administrative staff), red tape (mostly around excessive malpractice and CYA requirements) leading to incredibly overpriced line items (e.g. $1500 to hook you up to an oxygen tank), and a weird incentive scheme where it makes economic sense for doctors to waste money on pointless CYA tasks like uneccesary medical scans and specialist consultations. Two, fully private doctors in the US are actually vastly cheaper if you pay in cash. I have shitty major medical insurance, so I just pay in cash for routine medicine (checkups, prescriptions, etc.). It ends up being a fraction of the cost of what I would pay with insurance at a public hospital. There are a lot of reasons it's so much cheaper, but the biggest is that getting money out of insurance companies is itself a huge money sink for doctors. Insurance companies can't afford to be good or easy anymore.
> doctors will want to be paid US wages, not Mexican or Indian wages. And then you'll find the cost of their services much less affordable.
Doctors already get paid US wages. Not really sure what you were thinking when you wrote that.
You're also wrong on two counts here; one, the primary cost sinks in the US that they don't have in Mexico are increased regulatory costs (meaning huge administrative staff), red tape (mostly around excessive malpractice and CYA requirements) leading to incredibly overpriced line items (e.g. $1500 to hook you up to an oxygen tank), and a weird incentive scheme where it makes economic sense for doctors to waste money on pointless CYA tasks like uneccesary medical scans and specialist consultations. Two, fully private doctors in the US are actually vastly cheaper if you pay in cash. I have shitty major medical insurance, so I just pay in cash for routine medicine (checkups, prescriptions, etc.). It ends up being a fraction of the cost of what I would pay with insurance at a public hospital. There are a lot of reasons it's so much cheaper, but the biggest is that getting money out of insurance companies is itself a huge money sink for doctors. Insurance companies can't afford to be good or easy anymore.
I don't dispute that care in US is more expensive for a variety of reasons.
But your post stated that the only, or at least the biggest, reason why that difference exists between US and Mexico is because of less regulation in the latter, and more healthy private market resulting from that. I point out that a large part of that difference does have to do with standard of living. It's not true just for healthcare - the same goes for most other things. It's why people from US often retire to those countries.
> Doctors already get paid US wages. Not really sure what you were thinking when you wrote that.
Of course, but they get paid out of your insurance. You were, again, comparing that system to going to a place like Mexico, and paying out of pocket. If you were to pay out of pocket here in US for those wages, it wouldn't really be affordable.
But your post stated that the only, or at least the biggest, reason why that difference exists between US and Mexico is because of less regulation in the latter, and more healthy private market resulting from that. I point out that a large part of that difference does have to do with standard of living. It's not true just for healthcare - the same goes for most other things. It's why people from US often retire to those countries.
> Doctors already get paid US wages. Not really sure what you were thinking when you wrote that.
Of course, but they get paid out of your insurance. You were, again, comparing that system to going to a place like Mexico, and paying out of pocket. If you were to pay out of pocket here in US for those wages, it wouldn't really be affordable.
The problem is that you cannot have any sort of sensible health insurance on an unregulated market.
On an unregulated market, insurers would begin to drop people who get chronically sick, or land in risk groups.
Before you can say: "so just forbid dropping insured people" - that's what US initially did. But there was a simple loophole around that - you don't drop people per se. You just start a new insurance company, and offer a lower rate to the healthy people who want to sign in.
The healthy go to the new one. The sick stay with the old one. Old one's costs increase, they get pushed to the everyone who was left, to the level that is unsustainable, and either the sick leave too, or the company dissolves.
So you need more regulation preventing companies from only taking up healthy people. But you can't go overboard, because if a sick person can sign up at will, people will only seek insurance when they get sick.
And you end up with the clusterfuck that US is right now. Which they are exactly for the reason of trying to avoid government intervention and government-set prices for services.
And then you have medical companies and doctors, who invent a new treatment, and the insurance is obliged to cover that treatment. So it's complicated negotiations there too. Without government interference, the medical companies have no incentive to keep the costs down really.
On the other hand, you - as a patient - probably don't want the government to tell private medical companies how much to charge for what. That's a new kind of problem altogether.
On an unregulated market, insurers would begin to drop people who get chronically sick, or land in risk groups.
Before you can say: "so just forbid dropping insured people" - that's what US initially did. But there was a simple loophole around that - you don't drop people per se. You just start a new insurance company, and offer a lower rate to the healthy people who want to sign in.
The healthy go to the new one. The sick stay with the old one. Old one's costs increase, they get pushed to the everyone who was left, to the level that is unsustainable, and either the sick leave too, or the company dissolves.
So you need more regulation preventing companies from only taking up healthy people. But you can't go overboard, because if a sick person can sign up at will, people will only seek insurance when they get sick.
And you end up with the clusterfuck that US is right now. Which they are exactly for the reason of trying to avoid government intervention and government-set prices for services.
And then you have medical companies and doctors, who invent a new treatment, and the insurance is obliged to cover that treatment. So it's complicated negotiations there too. Without government interference, the medical companies have no incentive to keep the costs down really.
On the other hand, you - as a patient - probably don't want the government to tell private medical companies how much to charge for what. That's a new kind of problem altogether.
You don't need industry-specific regulations to prevent insurance fraud; you just need to enforce insurance contracts. If you're worried about becoming a huge medical cost in 20 years, find an insurance company that's willing to go into an n-year preset-rate contract. You might pay a premium corresponding to the increased risk on the part of the insurance company, but if insurance companies were allowed to do this and people wanted it, the correct price would be found sooner rather than later.
Insurance companies already do something like this. It's called "long term care insurance" and it is entirely separate from normal health insurance which they don't want to place on a multi-year contract because the health care costs themselves are changing too much year-to-year for it to be viable.
So, how come the car insurance market manages to survive? The industry can dump chronically risky drivers and cars all it wants.
Car insurance is a two tier market and full insurance is not mandatory. So people who are way too risky do without, or they just don't get their own car. You can't do the same thing with your health.
> There's a reason medical tourism to Mexico and India is so prevalent.
Yes: health care in Mexico and India is cheaper. Not better. Cheaper.
> I wouldn't want to get, say, complicated brain surgery in Mexico.
I rest my case.
Yes: health care in Mexico and India is cheaper. Not better. Cheaper.
> I wouldn't want to get, say, complicated brain surgery in Mexico.
I rest my case.
I personally find Indian capitalistic medical care equivalent to the US. Under most circumstances (i.e., I don't need a super specialist who happens to be located elsewhere) I'll always choose to have work done here in India.
I've made this choice before and never regretted it. You can read about a description of my spine surgery if you like:
https://www.chrisstucchio.com/blog/2015/medical_tourism.html
Similarly, I messed up my wrist a month ago while I was in the US. I waited until I got to India to even bother with a doctor - too much hassle in the US ("no I don't want narcotics, just tell me how to fix it") whereas over here I just swiped a credit card. Unlike in the US, I even knew the price before I bought services!
(Any doctor/hospital who won't tell you the price will get no business - that's capitalism + cost conscious consumers for you.)
I've made this choice before and never regretted it. You can read about a description of my spine surgery if you like:
https://www.chrisstucchio.com/blog/2015/medical_tourism.html
Similarly, I messed up my wrist a month ago while I was in the US. I waited until I got to India to even bother with a doctor - too much hassle in the US ("no I don't want narcotics, just tell me how to fix it") whereas over here I just swiped a credit card. Unlike in the US, I even knew the price before I bought services!
(Any doctor/hospital who won't tell you the price will get no business - that's capitalism + cost conscious consumers for you.)
> I personally find Indian capitalistic medical care equivalent to the US
Having had multiple friends and relatives get treated for identical diseases and/or undergo identical treatments between the United States and India, I respectfully disagree. Survival, technology, training and quality of care are undoubtedly higher in America.
Having had multiple friends and relatives get treated for identical diseases and/or undergo identical treatments between the United States and India, I respectfully disagree. Survival, technology, training and quality of care are undoubtedly higher in America.
Comparing averages, I agree. Most of India is rural poverty, with few good hospitals. Or, for that matter, few good toilets.
Comparing the places available to me - an upper middle class professional - I strongly prefer India. Spine surgery cost me 1 month of the average Indian software engineer's salary (vs easily 1 year of salary in the US), and quality was equivalent.
My doctor was as good as any in the UK (he was licensed to practice there, in fact), he just came back home for family reasons.
Comparing the places available to me - an upper middle class professional - I strongly prefer India. Spine surgery cost me 1 month of the average Indian software engineer's salary (vs easily 1 year of salary in the US), and quality was equivalent.
My doctor was as good as any in the UK (he was licensed to practice there, in fact), he just came back home for family reasons.
> Not better. Cheaper.
Nope, it's also better for the vast majority of medicine. Have you ever used Mexican private healthcare? I have! Customer service and convenience is through the roof compared to US healthcare.
> I rest my case.
Not a very good case!
The reason you wouldn't want to get complicated surgery in Mexico is that they don't have as many medical specialists, or as much equipment. The US is richer and has better schooling, so we have a huge supply of experts and medical technology. For the cutting edge of medicine, the benefit of having this outweighs the costs of receiving care in the US.
However, almost all medicine is simple and doesn't require a particle accelerator or superconductors or whatever else you can find in cutting-edge American medicine.
I wouldn't buy a radiation-hardened satellite microprocessor from China, but I'm perfectly happy to buy a Chinese laptop!
Nope, it's also better for the vast majority of medicine. Have you ever used Mexican private healthcare? I have! Customer service and convenience is through the roof compared to US healthcare.
> I rest my case.
Not a very good case!
The reason you wouldn't want to get complicated surgery in Mexico is that they don't have as many medical specialists, or as much equipment. The US is richer and has better schooling, so we have a huge supply of experts and medical technology. For the cutting edge of medicine, the benefit of having this outweighs the costs of receiving care in the US.
However, almost all medicine is simple and doesn't require a particle accelerator or superconductors or whatever else you can find in cutting-edge American medicine.
I wouldn't buy a radiation-hardened satellite microprocessor from China, but I'm perfectly happy to buy a Chinese laptop!
The reason is that what you pay for "cheap" service is actually the premium service over there. Super expensive private hospital in US would provide as good customer service.
Case in point in north Texas: Witness the staggering difference between the specialty hospitals that have cropped up like weeds over the past decade (many of them are clustered around the larger hospitals in places like Plano and Denton) versus, say, the public and not-for-profit hospitals that must take all comers.
Most of these specialty hospitals oh-so-carefully do not offer "Emergency Services" (as in, they don't staff a room called an "emergency room" even though they, conveniently, have an ambulance bay and are staffed 24/7) so they don't have to accept Medicare or several of the known-to-pay-on-the-low-side private insurance plans.
Meanwhile, Parkland, JPS, Baylor, and UTSW get to deal with the "cast-offs" who have no other choice.
Most of these specialty hospitals oh-so-carefully do not offer "Emergency Services" (as in, they don't staff a room called an "emergency room" even though they, conveniently, have an ambulance bay and are staffed 24/7) so they don't have to accept Medicare or several of the known-to-pay-on-the-low-side private insurance plans.
Meanwhile, Parkland, JPS, Baylor, and UTSW get to deal with the "cast-offs" who have no other choice.
Yep, you can get luxury suites at hospitals in the US; and they'll serve your every whim. And that "better customer service" often results in worse medical care. Just google "VIP syndrome" and see tons of examples where it appears that this "better customer service" of deviating from procedure killed these VIPs.
That doesn't make sense. The cost of goods doesn't magically scale linearly with GDPPC, even service-heavy goods. Even if it did, that wouldn't be a valid explanation. According to the OECD, average net-adjusted household disposable income is only 3x higher in the US than Mexico, but our medical care is many times more expensive than that.
US medical care is much much more expensive than most, if not all, developed world. I'm too lazy for google for source, but there was statistics that US gdp/capita medical expenses are like 2x next country. Even in super expensive countries doctors don't earn as much which is part of the issue.
I'm from rather cheap European country. We're on the receiving end of medical tourism. To cut costs, private hospitals save wherever they can. Nurses (as well as junior doctors) are paid less (gdp-adjusted) than in richer countries. Corners are cut in non-essential (parts of) procedures. Behind-the-scenes equipment is outdated. Anything customer-facing is top notch though.
Source: ex-gf was a nurse in private hospital
I'm from rather cheap European country. We're on the receiving end of medical tourism. To cut costs, private hospitals save wherever they can. Nurses (as well as junior doctors) are paid less (gdp-adjusted) than in richer countries. Corners are cut in non-essential (parts of) procedures. Behind-the-scenes equipment is outdated. Anything customer-facing is top notch though.
Source: ex-gf was a nurse in private hospital
US healthcare is expensive and, by some measures, not that good.
http://visual.ons.gov.uk/how-does-uk-healthcare-spending-com...
> Despite spending, by far, the largest amount on healthcare, the USA was among the 10 OECD countries with the lowest life expectancy.
What you propose will make it more expensive, and doesn't seem to address anything around patient safety or efficiacy of treatment. You will end up with nicer carpets and comfier chairs in the waiting rooms. The US medical system is currently risk averse, which leads to a lot of over-diagnosis and over treatment, which cause harm.
http://visual.ons.gov.uk/how-does-uk-healthcare-spending-com...
> Despite spending, by far, the largest amount on healthcare, the USA was among the 10 OECD countries with the lowest life expectancy.
What you propose will make it more expensive, and doesn't seem to address anything around patient safety or efficiacy of treatment. You will end up with nicer carpets and comfier chairs in the waiting rooms. The US medical system is currently risk averse, which leads to a lot of over-diagnosis and over treatment, which cause harm.
Yes, as I said multiple times, US healthcare is bad.
> What you propose will make it more expensive
Do you have any evidence for this, or are you just going to drop the claim and walk away?
I have some constructive evidence to the contrary, which I've already mentioned; the medical systems of Mexico and India.
> The US medical system is currently risk averse
Which is one of the many reasons that substantially deregulated medicine is a good idea.
> What you propose will make it more expensive
Do you have any evidence for this, or are you just going to drop the claim and walk away?
I have some constructive evidence to the contrary, which I've already mentioned; the medical systems of Mexico and India.
> The US medical system is currently risk averse
Which is one of the many reasons that substantially deregulated medicine is a good idea.
Mexico health care is doing very poorly [1] and they've switched to single-payer euro-style system recently [2]. India is switching to single-payer too [3]. Their current numbers don't look nice either.
[1] https://en.wikipedia.org/wiki/Healthcare_in_Mexico
[2] http://commonhealth.legacy.wbur.org/2012/08/mexican-universa...
[3] http://international.commonwealthfund.org/countries/india/
[1] https://en.wikipedia.org/wiki/Healthcare_in_Mexico
[2] http://commonhealth.legacy.wbur.org/2012/08/mexican-universa...
[3] http://international.commonwealthfund.org/countries/india/
I'm referring to the separate, private medical industry in Mexico, not the horrible state-managed medical system. But you're right; medical systems with heavy government involvement are usually bad.
But regular Mexicans don't go to those private hospitals. Actually Mexico is now introducing more gov involvement to fix things. They were much more lax before.
Btw, single-payer health care is going pretty well over there in Europe...
Btw, single-payer health care is going pretty well over there in Europe...
If America completely deregulated the medical industry then where would you get that complex brain surgery? It doesn't sound like completely deregulated markets cater to that speciality.
It sounds great until you need something that isn't routine.
It sounds great until you need something that isn't routine.
Speaking from experience, it's easier to get non-routine procedures done in France than in the USA. This is because the provider is less concerned with profitability of the technique.
So no. It's especially great when you need something that isn't routine.
So no. It's especially great when you need something that isn't routine.
Still America. We have the best doctors because we're rich and have the vast majority of the top schools, not because of red tape.
You're claiming that "totally deregulated private doctors" are better in terms of cost and service than any other system, but you can't give a single instance of a first world system that does this. More than that, you seem to be cherry picking the best of the examples you did give, which is not really helpful since the best in the U.S. (if you have a good insurance plan) is as good or better than these other countries.
India has some good healthcare in the major cities and major problems in the rural areas where many of its people live. Mexico is a public-private hybrid, like Australia and many other countries. Again, you can probably find excellent care in some urban areas which likely cater to medical tourists, but they do not match up to more advanced countries as far as high tech care goes.
If you can't give an apples-to-apples comparison for what you're advocating, then I don't see how helpful your example of "private being better" really is.
India has some good healthcare in the major cities and major problems in the rural areas where many of its people live. Mexico is a public-private hybrid, like Australia and many other countries. Again, you can probably find excellent care in some urban areas which likely cater to medical tourists, but they do not match up to more advanced countries as far as high tech care goes.
If you can't give an apples-to-apples comparison for what you're advocating, then I don't see how helpful your example of "private being better" really is.
Kaiser of Kaiser Permanente started out making ships during WW2
There are a few problems with this explanation:
1. FDR did not propose a wage cap until 1942, 3 years after the Great Depression had ended. It was a temporary wartime fundraising effort (and was quite popular with the public). In fact, health insurance really first came into existence during the Great Depression (mostly to ensure physicians and hospitals got paid).
2. FDR's wage cap did not pass.
What actually happened was the passing of the the Stabilization Act of 1942, which gave FDR a power (that he invoked) to freeze wages and salaries during the war. The freeze was deeply unpopular with the labor movement, who threatened mass strikes. As a compromise, congress exempted health insurance (and other benefits like PTO and pensions) from the freeze.
This was certainly a contributing factor (proportion of US population with healthcare roughly doubled from 1940 to 1945), but ignores the other factors that prompted the rise of employer sponsored healthcare. Indeed, by 1945, less than a quarter of Americans had health insurance.
Rather, the two largest contributors to employer-sponsored health insurance was the demand of health coverage by labor unions and the 1954 legislative change that made health insurance tax exempt.
1. FDR did not propose a wage cap until 1942, 3 years after the Great Depression had ended. It was a temporary wartime fundraising effort (and was quite popular with the public). In fact, health insurance really first came into existence during the Great Depression (mostly to ensure physicians and hospitals got paid).
2. FDR's wage cap did not pass.
What actually happened was the passing of the the Stabilization Act of 1942, which gave FDR a power (that he invoked) to freeze wages and salaries during the war. The freeze was deeply unpopular with the labor movement, who threatened mass strikes. As a compromise, congress exempted health insurance (and other benefits like PTO and pensions) from the freeze.
This was certainly a contributing factor (proportion of US population with healthcare roughly doubled from 1940 to 1945), but ignores the other factors that prompted the rise of employer sponsored healthcare. Indeed, by 1945, less than a quarter of Americans had health insurance.
Rather, the two largest contributors to employer-sponsored health insurance was the demand of health coverage by labor unions and the 1954 legislative change that made health insurance tax exempt.
There are many things that started 70 years ago which have long since gone.
So, there must be forces which sustain the US model, where the employer pays for medical insurance.
Also, I fail to see how employers offering medical insurance should make insurance for an individual any more expensive.
So, while I appreciate the sentiment that something is clearly wrong, the two things that you mentioned are not the cause.
So, there must be forces which sustain the US model, where the employer pays for medical insurance.
Also, I fail to see how employers offering medical insurance should make insurance for an individual any more expensive.
So, while I appreciate the sentiment that something is clearly wrong, the two things that you mentioned are not the cause.
A big one is that there is a tax deduction for employer provided health insurance. So offering a decent health plan is more compensation than just handing over the cost of the plan (which would be taxed).
As far as how employer coverage can drive up individual costs, there are a couple of factors. One is that people with good health plans often don't pay attention to how much they cost, and often don't have much of a deductible, so they just use the medical system without paying too much attention to costs. That at least has the potential to drive medical prices up.
The other is that people in the group insurance market tend to be somewhat healthier than the individual market. So the pool for individual insurance is more expensive to insure. Setting aside discussions about whether it is fair or not, it does result in higher costs for the individual market.
As far as how employer coverage can drive up individual costs, there are a couple of factors. One is that people with good health plans often don't pay attention to how much they cost, and often don't have much of a deductible, so they just use the medical system without paying too much attention to costs. That at least has the potential to drive medical prices up.
The other is that people in the group insurance market tend to be somewhat healthier than the individual market. So the pool for individual insurance is more expensive to insure. Setting aside discussions about whether it is fair or not, it does result in higher costs for the individual market.
The reasons that you have given might be part of the explanation, but on their own they do not explain it.
Yes, it is true that there is a tax benefit to employers purchasing healthcare insurance, which is tax deductible, and providing it as a benefit in kind.
However, it does not follow at all from that the insurers should benefit: their costs are not affected and in a competitive market, they would price at marginal cost.
Yes, it is true that people in employer plans could be perceived as being a better risk than those who are do not have them.
They would still be better risks (and 'deserving' of a lower premium) however they obtained their health insurance.
So, as I said before, there must be something else going on.
Similar arguments apply to your claim that employers are less price sensitive than consumers - that really is implausible, given their buying power and incentives to maximise profits.
Yes, it is true that there is a tax benefit to employers purchasing healthcare insurance, which is tax deductible, and providing it as a benefit in kind.
However, it does not follow at all from that the insurers should benefit: their costs are not affected and in a competitive market, they would price at marginal cost.
Yes, it is true that people in employer plans could be perceived as being a better risk than those who are do not have them.
They would still be better risks (and 'deserving' of a lower premium) however they obtained their health insurance.
So, as I said before, there must be something else going on.
Similar arguments apply to your claim that employers are less price sensitive than consumers - that really is implausible, given their buying power and incentives to maximise profits.
Employer coupled insurance has certain pathologies. But, I think that insurance as a funding model has is a bigger problem.
"It's a terrible Hobson's choice between affordable health insurance and protecting one's genetic privacy."
Genetics is just another way of getting useful information for pricing insurance efficiently, guessing future medical expenses more accurately. To the extent that pricing becomes efficient it ceases to be insurance. This is basically the case for sick people. Their medical costs are known and high. Price efficiency puts more people in that boat. Known high costs expensive. Known low costs cheap. In an insurance based system, information is priced in.
Insurance is good for costs that are unlikely but high. In medicine, we're looking for a system that caters to all medical scenarios regardless of likelihood. Insurance only makes sense for some.
"It's a terrible Hobson's choice between affordable health insurance and protecting one's genetic privacy."
Genetics is just another way of getting useful information for pricing insurance efficiently, guessing future medical expenses more accurately. To the extent that pricing becomes efficient it ceases to be insurance. This is basically the case for sick people. Their medical costs are known and high. Price efficiency puts more people in that boat. Known high costs expensive. Known low costs cheap. In an insurance based system, information is priced in.
Insurance is good for costs that are unlikely but high. In medicine, we're looking for a system that caters to all medical scenarios regardless of likelihood. Insurance only makes sense for some.
In the US many have a very flawed way of thinking: if we give more power to companies, than we won't need government. I've met so many bright & creative programmer types who even believe this.
Government should exist to protect it's people and environment. It should have the long term in mind & work with other governments to do the same, creating a level playing field for the companies to be within.
Government should exist to protect it's people and environment. It should have the long term in mind & work with other governments to do the same, creating a level playing field for the companies to be within.
The US's entire concept of "freedom" is wrapped up in this too.
If you take a service, for example household track/rubbish collection, that was being provided inexpensively via a mandatory household tax and move that service to a private company who bills households individually even if it costs more, Americans view this as "progress" that is "more free" (because you could theoretical "opt out").
A lot of other places simply view this as handing a private company a monopoly that used to be a public good (i.e. required but cheap); and because they as citizens now have less money and the same service level, they only lost in terms of quality of life ("freedom" isn't a metric here). Plus the externalities of making it optional, like having people illegally discard their trash by the side of the road.
This same thinking is prevalent throughout the US, from HOAs, to utilities (electric, gas, water, trash), to healthcare, to public transport, and so on. And none of it is REALLY about capitalism as these companies aren't competing with anyone else by the nature of the deal that was struck when the public service was sold. All people care about is "Keep government out of my X (even if it costs 2x as much)."
If you take a service, for example household track/rubbish collection, that was being provided inexpensively via a mandatory household tax and move that service to a private company who bills households individually even if it costs more, Americans view this as "progress" that is "more free" (because you could theoretical "opt out").
A lot of other places simply view this as handing a private company a monopoly that used to be a public good (i.e. required but cheap); and because they as citizens now have less money and the same service level, they only lost in terms of quality of life ("freedom" isn't a metric here). Plus the externalities of making it optional, like having people illegally discard their trash by the side of the road.
This same thinking is prevalent throughout the US, from HOAs, to utilities (electric, gas, water, trash), to healthcare, to public transport, and so on. And none of it is REALLY about capitalism as these companies aren't competing with anyone else by the nature of the deal that was struck when the public service was sold. All people care about is "Keep government out of my X (even if it costs 2x as much)."
Yeah, I was just having a conversation with someone today about how it never works out in practice. There is no free market, and in anything approaching it, companies simply e.g. collude to keep prices high or make things unnecessarily complex. Look at cell phone plans and what "unlimited" means, for example. Not that the wireless ISP industry is unregulated (far from it), but why not just start your own and fix it? Free market, right? Start a healthcare company and undercut everyone because free market. Start an ISP and take down Comcast, etc.
The point of a business is to make a profit. This is many times at odds with what people actually need to e.g. Stay alive. I'm not sure why many people keep attempting to suggest businesses as a solution to the modern basic needs of humans. They're fundamentally misaligned.
I guess there is still debate around if a modern society should let people suffer and die because they did not generate or inherit enough money to pay for medical care. It saddens me that our baseline of giving a shit about other people in our society is pretty low in America, even though we have far beyond the means to do so. Enough people with enough power here would rather have a few extra % in their shell company bank accounts instead of increasing the standard of living for the people of the society in which they exist.
"A rising tide lifts all boats"
The point of a business is to make a profit. This is many times at odds with what people actually need to e.g. Stay alive. I'm not sure why many people keep attempting to suggest businesses as a solution to the modern basic needs of humans. They're fundamentally misaligned.
I guess there is still debate around if a modern society should let people suffer and die because they did not generate or inherit enough money to pay for medical care. It saddens me that our baseline of giving a shit about other people in our society is pretty low in America, even though we have far beyond the means to do so. Enough people with enough power here would rather have a few extra % in their shell company bank accounts instead of increasing the standard of living for the people of the society in which they exist.
"A rising tide lifts all boats"
> why not just start your own and fix it?
Because the State punishes you if you start emitting? It's called spectrum allocation.
Just because you can technically start a company doesn't mean you have anything resembling a free market, and in fact the examples you gave (wireless and healthcare) are two of the most regulated industries.
That doesn't mean the free market wouldn't be even worse than what we have now. It's just that you can't use that argument against it.
> The point of a business is to make a profit. This is many times at odds with what people actually need to e.g. Stay alive. I'm not sure why many people keep attempting to suggest businesses as a solution to the modern basic needs of humans. They're fundamentally misaligned.
And the point of the State is to further the ambitions of politicians and their pay masters (like those business owners who lobby them).
You can never get real alignment, so that's an irrelevant argument. Even parents are often not aligned with the welfare of their children.
Because the State punishes you if you start emitting? It's called spectrum allocation.
Just because you can technically start a company doesn't mean you have anything resembling a free market, and in fact the examples you gave (wireless and healthcare) are two of the most regulated industries.
That doesn't mean the free market wouldn't be even worse than what we have now. It's just that you can't use that argument against it.
> The point of a business is to make a profit. This is many times at odds with what people actually need to e.g. Stay alive. I'm not sure why many people keep attempting to suggest businesses as a solution to the modern basic needs of humans. They're fundamentally misaligned.
And the point of the State is to further the ambitions of politicians and their pay masters (like those business owners who lobby them).
You can never get real alignment, so that's an irrelevant argument. Even parents are often not aligned with the welfare of their children.
Yes I'm sure no FCC would surely mean that wireless spectrum would remain usable.
Apparently the laws of physics are an invention of the state.
Apparently the laws of physics are an invention of the state.
Like I said, maybe the result would be even worse. But that doesn't mean one can blame the current mobile internet situation on the free market, since it definitively isn't one.
>>I've met so many bright & creative programmer types who even believe this.
I would posit that they aren't very bright if they actually believe it.
I would posit that they aren't very bright if they actually believe it.
Just because somebody is very apt at one particular kind of mental skill, doesn't necessarily make them immune to believing very silly things.
In fact, Obamacare (which significantly mitigates the healthcare related costs of changing jobs) had no noticeable effect on startup formation or job separations. I've seen similarly no effect from Romneycare.
https://images.washingtonpost.com/?url=http://img.washington...
https://www.bls.gov/opub/ted/images/2010/ted_20100816.png
Do you have any evidence (as opposed to hypothetical anecdote) suggesting this is actually a significant factor?
https://images.washingtonpost.com/?url=http://img.washington...
https://www.bls.gov/opub/ted/images/2010/ted_20100816.png
Do you have any evidence (as opposed to hypothetical anecdote) suggesting this is actually a significant factor?
> In fact, Obamacare (which significantly mitigates the healthcare related costs of changing jobs)
The ACA doesn't all that significantly affect the healthcare-related impact of switching jobs (it slightly mitigates the healthcare related cost of being a difficult-to-insure individual and moving from a job that provides a group plan to one that doesn't), and the parts of it that did have some impact on that were have not been in place long enough to have substantially affected people's expectations and behavior.
The ACA doesn't all that significantly affect the healthcare-related impact of switching jobs (it slightly mitigates the healthcare related cost of being a difficult-to-insure individual and moving from a job that provides a group plan to one that doesn't), and the parts of it that did have some impact on that were have not been in place long enough to have substantially affected people's expectations and behavior.
The parent poster said this: ...start companies [without loss of health care], and losing healthcare as you change jobs...
Obamacare does in fact solve both these problems.
According to you, how long will it take for potential startup founders to figure out that Obamacare actually gives them the ability to do a startup without losing health insurance? 10 years? 20 years? Is a person who is unaware of Obamacare after many years (and unable to adapt to changing conditions with years of warning) really a plausible startup founder?
Obamacare does in fact solve both these problems.
According to you, how long will it take for potential startup founders to figure out that Obamacare actually gives them the ability to do a startup without losing health insurance? 10 years? 20 years? Is a person who is unaware of Obamacare after many years (and unable to adapt to changing conditions with years of warning) really a plausible startup founder?
We have single payer here in France and we are way less entrepreneurial than the US. In fact most entrepreneurs here hate single payer as it imposes huge taxation on them for something that would be cheap under a private insurance system because most startup founders are young.
I'm not that familiar with France's system that much, but if national insurance is mandatory, wouldn't private insurance be essentially subsidised by it? Which is why you think it's so cheap in comparison. Can you even opt for private only insurance in France? It would be the only way to compare costs.
Don't take it wrong, I agree France is less entrepreneurial, I just don't think healthcare is the reason.
Don't take it wrong, I agree France is less entrepreneurial, I just don't think healthcare is the reason.
This is coming up as part of the reopening of the healthcare plan debate in the US. The nice framing of flat healthcare insurance pricing is that it "doesn't discriminate against the elderly." But an equally valid framing is that "younger people subsidize older people."
But this question is really at the heart of insurance mandates however imposed. In the absence of such, young healthy people don't want to pay for insurance because they don't really take into account unlikely events and they look at the health care they're likely to need for routine accidents, etc. and the insurance looks far more costly than their expected benefit (and it is).
But this question is really at the heart of insurance mandates however imposed. In the absence of such, young healthy people don't want to pay for insurance because they don't really take into account unlikely events and they look at the health care they're likely to need for routine accidents, etc. and the insurance looks far more costly than their expected benefit (and it is).
Places I've worked have provide life, health, AD&D, pet, dental, vision, and lawyer insurance. So yeah, it's a lot more than health.
But I still agree with you -- we need to figure out a way to separate insurance from a job. Although I don't like the idea of just precluding them from offering it. If a company wants to offer insurance we shouldn't stop them. We just need to make it so they have little advantage to do so.
But I still agree with you -- we need to figure out a way to separate insurance from a job. Although I don't like the idea of just precluding them from offering it. If a company wants to offer insurance we shouldn't stop them. We just need to make it so they have little advantage to do so.
I work in the UK with excellent national health service, but I still get private health insurance from my employer - mostly so that I can see a specialist quicker than through NHS. But it's really not too much of a perk for my employer to provide, we have the highest tier of insurance and it costs about ~$400/year.
"figure out" - the rest of the first world has implemented this.
Pick a model, deploy, tweak for circumstance.
There's not a learning problem here.
Pick a model, deploy, tweak for circumstance.
There's not a learning problem here.
I completely agree with your sentiment. “We don't get any other personal insurance from work” isn't quite true, though. Many companies include at least minimal life & disability insurance.
[deleted]
I get the sentiment but a lot of people do get life insurance through work.
It's simply insane to propose such a bill ... they may as well as people to sell body parts to cover healthcare costs ... it's simply not acceptable!
What is wrong with people selling their organs?
Almost 50% of US citizens don't have enough money on the bank to replace a broken 400$ item.
How many would out of desperation i.e. healthcare costs for relatives sell an organ?
1: https://www.theatlantic.com/magazine/archive/2016/05/my-secr...
How many would out of desperation i.e. healthcare costs for relatives sell an organ?
1: https://www.theatlantic.com/magazine/archive/2016/05/my-secr...
You seem to be implying that is a bad thing.
What is wrong with that? Allowing them to donate organs gives them more choices. Who owns a person's body?
And donating the organ helps people who needs organs. The person who donates and the person who receives do this voluntarily if they feel they benefit.
I think it's deplorable that people are dying from lack of organ donations while there are people with healthy organs who are poor. Legalizing organ donation would help both groups.
See https://blog.jaibot.com/the-copenhagen-interpretation-of-eth... .
What is wrong with that? Allowing them to donate organs gives them more choices. Who owns a person's body?
And donating the organ helps people who needs organs. The person who donates and the person who receives do this voluntarily if they feel they benefit.
I think it's deplorable that people are dying from lack of organ donations while there are people with healthy organs who are poor. Legalizing organ donation would help both groups.
See https://blog.jaibot.com/the-copenhagen-interpretation-of-eth... .
Having a compulsory 'lottery' for organ donations for all would help both groups too.
How would you incentivize donors? Are you saying we should force people to donate organs? That is horrible.
Wow! I wonder how long it will be before genetic tests become as pedestrian as finger prints.
Is it applicable to Law makers?
I suppose if this is passed it goes to the many reasons why I enjoy living my life trading with my own funds without the stability of holding a career with an employer. So far no drug tests is pretty much the winner but if genetic testing bill becomes law then I'm pretty sure that tops drug testing. I'm not a fan of background checks and I refuse to give references..but that's easy for me since I'm not applying to jobs. I wish more people collectively refused to participate in the whole reference thing as well. Nonetheless, I suspect this bill will become law and more things to occur to make working for employers even more invasive.
Why are you against references?
My current job didn't require drug tests or references. Just resume + whiteboard coding.
My current job didn't require drug tests or references. Just resume + whiteboard coding.
It's more of a personal preference than overt philosophical stance. I just don't think it's anyone's business where I'm applying or may end up working (I don't want the references to know where I'm applying or may end up working).
Edit: switched "stance" for "preference"
Edit: switched "stance" for "preference"
Employers collecting on death insurances might get a higher ROI now with access to such information isn't it? This gets too far.
While I think health insurance shouldn't be attached to employers, I don't really have an objection to insurance companies using genetic testing. This is certainly an unpopular opinion here, but as someone who believes that medical care is a service, not a right: I think it's unfair to force people to subsidize the healthcare of other people, regardless of the mechanism used.
When you have car insurance, the insurance companies are allowed to use statistical techniques to predict how much you are going to cost them. Competition between insurance companies involves treading the line between beating the price of other insurance companies while charging slightly more than the customer is expected to cost.
If we let health insurance companies do this, then yes, healthcare would get substantially more expensive for very risky/unhealthy people. Of course, it would also get drastically less expensive for healthy people. From a moral perspective, I think this is preferable, but obviously not everyone will agree.
Now, from a utilitarian perspective, these two possibilities seem roughly equivalent at first glance. However, I'd argue that the latter (where insurance companies are allowed to set prices like car insurance) has a number of (significant) positive side effects.
The largest side effect is that it incentivizes customer health improvement. A lot of health risks, including at least the top 6 causes of death worldwide (heart disease, stroke, lung infections, COPD, respiratory cancers, diabetes) can be substantially mitigated by personal choices such as diet and exercise. If you had to pay an extra $200/mo to your insurance company because you were morbidly obese, one would expect that this would encourage a lot of people to start eating better. Let the market do the heavy lifting! This is exactly the sort of thing that the market excels at. Society benefits from healthier people, but in almost all countries rich enough to have insurance (including the US and nations with socialized healthcare), there is no mechanism to incentivize this! An actual insurance market would do the job.
When you have car insurance, the insurance companies are allowed to use statistical techniques to predict how much you are going to cost them. Competition between insurance companies involves treading the line between beating the price of other insurance companies while charging slightly more than the customer is expected to cost.
If we let health insurance companies do this, then yes, healthcare would get substantially more expensive for very risky/unhealthy people. Of course, it would also get drastically less expensive for healthy people. From a moral perspective, I think this is preferable, but obviously not everyone will agree.
Now, from a utilitarian perspective, these two possibilities seem roughly equivalent at first glance. However, I'd argue that the latter (where insurance companies are allowed to set prices like car insurance) has a number of (significant) positive side effects.
The largest side effect is that it incentivizes customer health improvement. A lot of health risks, including at least the top 6 causes of death worldwide (heart disease, stroke, lung infections, COPD, respiratory cancers, diabetes) can be substantially mitigated by personal choices such as diet and exercise. If you had to pay an extra $200/mo to your insurance company because you were morbidly obese, one would expect that this would encourage a lot of people to start eating better. Let the market do the heavy lifting! This is exactly the sort of thing that the market excels at. Society benefits from healthier people, but in almost all countries rich enough to have insurance (including the US and nations with socialized healthcare), there is no mechanism to incentivize this! An actual insurance market would do the job.
> I think it's unfair to force people to subsidize the healthcare of other people, regardless of the mechanism used.
This is literally car insurance in the United States. You buy insurance, put money up front for your own health, or risk paying a penality. It's also literally the ACA.
> If let health insurance companies do this, then yes, healthcare would get substantially more expensive for very risky/unhealthy people.
Unaffordable. My mother in law died from cancer recently. Coverage was impossible before; in America's free market that constantly pays out dividends. The ACA was the first time any insurance was affordable.
I'm sorry, but the views you've put forth appear to diminish the plight of others who aren't young and healthy. Those views and policies would kill my friend afflicted with an autoimmune disorder.
_Edit: spelling_
This is literally car insurance in the United States. You buy insurance, put money up front for your own health, or risk paying a penality. It's also literally the ACA.
> If let health insurance companies do this, then yes, healthcare would get substantially more expensive for very risky/unhealthy people.
Unaffordable. My mother in law died from cancer recently. Coverage was impossible before; in America's free market that constantly pays out dividends. The ACA was the first time any insurance was affordable.
I'm sorry, but the views you've put forth appear to diminish the plight of others who aren't young and healthy. Those views and policies would kill my friend afflicted with an autoimmune disorder.
_Edit: spelling_
I can't imagine how people have such an incorrect view of how insurance works.
No, car insurance is not you subsidizing other people. Car insurance is you paying in proportion to your own estimated risk. That means if your expected costs are 5x higher (nicer car, young driver, etc.) you pay 5x more.
Medical insurance in the US emphatically does not work this way. More expensive people don't pay proportionately more than cheap people, meaning that the expensive people are being subsizidized. You should be alarmed at the fact that you apparently fundamentally misunderstood the way insurance works in an open market, or what the ACA is. The only part of the ACA that is even reminiscent of car insurance is the individual mandate, which is actually way worse than car insurance because you don't need to buy car insurance just for being alive. You only need car insurance if you drive on public roads.
It's too bad that your friend has a disease, but I'd rather have them pay for it than pass the bill off to a bunch of innocent people who aren't sick. If you choose to have tunnel vision and focus on health alone, it's worth noting that the second-order effects of making other people's lives more expensive will also include worsened health from poorer nutrition, increased stress, less frequent medical consultation, etc.
No, car insurance is not you subsidizing other people. Car insurance is you paying in proportion to your own estimated risk. That means if your expected costs are 5x higher (nicer car, young driver, etc.) you pay 5x more.
Medical insurance in the US emphatically does not work this way. More expensive people don't pay proportionately more than cheap people, meaning that the expensive people are being subsizidized. You should be alarmed at the fact that you apparently fundamentally misunderstood the way insurance works in an open market, or what the ACA is. The only part of the ACA that is even reminiscent of car insurance is the individual mandate, which is actually way worse than car insurance because you don't need to buy car insurance just for being alive. You only need car insurance if you drive on public roads.
It's too bad that your friend has a disease, but I'd rather have them pay for it than pass the bill off to a bunch of innocent people who aren't sick. If you choose to have tunnel vision and focus on health alone, it's worth noting that the second-order effects of making other people's lives more expensive will also include worsened health from poorer nutrition, increased stress, less frequent medical consultation, etc.
"It's too bad that your friend has a disease, but I'd rather have them pay for it than pass the bill off to a bunch of innocent people who aren't sick."
His friend can't pay for it, so what you're essentially saying is you'd rather have his friend, and people who can't afford their medical care in general, die rather than have others subsidize healthcare through their taxes (or any other way). In other words, because of the current cost of healthcare, only the obscenely-rich get to live while the rest die off. That's just incredibly cruel, vile, and disgusting, but sadly, hardly a minority opinion.
His friend can't pay for it, so what you're essentially saying is you'd rather have his friend, and people who can't afford their medical care in general, die rather than have others subsidize healthcare through their taxes (or any other way). In other words, because of the current cost of healthcare, only the obscenely-rich get to live while the rest die off. That's just incredibly cruel, vile, and disgusting, but sadly, hardly a minority opinion.
> If you had to pay an extra $200/mo to your insurance company because you were morbidly obese, one would expect that this would encourage a lot of people to start eating better.
That homo economicus myth is still going strong? Mental issues and addiction don't exist?
> Let the market do the heavy lifting!
What if the market decides it's not worth the risk and costs to cover the unhealthy? What do we do with the disabled that need more medical supervision?
> This is exactly the sort of thing that the market excels at.
...in some idealised simplified textbook version of reality with simple linear algebra.
That homo economicus myth is still going strong? Mental issues and addiction don't exist?
> Let the market do the heavy lifting!
What if the market decides it's not worth the risk and costs to cover the unhealthy? What do we do with the disabled that need more medical supervision?
> This is exactly the sort of thing that the market excels at.
...in some idealised simplified textbook version of reality with simple linear algebra.
Look at people who need an organ transplant.
Before transplant they have low quality of life. Their treatment is very expensive. They struggle to get an organ. They go through extensive support to help them realise that after the new organ they'll need to take meds for the rest of their life.
They have a very expensive operation that usually requires someone else to die and donate an organ.
After the surgery they need to take medication for the rest of their life.
This medication is the thing that prevents their new organ from being rejected; the thing that stops them going back to that expensive and painful life with a failed organ.
Currently the biggest caused of failure in transplanted organs is that people do not continue to take the meds.
This is the case in the UK where people don't pay for the surgery, and it's the case in the US where people pay considerable amounts for the surgery.
The money that people pay or the consequences for non-compliance don't seem to do much to change behaviour.
Before transplant they have low quality of life. Their treatment is very expensive. They struggle to get an organ. They go through extensive support to help them realise that after the new organ they'll need to take meds for the rest of their life.
They have a very expensive operation that usually requires someone else to die and donate an organ.
After the surgery they need to take medication for the rest of their life.
This medication is the thing that prevents their new organ from being rejected; the thing that stops them going back to that expensive and painful life with a failed organ.
Currently the biggest caused of failure in transplanted organs is that people do not continue to take the meds.
This is the case in the UK where people don't pay for the surgery, and it's the case in the US where people pay considerable amounts for the surgery.
The money that people pay or the consequences for non-compliance don't seem to do much to change behaviour.
> If let health insurance companies do this, then yes, healthcare would get substantially more expensive for very risky/unhealthy people.
Which is more risky/unhealthy - obese couch potato or mountain biker?
The only cheap way of living would be sitting on a couch and doing nothing. But then you gotta work out. Infinite loop :)
Which is more risky/unhealthy - obese couch potato or mountain biker?
The only cheap way of living would be sitting on a couch and doing nothing. But then you gotta work out. Infinite loop :)
A lot of health risks, including at least the top 6 causes of death worldwide (heart disease, stroke, lung infections, COPD, respiratory cancers, diabetes) can be substantially mitigated by personal choices such as diet and exercise
That's true, but genetics is literally the opposite: it's the one thing you definitively can't choose to change. So your argument doesn't work in the case being discussed.
If you had to pay an extra $200/mo to your insurance company because you were morbidly obese, one would expect that this would encourage a lot of people to start eating better.
One would expect that all the existing drawbacks of being morbidly obese would encourage a lot of people to start eating better. Why would this specific drawback work when others haven't?
That's true, but genetics is literally the opposite: it's the one thing you definitively can't choose to change. So your argument doesn't work in the case being discussed.
If you had to pay an extra $200/mo to your insurance company because you were morbidly obese, one would expect that this would encourage a lot of people to start eating better.
One would expect that all the existing drawbacks of being morbidly obese would encourage a lot of people to start eating better. Why would this specific drawback work when others haven't?
Because spending $200/m hits you more than just the thought of future illness.
I don't support this bill, I do want this idea explored / discussed - as in, why should healthy people subsidize costs of insurance for the unhealthy? (as in, is not fair is it?)
I don't support this bill, I do want this idea explored / discussed - as in, why should healthy people subsidize costs of insurance for the unhealthy? (as in, is not fair is it?)
Can we genetically engineer our kids too so they stand a chance in the future?
This article is very scant on details and seems to muddy the waters by comparing things like cholesterol and smoking to genetic screening which doesn't seem to help things.
If how they've framed it is true however, and this may become law, that's the final nail in the coffin for the GOP isn't it? What an absolutely nasty piece of legislation. I feel like the GOP got so much power since it's the usual "sick of the last 8 years" thing--but I think that may reverse fast if laws such as this start hitting people.
Then again, I've unfortunately overestimated the US voters in the past. Please don't let it happen.
If how they've framed it is true however, and this may become law, that's the final nail in the coffin for the GOP isn't it? What an absolutely nasty piece of legislation. I feel like the GOP got so much power since it's the usual "sick of the last 8 years" thing--but I think that may reverse fast if laws such as this start hitting people.
Then again, I've unfortunately overestimated the US voters in the past. Please don't let it happen.
Given her own lowly origins Virginia Foxx (opposed aid for Katrina, a bill against hate crime, hates gays - nice) you'd think someone like her would be against such forced disclosures. It won't affect her because she is nearly dead but her grandchildren will almost certainly carry defects causing hemoglobin mutations for sickle cell anemia, neurogenetic disorders and have increased risk for chromosomal disorders such as Downs. Republicans voting for this kind of widespread intrusion is like turkeys voting for xmas.
>A BILL: To clarify rules relating to nondiscriminatory workplace wellness programs.
>prevention programs that provide incentives, rewards, rebates, surcharges, penalties, or other inducements
How on earth is any of this nondiscriminatory?
>prevention programs that provide incentives, rewards, rebates, surcharges, penalties, or other inducements
How on earth is any of this nondiscriminatory?
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With logic like that, forced abortions could be "workplace wellness" programs.