site banner
PaperclipPerfector  9d ago (text post)   30228 thread views

Culture War Roundup for the week of December 9, 2024

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.

6
Top Bottom Old Controversial Comments
Jump in the discussion.

No email address required.

One thing I've heard (correct me if I'm wrong) is that European health systems like the NHS are more than capable of saying no to unnecessary treatment.

The worry is that we lack that ability in the U.S. As a result, we'd end up with all the monstrosities of our current system with even fewer checks on costs. That was certainly the system that Bernie Sanders was proposing during his campaigns.

In a way, this is part of the problem. A lot of conservative and libertarian criticism of nationalized healthcare is about people being “denied treatment” - almost always terminally ill children who have no hope of survival, brain dead people who will probably never come out of a coma or be non-vegetative, and other cases where the US spends millions of dollars on someone unnecessarily. See the furore about QALYs and death panels. With insurance, premiums can just go up next year, and employers and individuals will just have to pay. Insurers have no real incentive to even negotiate drug costs downward.

The British government is no less easily persuaded by public mawkishness about grandma needing care than the American government is. It is cost pressure and cost pressure alone that forces this kind of pragmatism on the NHS because managers know what the budget for next year is going to be for the entire healthcare system, and increases have to be directed approved by Parliament, the same way defense spending has to be approved by Congress. There’s limited obfuscation, if the industry needs 10% more money next year congressmen have to put their name to that increase. If they don’t, then the system has to cut costs whether it wants to or not.

Do you think that the British cult-of-NHS stuff sometimes mocked by contrarians is about government trying to "pay in appreciation" to make up for things that can't be paid for in real money due to constant cost control?

I think the US system allows the public to dump blame for high costs on insurance executives who are (as we see now) pressured into approving treatments. The UK system seems healthier, in that there’s less anger around healthcare and most people support stuff like QALY-based decisions because the fact that it’s “our” money is more obvious, such that even the median person understands it.

I'm not sure how well the QALY stuff works in practice. I heard stuff about the public being able to pressure the NHS into funding treatments that didn't pass QALY tests. Puberty blockers were also funded by the NHS at some point. Though, I think this treatment seems to be around £1000/year so maybe if your QALY bar is £20,000/QALY then you can make the numbers work if you are able to find some marginal net improvement across the cohort. But I'm very suspicious of these mental health treatments. What if some dude claims if he spends £1000/year on good quality alcohol that passes the QALY bar? At what point does it morph between healthcare and funding utility monster lifestyle choices?

With insurance, premiums can just go up next year, and employers and individuals will just have to pay. Insurers have no real incentive to even negotiate drug costs downward.

I don't think this is true, insurers do have a real incentive to negotiate on costs. Here is a basic insurance model, this is about where the money is going from premiums.

Payouts for care (by law an insurer must pay out 80% of premiums collected, the 80/20 rule): 83%

Overhead: 11%

Profit: 6%

I am justifying this model with the below link. You can quibble with the percentages I have assigned, I just guessed at them but they are approximately true.

Now take 2 insurance companies, Company X & Company Y. X negotiates it's drug prices, it gets its drugs for say ~70% of the cost that company Y gets its drugs. This reduces the amount company X needs to spend to provide the same amount of care, now X can either pocket that savings as profit or increase their market share by reducing their premiums. Company X is more effective at giving care, that money goes somewhere. I don't think this is a perfect model, negotiating will likely mean that X has comparatively more overhead vs Y. But I am assuming that companies act in their best interest and wouldn't spend eg $2 to save $1, which is a pretty good assumption.

I think that your model ("With insurance, premiums can just go up next year") really only makes sense when there is only one player in a market and they can do whatever they want, or when the costs of switching insurers are huge. Which I don't think is the case at all.

https://www.oliverwyman.com/our-expertise/insights/2024/jan/health-insurer-financial-insights-volume-12.html

Maybe you know, but how much chronic illness does the UK wrestle with compared to the US? About the same?

A while ago I went down this rabbit hole about how to combat childhood obesity, and the scourge of associated diseases it causes, assorted advocates are recommending Ozempic as a first line of defense instead of diet and exercise. Because psychopaths are employing HAAS or woke -ISM language to imply diet and exercise is unfair, but Ozempic for toddlers is "equity".

So I sit and I ask myself, does a NHS in the American context make this worse or better? My gut reaction is worse. These people have wormed their way into every level of government policy crafting in a way that has proven (as yet) impossible to uproot. I can't shake the feeling that if we had an American NHS they'd be reporting parents to child services for feeding their kids vegetables instead of pills.

Or take trans kids, an issue I am 1000% against. By and large it's fiat accompli as medical licensing boards have been weaponized, and if even ideologically critical doctors don't toe the "affirm affirm affirm" party line, they lose the livelihood they went into massive college debt and sacrificed over a decade of their life to achieve. All the same, does this get better or worse with an American NHS? My gut is it gets worse. Which is paradoxical as the UK NHS effectively banned the practice of transing kids. But my read on the beliefs of the PMC that would be in charge of an American NHS say the outcome would be the complete opposite.

Because it actually matters what people make up an institution. And presently, I wouldn't trust the federally employed PMC to manage my health. As the groundswell of support for RFK Jr shows, they've done a shit job in their already limited capacity the last 50 years.

Maybe in 4 years, or however long it takes to restore trust in institutions and non-partisan science, my thoughts on this will change. I want to believe things will be different this time around. But I am also prepared for disappointment.

fiat accompli

Just a minor nitpick, but since I see this so often:

It's "fait accompli," (French for "accomplished fact") not "fiat accompli" — a "fiat" is an authoritative command or order, and is from the Latin fīat "let it be, let their be, may it become, may it happen" (probably best known from the phrase in the Latin version of Genesis 1:3: fīat lūx, "let there be light").

Which is paradoxical as the UK NHS effectively banned the practice of transing kids.

Puberty blockers for under-18s banned indefinitely, published just three hours ago. Strange to see a country as culturally close to the US as the UK, to deviate so greatly from the policies of the Metropolis. Maybe Arjin is right, and that transexualism, unlike other minority sexual ideologies, will not achieve permanent victory.

Wes Streeting is an openly gay man and has (like a lot of the Labour cabinet) a fairly consistent record of being pro-LGB and trans sceptic. This is often framed as a matter of "they want to make gay kids trans instead of letting them be gay". Trans activists often frame this anti-trans attitude, the one area of an agenda which the country has otherwise enthusiastically embraced, as being due to the tabloid press. I have to say I agree, the media which has been broadly pro-refugee, gay rights etc. (with the only dissent coming sporadically from the Sun and Express) has been in near lockstep over the trans issue, at least since the Tavistock scandal. Even the Guardian publishes regular TERF-y op eds. Why? Honestly no idea, I mean the outrage stuff clearly sells, but it isn't as if the politicans are all anti-woke, just specifically on this issue.

Far out speculation: there might be a link to the fact that the Conservative party activist wing and MPs are incredibly homosexual from top to bottom, as is Fleet Street. They legalised gay marriage so have their credentials with the LGB crowd already, rather than in the US where it tends to be either LGBT rights OR anti-LGBT. Something there..?

It's interesting speculation, but generally the LGB organisations have taken up the T mantle, and this is no different in the UK (with Stonewall being a strong proponent of trans issues).

Two plausible-ish reasons I've seen come up to explain it are:

  1. The presence of JK Rowling, who was an early un-cancellable advocate for women's rights
  2. (Hilariously) that the years of Brexit shenanigans occupied all the political oxygen at just the right moment to delay the introduction of the topic for long enough that an opposing movement was already coalescing by the time it started to pick up steam (this idea is attributable to Helen Joyce, though I couldn't point to which podcast I heard her mention it).

What is this place?

This website is a place for people who want to move past shady thinking and test their ideas in a court of people who don't all share the same biases. Our goal is to optimize for light, not heat; this is a group effort, and all commentators are asked to do their part.

The weekly Culture War threads host the most controversial topics and are the most visible aspect of The Motte. However, many other topics are appropriate here. We encourage people to post anything related to science, politics, or philosophy; if in doubt, post!

Check out The Vault for an archive of old quality posts. You are encouraged to crosspost these elsewhere.


Why are you called The Motte?

A motte is a stone keep on a raised earthwork common in early medieval fortifications. More pertinently, it's an element in a rhetorical move called a "Motte-and-Bailey", originally identified by philosopher Nicholas Shackel. It describes the tendency in discourse for people to move from a controversial but high value claim to a defensible but less exciting one upon any resistance to the former. He likens this to the medieval fortification, where a desirable land (the bailey) is abandoned when in danger for the more easily defended motte. In Shackel's words, "The Motte represents the defensible but undesired propositions to which one retreats when hard pressed."

On The Motte, always attempt to remain inside your defensible territory, even if you are not being pressed.


New post guidelines

If you're posting something that isn't related to the culture war, we encourage you to post a thread for it. A submission statement is highly appreciated, but isn't necessary for text posts or links to largely-text posts such as blogs or news articles; if we're unsure of the value of your post, we might remove it until you add a submission statement. A submission statement is required for non-text sources (videos, podcasts, images).

Culture war posts go in the culture war thread; all links must either include a submission statement or significant commentary. Bare links without those will be removed.

If in doubt, please post it!


Rules


Recommended Posts And Communities

Recommended Realtime Chats