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naraburns  nihil supernum  2yr ago (text post)   33194 thread views

Culture War Roundup for the week of October 10, 2022

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The idea that you work for 40 years and then stop and do nothing for the last 15-20, spending all your accumulated wealth (which in this case gets sucked out by the service economy and healthcare costs), or in perhaps more welfare minded countries, by the taxpayer, is a historical anomaly. At some point we're going to have to come to terms with the fact that people will have to keep working much longer (or maybe that they ought to want to work longer).

Is this behavior actually unsustainable, though? A large group of people retiring for a long time is historically unusual, but so are many other things about today. The amount of work required to produce many necessities is historically unusual. The amount of workers we have now in service roles or in roles doing intellectual labor is extremely historically unusual.

While I share your disdain for the current model of retirement, I don't see the current model becoming unsustainable any time soon. The vast majority of modern economies seems to go towards making luxuries or money pits like healthcare, not the necessities for life. In these areas it is far more possible for quality to drop without disrupting the status quo.

Where and how do you see the current model breaking down?

The issue is more the healthcare system than retirement itself. Spending obscene amounts of money to tack on an extra year or two of life at the end, generally with awful quality, is what's really contributing to unsustainability.

Right, but doesn't that line up with it being basically fine for old folks to karaoke away their last vigorous years? The problem is shoveling money at pharmaceutical companies and hospitals to extend time in deathbeds.

I'm prettymuch in agreement about the karaoke period. Then again it raises the question of the amount of medication and care going into sustaining said karaoke period.

We should invest to keep people alive and healthy for the karaoke period IMO, but we do have an unfortunate aversion to death to where we keep people alive who are a shell of themselves through ever more invasive and difficult treatments. I’ve got a few ICU nurses in the family who always speak on this. It’s not the patients themselves who want this either, but usually the patients family who won’t accept anything less than keeping their loved one alive as long as possible.

Maybe you're right- I suppose the point where it begins to collapse is when demographics start to look like South Korea. The US will be fine for a long time (not as bad demographics issues, plus the petrodollar). But in for example, the UK, we're already nearly at breaking point with our social care system, and with inflation driven declining standards of living/property bubble, I don't see us having as good a time of it.

Then again, we don't have anything like the Villages, so perhaps there is a much shorter distance to fall.

But in for example, the UK, we're already nearly at breaking point with our social care system, and with inflation driven declining standards of living/property bubble, I don't see us having as good a time of it.

Is the crisis in the UK due to paying out pensions, or due to trying to give unrealistically good healthcare to every single person? I've heard a bunch about funding issues with public health in the UK but not much about funding issues with their pensions.

It's possible the UK will try to gut pensions to throw yet more money into the endless pit of healthcare, but the unsustainable element here isn't the part where we pay people a pension for 15-20 years after 40 years of work.

Well if the whispers coming out recently about public sector pensions are to be believed (extensive use of incredibly highly leveraged tools to try and deliver increasingly unrealistic inflation linked expectations) then pensions do seem to be an upcoming issue. But no, it is mostly due to healthcare costs. Not unrealistically good healthcare to everyone though, at this point it is nearing basic adequate healthcare to a subset of the population. The NHS is in a really, really bad shape at this point (Emergency response times are sky-high). But that's mostly just an allocation issue like you said.

Then again, we don't have anything like the Villages, so perhaps there is a much shorter distance to fall.

Arguably parts of Spain & Portugal were essentially the Villages pre-Brexit

Very good point- I'm not up to speed with what exactly the post Brexit settlement was in terms of healthcare transferability (vaguely recall it being an issue). Maybe with enough hot summers like we just had the south coast could become a domestic equivalent.

Germany is running into problems in the near future. I can't give you the hard numbers offhand, and even if I went looking for them I wouldn't trust my ability to interpret them correctly, but if the current discourse is to be believed then society is aging rapidly, health care quality is degrading steadily, we're importing doctors and nurses and caretakers from all over the world, health care is the single biggest expenditure in the federal budget even with most people seeing around 20% of their gross income going into health insurance, and then we could go into in how far it is accurate that the aging population is economically propped up by a dwindling supply of native skilled labor and culturally volatile unskilled immigrants.

If healthcare doubles in price do people start working longer to afford healthcare in their old age? Or do they just consume less of it and accept sacrifices to the quality of it?

I think the latter, which is why I put healthcare with luxury goods as an item where a decline in quality won't kill retirement.

Healthcare in particular is also not a great example of hitting limits on what is possible. I'm informed that in many western countries a large part of the scarcity is from strict limitations on how many people can head into the profession rather than from a lack of people who could do the work (after necessary training).

If this is the case then the issue is not that a large retirement population is unsustainable, but that a gross mismanagement of resources is occurring in healthcare.

This is Germany we're talking about. People will do what they're told. If they're told to work longer, they'll work longer unless they get a medical exemption, which at present most who want do manage to get. If quality goes down then they will indeed just accept that. What else would they do? Few people switch from public to private insurance, and the quality difference between the two isn't very pronounced to begin with.

So, you're right. A decline in health care quality will not kill retirement. In my opinion it's the increase in health care expenses that will sooner or later encourage a government to raise the retirement age in order to slow the decline in pension-provided purchasing power. Of course there's not much left to earn here; the nominal retirement age in Germany is at 67, compared to 62 in France. How much productivity can you squeeze out of septuagenarians? It's mostly a question of cutting expenses and leaving more for those who do draw a pension. So I say retirement will become more exclusive in Germany so it doesn't devolve into a joke pension that's insufficient to live off.

Germany also has an immensely expensive healthcare system.

IIRC correctly, people visited doctors on average more than any other OECD country. I'm also shocked by how common, e.g. MRI devices are in Munich. In BC in Canada there are a few mobile ones that services the entire interior, and there are often month long waits for elective scans (too long, IMO, by the way). Near Munich I was able to get an MRI for my knee the next day.

So, there's at least some fat to be cut.

(In a further out there way, I think there's an unserviced niche of 'low-level' medical care -- basically advanced first aid clinics, where I wish we could have 'associate doctors' trained in 1/3 the time (basically advanced nurses) in clinics, as I think they could handle many 'standard' issues that GPs do (including taking blood for tests and administering vaccines. But that's a whole 'nother area)

Where I am GPs would write a script for a blood test and you would go off to the clinic nurse or a pathology centre to get your blood taken. How many countries in the world have GPs that use consultation time for phlebotomy?

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