This weekly roundup thread is intended for all culture war posts. 'Culture war' is vaguely defined, but it basically means controversial issues that fall along set tribal lines. Arguments over culture war issues generate a lot of heat and little light, and few deeply entrenched people ever change their minds. This thread is for voicing opinions and analyzing the state of the discussion while trying to optimize for light over heat.
Optimistically, we think that engaging with people you disagree with is worth your time, and so is being nice! Pessimistically, there are many dynamics that can lead discussions on Culture War topics to become unproductive. There's a human tendency to divide along tribal lines, praising your ingroup and vilifying your outgroup - and if you think you find it easy to criticize your ingroup, then it may be that your outgroup is not who you think it is. Extremists with opposing positions can feed off each other, highlighting each other's worst points to justify their own angry rhetoric, which becomes in turn a new example of bad behavior for the other side to highlight.
We would like to avoid these negative dynamics. Accordingly, we ask that you do not use this thread for waging the Culture War. Examples of waging the Culture War:
-
Shaming.
-
Attempting to 'build consensus' or enforce ideological conformity.
-
Making sweeping generalizations to vilify a group you dislike.
-
Recruiting for a cause.
-
Posting links that could be summarized as 'Boo outgroup!' Basically, if your content is 'Can you believe what Those People did this week?' then you should either refrain from posting, or do some very patient work to contextualize and/or steel-man the relevant viewpoint.
In general, you should argue to understand, not to win. This thread is not territory to be claimed by one group or another; indeed, the aim is to have many different viewpoints represented here. Thus, we also ask that you follow some guidelines:
-
Speak plainly. Avoid sarcasm and mockery. When disagreeing with someone, state your objections explicitly.
-
Be as precise and charitable as you can. Don't paraphrase unflatteringly.
-
Don't imply that someone said something they did not say, even if you think it follows from what they said.
-
Write like everyone is reading and you want them to be included in the discussion.
On an ad hoc basis, the mods will try to compile a list of the best posts/comments from the previous week, posted in Quality Contribution threads and archived at /r/TheThread. You may nominate a comment for this list by clicking on 'report' at the bottom of the post and typing 'Actually a quality contribution' as the report reason.
Jump in the discussion.
No email address required.
Notes -
No, it isn't. Even if you are a consequentialist, the actions of this murderer will have large negative effects.
Here's what I expect to happen.
For 2025, health insurers will be on their best behavior, approving payouts at a much higher rate than normal. Most of the payouts approved over baseline will be for unnecessary procedures. Profit margins, already thin, will go to zero or negative.
For 2026, premiums will skyrocket to cover the cost of the unnecessary procedures.
This asshole is going to personally cost me a few thousand dollars a year, unless I decide to simply drop health insurance, which I might. Costs for insurance for my family are already over $20,000/year.
Oh, and he's a complete midwit to boot. Imaging writing this Reddit-tier slop and then thinking your ideas are so valuable you can have license to go and murder someone. Of course, he was more thoughtful before his likely psychotic break.
People are celebrating this murderer because they, like their Middle Age ancestors, feel powerless in their lives and want a scapegoat to blame for their problems. In the end, this murder did reveal some harsh truths, but it was not about the health care system, it was about the evil and stupidity that lurks just under the surface of the average person.
You can’t make a consequentialist analysis without considering all of the probable consequences. You predict that health insurance companies are going to approve more, but that instead of this affecting their profits (United’s 22bil), or C-Suite payouts and bonuses, it is only going to be passed on to consumers. As if, magically, the company would suddenly cease to exist except with the surprisingly high profit margins it currently has. I don’t find this probable. What I find probable:
the most important political discussion topic is now predatory practices in the healthcare industry, which politicians will respond to this.
everyone is reconsidering whether their coverage should be UnitedHealth, because their predatory practices are now common knowledge. The effects of this will take time.
health insurance boardroom meetings will reconsider whether predatory practices are a solid longterm plan, or whether they will result in reduced longterm profit and possible assassinations
His book reviews, twitter messages, and educational history show a different story.
If someone is on the run after the most high profile murder in the western hemisphere, I doubt their writing would be very good quality, even if they’re ordinarily a good writer. In any case, most men of action aren’t very good writers.
And yet he did! He gambled his life on the idea that he is right. Let’s see how it plays out.
Yes, his writings before his likely psychotic break were more cogent. He even wrote about how complicated systems can not be reduced to trivial solutions.
In any case, the profits of the entire medical insurance industry are $70 billion up against medical spending around $5 trillion. Even if we factor in executive pay, the total amount of profit that is taken from the system is very little.
The only possible justification I could see from his actions is on accelerationist grounds. His actions will results in hugely increased premiums that will drive healthy people out of the system, making it collapse sooner. Of course, nothing in his rant indicates that this is his justification.
But look on the bright side! If you want to get an expensive, dangerous, and ineffective back surgery in the next calendar year, you might be able to get someone else to pay for it!
The costs of the medical insurance industry are far greater than its profits. But a lot of that cost doesn't go to fat cat executives. It goes to armies of support personnel (claim evaluators, billing coders, etc) to produce the vast amount of paperwork involved, some of them working for insurance companies and some of them working for providers. It goes to diverting the time of people who are nominally care providers into handing that paperwork and arguing with insurance companies. And lots of other ancillary personnel.
Of course, if you got rid of that, medical costs would go to infinity even faster. The insurance gating function is a necessary thing given that the pricing signals at both ends (consumer and provider) have been systematically destroyed. Everything's downstream of people wanting medical care without having to pay for it.
How did those other price signals get systematically destroyed? What alternative solutions are there?
It started with employer-provided health insurance around WWII. There was typically 20% coinsurance on that, which only attenuated the price signals. Then we got HMOs, and PPOs and POS and all the other things which made health care essentially flat-rate (plus small co-pay), but had various gating methods to control cost (which users hated). Then governments worked on neutering the gating mechanisms, Obamacare being part of that.... and we are here.
More options
Context Copy link
More options
Context Copy link
Exactly. My worry is that the only place this could end up is with a Bernie Sanders style regime: unlimited luxury care provided at government expense, where every procedure is approved with no check on costs.
It's astounding to me that we pay 20% of GDP in health care. But if we follow the incoherent demands of the pro-assassination crowd, this is just the beginning. It could easily double, with hard-working healthy people forced to pay exorbitant taxes so that every drug addict gets a full-time nurse, every hypochrondriac gets exploratory surgery, and every minor illness is treated with a suite of expensive medications.
The problem isn't the insurance industry. It's waste and overutilization of the medical system.
Maybe there's some hope that, once premiums increase enough, the system will really collapse and revert to something resembling a free market. But I think the Bernie Sanders medico-tyranny version is more likely.
More options
Context Copy link
More options
Context Copy link
More options
Context Copy link
More options
Context Copy link
Maybe.
Or maybe bad actors are a bit too comfortable knowing their bad acts can never be proven. Or that their bad acts melt into a sea of bad acts, and it's impossible to ever sort out any single point of failure. When everyone is in on the take, who's to blame really?
In a system that is corrupt from top to bottom, with everyone fleecing everyone in a byzantine and dysfunctional system of rules of responsibilities, maybe we need a scapegoat lottery system. Maybe that's exactly the sort of outside the system pressure we need to nudge people into being a little more honest, and a little less greedy. Maybe if they were afraid of pissing off the wrong person, they'd make more ethical decisions instead of hiding behind process.
It's gonna be messy. It could decay into an even worse system. But America's "Broken Healthcare System" has been a talking point my entire life, and it's arguably only gotten worse. It's proven itself reform proof. I'm not shocked murder turns out to be Plan B. There never was a different Plan B offered.
I'm not excited about this. Assassinations are fucking terrifying. I'm a firm believer than the attempt on Trump, had it succeeded, would have been probably the single most tragic event for the world since the assassination of Archduke Ferdinand. We would have had WWIII, the destruction of America with open borders, the completely and unambiguous destruction of the bill of rights, and a dark age of multipolar global fascism. Instead I have hope. But, you open the "murder people I don't like" box, and you put events like that back on the table in a major way. It's no longer a single bullet we all dodged, but a relentless tide of entropy for our entire civilization.
That said, I'm not shocked people aren't just willing to lay down and die, especially not without taking someone with them. Maybe we shouldn't do that.
More options
Context Copy link
More options
Context Copy link