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U.S. Is a Rich Country with Symptoms of a Developing Nation (bloomberg.com)
143 points by ForHackernews on Feb 23, 2019 | hide | past | favorite | 223 comments

I am inclined to agree with the article.

As an American who has lived abroad for a sizable fraction of adulthood while frequently traveling back, the rising level of degradation — the people, public and private goods — in the U.S. simply can’t be ignored or smugly explained away. The country is rotting.

Life looks so hard, the conditions and future tenuous, that my family is making the conscious choice to raise our child abroad. While our American friends miss us to be sure, not a single one has recommended we return — esp. those with children.

I think people should stop using their personal experiences to support an argument that requires data on a much larger scale.

For example, OC claims there has been an alarming rise in degradation of public infrastructure in the US. Does the hard data really support this? If so, I'd love to see it (seriously). Observations from personal travel are virtually meaningless in this context.

Do you apply this standard to all beliefs you have? It’s interesting that you wrote what you did when you could have done a search and found some answers. From the third link below:

Meanwhile, Americans’ international peers enjoy more efficient and reliable services, and their public investment in infrastructure is on average nearly double that of the United States.....The United States generally lags behind its peers in the developed world. According to the World Economic Forum’s Global Competitiveness Report, in 2016 the United States ranked [PDF] tenth in the world in a broad measure of infrastructure quality—down from fifth place in 2002. That places it behind countries like France, Germany, Japan, and Spain.




Dive down the rabbit hole:


The Interstate 35W Bridge that collapsed in Minneapolis 2007, I used that four or more times a day on average shortly before its demise. The story was similar throughout Minnesota and proved poisonous to the then-governor who wanted to starve the state.

For us, we based our decision not on infrastructure alone but rather total system health. We need to be able to adequately commit to maintenance and future-proofing our societies, not kicking the metaphorical can down the road.

Which country are you going to raise your kids in?

At the moment, Switzerland.

We speak one of the languages, know enough of the culture and politics, etc. to be inconspicuous and blend into the crowd. More than that, the culture and people and country have grown on us tremendously. :-)

Switzerland is kind of made to appeal to rich foreigners who spend money. Not too long ago, most people here were very poor. A lot of problems are hidden.

Being a foreigner on the ground, I think the reality is more mixed:

CH appeals most to rich and upper-middle class foreign tourists, but I distinguish between “visitor” from “foreigner living there”.

In terms of the latter group, I don’t think CH attempts to appeal: practically all paperwork is in local language with no attempt at furnishing anything in the language of my mother tongue. Further, your immigration status factors into contracts: subscriptions (telephony), rental agreement, etc. We were once turned down for an apartment because of it. Throughout my time abroad, a common trend is that expats (note: first use of that word) don’t bother to learn local language and are typically unhappy. Those that do attempt to are far happier. Does a host country afford and coddling for the former? I’ve never seen evidence of that no matter how rich. Is it hostile? No.

The story could be different for the super rich who live there like Tina Turner and former Yukos Mikhail Khodorkovsky, but that is not the circumstances of our family nor any other family we know by a long-measure. Citizenship cannot be bought here either. I think for a few million it is purchaseable in Austria or Hungary.

But at the end of the day, in my top-level reply, I had stated “at the moment.” We have lived elsewhere in the world, and the assessment of the overall problems the U.S. are facing would have been identical. The decline is palpable.

> Throughout my time abroad, a common trend is that expats (note: first use of that word) don’t bother to learn local language and are typically unhappy.

In Switzerland, that's no longer going to be an option. They recently implemented a change that requires you to learn at least A1 level (super basic) German in order to keep your B-permit.

As a recent arrival on a B-permit, I think it's a good idea.

I thought they were extremely restrictive with immigration? Your wife wasn't born there or anything?

Naturalization in Europe is restrictive if you measure it across all axes:

- Allow time-based naturalization outside of marriage?

- Allow dual or more citizenship?

CH is on the more restrictive end, but it is one of the few European countries to allow either of the above. If you compare outcomes and hurdles, the U.S. has been more restrictive to foreigners coming in than CH (don’t believe me; tell that the the Canadians I know who moved to CH instead of working for U.S. branches due to U.S. not issuing family reunification visa).

So the question to ask: what do you want? Permit to enter, live, and work; permanent residency; citizenship? Each of these things are different.

CH is Switzerland, in case it helps anyone else out.

Their tld is also .ch if anyone hadn't noticed it yet

And it comes from its Latin name, Confoederatio Helvetica, just to be complete. ;)

More than one quarter of the Swiss population is foreign-born (comparable to Australia, only Luxembourg is ahead among OCDE countries): https://i1.wp.com/oecdinsights.org/wp-content/uploads/2016/0...

I don't think "extremely restrictive" is the right word.

If you're an EU citizen you have the right to live there no questions asked.

If you're not EU, you can live there to pursue gainful employment so long as your employer can show that you have skills they can't obtain from within Switzerland or the EU.

If you can get a job, you'll be given either an L permit, which is "temporary" but can be exchanged for a B permit after 2 years, which can then be renewed indefinitely. After 5 years, if you can demonstrate integration (criteria vary by canton), you can get a C permit, which is permanent (essentially a green card).

As a skilled worker, I actually found Switzerland to be substantially more friendly than the US, though a lot of the hard work was handled by my employer.

23% of Switzerland are foreign permanent residents. I'm not sure where you get the idea that Switzerland is restrictive with immigration?

Switzerland is restrictive with naturalization. You can be born here, have spent your entire life here, and still not have citizenship.

Due to bilateral treaties, immigration from EU countries is quite easy nowadays, but for citizens of non-EU countries, far less so. Almost 90% of resident foreigners are European: https://en.wikipedia.org/wiki/Demographics_of_Switzerland

Yes, but naturalization isn’t immigration.

It was super easy for me to get a working visa to Switzerland when I had a job there, and I’m not EU. Anecdata for sure, but I was hardly the only non-European around. There were even plenty of war and economic refugees around, far more than I ever encountered in the states.

Not GP, but I have American friends/acquaintances who have decided to raise kids in Sweden, The Netherlands, and Germany due to issues (either real or perceived) with the US.

I mostly think people with money in the US are unlikely to have much different quality of life than developed European counterparts, though. It's mostly people with fewer resources that are disproportionately worse off.

Even the seemingly wealthy or middle class still conduct crowd fundraisers for critical medical care, funerals, etc. We helped another American friend with one of these recently.

Just this week, a friend who is middle class with chronic but manageable health problems was expressing serious intent on leaving the U.S. precisely because of long-term bankruptcy from medical cost prospects.

The worst thing is that the incentives are perverse. Your chronic pain friend can easily cost a society more than they will return in value, but if society will not take care of its feeble and weak than what value does it have?

If your friend emigrates, they may put a burden on the country they go to. Even if they are productive, the cost of their ailment (assuming its not just ridiculously ovepriced medicine in the US that is in reality really cheap everywhere else, in which case the nation he immigrates to should be overjoyed at the opportunity!) can slow economic growth over if someone with no ailment and the same qualifications emigrated instead.

So the US "sheds" a "cost center" and another country takes on the burden. American companies keep turning over record profits and stock valuations while its poor and sick suffer and die, while other nations are burdened with those America should have taken care of itself with its vast wealth if only it had any morality to care about its citizens.

It’s the overpriced medicine problem.

> If your friend emigrates, they may put a burden on the country they go to.

Not necessarily - old or feeble doesn't mean useless. Brain drain is a real thing ...

In the middle / upper middle class of America, you are likely to have a much higher time demand than in Germany / Canada / France / Europe. Checking the government's mandated annual time off shows that Germany has 29 paid days off per year, while Canada has 16-30-the US has 0 mandatory paid days off per year.


While you probably have PTO in the US, the typical leave is 2 - 3 weeks, many companies will offer unlimited PTO to further obfuscate how much time you are expected to take and avoid PTO payouts.

Comparing San Francisco to similarly sized Marseille; I would suggest that Europe doesn’t necessarily have to answers either. I lived near Avignon and half of the storefronts in that town are boarded up. You’ll find a similar story across much of France. Paris, Marseille and Lyon suburbs often look like war zones and while the US has some similar areas, there are still plenty of places that don’t. Those that like to compare Europe to the US often look at the capital cities such as Paris as examples, but fail to look beyond the surface. France has considerable decay and economic malaise. Two of my kids were born in France and while it’s a nice place, the opportunity there doesn’t even come close to the US.

Using France as a representaiton of Europe isn't really sensible. And Europe as a representation of life outside the US even more so.

Travelling to France feels similar to travelling to the US to me. Horrible infrastructure (especially Paris IMHO). Similar feelings for some other European countries, Italy at the forefront.

Better models are places like the Nordics, New Zealand, Singapore. But more middlingly, Canada, Germany, Taiwan, all outclass life in the US or France. Heck, I'd even say China are doing a lot better in many regards (they have their own issues of course, but many aspects are strong).

I would disagree and say is the best representation of Europe. High output similar to Germany, and Sweden. High unemployment in the realm of Spain and Italy. While other countries sit on various points of different graphs (education, unemployment, immigration, GDP, etc) France just kind of sits near the center of most of them.

Having spent 10 days in France and driving from Paris to Lyon to Nice, this doesn’t jive with my experience at all. French cities were clean and nice. French villages look pristine and well managed. Unlike some of the broken rural areas in the US.

I've spent my vacations in rural France every year for the last 10 years or so. There are certainly some problems — smaller places just don't feel very dynamic economically. On the other hand, the French seem to have a vastly better life/work balance, and I really enjoy their unhurried way of life, even though as a customer, it's not always to my benefit. The one place in the US that reminds me most of this is the Big Island of Hawaii.


We've banned this account for repeatedly using HN for political, national, and racial flamewar and ignoring our requests to stop.

This is not what HN is for. It's tedious, destructive, and nothing good comes of it.



Please stop posting political, nationalist, racial, and/or flamewar comments to HN.

HN is for intellectual curiosity, which is not compatible with political venting. Regardless of how right your views are or you feel they are, please respect the mandate of this site when posting here.


At some point you have to step back and take a good, hard look at yourself when your ideological 'enemy' fights for justice. Maybe you're the baddie.

On the other hand, I’ve been to the following places and thought they were pretty good (although the commonality of graffiti in Europe was a big surprise):

* Roterdam * Amsterdam * Köln * Hannover * Heidelberg * Magdeburg * Berlin * Frankfurt (both of them) * Suhl * Zürich * Nuremberg * Strasbourg * Luxembourg * Bologne * Venice (even outside the touristy bits) * Barcelona * Torrevieja * Helsinki * Adelaide * Cairns

And yes, I know not all of those are in Europe; this is generically “nice places”. I’d name places in the UK if the UK government wasn’t currently digesting its own brain.

I’d give Budapest a miss thought. Even the street with all the embassies on is literally falling down and has barriers to keep the pedestrians safe from falling masonry.

It's Rotterdam - double t.

Whoops. Thanks, too late to edit now.

Also Cairns and Adelaide are australian.

This is so out of touch with reality. You have traded an insanely rich country for another super insanely rich country and called it a day. This in no way can even start a productive discussion.

Huh? Why? I'm an American who had traded America for Germany. It's no panacea but it is a marked improvement along multiple axes. That's real and unambiguous. Which is, I think, worth discussing.

What improved in your opinion?

Way more free time because of mandated holiday and a culture of taking it. Better maintenance of a rich social life post children because of a more handsoff attitude toward child rearing, and higher prioritization of "adults only" time. Less hassles in general because it's a less scammy and litigious society. The "default option" for many basics like health insurance and retirement just works, and is structurally simpler. Basically, more time, less hassles.

I'm interested in this topic because my father was a German citizen when I was born, which entitles me to German citizenship. (I've lived in the US all my life.)

Over half of German GDP stems from exports, which is a huge fraction and which is only possible because of the Eurozone and because of the Bretton Woods system. The Bretton Woods system was created by the US to help fight the Cold War by encouraging free trade and the US particularly since the election of Trump is not interested in supporting the system anymore. The Eurozone and the European Central Bank's monetary policy have been preventing the economies of the countries on the periphery of Europe from developing, and those countries will either withdraw from the Eurozone or at least force changes to monetary policy that will be detrimental to Germany's exports.

So it looks like Germany's exports will fall, maybe drastically. Taxes on the profit that German companies make on these exports is how Germany pays for its social programs.

When the economy gets bad in Germany, young Germans cannot find jobs. (France is the same way.) This youth unemployment has gotten so bad once or twice during the postwar period that people start worrying about riots and other kinds of social upheaval, which makes things bad for everyone, not just people needing to find a job. Youth unemployment never gets that bad in the US.

I don't see any challenges to the US similar to those 2 challenges facing Germany.

Although I concede that I probably would have been better off if I had moved to Germany 30 years ago in my 20s, let's see if you still think Germany is markedly better than the US in 15 years.

Export is not "only possible" due to the Bretton Woods system, and the rest of your thoughts on exports are just pure unfounded speculation. Germany makes sought-after goods and will continue to do so for all of our lifetimes. They will export and sell them one way or another. Of course there will be ups and downs, but really drastic changes? I highly doubt it, even if the Euro(zone) were to implode, which is looking increasingly unlikely.

Post war Germany has never had significant youth unemployment, and worries about "riots and social upheaval" because of that unemployment? That's a pretty outrageous claim.

Because it's just not comparable. Different settings and different environment.

You cant move around in Europe if you are an average folk like you can in the US. Moving around in Europe means almost a life time commitment to the language and the country and that does not always pay off.

Wow, "lifetime commitment" to a language or a country sounds harsh.

I think you can achieve a working level of any (European) language in around one year. And today we have Google translation in our phones, the job is 10x easier.

Nowhere is a "lifetime" commitment, but if you like a place, might just stay there.

Have you ever tried to become fluent in a language ?

I dont think you have even a clue about how hard european languages are and how hard it is to integrate.

I speak 3 languages non-natively, 2 at C1 level at least for oral comprehension.

So yeah, I have done that.

Yea I have seen people claiming they speak C1 when in fact they dont. Do you work profesionally with those languages?

I speak C2 Spanish and C1 French. I have certifications for both. I'm currently learning Italian, and expect to move from A2 to C1 within a year.

Its really not that hard if your study correctly and you're able to spend significant time in a country that speaks the language.

Why would you want to?

We never “called it a day.” We remain active on social, justice, and political issues from abroad. In fact, we are beginning the process to incorporate a small 501c3 around civic engagement and betterment. We spent a decent fraction of our pretax income on the aforementioned effort alone in 2018.

Nevertheless, when taking the whole risk and probability matrix into account, neither my spouse nor I feel confident that the U.S. will turn itself around successfully to warrant an all eggs in one basket approach. The United States would need to stop acting like a petulant family at war with itself and start taking better care of itself and its people.

Why is it out of touch? The US is a rich country, Switzerland (where the parent now seems to be living) is richer on some measures, this isn't apples and oranges though.

Because you cant replicate the questionable success of Switzerland in a country like the US of A.

You could try to converge and force others to foot the bill but sooner or later it would damage the industries that make you money.

Switzerland is an anomaly not the norm in Europe and other countries are paying dearly for Switzerland's success.

But you couldn't replicate the 'questionable'?! Success of the US elsewhere.

Most rich countries have some kind of USP. That isn't an argument that they shouldn't try to replicate the more successful elements of other nations.

Germany is an anomaly in Europe, France also, along with Britain, Ireland, Italy, etc, etc.

Can you ? USP is not a silver bullet and it is mediocre at best. I paid shitloads of money in austria for a mediocre healthcare. I pay far less for healthcare in Korea which is superior in every way.

I'm reminded of the Breaking Bad Canada comic. "You have cancer. Treatment starts next week. The End."

When I see "heartwarming" stories on tv about people donating to people that need help I can't help but think it would be more "heartwarming" to have a government that tried to make sure people wouldn't need to depend on the kindness of strangers for health care.

That to me is one of the most striking observations from spending time in the US. Good outcomes are singled out and praised, but there isn't a system in place to make sure that good outcomes can be expected.

This applies to health-care, funding for universities/hospitals/libraries/etc., or just making sure people have food on the table. To exemplify this, aren't food donation campaigns sort of missing the mark. Yes they provide a valuable service, but the service it self shouldn't be required.

And in return for having you most basic needs like healtcare/education/food covered, why aren't people fine with paying some taxes for this? I thought I've had is that the nature of having states 'compete' against each other with lower taxes plays a part in this vilification of taxes. But surely this would only explain a small part of this problem.

> And in return for having you most basic needs like healtcare/education/food covered, why aren't people fine with paying some taxes for this? I thought I've had is that the nature of having states 'compete' against each other with lower taxes plays a part in this vilification of taxes. But surely this would only explain a small part of this problem.

Because certain people in government convince people that citizens can manage their money better than the government can. Forget about the purchasing power of pooling your money (by way of taxes). Then you have people like Mitch McConnell who calls programs for the less fortunate as "entitlements". The people who need these services don't feel "entitled". Not one bit.

Because certain people in government convince people that citizens can manage their money better than the government can.

And this is wrong? Look at the absurd high speed rail costs, or the bloated military budget, or SLS vs SpaceX.

Then you have people like Mitch McConnell who calls programs for the less fortunate as "entitlements".

"Entitlements" is a standard term used to distinguish those programs from discretionary spending.

As a counterexample, look at the cost of socialized healthcare in Europe vs the privately managed one in the US.

Very simply, there are many sectors where the market works best. Healthcare isn't one of them.

US healthcare isn't a free market. How much of our costs are due to government rules limiting the number of doctors and hospitals? Perhaps healthcare could be cheaper if the government was less involved.

But let's compare the two systems as they are, both dictated by the government. The US is actually rather heavy handed, imposing regulations on healthcare and pharma that most of the world doesn't share. For example, in most countries medical education doesn't require a previous non-medical degree. Pharmacists are often allowed to provide basic medical advice. And medicines are often approved more quickly and less expensively in Europe.[1] How much of the extra cost is due to over-regulation?

Also, how much of our costs are due to our unhealthy lifestyle? If we lived as healthfully as Europeans, we'd surely have lower medical costs.

We can't honestly compare the cost of medicine without controlling for factors like those.

1: https://www.sciencedirect.com/science/article/pii/S2452302X1...

Yea it is wrong.

High speed rail cost overruns are almost always due to how expensive eminent domain is more than anything. The estimations given to state officials are often an order of magnitude off how much land they would need to buy. Its also the kind of project beyond the scope of anyone but the largest companies to even attempt, so even if an investment firm could do the math to recognize the economic benefit of having high speed rail and thus they could capitalize on investing in it through other investments in other industries that would grow substantially in the presence of better transit they can't raise the capital to do it and the time frame to realize those returns is too long for any investor to consider reasonable. So we don't get public or private trains.

> the bloated military budget

Its not a money mismanagement at all though. The money allocated to the military that is squandered on hundred thousand dollar toilets and billions on fighter jets that don't even work and will never see practical application in aerial combat were all budgeted intentionally to make private defense contractors rich. Those contractors paid the bribe money to see the budget allocated to them and get a tremendous return on investment.

Something like comparing NASA and SpaceX can be reasonable, but you have to be nuanced about it. A large part of the SLS overrun, for example, was due to their contract with Boeing which was budgeted for 4B but overran time and money up to 9B. Thats "private enterprise" at work wasting tax money because they knew the oversight wasn't there to hold them accountable, as is the case with many government projects mired in corruption.

But you know what? If your government is corrupt, the solution is not to give private enterprise - those that corrupted said government - control over the functions government was supposed to fulfill. You fix your government. If NASA is unable to budget or deliver projects on time, you fire those given the responsibility of managing said projects, do independent investigations of why they failed, and if some party is culpable for the intentional sabotage or deception of the proposals arrest them. If theres a revolving door in Washington of defense contractors lining the pockets of congressmen for taxpayer money via the defense budget investigate and impeach the corrupt politicians. When you contract with a third party to budget infrastructure expansion make them culpable for failure to deliver or for budget overruns.

Except that they are entitled to it, calling them entitlements is not wrong. "Entitlements" is just another word for "rights".

The whole libertarian and conservative sales pitch is just a sales pitch for business practices that hurt the many at the betterment of the corporations or rich few. They clamp divisive stances onto it to pull single issue voters into their pool. Whether any of their actual enacted laws decrease deficits or increase personal freedoms isn’t even discussed routinely. (The last time the US ran a budget surplus a D was in the White House. Deregulating is always pitched as a positive but winds up in selling people less than they had before - relaxation of banking regulations leading to recessions, etc)

I don't think you've accurately represented the libertarian pitch, which is that government bureaucrats, even if they are well meaning and better planners than you are, are not likely to understand your needs, wants, and preferences nearly as well as you are and, further, are likely to have incentives other than your welfare – careerism, political winds, and the pleadings of special interests, to name a few.

I don’t need to represent what is already widely marketed. In 2019 everyone knows the libertarian pitch.

People being forced to pay for someone's healthcare is more heartwarming to you than people voluntarily paying for someone's healthcare?

I would say so. It's very sad to think of someone dying from a treatable condition because their GoFundMe campaign wasn't popular enough.

The thing is that government doesn't reach everyone either. Often homeless vets don't seek VA help because why would you trust the government, which injured you and put you in the place you're in now (not to mention that the VA has a terrible track record of actually helping). The government also has a very terrifying incidents in it's history relative to providing healthcare, from the Tuskegee siphilis experiments, to offering healthcare in exchange for sterilization, and more recently, using a polio vaccination program as a cover to spy on bin laden.

> VA has a terrible track record of actually helping

Is this a fact? Would private industry do it better?

I ask because the VA is the closest thing we have to a single-payer experience in the US. Active or inactive, the VA is willing to treat you the only requirement being that you served.

Yet, when people bring up the failing VA they always pass along the Walter Reed VA hospital horror stories. I looked into it and you know what, Walter Reed is a huge military hospital base. It's so big there are multiple hospitals on site. And that site has government run VA hospitals and contractor run VA hospitals. And they are all called Walter Reed. But guess what? All the VA horror stories from Walter Reed come from the same contractor ran hospitals.

My dad was a hospital administrator at the VA. He complained about several issues and was rubber-roomed (dad was in the Navy, used to delivering products on time and in budget and was appalled at the treatment of his fellow vets). This was not at Walter Reed. The organization simply doesn't have a culture of taking care of veterans, or anything really, beyond CYA and job security for career bureaucrats.

> the VA is willing to treat you the only requirement being that you served.

They will make it very hard for you to qualify for VA disability by throwing bureaucracy at you.

I just can't see using violence against peaceful people, for whatever cause, as heartwarming.

Are you suggesting that taxation is equal to violence?

I'm confused.

If these are the opinions of Americans, then I think I have found out why the "US is a Rich Country with Symptoms of a Developing Nation". Viewing taxation as direct threat of violence 10000% will result in a crumbling society that is built on democracy and taxation.

> Are you suggesting that taxation is equal to violence?

It's a frequent comment on HN and it's fucking stupid everytime.

You are forced to pay taxes under the threat of violence.

I don’t understand this argument. We comply to every law “under the threat of violence”. Are you advocating for a lawless society ?

Wait, in what country? Not in the USA! You ain't forced to pay shit here if you don't want. Don't want to pay taxes? Go work minimum wage job then, don't pay taxes okay? Or be megarich and still don't pay taxes. Nobody's forcing you by threat of violence to make a ton of money in your salary and pay taxes on it.

The laws are clear, and you agree to them by living here. A taxation-related arrest will be done non-violently anyway, what on Earth are you talking about here?

Where is this threat of violence coming from?

What's being referred to here is the premise of the monopoly on violence[0]. Essentially that a state can be defined as an entity which claims for itself a monopoly on the legitimate use of force, often violent force, denying the same right to the public. That legitimacy, in free societies is granted by the people, while in nonfree societies, it's often simply taken though further violence. The enforcement of laws and collecting of taxes are backed up by the threat of the state executing on its monopoly on violence against its citizens.

The opposite of the monopoly on violence would be anarchy, which could be interpreted as a free market of violence.


100 years ago, maybe, as cited in your wiki link, that could have some interesting discussion behind it. But that model of the world quite clearly does not fit today, and viewing modern society like that is exactly the kind of attitude that results in our infrastructure - and morals - crumbling.

I can't find anything in that article that has any relevance to today.

The monopoly on violence is the way all civil societies work, even in the present day. It's why the police are legally allowed to beat someone, kidnap them against their will and throw them in a cage, and you aren't. It's why the social contract isn't a literal contract you needed to sign first before being subject to your government's authority.

Tax liens and wage garnishments are violence, apparently.

What happens if you fail to pay your taxes?

Oh, you've committed violence against your peers by depriving them of the money that would have been used to save them in the healthcare system? By not paying taxes, you're being violent to your fellow Americans? Is that the take here? Confused still.

No, if you fail to pay taxes, you will be carted off to jail, violently, if necessary. The point is that whatever you feel government should or should not do, government is the entity that as a society we collectively decide should be allowed to violate your individual consent in favor of some sort of partial group consent (if you're in a democracy). Thus, if you think consent is important, a system where private charity provides adequate healthcare should be preferable to one where the government provides adequate healthcare.

Healthcare in the us is seriously fucked up. It's highly regulated and prices are set in an incredibly corrupt fashion. Insurance is misunderstood by politicians as a magic trove of money and then gets the blame when it falls short. We get quite honestly the worst of a privatized and the worst of a public system.

> No, if you fail to pay taxes, you will be carted off to jail, violently, if necessary.

That is simply false. You will not be "carted off to jail, violently, if necessary". If you refuse to obey the laws of the country of course you will be arrested. They will not be violent! If you choose to pull out a gun or something and fight them, then you have initiated the violence and they will defend themselves. This is all fucking insane anyway, why are we even talking about this? You don't have a clear understanding of how the laws or modern society works.

You're not living under a threat of violence with taxation, my god. I can't imagine what kind of misconceptions you have that result in you thinking that a result of you not paying taxes could end violently. We have looooong surpassed that, and in fact, our Constitution written hundreds of years ago, while flawed, absolutely prevents the scenario you are describing.

"If you refuse to obey the laws of the country of course you will be arrested. They will not be violent!"

Are we talking about the US? Perhaps you're not a person of color, so you don't understand what it's really like here.

Careful or you'll let a libertarian define a term very broadly then start making bad syllogisms at you with it.

[edit] actually may be an Objectivist, I guess. They argue the same.

I find it telling that this particular argument is only trotted out against the idea of universal health care. It’s not used in disagreement with military spending, subsidizing religious institutions, agricultural and land-use supports, etc.

I would rather we didn't have to have "heartwarming" stories like this at all.

People pay for other people’s roads, fire fighters, police force...

When you buy car insurance, you’re not buying it for yourself, you’re buying it for everyone who has car insurance

The people that need the help are overwhelmingly declaring that they don’t want the government’s help.

This is demonstrably false. Here's one person's story (who I happen to know):


And then here's the data on improved access to health care: https://www.kff.org/slideshow/public-opinion-on-single-payer...

What's with Americans constantly attempting to paint their situation as more dire than it actually is? Is it just a blatant lack of perspective on the rest of the world? Reminds me of an article I read attempting to claim that child mortality in Memphis was worse than in Bangladesh.

No, the United States isn't like the "developing world" if you're poor (and since when is Italy, the comparison country, considered "developing world"?)

Comparisons like these (which are rather frequent, I've found) are obnoxiously disrespectful to the millions of people actually living in developing world countries. The same millions who would give up their first kid (and often, in many ways, do) to be allowed into the US.

We can discuss improving the US while also still acknowledging that, on a global scale, their problems are fundamentally "first world problems". You don't need to spend hours crunching numbers finding some favourable metric to the South Sudan to make your damn point.

I guess this depends on what your definition of a first-world problem is.

People die here because they can't afford care. People avoiding the larger milestones in life like owning a home and having children because it's untenable. This will cause larger, show-stopping problems.

People in the rest of the world die because there literally isn't good care available, regardless of whether they can afford it. As a kid, I once got a big cut and my doctor's only solution was to dump an old vial of iodine on it because they didn't have bandaids.

All you (and a few other comments here) are doing is proving my point. Complain all you want, but don't for a second think your problems are even remotely close to what the majority of the rest of the world endures.

I suspect the West as a whole hasn't had real problems in a very long time, so a generation is growing up magnifying their own to victimize themselves. Americans are particularly bad about this.

I think I agree with your summary of what's happening in the US re: magnifying problems - our range of experiences has become much narrower as things have become safer and more controlled, so it takes less and less extreme experiences to reach the extremes of our personal experience.


I never said you can't have problems. I'm saying the fact that you think your problems are even comparable to most of the rest of the world comes from a lack of perspective & education.

You're more likely to get hit by an asteroid than killed by a cop in the US - the fact that you think it's a real issue worth talking about, in a thread about 3rd world countries, shows your lack of perspective. Go tell someone in Sierra Leone about police brutality stats and poverty levels and see how you get on.

I highly recommend you get out of your internet-San Francisco bubble and go and travel off the beaten path to get a better understanding of what the rest of the world still lives like.

I am IT support for an organization that does long-term disaster recovery work. I directly support coworkers that coordinate some form of mass-care (clothing, food, and alternate housing). And I live near San Francisco.

People die in developing countries because they don't have access to clean water.

That a completely different problem than not being able to afford healthcare or own a home.

Do people in Flint have clean water? The fact that the problem still hasn't been solved but instead brushed under the rug and even the president going there declaring it's all good now shows how corrupt the whole system is. Something like that you find in 3rd world nations.

Have you ever been to a 3rd world nation? You have no conception of what it's like if you really think living in Flint is somehow an analogue.

The sheer lack of perspective of Americans is baffling. You have no conception of just how difficult life can be and frankly, is, for the vast majority of people.

The issue is the trend lines.

Play the tape forward on our continual lack of infrastructure investment, our slouch towards oligarchy, our fractious internal tribalism.. the root causes behind 3rd world problems are sneaking up on us.

What if I told you TA doesn't work for geopolitics.

Care to make a more substantive analysis and educate me?

Hookworm in Alabama and the Panhandle: https://www.bcm.edu/news/school-of-tropical-medicine/hookwor...

Enough said.

It’s really not. Go down to Dhaka’s main river. Gag due to the clouds of gas coming off the raw sewage, and watch as people wash themselves and their clothes in the same river that people are shitting in. It’s absolutely absurd to compare the US to anything like it.

Guess we have different expectations for a first-world country then. This kind of sewage-borne disease should have been eliminated in any developed country, a hookworm infestation is soil-transmitted, you acquire it by walking through sewage.

The municipalities can't fix the sewage system, and the health authorities can't screen for intestinal worms and hand out medication worth pennies. It's shameful to see.

I'm not saying that the US shouldn't do better, it absolutely should. But it's also important to try to keep a little perspective, and be thankful for how lucky we are.

There is an actual commenter here suggesting Flint is an example of "3rd world country".

You'd think in the age of YouTube people would have more perspective on the rest of the world. Seriously, one stroll down the giant open air landfills (which double as housing for hundreds of people) of Dhaka should be enough to be eternally thankful for what one has.

The poster you mention absolutely does not say that. The poster says Flint’s clean water problems are the kind you would find in a 3rd world country.

I think you are clearly misreading both the article and people’s comments to it. No one is suggesting the US is a 3rd world country. But in certain areas it’s statistics resemble 3rd world country outcomes more than it does developed country outcomes.

The reason this is important is that the US is usually an outlier in developed countries in this area, which means solutions to these problems exist.

Not being able to afford a home is definitely a first world problem. In the third world you have to regularly bribe police, hope no one visits your family in the middle of the night, don't have access to clean food or water...

Even life at the lowest rungs of US culture have it way better than most in a third world country. We have law and order and pretty good public infrastructure.

When was the last time you stayed in a "third world" country?

About ten years ago and I have relatives that live in one. The examples I gave come from personal experience or that of people I know.

> third world you have to regularly bribe police,

Been living in India for more than 2 decades. Never had to bribe the police once.

> hope no one visits your family in the middle of the night,

Funny you mentioned that. USA has worse criminal violence than most countries in the world. Gun violence is entirely a US phenomena.

> don't have access to clean food or water.

Never faced the issue of clean food or drinking water in my entire life. And I am from lower middle class.

> Even life at the lowest rungs of US culture have it way better than most in a third world country

Really? I prefer to live in a country where I can afford healthcare atleast. Probably a great idea to visit some so called "third world" countries and see for yoursevles. If you dont have time for that read Fact-fullness.

India is number 2 on this list, the US is 14:


You haven't had issue with clean water? I'd say you're pretty lucky then:



Incorrect. It's per capita. From the article:

"Intentional homicide, number and rate per 100,000 population."

Nope. It shows totals by default. Click on per capita to show the per capita rate. India is at 107 and US is at 99.


Don't get me wrong but you're one person in ~1.4bn (!). I'm pretty sure your experience isn't applicable to most of the population. Judging by the first statement, one that's contradicted by basically all statistics and most citizens, I'd say your experience may very well be a statistical fluke. [0]

And related to water, we may have different standards for cleanliness. But when the whole world agrees that most of the water is not fit for consumption you have to wonder. [1]

Anecdata. I went with a friend to a wedding in India. And while we were warned to only drink from water bottles that we unseal ourselves (we even received refilled bottles of water in the Hilton hotel we were living in), my friend did not account for the ice cubes in his drinks. The outcome wasn't pretty.

[0] https://en.wikipedia.org/wiki/Corruption_in_India

[1] https://en.wikipedia.org/wiki/Water_pollution_in_India

Yes. The issue was that the OP used this phrase which is a great exaggeration

> Even life at the lowest rungs of US culture have it way better than most in a third world country

I agree that some portion of my country is living in bad conditions. But majority are not and nobody is going to trade their spot for the lowest rungs of US culture. Don't get me wrong. I have been to US as well. I would probably trade my place with a person living in a good neighbourhoodn with his own house in California if I was offered Greencard and a job with good salary. But lowest rungs of US culture? Defintely not.

You have to look at Per Capita. India is a far more populous country than the US.

And guess what. The US is at 99 and India is at 107 which reinforces the idea that the US has developing country outcomes in certain areas. It’s not the worst (there are 98 worse countries), but it’s signficanrly worse than its wealth should indicate it should be.

I have lived in Europe earning an above average salary for a swe and never saved enough to really feel I made it in life. The healthcare was just good enough, almost mediocre and living there felt like all in all just "good enough".

I moved to Asia, to a country with much lower taxes and live a much better life.

The article isn't making the comparison you seem to think it's making.

Neither the US nor Italy are being directly compared to the developing world. The author is taking the UN's term of "in transition" and considering whether it might apply to the dynamics at play in both countries.

The phenomena you’re describing feels very real. I think it’s a deformed manifestation of a victim complex. I’m not sure.

I remember reading an article proclaiming that the United States is the 10th(!!!) most dangerous country in the world for women[0].

[0]: https://www.haaretz.com/world-news/10-most-dangerous-countri...

> Reminds me of an article I read attempting to claim that child mortality in Memphis was worse than in Bangladesh.

It sure isn't. Infant mortality in Bangladesh is 27/1000 (in 2017), whereas Memphis is down from 15/1000 (in 2003) to 8/1000 (in 2015).



Agreed, these discussions seem more like “America has a more disfunctuonal government than most Eurocentric countries” which feels valid. I get it, I almost took a job in France but we were worried our parents would never get to see their only grandson.

Comparing America to developing worlds can be done but it’s hyperbolic and can turn people off of discussing it.

I wish Americans showed more gratitude for what they have. Right now, you gain friends and influence by complaining. I'm not saying problems don't exist, but man, we are the 1% in human history.

EDIT: Downvotes on this comment just confirm my point.

The man dying from preventable illness really should feel mighty grateful he lives in a country where he has the right to buy a gun with all that money he doesn't have.

The black teenager being bludgeoned into permanent disability by a cop should feel extra grateful the water only has iron in it and not ebola.

Humans are infinitely capable of inflicting and causing misery. Just because some are more miserable than others doesn't make some not miserable. And we are all only unto ourselves - I cannot do anything to solve the suffering of billions abroad, my influence is functionally limited to who I vote into office that has macroeconomically influential power.

And I'll keep doing my best to try getting those elected into such positions of power, using the power I have, that would work to reduce misery everywhere when they are able, but each of us is only one person usually with only the capacity to influence those immediately around us. We cannot all be changing the world at once.

I live with a chronic illness where I can't work. My life sucks more than most people. I never said problems don't exist but it is undeniable that it could be so much worse if I lived in a different country or in a different time.

If you NEVER allow yourself to be grateful for what is good in your life, you are going to INCREASE the misery you have.

And that's what is missing in our culture. We goad each other online into complaining and more complaining about things that, while problems, make us forget the good we have and which robs us of happiness.

There's kind of a perverse incentive to come up with the biggest "woe is me" story because it often confers a sort of status in today's culture.

The fact of the matter is that in the history of all humanity, suffering is the norm. Falling asleep on a soft bed with a full belly after a clean shower with an entertainment screen is what is unusual.

Could you go ahead and help us through the logical steps you took that got you from "my comment is being downvoted" to "therefore my comment is correct"? Thanks.

Yes. People bristling at the suggestion to have more gratitude justifies my assessment that more people should show gratitude.

It really is unpopular these days to be thankful for what we have.

I mean, is promoting gratitude really something deserving of downvotes?

So you stepped from “people are downvoting my comment” to “people are bristling at the suggestion to have more gratitude”, and then you jumped from there to “more people should show gratitude”. Both of those are non-sequiturs and therefore must be dismissed. I trust that you’re able to see why those don’t logically follow.

We've all heard of virtue signaling. Meet his ugly brother, "policy shaming".

A few days ago a story hit HN about how ISIS is banning single-use plastics. That was very problematic because my eyes almost rolled into the back of my head.

One of the few US places that actually resembles a developing nation is San Francisco. Whatever economic policy those people employ, the nation should do the exact opposite.

$77 billion spent on a train from Merced to Bakersfield. I’m sure that money could have easily solved many infrastructure issues.

Always wanted to move to the US, but having:

Crohn's disease

MEN-1 [0]

and medications for them, and bi-yearly MRIs and CTs as well as expected surguries to remove tumours now and then

I have just dismissed the possibility of ever moving there.

Here in Sweden I pay less per earned dollar in taxes towards healthcare, and my total healthcare costs (all inclusive) are <$270/year (~half for maxing out pharmacy costs, other half for maxing out medical treatments/doctor's visits etc).

How much would insurance cost me per month in the US to make me covered so that I never had to worry about not being able to afford medications or a surgury?

[0] https://en.wikipedia.org/wiki/Multiple_endocrine_neoplasia_t...

> How much would insurance cost me per month in the US to make me covered so that I never had to worry about not being able to afford medications or a surgury?

It’s not the right question. The reality is that you’d never be free from worry due to insurer denials, changes to laws that may affect your coverage, provider network status changes and rate increases, job loss, employer changing insurers, etc.

There is no end to your risk in the long run, even when you have “good insurance” at a particular point in time.

Yeah, the system here is such utter shit.

I would like to see us start gradually expanding the existing system of "socialized medicine" in the US: The military medical system.

I think an extremely moderate position would be to expand medical benefits for life to anyone who has served on active duty, even if they didn't stay in long enough to retire. Currently, you have to stay in twenty years -- or be the dependent of someone who has done so -- to remain in the system. This screws over a lot of veterans and is a travesty.

The American military medical system is an excellent system with a lot going for it. We have no need to look at how other countries handle "socialized medicine." We have a perfectly functional system within our own borders already run by our own government. We just need to find a politically viable and practical means to start expanding access to it.

Another possible step: If you qualify for Medicaid/Medicare, instead of the current fucked up system, we move you to having access to the military medical system.

Worse case? About $1000/mo. Likely case with an established employer? <$400/mo. You're likely to earn enough more in the US to cover that cost.

Try being self employed with a family! $1,400/mo premiums and $8,000 deductible. Certainly not even the worst case.

For me (bronze ACA plan w/ no subsidy) it's approaching $800/mo with a $15k max family deductible ($8k/person), and $18k maximum out-of-pocket expenses.

So minimum to maximum liability spread for healthcare cost is ~$10k-$27k. If I pull down $100k in a year, 10-27% of my gross paycheck goes to healthcare.

A shoddy analysis of ACA programs countrywide for 2019 [1] (e.g., for a 30-year-old couple with one child) lead me to the conclusion that it really doesn't get that much cheaper. Bronze, silver, gold, or platinum -- you're going to end up paying a good chunk for premiums. The metal level just is a gamble whether to front- or back-load the costs to you (roll the dice on if you think you're going to be sick next year). At absolute minimum $6400/yr, and if you get really sick, it's going to cost you $17-50k.

It's incredible and terrifying to me how small business owners -- at least those who earn too much for a subsidy -- have fallen through the cracks of the ACA. It's far better than it was, but we need universal healthcare, period.

It will lower total cost of healthcare (even though taxes will obviously increase, they should increase less than healthcare costs will decrease, since the US often pays double what other rich countries pay for healthcare [2]), remove the sword of Damocles of employer-subsidized healthcare hanging above the head of would-be entrepreneurs (who hope to leave and follow their own path, but many don't because if they don't make enough in your new business to offset the massive increase in healthcare costs, they're screwed), remove medically caused bankruptcies, and remove "should I get this cough/lump/etc. checked out" as an economic vs. health question (which is just a perverse calculation, but one that happens often in the US). These are just a few of the primary benefits.

[1] Data available here: https://www.healthcare.gov/health-and-dental-plan-datasets-f...

[2] https://www.healthsystemtracker.org/chart-collection/health-...

And if you lose your job, you're screwed.

What? You can buy insurance or go on Medi-Cal, right? Am I missing something? You’re only screwed if you don’t do those things, but at that point it feels more like a medical literacy problem—you’re also screwed if you don’t go to the doctor.

> You can buy insurance or go on Medi-Cal, right?

You can continue your exact insurance plan via COBRA and pay both your portion and your employer's portion of expenses. Having done this, I paid nearly $3k a month in premiums alone for continued individual coverage. That is not feasible for everyone who were just laid off and still have bills to pay.

To be eligible for Medi-Cal, you must make under 138% of the federal poverty line, or be disabled or elderly[1]. A tech worker who was just laid off would not be eligible for Medi-Cal unless they were recognized as disabled by the state, and the program they'd be eligible for during that tax year would require them to spend a significant portion of medical costs out of pocket before Medi-Cal kicked in.

There are special provisions to purchase health insurance on the individual private market if you're laid off. However, anyone with a chronic condition can attest to the problems that arise when you're forced to switch health insurance plans and continue treatment at the same time.

[1] https://ca.db101.org/ca/programs/health_coverage/medi_cal/pr...

What money are the unemployed spending to stay on insurance? COBRA costs quickly exceed anyone’s savings.

The suggestion to leave a stable healthcare situation for a hard to secure position at one of the top employers in the world in the most expensive to live place in the world is downright bad.

In San Francisco, you can get basic healthcare at no/low cost. It is far from perfect, and I would not want to have a chronic condition that needed to be maintained. To your point, moving from Sweden to the USA for a great work opportunity makes sense. Staying in the USA for the low income healthcare options wouldn't be one of my top choices.

I tried Medical when I finished a contract job in 2014. I immediately found that a medical doctor wouldn't prescribe a prescription I needed at the time (an ADHD medication), and I couldn't see my own doctor to get the prescription. You are correct that some coverage is available to some people, but it' a bureaucratic nightmare, slow, and you're going to be limited to coverage other people think you need. Maybe it's pretty good once you learn the system, but you have to learn it, and I had to spend hours navigating the system when I really needed to be looking for a new job.

That’s really not the worst case. The worst case is dying for lack of treatment.

Depends on your insurance / employment benefits.

Treating CD/IBD in U.S. could easily cost $250+ month.

But pre-existing condition exclusions might help to secure insurance with comparable treatment.

Assuming you're an engineer and a decent one at that?

Move to SV, get a job with Google/FB/etc.

If you're single, you'll have a max-out-of-pocket of a few thousand dollars, but that will more than be made up for by the increase in salary. And you will have good insurance subsidized by your employer.

Suggesting you have to be a good enough SW engineer working for FAANG (a relatively high bar) to afford to be sick in the US really doesn't paint the system in a good light.

Such high earners can cover their healthcare in any country. It's the rest of the people you have to worry about. And if your illness endangers your employment status you definitely don't want to be in the US.

Agree. But only the OP could assess the risks.

But if it’s something that is controlled with the the right care and they’re a pretty good engineer, then the risk of moving here is much smaller than they realize.

> Move to SV, get a job with Google/FB/etc.

I'm not sure americans understand how annoying it is the process of getting an H1B (or any other visa to be honest)

And it's a lottery in the end. You can't count on it until you're selected.

If you’re on a group plan, which you would be with your employer, they’ll cover your preexisting conditions.

You will have so much more leverage to negotiate for your skill set. They Truly value your skills.

Kick your safety net to the side, jump the pond and make a good business decision for yourself.

Do insurance companies in the US pay out for preexisting conditions?

Not if they can help it. Iirc, that portion of the ACA was just repealed in the courts. Group insurance for a large employer will though.

They do now

Fix your diet and your symptoms will greatly improved, you won’t find the right advice among typical doctors either.

Check this guy out — https://www.instagram.com/p/BuJkJILA_8I/utm_source=ig_share_...

EDIT: If you’re going to downvote, at least have the respect to state why. My post is a serious one, I’m not trolling — people have freed themselves of Crohns with carnivore diets.

Hello, I downvoted and will tell you why. I don't have crohn's or UC, but I do have ankylosing spondylitis which is a related autoimmune issue which is very correlated with crohn's/uc especially in the genetic incidence (HLA-b27 positive).

I am entirely sympathetic to the idea that certain diets do really help symptoms at times. Examples that have been studied include Specific Carbohydrate Diet, Low FODMAPS, etc. These diets do NOT work for everyone and thus are highly variable.

I've spoken to many rheumatologists who openly say that they are open to patients experimenting. HOWEVER, that broken instagram link you posted is likely one of the few success stories that filters to the top. All the people who try these diets and fail you do not hear about.

The role of the gut and diet in autoimmune is being researched and further elucidated. Patients should safely experiment with the role of diet.

But for you to say "Fix your diet"?! As if you KNOW that other diets are simply BROKEN and that an all carnivore diet is fixing it?? It is not supported by the data at all. It runs contrary to most of the research done on dieting. I'll agree that plenty of research in dieting is flawed (often centered around mediterranean diet), but your tone of "Fix" is why you earned my downvote as a person who has an autoimmune but I don't think you are guilty of trolling. No hard feelings but be a bit more humble around these things when there's so much unknown and ANYONE telling you that they have a perfect FIX is not telling the truth.

Fair point on the tone, I added an updated edit to reflect this.

Most people’s diets ARE broken though, even 50 years ago we didn’t have hardly the level of autoimmune disease that we have today. The standard medical approach to chronic/autoimmune disease is to tell people the best that can do is manage it, not heal it.

There are plenty of people who have in fact healed themselves from autoimmune diseases and there’s a very common theme — avoid all processed foods, avoid most grains, avoid most sugar, etc. Focusing primarily on animal products (which is where the nasty majority of people got the majority of their calories over until just a few thousand years ago has been shown to ameliorate autoimmune — you have to test it out for yourself, if you wait until the medical establishment comes around you’re going to be waiting your whole life, it is completely against their incentive to find a dietary method of healing Crohn’s or any other autoimmune disease).

I completely agree with you about the rising levels of autoimmune diseases. Lots of ideas are swirling around such as the Hygiene Hypothesis. You may in fact be right about your diet choice.

However, look up "mcdougall starch diet autoimmune". Here's a doctor who runs a starch based clinic (Starch heavy, avoid ALL animal products). He has client testimonies, a legit clinic, and patients who cured their autoimmune disease.

I personally find that the diet you recommend (albeit with more vegetables) is best for me, but the paleo vs vegan argument has proponents on both sides claiming they've cured autoimmune diseases. I cannot find strong clinical trial data favoring one side over the other. With that said, look up "Dine-CD research study" that is trying to be the first clinical trial of specific carbohydrate diet for crohns.

Be well and enjoy the steak!

EDIT 2: Let me re-phrase my comment as follows — I highly recommend you explore a therapeutic diet such as carnivore which has helped many people heal issues such as Crohn’s.

Here’s an updated link worth exploring — http://meatheals.com/category/crohns-disease/

EDIT: wording

Eating to avoid symptoms is very common and very much recommended.

Thing is, it doesn't stop the illness itself. You are confusing eating things (like meats, also no fibers etc) that are known to not cause bowel issues in people with crohn's disease, with curing the illness. Being on that diet does little to reverse the illness and it's effect on the digestive tract other than the proccessing in the intestine and down. And what's the point of calling it a treatment if you can never revert to normal?

I asked how much insurance was. If I wanted woo-science shoved down my throat I would return home to my parents.

I highly recommend you try out a therapeutic diet such as carnivore which has helped many people heal issues such as Crohn’s.

Please don't make medical "recommendations" of any kind at all on the internet -- even if you are a doctor. It is a really, really bad practice that doesn't work at all and actively interferes with reasoned and serious discussion by people who are directly impacted by such conditions and in dire need of the ability to have meaty discussions about life, the universe and everything as it relates to their condition.

Signed: Someone with a serious condition.

Thank you.

Who said I made a medical recommendation?

Do you feel it’s a scientific approach to NOT test out something before concluding it doesn’t work?

I’m not a doctor and don’t play one on the Internet but everyone can think and test out things for themselves. A mostly carnivore diet is low risk to say the least considering that’s how almost all humans ate for thousands of years, the modern food supply and diet is what’s radical.

Who said I made a medical recommendation?

You previously said -- and I already quoted it, above:

I highly recommend you try out a therapeutic diet

That's what I'm talking about right there. That right there is a medical recommendation.

I think we’re splitting hairs here, but words matters, so I went ahead and changed the wording to make it clear what I’m saying.

My whole point is that modern diets are broken, lots of people are healing autoimmune conditions with therapeutic diets such as carnivory (or if you want a less strict but IMO less therapeutic autoimmune diet you can check out the autoimmune protocol — see Sarah Ballantyne’s The Paleo Approach).

You are still saying you "highly recommend." This is the thing I am objecting to.

The OP in no way asked for alternative remedies. They asked for info on how one might adequately access conventional treatment if they moved to the US, without breaking the bank.

It is inappropriate in that context to "recommend" alternative remedies at all for any reason.

A better approach -- if you absolutely feel compelled to butt into someone else's life and just cannot restrain yourself -- is to ask if they would be interested in alternative treatments and any hard data or good info you might have about such approaches. And if they don't say "yes," drop it rather than arguing endlessly with all comers about your right to promote a carnivore diet as some kind of cure-all for autoimmune disorders.

As stated previously: I have a serious condition. I happen to manage it with diet and lifestyle, which gets me called a nutter and given all kinds of headaches. Remarks and behavior of the sort your comments are engaging in are a huge headache for me because it is part of why I am treated so shittily when I want to try to have a reasoned discussion about such topics.

I would never pursue a carnivore diet. I generally eat less meat than the typical American. My current dietary approach is basically working miracles.


so it's not surprise people don't ask.

And I suggested a methodology for trying to educate people that does not veer into the territory of making medical recommendations.

I don't intend to discuss this with you further. I will just leave this here as an FYI:

Please don't use Hacker News primarily for political or ideological battle. This destroys intellectual curiosity, and we ban accounts that do it.


Wow, I find it interesting that you choose to stop debating the moment I ask a simple question about why you wouldn't consider carnivory. Your blog name really is appropriate, you are quite salty!

You believe that nutrition is an "ideology"? Jesus. It's a science, and I make no claim that it's 100% clear what the science shows (in fact most of it is corrupt), but I do believe people should treat themselves as n=1 experiments (your blog clearly shows that you treat yourself as such, much to your benefit it seems) -- and there is plenty of evidence that carnivore or at the very least an AIP diet greatly reduces or completely eliminates autoimmune conditions.

If you want to claim that the way people, lived largely disease free, for hundreds of thousands of years doesn't constitute any form of evidence, then I'm not really sure what to say.

Hi. Me, the guy you are recommending the diet to, here again.

Crohns is like not an issue dude. Compared to my other issue that I linked in the same post.

And a little citation needed on people living disease free for any extended period of time ;)

Pshhh this is the internet, which is all about side arguments with random people!

Small sample sizes but the fact that most went into complete remission is worthy of consideration


Also check out some of the anecdotes here


Hope things works out for you!

I'd say the obvious comparison is to Brazil. The upper end of Brazilian society lives in first-world conditions. Some of them a really rich. But the bottom end lives in the third world, in gang-run unregulated slums that have dodgy water and power.

The US isn't there yet, but that's where things seem to be headed.

I grew up in the USA but have lived abroad for many years. After seeing life in Europe and Asia, I agree with this article. Generalization below:

Americans are isolated from other countries and from each other. It creates fear insofar as that we don't even let our children play in the front yards anymore, all the while kids in Tokyo ride the metro unattended by an adult.

My life is much better outside of America, but yet I remain for now, because of the money I make here. Few more years to go and I'm done.

It depends on how you define better. I happen to love Tokyo but let's not pretend like it's universally better than the US in all regards. In fact a lot of the countries people would think of as having better quality of life than the US have a higher per capita suicide rate:


I regret bringing up any country by name, because every country has at least one issue that is easily searchable on the internet.

That's a favorite trick of politicians for criticizing health care proposals.

There are hundreds of different factors that you could use to compare the health care systems of any two countries.

When someone proposes some change, and offers country X as an example of a place that works that way, opponents can always find among those hundreds of factors some particular things where we have better care than X, and then that's all they talk about.

And of course if you propose a change and do NOT cite places that already work that way, then the opponents say you are trying something that is just theoretical and it would be irresponsible to risk our health on such experiments.

Of course. That's why the original article is kind of ridiculous. Every country has its pluses and minuses but suggesting that the US has the quality of life of a developing nation is pretty off the mark.

I lived in Tokyo, I find life in the US to be of much higher quality, though I live in Seattle now and Seattle is probably better off than most US cities.

Depression and suicide rates are a bad measure of unhappiness or social dysfunction. See https://slatestarcodex.com/2015/01/15/depression-is-not-a-pr...

That's only true if you don't count depression and suicide as unhappiness or social dysfunction. Unlike that opinion article, I do count both those as unhappiness and social dysfunction.

Where will you retire to?

I'll spend my 40s in Japan/Bulgaria. Not sure where life will take me after.

Kids in Tokyo are also sexually repressed and have societal mental health issues that continue to baffle academics. Kids in Tokyo also have absurd work hours, brutal education standards and are exposed to large amounts of pollutants.

But hey, at least they can ride the subway alone.

Every country has its' problems, and any country can seem great until you actually live there.

The first time I moved to the US was in 1981. Coming from Germany, a lot of it was quite shocking and seemed like a developing nation even back then, relatively speaking. Infrastructure crumbling. Highways made of concrete slabs that go badum-badum at the seams. Can tell if you're going too fast just by following the rhythm. The cars (rigid axle? seriously?). The appliances. The furniture. Windows that don't really close. Power lines on poles.

We had an ice-storm once that knocked out power in a 500 mi radius. For at least three days. This was, at the time, one of the wealthiest communities in the country.

All that despite a significantly higher GDP/person.

Came back in 2007 to the Bay Area. A lot still the same, though the highways are nice and most people drive foreign cars. You have to be really quite well off in order to get things that don't suck, and I determined I could maintain the same standard of living for a lot less income if I moved back to Berlin, which I eventually did. On the other hand you can learn to fly for (comparatively) cheap. ¯\_(ツ)_/¯

Oh, some of my colleagues at <super-wealthy-top-bay-area-tech-firm> had this idea for an automatic washer-dryer combo: you put the washer on top, then when it's done the clothes drop into the dryer on the bottom. They had a hard time believing that single-unit washer-dryer units have existed for quite some time.

> Oh, some of my colleagues at <super-wealthy-top-bay-area-tech-firm> had this idea for an automatic washer-dryer combo: you put the washer on top, then when it's done the clothes drop into the dryer on the bottom. They had a hard time believing that single-unit washer-dryer units have existed for quite some time.

Is this for real? I find it quite funny that they conceived it to require clothes to 'drop' from one section to the next.

I'm not sure why you're being downvoted. I travelled to Denver for business recently and felt similar things. Outdated fire sprinklers in my hotel (a good one at that) where very strange.

That and the absolutley shocking number of homeless people.

> They had a hard time believing that single-unit washer-dryer units have existed for quite some time.

Indeed, and unfortunately they still aren't good. Just useful if space is a premium (e.g. apartments).

I was recently reading extensively on them, and the consensus seems to be that the washer part is roughly as good as a stand-alone unit, but the dryer is significantly worse (slow and inefficient). Often taking twice as long to dry the same loud.

This seems to be because the dryer is a condenser dryer (stand alone dryers are typically vented dryers). This means instead of pumping warm-wet air outside, they use a heat exchanger to cool the warm-wet air, causing water to be deposited which is then drained.

This results in the combo units consuming water to DRY. Since the heat exchanger has water pumped through it to keep its temperature low, and that water has to be discarded when it gets warm.

>>The first time I moved to the US was in 1981. Coming from Germany, a lot of it was quite shocking and seemed like a developing nation even back then

Actually, the USA has been improved much since the 70's and 80's it's not even funny.

Large cities like NYC and SF were hell holes with tons of crimes and murders and poor people. They've really gotten rid of most of the crime and cleaned up the streets and neighborhoods. Watch a movie set in either city from 40 years ago compared to now. The pollution has improved drastically as well.

Do you have ice storms in Germany? Certainly not in the Bay area. Inclimate weather reaks havok on the roads. Not such an issue in areas that don't get pounded by winter weather. We have issues in the US, but that seems a bit like complaining that the power went out for days during a hurricane, but when I went back to New York we never had issues.

> Do you have ice storms in Germany?


> Certainly not in the Bay area.

Yeah, not so much. My first USA stint was in Michigan.

The problem is that much of the intermediate-level power distribution grid is carried on poles. With the ice freezing on the power lines, a lot of them came down. The power company had people working round-the-clock, but it was just so much of the distribution grid that had failed.

Even little backwater valleys (or even mountains) in the alps don't have those problems. For me, the power going out for 3 days after a bit of bad weather was just not something I had ever even heard of, never mind experienced.

I've studied abroad for some brief periods, but I've lived almost all of my life in the US, particularly in some of the more rural states. I'm at this weird place mentally where I'm sometimes both exasperated by the economic situation here, while still annoyed by 'outsiders' who draw attention to it. Sometimes I feel that the faults of the US get more negative international publicity than other countries, leading people who don't really know the situation here to constantly try to bring up our issues. At the same time, there is still a Cold War-esque "We're number 1" attitude that makes some people here unwilling to see the faults.

In the end, I wish I had an answer. Even more so, I wish I knew what the problem is. As the article says: I'm not surprised that bridges and roads built primarily from the 50s-70s are crumbling and need to be repaired. I'm just surprised that it costs so much to do so, and no one is sure why.

People have gotten too comfortable. We no longer have the will to care for the things we are surrounded by.

We wait for government regulations and lawsuits to make things happen. That was not how this country was built.

Once you concentrate power in corporations or in politics, people just don't have the will or say anymore to do anything.

It takes too much time to build a bridge, and too many players involved and everyone seems to need more checklists and committees and regulations and vendors and contractors just to build a damn bridge. Private construction/ builders are only slightly more efficient because they don't run for election but due to monopolies or regulations they are ever more inefficient than before.

And everything gets amplified a million times through Twitter with not much substance but just generally shouting about things and not actually doing shit.

I remember when it took almost a year to refurbish a small bridge in downtown Ithaca.

There used to people who said the Egyptian Pyramids were built by aliens, but the experience with that bridge made me wonder if the Tappan Zee bridge was built by aliens.

From a very long article on healthcare, "High US health care spending is quite well explained by its high material standard of living", I got an idea that neatly explains my experience in the USA and the perception of various groups from outside in (I'm from Moscow, that some people jokingly claim is a separate country from the rest of Russia). It's still not a well-formed idea, just a gist of it.

US to me looks like a first world country with a 3rd world country attached to it; with the bleed of culture both ways (making urban-rural divide worse, sort of), and obviously economic effects both ways. It's sort of like if Russia joined the EU as far as people and economics are concerned - it'd still be a hellhole outside few major cities, but overall richer and with lots of angry anti-EU people. The US is like that, and the states are much more integrated than the EU is.

The strongest case for this can probably be built by analyzing human capital as well as metrics such as healthcare (like the original article did), crime, etc by county. The weaker case for me personally is that the "feel" (and the norms if online sources are any indication) of rural/small-town places in the US vs urban/rich places in the US, is much more like small-town Russia vs Moscow (except more pissed instead of resigned to their fate), or other semi 3rd world countries, than the same in Europe.

I don't actually think that Civil War was a war between those countries, but its interpretation these days by many people seems to cast it as such... and the present-day GOP leadership looks to me basically like United Russia in Russia - it's a party of power, plain and simple, that aspires to unleash the freedom to shear the great unwashed.. a typical 3rd world party of which there are few or no European equivalents. The Dems (and centrist GOP, I guess) are such a bizarre party these days because they, in turn, have to represent almost the entire spectrum of the first-world parties - from Bill Clinton liberal and Christian centrists, to Greens and Socialists.

My rule of thumb: if an article has a line chart with non 0-based Y axis it most probably tries to manipulate the reader's opinion by trying to present an increasing/decreasing trend as more significant than it actually is.

Surely this is just normal for a big country. USA, China, Brazil, Indonesia, Russia. There are some outliers - Germany, Japan, France, but they're stagnant with falling populations as people want to leave them. There are also some smaller countries Australia, Sweden, South Korea that have done well the last few decades, but we'll see how much longer for.

When you have a sizable underclass because the upper classes want that sort of thing, then you have these sorts of issues.

I think we should acknowledge that we accept over a million legal immigrants every year - comprising over 12% of our population.

Obviously many of them are immensely beneficial and some are not - but I think this statistic belongs as part of the equation.

I don’t see how they the presence of those legal immigrants is causing the US to stop taking care of its infrastructure or providing services like health care, etc. Your claim is a bit of a stretch and is the kind of typical nationalistic nonsense that distracts people from focusing on the real causes of these problems.

A similar percentage applies to many Western nations.

1 million legal immigrants comprises over 12% of our population? What exactly do you believe the US population is?

I can’t tell if I’m on Facebook or hacker news.

Year over year a million immigrants adds up to 14.2% of our population as stated in this UN report:


This is germane to the topic because many of our recent immigrates are from developing countries.

Broken link

Looks like they're having some server issues.

Here's a PDF of the UN 2017 report - it shows America has over 49 million immigrants on page 6.


What, you didn't know that the entire population of California was illegal immigrants?

Op never called out California by name and made it sound like they’re referring to the whole country.

Strong Towns has the best explanation of this phenomenon that I’ve seen: https://www.strongtowns.org/the-growth-ponzi-scheme

I recently started to understand US politics a lot better by realising that it's a global moon-landing superpower and a Latin American banana republic that occupy the same physical space.

It seems it is both the richest and the most unequal among the developed countries.

Most issues are a consequence of this inequality.

Sigh I am sad we cant have a productive discussion without going into "grass is greener on the other side".

From a European point of view, the growing use of GoFundMe campaigns to pay for health care bills in the US feels like a wild capitalist dystopia. Your Facebook friends decide if you'll live or die.

You guys need a good dose of socialism!


Please don't post ideological battle comments to HN. That's not what this site is for.


Could you elaborate on “math-fearing”? I’m really curious to hear your justification for its inclusion in your lists

I expect it's a dog whistle referring to black and ethnic crime statistics.

It's not, and I'm not even sure what you're getting at.

If that's the case then I apologize. It's a common thing to cherry pick out of context and misleading statistics to push a narrative, then say "you must hate statistics/maths/reality" when you point out they are misleading.

"The left hates math" = "the left hates our statistics"

Perhaps you could elaborate on your comment.

So what do you mean by “math-fearing”?

The US is a rich country with the symptoms of a rich country.


That makes it sound like being a developing country is a disease.

Welcome to the effect of too much government, between Federal, State, and Local, there is so many layers of inefficiency, graft, and corruption, it has become incredibly expensive to get a lot done. Corruption isn't simply down to giving and taking of bribes but the outright placing campaign officials in places of authority and nepotism.

County level in many states works out just fine but even they are subject to harassment if not extortion by higher levels of government.

We have a government too big it fails. Worse it costs the poorest of our country an inordinate amount due to taxes, fees, and penalties.

And yet there are countries with more government and much better outcomes along many axes, e.g. Denmark. So maybe there's a difference between a big government and corrupt one?


Also it's hard to define "too much government."

Too many/too steep of taxes?

Too many Government employees?

Too much regulation of industry?

There's definitely some correlation, but I don't think these are strictly coupled.

It would be possible to have France-like tax rates but not employ many government workers by paying private industry to handle tasks like health and education.

I'm of the belief that practices like this might be part of the reason the US has so many healthcare inefficiencies though. Corporations are solely focused on making profit and there just isn't enough competition in areas like telecom, healthcare, etc. to keep prices down.

I'm Canadian and our healthcare isn't perfect, but it's also not the kind of political talking point it is in the US for a reason.

That’s weird, considering the countries that are better off have even more government

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