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MadMonzer

Temporarily embarrassed liberal elite

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joined 2022 September 06 23:45:01 UTC 

				
User ID: 896


				
				
				

			

		

	














	


		


			



	

		

			

			

				

					

						

							
						

						

							
							

								
MadMonzer


								

								

								
								
								

								
							
					
 
				


				
Temporarily embarrassed liberal elite

				
				
				

				

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					joined 2022 September 06 23:45:01 UTC
				


				
					

					
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User ID: 896


					
					
					
				

			


					

						
					



		

	

 











			
			

			
			

			




	


		

			
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				Transnational Thursday for December 12, 2024
			
		

	

	

	

		
			

			

				

			

		

			


				

					
It's worth noting that our black murder rate is about the same as the US white murder rate, and that high-volume violent and property crime is still at less than a quarter of the 1990's peak when measured by victim surveys (which are not affected by declining police reporting) which have used a comparable methodology throughout the period. Knife crime is probably up (it's hard to measure accurately because it isn't common enough to show up in victim surveys or serious enough to be reliably reported to police) but that isn't what the burghers of Hadley Wood are complaining about.


Crime is always out of control according to the media. Crime is always out of control according to the "children, nowadays" crowd. Crime was out of control according to the media and the "children, nowadays" crowd right through the dramatic drop in crime in the nineties and noughties. Media coverage of crime being out of control tells you nothing unless backed up by some form of reliable numbers. And even then you can cherry-pick numbers - the same people claiming that the police-recorded numbers showing falling burglaries are fake are citing police-recorded numbers to prove that violent crime is increasing despite victim surveys showing the opposite.


				

				

						

							

								
							

						


						
					

				
			


			

	


			
			
				

			
		

	






		

			
			
				Noah Smith: Insurance companies aren't the main villain of the U.S. health system
			
		

	

	

	

		
			

			

				

			

		

			


				

					


These are all solved problems in every field, except medicine.




Including medicine outside the US. Private hospitals in the UK are happy to offer fixed-ish prices for elective surgeries and take most of the financial risk of complications.


				

				

						

							

								
							

						


						
					

				
			


			

	


			
			
				

			
		

	






		

			
			
				Noah Smith: Insurance companies aren't the main villain of the U.S. health system
			
		

	

	

	

		
			

			

				

			

		

			


				

					
It is worth noting that England has abolished the English rule for personal injury cases (including medical malpractice) - we now have a system called QOCS (qualified one-way cost shifting) where the claimant can never end up owing the defendant money for costs. (In the case where a winning claimant has to pay costs because they failed to beat a timely settlement offer, the costs can be set off against the damages). This rarely matters, because the vast majority of personal injury cases are slam dunks against at least one defendant.


The reason for doing this was that ordinary middle-class personal injury claimants needed to insure against owing the defendant money, and the insurance industry and tort bar had worked out ways of turning these insurance policies into a total rort the cost of which ended up being collected from losing defendants.


				

				

						

							

								
							

						


						
					

				
			


			

	


			
			
				

			
		

	






		

			
			
				Small-Scale Question Sunday for December 15, 2024
			
		

	

	

	

		
			

			

				

			

		

			


				

					
My understanding was that the Mars rocket would be assembled in LEO from parts launched in Starships, and that a tanker configuration of Starship would be used to fuel it.


				

				

						

							

								
							

						


						
					

				
			


			

	


			
			
				

			
		

	






		

			
			
				Culture War Roundup for the week of December 9, 2024
			
		

	

	

	

		
			

			

				

			

		

			


				

					
Only outdoor wooden furniture that has been frost-damaged, like benches in Alpine resorts.


				

				

						

							

								
							

						


						
					

				
			


			

	


			
			
				

			
		

	






		

			
			
				Culture War Roundup for the week of December 9, 2024
			
		

	

	

	

		
			

			

				

			

		

			


				

					
There was no thousand-year rut. Christian Europe in the High Middle Ages had already overtaken Rome in terms of technological sophistication, with notable inventions in the period including spectacles, the windmill, mechanical clocks cheap enough to be installed in every village church, sandglasses which keep accurate enough time to be useful, and the architectural techniques needed to build the Gothic cathedrals. (Neither the Romans nor the Chinese could build anything like that). The translation of the key Greek and Arabic works into Latin had been completed by 1200, and at that point Western science and maths started to move ahead (most obviously in astronomy with Oresme). The fall of the Baghdad caliphate and Song China to Genghis Khan allow the West to move into first place, but we never look back and continue to forge ahead through the Renaissance, Commercial Revolution, Age of Exploration, Industrial Revolution, and American Hegemony. If we are not the same civilisation that built Notre-Dame, it is because of some loss of faith in the last hundred years, not because the Renaissance was a RETVRN to an older continuity. (And in any case, the implausibly effective rebuilding of Notre-Dame is strong evidence that we are the same civilisation that built it.)


I am less confident, but on balance believe based on Tom Holland's work, that the key ingredients of the thing that grows into Western Civilisation come together during the Ottonian Renaissance (950-1030), the Cluniac Reforms of Christian monasticism and worship (910-c.1130), the Gregorian Reform of the Church which grew out of Cluny (1050-1080), and the Peace of God movement (989 onwards). Those ingredients are Christianity, the example of Rome, and some kind of customary law or oligarchic cultural trait of the ascendant Germani that counteracts the worst aspects of Romanism. Greek paganism is only essential to the extent that Roman paganism is an offshoot of it (a point of great controversy among classicists).


				

				

						

							

								
							

						


						
					

				
			


			

	


			
			
				

			
		

	






		

			
			
				Culture War Roundup for the week of December 9, 2024
			
		

	

	

	

		
			

			

				

			

		

			


				

					
This would make "there are roughly pi gigaseconds in a century" an actual useful fact.


				

				

						

							

								
							

						


						
					

				
			


			

	


			
			
				

			
		

	






		

			
			
				Culture War Roundup for the week of December 9, 2024
			
		

	

	

	

		
			

			

				

			

		

			


				

					


Germany could have a rate of healthcare executives being murdered 4x as large as the US and given it's happened a single time in the US, a country >4x larger than Germany, we still wouldn't know it because it's only happened a single time over a very long time horizon.




Good point. I do think that there is a difference in public sympathy. Brian Thomson's killer gets more sympathy than the killers of politicians, for example - implying that health system executives in the US are less popular than politicians. If you are at a medical law conference where all the lawyers are in one hotel and all the hospital and insurance company executives are in the hotel next door, and you only have one bomb...  In the US this is a difficult question. In most other countries, "don't set the bomb off" is the right answer.


I don't think this forum is a good place to make large long-term conditional bets, but I would bet at 4:1 odds conditional on a German healthcare executive being murdered by a stranger in the next 10 years, the killer does not get public sympathy from anyone as prominent as a backbench Bundestag member. 10:1 for an NHS senior manager in the UK.


				

				

						

							

								
							

						


						
					

				
			


			

	


			
			
				

			
		

	






		

			
			
				Culture War Roundup for the week of December 9, 2024
			
		

	

	

	

		
			

			

				

			

		

			


				

					
At a clinical level, I am going to call bullshit on the claim that this guy died because of shockingly poor medical care. I am not a doctor, but I have had two relatives die of aneurysms and been involved with the pro forma inquests into sudden deaths outside hospital that resulted. Based on the information provided in the MSM coverage:


    

  • A 39-year old male with no other current health conditions (former drunk and methhead, but clean 6 years - not stated if the ER knew this) presented to the ER with acute chest pain
    • 

  • He received initial treatment promptly
    • 

  • The first ECG was normal and there was no other obvious reason to suspect heart attack
    • 

  • He self-discharged after 6 hours
    • 

  • He died of an aneurysm (type unstated, but presumably aortic) about 24 hours later.
    • 

  • The ER would have taken and recorded blood pressure, but we don't get to see it. He didn't get treated for immediately dangerous high blood pressure, so he presumably didn't have it.
    • 



First point - this guy is very low risk for aneurysm based on the presentation. The main risk factors in rough order of importance are age, smoking, blood pressure and obesity. History of cocaine abuse is also listed in some places, but not alcohol or meth. None of these were present. And in any case, aneurysm isn't one of the top 10 causes of acute chest pain at all (most aortic aneurysms are in the abdomen, not the chest).


Second point - if they had done the X-ray and bloodwork that the guy thought he was waiting for, it wouldn't have found the aneurysm - aneurysms don't show up on X-ray. You should find an aneurysm on ultrasound (but nobody does ultrasound in chest pain cases), and you will find it on CT or MRI. Whether the standard of care for chest pain with a normal ECG is chest X-ray or CT scan * appears to be controversial in the US. Anecdotally, the vast majority of aortic aneurysms are found as a result of doing a scan for some other reason. (In this case, it would have been while doing a CT scan of the heart to check for cardiac causes of chest pain other than a heart attack).


Third point - if they had found the aneurysm and chosen to repair it, it would have been scheduled as urgent surgery (the UK guideline is within 2 weeks), not immediate emergency surgery. They wouldn't have known that was going to rupture within 24 hours. So he dies with probability >50% even if they do find it.


Fourth point - the US standard of care for suspected-cardiac chest pain includes observation for 24 hours. If that's what you are doing, and (as the Canadian docs did) you know that the guy isn't having a life-threatening heart attack right now, the slowness is excusable if adequately explained.


Provisional conclusion - this guy was not killed by Canadian cheapness - the key clinical decision (i.e. not doing a CT scan) is balancing radiation risk against a marginal improvement in diagnostic accuracy, not a cost-based one. And in any case, this is a case that would if probably have been missed by a perfect medical system because when the horse is a heart attack, you don't fuck around testing for zebras. There may have been** a culpable failure of communication - if he didn't know why he was sent back to the waiting room after the ECG, or what the short-term plan was that was worth waiting another 6 hours for, and he absolutely should have done. If they told him and he just got tired of waiting without a clear ETA, then that is normal for a non-life-threatening case in a busy ER, regardless of funding levels. But even if they had provided an adequate explanation, it probably wouldn't have changed the result.


* Chest CTs are one of the highest doses of radiation that a normie is exposed to, so they are treated as an "only if strictly necessary" procedure.
** It isn't clear if he was told he was waiting for bloodwork and X-ray, just not when it would happen, or if he worked that out himself.


				

				

						

							

								
							

						


						
					

				
			


			

	


			
			
				

			
		

	






		

			
			
				Culture War Roundup for the week of December 9, 2024
			
		

	

	

	

		
			

			

				

			

		

			


				

					
I think the you-can-only-blame-yourselves-voters aspect of the NHS is specific to systems where the payers look like democratically accountable government organisations. The social insurance systems of Continental Europe (tl;dr for Americans - more like Obamacare done right than Medicare for All) work better than socialised systems if you are collectively willing to pay first-world prices for first-world healthcare (something the British voters are deeply conflicted about right now), but they do involve organisations that look like non-profit (but somewhat commercially managed) insurers and non-profit (but very much commercially managed) hospitals which are scapegoatable for the same reason that Brian Thomson is.


The reason why nobody is murdering Krankenkrasse executives is that the German system works well in general, and very well on the dimensions that are most emotionally salient to patients (waiting times, patient experience, prevention of the kind of horror stories that go viral on social media).


				

				

						

							

								
							

						


						
					

				
			


			

	


			
			
				

			
		

	






		

			
			
				Culture War Roundup for the week of December 9, 2024
			
		

	

	

	

		
			

			

				

			

		

			


				

					
And noon will never be noon as UTC drifts away from solar time.


Do views on leap seconds in UTC (among people geeky enough to care) line up with views on DST in ways which reflect the underlying logic of "noon is noon"?


				

				

						

							

								
							

						


						
					

				
			


			

	


			
			
				

			
		

	






		

			
			
				Culture War Roundup for the week of December 9, 2024
			
		

	

	

	

		
			

			

				

			

		

			


				

					
Animals of the farm type don't know what time humans' watches are showing.


The argument that "farmers start work at 6am and it will be too dark to do farm work that early in the morning if we have permanent DST" is widely made in the UK, and believed by significant numbers of farmers, but it is the stupidest argument on either side of the debate. Farmers have to start work at dawn (or slightly before, depending on what they are farming) regardless of what time the clocks are showing. All moving to permanent DST would do is take away part of the early-riser machismo that attaches to getting up early (relative to dawn) when we have set the clocks so that urbanites do that.


				

				

						

							

								
							

						


						
					

				
			


			

	


			
			
				

			
		

	






		

			
			
				Culture War Roundup for the week of December 9, 2024
			
		

	

	

	

		
			

			

				

			

		

			


				

					
Mostly ones aggressively signalling philosemitism.


				

				

						

							

								
							

						


						
					

				
			


			

	


			
			
				

			
		

	






		

			
			
				Culture War Roundup for the week of December 9, 2024
			
		

	

	

	

		
			

			

				

			

		

			


				

					


I do think UK doctors honestly should retrain, just less than those from third world countries.




Why, when doctors who are willing to cross oceans can get most but not all of the benefits of moving to America without retraining by moving to Australia instead? You would need to have an unusually serious money-solvable problem to make it worth redoing residency for the delta between US and Australian doctors' incomes.


I don't think it would be difficult for the US to compete with Australia for disgruntled British doctors, but right now they aren't trying.


				

				

						

							

								
							

						


						
					

				
			


			

	


			
			
				

			
		

	






		

			
			
				Culture War Roundup for the week of December 9, 2024
			
		

	

	

	

		
			

			

				

			

		

			


				

					
I wasn't claiming that US residency was worse than being a junior doctor in the NHS (I have no idea if it is or not) - I was saying that being an early-career medic is a crapsack lifestyle anywhere because of the intensity of the training plus the amount of medical scutwork you have to do to justify the senior doctors paying attention to you plus the hazing element of it all.


Three years of "hell" that gives you the power to heal the sick is worth it for both career and soul reasons. Doing it again for mere money when you already have a ticket to the upper-middle class - well I'm sure the dignity of a British doctor has a price, but it isn't cheap.


				

				

						

							

								
							

						


						
					

				
			


			

	


			
			
				

			
		

	






		

			
			
				Culture War Roundup for the week of December 9, 2024
			
		

	

	

	

		
			

			

				

			

		

			


				

					
Thanks. So modulo a relatively minor argument about capital gains when retiring doctors sell their practices, this is total physician earnings and not just salaries.


That does indeed point to "overpaid doctors" not being the problem.


				

				

						

							

								
							

						


						
					

				
			


			

	


			
			
				

			
		

	






		

			
			
				Culture War Roundup for the week of December 9, 2024
			
		

	

	

	

		
			

			

				

			

		

			


				

					
It isn't just "three years" - it's "three years of hell", and if you are doing it for the second time to tick a bureaucratic box, it's unedifying hell. People who are already upper-middle class don't put themselves through just to double their salary. You either need to offer enough upside potential to take the winners out of the upper-middle class (startup founders, finance jobs) or something that speaks to the soul.


Also those are the specialties that are at the bottom of the food chain in the US in a way they are not in the UK, so they are the ones where the benefit of moving is least. NHS GPs who want to graft can make as much money as successful surgeons.


				

				

						

							

								
							

						


						
					

				
			


			

	


			
			
				

			
		

	






		

			
			
				Culture War Roundup for the week of December 9, 2024
			
		

	

	

	

		
			

			

				

			

		

			


				

					
IF the US wanted to poach British doctors, you could get about half of them (including some of the ones who are currently heading to Australia). Please don't. I love my family, and several of them are dependent on healthcare to stay alive.


				

				

						

							

								
							

						


						
					

				
			


			

	


			
			
				

			
		

	






		

			
			
				Culture War Roundup for the week of December 9, 2024
			
		

	

	

	

		
			

			

				

			

		

			


				

					


-Okay how much of healthcare spending is doctor’s salaries?






About 8%. If you cut physician salaries by half you get 4% savings. That’s not a little but it is also not a lot.




Obvious question - is this the total income paid to doctors or just the salaries of salaried doctors? The fraction of doctors who are salaried is increasing over time, but most of the doctors who are allegedly overpaid are not salaried - they are surgeons being paid a fee-per-procedure, or owner-partners in physician-owned clinics.


				

				

						

							

								
							

						


						
					

				
			


			

	


			
			
				

			
		

	






		

			
			
				Culture War Roundup for the week of December 9, 2024
			
		

	

	

	

		
			

			

				

			

		

			


				

					


US life expectancy at birth sucks versus peer countries, and even still sucks around age 40. But as you get into retirement years it reverses, and the US eventually climbs to 4th place among the 18 countries




Thanks for the link - this is fascinating data. My interpretation:


    

  • The big reversal (when US age-specific mortality drops below the OECD average) is around age 80 for men, 85 for women.
    • 

  • This isn't an advertisement for "the US healthcare system" as discussed in political ranting (i.e. mostly-private insurance and a freeish market for providers) because the age groups with good results get almost all of their healthcare via Medicare, which is a single-primary-payer system with price controls on providers.
    • 

  • It isn't an advertisement for Medicare either, because the age at which US relative mortality starts to improve is well above Medicare eligibility, and in any case the pattern of falling US mortality relative to peer countries predates Medicare.
    • 

  • The authors thought that smoking would be a big driver (US boomers smoked more than European boomers, particularly women, and smoking kills you before 80 so smokers don't really show up in the over-80 mortality rates), but it doesn't seem to be. Excluding smoking-related deaths makes a big difference to the figures, but not enough to lift the US off the bottom of the league table for under-75 mortality.
    • 

  • A big cause of the difference, but by no means all of it, is resource allocation decisions. At the margin, Medicare is more likely to pay for advanced cancer treatments or open heart surgery for older patients who a European system would send to palliative care. [As someone who is involved in UK politics, I can confirm that the NHS does discriminate by age making resource allocation decisions, and that a 65-year old is much more likely to get their cancer treated aggressively then an octogenarian] This is a choice, but not one that has really been discussed with the demos on either side of Atlantic. In the case of the UK, it was a deliberate choice taken by elites. (It isn't covered up, but we aren't exactly trying to make the issue salient in the public debate either - we think, mostly correctly, that the plebs are incapable of engaging in discussions about healthcare resource allocation in a sane way). In the US, it appears to have been a decision stumbled into rather than taken deliberately. I have no idea what is going on in Continental Europe.
    • 

  • Guns and car crashes aren't big enough to explain the effect, although they contribute by raising US mortality at lower ages.
    • 

  • Obesity-related deaths don't have the correct age structure to explain the effect.
    • 

  • I suspect this is related to the black-white crossover - US black mortality is higher than US white mortality at almost all ages, but increases more slowly with age leading to a crossover in the late 80's. The paper also suggests this, but doesn't come to a conclusion.
    • 



So the age pattern doesn't answer the key political question, which is "Is the high working-age mortality in the US an indictment of how the US healthcare system performs for non-Medicare-eligible Americans?"




Coming up for air here, and approaching the #assassinbae story from a different angle, at what point can we consider misinformation surrounding this life expectancy vs health expenditure chart as stochastic terrorism?




Only if all political discourse is stochastic terrorism. Indicting the US healthcare system doesn't incite violence against any particular group. I suppose you could argue that "The US spends most and gets least, ergo executives of for-profit health insurers are bad people who should feel bad." is stochastic terrorism, but "The US spends most and gets least." is no more incendiary than "taxes are too high" or "someone should fix the potholes".


				

				

						

							

								
							

						


						
					

				
			


			

	


			
			
				

			
		

	






		

			
			
				Culture War Roundup for the week of December 9, 2024
			
		

	

	

	

		
			

			

				

			

		

			


				

					
I don't know if it is a rule like "no brown in town" or "dinner suit trousers have a silk stripe", but my social circle includes a lot of people who know how to wear formalwear correctly, and the only people who wear bow ties in the daytime are people performing the social role of "eccentric academic".


				

				

						

							

								
							

						


						
					

				
			


			

	


			
			
				

			
		

	






		

			
			
				Culture War Roundup for the week of December 9, 2024
			
		

	

	

	

		
			

			

				

			

		

			


				

					
If you wear a 3-piece suit and bow tie, it is obvious that you are countersignalling. (Although I'm sure die_workwear would call you out for wearing a bowtie in the daytime).


				

				

						

							

								
							

						


						
					

				
			


			

	


			
			
				

			
		

	






		

			
			
				Small-Scale Question Sunday for December 8, 2024
			
		

	

	

	

		
			

			

				

			

		

			


				

					
The incentives facing executives at for-profits and executives at commercially managed non-profits (including large mutuals, and also fee-charging charities like university hospital systems) are more similar than they probably should be given the difference in mission.


				

				

						

							

								
							

						


						
					

				
			


			

	


			
			
				

			
		

	






		

			
			
				Culture War Roundup for the week of December 9, 2024
			
		

	

	

	

		
			

			

				

			

		

			


				

					
Communists avoided random assassinations precisely because it was an anarchist tactic, and communists are not anarchists and did not want to be mistaken for them. "Don't be an anarchist, they are ineffectual morons" is a fairly common theme of early 20th century communist propaganda. The relatively small number of communist assassinations (Icepick Ho!) were carried out by professionals working for Soviet intelligence.


Lawful vs chaotic evil is a convenient way of explaining the difference between communists and anarchists to modern American geeks who are not familiar with the history.


				

				

						

							

								
							

						


						
					

				
			


			

	


			
			
				

			
		

	






		

			
			
				Culture War Roundup for the week of December 9, 2024
			
		

	

	

	

		
			

			

				

			

		

			


				

					
A quick google says that the drinking age in Germany is 14 if a responsible adult is buying the drinks, and 16 if the kids are buying beer or wine for themselves (18 for spirits).  I'm not sure about Germany, but teens openly drinking with parents including in bars and restaurants is normal in France and Italy, even when it is technically illegal (which it now mostly is - France raised their drinking age to 18 in 2009 and Italy in 2011). I used to travel round France a lot with my parents, and I was noticeably younger than 14 (at that time the legal drinking age for wine with a meal) when waiters at respectable French restaurants started offering me a glass of my parents' bottle of wine.