It’s not just this, it’s a fundamental inability to *identify* with other people and realize that *that could be me*.
Today I am 31 and healthy and always exercise regularly and eat well so why should I pay for other people’s expensive preexisting conditions and disabilities? Because obviously it’s not possible that when I’m 34 I might get diagnosed with an autoimmune disease or a chronic leukemia and need expensive meds forever. Or that when I’m 36 I might have a child with cerebral palsy who is able to live a full, rich, happy and ~productive~ life but will need expensive healthcare and ongoing assistance to do so. Or that when I’m 48 I might get hit by a car and be left unable to work full time, in need of assistance, etc, myself. Or that when I’m 53 I might get some random-bad-luck cancer (let’s make it easy: not even talk about how lung cancer does in fact happen to nonsmokers or how in any case it’s disgusting to call it “fair” when it happens to a smoker because that punishment doesn’t fit the crime you sadists; instead, let’s consider one of the myriad cancers that hits at genuine fucking random or by some familial genetic vulnerability the individual can’t affect) for which a curative treatment actually exists but it costs $260,000 and without it the prognosis is eighteen months.
Same applies to poverty. (And for some of the same reasons as already sketched, as well as economic cycles and industrial shifts and automation and so on.)
It’s this pervasive prosperity-gospel belief that bad things by definition only happen to the undeserving and trying to help people who experience misfortune is hubris and interfering with the will of the great gods Natural Selection and The Market and doomed to create more problems than it solves because fate favors the lucky because the lucky are deserving because Gnon because *blithering evil*.
I don’t know how to explain thermodynamics and free lunch stuff to people who don’t already have some acquired grounding in physical reality. I also keep saying that caring about other people isn’t the problem (Richard Spencer would probably say he “cares about people”). It’s caring about systems, some of which take care of people (and in a catastrophic failure would become unable to take care of people at all) that’s the problem. If you’re too nihilistically individualized, you’ll apparenrly fail to notice how systems fit together (and don’t). Screaming about it doesn’t seem to help, because systems still fail even when you scream at them. I don’t have an easy answer, but if the most widespread centrist position means ignoring Rotherham-type stuff, then fuck that too.
The economy is like the tyranny of a rocket equation. You only have so much fuel, the gravity between the worlds is already there and you can’t change it.
It is physically impossible to meet all the goals - there just aren’t enough resources (natural resources * capital * labor * technology) to accomplish them all.
American GDP-per-capita is above $50,000. Foreign GDPs outside of a few hyper-efficient places like Hong Kong or Singapore are lower.
If one person takes $3,000,000 to keep alive, you have effectively consumed the complete economic output of one person’s whole entire life.
But it’s worse than that, because our worker had to pay for housing, for food, for transport, for education, and taxes to support all the secondary systems required, and also raise a child to perpetuate the system. If all that’s leftover after all that is $10,000 per year, then any $3,000,000 case consumes the total lifetime surplus resources of five workers.
And I look at many of these cases and do think “fuck, that could be me” - which is part of why I suggested a wage subsidy program!
But a lot of Leftist or Liberal language wants to allow people to create unlimited burdens on society. They want us to pay for treatment while not allowing us to prohibit people from doing things that would require more treatment, or creating people that require more treatment.
You can’t have both! You can’t have both!
The fewer the number of people that require expensive treatment, the more resources you can spend on them. The more that need expensive treatment, relative to the size of the productive economy, the less you can spend on each one, until it falls below the level required for them to survive.
If is vitally important that society become more efficient and more technologically advanced. We must produce more, and more efficiently.
And we can’t just throw aside social technologies. If broken homes fuck people up, statistically, and cause them not to do well in the labor force, then the cost of that comes out of liver transplants, not just ferraris.
@mitigatedchaos
“But thermodynamics!” isn’t even remotely convincing. In asserting that, you’re merely creating a word problem or thought experiment defined in your chosen terms for your chosen purposes. Deductive reasoning from first principles in the clean arena of the logical mind is seductive, but we aren’t actually dealing with a
thought experiment set in deep space describable by a zero-sum cold equation™ that’s expressible using only two or three variables all of which, most terribly unfortunately, turn out in the real world to be empiric constants i.e. unchanging and unchangeable facts. In fact there are literally thousands of variables involved in varying degrees, and most certainly a meaningful proportion of those are going to be subject to varying degrees of adjustment, mitigation, recalibration, disruption, etc, etc. I have yet to see a compelling argument based on real numbers that a rich nation literally ~cannot afford~ to provide its citizens with healthcare because ~not enough money~. And quite frankly if I do see such an argument I am going to approach it with the prior that it’s highly suspect and extremely likely to be based on misrepresented and/or cherry-picked metrics and statistics. This is because I am able to observe many counterexamples in the actual empirically verifiable real world: Germany, for instance, provides and pays on a national basis for very good universal healthcare that includes excellent coverage in oncology and other expensive therapeutic areas.
Even just looking at your abstract-example numbers: if by “$3,000,000 cases” you mean cases that cost $3,000,000 in a single year, well, I don’t know the incidence of those but I’ll bet you $3 in cash that it’s far, far lower than than 1 case per 5 average productive workers. If you mean cases that cost $3,000,000 over the course of an entire normal lifespan following a catastrophic diagnosis in young or middle adulthood, or in infancy, then first of all I’d like incidence figures on those as well, but, unlike in the previous case I can intuitively accept that it’s at least a potentially meaningful question to be asking in this context, so let it slide, BUT if nothing else we need to amortize those people’s maintenance costs out on an annualized basis in the same way we do for per-worker economic output. I mean, if I compared my personal expenditures over a lifetime to my average annual income I’d be despondent, but I don’t, because it’s pointless. The only possible motivation I would have to do that is to depress myself profoundly enough to induce an extreme frugal mood, and I respect myself enough not to feel like I need to fool myself into frugality using dirty tricks. And if you’re just lumping these very different health cost scenarios together as “$3,000,000 cases” and comparing that to annualized per capita output, tbh it reads as a low and transparent ploy to rack up scare points. (NB: if by “$3,000,000 cases” you mean neither of these, nor an amalgamation of both, but something else, please advise. I’m reading and writing hastily today.)
Pursuant to both of the above points: healthcare pricing, specifically, in the U.S., specifically, is extremely distorted by employment-tied insurance and assorted other fuckeries. A nominal $3,000,000 price tag cannot be simplistically assumed to represent $3,000,000 in value. If an MRI costs the payor — not the patient; the payor — $8000 here and $800 in France due to a bunch of systemic blabla, and I am suggesting that we consider altering the U.S. way of doing things at the systemic level on the grounds that the system we have observably sucks dead donkey dick, then I am in no way obligated to accept the U.S. cost of the MRI as a fixed constant for purposes of discussing What We Can Afford. The same goes for lifesaving drugs priced at five and six figures per patient-year.
(Yes, screwing too much with pricing will break R&D, and we need to look at other approaches as well and generally to prioritize coming up with and operationalizing ideas that can preserve and ideally increase the incentives for innovation and remove barriers thereto. That’s not an insurmountable difficulty. If we can change the system we have wrt delivery of care, we can also change it wrt advancing care.)
We’re humans. We solve hard problems. It’s our best thing. If all you have for me is really “that’s just not possible! because, thermodynamics!”, quite honestly that seems to me to be defeatist bullshit unworthy of a transhumanist.
Postscript: the hint-dropping in this thread regarding immigration is not lost on me; I’m ignoring that angle for the time being because my time and my mental and emotional bandwidth are limited, not because I don’t have responses.
A rich nation can provide some level of healthcare to all its citizens, under certain conditions.
One of those conditions is that the people implementing it are not incompetent. Another is that there is a cap to healthcare expenditure.
Pursuant to both of the above points: healthcare pricing, specifically, in the U.S., specifically, is extremely distorted by employment-tied insurance and assorted other fuckeries. A nominal $3,000,000 price tag cannot be simplistically assumed to represent $3,000,000 in value. If an MRI costs the payor — not the patient; the payor — $8000 here and $800 in France due to a bunch of systemic blabla, and I am suggesting that we consider altering the U.S. way of doing things at the systemic level on the grounds that the system we have observably sucks dead donkey dick, then I am in no way obligated to accept the U.S. cost of the MRI as a fixed constant for purposes of discussing What We Can Afford. The same goes for lifesaving drugs priced at five and six figures per patient-year.
My great worry here is that the people looking to implement such a system will, instead of doing it in a way that lowers these costs, do it in a way that retains these costs and fucks us all over in paying for them.
The reason I suggested the approach that I did in What GOP Must Do To Avoid An American NHS is that I think it’s actually the safe medium-term approach (except for the amount, which may need to be higher). Then, once that is in play to help start decoupling Americans from employer insurance and take some of the pressure off of American families, we can do the harder and more intricate work of untangling, trimming, replacing, and sometimes adding to the various regulations and conditions responsible for healthcare costs.
There was also an analysis, and I really wish I could find it (why isn’t it in my bookmarks? ugh), showing that American healthcare costs are actually more in line with its number of different populations, level of development (being somewhere in-between, in some cases, first world and third), and so on.
(Edit: I spent some time looking for this last night and could not find it, but I know I didn’t hallucinate it. It’s out there, on some contrarian blog, somewhere.)
