But I mean what else could she do? You tell the electorate the truth and they don't understand it or don't listen, you lie and say "fine we will fix it with price controls" and they freak out all the same. Only one side of the political apparatus can like with impunity, apparently.
Interestingly, if you said that “The Federal Government” should build and run small nuclear reactors, I bet you’d get a lot of pushback; I’m always fascinated by how “the military” is culturally considered very different from “the government” in the US. The military is perceived as able to do most anything while the government is considered lazy and wasteful.
I’m Canadian and don’t know all of the inner workings of the US Military, but an observation from the outside is that it seems that the US Military oddly captures a lot of the more left-leaning ideals:
- Health care provided by the VA
- Education, both before the job (officer school or trades training) and for post-military life (GI Bill)
It was not an issue of refining the content on one site, you make a good point though.
It was more of an issue that they had a bunch of clients on an old CMS system, and they did not want to make any changes the way that the sites were built or hosted.
I can make arguments for and against either side of this idea, it all depends how you want to run your business.
U.S. tax law needs to change for this to happen. Individual health care should be totally tax deductible (the way it is for businesses) or should not be tax deductible at all for business (a small step in this direction by the Obama Administration was vilified as a "Cadillac Tax"
If proper single payer is out of the question, the biggest mistake in Obamacare is that employer-sponsored health plans remained legal. Everyone should have been forced into the same market.
Medicaid spending-- driven by huge federal incentives-- is crowding out state dollars for higher education. Medicaid enrollment has increased 50% in WV in the last decade (while the state population has declined). The US is making a policy choice to funnel more of GDP into a wildly inefficient health care system to support obese and aging populations, instead of funding K-12 and higher education.
We are screwed on healthcare and most of the proposed "solutions" will only make things worse.
We need smart legislation to eliminate global free ridership on medication as well as less insurance, not more (combined with universal catastrophic high deductible insurance a la Singapore's medishield). We also need occupational licensing reform and to decouple healthcare from employment (ie. the politically impossible cadillac tax that Obama tried to push through).
Shielding people more from the true cost of healthcare is the politically popular option but does not improve health outcomes and drives utilization (and thus resource allocation) higher.
Medicaid enrollment went way up but federal spending growth remained relatively close to the trend. They didn't even overhaul the system to combat the price gouging that is going on. To me this trial run proves the opposite of your conclusion: the US would be able to afford public healthcare if it adopted an intelligent model. We need to set the bar higher as a society when it comes to social well-being, not pull back on our ambitions.
In a situation with declining proportion of working age population (and lack of sufficient automation to offset it), one will lead to the other, as more and more of the share of resources from the working population are reallocated to the non working population.
It's not so much a choice that we take pride in doing but a problem we have boxed ourselves into. Path dependency sucks. The benefit of a republic is that huge political shifts happen over a long period of time. Sharp changes only happen in response to an immediate crisis. Normally the system rewards grafting yet another patch onto the existing system instead of throwing it out and setting an entirely new set of rules.
Medical services became much more effective when physicians accepted scientific methods. Allopathic physicians used state licensing to restrict who could call themselves a physician. Due to post WWII price controls employers offered health insurance. Baby boomers did not grow up with the existence of all the drugs we have or neonatal intensive care units. People are still considered alive after their heart stops beating. Standards of care went up. Health workers' scopes of practice are carefully circumscribed by their license which does not transfer across state lines. The government agreed to pay for the medical costs of the elderly and poor, letting private health insurance skim profits from the lower cost working age population. Attempts to rationalize the system via a National Health Service, single payer financing, or heavy regulations on a universal private insurance market have failed. Instead the ACA just plugged the most egregious pitfalls for Americans and tinkered around the edges to try get everyone insured. Some states have chosen to not expand Medicaid to the detriment of their indigent population and rural hospitals.
If medical costs are to ever stop growing at 6% per annum the end result will likely be due to a combination of price controls, wait times and limits on care to hold down demand, lower health worker pay, free training for health workers, and rationalization of the system to incentivize population wide health. Switching from fee for service to per capita removes the incentive to treat more to generate more revenue. If universal eligibility is achieved that removes the incentive to refuse service to uninsured patients or discharge them ASAP. When outcomes are measured for the health sector as a whole, problems like hospital re-admissions or high co-pays that result in some patients not filling their medication orders get a harder look instead of being a perverse gain for one business and a bigger cost for the rest of us. Right now healthcare is run as a business. Each firm optimizes for the profitability of their link in the chain. The government tries to help those left behind by loading money into the top of the medical-industrial complex without ever making changes to the Rube Goldberg machine within.
Florida is overall one of the best run states in the country. The public pensions are largely pre-funded and there's no state income tax. The biggest issue is the property insurance marketplace.
You're measuring success by spreadsheets, not quality of life. As a Florida resident for half a decade, the state is a dumpster fire. It is designed as a place for the very wealthy to live well at the expense of everyone else (with the tax framework built to be regressive vs progressive).
~26% of Florida drivers carry no auto insurance (raising prices for everyone else). Property insurance market is collapsing due to roofing fraud and climate change risk repricing. If you have kids, public school is not an option due to quality. Pedestrian deaths are higher than the national average. Despite transparency laws, there is still substantial corruption and nepotism in government. Electric rate increases exceed other areas due to primarily investor owned utilities regulatory capture and their heavy reliance on natural gas fired generation. There is an extreme shortage of healthcare workers and teachers currently (construction and agriculture aren't far behind due to recent legislation). The people of Florida elected Rick Scott for governor twice. Before he ran for governor, he was CEO of Columbia/HCA. The company presided over the biggest Medicare fraud in history, and the company had to pay a $1.7 billion fine. Rick Scott claimed he didn’t know anything about this fraud, but he had to plead the fifth ~75 times during the investigation. Rick Scott is now a Florida senator. You can also carry a concealed weapon with no concealed carry permit as of July 1st. There is an affordable housing crisis, with Florida ranking third for homelessness.
But yes, warm weather and no state income tax.
(I can provide citations for all of my assertions above but won't pollute the thread unnecessarily)
That's the issue. Florida's effective tax rate is about equal to Georgia which has a ~5.5% income tax. And it's going to continue to increase with homeowner's insurance prices even outside of the Miami metro area skyrocketing (which you pay for even if you rent, in terms of rent increases owners enact to cover costs).
My family member died from his addiction and I'm still angry at him. He made several decades of selfish, disastrous choices. He had every advantage in the world and squandered it all. I'm angry we don't do more to fight these drugs. Drug dealing is very much a violent crime, it killed my cousin. The popular culture that celebrates drugs and dealers.
Plenty of blame all around but central is the person who decides to use.
> He had every advantage in the world and squandered it all.
I don't believe people get on addictive drugs and squander their lives when they truly have "every advantage in the world". I've been to rehab and recovery programs and I haven't a single person for whom this was the case.
Usually when people say this, they're talking about privileged people who outwardly seem like they have everything they need to succeed. But they have demons: depression, bipolar disorder, mental health, trauma, chronic pain. What's worse, other people are often unwilling acknowledge those demons, and say things like "you have every advantage in the world" which can just make them feel more isolated.
This can lead people to seek relief however they can get it.
I'm sorry for your family member and for you and your family; but for anyone reading this with a loved one struggling with similar issues, know that helping them can sometimes require willingness to understand them first.
> The popular culture that celebrates drugs and dealers.
You mean modern medicine? That's what makes this problem so pernicious - so much of it was created by the people fictionalized in shows like House MD and Grey's Anatomy not The Wire and Breaking Bad.
For thousands of years the natural opioids morphine & codeine have been almost universally recognized as harmful dependency-inducing substances in their own category, that build a tolerance which can almost never be limited beyond a certain number of years, before the toxicity overcomes any therapeutic benefit there might have been upon initial administration.
After all this time a religious person of many different faiths over the recent centuries might have often said that for long-term use they were put on earth by god for people who can not be expected to recover.
Synthetic opioids are just the modern version which were developed because the natural product itself can not be patented.
Hence "patent medicine".
The habit-forming effect is what made the Sacklers the richest pharmaceutical barons so far.
Obviously he doesn't mean that, there's an enormous body of media and art that glamorizes drug dealing and using. It stretches across ethnicity and class. It begins with alcohol and weed, stretches into cocaine and hallucinogens, and from there gets into the heavy drugs.
If the only input into drug addiction was the modern medical industry over-prescribing opioids, the landscape of modern drug use would look very different.
Does any recent media actually glorify the drugs that are causing the worst problems right now? I watch a lot of TV but have less exposure to popular music so I'm genuinely unsure.
There's plenty of alcohol, weed, cocaine, and hallucinogens, I'll give you that, but they're not gateways to opioid addiction. Breaking Bad glorifying the manufacture and sale of meth is the only except I can think of - Oxy, fentanyl, and p2p meth aren't exactly the drugs musicians and Hollywood turn to as a lyrical/plot device.
There's also a fine line between glorifying and entertaining. I struggle to find any such glorification in shows like Snowfall, for example, which mostly shows the very negative impacts of crack cocaine in cities. There's only a single character in the entire run that manages to overcome the drug and the main character is a tragic anti-hero at best.
Any time heroin or another opioid comes up in pop culture it's almost always in the context of horrifying drug dens.
I would argue that if one watches Breaking Bad to its conclusion that it's hard to say that it glorified the manufacture and sale of meth. Everyone involved has huge negative consequences in their lives as a result. The collateral damage is staggering. By the end, Walt seems as addicted to the sense of power that making meth gives him as the user of meth desperately seeking their next hit. He sabotages himself and ultimately gets himself shot (probably killed -- though I think this is open to interpretation) chasing his last hit.
I think "high school chem teacher builds a drug empire that rivals Mexican cartels" is definitely a glorified macho-suburban fantasy elevated to an art form. In reality season 1 would have ended with Bryan Cranston's character dissolving in a vat of drain cleaner or buried out in the New Mexican desert missing his head and fingers. I mean, look at the drug addict that gets the most screen time in the show: he's the cofounder of the drug empire guiding the main character through the drug game like a methed out Master Miyagi.
Compare it with Snowfall: the main character's family has at least some history of drug dealing and he only succeeds because he discovers a cheap and ultra-addictive recipe for crack cocaine and because the CI-freaking-A is using him to fund the global war on communism. Recurring characters get killed off in dumb gang skirmishes all the time and the drug addict with the most screen time is literally a shell of her former self that can barely get through the day up until the latest season.
Or compare it with The Wire: all the people involved in the drug game are only in it because they have literally nothing else to live for except the glory of the game. Basically no one survives except the cops and Bubbles never really gets fully clean.
It does the antihero bit pretty well. It shows life going on after Walt's brother in-law is killed. In real life people would be a lot more torn apart by it, and not just sad.
The main thing it glorifies I think is that boys will be boys, not drugs per se.
> There's plenty of alcohol, weed, cocaine, and hallucinogens, I'll give you that, but they're not gateways to opioid addiction.
This is only partially accurate. There are two primary "pipelines" to opioid addiction; one of them is overreliance on painkillers, but the other one is fairly standard risk-seeking escalation through a socially deleterious lifestyle, often culminating in an OD or a prison sentence after a predictable years-long risk escalation path through social drug use.
I will agree that I don't think there's a lot of media showing meth or fentanyl use as cool and attractive, but my overall point is less that a specific drug needs to be shown to be cool, and more that the artistic construction of the drug lifestyle as alternative, exciting, rebellious etc. wears down the emotional barriers of a lot of people when they're young and malleable. I've done a good number of drugs in my day and I can assure you that in the case of most of the people I did drugs with, early exposure to "drugs are cool" art and music played a part in their ready acceptance of the lifestyle.
As one example, if you go to a high school party, often the riskiest, coolest kids will go off in private and do drugs. There's no feedback loop in the media to make this look pathetic or sketchy--on the contrary, most drug use is played for laughs, or it's added as another dimension to a lifestyle that's supposed to be tragic but instead looks awesome. "Oh my god, look at this guy's life, he's a mess, his apartment is so dirty, he's doing lines off the mirror... with a smoking hot supermodel-actress while we do a B-plot story about how his small-town parents are boring and stodgy... and he's a rock star..."
I don't really know whether or not you could seriously reduce drug use by not showing it in the media, but I do believe that showing it as positively as it is now increases drug use. And I haven't even mentioned the music surrounding drugs.
> Oxy, fentanyl, and p2p meth aren't exactly the drugs musicians and Hollywood turn to as a lyrical/plot device.
Oxy is hugely glamorized in rap music. Drinking "lean" / cough syrup and doing Percocet pills. Future song "Molly Percocet". The Weeknd's record label is called XO for Ecstasy / Oxy.
I still tend to disagree because I have a hard time finding balance and not going too far in restricting the media I consume, but it's a nice vision.
A lot of the religious right in the US, especially the part that is led by televangelists like the late Pat Robertson, just wants to suppress it out of ignorance and they have no plan except to throw more and more people in jail, creating more X to prison pipelines.
After reading this article, I agree with the words of Thich Nhat Hanh, thank you for the recommendation.
> The religious right in the US just wants to suppress it out of ignorance
I tend to agree that the religious right in the US is a legislative force that does more harm than good, and that many people who campaign against drugs don't have a solid understanding of drugs or drug culture. However, I don't think that it's ignorant to want to suppress drug culture (either in the media or in real life), and I think more religious conservatives have experience with addict family members than you think.
Good point, I ninja edited just before you posted to say that a chunk of them have been mislead by televangelists and such.
I can tell Thich Nhat Hanh appreciated the people you're talking about, having read about him traveling all around the world and meeting people from the US (where he lived for quite some time) and countless other countries.
One of the principles that I hold to pretty strongly is that the more performatively famous someone is surrounding a certain idea, the more likely it is that they don't have any real principles, and they're just beating whatever drum allows them to continue to hold influence over people. So someone like Pat Robertson doesn't actually believe what he's saying in private, but if he kept banging that drum he kept his lifestyle and acolytes. I think the majority of US politicians that people recognize by name are like that, and certainly most religious leaders like Pat or Joel Osteen.
> Plenty of blame all around but central is the person who decides to use.
Oh get off your high horse.
I've had two uncles die from alcoholism. In reality, it was the divorces and way more complex circumstances that really did them in. It really is the cage.
It's important that we avoid the twin extremes of, on the one hand, categorically blaming circumstance for everything, and on the other hand, categorically assuming 100% culpability. The proper view is that human beings operate at a nexus between circumstance and decision. Circumstances can create good or bad incentives, and statistically, people will follow incentives (hence the need to legislate properly, for example). These incentives can be strong or weak. They can create more or less pressure to follow through with the incentive. But we must ultimately make a choice and that rests with us (in the extreme case, something like extreme pain can blind a person and effectively rob him of the freedom to choose intentionally which is to say with the capacity to use reason). So how culpable we are for a decision varies on a variety of factors, but there is almost always some culpability.
In the case of your parent comment, it sounds like the person in question is very culpable, that he had the capacity to reason, to know he should have chosen otherwise, but did not. There's nothing wrong with the content of that claim as such.
I mostly agree with you. But when your doctor is telling you to take some 'medicine', and that is what makes you addicted it's not completly in your hands anymore.
After I had surgery on my ankle in college, my dad took away the pain medicine the moment it was no longer necessary (1 day later) and just gave me Advil after that.
I didn’t fully appreciate why until I saw somebody go through it.
But then I got the entire picture. This man struggled. Hid it from his family. Finally confessed it to his wife who stuck by him and sent him to a rehab program to get clean. He was gone for about 4 months and got clean. Got his life back. Got his family back and got back to work.
And then his old dealer came back around. It took another family member telling the dealer he’d shoot him on sight if he ever came around again to get that predator to leave.
