100ProofTollBooth
Dumber than a man, but faster than a dog.
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User ID: 2039
100ProofTollBooth
Dumber than a man, but faster than a dog.
5d ago
I'm sort of getting the feeling that it's going to get a whole lot worse before there's any hope that it'll get any better
My prediction for failure mode of us healthcare;
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Good doctors (most, not all) become too frustrated with the insurance regime and become cash only concierge providers for the wealthy.
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The surging demand paired with vanishing supply for those who cannot afford out of pocket healthcare creates healthcare gridlock (look at the British NHS for an example of this). No one can get seen in a timely manner, the care that is provided is perfunctory, follow up visits are non-existent.
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Amateur and grey market pharmacology takes off and we see a spike in accidental overdose deaths. These stats, however, are probably laundered by calling some of them suicides, some of them related to pre-existing conditions, or even more blatant cooking of the books.
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Eventually, Federal laws do change for "low level" or "routine" medical care; You can do visit local clinics to get band-aids and aspirin and not have to get it from a doctor, but some sort of glorified EMT. This expands to cover most types of prescription drugs as well.
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Medical insurers become financially insolvent gradually as the healthy and wealthy drop out of the system. Eventually, some tech company figures out how to create non-insurance-insurance wherein they can deny you based on risk factors (like insurance used to work). The work around is that they aren't technically insurance, but function as some sort of mutual liquidity market (you're, very technically speaking, exchange mutual contracts with other individuals to help defer costs of medical care at an undetermined date in the future, the tech company in the middle just provides a digital marketplace ... something along those lines).
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All of the Americans who want health insurance have it (Obamacare: Hooray!) but all of the Americans who have health insurance cannot actually see a decent doctor in any timeperiod less than 1 - 2 years. Most simply rely on long term prescription drugs for pain management and placebo effect.
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Americans without healthcare (and without independent wealth) create this wholly new side industry of non-insurance-insurance and, in so doing, create new demand for medical care provided by doctors, perhaps, not from this country originally - or ever (i.e. medical tourism partially or fully covered by the not-insurance-insurance).
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People (not yet doctors) see that they can pursue medical careers without going to the traditional medical schools or passing boards. A whole new shadow-doctor industry staffs up. After 5 - 10 years of this group demonstrating not only equal, but superior health outcomes, the traditional Medical School cartel is finally broken up.
I think this takes about 20 years, starting roughly the time the Social Security Trust becomes insolvent.
100ProofTollBooth
Dumber than a man, but faster than a dog.
5d ago
but most florists are the female version of model train enthusiasts,
Excellent analogy. And fucking scary. I once met an actual "foamer" and my spidey sense went off like an air raid siren.
100ProofTollBooth
Dumber than a man, but faster than a dog.
5d ago
- Politicians and "domain experts" craft exams for all sorts of things
- People take this exams, often with more "domain experts" arriving to act as add-on guidance.
- Simulators, complex liability forms, probably several legal loopholes about informed consent and procedural integrity.
At this point, we're just living in a "light all of the tax dollars on fire" fantasy land with a ballooning bureaucracy to boot (who else administers all of these very involved exams).
I can't think of a worse hell for personal liberty.
100ProofTollBooth
Dumber than a man, but faster than a dog.
5d ago
Well sure if you already assume the sociopathy.
I do.
It would be like saying “I think Person X is a sociopath. He did something that generally would not be sociopathic but because I think X is a sociopath he must be doing it to hide his sociopathy.”
This is a good point. It made me think of my own post on conspiratorial thinking and I think that I might be a victim of that in this Altman case. I'll reconsider.
Rejoice, ye mods! The spirit of the Motte lives.
100ProofTollBooth
Dumber than a man, but faster than a dog.
5d ago
Yes!
Although there is still a body of evidence before the kid that would point in that direction.
100ProofTollBooth
Dumber than a man, but faster than a dog.
5d ago
Who would approve the questions and composition of your "Rational Adult" exam? State legislatures? The Federal government?
I'd like to request a straightforward answers. Are you saying that bureaucrats and/or elected politicians will be granted authority to prepare an exam that deems be sufficiently "rational"?
100ProofTollBooth
Dumber than a man, but faster than a dog.
5d ago
There is a categorical difference between an employer requesting you put in ear phones or get a health check up (both of which you can refuse) and agreeing upon incubating a human inside of you for nine months in order to receive payment. If you're saying "No, it's just a difference in degree" then we have an intractable disagreement.
Regarding job quality and relative value, my response was when you asserted "we all pay an emotional toll" - which I think is incorrect. Some people do, absolutely. All of us do not.
I can't quite follow your thread on McDonalds PhDs etc. It seems to me your argument is roughly "find the best mix of compensation / perceived labor / emotional stress" and go from there. Valid enough, but I'd argue there are jobs that may in fact be pay well, be low in labor requirements, and have limited emotional stress that you shouldn't take - drug dealer, pornstar etc. (although, I'd also argue that those "jobs" specifically have high emotional stress - those that do not feel emotional stress in those "jobs" are perhaps demonstrating dissociative or anti-social mental states)
100ProofTollBooth
Dumber than a man, but faster than a dog.
5d ago
How so?
To be explicit; I think it is probably (further) evidence he is a sociopath who will use people and deceive people to further his own ambitions.
100ProofTollBooth
Dumber than a man, but faster than a dog.
5d ago
The conservative project relies on an idyllic view of the past and of conservative families
Well, no. I don't know what you mean by "conservative project" but conservatives don't simply register the past as "idyllic" as a rule. There's plenty of bad stuff in there! Communism, Nazism, the origin point of modern conservatism was Burke's response to the French Revolution.
The point is that conservatives point to pro-social behaviors, practices, and traditions that over hundreds and thousands of years have repeatedly shown themselves to be unquestionably beneficial to humanity and society. These are the very concepts, ideas, and traditions we seek to conserve. We don't believe in radical and accelerated experimentation with these. Within living memory, we went from "boys shouldn't hit girls" to arguing that more boys should be allowed to pummel girls for money.
My grandparents ‘s generation were all very religious, and so it was common for spouses to hate each other all their life.
Then I'd argue they weren't people of genuine faith, but scrupulous virtue signalers who used organized religious practices - and voiced adherence of them - to assuage their guilt for being shitbags. This is extremely common in evangelical circles and in the online RadTrad and OrthoBro spaces. It is astonishing how people who truly, deeply live the principles of their faith come across as intensely normal, pleasant, and happy people.
‘all mothers love their children’
This is not a core conservative claim unless you add in "should" between "mothers" and "love"
‘all men feel the need to protect women and children’
See above.
‘all people have a god-shaped hole’
Ah, well, credit where it is due. I think this is probably a core conservative claim and one of the big wedges between conservatives and "libertarians" (although, personally, I find the term "libertarian" to be close to meaningless.) For instance, one can't help but smirk at the fact that the "Rational" community has re-invented the concept of Satan as Moloch....when Moloch is literally a Biblical demon.
100ProofTollBooth
Dumber than a man, but faster than a dog.
5d ago
We all sell our bodies and limited time under the sun to make ends meet.
I've never had an employer or customer put something inside me for even a moment, let alone nine months.
And we all pay an emotional toll for it, unless you're lucky enough to have a job that you'd do for free.
I wouldn't do my current job for free. But I also enjoy talking about it - and find no shame it doing so - with my friends, family, and other acquaintances. Sometimes I have stressful days, but I don't end every day or week thinking, "A what a fucking emotional toll I had to pay!" In fact, I'm quite excited about my job because it lets me do all these other cool things with friends and families - and I feel like I really am creating some tangible value on a day to day basis.
100ProofTollBooth
Dumber than a man, but faster than a dog.
5d ago
If I'm allowed to daydream, everyone old enough to vote takes a Rational Adult exam, potentially one that's subdivided into multiple ascending tiers of difficulty. The more you pass, the more you are allowed to do, because the presumption is that you've proven yourself intelligent enough to be responsible for yourself. For an existence proof, look at driving tests.
Maybe have people pay for bonds. Maybe allow insurance companies to charge them more for risky behavior. Tax negative external ties and strongly punish anything that spills out of personal bounds.
So, you don't like "blanket illegality" for heroin, but you are totally ok with a kind of authoritarian state evaluation (with follow on coerced financial behavior) of your intelligence, psychology, and ability for self-determination.
100ProofTollBooth
Dumber than a man, but faster than a dog.
5d ago
I disagree.
The threads around the OpenAI coup attempt highlighted multiple inside sources who have stated that Altman is a unique kind of sociopath. He's a non-technical non-founder. He is the networker's networker.
Him having a child, unfortunately, points to one of two pretty extreme scenarios; either he's in the midst of a pretty big change of heart about Techno-post-humanity and does believe in the future in a "people should have kids an invest in them" sort of way. Or...
He's had a surrogate child (who he can easily support as a billionaire) as a magic talisman to deflect precisely these "you don't care about a human future" attacks. "Sure I do!" Sam says, "Look at this human infant that I now pay for! Is this not our culturally agreed upon signal indicating my allegiance to the future of humans?"
Ask yourself if a billionaire sociopath is capable of this.
100ProofTollBooth
Dumber than a man, but faster than a dog.
5d ago
Serious question; could I write a surrogacy-style contract for a woman I am married to so that, when we have a child, she gives up all maternal rights to that child?
If I could find a woman willing to sign such a contract - even though we are married - could any state conceivably allow such a contract to stand?
If the answer to both of these questions is not "yes", then I cannot see how all surrogate mothers do not still possess some sort of maternal benefits claim over their surrogate children, despite any contracts signed.
100ProofTollBooth
Dumber than a man, but faster than a dog.
7d ago
Where this gets even more hilarious is when a WM-WF sniffs around the WMAF couple to determine they're probably kinksters, invites them (the WMAF) to some sort of sex party - and then horribly out-freaks the WMAFs.
The two dudes have to join different run clubs. Sad.
100ProofTollBooth
Dumber than a man, but faster than a dog.
7d ago
All of the FFANGS discovered that the top performers from Land Grant Flagship universities were nearly as elite as CalTech/MIT years ago. In fact, one of the draws for FAANG was that the NAME on your alma mater didn't matter as much - what counted was work product like a GitHub portfolio, or performance in some of the CS / Cyber competitions etc.
100ProofTollBooth
Dumber than a man, but faster than a dog.
14d ago
So, I'm not talking about earmark at all. Try to be less stupid.
Here's a CRS report on NIH funding for instance
To the basically literate eye, one would find a table with the following budget authorities:
Institutes/Centers
Cancer Institute (NCI) Heart, Lung, and Blood Institute (NHLBI) Dental/Craniofacial Research (NIDCR) Diabetes/Digestive/Kidney (NIDDK) Neurological Disorders/Stroke (NINDS) Allergy/Infectious Diseases (NIAID) General Medical Sciences (NIGMS) Child Health/Human Development (NICHD) National Eye Institute (NEI) Environmental Health Sciences (NIEHS)
Those aren't the only ones. There are more, but it's easy enough to understand the breakdown.
Moving money from NCI to NIGMS, for instance, would require congressional approval. How money within NIGMS is spent is more discretionary, sure. But your contention is either a deliberate misunderstanding of my original outline of the problem, or a weird semantic gotcha. Either way, it betrays a profound level of ignorance (intentional or otherwise) of how Congressional appropriations work. But I repeat myself. Your use of the term "earmark" in a wildly inappropriate manner betrays you.
The result of this is grant applications for this money have to include some section about how their research is related to study of cancer, and this is enough for it to qualify.
Fraud is generally not covered by Congressional appropriations.
100ProofTollBooth
Dumber than a man, but faster than a dog.
14d ago
Did you intend to offer a serious reply, or just use my comment as a way to jerk the spotlight towards yourself?
100ProofTollBooth
Dumber than a man, but faster than a dog.
14d ago
AUTISMVILLE LOOKS LIT!!!!
100ProofTollBooth
Dumber than a man, but faster than a dog.
14d ago
For those of you too lazy to click on the link; the CBO has crunched the numbers and the net effect on income due to transfers (i.e. medicare, medicaid, SS, etc.) beings to be a net negative starting at the middle quintile.
Phrased differently: the top 60% of Americans have less income, on net, because of the massive transfers to the bottom 40%.
Culture war angle: Which quintiles are the sources of new business formation, full time employment, responsible family practices etc?
60+ years of Great Society-ism and horrific perverse incentives for family formation and work mean that we now have a situation where 40% of the population can be - indelicately - called a drag on growth and prosperity. 40%.
Even Sarah McLaughlin can't save this DOGE, and this DOGE can't save America.
100ProofTollBooth
Dumber than a man, but faster than a dog.
14d ago
One distinction: homosexual men and men who have sex with men (MSM) are different terms.
As a gay man who has only ever had sex with women, I appreciate this.
This is one of the artifacts of left thought that I find to be especially intellectually bankrupt. The idea that identity is only ever a personally applied label without dependency in the real world, especially behaviors. If I can identify as whatever I want despite hard counters by reality and/or a repeated behavioral pattern, then "identity" is as meaningful as fantasy LARPing; I'm gay, and also a level 40 dwarvish warlock. They're both made up and just fun things to goof around with!
But the problem is that we've imbued identity with the force of law. Protected class of people exist. Bostock v. Clayton County linked sexuality identity and gender identity to the 1964 Civil Rights Act --- what I "identify" as is literally as important, legally speaking, as age and pregnancy status - things that, for now at least, is still objectively measurable.
Either something is real and important or it isn't. If the only arbiter of my "identity" is my own self conception and subject to instant total revision based on nothing more than my mood, how can we ever approach something like equal protection under the law?
100ProofTollBooth
Dumber than a man, but faster than a dog.
14d ago
Unfortunately, this isn't how it all works - by law.
Congress approves various agencies budgets at various levels of detail. If, however, Congress is approving your funding line by line (most common in the Defense budget), you are not allowed, by law, to take funding from one line and apply it to another line without congress explicitly re-authorizing it.
Okay, so this must be pretty easy, right? When everyone agrees AIDS is super important to research, Congress just dashes off a little law saying "yeah, do it."
Well, no. In regular order, it would have to go through the committee of jurisdiction with all of the committee processes - markups, hearings, etc. Then, once it passes committee, it goes out to a floor vote.
Why not just skip to the floor vote? Because floor time is incredibly scarce and is controlled by party leadership. If you just go out and start introducing bills, you aren't even going to have a quorum to vote on them (which is why most bills introduced don't get passed and are "signalling" bills only).
I could go into more detail, but you get the point. The U.S. gov't is NOT like a corporation where you have budgets as guidelines for spending but, really, it's all coming from the same corporate account so just spend how you need to. The money not only has to exist, but has to be specifically slotted in for its purpose. If you don't obey those rules as an agency, you're violating federal law.
Yet another reason why state capacity is so fucked. We've created this arbitrary and capricious self-limitations that are blindingly obviously inefficient
100ProofTollBooth
Dumber than a man, but faster than a dog.
15d ago
If you're full time employed by a single employer at a company over 50 people, by law they are required to provide some level of health insurance. You might still have to pay some level of premiums out of pocket (in fact, most people do) but the cost is heavily deferred by the employer.
If you're making 100k or so per year on your own (self employed) you will have to pay out of pocket one way or another. I believe there are some small biz health insurance co-ops but it's still going to be painful.
To answer your question directly - I am not saying you should do anything. Personal choice is important! I'm say that, from a median financial expected return and risk perspective, at about 100k / year, yes, you should be buying health insurance.
Returning to the conclusion of my original post; Health Insurance in America is fucked up. Its cost only becomes reasonable once you're already a top 20% earner or if you have an generous employer who can afford to cover most of your premiums for you (and, perhaps, provides some sort of HSA for deductibles). But, by definition, this means that the big majority of Americans aren't in this position. So, the bottom 30% or so just defect. They don't buy insurance and when they need medical treatment they either skip out on the bill or (kind of) use government subsidies to get in the door...and then skip out on the bill anyway. For the middle ~30% percent, they pay crazy premiums, still get hit with deductibles that don't square with their savings capability, and receive substandard care. They lose in nearly all cases except for that rare medical emergency that happens in just the right way so that insurance does, in fact, pick it all up.
In this system, the people who "win" are those who don't need the system in the first place (the wealthy) or those who actively corrupt it (the non-insurance-having non-payers).
100ProofTollBooth
Dumber than a man, but faster than a dog.
16d ago
Sorry, I realize I made a very unclear presentation there.
It's either/or. You have $1m in liquid assets at an income of any level. Well, probably not poverty wages. Let's say any income at or above median household for your local area.
-OR-
You have approx $500k in annual income for your household. And it's a reliable and consistent income - betting big on a commission only sales role, or your crypto day trading does not count.
As an aside to your aside: You'd be surprised how many people in super high COL areas (NYC, SF, LA) have > $500k annual incomes with low single digit savings. Private schools and even modest "keeping up with the joneses" are wild.
100ProofTollBooth
Dumber than a man, but faster than a dog.
16d ago
I've been passively thinking about this for a few years now after a conversation with my parents. They actually kept the receipts and did the math - they would've been better off paying out of pocket for the last 40 years of medical expenses than having insurance (which they did have for everyday of their working lives without exception). At ours was not a family of indestructables; a sibling had four major surgeries over about an 8 year span, and both Mom and Dad have been on a variety of not-so-cheap prescriptions for 20+ years.
Especially considering the surgeries (which had approx 10 day hospital stays after, each time), I was totally blown away that the numbers still came out against the insurance. As a side note: To note let the insurance companies weasel out of some of the major costs for the surgeries, my Mom was spending up to 20 hours a week painstakingly collecting documentation from all necessary parties.
That's some background. Here are some numbers. This is better than back of envelope, but not perfect and, as usual, normal caveats; what's your risk tolerance? What's your family medical history etc.
Liquid assets: You should have $1m in liquid assets beyond your home. Income: 250-300k for an individual, 500k+ for a family of the usual size (1-3 kids)
With some smart negotiating, you can survive even the most catastrophic events so long as they don't cluster in an insanely unlikely scenario (i.e. you get into a car wreck driving home from your chemo appointment and the ambulance taking you to the hospital T-bones your poor spouse who is speeding to meet you there).
But, take a look at those numbers again. With that kind of wealth and income, you can afford to pay for a "cadillac" insurance plan. So, why not?
And here we confront the real decision about healthcare. It isn't so much about the cost - if you're rich, you don't need it and if you're rich you can pay for it. If you're not rich, you basically throw your money away for multiple decades a little bit at a time so that in the low probability change you need it, you do have it.
The real decision is; how do you feel about subsidizing a system that works BEST for people with horrible habits and defectors in the system? We've created a situation in which doing the "right thing" with health insurance and personal health habits makes you the sucker. The game theoretic optimal path of behavior is to smoke, drink, never workout, and then walkout on all of your medical bills.
Short of the Government mandating we inject ourselves with an untested substance lest we lose our basic rights (WAIT WHAT?!), I don't see how you could make a worse healthcare scenario.
Yep. This has been directly addressed
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