Stop Blaming America’s Poor for Their Poverty | Hacker News Reader

Stop Blaming America’s Poor for Their Poverty

bloomberg.com

300 pointsstablemap366 comments

I think the question should not be "Why are there so many poor in USA", but "Why does it suck so much to be poor in USA". I believe that the urban layout and exorbitant healthcare costs are the main issues. If poor neighborhoods were walkable and had cheap supermarkets with fresh produce then you wouldn't need a car, and the density would mean that you have plenty of potential friends within walking distance so you wont be bored. If healthcare was cheap like in Europe then it could have been government funded so that poor people wouldn't have to worry about getting sick more than anyone else. Also with free healthcare and no car there are basically no big large random expenditures, so you don't have to worry about anything on the economic front.

That style of life is not a dream, that is how most poor people live in Europe and I assume also in Japan. There are therefore a lot of people who could pull themselves out of poverty, but they don't since they are fine with doing a simpler job or work less for less pay since it doesn't suck to be poor. I am one of them, I have lived below the poverty line most of my life. I didn't chase money, but I happened to get a good job and started making loads of it. But I still continued that lifestyle even when I began making lots of money. I see no reason to spend more, I wasn't unhappy when I didn't have money so all it would result in is me having to work more years before I can retire.

Sometimes I wonder if Americans want it to suck to be poor just to ensure that people like me work harder. Neither the left nor the right seems to want to fix this.

It sucks to be poor because it sucks to be at the bottom of social hierarchies. This is an evolutionary feature of society, not a bug.

Many countries try to decrease the difference between being at the top (or at least in the upper quartile or so) of the social hierarchy and being at the bottom, resulting in less suck for the poor.

My biological grandfather (long story) is considered poor in the US, and is at the very bottom of the social hierarchy (you know, early 70 hippies that got stuck in the past?).

Yet he lives way better than at least half the US population imo, and would never trade his place with the other half. He live in a cabin in West Virginia, share 100 acres with two other people, have access to a natural gaz well for 100$ a year (shared with 4 other people). Free food, almost free gaz, free beer, and he make 20 to 50 bucks a month from playing banjo at local jam/bars. Well, winter sucks up there in the hills, but still. I think that the most he have worked in a year was 3 month doing odd construction jobs (I think the town name was Akron).

Being poor doesn't suck because you're poor, it sucks because you don't live well enough and you can't really enjoy life. If you're poor but live well enough, it doesn't really matter.

> If poor neighborhoods were walkable and had cheap supermarkets with fresh produce

I don’t know about walkable but poor neighbourhoods full of recent immigrants have cheap supermarkets with fresh produce in the US. The poor neighbourhoods with no fresh produce don’t have it because the people living there don’t want it.

https://web.stanford.edu/~diamondr/AllcottDiamondDube_FoodDe...

> THE GEOGRAPHY OF POVERTY AND NUTRITION: FOOD DESERTS AND FOOD CHOICES ACROSS THE UNITED STATES

> We study the causes of “nutritional inequality”: why the wealthy tend to eat more healthfully than the poor in the U.S. Using event study designs exploiting supermarket entry and households' moves to healthier neighborhoods, we reject that neighborhood environments have meaningful effects on healthy eating. Using a structural demand model, we find that exposing low-income households to the same availability and prices experienced by high-income households reduces nutritional inequality by only 9%, while the remaining 91% is driven by differences in demand. These findings contrast with discussions of nutritional inequality that emphasize supply-side factors such as food deserts.

Spear son of Dread?

The food desert thing is a big problem in areas populated by the native-born American poor.

It should be noted that their findings come entirely from a model they built, and the model was built using existing purchase data. They did no empirical work to verify the model results.

Once again the rural poor get ignored and have their existence denied.

The rural poor face some of the same problems as the urban poor (such as car dependency), combined with a whole host of problems unique to rural life. You're right to point out that rural development is widely overlooked, as is the plight of the rural poor.

Your point about urban planning is an important one, and one I often point out when trying to explain the difference between being poor in the US and e.g. in western Europe.

Urban (and rural!) sprawl makes the economic burden of car ownership universal and unavoidable.

Changing course on urban planning and zoning could do a lot of good.

There will always be relative poverty. In other words if we "solved poverty" and there were no more hungry people without health insurance sleeping in the streets, you would still have people who had less than others around them.

But we can try to solve absolute poverty. We can try to make sure everyone has medical coverage, adequate nutrition etc.

An important element of that is we need to design systems where having less than others doesn't close doors in your face and become a trap you can't escape. (I don't think UBI accomplishes that.)

Do you mean inequality? Poverty has a specific meaning. We define poverty thresholds. Middle class is not in "relative poverty" compared to billioners.

The threshold at which people use the term "poverty" is very different in different countries (including the official American definition, which changes), even after adjusting for PPP. So whether or not it's officially supposed to be an absolute measure, in practice it's relative.

No, I mean relative poverty.

Many years ago, I saw a study that indicated that less than 1/2 of 1% of Americans were poor by the standards of India. Even homeless people in the US typically ate better than people classified as poor in India.

But we still have homeless people here in the US. They typically have serious personal problems, such as serious medical conditions. Being homeless in the US is a genuine hardship and it's partly caused by the lack of cheap, small housing.

We've torn down about a million SROs.* There are homeless people in the US who could afford an SRO if they could find market rate SROs.

If you live on Social Security as your only income and can no longer work, we don't have any market based housing for you and many government housing projects have wait lists that are years long.

We've raised the bar so extremely high in this country that it's a genuine problem for a high percentage of the country. It actively creates hardship and privation in a wealthy country that really ought to be able to virtually eliminate homelessness.

But we don't. And after tearing down a lot of very basic housing for literally decades, when someone ends up homeless, we don't blame the lack of housing supply for people with low incomes. We say they have a personal problem and are probably just a junkie.

* https://en.m.wikipedia.org/wiki/Single_room_occupancy

The average social security check is $1461 (https://money.usnews.com/money/retirement/social-security/ar...). There are plenty of places in small town USA that you can rent for $600-$700 a month and have money left over.

Of the 7.5 million existing rental homes that extremely low-income families can afford, 3.5 million are occupied by higher-income households. In other words, families who need affordable housing the most don’t necessarily get it.

From this article:

For every 100 families living in poverty on the West Coast, there are no more than 30 affordable homes

https://www.geekwire.com/2018/every-100-families-living-pove...

Most people will absolutely not be getting the average amount. Some will be getting quite a lot less than the average.

(Someone with a PhD once told me: "The average human would have one breast, one testicle and a three inch weiner." Designing policy around averages is practically guaranteed to go bad places.)

For every 100 families living in poverty on the West Coast, there are no more than 30 affordable homes

There are 45 more states in the contiguous US that are not on the west coast.....

That's merely the title of the article. From the article:

No state in the nation has more than 60 affordable rental units for every 100 families living at or below the poverty line. What’s more, 71 percent of extremely low-income households spend more than half of their incomes on rent and utilities.

What point are you trying to make here?

How is the average retiree's income from Social Security relevant to the broader issue of poverty and homelessness among people of all ages?

From the parent post:

If you live on Social Security as your only income and can no longer work, we don't have any market based housing for you and many government housing projects have wait lists that are years long.

Maybe all the poor people aren't too stupid to figure this out but have various complicating factors that often tag along with poverty like bad credit or losing their home due to poverty or job loss which is often described as a "poor rental history". It also assumes that one can find housing so cheap in areas where other people in your household can also find work.

Lets be charitable and assume that poor people aren't struggling because they are too stupid to find cheaper places to live.

I never said that wasn’t the case, I replied to one specific part of the comment.

My wife is disabled. We don't get checks for 17k instead we get 10k+ in premiums + medical expenses + 3k in taxes out of what might be 34k gross 21K net.

You can be in fact disabled but not disabled enough to receive much in the way of help.

You can easily be poor but not poor enough to have your medical needs paid for and be poorer than if you were barely working and sponging off the system.

Poverty thresholds have always been set relatively, even in the USA.

Poverty is usually defined as a percentage on the income distribution. This may be useful in deciding who qualifies for aid, but is useless as a KPI. There will always be 10% of the population in the bottom 10% of the population.

Inequality is defined as the difference in income between points on the distribution. Inequality can get worse, even as material conditions at the bottom get better, when growth accrues more quickly to the top. Inequality can also get better, even as conditions at the bottom decline, if conditions at the top are declining faster.

Absolute poverty would be the share of people living without some fixed level of material comfort (i.e. shelter). This is probably what we should focus on.

Where is poverty defined like that? I have always seen poverty defined as a function of the standard of living, not of income distribution.

>... (I don't think UBI accomplishes that.)

Does anyone have a flashlight? I can't quite see, it's so dark all the way down here where this lede is buried.

Is there absolute poverty in the US ?

Poverty has a distinct absolute definition (at least in the US). The line is so clear it is, in fact, called the poverty line.

Also, even if you can always rank net worth, you can still greatly reduce the relative inequality from what we see today.

I not American and was curious about that.

For those wondering: their poverty threshold seems to be determined by some form of inflation adjusted basket containing basic goods like food:

https://en.m.wikipedia.org/wiki/Poverty_thresholds_(United_S...

When we redline, assign schools without regard to quality, hassle folks for petty infractions to pump revenue, sieze assets without due process, limit entrepreneurship with onerous licensing requirements, and imprison poor folks at higher rates you end up with a perpetual underclass.

> limit entrepreneurship with onerous licensing requirements

I work for a government agency that provides professional licensing in my state and was shocked the other day to learn that you need a license to operate as a "hair braider". This seemed a bit excessive to me

In some places you need a license to wash hair.

Because without minimal standards for sterilizing tools, hair dressers can spread lice. Basic licencing requirements give the municipality a chance to ensure that everyone washing hair has been told about basic hygienic standards for washing hair.

Leave it to the HN community to view a lice outbreak as an acceptable price to pay for the freedom of the market.

It is not necessarily HNs view but the reason for the license.

I'm from a western European nation (often referred to as "socialist") with none of that licensing BS and as far as I know we don't have perpetual lice outbreaks.

Are you saying lice outbreaks would not happen if we did not have a free market?

To go a step further we probably should license dish washers. To make sure they know the risks of spreading food borne disease.

Look up Typhoid Mary [0]. We don't licence dish washers because running a restaurant requires adhering to a large body of commercial food safety law that requires the restaurant owner/operator to maintain standards of hygiene. If freelance dish washing were a thing, we probably would licence them.

[0] https://en.wikipedia.org/wiki/Mary_Mallon

Having been a microbiologist in a past life I'm very familiar with Typhoid Mary.

I do however think you are attacking a straw man.

"Under Board of Cosmetology regulations, an individual “must complete not less than 300 hours of instruction on the theory and practice of shampooing” at an approved school. That instruction includes how to answer the phone, order products, information about the composition of shampoos, and on the Occupational Safety and Health Administration’s rules governing hair salons."

Would you approve of dishwashers needing 300 hours of training on ordering soap, answering phones, waiting tables, and washing hands?

You ignored the substance of my point: a dishwasher is an employee of a licenced/regulated business operator, who is answerable to a regulatory regime. The state has a regulatory handle on the dishwasher already, and doesn't need to licence them or force them to take training to ensure minimal standards. Cosmetologists are usually independent contractors and are the responsible party, equivalent in legal terms to the restaurant owner/operator, not the dishwasher.

I understand what you are saying. However, I believe your conclusion is absurd. Considering most of the US does not require licensing for a "shampoo technician", it would appear you are arguing for something that is currently a fringe practice to become mainstream. Is that correct?

Also, a cosmetologist and a shampoo technician are two distinct positions.

I'm not arguing for more or less regulation. I'm arguing that we have a societal interest in having some direct or indirect regulatory handle on many jobs that don't obviously require it, and cases like you're raising of the dishwasher, where regulation seems obviously unnecessary, are in fact indirectly regulated--and the costs of regulating the dishwasher, among other restaurant employees, are actually quite significant (meaning that '300 hours' of regulatory training, appropriately targeted at the business owner, isn't as obviously unreasonable as it appears).

You're holding up 300 hours of training for a dishwasher as a reductio ad absurdum of professional regulation of hair washers in salons, when what's obviously happened is a local regulation saying that salon 'workers' (again, actually independent contractors) need a diploma from a cosmetology school. 300 hours is less than 10 weeks of full-time school; a 3 month program teaching salon workers how to effectively, hygienically and with due respect for local business regulations, work in a salon. When you see 'even the hairwasher needs a cosmetology diploma', it's closing a back door where the not-a-cosmetologist hair washer is allowed to do all the things a cosmetologist does for cheaper--and without the required training to actually be an independent contractor.

I'm coming at this from the perspective of someone on my condo building's strata council (i.e. HOA). I'm continually dealing with the push and pull of rules at the most petty level, part of which means people being shockingly petty about avoiding the plain intent of a reasonable rule. You'll never see the truth of the saying 'decisions are made by those who show up' as you will in a minor bureaucratic positions like strata/HOA. It's a constant battle against senior citizens who want your garbage bagged up into one of eight separate classifications and the guy who argues that his truck that hangs six feet out of his stall in the parkade isn't a problem because the rule says "don't block the lane" without specifying by how much.

That license may also require formal schooling in the amounts of many hundreds of hours of instruction as well...

But what it usually requires is an eight hour course in which you're told repeatedly that you need to sterilize combs in a solution that kills lice so you don't spread lice.

Let's not pretend that licencing requirements are always some sinister cartel action to limit the number of nail-painters in a given municipality. Usually they're just a response to some obviously avoidable consequence of a large number of unlicenced practitioners paying little attention to minimal standards.

Have you done a survey of different state laws to determine what is usual or did you just give the state apparatus the benefit of the doubt and assume it was sane?

I give you TN

>But after doing that for a few months, Tammy heard from officials at the state Cosmetology Board, informing her that she could not continue washing hair because she lacks a governmental license to do so. Under Board of Cosmetology regulations, an individual “must complete not less than 300 hours of instruction on the theory and practice of shampooing” at an approved school.

https://www.forbes.com/sites/georgeleef/2016/05/13/you-need-...

Here in Washington state hair design requires 1,400 hours plus 1750 hours apprenticeship. This is the equivalent of working full time for a year and a half.

Looking at a list of every US state

https://nacams.org/cosmetology-states/

How many of them require an 8 hour course?

Note that cosmetology isn't just hair-washing: it covers a wide range of applying a variety of substances to people's hair and skin, often near orifices that more easily absorb toxic subatances like eyes or mouths.

Note that the person who wrote the first article you linked to lists his occupation as "I write on the damage big government does, especially to education."

Note that you elide simple hair washing with 'hair design' and its much more onerous requirement of cosmetology school or apprencticeship (not both).

Did you just assume that all regulation is bullshit and let a quick google search provide your argument?

>Did you just assume that all regulation is bullshit and let a quick google search provide your argument?

It's not that unsafe a bet when its virtually impossible in most of the nation to do ANY work on people's hair without thousands of dollars and 1k+ to burn becoming certified to do so.

I assure you having taken a 8hr class has approximately no impact on whether one sanitizes combs and the desire of management to provide the resources necessary to sanitize combs is the determining factor.

This generalizes to basically every industry unless the labor pool is so small that the bad places to work can't find new employees faster than they wash out.

In point of fact, barbers and hair dressers are virtually always independent contractors sharing a shop space. It's basically never the case in North America that they're employees; this saves the shop owner all sorts of hassle, but puts the onus on the barber/hair dresser as the responsible business owner and thus the one required to be licenced. They provide their own clippers and barbasol. The hair dresser themself is the management that needs to provide necessary resources.

Compare with the comment above about "should we licence dish washers too?" No, because dish washers are employees of a restaurant that deals with licencing and compliance with food safety laws.

How else will government bureaucracy grow itself? Create more bureaucratic hurdles in the name of safety/regulation and create the need write 800 documents so they can hire the closest relative that graduated from English Literature.

The Institute for Justice has been challenging laws requiring licensing for hair braiders in the courts and has successfully overturned them in several states. https://ij.org/issues/economic-liberty/braiding/

Not just braiding. They challenge lots of different types of (unnecessary, protectionist) licensing requirements.

Blaming those without power for the way The System has tilted the game against them is Orwellian.

Poverty is not a choice (any more than drug addiction is a choice). But we prefer to blame the victims because it's easier than looking in the mirror and accepting our role in the mess.

I am not a typical homeless person. I am educated, skilled and I have no addictions, etc. I'm also not living on the street, and am lucky to not have any health problems. But I think my story really can perhaps reveal how incredibly easy it can be for one to have the misfortune to end up in such situations.

My own experiences have opened my eyes to how abusive people can be, and perhaps this is a significant aspect of the stories of people who have failed to thrive. I don't know everyone's experience -- this is just mine.

Actually, I've often been afraid, or ashamed, to speak about the unfortunate circumstances of my life, and I've never known where to get help. I mentioned it here[1], recently on HN. The discussion there made me wonder if it is better for people like me to share their stories.

It's interesting that in the public conciousness, there is such a vocal push back against abuse, tyranny and even victim blaming. Of course it does still happen, even with consensus being against it. Most reasonable people do not appeal to living such a world, but there is an unfortunate hypocritical nature in humanity, where while people don't want to live in such a world, some of the same people are keen to take advantage, and in ways can be submissive to bullies and tyrants.

I wonder how many people there are out there with stories like mine, who have survived pscyhopathic aggression and extreme bullying, but with irreperable social or professional lives and nobody to fall back on.

I think history is full of examples of people who have been victim to such crazy, immoral things. And of course everyone says in retrospect, "if I had been there, I'd have done something."

I live in a van in the Valley, have an engineering degree from a top school, bankruptcy, student loan debt over me I can never hope to repay but cannot hold a job. No drugs, no smoking, no drinking, no sanitation issues, and no hanging out in the daytime with the locals.

As the learning experience of life, I realize that much of what Americans believe is a lie and that they cling to ideas and beliefs that aren't helpful for them in their circumstances: aspirational "rich" people who take up attitudes and political fashions that hurt themselves and let themselves be divided-and-conquered with artificial divisions until we're atomized and estranged from one another into seemingly virtual isolation. Plus, there's American hyper-individualism and anomie of discontent and hopelessness that's degrading the society from a network of communities into a Kafkaesque Lord of the Flies, anarcho-vulture-capitalist nightmare. American "exceptionalism" now seems to mean "If I get mine, screw everyone else."

When you say you can't keep a job, why do you think that?

One thing I learned from my experiences is "to be the change I hope to see in the world."

In my case, I could have made my life about revenge, but I chose to move on. When the bullying, stalking and pscyhopathy followed me, one of my coping mechanisms was to start complaining about the world. After all, my world really was crazy.

I see you doing this in your post. And I'm sorry if that sounds condescending, but I don't intend it to--I do the same thing. So it may be possible that you should seek the ideals and virtues which you desire in the world as goals within yourself. If you're not dealing with a kind of extreme bullying, I think you should have a chance to thrive if you can find a lucky break getting someone to take another chance on you. An engineering degree from a top school is a marketable asset.

I haven't tried finding a job for years now. I got overwhelmed with all these attacks that were happening to me, what to do about it, and have frankly had some PTSD about it. So maybe I'm speaking from ignorance about finding someone to give you another chance. Especially back in America... I suppose it is hard to build momentum again.

I tried to counter the backlash but I only have one vote. I hear you, agree with you, and know it to be true no matter what angry "nope" people choose to respond with. Some people refuse to believe any truth until they themselves suffer it.

> As the learning experience of life, I realize that much of what Americans believe is a lie

Wait til you realize all of those things are also true.

Then you’ll be really lost.

Eventually you have to accept that we either make our own truth, or defer to an authority.

Reality isn’t consistent from person to person. We are in a mutuality with the world that both observes and constructs itself.

We can find other people who we “track” with, for a time, in some slice of life. But if you want to stay in that place, you’ll need to discount some conflicting bits of those people, which takes you back to choosing your reality.

Reality is not absolute. It's more of a consensus.

Can you share why you can't hold a job?

I have similar background and problem, just wonder how and if you can define yours.

Yes please share. People need to know this is real and not abstract. I share often if nothing else to feel less alone and that I am still a human being. I used to be ashamed of it but don't care anymore because I've already lost everything I had built in life. They cannot take anything more from me but some old physical belongings and fading vestiges of hope. Tell us your stories. I will read them.

Do you know of the book "Evicted" by Matthew Desmond? It was for me both enlightening (in what it revealed) and depressing (in what it revealed).

Yeah, some people make bad decisions. We. All. Do. The difference is, some are more unlucky than others. Life is hard. I'm not sure why we go out of our way to make it hard for others (who need our help).

http://evictedbook.com/

I personally think that the reason that some people act callous towards those who are poor/experiencing misfortune is ultimately because they're afraid. If you tell yourself that people end up poor because of a moral failing, you make poverty seem like something that won't and can't ever happen to you, because the very fact that you're not currently in poverty proves that you must have a better moral constitution somehow.

Yes. Fear drives a lot, if not all, negative human behavior. What makes matters worse is it's difficult to self-identity that we are acting out of fear.

I want to believe in such a redeeming explanation for moral failings, but I think my experiences have shown that a lot of people just care about themselves, and some are enthused to defeat or put down others, even by cheating or other abuse.

I wish I knew where to get help. I just want to have a normal life.

I have been unemployed in a major part of my life, I live in france and am 34 now, and honestly, the fact that we still have welfare here that allows people to live a decent life is a lifesaver.

What I'm scared about, is how people often look down on welfare recipients, and how politicians could decide to force me to work somehow. As long as slavery is forbidden, nobody can force me to work.

What is weird is that in order to receive welfare, you have to be registered as unemployed, and declare every month that you're looking for work. Of course it is difficult to check if all those people are looking for work and you cannot really cut their welfare if unemployment numbers are what they are.

If you're a politician, you understand that welfare policies are buying the "social peace", but it's a paradox because most people will feel guilty for being unemployed, and people who work will accuse the ones who are not working.

Here in the USA, slavery is still legal under case of incarceration. In Florida, Texas, and Louisianna, prisoners are forced to work without pay. In other states, you are charged "prison rent" that is magnitudes higher than you could ever make working per day.

As it has always been, this prison slavery system generates massive profits for the companies that use it, such as Amazon and Walmart. If you are a free worker, it is likely you will be shouldered with student loan and medical debt. Not to mention the debt accrued when financing a home.

Our nation was built on free labor, slavery is one of the driving factors of American economic success. Yet the workers do not enjoy first world rights and living conditions, it makes you think about the efficiencies of such an economic system.

> So Japanese people are doing everything right -- eschewing violence, avoiding drugs, working hard and not having kids out of wedlock. They are following the conservative prescription, as well as or better than any other developed country in the world. And yet still, many of them are poor. This suggests that there is something very wrong with the conservative theory of poverty.

No, the author is confused. There is a big difference between -

- you cannot be poor if you make good choices, and

- you can get out of povery by making good choices

The conservative position is the later. There will be cases where it doesn't work, but it is a sound recommendation in general.

Now, poverty does make it harder to make good choices. So welfare $s should be spent to make that easier, e.g. free food at school helps kids do better at school.

You say there is a "big difference" but logically they are exactly the same claim. Also, no need to "recommend" making "good choices" any more than you need to recommend breathing.

Not at all. One is saying that it's possible to get out of poverty by making good choices. One is saying that it's impossible to be in poverty if you make good choices. Subtle but big difference.

I disagree with both statements regardless, but there is a difference.

If "good choices are likely to lift you out of poverty" like OP claims, it logically follows that "you are unlikely to be poor if you make good choices".

"There will be cases where it doesn't work" let's say that means 99%/1%. So the statements become "you would have 99% chance to be lifted out of poverty if you made good choices" and therefore "you have 1% chance of being poor if you make good choices". Whether you believe it's 1% or 0% the behavior will be the same. If a smoker gets lung cancer you will blame their smoking everytime even though there was a 5.8% chance that it was not smoking caused so 0% and 5.8% is not any different, why should 0% and 1% be?.

Sure but the statement the original commentor made wasn't that it was "unlikely" for you to be poor. He said "cannot".

What you mention in your comment is logical, but you moved the goalposts by using the word "unlikely". Can and cannot are vastly different words to likely and unlikely.

Put simply, one claims it's impossible to be poor if you do X. The other claims it's possible to be poor but you have a better chance of not being poor if you do X.

thank you for calling that out, more people need to be called out when doing that crap.

Yeah it's a pet peeve when people move the goalposts to make themselves look smart/correct. I actually am against the conservative position myself but I prefer more clear reasoning. In my case it's because I don't think the "good decisions" are always realistically available when you're in poverty.

Yes in a vacuum and out of context, those are vastly different words with different meanings. That's how the original commentator is trying to fool you who stop at that without considering the actual implications.

For this context in reality "unlikely" and "impossible" are the same thing, barely a distinction definitely without a difference. It makes absolutely no concrete difference. But you ignored this point of my comment.

No, you chose to ignore the word choice of the original comment to fit your own argument. Note that in the comment chain I've repeatedly said that I actually support your viewpoint. I just don't support the means by which you argued it.

How would you argue for it then? Let's take a similar "defense" in some unrelated scenario that we have some distance from.

Let's say someone demonstrated that they are a xenophobe, inevitably someone will call them "racist" because it carries more rhetorical weight and is effectively the same thing (using arbitrary unrelated quality about someone to justify discrimination).

Now their "defense" will be that "no no, I am a xenophobe not a racist". How do you effectively convey that this is a bullshit defense and the connotations of racist apply equally? Without going into nuance where you will lose most people... :(

I was disabled by bad surgery and lost my career. No system that ostensibly should have helped, did. Denied. Denied. Denied. YEARS of adversarial, not default helpful, meetings and challenges and interviews. I saw people worse than me refused help. I saw real time as people who knew me for years or life, who respected me and my career choice helping others, decided I was a lazy mooch who wasn't trying hard enough, was somehow responsible for my situation, and needed to "take responsibility" but nobody could describe WHAT that meant or HOW to do it. It was all so soul crushing and and literally ruined my life and future. I didn't do it. It was done to me. But blame and dismissal is easier for people.

Contrast that with a former friend who had a similar medical issue in Europe. He wasn't bankrupted by medical costs, had social support for basic living as he was treated and recovered long term, had social education which allowed him to go back to university and obtain useful skills for his new situation. He now has a thriving business and as full a life as anyone could expect. Because he had help and options when he needed them in the beginning. Having that help and those options also made it easier for him to hold into his relationships because he was able to stay IN life and move forward. People can only take so much loss.

Yeah I resent it. I resent being born here where I hear how amazing it is every day and how Europe is a socialist dystopia (I've lived there, the people telling me this have not and I'd happily fufill their "get out of you don't like it" wishes if I could) and the usual middle American beliefs, but we don't even have the most basic of social protections. I resent being blamed. I resent that even seeing this happen people still decided just what the Murican culture told them to decide about me because its easier to live with ones own fears that way. I resent having my life end in such a miserable and painful mess when I earned more and did what I was supposed to.

America has a real empathy problem. People won't treat others as they wish to be treated when they are in need. Being poor is an infection and they avoid you. It's not a need they reach out to solve. And being poor is very expensive. A society of individualists is no society at all.

I'm from Norway. The backside of the medal when it comes to welfare services of that kind is the rather humiliating process you have to go through to actually get them. I've heard many stories about this.

Yes, you'll get help if you do as they say, but it can feel very invasive at times. Some clueless bureaucrat will need to know about your finances and all your medical issues, and if it's not a clear-cut case, these clueless people will need to form opinions about how sick you are and how much help you need, and they'll often be wrong, and you'll have to fight them.

It's better than the alternative, of course, but it's not anywhere near being the utopia that U.S. liberals like to describe it as. They're just using us to promote their own agenda.

With that said, I do find myself thanking heaven that I was born in this country from time to time.

For what it's worth, the ambition on the left over here (in the US) is to eliminate means testing for programs as much as possible. Healthcare problems? Free healthcare for everyone, no forms required. No home? Everyone gets a free / low cost house. We aim to do much more than that (give control of the economy to the people), but a robust welfare state is a good start.

Those are compelling policy handwaves, but they really aren't going to the heart of the issue; which is someone in the broader conversation is basically misrepresenting reality to an astounding degree. The OECD reports that the US already spends more on healthcare per capita than any other nation by a substantial margin [0].

If it were believed that the ambitious left were going to implement free healthcare by bringing actual costs down into line with the rest of the world they could probably muster bipartisan support in a few years. But I bet their plans don't do that - eliminating means testing and more handouts are are just avoiding the real issues.

[0] https://en.wikipedia.org/wiki/List_of_countries_by_total_hea...

That's exactly what the left wants, but they are facing bipartisan opposition from both Republicans and the majorty of centrist Democracts, both of whom receive large donations from the massive insurance industry that stands to lose everything.

Giving it to everyone is the cost reduction.

Leaving aside the question of old age and focusing on healthcare for people of working age, it is almost always cheaper to intervene earlier, and it helps people get back to work sooner. The case is even stronger in children where healthcare gets to determine if they get to live a decent life or not.

Not to mention the benefits of time saved fighting back and forth over bills.

A little bit of cost control pushing people onto the cheaper versions of insulin and things like that, in the manner of the UK National Institute for Clinical Excellence would help. This is also what every private insurer does, but people go bananas when contemplating the idea that the government might do it.

Oh, and pharma marketing needs reining in. Some of the people who were marketing opiates should be jailed for the damage they've done.

Medicare has for a long time been banned from negotiating drug prices in most instances, and that is a large part of the problem. They have a limited indirect ability by basically being able to contract with private healthcare plans to provide services, who in turn can negotiate, but it does in no way allow them to leverage their size to the full extent.

Compare to e.g. the UK where the NHS does not just negotiate on generics, but also use the considerable value of their contracts for generics or drugs that can easily be substituted to drive down prices on other drugs by bargaining on combined contract values.

Imagine there was a button you could push that would give every single person everything you're mentioning - a free house, free healthcare, and all the things you're not mentioning - free education, free sustenance, free childcare, free longterm paid pa/maternal leave, guaranteed high paying jobs, etc. Who wouldn't push this button? I think every single individual, right/left/libertarian/liberal/conservative or whatever other identity would. The reason people are critical of ideas such as you are mentioning is not because they don't want them, but because they do not think they are economically viable.

To get a ballpark for economic factors, let's try to figure out what the total value of absolutely all goods and services transacted, at market value, per year in the US and then divide that by the national population. I think if you asked the average person what they thought this figure would be, most would put it in the hundreds of thousands. Some might even put it in the millions. Fortunately it's really easy to figure out exactly what the answer is. It's precisely what the GDP/capita captures. It's about $62,000. And we're already chopping 27% of that in taxes to fund our current [generally underfunded] programs, so you can drop it down to $45k.

That is, as hard as it is to believe, the entire economic product of the country. Our unimaginable achievements - both social and personal can make it hard to realize how little we actually have. So you need to fund all the grand ideas you have in proportion to this keeping in mind that it doesn't mean you have $45k per person to spend. That is the entire economic product of the country.

This is why it's much easier to have a grand vision than to actually think about implementing it. Taxing the rich is hardly a solution because it again misses out on just how little we really have. If you go and just take 100% of Bezos' wealth from him, all $150 billion, that works out to about $470 per person - for one year. And he is exponentially richer than most rich. By the time you get to stripping the 20th richest person of all his wealth, you're down to $10s of dollars. Not too long after that, you're down to pennies per person. And that is, again, just money for a single year. These grand ideas need neverending annual funding.

---

This is why even in places like Norway, which has extensive national wealth due to a mixture of a small population and large sums of nationalized oil money, it's not just free everything for everybody. Solving all of these issues requires much more than just a desire to solve them. The reason I mention this is because I think this shared desire is something that often gets lost in today's increasingly polarized world. We all want the same things; it's just we disagree on how to get there.

> Who wouldn't push this button?

My father's entire family, who have literally said that being homeless should be a capital crime because it proves how useless you are.

Yes, bad people do exist. Why is this still a surprise to conservatives?

It's easy to make an argument when you generalize your opponents viewpoint to the most extreme and ridiculous standpoint.

Switzerland is by no means a socialist utopia. You don't get a free house, or are somehow guaranteed a high paying job (who was even arguing that?).

But when it comes to healthcare everyone is in the same pot. I.e. you contribute the average for a person your age and share the risk across the population, as it should be imo.

We could absolutely stop people going bankrupt when they get cancer.

Switzerland has a very strong social support system for people who make what, in other countries, would be a solidly middle class income.

This includes subsidies for housing, basic necessities, and healthcare insurance.

When you already started, why didn't you try to really compare the numbers? Norways GDP per capita is only a little higher - 75k USD, and if you actually checked, much of their oil profits go into their national fund and not spent. But if we actually start checking more, Sweden, who has a much higher population and no oil profits, also has the same socialistic policies with a per capita GDP of only 53k USD. I dont believe in free lunch, unlike many left leaning people, but some form of universally free policies are clearly possible, if taxation and implementation are done right.

> a free house, free healthcare, and all the things you're not mentioning - free education, free sustenance, free childcare, free longterm paid pa/maternal leave, guaranteed high paying jobs, etc

The great majority of Americans nevertheless do have houses, healthcare, education, sustenance, childcare and jobs. This suggests that the economy can provide these things and that also providing them to the small proportion currently without them is probably feasible.

Making them 'free' and involving taxes just rearranges the payments involved. It doesn't require producing much more than America already does.

The challenge is to do this without damaging incentives and the economy or creating moral hazard (free riders). That's the difficulty.

IMHO some free riders must accepted, or the system will be too draconian and or investigation heavy.

this is a quite simple problem to solve.

If the freeriders drain less from the system then it costs to perform measures to counteract them, the system is effective.

> It's precisely what the GDP/capita captures. It's about $62,000. And we're already chopping 27% of that in taxes to fund our current [generally underfunded] programs, so you can drop it down to $45k.

I think you've misunderstood the nature of government spending. It's not like the government destroys that 27% when it spends it: the money is just redirected from where it might have gone (i.e. consumer spending) to other places (like the maintenance of roads and hospitals). You've forgotten about the circular flow of income.

Besides, GDP per capita as a measure of the productive capacity of a country actually misses quite a lot. Suppose I run a drug company, and I charge $10k / year for a drug that's cheap to manufacture (so there are no worries about the price of intermediate goods or the value that I add). That's 10k per annum that I'm adding to GDP.

But if a competitor offers a generic version of the same drug at ten dollars a year, putting me out of business, that $10k / year diaappears from the GDP figure.

> It's not like the government destroys that 27% when it spends it: the money is just redirected

It's easier to think about these things in terms of labor than in terms of money - money is too abstract and it's easy to make logical errors.

Imagine we have a 100% labor/service economy. Each time money changes hands, it means that that much "value" of labor has been exerted. In this sense, it is clear that the GDP is an accurate representation of precisely how much "value" or labor is being exerted in total across the country each year.

If each time money changes hands, the government takes 27%, that means that 27% of all labor exerted in the economy goes to the government, and is spent, permanently. Money is finite in the same sense that labor is finite in this example.

> But if a competitor offers a generic version of the same drug at ten dollars a year, putting me out of business, that $10k / year diaappears from the GDP figure.

No, then the consumer would put that 10k / year towards some other purpose instead, and it would still show up in the GDP.

> If each time money changes hands, the government takes 27%, that means that 27% of all labor exerted in the economy goes to the government, and is spent, permanently.

But the labour goes towards a government program. If the program is absolutely worthless, then you're right: nothing of value was created and 27% of GDP was "spent". But if the service was just as valuable as what each worker would have done, then nothing is lost. The reality is probably somewhere in-between. Some work is wasted as a result of bureaucracy, but otherwise the government makes good use of its taxes.

> No, then the consumer would put that 10k / year towards some other purpose instead, and it would still show up in the GDP.

GDP measures value added to an economy. If the price of a product drops, it adds less value. Consider the cost of adding a column of numbers in the era before computers (done by a trained clerk) vs today, where the cost is effectively zero. We don't account for all clerical work that has been automated away in the GDP figures anymore because it's essentially free.

> But the labour goes towards a government program.

I agree. I'm not saying government programs are useless. The person you replied to was simply saying that we only have $62,000 a year to spend on each person (and that's all of the resources in the entire economy) and it sounded to me like you were disagreeing and saying we had more than that.

> GDP measures value added to an economy.

I agree.

> If the price of a product drops, it adds less value.

By what definition of value? Are you just defining value as being equal to the price? In a utility-based sense, I think GDP does measure value added to the economy.

> We don't account for all clerical work that has been automated away in the GDP figures anymore because it's essentially free.

In some cases, the GDP might not change if the cost of goods has only gone down, sure, but GDP is a useful figure only relative to the cost of goods. This is how we compare the GDPs of different countries with different currencies.

In utility based sense, GDP is not a measure because one dollar has zero utility if you cannot spend it on something you need.

Even $100k can have zero utility if you need cancer treatment that is more expensive than this.

This is because service costs are usually not negotiable, and especially not privately if you have zero power.

Deriving utility from money directly is an exercise in futility.

In comparison, items can be used for the intended purpose, meaning they have utility for that and related purposes.

Money has unknown utility depending on prices and other various factors.

Without specifying purpose and other constraints you cannot actually talk about utility of any asset.

PPP adjusted GDP is better, because it relates money value to a certain basket of goods which have utility for certain common life purposes. However, the basket typically skips critical pieces like shelter (housing), clothing or indeed weighted averages of medical care. (Medical care is especially tricky because it is very heavy tailed in cost. Low probability events have huge costs, which means in normal average they're hidden. What is needed is the likelihood of a person hitting any of the expensive conditions, which can be had by binning expensive ones together.)

Not to mention if a service is paid by taxes, PPP essentially should count the cost by using the tax value split among all the free services. If it is gated conditionally, then likelihood of that condition has to be counted in. (E.g. free for people making $x or less.)

Oh my god, I just read news about some "centrist" Democrats arguing against universal single-payer healthcare on the grounds that some segment of the working population already gets a nice healthcare package as a benefit, and somehow it would be unfair to those people if everyone was eligible to reasonable medical care. I mean, with Democrats like that, why do you even need Republicans?

Right, of course we should want single-payer, just like Canada!

Never mind that the average wait time to see a doctor in Canada is almost 20 weeks, and that tens of thousands of Canadians cross the border to the US every year to avoid that wait...

There are tradeoffs with everything. Personally I think people should proactively try to live healthier lives - the medical establishment is about making money, not making you healthier.

The other major side benefit of that is our society might be able to afford the overall cost of healthcare - it's not looking too good at the moment!

Oh puh-lease. Even a trivial googling tells me that Canada has longer waiting times than most other comparable countries with single-payer healthcare. And those waiting times? About half of GP visits are same- or next day appointments, with 20% of Canadians having to wait for a week. As for specialists, the median waiting time is roughly four weeks. [1]

So those numbers are definitely not optimal compared to many other countries, but your claim about the average being almost 20 weeks is completely ridiculous. You're entitled to your own opinions, but you are not entitled to your own facts. And if your opinions are based on your own facts, don't expect to be taken seriously in any reasonably educated company.

Now, according to [2], the US fares well on two metrics: waiting time to see a specialist and waiting time to elective surgeries. Unsurprisingly, both of these are conditional on already having gotten a referral and/or having decided to book the appointment or operation. That is, most of the time, if you have decided you can afford it! Indeed, cost barriers were by far the highest in the US, as measured by the fraction of people who skipped treatment or medication due to cost.

[1] https://globalnews.ca/news/3251833/canada-has-some-of-the-lo...

[2] https://www.cihi.ca/sites/default/files/document/text-altern...

I may not understand what's being got at with this 'Canadian wait time' issue.

I've needed to go see my doctor - usually I can't get a same day appointment. Sometimes I can get a 'next day' - usually it's "pick some time in the next week or two". Am I now "having to wait"? It's been this way for me my entire life in the US (more than 40 years I can remember), across different states, political leadership and insurance companies.

I needed a procedure by a specialist last year. Regular checkup produced "this is serious - I'm referring to you ABC for procedure X - we need to get this done ASAP". It was still more than 2 weeks before the specialist could see me. There was an option of seeing someone else sooner, but it would have meant a 2 hour drive. That was possible but very inconvenient, and we decided that the 2 week period was acceptable vs the alternative.

Does everyone else in the US get same day service for everything they need, and I've just been wholly unlucky my entire life in multiple regions of the country? Or, do we actually have 'wait times' just like everyone else?

Well, I guess that's why you need to creatively misinterpret the statistics in order to make the argument "Canadian wait times long -> single-payer systems baaaaad". Never mind the other logical fallacies in said argument.

Is there any evidence that the reason healthcare is so unaffordable and people go bankrupt is because people are unhealthy? Your "just be healthier" solution is no solution at all.

Regardless, people fall ill through no fault of their own all the time. I am very healthy and very active, but right now for all I know I could have a brain tumour. Your response is so stereotypically American: just ignore the problem and encourage people to take responsibility over something they by definition have little control over in the first place.

That is something has always confused me a bit. Many people tend to object to universal system on the basis that it leaves it up to the government. But if you don't have universal systems the government, and the companies operating in the market, have little incentive to take care of its citizens. Because the cost of not doing so is left to you. Even if you want to argue that a health care system is a factor of how healthy people are, it is the universal systems that have the incentive that people are healthy. It is those systems that more often regulate things like transportation or drugs as public health issues.

> Never mind that the average wait time to see a doctor in Canada is almost 20 weeks...

The way this is stated is very misleading. The average time to get surgery is 20 weeks. This varies a lot by what kind of surgery you're talking about[1]. The average waiting time to see a doctor in the ER is measured in hours, with 27% of Canadians waiting 4 hours or more[2].

As a Canadian, I'm tired of Americans shitting on Canada's health care system and spreading misinformation to score political points. It's not perfect, but I'll take it over the financial devastation wrought by the US system any day.

Edit: Also, let's not forget that US citizens regularly cross the border into Canada so they can afford basics like insulin[3].

[1] https://globalnews.ca/news/3084366/q-a-how-long-are-medical-...

[2] https://www.cbc.ca/news/health/medical-wait-times-up-to-3-ti...

[3] https://www.cbc.ca/news/canada/windsor/bernie-sanders-insuli...

Some preeminent foreign statesmen rulers who have gotten / who are getting their surgeries done in the United States.

Daniel E. "Danny" Williams, QC a Canadian politician, businessman and lawyer who served as the ninth Premier of Newfoundland and Labrador between November 6, 2003, and December 3, 2010. [1]

Abdullah bin Abdulaziz Al Saud was King of Saudi Arabia and Custodian of the Two Holy Mosques from 2005 to his death in 2015. [2]

Moses Veerasammy Nagamootoo is a Guyanese politician and writer who has been Prime Minister of Guyana since 2015. [3]

[1] 'Danny Millions' Williams heads south for heart surgery

https://www.thestar.com/news/canada/2010/02/03/danny_million...

[2] Waldorf-Astoria Bumps Guests for King Abdullah's Entourage / The Room Is Booked, Until the Hotel Says It Isn’t

https://www.nytimes.com/2010/12/14/business/14road.html

[3] Prime Minister Nagamootoo to Undergo Heart Surgery in the United States

https://www.thewestindianonline.com/prime-minister-nagamooto...

edit: typo; rephrased sentence

Yes? Nobody's denying that it's easy to get very good medical care very quickly if you have enough money! That's of course, completely irrelevant to the topic of this discussion, or, if anything, emphasizes the inequality inherent in the American system.

Just adding context that when it comes critical medical care involving specialized care, the United States almost has no equal - not even close. Whether that is Level 1 trauma facilities, oncology facilities, cutting edge research laboratories or doctors with deep expertise in such fields, the United States is second to none.

This is not an oft brought point when discussing the merits of the U.S system despite its failings and short comings.

Also:

    The Fraser Institute, a Canadian public policy think tank, 
    estimates that 52,513 Canadians received non-emergency medical
    treatment in the U.S. and other countries in 2014, a 25 
    percent jump from the roughly 41,838 who sought medical care 
    abroad the previous year.

    In citing those numbers in its 2015 report, "Leaving Canada for 
    Medical Care," the organization said difficulties in obtaining 
    timely medical care at home is, increasingly, leading Canadians
    to seek it abroad. "It is possible [they] may have left the 
    country to avoid some of the adverse medical consequences of 
    waiting for care, such as worsening of their condition, poorer
    outcomes following treatment, disability, or death," the report 
    says. "Some may leave simply to avoid delay and to make a quicker
    return to normal life."

    Canadians could expect to wait 9.8 weeks for medically necessary
    treatment after seeing a specialist in 2014, the researchers found,
    three weeks more than the time physicians considered to be 
    clinically "reasonable."[1]

[1]

Canadians Increasingly Come to U.S. For Health Care / Crossing the Border for Care

https://www.usnews.com/news/best-countries/articles/2016-08-...

But, again, we’re not talking about how amazing the system is if you have money. We’re talking about how the system utterly fails to disseminate basic healthcare to the vast majority of people in a way that doesn’t destroy them.

There's also a scale that the United States has over all other OECD countries. It's by far the largest in population and therefore has more specialist equipment. A country like Canada with almost a tenth of the population will have less facilities.

Uh, maybe in some places in Canada? I grew up in Nova Scotia and seeing a doctor with an appointment was possible within a week, emergency was always possible right away. (Had 34 stitches by the time I was 17 due to growing up on a farm so I had a lot of experience.)

Here in Austria it's even easier, I can go directly to my family doctor at any time and wait ~hour with no appointment necessary. Xrays, or other things are usually possible same day and even elective surgery that improves quality of life is free and is plannable within a couple months with the recovery time as paid leave from work.

> Never mind that the average wait time to see a doctor in Canada is almost 20 weeks...

This is just false.

The number you're referring to is from here: "Specialist physicians surveyed report a median waiting time of 19.8 weeks between referral from a general practitioner and receipt of treatment—shorter than the wait of 21.2 weeks reported in 2017. This year's wait time is 113% longer than in 1993, when it was just 9.3 weeks."

It's for receiving treatment from a specialist (surgery, etc.) not 'seeing a doctor'.

Somewhere around 40% of Canadians reported being able to see their primary care physician the same day. Very few reported a wait of longer than 7+ days.

Many parts of Canada are very remote. The average waiting time for someone in a major city is not as long as that.

There simply aren't medical facilities in a lot of remote / regional Canada. If you need a fairly complex or specialized surgery you're essentially going to a big city or regional hub.

Keep in mind that Canada may be huge, but has less people than California, and most of them are concentrated in a handful of places.

Anecdotal: my wife's wait for an orthopedic surgeon was 3 days... but was in a city 1.5 hours away.

It is not twenty weeks to see any doctor: it is twenty weeks to go from a referral from a general practitioner to receiving treatment from a specialist [0][1][2]. I’m not sure if things like consultations are counted are as treatment or not.

[0] https://www.ctvnews.ca/mobile/health/health-care-wait-times-...

[1] https://globalnews.ca/news/3251833/canada-has-some-of-the-lo...

[2] https://www.fraserinstitute.org/studies/waiting-your-turn-wa...

The problem at the very outset with this argument is that a system where patient pays hides the queues, because everyone can afford to go.

As such you can not directly compare a system where going to the doctor costs money with one where it does not.

This is one of the biggest problems with the US system: Nobody knows the extent of the unserved need, and what that ends up costing society in lost productivity (never mind the human suffering) because people avoid healthcare services they know they can't afford.

But we can compare Canada to other socialized systems, and many do more with less and still end up with shorter wait times.

The vast majority of the worlds healthcare systems also do not prevent people from going private.

Most places also allow you to buy your way past the queues. As such, the difference is stark: Most places you have the choice of waiting, and paying much less, or paying for private services and get seen as quickly as those who can afford it do in the US while a large number of people in the US has no access to a lot of healthcare services at all.

Want to bet whether the people who can't afford to buy healthcare services would prefer waiting 20 weeks - or any amount of weeks - to get treated vs. getting no treatment at all?

Now consider that average US spending per taxpayer in the US on Medicare and Medicaid is substantially higher than the per taxpayer spending to fully fund universal healthcare in the UK for example. And then on top of that Americans buy private insurance since most are not covered by Medicare and Medicaid.

Most Americans pay twice. Meanwhile in the UK only 10% find it worthwhile "paying twice" by having private insurance, even though most private insurances in the UK are very cheap for the simple reason that there's simply no demand for replacing A&E, ICU type services, and relatively little demand for covering private GP services (most people can be seen by their GP quickly, and a private consultation on occasion is cheap), so the insurances mostly cover seeing a specialist quickly if the NHS has a waiting list, or getting surgery quicker if the NHS has a waiting list.

This is what I really don't get about the US debate: The poor regulatory regime basically mean Americans are already paying enough towards healthcare to provide universal coverage via taxes alone if the regulations were properly reformed. A start would simply be to remodel Medicare after e.g. the NHS model, and allow it to exercise its market power to drive down costs, and use the savings to extend coverage.

As it stands, the inadequacy of the US healthcare system is largely down to corporate welfare in the form of regulations that actively prevent the government from providing cost-effective healthcare services.

The US political spectrum is such that many Democrats are right wing by European, or at least Nordic, standards. What people tend to characterize as "utopia" is the socialist welfare state, where means are tested to a much lesser degree. What countries like Norway have increasingly done is to move from that system to a more liberal one. That is where you find yourself "begging the government for help", because you don't fit into the market.

This is a bit of a long paste, but people don't generally understand the differences:

---

There are three measures for welfare-state regime stratification: conservative, liberal and social democratic. For the conservative welfare-state regimes, the traditional societal class model is a prevalent idea, but also the rejection of capitalism. Which leaves conservatism between the market based ideology of liberalism and the social democratic wish for social leveling. EspingAndersen distinguishes between two branches of conservatism: corporatism and etatism. Corporatism is described as a response to industrialism and its effects: social fragmentation and individualization. In modern societies, corporatism is described as "...built around occupational groupings seeking to uphold traditionally recognized status distinctions and use these as the organizational nexus for society and economy". Corporatism was mostly influential in the continental European nations, as a response to the Church’s strong position. Etatism, on the other hand, focuses on the primacy of the state. Esping-Andersen illustrates etatism with Bismarck’s wish to tie workers directly to the state with social benefits, instead of tying workers to the guilds, as in the corporatist model. Today, etatism can be traced in two areas of welfare state stratification, where one is giving generous welfare provision to civil servants, giving state servants an elevated position in society, as in countries such as Austria, Germany and France. The other area where etatism can be noted today is the relatively generous poor-relief or income protection, based on the idea of noblesse oblige.

The liberal response to the conservative ideas of etatism was the opposite. The state and the stratified society were seen as something that had gotten in the way of market emancipation, and in extension, individual liberty. Social policy were to be replaced by the market in order to achieve social leveling, not to eliminate aid, but to have a less active state. Today, liberalism does accept income-tested social benefits, although it is associated with social stigma to be a social assistance beneficiary. Due to the core liberal idea of the smallest state possible, benefits are usually means-tested and modest, given only to those that are genuinely poor, creating the stigma. The liberal welfare-state system is based on the notion that those who are entrepreneurial and self-reliant should be rewarded. Social insurances exists, but they are privately held and paid for.

The socialist movement started as a response both to conservative and liberal reforms. The most important notion of socialism was to change the societal stratification and achieve social leveling. The primary target was to change the means-tested poor laws since they created a stigma within the proletariat and that beneficiaries were disenfranchised. The social democratic idea of universal benefit system as a prolongation of democratic rights was most evident in the Scandinavian countries and particularly in the Swedish "People’s home". The universal benefit system came to include even the middle-class in order to "preserve the solidarity of a universalistic welfare state". A universal benefit system denotes a system where social aid is for everyone. This picture is somewhat simplified, although benefits are universal in general, and more general than the means-tested system where only a limited group qualifies for benefits. Moreover, the socialist movement focused on the concept of solidarity and in extension, one of its most distinctive features: centralized bargaining trough trade unions.

---

Do Capitalist Welfare States Still Consist of ”The Good, the Bad and the Ugly?” http://lup.lub.lu.se/luur/download?func=downloadFile&recordO...

Trade unions is the specific kind of socialism, others were also invented but have never really taken off. One was direct partial ownership of means of productions, such as giving out diffuse controlling stock or equivalent, paying out dividends. The other was using bottom up small societies with representatives, essentially democratic, defined by bottom up hierarchical organization, which are not across trades (sounding like rebranded corporatism) but spatial - per city or area.

Both are vulnerable to being hijacked. Financial variant can be driven into the ground by others cutting corners or essentially exploiting workers - plain corporatism. The democratic bottom up variant shares the vulnerabilities vs demagoguery but makes it harder to counter, though also more expensive to pull off. Also does nothing against special interests or basic greed.

(USSR was actually etatist conservative bureaucracy rather than socialism.)

I don't think Democrats (or Republicans when they take power) are clever/smart/kind/honest enough to offer universal single-payer healthcare without rationing. Is there an intent to take my health care choices away, and is that intent benevolent or malicious?

You paint a very abstractly wonderful picture, so let's assume yes and benevolent if rationing is to be expected given the finite tax base. I still need more details before I get on board with your plan.

First of all, my employer and I pay through the nose for my decent healthcare right now. Under your universal single-payer healthcare system, will I still be able to pay quadruple-through-the-nose to buy supplemental insurance such that I can still continue to get halfway decent service when I want it? Or, am I going to be stuck with everyone else waiting for rationed care out of fairness?

Also, are you planning to cap salaries of doctors and profits of hospitals and insurance companies out of fairness? (You think it's hard to get quality specialist care now??)

A different opinion from yours goes something like this: US health care is so expensive and inaccessible to 10% of the population because government got involved. The federal government twisted the HC system into a bureaucratic pretzel with no market forces to control costs. The absurd system we have now is a consequence of letting busybody crusaders and insurance company cronies write the laws.

I am not saying that viewpoint is accurate, but it's worth getting diverse voices into the discussion so that we don't wind up with an unhealthy progressive monoculture here on HN.

If we talk to each other like friends that have differing opinions, then we can find lots of little improvements that a majority of us can agree on, like maybe up-front pricing in hospitals or tort reform. If we can bring costs down and make health care more accessible to more people, then maybe we won't feel forced to take risky steps like forcing everyone to cede their personal health care choices to indifferent government pencil pushers.

Reaching out to you as a friend, I feel we both want the same thing - to have the maximum number of people possible receive quality care. I feel we're both frustrated that the current system is so unfair in so many ways.

I'm not opposed to setting up a safety net, as long as it doesn't get out of hand cost-wise or turn into a racket for the cronies. I'm thinking like mending broken bones, treating infections, vaccinations, most generics, and addiction treatment all should be abundant, cheap and/or free. Panacea it would not be with a fixed budget so that as a program it cannot grow to crony levels. You could sell me on providing basic health services like that because it just makes sense economically and public health-wise.

And I hope you're not opposed to weeding out waste, fraud, and abuse as one approach (of many) to fix a broken system. If we can get costs demonstrably down, maybe you'd even be open to deep cuts in existing nondiscretionary programs like medicare that have insane unfunded liabilities and will eventually crush us.

Maybe there is a middle ground that satisfies between us politically such that we can move forward together rather than lurching crazily right and left every 8 years.

check out Australia's healthcare system as a middle ground then. I've lived in the UK (free, single-payer, government-run) and Australia's, and I prefer Australia's because it has a mix of both government and market.

The basic principle is that the Australian Federal Government subsidises healthcare by a fixed amount for each procedure. So iirc, it was AUD$45 for a visit to the GP. That's enough for some GP practices to be able to offer a free service (referred to as "bulk billed" because they only billed the government). Obviously those services become popular, so to get a free appointment you have to wait a while. Or, you can pay a bit yourself to get an appointment with a doctor who charges more than the government rate and are therefore less in demand.

In Australia I could usually get an appointment next day if I paid $25-50 or so. In the UK it was usually a 1-2 week wait, but free.

This goes for everything (except dental care for some reason, I don't know what's up with that). So an X-Ray costs $200, or nothing if you can wait until next week. And so on.

Health insurance covers the additional costs, and I paid $25/month for a plan that meant if anything serious happened I'd be liable for the first $250. And it also gave me dental cover, so I could claim some (but not all) of my dental care from my health insurance - a net gain for me most years.

The NZ system is similar. GPs are subsidised (your primary health provider) but hospitals are run by the government and are free. The unfortunate thing is you have to go through the GP to get a referral to the Hospital (unless you go into A&E).

The other interesting system that NZ has is something called ACC which also pays for rehabilitation and loss of income when someone has an accident. If you are paralysed and can no longer work then ACC will pay you something like 80% of your income until you manage to find another job. That could be for the rest of your life.

  my employer and I pay through the nose for my decent
  healthcare right now [...]
  Under your universal single-payer healthcare system,
  will I still be able to pay quadruple-through-the-nose
  to buy supplemental insurance

Here in the UK, the private health insurance arranged by my employer costs them $450 per year.

I don't know how much US insurance costs your employer, but I assume it's several times more, rather than several times less, than mine pays!

After all, in the UK private medical insurance doesn't have to cover ambulances or emergency surgery or pre-existing conditions or chronic illnesses or old age or organ transplants or childbirth.

> I don't know how much US insurance costs your employer, but I assume it's several times more, rather than several times less, than mine pays!

You also likely make half what I make and that's before taxes (my wife is from the UK, I looked at jobs over there and rural US IT salaries can beat London IT salaries). I prefer my deal to yours.

That’s true, but how much of that extra money you get to keep in the long run is determined by the health lottery. If you end up having cancer for 5 years, you can kiss it all goodbye.

But yes, one thing that's tough for Europeans who haven't lived in the US to comprehend is that Americans really do prefer being able to buy a bigger TV to having proper security when it comes to health care.

If I lived in the London with the salaries they wanted to pay I'd be poor either way. It was enough to live in a tenement block. take public transport and eat cheap food. In the US I own a home, two cars, and support my entire family from just my salary. If I got cancer in the US I'd have be forced to live in a tenement block. take public transport and eat cheap food just like if I was "lucky" in the UK.

I'm not sure exactly what you mean by a "tenement block", but a typical tech salary in New York or San Fransisco isn't going to be enough to live in a town house. If you're in a city, you're going to be in an apartment, and that apartment is probably going to be in a block of apartments.

>If I got cancer in the US I'd have be forced to live in a tenement block. take public transport and eat cheap food just like if I was "lucky" in the UK.

That's an interesting perspective on public transport. Public transport is a far more pleasant way to get around London than driving :)

But, no, you could end up in a far worse situation than that in the US. Medical costs are very unpredictable and bear no relation to your wealth. You could easily end up bankrupt and unable to pay for vital medical treatment. I realize that most Americans like to live in complete denial of this fact, but it's inarguably true.

Also, even taking what you say at face value, it's quite incredible that you're satisfied with this. Why should you have to take a massive hit in living standards just because you get sick?

>but a typical tech salary in New York or San Fransisco isn't going to be enough to live in a town house.

That's true, but then I'd be talking about salaries that aren't double of what is offered in London but 5 or 6 fold higher. I own my home and support my wife and daughter by myself in a low crime suburban area in the US, that isn't possible anywhere I could find in the UK. Did I also mention I didn't go to college?

>But, no, you could end up in a far worse situation than that in the US. Medical costs are very unpredictable and bear no relation to your wealth. You could easily end up bankrupt and unable to pay for vital medical treatment.

When you get that sick you end up on socialized medicine, SSDI and medicaid cover those costs at that point. Also while you will receive medical bills you don't actually have to pay them while hospitals are not allowed to refuse you life saving treatment.

Tech salaries in NYC and SF aren't 5 or 6 times higher than tech salaries in London.

>I own my home and support my wife and daughter by myself in a low crime suburban area in the US, that isn't possible anywhere I could find in the UK.

I'm not sure what you're saying at this point. I grew up in a low crime suburban area in the UK. My Dad worked, my mom stayed at home. They owned the house. My Dad works as a programmer.

>When you get that sick you end up on socialized medicine, SSDI and medicaid cover those costs at that point.

Erm, no. You will not likely meet the eligibility requirements for medicaid. That's just wishful thinking. If that's how the system worked, medical bankruptcies wouldn't happen.

>Also while you will receive medical bills you don't actually have to pay them while hospitals are not allowed to refuse you life saving treatment.

They're not allowed to refuse you life-saving emergency treatment. They sure can refuse to give you chemo, refuse to give you reconstructive surgery if you've been badly burned, etc. etc.

It's astonishing how unaware you are of how the health system works your own country. America has a lot of work to do on this issue.

You really could suddenly end up with a $500,000 medical bill. It's tough to face up to that fact, but it is a fact. https://www.nbcnews.com/health/health-care/first-kidney-fail...

> Tech salaries in NYC and SF aren't 5 or 6 times higher than tech salaries in London.

I've seen 75k USD salaries commonly in London and 400k+ is not unheard of in fang companies.

>Erm, no. You will not likely meet the eligibility requirements for medicaid. That's just wishful thinking. If that's how the system worked, medical bankruptcies wouldn't happen.

If I have money and insurance why do I need assistance? The disaster situation you were describing seemed to imply that I would no longer be working and have insurance. If I'm working and have insurance I'll just pay my copays and get care that way. If I have no income due to a disability, I'd get SSDI and medicaid.

>They're not allowed to refuse you life-saving emergency treatment. They sure can refuse to give you chemo, refuse to give you reconstructive surgery if you've been badly burned, etc. etc.

Care to cite a time where that ever happened?

>I've seen 75k USD salaries commonly in London and 400k+ is not unheard of in fang companies.

You're just comparing a typical dev salary in London to an unusually high dev salary for NYC or SF. I don't see what insight you hope to gain by doing that. (The people making big money as software developers in London work as independent consultants rather than employees, by the way, as it's more favorable from a tax point of view and - lol - you don't have to worry about not having health insurance.)

>If I have money and insurance why do I need assistance?

Because you don't have enough money. There's no cap on medical bills. See for example the article I linked to regarding the $500,000 bill for dialysis. The person in question had insurance.

>Care to cite a time where that ever happened?

Holy crap, you really mean it. It happens all the time, as you can find out just by googling. Hospitals are under no obligation to give you chemo if you can't pay for it.

https://www.upi.com/Health_News/2016/06/03/Study-One-quarter...

https://www.webmd.com/cancer/news/20170221/many-younger-canc...

>You're just comparing a typical dev salary in London to an unusually high dev salary for NYC or SF.

If you make much less than that in SF or NYC, there is no point in living in such an expensive place. Go make that London salary working in a rural area of the US.

>Because you don't have enough money. There's no cap on medical bills. See for example the article I linked to regarding the $500,000 bill for dialysis. The person in question had insurance.

From your article: "A few days after the treatments began, an insurance case manager called the Valentines warning them that since Fresenius was out-of-network, they could be required to pay whatever the insurer didn’t cover. The manager added that there were no in-network dialysis clinics in Montana, according to Jessica’s handwritten notes from the conversation. (The insurance company disputes this, saying that its case manager told Jessica there were no in-network dialysis clinics in Missoula.)

Jessica repeatedly asked both the dialysis clinic staff and the insurer how much they could expect to be charged, but couldn’t get an answer.

Then the bills came."

So basically, insurance said they would not pay for the clinic this person selected and since they have zero agency they kept going and got the bill that they were told they were going to get. So sad. Did they actually pay the bill? Of course not. They took a credit hit.

>Holy crap, you really mean it. It happens all the time, as you can find out just by googling.

What was one individuals name who this happened to. Not a study. Not "we think it happens". What is the persons name?

>If you make much less than that in SF or NYC, there is no point in living in such an expensive place. Go make that London salary working in a rural area of the US.

The median household income in New York is $50,000. I would rather live in London than in a rural area of the US - thanks. You talk as if people have no preferences besides maximizing the salary to cost of living ratio.

> So basically, insurance said they would not pay for the clinic this person selected and since they have zero agency they kept going and got the bill that they were told they were going to get.

I can’t figure out exactly what you’re trying to say here. It seems you are trying to find some way to convince yourself that these people deserved to get a $500,000 bill so that you can kid yourself that this could never happen to you. Yes, it’s their fault for failing to fly to another state in the middle of a medical crisis to find an in network provider, in the absence of any clear information regarding treatment costs from from medical staff or the insurance company.

> Did they actually pay the bill? Of course not. They took a credit hit.

We don’t know from the article how much they ended up paying. In any case, taking a credit hit is not a trivial thing. In your earlier comments, for example, you clearly placed a large value on home ownership. It’s difficult to buy a home with bad credit.

>What was one individuals name who this happened to. Not a study. Not "we think it happens". What is the persons name?

This article collects a number of stories involving named individuals:

https://www.bustle.com/p/these-20-stories-refute-the-idea-th...

You are citing bustle who is in turn citing tweets with that article. That's your best evidence? Can't find a AP article anywhere? Shouldn't there be thousands and thousands of examples to pick from?

You asked for personal stories. If you want something more robust, check the Harvard Medical School study:

https://pnhp.org/excessdeaths/health-insurance-and-mortality...

"Care to cite a time where that ever happened?"

There's a documentary about the Mayo clinic on netflix. In it, a woman finally recieves a diagnosis of her mysterious and debilitating illness, of which she is pretty sure she would die from without diagnosis or treatment. She responds to initial treatment, which makes her hopeful the quality of life will finally approve. Then she no longer has money, and cannot have treatment anymore. She leaves the clinic and we never know what happens to her.

From what I'm told should be thousands of stories like this, why can't you find one where you can prove that the person died? It's all rumor and second hand stories. If someone in my family died due to someone refusing them medical care I'd be all over the media about it.

https://www.thenation.com/article/the-devastating-process-of...

https://www.theguardian.com/us-news/2017/jun/24/us-healthcar...

https://www.patheos.com/blogs/dispatches/2018/10/15/study-45...

https://www.nap.edu/catalog/10367/care-without-coverage-too-...

https://www.bustle.com/p/these-20-stories-refute-the-idea-th...

??? There are studies that directly show that not having insurance is deadly.

From the first example: "By the time Portillo found out about a small county program that sends health workers to the homes of low-income, bedridden patients, her father had been at home without pain medication for two and a half months. The nurse practitioner who came, spurred by Aquilino’s obvious suffering, rushed to order medication to make him more comfortable. Two days later, when the morphine had barely had a chance to soothe him, he was gone."

There was a program, they didn't use it until the end, he was going to die anyway. He did not die due to lack of medical care.

I'm not going to go through each one, give me your best example.

>??? There are studies that directly show that not having insurance is deadly.

Also that tobacco doesn't cause cancer, guess what those studies have in common?

"Also that tobacco doesn't cause cancer, guess what those studies have in common?"

No, please do tell me exactly what those studies have in common, with citations.

You asked for something that isn't rumor and second hand stories. I provided. Now you move the goalposts and ask for my single best story. Please clarify your behavior and your motivations in engaging in this discussion: Do you actually wish to process data that is contrary to your belief on how the world functions?

The people who produce them benefit from the result.

Who says we need massive governmental spending in healthcare? Why governmental healthcare authorities of course! I'm skeptical, especially when the specific examples provided don't match up with the rhetoric.

Also the burden would not even be that people die from lack of healthcare in the US, it would be that more people die from lack of healthcare in the US than people die from healthcare rationing in the UK. He's a case of someone who actually died from that[0].

[0]https://en.wikipedia.org/wiki/Charlie_Gard_case

"The people who produce them benefit from the result."

Can you cite specific studies, their specific researchers, and their specific funding grants?

"Also the burden would not even be that people die from lack of healthcare in the US, it would be that more people die from lack of healthcare in the US than people die from healthcare rationing in the UK"

This is not what you claimed. Please clarify the contradiction between your statements.

Readers will see my point, I don't need to get into the weeds with you like this over minor details.

Please clarify: What is your point? You asked for any evidence, and when provided, denied it as evidence, reiterated that you had always asked for specific evidence.

Nobody can seem to find a specific person who died due to lack of healthcare with anything more than a tweet to back it up. Lots of "almost" cases but no definitive deaths. Why do you think that is given you claim this is happening all day every day.

At least one reader certainly doesn't. You're asking everybody for evidence that could stand up even in court while you respond with anecdotal data and personal experience based on biased, incomplete, or generic data.

"I live and work in rural US and suddenly I can afford a lot more than I could if I had one of those jobs I found after an internet search for London" does not pass the bar you expect other people's evidence to. Not by a long shot.

"People are dying due to lack of healthcare!"

"Who?"

"This guy tweeted about it"

"I'm going to need more than that"

"Here is a study where they claim it happens in aggregate"

"Who died specifically and what were the circumstances of that death"

"PEOPLE ARE DYING"

pretty much how this debate goes every single time

If you consider that study data bad so be it. But then accept that your data is equally bad at best. And I'm being generous here, you provided no "data" to speak of. No aggregate data, no study, not even a hint of specificity.

On one hand you talk about London (very specific), on the other it's "rural US" (97% of US!). Nothing about the actual job or its conditions, what you looked at to compare, etc.

I mean it's absurd to discredit a study with sources and actual figures but try to pretend your claim looks like anything more than an impulse comment.

To make this anecdote into a data point the GP should post his whole financial history. E.g. how much they made and spent. What do they own and then we can also check what can they buy.

For example, can he buy a typical hip surgery, which over time is likely? CLL treatments? Medical transport should it be necessary? Hire a nurse? Get a broken limb in a cast?

... Not lose a job because they cannot get to it for a month because of bum leg?

Cost of each of these can be actually checked ahead of time, for UK and for US. Including a split between in network vs out network in the US.

If people are dying, we can count deaths due to causes that would be preventable in UK and in the US, as well as cost in each case.

No, he would have to say something just slightly more specific like: "rural means a suburb of City X". Or "I'm a programmer working remotely for a Fortune 500 company". Anything that can make the rest of the statement meaningful. I mean I understand not wanting to give out personal details but then don't bring it up if it's so generic.

I can tell you rural Kazakhstan can pay 5 times more than the same job in US. But without giving you details it will seem like an exaggeration or flat out lie. It's not, just a cherry picked example.

If a study comes up with figures that don't have particular names attached (data protection and all that) then unless you have some evidence to disprove it we can take it at face value. Fighting it with empty hands and generic unverifiable counterarguments feels like trying to save face.

It’s dishonest to refer to the Charlie Gard case as an instance of healthcare rationing. Doctors refused (experimental, zero-chance) treatment for purely medical reasons: it wasn’t the best thing for the baby. The resulting court case was over the question of whether doctors are required to (a) act in accord with the best interests of the child or (b) do whatever the child’s parents want. The answer turns out to be (a). Financial considerations never entered into the decision. The deciding factor was medical: a series of epileptic seizures which reduced the chance of a successful outcome to ~0. It isn’t ethical to torture a baby with ineffectual treatments just because the parents are (understandably) not ready to accept that the baby is going to die.

It's not just about dying. It's about living. I have had minimal to no access to quality medical care in America since I went through this. I have had to choose NOT to seek care for things I needed to because I cannot pay for it. I have been denied many things a reasonable person would expect to receive. There is only one reason people defend this system...ego. They cannot accept that American Capitalism isn't the best thing ever. Their pride matters more than other people. It's shameful.

Most employer sponsored healthcare plans in the US have a maximum out of pocket the patient can be charged per year.

The average cost for someone with cancer and an employer sponsored plan in the US is around $6000 per year. That's $500 a month.

https://www.cheatsheet.com/health-fitness/how-much-you-can-r...

Both my parents had cancer and survived in US, so I do know from first hand experience. They did not get ruined financially.

That said, I do support healthcare for all in the US.

>Most employer sponsored healthcare plans in the US have a maximum out of pocket the patient can be charged per year.

Yeah, but that's irrelevant if you have to use an out of network provider in an emergency situation, or if you need a treatment that your insurance provider refuses to cover.

The lack of global insurance policy for actual emergencies is a crime of this insurance system you have in the US.

This is where the government is supposed to step in. Nobody is in any position to predict where they will be taken for emergency care, and copays for random amounts is essentially ransom.

How much paid vacation do you get? Sick days? How much maternity leave does your wife get? What sort of employment protection do you have?

The difference isn't as clear cut as it seems on the surface.

Four weeks. No sick days part of the four weeks. None but I can afford to support her while she is home with our daughter for as long as they need. None besides about 5 job offers in my inbox per day.

On one hand you ask for exact names of people who have gone through unfortunate health or medical bills related moments but on the other hand you compare esoteric "identical jobs" with no consistency or transparency. One in London which barely pays for an apartment in a tenement building, public transport, and nothing else. The other is in "rural US", pays double, you can afford a house, 2 cars, and to support your whole family by yourself, and a whole list of other benefits (some unusual for the US).

Are they really the same job? Are the 2 salaries/conditions representative of the job or you just got lucky? Are they actually identical (what happens if you're sick for 6 months?)? Are the salaries that you could find published on the internet representative for London? What's "rural" US? Are you working from home for a big company or do you have to be on site? If you have to work in your town/suburb what other career opportunities are available for you and your family there compared to London? You may be happy with your salary now but if there's no room to grow, or you have no choice if you lose you job/company goes bust, then it's not quite ideal.

I understand you may not want to provide details about your personal life but as it stands you have anecdotal evidence that may or may not be based on flawed data (cherry picked examples or low quality information), while everyone else supported their claims with actual links.

Just in case: I'm not British, nor do I live there.

You're privileged enough to be in the right industry in the right location, with the right skill sets and experience, at the right time. If things were different you'd get no holidays, no job security, etc. I know people in tech on the east coast of the US who struggle to get two weeks leave and struggle to change jobs. Four weeks is something the rest of the world just takes for granted. I also know people that have been bankrupted because of health costs, this was my uncle who was a millionaire and had the best insurance money could buy. His wife got cancer, they fought the insurance company, sold the business and the car collection and houses, she died, he went bankrupt. It was very sad.

I used to work in the bay area but ultimately decided to come home. Here in NZ in the tech industry I earn a couple of hundred thousand which is admittedly less than I'd learn in the US but while things like employment protection aren't important to me right now I also take comfort by the fact that if I get hit by a car ACC will cover my loss of income and rehabilitation, I simply don't have to worry about getting sick or injured. I also take comfort by the fact that everyone, be it a barista or a barrister, has the same perks (like four weeks paid leave, sick leave) and protection that I do.

Another example: a company I worked for in NZ was a US multinational, they did a big restructure where they laid off thousands. Because of employment law most of the lay offs were people in the US, South America, and Asia. Europe and New Zealand were almost completely unscathed, it was just easier.

Health care is always "rationed". In the US it's rationed by ability to pay. This is far worse both ethically and practically than any means of rationing it via a cost/benefit calculation.

As far as I know, no presidential candidate is proposing to stop people from buying private medical insurance, so your worries seem entirely unfounded in fact. Even in the UK, you can get private medical insurance if you want to.

There is a lot of abstraction in your statements culminating in an attempt to paint me as unethical. I wish we could just talk like friends who happen to disagree on policy.

I don't believe a functional health care market where providers must compete on price and quality is as static as the system we have now. The "rationing" you describe that we have today is because we don't have a functional market or insurance system.

> As far as I know, no presidential candidate is proposing to stop people from buying private medical insurance, so your worries seem entirely unfounded in fact.

Rewatch the debates and listen to the policy statements and their implications, I don't think you're correct.

>I wish we could just talk like friends who happen to disagree on policy.

I think it's a terrible mistake to treat this as a wonky policy issue rather than an urgent ethical issue. That conception of things is part of the reason that it's been so hard to reform the system.

> I don't believe a functional health care market where providers must compete on price and quality is as static as the system we have now. The "rationing" you describe that we have today is because we don't have a functional market or insurance system.

I've read through this a couple of times but can't really make any sense of it. As long as people have to pay for their own treatment, people with more money will be able to get better treatment. That's a form of rationing, and it wouldn't go away if the "market" were to get more "efficient".

>Rewatch the debates and listen to the policy statements and their implications, I don't think you're correct.

If one of the candidates is proposing to ban private health insurance, it should be easy for you to reference a statement to this effect.

> I think it's a terrible mistake to treat this as a wonky policy issue rather than an urgent ethical issue.

Your passion is admirable, but no need to insult, friend. I'm not a policy wonk, I just disagree with you. I don't have the same faith in government's ability to deliver services as you do. America is especially bad at delivering services, given our tendency towards crony capitalism and a disengaged public. It is possible to make things worse than they are now with totally well-meaning, but flawed, economic and social policies.

> it should be easy for you to reference a statement to this effect.

I searched on DDG, got tons of good hits for "debate ban private health insurance" and I picked the first link. The socialists (who aren't looking too hopeless in the polls and actually stand a chance at being the nominee) want to run things soup to nuts, no surprise here. Harris walked it back afterward, Sanders stood his ground and beat her over the head for a lack of conviction.

https://www.reuters.com/article/us-usa-election-harris-idUSK...

> Harris and U.S. Senate colleague Bernie Sanders were the only two candidates to raise their hands during Thursday night’s second Democratic debate when asked, "Who here would abolish their private health insurance in favor of a government-run plan?"

> On Wednesday night, U.S. Senator Elizabeth Warren of Massachusetts and New York City Mayor Bill de Blasio were the only two candidates to raise their hands when asked if they would scrap private insurance.

Please just watch the debates and don't give anyone a pass. I'm counting on you and others to not pick an unelectable wacko to run against Trump. Full disclosure, I didn't vote for Trump (or Hillary) in 2016.

Ethical disagreements exist. You may not think that this is an urgent ethical issue, but I do. I'm not going to say that your position is ethically acceptable just because it would make you feel better - sorry.

You're really selling the US short if you think that it can't implement any one of the multitude of healthcare systems that exist in other first world countries - all of which are superior both in terms of outcomes and in terms of basic decency. This kind of pessimism is just a convenient excuse for doing nothing while people are dying.

I believe there will come a time when the right to healthcare is no more up for debate than, say, women's right to vote (no longer a "policy" issue). But, clearly, we're not there yet. You still seem wedded to the idea that the system has to be set up in such a way that a person's access to health care is significantly limited by their wealth. Thus, only certain basic treatments will be "abundant and/or free" even in your ideal conception of how the system should work! And you talk about giving the "maximum possible" number of people in the US access to high quality care - as if this maximum were somehow obviously less than 100%! When you can't get care, it's "rationing". When 15% of the population can't get it because they're too poor, then, well, gee, that's just the market at work I guess.

The bottom line here is that Americans still see healthcare as a job perk rather than as a right. That's ethically obscene, but it's still the mainstream point of view, so you're by no means alone. If you are happy with your own personal situation at present, then by all means sit out elections and float pie in the sky market-based schemes as alternatives to actionable policy proposals that would actually make a difference.

Thank you for your detailed response, I'll try to honor it.

> Ethical disagreements exist. You may not think that this is an urgent ethical issue, but I do. I'm not going to say that your position is ethically acceptable just because it would make you feel better - sorry.

Yes, we do disagree. But, we have to go forward together by dealing with each other honorably and not operating from the default assumption that the other is below reproach or sub-human in their thinking. We need to hammer home that the perfect should not be the enemy of the good (myself included.)

We have to make deals and compromise to implement any policies that will be durable and maintain their original spirit. Think Medicare and SS as examples of big compromise bills that lasted, and the ACA as a contra-example. If you don't believe in your bones that we need to compromise on the big stuff, then life will be full of disappointments.

> superior both in terms of outcomes and in terms of basic decency

What about our obesity epidemic, isn't that a factor contributing to our outcomes? Do all countries use the same measure when tallying outcomes? What are our comparative outcomes for health care at the extremes? Like, when your twins are born 2'10" and 2'11" respectively and still live and are healthy after 7 years?

I'm sorry, but respectfully, that talking point is so cherry-picked, and ignores so many factors, that it is meaningless. It is only intended to shock and to shame. Reality is more complicated than just "outcomes are worse." Do not insult my intelligence.

> I believe there will come a time when the right to healthcare ...

Medicare turns people away all the time, it's actually hard to get them to pay a claim. A right is a only truly a right when it can't be denied. Just start asking simple questions, and the 'HC as a right' concept falls apart.

Like, which health care procedures are a right and which are elective? Sex reassignment isn't a right ... this year ... maybe next year ... until the Republicans take power again ... see what I mean? A service like health care isn't so simple, nor black and white, as you paint it.

I do not believe you can make your "100% covered" math work AND pay doctors and hospitals such that they will continue to work for you such that you don't wind up with a doctor shortage and induce rationing.

I do believe that my "maximum possible" can reach an effective "100% covered". Think of how cheap technology and process changes can make things over time. The world is not a static system, it's dynamic and fluid! For example, Amazon.com, a recent phenomena, is being described as an anti-inflationary force across the entire economy because they are so effective at driving down costs and haggling on prices!

> pie in the sky market-based schemes

Come now... Consider there is no rationing of food. Food on store shelves regularly goes bad and we have to throw it out, we produce such an abundance.

Consider the US manufactures 8x the amount of clothes that actually gets sold. If it weren't for Africa taking, basically for free, all of our excess clothes, we would be incinerating the excess at the end of each fashion season.

Consider veterinary services and how much affordable they are relative to comparable human health care. Like, vet services paid out-of-pocket, no insurance at all affordable. Why? How?!

Consider health care and student loans - both seeing spiraling cost increases. What's the connection? Heavy government involvement and crony influence.

What I'm saying is ...

Market forces perform! Pay people up to what the market will bear, and you'll never have a shortage of workers to provide a service. Then, encourage competition and allow people to shop based on price and quality. Next, the market will control for excess and will find a stable value for each service that will be as optimal as it can get. Finally, if you can ease up on regulations, then the cost of providing a service goes down further and businesses will reinvest in themselves, which can further lower the costs.

It's economics. The model for how to unleash market forces and make services cheap and accessible exists in standard textbooks.

The fact that health care is currently expensive and people's lives hang in the balance makes this discussion more than just economics. I think that's mainly what you are driving at. And I respect your passion in that regard. Honestly, I get you on that! Your whole paragraph there is full of bitterness for me, but why can't you get me, friend?

I'm passionate too AND I don't want anyone to suffer! Like, no one normal wants other people to suffer. You know that, right? Finally, if it is true that I actually want to alleviate suffering just like you ...

A market system means that you get what you pay for. Poor people get crap healthcare while rich people get great healthcare - for as long as their money lasts. Unless you think that MRIs are going to become as cheap as paperclips, there's no market mechanism that will level the playing field in that respect.

You may respond that poor people would still be covered by Medicare. But your skepticism of the efficiency of the government should extend to its ability to reliably identify the people who need assistance. And if you are ok with the government paying for some people's healthcare, it seems to me that you've given up the main principle. Why not just have a public option open to anyone, and let "the market" compete with that? If the government is as useless as you say, insurance companies should have nothing to fear.

The problem with student loans in the US is arguably a lack of government regulation. In the UK, for example, there are very strict regulations on interest rates and the repayment schedule. Although student loan debt is still a drag on the younger generation, it doesn't bankrupt anyone.

s/medicare/medicaid

> you've given up the main principle

If you are still looking for inconsistencies in my position, then you haven't yet accepted that I want to find compromise solutions. I am ok with not getting everything I want. We're all walking inconsistencies anyway.

That said, you are right to call me out on that and student loans because I slipped into talking points mode, which was a futile attempt at one-upsmanship. I'm never going to convince you my opinion is the right one, and vice-versa. All that matters is we both have an accurate understanding of the other's worldview so we can discover where the give and take can happen.

> Why not just have a public option open to anyone, and let "the market" compete with that?

My answer is just another weak talking point regarding US states that have tried that and failed. The private market in those states predictably collapsed because employers took the opportunity to dump employees onto the state run plan. Which was, of course, the goal and no one is fooled.

The story ends sadly however, the state tax base couldn't support everyone dumped on the public option and virtually no one remained on the private plans to subsidize the public ones. So, the public options got scrapped. States can't run a debt like the Federal government can, so their plans have to square financially or the whole apple cart gets upturned. There's the harsh reality for ya! <mic drop>

And that was the most pathetic, cherry picked story with zero details that didn't include counter-stats about the thousands of mothers and children getting health care for the first time in those states, etc etc. You sank my battleship! Did I just change your mind about single payer? Of course not, and that's fine by me.

I just hope you are softening to the idea that someone who disagrees with you is not automatically an ogre, and can be well-meaning. There is far too much distrust driving factions in our society, when it is easy to find so much common ground if we just talk.

My position is: the market left to do its thing produces goods/services that are cheap and plentiful. Yours is, I think: the market has no soul and there is corporate greed/corruption and the market will always have losers, so we need to intercede and level the playing field for people. Please correct me if I got you wrong.

See, we both have solid points that the other must certainly agree with - the evidence is clear on both sides. What is not obvious is that one position does not negate the other. There is a right balance to be found between the two.

Here's how we balance as I see it: we don't dare make policy that wrecks the market so we keep the bounty -and- we don't dare leave people to suffer and die when we have all this bounty. BOTH! Not one at the expense of the other. Cautious, tuned, scientific, numbers based, avoid failures from history, and give ourselves grace that we're doing our best and we'll never reach Utopia.

> Poor people get crap healthcare while rich people get great healthcare

The world is not static. Today's crap healthcare and over the counter meds are impossible, miraculous health care if you compare with what people experienced historically. Caesar lived less healthfully than the American lower class. How can we get more good stuff into more people's hands more efficiently?

MRI's won't ever be as cheap as paper clips, but in twenty years TCFT hand scanner technology will make MRI's a blip in history and you will even be able to buy a consumer-grade scanner for a few hundred bucks at Walgreen's. Ok, I made that up, but hopefully you get the point that greater things are coming than the things we have now.

>The world is not static. Today's crap healthcare and over the counter meds are impossible, miraculous health care if you compare with what people experienced historically.

Isn't this just a weaselly way of saying that you're perfectly fine with poor people getting much worse care than rich people? What does it matter that they're getting better care than rich people did 100 years ago?

>Ok, I made that up, but hopefully you get the point that greater things are coming than the things we have now.

I'm sure that is a great comfort to uninsured patients with stage 3 cancer! We could just give them the care they need right now, but I guess it's better to wait some indeterminate amount of time till the market brings the cost of chemotherapy down to $100/month.

>My position is: the market left to do its thing produces goods/services that are cheap and plentiful. Yours is, I think: the market has no soul and there is corporate greed/corruption and the market will always have losers, so we need to intercede and level the playing field for people. Please correct me if I got you wrong.

As far as compromise is concerned, I don't really see any room for it here. There are many ways to provide universal health coverage. I have not insisted on a single payer system at any point in this discussion. However, it seems that what you want to compromise on is not the means of delivery, but the universality itself. In all of your long and irrelevant discourse on various economic points, I don't detect any concrete statement of what it is about the current system in the US you don't like, and how you'd actually propose to change it. So it seems to me that you de facto support the current system.

No economic system has abolished status or privileges.

Not even Communism. To fight status itself is to fight human nature. People will always try to obtain benefits and pass them down to their children.

200 years ago, all medicine was hospice care. Allocating resources to an industry for which there is infinite demand for - staying alive - will be difficult.

>Allocating resources to an industry for which there is infinite demand for - staying alive - will be difficult.

Will it? The NHS does an ok job. Not perfect by any means, but much better than the US.

I don't demand perfection, just something significantly better than a situation where 15% of the population are uninsured. Do you think that is so terribly difficult?

> Isn't this just a weaselly way of saying that you're perfectly fine with poor people getting much worse care than rich people? What does it matter that they're getting better care than rich people did 100 years ago?

Why do you want to fight, friend? Maybe you perceive moral superiority such that it's easier to tear down than cooperate. Like I said before, that's a recipe for disappointment. Improvements in health care matters because that's a trend that is apparently still continuing. What am I missing?

And I'm not fine with cancer, another insult! Don't you get me yet, my friend?

I do know we're going to definitively cure cancer soon such that the treatment doesn't break the bank as it does today. Until that happens, let's work to bring down the costs AND help out people who can't afford what services are on offer today. Why not both?

> what it is about the current system in the US you don't like

I don't like how the health care insurance covers everything. The cheap stuff should be out of pocket so that individuals shop on price for those services and we build a competitive marketplace on the simple stuff.

I want up-front pricing for services in hospitals, and if I am of sound mind, I must opt into services before they are delivered. Finding out what services cost after I get them is one of the scammiest features of the current system.

I don't like how drug prices are artificially inflated in this country by Medicare and Washington cronies.

If I were a dictator, I'd mandate everyone who takes a salary must save some percentage (6-8%) of every paycheck in a personal medical savings account the way that Singapore does. If you get health services, you have to pay the full freight for the services out of your account, encouraging market forces. When that account runs out, you're screwed.

It's not taxed, and you can leave your account to your heirs. You can also buy catastrophic health insurance so you're not screwed in the event of a big event. The government offers low-income people additional catastrophic health insurance options and charities help pick up the rest of the slack.

We can't force that kind of mandatory savings in the US, it's unconstitutional. But, if we could go the mandatory MSA + catestrophic health insurance route, we would maximize market forces and yield results close to universal coverage that results-wise goes far beyond anything you can propose.

See? I've thought all about it.

I could just as easily say, "you have no realistic plans for controlling costs while delivering high quality service in abundance." But I suspect the life and death aspect of health care is an overriding priority for you, and delving into cost/waste/fraud/abuse is a non-starter. I believe that access to health-care in name only (a.k.a. government-induced rationing) is no health-care at all, though. Affordable, effective, abundant: pick 3.

So, no more insulting my intelligence, and please assume good faith, my friend!

You've written a lot without addressing the key point. It seems that you are fine with poor people getting much worse care than rich people. At least, you've declined several opportunities to indicate that you're not fine with this, and none of the suggestions that you're making would make things any better for Americans who currently lack insurance. Indeed, you're quite clear about what happens to people who can't pay up: "When that account runs out, you're screwed." Charming.

The fact that the cost of cancer treatment may go down in future is totally irrelevant to the question of how we pay for people's cancer treatment today. As far as I can see you only bring it up as a means of dodging the question of how poor people can get cancer treatment now. Rather than indicate how this might be possible now under the system you envisage, you talk about how it might be possible 100 years hence. You may whine about me taking the moral high ground, but can't you see how crass it is for you to play down people's present suffering on the grounds that people 100 years hence may be better off? What sort of reaction were you expecting to comments of that nature?

The concept of "catastrophic" health insurance transparently makes no sense. Any insurance plan that doesn't cover all the expensive treatments is next to useless. So obviously, no-one (either insurers or patients) can save very much money by nickel and diming patients for inessential treatments. Indeed, if these "catastrophic" plans don't cover screenings and other preventative measures, they'll probably end up increasing everyone's costs in the long run.

Bizarrely, you seem to think that the main problem with the current system is that people have too much coverage. This makes so little sense that I'm unable to engage you on that point. This is particularly so given that you are simultaneously so vague about the nature of the system that you favor and so unwaveringly certain that it would deliver better "results" (if, of course, we ignore all the poors).

The countries that pay less for drugs are the countries with a greater level of centralisation and government control. Drug companies are behemoths, and it takes another behemoth to negotiate a good deal.

>I could just as easily say, "you have no realistic plans for controlling costs while delivering high quality service in abundance."

I can point to plenty of existing systems that do this. E.g., the healthcare system of pretty much any European country.

Thank you for a respectful reply. I feel like we're finally talking.

> You've written a lot without addressing the key point. It seems that you are fine with poor people getting much worse care than rich people. At least, you've declined several opportunities to indicate that you're not fine with this, and none of the suggestions that you're making would make things any better for Americans who currently lack insurance. Indeed, you're quite clear about what happens to people who can't pay up: "When that account runs out, you're screwed." Charming.

I said that blunt thing on purpose, partly to draw you out and get you to express yourself, and partly to express my philosophy.

I am not fine with disparity, I just don't believe we can eliminate it through top-down, central planning or through collectivization. That's my bottom line; we probably won't ever bridge this philosophical chasm between us. But I appreciate having the opportunity to explain myself conversationally to you.

Expanding my thoughts a little, in my opinion government is particularly bad at addressing inequity because on the ground there is zero incentive for individuals in government to fully solve problems - that would put government workers out of a job. Yes, some people get aid, there's some salve for the hurt, but on the whole government spending on "programs" tends to be a racket for cronies.

I don't expect you to agree, just explaining my thoughts. If you want to provide contrary notions, and give some depth to your worldview, I'd like to hear it. I would like to know how we solve the problem of poor and rich getting the same quality services without also degrading the services.

Regarding the "screwed" comment - guilty as charged - that was too harsh. Here's the nagging concern that drives my thinking: when there is a natural disaster and community, family, and government structures are stripped away, people are forced to fend for themselves. If they haven't prepared for disaster mentally and with provisions, they can die needlessly.

So, I favor a government whose policies encourage self-sufficiency and resilience that will lead to a robust populace that can be free and happy in their own situation and not make themselves prostrate to others for their survival. Dependency, like debt, is slavery. Freedom is totally worth the trouble we put people through.

In my dictator scenario, I envisioned forced savings for routine medical bills, optional catastrophic health insurance for the unexpected huge claims, and freedom to shop for providers as the route to "well-nigh universal" health care.

You would need to be my advisor though, because there are always destitute people in any society that have no income and have no insurance. We'd would need to provide for them somehow. I'm open to haggling on various points. ;)

> The fact that the cost of cancer treatment may go down in future is totally irrelevant to the question of how we pay for people's cancer treatment today.

Yeah, it's an awful problem! You sound very fed up and in a rush to see action especially on cancer. What would you do as dictator to address this? Make me your trusted advisor!

I observe cancer treatments are at least improving and we're getting better outcomes. We should at least look for ways to lower costs to make treatments available to more patients. It's not a perfect solution, but it's a start.

> The concept of "catastrophic" health insurance transparently makes no sense.

We just see the utility of insurance differently than you do. I see it as a backstop, not a catch-all. I want people to pay out of pocket for the simple stuff so they search for and demand lower cost options. That lets the market deliver the goods.

> Bizarrely, you seem to think that the main problem with the current system is that people have too much coverage.

No, I don't think that. The US definitely has a dysfunctional way of covering the poor however (emergency rooms that take all comers.) I would love to see some fixes there, because the system we have now encourages the poor to suffer with easily treatable conditions and is very inefficient economically. It's easy to make rational arguments about delivering health care services to the indigent. Frankly, I think such arguments are unassailable.

My position is that health care in the US is overregulated and lacking market forces that could control costs. I don't believe a single-payer system in the US would be accompanied by deregulation, and therefore costs would continue to rise.

> The countries that pay less for drugs are the countries with a greater level of centralisation and government control. Drug companies are behemoths, and it takes another behemoth to negotiate a good deal.

I have heard this argument before and never understood why the blame isn't placed 100% on government. What you describe should have happened decades ago.

Medicare and Medicaid covered 37% of health care costs in the US in 2017.[1] That is HUGE buying power, they can set the worldwide prices for drugs. Noone who is in power at the federal level seems at all interested in negotiating.[2]

That's a very interesting article that takes years to get to the money quote:

> No Negotiation, the Price Is Set

> The major reason for the disparity in pricing is that the United States lacks any sort of central or universal healthcare system or agency that regulates across the board cost. In contrast, negotiations of drug prices between governments and pharmaceutical companies are routine in Canada, most European nations, and most countries in the Middle East and Far East. They have centralized authorities to negotiate more favorable prices with manufacturers, and some also have drug formularies and advisory boards that put restrictions on the use of new and expensive medications.

Wow, sounds good, what's the hold up?? From later on:

> However, by law, the federal government cannot negotiate for Medicare drug prices or obtain any sort of volume discounts.

It was Medicare Part D where the feds jumped deep into the prescription business and this mischief got started. High drug prices in the US is baked into the plan. And there's no incentive to fix the problem because everyone is on the take.

This is where you and I are, I hope, arm-in-arm. Medicare should negotiate with these drug companies such that all Americans get drugs at rates offered to comparable countries! Abolish that corrupt law. I'm not even talking about price controls, I just want the same or better deal that every other country negotiates.

But, Democratic and Republicans are attached like barnacles to the special interest money and that bad law is a worth a fortune. This isn't an abstract issue: people are suffering and dying today because of cronyism. Awful realities like this destroy my faith in government, especially federal. If I am wrong on this, I would love to have you explain it to me.

Thank you again for being so peaceable in your reply. I felt very relaxed replying to you this time.

[1] https://www.cms.gov/research-statistics-data-and-systems/sta...

[2] https://www.medscape.com/viewarticle/835182

> As far as I know, no presidential candidate is proposing to stop people from buying private medical insurance

A couple of the variants of Medicare-for-All, including Sanders’, would prohibit normal private health insurance (they would allow private plans for certain non-core benefits, but those aren't what people talking about private medical insurance are mostly talking to about.) I mean, technically, they don't prohibit buying plans, only selling them, but...

> Even in the UK, you can get private medical insurance if you want to

As far as I know, no Presidential candidate is campaigning on a healthcare plan based even loosely on what the UK currently does.

The core problem at hand is FPTP and the Electoral College. The presidential election is decided in the swing states and with the current system the centrist Democrats do have a point - even if the hardcore Democrat states love Sanders or Warren, their landslide victories in these states won't help anything if all the swing states go Republican.

America needs two periods with Democrats: the first one won with/by centrists, who then fix up the electoral system issues (gerrymandering, FPTP, voter suppression, campaign financing) and the second period where the left wing fixes the societal issues (income/wealth inequality, healthcare, "free speech" allowing people to walk with Swastikas).

The US had the period of centrist Democrats with Obama, yet none of the things you mention happened.

Canada currently has one with Trudeau, and reforming FPTP was one of his explicit goals -- didn't happen. Probably not going to.

We got legal weed though, so there's that.

https://www.cbc.ca/news/politics/trudeau-electoral-reform-ja...

> The presidential election is decided in the swing states

That's both true and misleading. The decisive factor in Presidential elections is base turnout. Obviously, the states where the outcome is least certain are most decisive, but this doesn't make centrism a particularly winning general election strategy for either party, which is why the Republicans haven't nominated a centrist Republican in decades, and the Democrats have consistently underperformed where they naturally should perform from party ID (including taking into account he state-by-state distribution), despite nominating candidates from the center-right neoliberal wing in every Presidential election since 1992.

> and with the current system the centrist Democrats do have a point

No, they don't. Their point is literally “We should keep doing the thing that we've been doing and expect that doing so will result in something other than the results it keeps producing.”

> America needs two periods with Democrats: the first one won with/by centrists, who then fix up the electoral system issues (gerrymandering, FPTP, voter suppression, campaign financing)

Why would centrists Democrats—who use all those things to argue for why progressives must vote for them instead of actual progressive candidates (and despite the fact that that strategy manifestly doesn't work)—want to fix any of those things and thereby terminate their own argument for dominance within the party?

You might as well expect Republicans to fix them; they have just as much (that is, negative) incentive to do so.

> For what it's worth, the ambition on the left over here (in the US) is to eliminate means testing for programs as much as possible.

No, it's not.

There's a subset of the left that has that ambition, but there's a subset of the left that subscribes very hard to the idea that doing so is improperly aiding the wealthy (even though “eliminate means testing” mostly means “consolidate means testing into the tax system rather than duplicating the income verification function redundantly across various programs plus the tax system”.)

Now, it's true that the thought leadership on the left is mostly in the former group, and the public figures talking up the latter position are mostly center-right neoliberals. But they are using the specific rhetoric they are using because it appeals to a wide swathe of the rank-and-file left and allows them to seem progressive when what they are actually doing is defending the ability of the rich to preserve advantages that exist for them in the status quo system while blocking progress to universal access. (And that's true whether it's healthcare or college funding or whatever else.)

I will take what you described over the US situation any day, and don't hear any liberals I know describing it as perfect or a utopia...people in the best quality of life nations on Earth still complain about things of course, but don't really understand being without that net...it's not perfection, just much better than here, and keeping people from losing everything due to medical debt etc, and giving them help to rebuild when a catastrophe hits. If the agenda is to get those things then push away I say. Personally I will either be back abroad if I can succeed somehow, or dead if I cannot, by the time real change could even begin happen in the USA. It's many years away for even the first real steps to be enacted, and many decades at a minimum before it could even begin to approach parity with your region...if it happens at all and isn't sunk by more of the same old. But I wish it for the masses here.

This is why I support a universal basic income without means testing i.e. universal.

Me too, though in the case of big medical issues etc there will still be a requirement to somehow get more than that. Same with unemployment benefits etc. E.g a 1000 $ per person is not good enough should you find yourself unemployed suddenly. Some insurance (private or gov or both) will remain.

I believe helath care is an issue, like housing, that needs especial attention from additional local,state, and federal policies

"Backside"

All of this sounds like just regular checks to prevent abuse of the system

"Humiliating"? Maybe, but that's their job. No I don't think it could be much different.

Of course it's not an utopia, but I've heard much worse from countries much less well off than the US.

I don't think any country does that much better than Norway tbh

Agree—it’s perfectly reasonable for them to do this, and likely the only way the system could function at good cost and without abuse.

However, the problem in an American context is that people would likely see this as invasive. They’d demand the free treatment without the privacy invasions needed to make it work.

To be clear, I think the tradeoff is absolutely worth it, but America’s track record in making reasonable tradeoffs is awful.

> the problem in an American context is that people would likely see this as invasive

Stop miseducating them.

People has been educated to accept their TV spying and registering their home conversations all day as the new normal, but 'this' is too invasive?.

shrug People freak out about national id numbers, even though SSNs are already that.

I don’t know why Americans react worse to certain things, but they clearly do, even in the face of lots of education.

This used to be a problem in Norway too. People going without services they were entitled to because it was seen as humiliating to ask was a real thing. The only way of getting rid of that is to actually offer the services and point out that it is a choice: You don't have to go through it, but then you don't get the money.

I generally think that a lot of the more invasive checks are not justified, but if the price to pay to get agreement for more expansive welfare services is an invasive means testing process, then it's certainly better than not having the services.

OP here...I would happily go through checks and balance and accept sometimes I would have to appeal in a system where the goal is to help. In the US system its adversarial from the outset and the goal is to deny. I cannot even read some of the reports from various offices because they enrage me so much. Lies and excuses. You hear story after story of people in even more dramatic and urgent need being denied, terminal illnesses with boss legs missing and just obvious stuff. Denied. It's a terrible system and a shameful blight. But it's working as intended according to half the nation...and not good enough in their view as their first stories on the topic will always be dramatic tales of abuse and cheating.

I’m from Sweden, same system. I’d MUCH rather have this than the alternative.

På riktigt! :)

I feel like it's partly made to avoid people abusing the system.

In France for example a lot of people go to the doctor for the most ridiculous things because 1: it's free (at least at the individual level) and 2: it's an easy way to get a sick leave (sick leaves have been exploding in the last few years). Same with emergency rooms, people don't know what an emergency is, they just use them as walk in clinic.

Every time someone goes to the doc for a small headache or a common cold, just for the doc to tell them "well, just wait it'll go away, here have some aspirin", it cost something like $30-100 to the whole system.

>it's free (at least at the individual level)

Is it though? As far as I remember, to visit a doctor you had to pay €25 out of your pocket at the moment of the visit, 70% of which would be refunded by your health insurance at a later point (under the state system, and potentially more if you're paying for the additional private insurance or "mutuelle".

Cannot comment on France, but [0] is a german wikipedia article about a counterpart we had in germany. From 2004 til 2012, you had to pay 10€ to the first doctor you visited in a quarter.

Not a great system and we thankfully got rid of it again.

[0] https://de.wikipedia.org/wiki/Praxisgebühr (in german)

Doctor visit are never free in France you always pay 1€ which is deducted from future reimbursements. Also you still have to pay 70% of the 25€ unless you have additional private insurance.

Here in New Zealand you don't get asked any questions about finances or being able to afford it but if it's elective and not urgent you'll be prioritised behind those who need the healthcare urgently. No bureaucrats involved (unless it's very specialised care like experimental medication or the need to send someone overseas) just the doctors and specialists.

Public healthcare isn't the same in every country.

If it’s elective it’s not covered at all in NZ. Was my understanding. If it’s not urgent you’re on a waiting list unless you have private insurance.

I haven’t lived in NZ for like 12 years so I could be wrong.

You can definitely have elective surgery through the public health system but there's a set number done per year whereas all other treatment are done as soon as possible.

Interesting. Learn something new every day. My dad’s cancer treatment last year was completely covered. Even the hospital lodge my parents stayed at for a few weeks while he was in hospital was covered. I’m Glad that NZ isn’t a completely socialist country and just has socialist ideals.

It's always going to be a balance. Capitalism drives innovation and investment but making money at the expense of everything else isn't good for individuals or the environment. Socialism might be better for the environment or individuals in theory but it's not good for investment or innovation.

Like with most things in life being a purist is damaging, you need to be pragmatic and let capitalism do what it's good at and temper it with socialism when it's counterproductive.

Is sorry for your story and hope you can get well soon.

In Israel we have a complete social coverage system and while not perfect at times, still provides much necessary help for those in need. Everytime I hear those stories about the US and medical system, I find it so hard to believe that a country with so much wealth and talent, still hadn't solved it.

A possible explanation for what you've experienced can be found in the just-world hypothesis [0], or in the belief that we live in a meritocracy. It is simply a foundational part of many people's worldview and nothing sort of experiencing similar traumas will make them reconsider.

[0] https://en.m.wikipedia.org/wiki/Just-world_hypothesis

the just-world fallacy is a much more appropriate term.

> the cognitive bias (or assumption) that a person's actions are inherently inclined to bring morally fair and fitting consequences to that person

Too many wealthy Americans suffer from some version of this. If you are born to wealth and grow up in wealth I guess your viewpoint of the universe won’t be a very accurate one. The disproportionate power that wealth grants to you then becomes even more destructive.

What I cannot understand is how so many who suffer or struggle themselves attack fellow victims of this. Punching sideways or down i disgusting but it seems people are always looking for someone to blame and feel better than. This entire experience made me a misanthrope in large. I cannot every discuss my experience without a large number of attacks. It's comforting in a small way to see its not the majority in an international audience, but the American audience and many interactions are very hostile to someone else's pain.

the whole "prosperity" thing in modern US christianity associates with this: that if you're a good christian then god will make you wealthy. So therefore poor people are by definition unworthy, and wealthy people deserve their wealth.

Note that this is in exact opposition to the wealth-heaven-camel-needle teaching in the bible. But that doesn't seem to matter. I'm sure there are interpretations that can make it go away.

for real, in addition, there's interesting research looking at how, punishing and exiling groups of people alters society's relationship with that group.

Stuff like harrassment, arrest, and enforcement actions against a specific group of people isn't the _result_ of prejudice, its frequenty the _cause_ of prejudice due to the just-cause fallacy.

A good explanation on meritocracy: https://www.youtube.com/watch?v=bTDGdKaMDhQ

TL;DW: if you believe the crap that hard work will make you successful (discounting luck), than you'd have to believe the opposite is true: that poor people are lazy.

Only if you discount luck completely.

There are degrees of bad luck otherwise that nobody can surmount. As a simple example, do you consider a person bedridden due to a sickness lazy?

I've found the sort of people who deny my experience, who blame me, ALWAYS discount how much luck has played in their own life and success. They all believe its entirely due to their effort and deserving. I used to try and convince them, now each time they respond this way it just takes one more notch out of my hope belt and there aren't many notches left.

hestipod's response says what I mean... I remember reading an article saying that trust fund kids living in luxury can't live with themselves when they tell themselves their richness is due to luck, so they make up a reality where their success is due to hard work...

> A possible explanation for what you've experienced can be found in the just-world hypothesis [0]

As a sub-class of that, see also the Prosperity Gospel:

> Prosperity theology (sometimes referred to as the prosperity gospel, the health and wealth gospel, the gospel of success, or seed faith)[A] is a controversial religious belief among some Protestant Christians, who hold that financial blessing and physical well-being are always the will of God for them, and that faith, positive speech, and donations to religious causes will increase one's material wealth.

* https://en.wikipedia.org/wiki/Prosperity_theology

The Book of Job of course is a good counter-example:

* https://www.youtube.com/watch?v=1ip4Jx92F94

"The Book of Job of course is a good counter-example:"

Or Jesus saying about the rich:

"It is easier for a camel to go through the eye of a needle than for a rich man to enter the kingdom of God"

Mark 10,25

"They claim their labours are to build a heaven yet their heaven is populated with horrors. Perhaps the world is not made. Perhaps nothing is made. A clock without a craftsman. It's too late. Always has been, always will be…too late." ― Alan Moore, Watchmen

Look to examples of people who give without expecting anything in return.

Sounds like Calvinism, but with bribery

Job is a fantastic piece of Hebrew literature and a great look at an important question in religion: Why does bad happen to good people? I'd be hard pressed to find a better look into it.

Unfortunately, the KJ and NIV translations of Job are, well, almost incomprehensible. You have to read it a few times before you begin to grok it. If you are interested, the CEB translation is a lot more accessible for first time readers: https://www.biblegateway.com/passage/?search=Job+1&version=C...

People like meritocracy because it simply appeals to the desire for fairness which luckily many people like very much. There is no further hypothesis needed to explain why some might like the idea. It doesn't have an inherit contradiction to a standpoint that the advancement of a society should be measured by how the weakest members are treated for example.

The hypothesis you linked can justify monarchies which meritocracy is intrinsically opposed to.

You can find inherent contradictions between freedom and equality for example, so a compromise is needed if you try to achieve both to a sufficient degree.

Social security has its dark sides in Europe and it isn't really clear what its future will look like with demographic problems. Is it better than the American model? I would enthusiastically say yes, but that is more due to corporate interest in medical fields in my opinion. Something the state might have difficulties to solve at this point.

But in many countries social security is in favor of older generations against younger ones. Still, it supplies aid where it is needed for now.

>..in many countries social security is in favor of older generations against younger ones...

Including in the US of course, in the form of Medicare. Which also disproportionately helps people already well off, because they survive longer and so benefit from it for longer.

This is absolutely the case and no matter how many times I have tried to explain it to the people here they will not accept it. As you said...they have to suffer it to believe it...and that is too late for me. You either have empathy or you do not. If the only way you can feel it is to suffer yourself and then care since it affects you, then you will go through life denying others.

Where does this "Europe is awesome place to live" come from?

I live in Germany, I got ear wax, the doctor waiting line was more than a week, so I developed tinnitus problem in a couple of days because of the wax (I don't use any headphone, I don't work in any noisy place so they don't have any effect). Insurance didn't cover medicine cost, so I paid it in cash while I was a student. Then the doctor said, it's too late and now I have to deal with a permanent tinnitus disorder for rest of my life.

Do you see how awesome social security is in Europe? #StopSpreadingBullshit

I'm sorry for your experience, but individual anecdotes are still not data.

Absolutely. What I meant is, shit happens all the time and you have to be prepared for that. Medication cost didn't cause me an issue, because I save my money quite aggressively.

Being poor (by global standards) in a developed country heavily depends on person's lifestyle and decisions.

We have long wait times here in the U.S. too, at least in my experience. Two months for my last specialist, three weeks for a gp. This isn't a competition, so please don't take it that way; what I'm saying is that, despite your anecdote, I'm desperate for your healthcare (at least I think I am). I'm really curious if there are situations there, akin to those faced by the uninsured here, where corners are cut to save costs and the patient is left abandoned with a partial diagnosis / misdiagnosis.

Yes.

French hospitals are underfunded and desesperate right now. They cut corners everytime they can, often on the back of nurses and mediacl assistants (who are wholly underpaid). Doctors are in an okay position, but some specialties lack specialists (especially in position where French medical education is really good, or very lucrative: i.e. surgery and anesthesia). We are far from a great medical country. I would happily give another 100€ per month to resolve those issue (and i do somehow with not asking for rembursment after consultations as i can easely afford those).

It's not perfect, but still seems better than in a system were a broken arm can literally ruin you unless you have a good job.

just don't pay the bill.

That's the solution. It won't ruin your life. It may mess up your credit for a few years, but how many people in the situation have both good credit and will actually use it in the next few years? Hell, having bad credit may protect them from "predatory lending" we also hear about constantly.

Remember kids, if some areshole sends you a bill for hundreds of thousands of dollars that has little legal recourse for you to actually pay it. Don't.

just... don't... pay... the... bill...

"It may mess up your credit for a few years, but how many people in the situation have both good credit and will actually use it in the next few years?"

Clarification: Going bankrupt will be a mark on one's credit for the next 7 or 10 years. It may prevent someone from acquiring necessary loans to get a car, housing, opening a small business, and other things people consider to be advancing their life or career.

More than a week for a doctor? It is possible in large city, especially if you don't want (or can't afford) to pay a premium (at least in Paris). Never had any troubles in Munich, Liege, Lille or Rennes though.

The premiums are not really fair for the people living in those cities, but with the square meter price, it is understandable that cost increase for medecine too.

But if you think you have an emergency (and no money), you can still get to a hospital (at least in France). University hospitals are great too (if you have one nearby), because if your affliction is weird, you'll get some of the best doctors available to help you. Clermont-Ferrand dental surgery speciality saved two of my teeth when i was 16 and my mother on minimal income for the grand total of 0€. Any private dentist would not have bothered and have removed those two and replaced then with false ones (the teeth were stuck into the jaw bones if you want details), for probably much more.

If you were poor in the US you'd have had the same result, but with a doctor's bill on top.

I wasn't rich either. I saved enough to survive the incident. save people, save!

I did save. I had a significant savings beyond what most Americans do. My life was still ruined. I am sorry for your experience and deeply understand how pain and medical issues can affect you, but what you are doing in my case is victim blaming. None of this was in any way my fault. It wasn't because I didn't prepare. I was more prepared than most. You cannot reasonably prepare fully for this. The costs are immense and you have less means and more needs. I didn't ever say Europe was a utopia. I said the system in most places it far better than the US. Even paying the private system in most places is FAR cheaper. You are rightly upset you suffered...suffering sucks. That suffering would have been worse in the USA and it's not fair to say "just prepare".

Having your ear wax not removed quickly will not cause permanent tinnitus, that's ridiculous. If tinnitus is caused by ear wax it will be gone after removal.

It is the removal process that can cause permanent tinnitus[1], like ear irrigation done incorrectly, which would be your doctor's fault.

I have 2 different permanent tinnitus caused by improper ear irrigation (one by a nurse and one by myself), one is low freq thumping and one is like crickets. I use some kind of ear wax softener daily hoping I won't develop blockages again and risk more tinnitus.

1. https://pdfs.semanticscholar.org/2ca6/54e2df68d4e3509cdafbc4...

The whistle noise started two days before cleaning it. After cleaning it started getting worse. Nowadays, it's variable. It goes up and down irregularly.

Uh, I don't mind if getting to the doctor or dentist for a non-urgent problem takes a week or so. I also don't mind if you have to pay a nominal fee (we've got a flat fee of about 20€ for a doctors visit, regardless of what treatment you receive).

The important bit is when you have an acute accident, you'll get treated immediately (without checking your insurance first!) or develop life-threatening illness like cancer, you get good care without going bankrupt.

In this regard, most European countries are vastly better than the United States.

It's also important to know that Europe is not a single country and the health care varies a lot country by country. I have heard horror stories about the health care in some southern European countries that might be a lot worse than the US.

I'm sorry to hear that happened to you.

Sadly, this ancient proverb is all too true.

"All the brothers of a poor man hate him; How much more he is shunned by his friends! He pursues them with requests, but no one responds."

Perhaps this article will help lift your spirits. http://bit.ly/2K6cVi5

Thanks for the kindness. I know there are good people out there. I know even being poor you can have joy. I have moments of it...my cat...photography...a small number of people I love...but its not enough when you can't get off Maslow's bottom rungs.

> America has a real empathy problem

Hypothesis: that’s a function of some kind of Dunbar’s Law thing about the population size of a country. China and India as confirming examples, Japan as possibly an exception

Not likely. Why would the groups subject to this effect be defined at the relatively artificial level of the nation state, and not at any other subnational (states or provinces) or supranational (EU or cultural sphere) level?

Furthermore, watch out for confirmation bias: why is Japan a possible exception rather than a counterexample?

Nation states provide a level of isolation that states or provinces don't, at all.

I share that suspicion: when you pay taxes for lifting the poor from your doorstep, it not only helps them, it also improves your own quality of life. The poor half a continent away, not so much. The same applies when you replace "paying taxes" with any other measures that reduce inequality, like a preference for level education access, a judicial system that prefers rehabilitation to vengeance, minimum health standards and so on.

The dark side of this hypothesis is that it predicts that all those civilizatory achievements will increasingly come under pressure as national states become more open and integrated. It's almost a "national" and a "socialistic" idea, if you look at the terms without blending them into one. Which makes any meaningful discussion really hard.

"get out of you don't like it"

Nobody saying this has actually researched it. Too many people in the states are under the impression you can just up and move to a European country, no problem. One friendly-but-clueless acquaintance got flown back from Heathrow for asking the immigration officer about where to find jobs when she landed.

If you don't/can't:

* work in tech or medicine

* go to university in Europe in a high-demand field

* woo a European to marry you (a favoured option among women I knew in college, I notice - wonder why the gender disparity?)

your options are pretty limited. There's the Dutch American Friendship Treaty and digging through the family bible for the birth cert of some Irish or Italian grandparent and that's about it.

> Nobody saying this has actually researched it

Acknowledging this would be acknowledging how attractive alternatives are in comparison.

My girlfriend recently moved in with me so we've done a lot of research. It's relatively easy to move here from within Europe, as in, if you move from an EU country you have a right to work and live here, and you get the same rights and responsibilities as soon as you register yourself as living here.

If you want to move here from outside of the EU it's a whole other matter though. It boils down to two things though: Can you look after yourself (for example have a job ready; just as long as you won't come here expecting a handout from the government), and can you integrate (you have to do a language and culture certification in your country of origin).

How ironic that the “progressive” European welfare states have highly restricted immigration and America naturalizes more new citizens each year than the rest of the world combined. The US also allows illegal aliens de facto residence assuming they haven’t committed a significant crime. We even provide free education. If those illegal aliens have a child in the US, we give that child citizenship and subsequently make the child’s family eligible for welfare benefits in the interests of helping the American citizen child.

I was a legal resident of France and two of my children were born there and they didn’t get French citizenship, nor even automatic permanent residence.

It is impossible to have open borders, provide amnesty for 20+ million illegal aliens, birthright citizenship while simultaneously having European style welfare. There is a very good reason EU immigration is so hard, the system would collapse if US style immigration liberalization existed.

You can’t have nearly open borders and free everything.

As far as a previous poster said about Americans and our empathy problem —- it is interesting that Republicans give to charity at a vastly higher rates than Democrats [1] and American charitable giving is vastly higher than the rest of the world. More of the donations for the Notre Dame restoration are coming from Americans than even the French. The US funds UN humanitarian orgs at profoundly higher levels than any other country. The US funded the Marshall Plan to help rebuild Europe from a war we didn’t even start. Where’s the European version of the Marshall Plan for former colonies of Africa? It seems like European countries are rather selfish when it comes to helping others while American is quite generous with foreign aid. Perhaps Europeans have an empathy problem? Or maybe a fiscal one?

Suggesting that Americans don’t have empathy isn’t entirely accurate. Many of us just don’t want the government doing what private charity should do. I don’t want Congress deciding what causes are “worthy” — using human misery as a means for buying votes. I’m sorry for people who have bad luck, but where is their family? Their church? Their local community? How is someone outside of my community or family circle my problem? And, the US does have welfare programs. Medicaid exists and serves the poor. I know, I once was on Medicaid for a year. Food stamps also exist: I know, I used that program in New Jersey for about 6 months. I am not sure what else we should be providing as a government. Government isn’t a charity and nor should it be. Certainly it should provide a minimal safety net to ensure people aren’t starving in the streets, but charity is really about the local community, local organizations, and local priorities. And giving to charity should be voluntary, not compelled at the point of a gun like taxes are. I highly resent someone that has been unemployed for literally years while I took whatever shitty jobs I could find to stay off the street. I also resent people that never cared about buying health insurance (for example the young and healthy that tend to avoid buying insurance,) then they get a critical illness and go bankrupt and blame “the system” when they chose not to buy cheap disability or health insurance while they had the chance, instead buying plenty of the proverbial avocado toast or #yolo-ing through social media while the rest of us were, as they say, “adulting.”

The other problem I have is when people claim that medical bills “bankrupted” them. Do we know what that means? That means they didn’t have to pay any of that money back. The debts were discharged by bankruptcy. It doesn’t mean they go to debtors prison, nor does it mean they even lose their primary residence. It just means their credit is ruined for a few years. That just means they can’t borrow money for a few years; they aren’t thrown into some Dickens novel and forced to beg on the street for more porridge. It means all of their debts are discharged and they get to start over and rebuild. I am pretty sure that most people don’t know what bankruptcy actually means, they just throw the word around like it’s some kind of bomb, hoping that enough people are scared and horrified by it that they agree to raise taxes in such a way to prevent people from ever failing — but then also never succeeding. America is a place we’re you can start over, you can rebuild, and bankruptcy isn’t some life sentence dooming you to poverty. In fact, it’s possible to have multiple bankruptcies and still become president of the United States.

"America naturalizes more new citizens each year than the rest of the world combined."

Source?

"it is interesting that Republicans give to charity at a vastly higher rates than Democrats [1]"

Where is the [1] source?

" I’m sorry for people who have bad luck, but where is their family? Their church? Their local community? How is someone outside of my community or family circle my problem?"

Isn't this the argument here that there is an empathy problem, as your post is displaying a lack of empathy?

I don't have that guy's exact statistic, but here's a page that supports the immigration argument. The US lets a lot of people in from all over the world. Also note those numbers for Germany include people from other EU countries. https://immigrationlawyerslosangeles.com/immigration-law/imm...

Here's a source for the R versus D charity: https://www.realclearmarkets.com/articles/2018/11/06/whateve...

> You can’t have nearly open borders and free everything.

The point of the article is precisely that the US _doesn't_ have free everything, much less adequate support for the poor.

> it is interesting that Republicans give to charity at a vastly higher rates than Democrats

This is because churches are are automatically considered 501c3 charities in the US. Another way to look at the issue is that Democrats generally support a systematic approach to social welfare - i.e. a sufficient government-run social safety net - rather than an uncoordinated collection of religious groups to administer benefits.

> I’m sorry for people who have bad luck, but where is their family? Their church? Their local community?

Not everyone has family. Not everyone attends church. You realize that impoverished communities are a thing, right? Have you never been to the rural South? To an inner city neighborhood?

> How is someone outside of my community or family circle my problem?

Wow. I don't think I can make an argument that will give you a basic sense of human decency. For someone who mentions churches several times, you seem to have missed one of the core lessons about caring for thy neighbor.

The point of the article is precisely that the US _doesn't_ have free everything, much less adequate support for the poor.

Huh?

The chart at the bottom says US safety net spending is higher than Australia and Canada.

And it still does not work for all the expense. The money does not reach the poor and special needs or the service prices are way too high.

Either problem is a policy problem which poor cannot solve.

> This is because churches are are automatically considered 501c3 charities in the US.

False. While donations to churches are tax deductible, they aren't automatically 501c3 orgs. Source: my church applied to be one, in the event that church donations aren't automatically tax deductible.

> For someone who mentions churches several times, you seem to have missed one of the core lessons about caring for thy neighbor.

You seem to have missed the part where he mentioned 'my community'.

> You seem to have missed the part where he mentioned 'my community'.

See the parable of the Good Samaritan. Jesus' own interpretation of commandment to "Love thy neighbor" is that _all_ people are one's neighbor, not just one's set of geographically near persons.

It's a lesson in empathy, which you seem to have missed as well.

"De facto residence" - hardly. Living without papers is dubious and stressful. Trying to build a life when you could be deported is not easy.

"You can’t have nearly open borders and free everything." - don't disagree, free riders are a problem. How many people show up to the US to get their free healthcare and leave, exactly?

"I was a legal resident of France and two of my children were born there and they didn’t get French citizenship, nor even automatic permanent residence."

OK. This is how it ought to be per your views, right? I sympathize for your kids.

Many people do not have family, do not live near their family, do not attend church (for damn good reasons, aside from just not feeling like it. Pretending to have faith so you can have your church friends bail you out is not sound policy).

Your approach won't help the gay former Baptist estranged from their parents.

Even if your motivations are purely selfish, it is worth noting that the US spends more per capita on health care than other countries, so maybe we could learn from them.

https://en.wikipedia.org/wiki/List_of_countries_by_total_hea...

However, public health care spending is ALSO quite here -

https://www.healthsystemtracker.org/chart-collection/health-... (note they provide source data and references)

Ultimately, though, the big problem is that poor people are poor because the system putting them there is a fantastic way to limit freedom in all but name.

If you restrict housing near decent jobs, then most people will, BY DEFINITION, be spending an inordinate amount of money on housing, because all it takes is a few people to say "well I'll push myself and spend 70% of my takehome on rent" before everyone has to do it. This is great if you need compliant workers who fear losing their job.

If you make medical pricing opaque and inconsistent (charging individuals differently from insurance companies) you're telling someone "well you can die or you can just pay whatever we feel like charging you". This is great if you need compliant workers who fear losing their job (and you're willing to offer health insurance). It works even for better-paid jobs too!

Lasik and dentists have price competition, and are pretty affordable, but not critical for life. Hell, even ambulances are losing out to Uber/Lyft (thankfully).

If you make going to college a prerequisite for most decent jobs (18 years of "if you don't go to college you'll be flipping burgers!" in popular media will do that), make it scarce by underfunding it, then offer people draconian loans that can't be repaid by a decent chunk of them, it will be extremely expensive. In fact, the more loans you make available, the more expensive it becomes as people chase it (same goes for mortgages for that matter - increasing funds without increasing supply just raises prices). This is great if you need compliant workers who fear losing their job.

There's a path out of this, even in the US - fortunately folks like Mr. Money Moustache have gained traction as people call bull on the whole system. It involves telling your metaphorical parents their advice is outdated bullshit, among other things, and avoiding the ponzi schemes of housing and student debt.

But don't get sick.

I come at this from a slightly different angle. I’m not a socialist, I’m a true believing dyed in the will capitalist, but still believe a robust social safety net including single payer health care is essential infrastructure for a healthy nation.

I cane to this fur the same reasons many other conservatives like me did in the UK in the inter-war years. To have a prosperous society we need to be able to defend ourselves effectively, and have a healthy educated work force that is fit for purpose. The fact is, centrally administered health care through national insurance, state education and a professional military are three essential pillars of a stable, safe and prosperous nation.

The US gets by simply by being huge and wealthy. Britain hasn’t got those advantages so we can’t scrape by as a society with cobbled together patch provision for these essentials. The world wars weeny a distant foreign adventure, they were existential crises that brought us to the brink. The same applies to the rest of Europe.

I hope the US can learn that lesson without going through such a dire experience.

Why are you so hostile to someone suffering and who has lost their life? I will address some of your points:

>Government isn’t a charity and nor should it be. >Certainly it should provide a minimal safety net to >ensure people aren’t starving in the streets, but >charity is really about the local community, local >organizations, and local priorities. And giving to >charity should be voluntary, not compelled at the >point of a gun like taxes are.

For all the stats Americans like to show about high rates of giving...little of it makes it to those in need. Governemnt running essential programs is so ALL have access. Not just those a charity CHOOSES as worthy. America proves the "charity covers this" BS doesn't work. taxes are needed because people with your mindset wont do their part vountarily and pick and choose who "deserves". Maybe if people who decry such systems were more kind and helpful we wouldn't need taxes. If charity was sufficient we wouldnt be discussing this. it really boils down to people with your mindset saying "Nobody can tell me what to do".

> I highly resent someone that has been unemployed for >literally years while I took whatever shitty jobs I >could find to stay off the street. I also resent >people that never cared about buying health insurance >(for example the young and healthy that tend to avoid >buying insurance,) then they get a critical illness >and go bankrupt and blame “the system”

I worked multiple, service to society jobs. I HAD insurance which I lost with them. I did as much as I could after being disabled but things just get worse. I resent YOU framing of this as you have. It's cruel and unempathetic proving my point. Feel fortunate you were able to make it instead of punching down.

>The other problem I have is when people claim that >medical bills “bankrupted” them. Do we know what that >means? That means they didn’t have to pay any of that >money back. The debts were discharged by bankruptcy.

I didn't say I filed bankruptcy. I said I was bankrupted by medical costs. I spent most of my fairly significant life savings, earned through hard work and a frugal nature, paying for the medical effects of the surgery and surviving this long. Nothing was discharged and you are simply wrong.

>America is a place we’re you can start over, you can >rebuild, and bankruptcy isn’t some life sentence >dooming you to poverty.

If your only issue is a financial disaster its POSSIBLE to rebuild some sort of life through effort if things work out. My issues are more than financial and I can't just dig in and create as I could when I was young and healthy. You are strongly victim blaming and you don't seem to care at all how harmful your position is to suffering people. It sure harmed me. I hope whatever you are dealing with that makes you so resentful of victims gets better and that is genuine, not passive aggression. Everyone deserves peace, even those I disagree with fundamentally. Empathy is required for a society. It's not an excuse or "liberal propaganda".

I am a real person. A human being. I am not a political argument or keeping YOU down. I lost my life due to this system. I was refused help due to this system. I will most likely end things because there is no way out. How dare you twist every aspect of that essential experience into some debate to reinforce your selfish position. This is exactly WHY I have no hope. If people spent as much time HELPING in this world as they do arguing why they shouldn't help then it would be a wonderful place. It's not YOUR life that was stolen and is ending. I cannot imagine ever treating someone that way.

I don't think you'll find that progressive people outside of the US advocate open borders. Having a points based system which actually means you bring in people who'll have a job waiting for them is better for everyone involved. You also have humanitarian based immigration as well of course. The US is big enough that it can absorb people from all industries and backgrounds, but in smaller countries that's not the case. And it's wrong to bring in people if they end up being Uber drivers because there's not the jobs available for them and their expertise.

You also can't rely on charity and the community. Just look at people who crowd fund for operations, etc. that biases to people who are attractive, young, outgoing, etc. I don't want anything to do with a church based charity personally and I'd feel embarrassed begging for money, I would not want to rely on such a corrupt institution with their ulterior motives. It's much more practical to centralise the costs of looking after the poor, if you look at the US they pay more per person than pretty much any country on healthcare yet it's ineffective and expensive because of everyone clipping the ticket.

People also don't use misery to buy votes. Here in NZ even the most right wing party wouldn't dream of going to private healthcare. Different parties do have different priorities and because it's a proportionate system with multiple parties in government it's a better reflection on the will of the people. I think one of the biggest problems that you have is that you've got a pretty broken democracy where the majority don't get a say and even if they did you're restricted to two parties and their policies, there's no compromise or grey area it's an all or nothing approach.

As usual, if you're well-off you have extra options. Get $500k to buy some property (which you can then rent) in Portugal or Spain and you get residency (and later can apply for citizenship).

Then again, if you have access to $500k, the safety net is probably less interesting.

Greece has a similar program if I'm not mistaken.

$250k. But why go this way? You're limited to live in those southern european countries. You can't live e.g. in Netherlands with golden visa of Portugal or Greece.

interesting, I didn't know that

It just takes five years to get citizenship in Portugal, then you can.

Five is the minimum. Plus many strings attached. Few people want to wait 5 years to solve a residence problem.

$400k CAD to get an investor visa in Canada.

There is also an entrepreneur visa, though you have to have funding via some of the approved venture firms.

QC will add its own rules -- they have their own Immigration Dept. -- but if you have a lot of money to spend you're probably not going to Quebec anyways, since their taxes are high, even by CAN standards.

Dunno about UK. Settling in Poland is not that hard, although no piece of cake either.

I believe you can get a job with the associated temporary residence permit, extend this as many times as necessary to meet the uninterrupted legal stay requirements, then apply for the permanent residence.

Getting citizenship is probably a bit harder but not impossible - about a thousand people get it in Poland each year by the decision of the president.

"Get a job with the associated temporary residence permit"

I'm not familiar with Poland specifically but this is generally the insurmountable barrier for most folks. Remember not everyone is a dev! "Sick person who works at Best Buy and drives for Lyft on the side" is going to have a really hard time with that step.

Generally speaking, employers need to make a reasonable enough case that they couldn't get an EU person to do the job, and there are often income minimums, specified in-need fields, etc. .

So it's definitely not impossible (I did it), but for the sort of person getting told "if you don't like it you can 'git out" it's an issue.

There are other arguments, such as if you have a family in Europe (even semi-distant) getting residency in that country is much easier, even if the job you have landed is possible to do by a citizen. They presume you want to return permanently.

But if you have nobody around here... Well...

Cześć...Warsaw is where I spent the majority of my time living abroad. I love the city, people, my closest relationships are there along with the best doctors I ever had, and I'd love to return but since my health is so frustrating I was never able to have stability in work or life long enough to legitimize. The years spent trying were always derailed by something outside of my control. I was unable to renew my Karta Pobytu the final time and had to return here. Even knowing the cons there, as Poland is certainly not as robust in the social arena as the West, and the populism is sadly growing like in the USA, I still long to return. Even if I only had access to the private system my care in it was always superb and affordable.

Had I been healthy or had some consistent support I'd have long since legitimized and possibly had citizenship if it were granted. But I'd have settled for permanent residency. Not really going to change anything to mention all of this, and things are far worse for me now all around than even then so it's possibly wishful thinking to imagine I could even have THAT life again, but it was just relevant to your comment.

I have heard it is pretty easy to become an Israeli citizen if you are jewish. They have socialized healthcare.

https://en.wikipedia.org/wiki/Law_of_Return

> The law since 1970 applies to the following groups:

> Those born Jews according to the orthodox interpretation; having a Jewish mother or maternal grandmother.

> Those with Jewish ancestry - having a Jewish father or grandfather.

> Converts to Judaism (Orthodox, Reform, or Conservative denominations—not secular—though Reform and Conservative conversions must take place outside the state, similar to civil marriages).

> But Jews who have converted to another religion are not eligible to immigrate under the Law of Return, even though are still Jews according to halakha.

> Section 2(b) of the Law of Return empowers the Minister of Interior to deny Israeli citizenship under the Law of Return on a number of grounds. For example, an applicant may be denied citizenship if he or she is considered a threat to the security of the State of Israel (e.g. treason against the Jewish State), or who has a past criminal record involving a serious crime, such as murder, and poses a danger to the well-being of the State of Israel; or, for example, may be a fugitive in another country for any felony (unless they are persecution victims); or such persons who, by virtue of their illness, may pose a serious public health risk to the people of Israel; as also any person who may be actively engaged in any campaign that vociferously speaks out against the Jewish people and undermines their cause (such as demagoguery).

> In 2014, Interior Minister Gidon Sa'ar officially decided that, according to the Law of Return, Jews in same-sex relationships married abroad wishing to immigrate to Israel can do so - even if their partners are not Jewish - and both they and their partners will receive Israeli citizenship.

Here's how it looks from the inside: https://www.israeltoday.co.il/read/israels-universal-healthc...

Israel has good public healthcare, but it has been severely under-funded for years.

Also, if you have long term medical problems which are going to burden the tax payer they're not going to let you in.

Very true. I have to hold private medical insurance as part of my permission to be here (and to get here in the first place).

What makes you think someone who can "work in tech or medicine" is somehow EU immigration eligible?

>What makes you think someone who can "work in tech or medicine" is somehow EU immigration eligible?

Most of the more restrictive EU countries (e.g.: UK, Ireland, etc.) have barriers to getting immigration stamps, which the most oft way of immigration is through employment and the most labour available to foreigners is either tech or medicine.

For example, in Sweden, a position must be listed as a highly qualified skill, the role must be listed for 20 days (I think it is) - so that EU citizens can be afforded an opportunity before the role is given to an immigrant, and then the employment contract must be agreed upon by the labour union before it can be approved.

You're not getting an employment contract, for example, to work in Burger King in Stockholm because it wouldn't pass the labour market needs test.

So, this is presumably why the OC thinks that medicine and tech make you immigration eligible.

Worthy of note is that tech or medicine are the best ways to get the EU Blue card (the equivalent of the US Greencard); so, the assumption isn't without its merits.

> You're not getting an employment contract, for example, to work in Burger King in Stockholm because it wouldn't pass the labour market needs test.

As far as I know there isn't any labour market test in Sweden anymore. The unions only gets to comment on whether the contract is similar to that of the collective agreement for the sector.

http://www.nordiclabourjournal.org/i-fokus/in-focus-2013/soc...

Are you saying a poor American can go work at Burger King in Sweden? That's revelatory.

Yes, you can get a work permit as for example a dishwasher at a restaurant (In theory at Burger King, but maybe they wouldn't hire unqualified migrants for image reasons). You can also bring your family and kids. I think you don't have the right to some things for the first year though. But as long as you are paid the normal wage and benefits you can get permanent residency after four years, and citizenship after another five.

This is the best document I could find: https://portal.research.lu.se/portal/files/40268826/Labor_Mi...

This entirely depends on if the employer is willing to initiate the application for the permit for you to fulfil the role. See the authority on this here (in English for obvious reasons)[0].

Edit: "Authority on this" as in Migrationsverket is the entity that receives the application and ultimately decides to grant/deny it.

[0] - https://www.migrationsverket.se/English/Private-individuals/...

Come over here, please. :)

Because those industries are most in need of workers at the moment. And because those are the sorts of people I've known who succeeded (anecdata, of course).

But I am biased by my own experience of being unable to find a way to move until I skilled up in development. "Idealistic physics grad with a spotty academic record who wants to help the Earth" didn't cut it.

Also, they tend to pay reasonably well (though nurses are scandalously underpaid in too many places, which is shocking).

In many cases, there's a "if you can make more than X you can get in" provision too, generally with some fairly high threshold. Last I checked it was around 154,000 GBP in the UK for instance (remember that dev salaries in the UK and most of the EU, for that matter, are incredibly low compared to the US).

In many ex-Eastern block countries (for example in Lithuania) there are repatriation laws that allows you to get back citizenship if you or your (grand)parents that had citizenship before 1940 ran away from country during or after WW2. Of course this needs to have papers that would prove that.

But that's not an EU-only thing. In essence, immigration process boils down to this question:

- can you support yourself (i.e. have job contract or enough savings)?

Prove that you can and the rest is somewhat easy, providing you follow procedures, official documentation requirements, etc.

It's still by no means an easy task. Moving to another country is hard, one of the hardest things a person can do in their life.

I've found most things people say to defend/ignore/deny this issue and their views on it to be entirely unbased in factual knowledge. As you said it's hard to immigrate when healthy and having good options. Once you are down its harder and more costly to do everything, and it doesn't stop getting worse. I was half immigrated to another country when the path was derailed by coming up against these things. I have no claims to citizenship based on family or any other option either, or I'd have been gone decades ago. Once you fall from grace in the USA you are stuck. Can't afford to be poor and broken here.

I've seen the propaganda of "communist countries kill X people".

Yet in capitalist societies, the blame is never on government, and is put squarely on the individual. It's YOUR fault you're sick. It's YOUR fault you're lazy. It's YOUR fault blaa, YOUR FAULT...

The costs of capitalism as a form of governmental policy are just as hidden as the externalized costs in everything around us. When do we start counting deaths due to extreme poverty? When do we count deaths due to 'Corporate Death Panels' (aka: insurance companies), and not having socialized medicine? When do we count the deaths of 'spreading democracy' via hegemonic expansion? When do we start counting illness and deaths resulting in subsidizing diabetes-inducing foods (corn, wheat, sugar, etc)? When do we start counting the extreme losses incurred (deaths, property, etc) about ignoring climate change?

Sorry to hear about what you went or are currently going through. The medical insurance situation in US is beyond f’ed up. Most people who can afford it just don’t think about how terrible it really is. It takes some serious illness or accident to wake people up to the insane situation that is US healthcare. It sounds like you are well aware of that, unfortunately.

I grew up in a communist country and for all the shit communism gets, I was never denied medical care or could not afford it. In US I made above average income and yet the cost of healthcare was far from unnoticeable, especially with deductibles, excluded procedures and ridiculous billing free for all. I have some f’ed up stories, but for another day.

I now live in Japan. I still pay a fair bit for insurance, but I can feel very confident that in a case of a serious injury, illness or extended hospital stay, I will not go bankrupt. In fact, it’ll be like nothing changed - financially. I used to lose sleep over thinking about insurance issues in US, but now I never think about any of that. It’s such a huge relief to focus on other more important things in life. But, Murcia, they tell you it’s the best place, if you kindly forget about the healthcare issues. Don’t get me wrong, there are many wonderful things about the good ol US of A, but healthcare is not one of them.

It's really hard for me to understand how this system makes sense. I get it: if you make it easy for people they get lazy. But on the other hand you are making it too hard for productive people too and many will leave or not even come. What's the net result?

I grew up in Europe thinking USA was a great place to live. Now I wouldn't live there unless some very clear guarantees were made. It scares me. And I lived in countries many Americans would consider scary.

> Contrast that with a former friend who had a similar medical issue in Europe.

I also have "a friend from Europe", he's on government disability and it makes for a very basic living. Furthermore, should he be able to find work, most of that money will be taken away. He wishes he would've bought private insurance when he still had the chance.

Two guys from Europe aren't statistically relevant, of course.

> America has a real empathy problem. People won't treat others as they wish to be treated when they are in need. Being poor is an infection and they avoid you. It's not a need they reach out to solve. And being poor is very expensive. A society of individualists is no society at all.

I must ask you this: Have you reached out to private charity and been "denied"? Until then, I would not make this claim.

There's a difference between a society not caring for another and a society being forced into paying for one another's care through the government. The latter has nothing to do with empathy.

Furthermore, US welfare spending is not substantially different from that of most European countries:

https://en.wikipedia.org/wiki/List_of_countries_by_social_we...

Perhaps the US government is worse at spending that money than other governments. The healthcare system certainly is less efficient. That too has nothing to do with empathy. Even if the US population was against welfare spending, which I don't think it is, the spending is still there.

Lastly, in any welfare system, some people will "slip through the cracks". Reform is possible, perhaps you can find some meaning in advocating for that, identifying what exactly went wrong in your case and what would need to change.

"I must ask you this: Have you reached out to private charity and been "denied"? Until then, I would not make this claim."

Does the homeless begging for the spare change of private citizens count? I see this all the time.

You left out many important details in this story: 1. Did you have health insurance? If not, why? 2. What was your job previously? 3. Who signed the paper relinquishing the hospital of all responsibility of botching the surgery?

Important details to someone looking to twist things to blame me for the outcome. But I will answer even though I know your questions aren't meant with any good intent AND they display victim blaming from the outset. But I have a small hope you can learn empathy. Frankly responses like this, which are the bulk I have experienced IRL...are why I am so depressed and have no hope...and reinforce my view of the empathy problem.

1. Yes I had health insurance, lost it when I lost my career as a result of the surgeries. This wasn't some case of someone refusing to get it and then getting burned so this THEIR fault as you infer.

2. Public safety helping others...I don't want to get more specific due to privacy...but this is also irrelevant. Whether unemployed, with a respected job, or with a high paying job...nobody deserves to be left behind by society.

3. I signed the paper. The paper you HAVE to sign to get the surgery you are up for. I know what you are trying to say with that and I find it cruel and lacking in the smallest compassion. You have no choice. Sign or leave. It's another part of the problem.

I won't go back and forth with you. Probably shouldn't even have answered these. But there it is. Now you can tell me why I am wrong and what I NEED to do now to fix it. It's a script I've heard 1000 times. But it's never true.

In EU you have a right to amend an unconscionable contract. People use it all the time to not sign stupid clauses in bank.

Additionally, a hospital here cannot disclaim health damage (and other damages) due to poorly performed procedure. The thing is, sometimes even well performed procedures are not enough.

Finally, since critical health care is insured by state and therefore stupid charges like in the US rarely happen, but you might get kicked out slightly early and get poorer bed and care without extras. Acceptable still.

People in the US just really do not want to believe luck is a factor. Victim is always blamed one way or another.

Even if any of the 3 above was not met, the follow up question of "why" often reveals "I couldn't afford anything better" or "I was not given advice". Someone who is ignorant is not too be blamed, people are ignorant of all things before they actually happen to them.

I think there's a lot of nuance that gets missed, but before I get into it, a few things about me.

1. I grew up extremely poor. By poor I mean living in a pup-tent down by the river. Going to school with duct tape around my shoes to hold them together. eating beans and oatmeal for 3 meals a day months at a time. Having 3 sets of clothes, all of them involving sweats, and recycling them throughout the week. You get the picture.

2. I agree that we need the safety nets you're speaking of.

3. I turned 40 this year. Long enough to get more of an objective perspective on my childhoold than could have happened 10 and 20 years ago.

4. I'm Native American, as is my mother.

And now having said that. There are many poor people who are poor because of the decisions they make. And there are many poor people who are that way due to circumstances beyond their control.

Both sides of this debate are right, neither side is actually interested in reality.

Looking back on my childhood, my step-father was not of average intelligence. He was, without a doubt, the dumbest person in our household, and I think at some point he realized that.

This man would make piss-poor decisions. I don't want to get into specifics, but as an adult looking back, a large part of our problems were stupid shit this man would do. I remember one job he had in which he was making decent money. By decent money, I mean we could afford to order pizza for the family every other friday, and for us it was amazing. We felt rich just being able to do that. It didn't last for more than 6 months because he's an idiot.

My mother was sent to a boarding school at the age of 5 where she was beaten and raped until she married at 16 to get away from the school (no HS diploma). I've heard her tell stories and I know I haven't heard all of it. They would put the children into the showers and tell them to cover themselves with soap. If they weren't white enough, they would strap them with a belt under those showers until they were. My entire extended family went to those boarding schools (my grandmother had 16 children and 3 step-children), but my mother and 1 of my uncles went at a very young age. The way my mother tells it, that school eventually got shut down when the child of a senator wanted to go to the school to be with a friend and the child got beat. I can't vouch for the accuracy, but that's the story she tells.

When I was in HS I have a vivid memory of walking in on my mother crying and asking her what was going on. She started talking about many of the things she never revealed to us as children. And I remember crying because I knew she was hurting and I had the wisdom to understand there was nothing I could do.

Even now, years later, I get emotional just thinking about it.

----

So with all that being said, I want to address 3 different ideas that often get spoken about.

1. poor people bring it on themselves

Yes they do. very often.

2. Poor people are poor due to circumstances outside their control.

Absolutely. It does happen, and we need safety nets for it.

3. People who are not poor are just lucky.

yes and no.

Here's where my luck ran.

- I'm pretty smart

- My step-father was very abusive and it caused me to close in on myself. Due to this I discovered reading. through reading I discovered a love for sci-fi. Through sci-fi I discovered a love of technology. And through that love of technology I chose CS in college. I also discovered I like math and double majored in CS and Math.

- I went all-in with software development. It was a passion. This helped me start self-identifying as a software developer and not that abused poor kid. I would eventually realize just how big of a deal that is.

- My mother pushed education on us as hard as she could. It was the one thing she would never budge on. She knew how much she missed out on. My mother was not dumb, just uneducated.

- My childhood taught me that decision making is an important life skill. I'm damned good at it because as early as middle school I had learned that lesson, and have fostered it all these years.

Here's where my luck didn't run.

I tend to make good decisions. That's all me.

I work my ass off. That's all me.

I choose not to allow other people to affect me. Yes I've been called a red N-word in my life. Those sorts of things never had any effect on my life, I simply stay away from those people. When you allow these people to affect you to the point that you're spending energy on them, they win.

My overarching point is this:

This debate gets super old because most of the people involved in it aren't interested in reality. I've lived and seen both sides of it and I get really tired of seeing these same simplistic arguments argued over. Both sides are right. and wrong.

You're lucky that things worked well for you in spite of your poverty. Most people born into poverty are not so lucky.

it's like you didn't read the post...

I thought I heard it said that poverty needs no explanation. It is the default state of human existence. The real question is why wealth exists.

Not all rich should be praised for their hard work and gumption in getting to the top either...but some still deserve it. Painting these groups as solid black and white maybe isn't the best tool for the job.

Are we sure that half the median is a good definition of “poor”? At least hypothetically, in a very wealthy country, that may still be an adequate amount to get by.

The median individual monthly income in WA state is slightly above 4K monthly. Half of this is 2K monthly or more accurately given how most people actually get paid 923 every 2 weeks. After taxes this is more like 784. After paying for insurance as you are too rich to get free health care you are looking at more like 684.

This qualifies you to live virtually nowhere because most places want you to make 3x the rent and start at 700-800 per month. In King County where the lions share of the jobs are you probably will have to move to a street corner.

Elsewhere you can perhaps afford to beg someone to rent a bed for 2 weeks wages and afford to eat as long as you have no hobbies and shop exclusively at thrift stores for clothes.

It's probably a mostly acceptable definition of poor that only breaks down in a tiny minority of cases where someone adjacent to a very wealthy area makes enough to barely get buy in the wealthy area but enough to survive slightly more comfortably in the poor area wherein jobs are as scarce as the cost of living is low.

Housing as an investment is the problem here. The cost of the houses and the cost of the rent are adjusting to the income, if you double the income in the region you will have triple the rent (because the disposable income will increase much more than the actual income increase). See Silicon Valley for a good demonstration of this.

I’m not sure I’d do the math the same way. First, it seems to me that the median household income is a better number, as most people share expenses and many households have two incomes. That seems to me to better inform ability to get by. In Washington, that’s $70k.[1] Half that is $35k, or just shy of $3k/month. With ACA subsidies, a person in that situation won’t likely be paying $400/month in health insurance. The max for a family of four at $35k is actually $1300 per year, or a little over $100/month, and an individual at $35k is closer to $200.[2] $2800/month is not a great deal of money, but it’s not living in squalor. And, as you say, it depends on location. A high proportion of of those people will not be living in Seattle, but rather rural areas where the cost of living is cheaper. The median household income in Seattle is closer to $85k. Also note that federal after taxes income after accounting for transfers actually goes up for the second quintile.[3]

[1] https://www.deptofnumbers.com/income/washington/ [2] https://www.financialsamurai.com/subsidy-amounts-by-income-l... [3] https://taxfoundation.org/average-federal-tax-rates-income-g...

I will in fact make nearly the figure you started with for half of the median household for in my case for a household of 2. Despite your links I'm not sure how you figured the rest of your numbers despite citations.

The ACA subsidies turned out to be a joke for me.

A) Cheap options like high deductible plans or plans with very high co-pays for drugs make no sense if you know your medical expenses will be quite high.

B) They misjudged how much they should pay towards the VERY expensive options they offer on the market and decided at the end of the year that they had paid too much and I ended up with a huge bill.

C) Non of the options were affordable this year

I'm paying $361 every 2 weeks for employer provided medical and this is still cheaper than the market options were.

If you add the cost of drugs I'm paying closer to 10k out of 36k for medical costs + 3k in taxes leaving me with 23k leaving me with 1900 per month.

In regards to the disposition of people in the state people actually tend to cluster around where the jobs are not where the cows are. 75% of the population of WA state lives in the western 40%. Nearly 1/3 in king county alone heavily clustered around Seattle and outlying cities.

I had some difficulty digging up exact recent sources. In 2000 around 69% of citizens lived in places with populations 50K or more.

https://www.ers.usda.gov/webdocs/DataFiles/53180/25602_WA.pd...

Your household makes $36k and you pay $10k for drugs on a private plan and that’s somehow a better deal than an ACA plan? Yeah, that’s not making any sense to me at all.

Putting that aside, I’m not saying that’s a good life. But in the context of the article, where it’s comparing the absolute number of poor to crime rates, I’m skeptical that it’s an apples to apples comparison when defining poor in the way they do. Half the median in Japan is a very different thing than half the median in the US nationwide.

I pay 10K in total between drugs, premiums, and all other medical expenses of which about 8600 is premiums.

A plan as good in on the market in my state would have cost 1300. To be clear 1 take an inhaler which retails for $400 for asthma and my wife has an expensive chronic illness which would cost 10s of thousands to treat out of pocket. Buying a cheap plan would be disadvantageous as I can figure on trivially paying the deductible out of pocket in the first couple of months. High deductible or high copay plans just mean paying less in payroll deductions and more out of pocket.

For 2018 it was a lot less AFTER I argued for 4 months about the tax credit that initially wasn't included in the price and nobody could figure out how to fix.

This is basically a tax credit paid in installments to your medical insurance provider and is supposed to be calculated based on your expected income for the year. If in fact you make too much they can turn around and reevaluate how much they helped you and demand some of that money back. For instance they total help I received in 2018 to buy a silver plan was I think on the order of 11 or 12k this turned out to be too much by about 1k.

If as a poor person you don't actually HAVE that money to pay back they can just not offer this and then your choice is to pay $1300 for the same plan you were paying $300 for last year or pay for your employers plan.

Did you assume I was just too stupid to sign up for the ACA plan? Health care in America is a joke for the poor.

Nope. Just trying to understand the facts. I know several people on ACA plans, and I do not believe your experience is representative of the majority. Nevertheless, my comments aren't targeted at you. I maintain that half the median income can vary a great deal in quality of life between different countries.

Linking health care to taxes is a tremendously stupid idea. I wouldn't be surprised if lots of people who were already on employer provided health plans didn't even look at ACA options or were poorly served.

In America if you are really poor you are fucked if you claw your way up slightly you are barely better off or worse than when you started.

I'd bet dollars to donuts that the people you know on ACA plans aren't by most people's definition poor.

And you'd be wrong. In any event, again, your expensive illnesses are not representative, and many people in Washington at half the median income would be getting along suitably well. That same stat in Arkansas may be a very different story. It's at least hypothetically possible (and I don't have a great deal invested in the thesis) that industrious upstanding people in the bottom quartile are actually better off in Japan than in the US, and that could be precisely because of those virtues. The author takes it as a given that being in the bottom quartile is poverty everywhere and concludes those virtues don't matter (see, both countries have lots of people in the bottom quartile -- those Japanese virtues don't make them better off). But because half the median income means different things in different places, I cannot make it there. Not, at least, without more information.

It's a complicated issue.. but every person or family that makes a level up transition (without rent-seeking) like.

poor -> middle

middle -> upper

upper -> rich/millionaire

millionaire -> billionaire

have my respect.

Only the first one has my respect. The second one I'm neutral towards, the others fail as human beings in my view.

Why do they fail? (Unless you assume the money is hoarded and not used for something meaningful)

If you provide something society needs and people give you money in exchange then how on earth is that failing as a human being?

It depends a lot on how they make that money. Do they do it by writing a popular, insightful book that everybody wants to read[0], or by running a hedge fund that buy companies, fires half the employees, loads them with debt, and sells them in an IPO?

[0] Hasn't this taken JK Rowling straight from poor to billionaire?

I think "upper" comes after millionaire. Someone in the middle class should be a millionaire by the time they retire.

>In Japan, people work hard, few abuse drugs, crime is minimal and single mothers are rare. The country still has lots of poverty.

Conversely, does that mean we can't blame crime, absent fathers, and drug abuse on poverty?

If you have been fortunate in life, then you realize how much of your life is just luck of the draw and you start having more empathy for other people (hopefully) and you realize that we (America) are at a stage where we can afford to give basic social safety nets to people who need it the most. Hell, i think medical insurance is one of the biggest scams. I haven't gone to the doctors in years, yet i pay every month, i would much rather this money go into a pool which can pay for the health care of the poor instead of making insurance company owners rich. Just implementing free healthcare would be enormously beneficial to most Americans.

And how "free" is it when we pay the taxes for it? Public healthcare is a term that is less likely to trigger red flags, pun intended, in the minds of conservatives who react to "free" or "socialized".

>And how "free" is it when we pay the taxes for it?

It's free as in... when someone needs it, no matter how much money they make or do not make.. whether they are employed or unemployed.. they can use it "FOR FREE".

Calling the police for me "IS FREE". My kids going to public school for me "IS FREE". Calling the fire department "IS FREE". Going to the doctor when you are sick should also be "FOR FREE".

Right, just pointing out that the media often uses the term "free" when referring to public programs that workers pay for with their tax dollars. It is deceptive.

I still don't understand why you are pointing this out? You seem to be the one hung up on the word free. It IS FREE when using the public program- and that's what people want. Calling the police when you need help is free- I don't care how it's been funded. When I need it, I don't need to think about a cost whatsoever.

If you are a disabled person who has never been able to work in your entire life and has never been able to pay a dime in taxes.. yet you are able to use all of these public programs, that is completely 100% free, right?

You say the media is being deceptive when using free.. no, you know what they mean by free, so if anything I would call you the 'deceptive' one because you are intentionally making the discussion more complicated by getting so hung up on semantics.

What everyone in this entire planet wants is to be able to get healthcare when they NEED it and not worry about the cost. So they want FREE healthcare. If you still have a hard time with this concept then just think about free as in "use". If using something means you don't have to think about the cost, then using it is free. Was it funded by someone somewhere? Well no shit- you can put a 'cost' on anything no matter what it is.

Next you will tell me free healthcare isn't free because you need to drive yourself to the doctor, or take a bus. And that costs money. So it's not free anymore! Scandal!

You've made my point. It may not incur a personal cost at the time of use, but it incurs a cost regardless.

I have no problem understanding, I am the subject of the article. I have medical debt, and I would prefer a public healthcare system to one that charges consumers thousands for a single ambulance ride.

They call it public or socialized healthcare in nations where it is instituted. There is no such thing as "free healthcare" because workers need to be paid and supplies need to be purchased. Many conservatives will conflate "free" with "undeserved". And yes, personal transport costs add up when you are in that state and every dollar counts. It is deceptive to call something free when it actually costs a lot of money.

>You've made my point. It may not incur a personal cost at the time of use, but it incurs a cost regardless.

You really think that made your point? Wow you are really really really trying to never let anyone use the word free aren't you? By your logic of ultra stretching- nothing whatsoever anywhere in the universe is free. We can ALWAYS put a cost on something.

So that means we should never use the word free?

My kid opens up a lemonade stand and puts "FREE LEMONADE!" on it. I bet you are going to go to her and talk about how it's not really free, because you had to use energy to walk up and get some. She went into her parents fridge and got some lemons and did all the work to squeeze them and make your drink.

You know what "free" means. But ok go ahead and pretend not to know.

> Defined by the percentage of the population earning less than half of the median national income,

I'm not sure I buy their definition of poverty. It speaks more about the income disparity than people living in without basic food and shelter covered, which I think the term implies. It might be more meaningful if it were the mean, but as is a few really high income earners would skew the results. I don't think using the medium makes sense as a calculation of poverty giving modern wealth distribution.

Median is the 50th percentile, it's unaffected by Bill Gates. So half the median is a better measure than half the mean.

However as you say it's still a measure of disparity, not an absolute level.

The median is the 50th percentile including outliers, so the Bill Gates of the world to impact it. The mean normally removes outliers to get a better idea of the real average.

No, I think you may have this backwards. The median really is unaffected by adding a zero (or ten zeros) to Bill's income. All that matters is that if half the population makes less than Joe the plumber, and half more, then Joe is at the median. (There's a chance that if you shot Bill, then Joe's brother who earned 0.1c less would become the median, but this will be tiny, tiny effect.)

The mean would however be affected by such things.

> Defined by the percentage of the population earning less than half of the median national income, Japan’s poverty rate is more than 15%

Okay, but how bad is that, relatively speaking? Let's imagine income in Japan doubled over night for everyone. You'd still have that same rate of poverty. We need to look at the outcome. As the article says, you don't find drug addicts and petty criminals roaming the streets in Japan.

This number also disregards price differences. If you are a young worker, you likely live in the city, paying exorbitant Japanese urban rents, requiring a commensurate salary. If you are old, you likely live outside the urban center on a modest pension, with far lower living expenses. Japan of course has a very large elderly population.

Is he seriously comparing to Japan to the US? I would say it is far, far easier to get out of poverty in the states (I have and know many who have) than it is in Japan. The two cultures have vast differences in everything from family dynamics to education to politics.

The US lifestyle is like playing poker with your life, but only being allowed to go "all in" on every hand. You make it, you're living the American dream. You don't, it's all your fault.

It doesn't matter who's fault it is. What matters is "can we afford to help these people?" and for a lot of definitions of "help" we can, and most people think we should.

How about the question: "should we force everyone to help these people?" I don't think you are talking about charity in any of the "help" definitions.

What would your answer be?

In keep seeing this devious mixing of 2 different concepts in order to support one's political ideology.

The 2 different cases the autor of the article tries to mix here are:

1 - People born poor normally have much more difficulty in reaching the highest economical levels of society.

2 - People born poor cannot reach an economical level above poverty, even if they put a fair amount of effort in it.

The author (and many people discussing the subject) usually try to mix no 1 with no 2 in order to write these kind of articles and cause indignation about a false premise.

Who exactly is blaming the poor for their poverty?

Libertarians and conservatives, are we pretending otherwise?

Plenty of liberals, too. I say that as a liberal.

That is pretty shallow. There is a loud subset of the Libertarian party that mostly focuses on the desire for minimal taxation. There is also a substantial subset of Libertarians who advocate for a Universal Basic Income in order to make society itself more fair. This does not necessarily change the idea that slackers choose and deserve their fate, but merely provides people with more opportunity to live for themselves.

I've also met pro-establishment "liberals" who look down on poor people as long as they're white. This sentiment started the whole "learn to code" backlash meme on Twitter, although to be fair I've never seen any journalist directly make that suggestion.

Have you read the first paragraph of the linked article?

This article is a political comment so... the author opponents is always the guess.

Opponents of aiding the poor in ways that might cost money assert this kind of thing.

There are multiple issues woven in here, but one of the most basic is the concept of moral or metric based economics in which money flows toward those who are virtuous and work hard. To tax them or use some of that money is seen as stealing from the virtuous and limiting the total virtue of society.

This belief is in stark contrast to the verifiable function of aid as social stimulus. First of all, when the virtuous rich get incrementally more money they tend to save it because they don't really need it. This takes the money out of circulation, at least for a time. On the other hand the poor and middle class tend to immediately spend most of their money on strategic goods like education for their children. This not only puts the money back into circulation but also enables elites to capture a small amount of every transaction.

The important thing to take away is that social constructions like money and economies are not inherently connected to morality or reasonable metrics and really need to be thoroughly inspected and managed in order to get results that may correspond to some moral or metric projections.

But if you stopped blaming the poor for their poverty, you’d no longer be able to fête the privileged for their privilege

I can't help but think of how many poor....vote for those who blame them.

solutions to poverty should be compartmentalized separate from moral considerations. they should be pragmatic and divorced from Calvinist puritan views on morals and work ethic

Poverty is a moving target; no matter what we do, there will always be the bottom 10% that will be considered poor by comparison. Double the income of everyone - bottom 10% will remain there. Triple the income of the lower half of the population: you still have a bottom. So what exactly is the measure of the problem and how to measure it was solved, when it will eventually be solved?

There's a huge difference between "poor as in can't afford a meal or go to a doctor" and "poor as in can't afford an apartment in the middle of New York".

This article is kind of all over the place.

Do note that according to the chart near the bottom, the US actually spends more of it’s GDP on the social safety net than Canada and Australia, two countries perceived as having better social safety nets. It’s probably even higher in the US since Canada and Australia cover 100% of their citizens for healthcare when the US only covers ~60%.

Many conservatives in the U.S. believe that poverty is mainly a result of bad personal decisions.

Is this article arguing that poverty is never a result of bad personal decisions?

If so, I have a few anecdotes that would be contrary to that.

No, it's not. But no personal decision is made in a void. Locally rational decisions are often inexplicable to people who've never struggled with money.

> Is this article arguing that poverty is never a result of bad personal decisions?

No I think this article is arguing that ending bad personal decisions (if at all possible) will not significantly affect poverty, but a safety net will.

Another interesting topic, which is not mentioned in the article, is how poverty causes bad personal decisions.

I have an analogy. A poor guy lives on a cliff. He is a careful man and watches his steps, being only human, he missteps and falls to his death.

A better off guy can afford a house further from the cliff, and can even to put up a fence. Just like the poor man, he makes missteps once in a while, but the cliff is far away, and continues to live.

In this wealthy country, there is no reason for anyone to have to live near a financial cliff where ordinary mistakes or bad luck will devastate you. It is not productive. It hurts economic growth and is, in my opinion, immoral.

A universal income would allow us all live a little further from the cliff, and not punish you for managing to build your home further away.

I like the spirit of the article, but being poor does not resolve you of personal responsibility. You do not have a pass to commit crime because you make under a certain amount a year. There are definitely a great number of poor people in this world who have no one to blame but themselves or their family/upbringing. I think that a civilized country should have a good safety net for everyone equally, even if their poverty was their own fault. There should be no shame there. People make mistakes. People are sometimes in the wrong place at the wrong time. We should still help them even if it was their fault. I dislike this mindset in America that people get what they deserve and if they made a mistake, they should suffer for it.

Wow, that is one pointedly political article. Bloomberg is now solidly in my 'partisan source' category.

(Read the article before downvoting, please. Give it a fair read.)

It appears to be in their "opinion" section.

The point of an editorial section is to have an opinion.

(But a newspaper with no opinions isn't very useful either.)

It seems premature to discount a publication because it once expressed an opinion you disagreed with. If one was a diligent reader then one would quickly conclude that they couldn't trust anyone.

It’s funny how you can say that while the comment you replied to is so pale I can’t even read it. Apparently people will try to bury anything that even has an inkling of something they disagree with.

Funny that at the point high quality LED tv's and digital signals come onstream, the world moves from Free-to-Air into pay-to-watch. So the poor can afford amazing TVs but cannot afford to buy the content we rich get to watch.

Absolute poverty improves but relative poverty goes backward is a constant. Taxing cigarettes to contain cancer risks is a no brainer, which rich people can buy themselves out from but poor addicted smokers get penalized on, and then have to wear "you are poor because you are sick and make bad choices" pushback, and are denied basic health support.

I don't have cable and use on-the-air TV and the image quality is better than before. They work find with digital TVs.

The funny thing about HDTV is that cable quality is terrible, but OTA quality is amazing. It's got way more bandwidth.

Good point. I used to have basic cable and they forced me to digital and the quality went down. That is what made me try out OTA. I ended up putting an OTA antenna on the roof and the reception improved 10x.

OTA works fine but you can't have a water cooler conversation about PBS the same way you can about boobs-and-dragons.

If you want to talk about dragons-and-boobs you have to pay somebody to let you see 'em.

> the poor can afford amazing TVs but cannot afford to buy the content we rich get to watch.

I was surprised to discover the local public library http://kcls.org seems to have a greater selection of DVDs than Netflix. You can also check out a box set all at once instead of Netflix sending one DVD at a time, which is nice for binge watching.

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