What I've never understood is the weird dichotomy of preventive and reactive governance in the minds of US citizens.
We're willing to spend god knows what shooting rounds that cost entire mortgages to save miltary lives and project a presence of power to deter acts of terror/war, but then are also totally fine having people way as much as 4 or 5 people, eating several days worth of sugar for breakfast, smoking tobacco, putting 3 cups of coffee in a can we drink 4 or five of in a day, do next to nothing to adress recidivism of all classes of criminal, drag our feet kicking and screaming in to a semblance of modernity in worker protections...
In some ways, US healthcare is already very aggressive for some forms of preventive medicine. Compare the colon cancer protocols across the world. Basically nobody else is recommending colonoscopies to the entire population with no cheaper tests, but that's the standard of care in the US. It's not free to receive, and it's expensive in general, but for some reason in the US it is standard, instead of starting with non-invasive tests.
And yes, regarding smoking, the US has had one of the most effective preventive actions in the world. Compare actual numbers of smokers in the US vs, say, Spain, France or Turkey. So it's not anywhere near as clear cut as what you are trying to make it sound.
Walk into a US gastro with a hang nail and you'll walk out with a colonoscopy requisition.
They make money on the procedure, not the office hours. And they write the standards of care.
That being said, my father delayed a screening, developed colon cancer, and now no longer has a colon. Would cheaper / higher compliance tests have caught it sooner? Hard to say.
That's not entirely true. For screening procedures it's mainly the USPTF that writes the standards. They take inputs from the gastroenterology community but the process is more holistic.
https://www.uspreventiveservicestaskforce.org/uspstf/
Insurance is mandated to pay for preventive colonoscopies with no patient responsibility. No coinsurance, no copay, no deductible.
https://www.cancer.org/cancer/types/colon-rectal-cancer/dete...
> The Affordable Care Act (ACA) requires both private insurers and Medicare to cover the costs of all colorectal cancer screening tests that are recommended by the United States Preventive Services Task Force (USPSTF). The law stipulates that there should be no out-of-pocket costs for patients, such as co-pays or deductibles, for these screening tests.
Smoking ironically saves in medical costs because people die before getting into real expensive age related care, and also smoking disqualifies you from a large number of medical procedures that would otherwise be given. Keeping a relatively healthy 90 year old alive for 2 more years costs significantly more than keeping an unhealthy 60 year old smoker alive 10 more years before they have a heart attack or stroke.
How do you figure? I know several smokers who are now over 60 who had gotten lung cancer, becoming unhealthy and costing 200k each chemo session.
It is in lifetime medical care costs and there have been a few studies in Europe. The majority of medical costs is for age related care that grows exponentially with age, and smoking cuts decades off their life. Most smokers die before they get lung cancer, when they do it rarely results in surgery because they smoke, and it is easier to give a younger person chemo than and older person.
Also have you seen the kind of medication regimes that most 90 year olds take? Many of them take as many pills in a week as a 60 year old has took over the last decade or more.
You did not say lifetime medical costs initially but compared adding 2 years to a 90 year old vs 10 years to a sick 60 year old.
> Keeping a relatively healthy 90 year old alive for 2 more years costs significantly more than keeping an unhealthy 60 year old smoker alive 10 more years before they have a heart attack or stroke.
Population statistics
Population statistics showing it is cheaper to prolong the life of an unhealthy 60 year old for 10 years than a relatively healthy 90 year old for 2?
> Basically nobody else is recommending colonoscopies to the entire population with no cheaper tests
I'm not sure if I understand what you're saying. Kaiser Permanente sends me a take-at-home colonoscopy test every year, and some light googling suggests the cost is $20-$89. I've never done an in-person colonoscopy, but the home version must be cheaper, right?
Unless you're putting a camera into your colon, it's not a colonoscopy
they're referring to a screening kit like this: https://www.cologuard.com/
That's not a colonoscopy. It's a colon cancer test, but not a colonoscopy, which, by definition, involves a scope.
Camera-pill?
Based on my personal experience with Kaiser and their home fecal test (FIT test) as a cheaper screening method, I suggest opting out of it and insisting on a colonoscopy.
The problem is that the fecal tests are totally inconclusive. Every positive test must be confirmed by a colonoscopy. And then you get into tricky waters with insurance. My Kaiser gastro doc insisted that my colonoscopy after a positive home FIT test would be billed as diagnostic and not covered at no charge as preventive screening. Which means I would pay over $2k. Despite the USPSTF publishing explicit guidance on this exact scenario still being screening. He was dead wrong, and I wasn't billed, but he and his department did everything they could to discourage me from following up with a colonoscopy.
And at one point he even turned the tables around on me and said this was all a consequence of my having opted for the FIT test instead of a colonoscopy. Which I never did, I was not given a choice. But from his statement I would assume that you can opt in to colonoscopy instead at Kaiser. Then again this could be yet another piece of misinformation on his part.
Kaiser has some very opinionated beliefs that their medical leadership pushes. From my partner's T2D issue (from no history to an ICU stay with DKA): "You cannot go into remission with T2D". "You will need to keep your A1C between 6 and 8 otherwise you will have issues with the medications you are on". They also have many medications they will not prescribe, regardless of the reason.
And don't start me on their pharmacy. She had root canals with some infection, and was in substantial pain. Dentist prescribes short term pain meds between procedures - she's in agony. I drive her from dentist to the Kaiser pharmacy at their UC/ER-lite/whatever facility, that I know from my previous work as a paramedic has pain management medications on site (day surgery, etc.)
"This is a pain management prescription. We do not fill those in person. You will need to submit it to our mail order." "How long will that take?" "5-7 business days, and then shipping time."
"Oh, look at you, coming from the dentist with verifiable surgical procedures done and in pain - just in case you might be drug seeking, you can hang on for a week or two and get your pain management then."
That last one is, I'd argue unethical and against most pharmacists "oaths".
I haven't heard of a take-home colonoscopy. How does that work?
The take home thing is a vial into which you put a stool sample and mail it back. Then it gets tested for signs of colon cancer. I've seen them advertised on TV as well.
That is not a colonoscopy. That is a stool sample and as other replies noted this gets sent out every two years to every one. In the UK from age 60 Australia seems to be from 50.
If that tests positive then you get a colonoscopy to check more things. If you have had colon cancer then you get a full colonscopy evry two years and an MRI every year.
Right, it's an alternative to a colonoscopy. As standard-of-care it's relatively new in the US.
No it is not an alternative to a colonoscopy it is a different test.
If this test finds something then the next step is not treatment it is you need a colonoscopy.
It is a test that cuts down on the number of colonoscopies needed and is cheap enough to find problems earlier than everyone having a colonoscopy which is just unaffordable,
I've got extremely normal marketplace health insurance and my doctor is at an extremely normal overworked large regional health chain, and I would have to argue with him to get an at-home test; the whole system is set up to funnel us all into colonoscopies.
Replace colonoscopies in that sentence by anything that can be made money from and pays doctors.
Sigh, we’re so far behind in anything that’s actually good for the common person. We’re way ahead in capitalistic societal development, though.
This is standard in Australia. Everyone between 50 and 74 receives a free kit in the mail every two years, and there are regular TV ads from the federal government (featuring actual TV stars) encouraging everyone to do the test and mail the results in.
The home version is cheaper, and inferior
Hypothesis: The American diet contains more carcinogens (dyes, additives, pesticides, supplements in poultry/beef/pork) and therefore USA is is more need of CRC screening.
USA generally has higher CRC rates than other developed nations:
https://pmc.ncbi.nlm.nih.gov/articles/PMC2796096/
the screenings may make sense, here
I think that article is from 2009. Need something more recent. Also it mentions that as countries become high-income economies, the incidence rate increases.
[flagged]
Based on 2022 data, rates are lower is US compared Japan, Russia, Italy, France and UK.
https://www.wcrf.org/preventing-cancer/cancer-statistics/col...
Maybe that implies more dyes, additives, pesticides, supplements in poultry/beef/pork in those other countries?
My doctor in the US did everything he could to tell me that my screening colonoscopy would be charged as diagnostic and I would have to pay over $2,000 for it, despite no history or indications of a problem. So it isn't all a bed of roses.
Most insurance covers preventive care, so that’s why it’s popular
> smoking tobacco
There actually has been a really big push against this in the US. I was shocked by the amount of smoking I saw on a recent trip through Northern Europe, whereas smoking in public is pretty rare to see in the US these days.
Now we just vape our nicotine directly, or smoke weed, depending on the state.
Cigarettes have definitely gotten a trashy vibe in the US. It's kinda nuts how fast we went from smoking sections in fast food restaurants just 30 years ago to even bars banning it. In college 10 years ago, the only people I knew who regularly smoked cigarettes were from Europe, China, and India.
Cigars are still cool though, but those have always been the higher status tobacco due to the cost per stick. Also most people don't go through public spaces smoking a cigar, so it doesn't have the annoyance factor of vapes. Hookah still has a fun vibe too, probably because of the social factor.
Pipes are making a comeback amongst young adults.
Cigs are still huge in the boozing scene.
I haven't seen anyone smoke in a bar in over a decade (it's been illegal where I am for quite a while).
You can't smoke in the bar but you can smoke outside the front of the bar and they don't care in open air patio areas generally. People smoke a lot casually outside too. I see a lot of people smoking golfing or skiing.
Can you say where in the US you find it rare to see smoking in public? I live in Kansas City and have been in Vegas, Seattle, and NYC recently and there is plenty of smoking everywhere. Less than the 80s, sure, but certainly not rare.
How recently were you in Vegas? I was blown away by how little smoking there was post pandemic even compared to 2018. Like, most casinos no longer reek of cigarette smoke. I'm sure that's partly explained by better air circulation installed to reopen sooner post-COVID, and probably taking the closures as an opportunity to replace some seriously steeped carpet, but the amount of smoking was way, way down. It used to be if you saddled up to craps table, at least one, if not two people would be actively smoking. Now you can look around the entire pit and not even see one. The combination of anti-smoking measures in broader society, and the uptake of vaping has wildly reduced the amount of smokers. We're talking a 60% reduction since 2000, and that was after the trend was already heading that direction.
Compare that to most places internationally, and the contrast is stark. The US has less than half the cigarette consumption per capita than the EU, with only the U.K., Norway, and Sweden having lower rates. China has a similar rate to the EU.
Just to drive that point home a little harder, the state with the highest number of smokers is West Virginia, sitting at 21% (the national average is 9.6%). That would be middle of the pack in Europe, similar to Italy.
I was in Vegas in August for Def-Con and there was a ton of smoking. Our hotel’s casino/lobby was disgusting. The smokers area outside the convention was plenty busy. Walking to the monorail there were people outside most hotel back doors smoking.
Which reminds me: Also, the smoking area of every airport I’ve been to in the last 2 years has been thick with smokers.
I know it’s better than the 80s. I was there. But I don’t think it’s rare in the US at all.
rare compared to Europe where seemingly everyone smokes
Rare as in you can absolutely spot a person smoking sometimes, but there is not the perception that everyone is smoking, the air does not always smell like cigarettes on the streets and even inside businesses, and the ground is not covered in cigarette butts everywhere.
NYC vs Hamburg, Amsterdam, or Brussels are night-and-day differences on this point.
I'm not sure Vegas is representative of much of anything, but last time I was there what I smelled was weed, not tobacco.
In my daily life, every day, I am behind cars with people smoking, see people on their smoke breaks outside the doors of offices and retail, walk behind people on the sidewalk smoking, and see it on basically every job site I pass.
I only bring this up because I keeping seeing people say it's "rare" in the US, but is something rare if you run into multiple times every single day?
https://worldpopulationreview.com/country-rankings/smoking-r...
I guess we can keep arguing about the definition of rare, but about half the smoking rate of many European countries is pretty significant, and immediately noticeable walking around cities in both places. It's also a significant reduction in the US since the 90s, when every restaurant and workplace, and decent number of homes, smelled like cigarettes.
The price of cigarettes varies widely around the US, which may affect demand. Though I thought VA is a tobacco state.
I loved Amsterdam but the amount of litter, composed mostly of cigarette butts was eye-opening.
Rare in the northeast US. In fact, I saw two students smoking on a college campus just last week and did a double take. I had not seen a single student smoking in at least a decade. Then I laughed remembering how when I was in college in the 90s, almost everybody smoked at least a little (often at parties), and seeing students smoking at the entrance to the dorm was pretty normal. I am an asthmatic so I've never smoked, and I remember my friends being stunned by this one night when we were out at a bar. Things have changed a lot around here.
In my college dorm in the 70s, nobody smoked. Well, there was one. He got a lot of pressure from the rest of us, because it stunk up his room and the hall. He finally gave in and moved elsewhere.
Maybe smoking trends come in waves.
I think this is a case of rare being relative to the past.
In the 90s and earlier it was hard to be in a city and not be breathing cigarette smoke pretty much constantly. Offices had ashtrays in the elevator waiting areas for people who couldn't wait to get to their office, restaurants had half the seating reserved for smokers, there were ashtrays in the armrest of every single seat on an airplane.
Its kind of crazy how much norms have changed around smoking in public. It's not "rare" to see a smoker, its that it is much rarer than it was in the past.
Idk if it would call it rare because yeah going on a walk in a downtown area you will definitely see at least a couple people smoking. But 30 years ago it seemed like every other person you passed on the sidewalk was smoking.
I remember walking into buildings in the 1960s and they all stank of stale cigarettes. Not at all today.
The massive shift away from cigarettes is incredible. I didn't believed it possible.
DC suburbs here, I can’t remember the last time I saw someone smoking.
The US is founded on the idea of individual freedom, and that one of the few areas of "collective" spending should be defense.
This is 101. If you don't like it that's fine, but not understanding it can be resolved with a simple google search.
What does individual freedom have to do with whether or not medicare will cover a preventive test?
Maybe read the comment i responded to.
It’s very strange to include caffeine in that list of unhealthy things. Everything else in that list is proven to be bad for society/health, except for caffeine. Why did you choose to highlight caffeine consumption when there is not really any evidence it causes health issues?
I don't think there's long term evidence for negative problems. However, high dosages of caffeine are dangerous and have killed people. Those dosages are easily achieved through the likes of energy drinks.
Chronic long-term use of high amounts of caffeine (>600 mg, or two Starbucks Grande coffees) are linked with: bone density issues, sleep issues, anxiety issues, cardiovascular strain, stomach acid issues. They aren't super bad, but definitely not harmless.
High dosage of water have also killed people. And easily achieved through energy drinks? I strongly doubt that. Most energy drinks are not any stronger than coffee
Lower dosages of caffeine kill you than the water dosages that kill you.
> And easily achieved through energy drinks?
Yeah, once you start pushing 1000mg of caffeine, you are getting into areas where if you have heart problems, you could be putting yourself in danger.
> Most energy drinks
But not all. So why strongly doubt it?
There are plenty of energy drinks which are fairly popular with huge amounts of caffeine and there's little labeling requirements to let people know that. Bang energy drink is a good example of that. 300mg per can, meaning 3 cans is putting you in dangerous territories.
You can buy a bottle of caffeine pills at Walmart for a few bucks. What are we even talking about?
How dangerous caffeine is. You can also buy a bottle of Tylenol from Walmart, that doesn't mean it's particularly safe to OD on.
The comment said “putting 3 cups of coffee in a can we drink 4 or five of in a day” that would be 1,000–1,500 mg of caffeine. The FDA guidelines is 400mg a day and drinking 1200mg quickly can induce seizures
16 oz can of white monster (stereotypical energy drink) has about 150mg of caffeine. A grande (16 oz) black coffee from Starbucks has about 310mg of caffeine. You would need to drink 2 16 oz monsters to get the same amount of caffeine as a single grande cup of coffee from Starbucks.
If you're just looking at caffeine intake you'd be better off switching from coffee to energy drinks. You could drink about 3 per day and be close to the 400mg/day guidance.
edit: white monster has no sugar in case anyone was about to bring that up
Coffee varies. I've long understood that a normal (8 ounce, ish) cup of drip coffee averages around 100mg of caffeine[0].
Java Monster Triple Shot Mocha comes in a can, and has 300mg of caffeine per can[1][2].
This seems to suggest that getting the equivalent of 3 cups of coffee in one can is, in fact, a thing that people can accomplish.
[0]: https://www.aboutcoffee.org/beans/decaf-coffee/ https://ific.org/resources/toolkits/caffeine/ https://www.mayoclinic.org/healthy-lifestyle/nutrition-and-h...
[1]: https://www.monsterenergy.com/en-ca/energy-drinks/java-monst...
[2]: And they're delicious
> If you're just looking at caffeine intake you'd be better off switching from coffee to energy drinks
This is less true now than it used to be. I'm somewhat sensitive to caffeine and always look on the can to see how much is in it, and 150 is on the low side of most of the options available now-. 200 to 300 seems to be a lot more common among the brands that are newer than when monster and Rockstar first came out.
Caffeine ≠ caffeine.
Forget the numbers you’re being given - what does caffeine crop that goes into a Coke or Pepsi product look like, compared to green tea caffeine?
What does the sugar look like, as a supply chain, vs sugars ingested from fruit?
Hint: it’s disgusting.
Caffeine is caffeine. Sucrose is sucrose. Homeopathy isn't real.
No.
When a flock of geese shit into the pile of beets, gnaw on the beets for a few days, and then the beets get boiled down and put into your Gatorade, sucrose ≠ sucrose.
No idea what you mean with the homeopathy quip.
You know manure and the soils produced from composting are literally feces from animals and bacteria, right?
And that manure is an excellent natural fertilizer?
And that outside that, worms exist? And they poop?
Oh, and that if you were to take bird shit beets and worm poop beets and mash them up and extract chemically pure sucrose from both you'd have no way of determining which came from which?
Assuming that you do know all of these things, you're saying that horse shit and worm poop is fine, but you'll be damned if a bird is involved?
I mean, I can see where you're coming from. A potatoe coming from a toilet is probably not as clean as a potatoe coming from a sterile lab, but that's not what you're saying. You're saying that the toilet has somehow altered the physical chemical compounds involved in the structure of the potatoes rather than has potentially added other chemicals to the mix that was the potatoe. The starch is the same in both. The starch = the starch. The starch and the toilet =/= the starch and the lab because the toilet =/= the lab, but those are different arguments.
I think growing food on soil containing shit is a whole different world than boiling my food with shit,
and if you don’t, well, let’s just leave it here.
> You're saying that the toilet has somehow altered the physical chemical compounds involved in the structure
Nah - I’m pointing out the shit that comes along with your very simplified label should be known.
Same as the folic acid American rice is washed in - but never labeled with.
> if you were to … extract chemically pure sucrose
My point is: they’re not.
and in retrospect, it was weird that I ever assumed they did.
It’s included in a list of things bad for “ society/health.” While overconsumption on that level would certainly be a health issue for an individual, it doesn’t even register compared to the other things he lists as a social issue, like chronic obesity and Tobacco use. It’s just weird and misleading to include it in that list, is all I was pointing out.
less the caffine itself and more the amount. It sounds like they are talking more about energy drinks or some highly concentrated espresso shot.
I don't think that much caffeine is good for you, especially 4-5 times a day. But with everything else we gulp down it probably isn't priority #1.
Tangential, but I suppose this is a good time to highlight how caffeine undisclosed can in fact kill some people:
https://www.bbc.com/news/articles/c5y95yylxv7o
There’s an economic disconnect working against preventative medicine in the USA. The commercial interests take more of a cut on the expensive reactive treatments.
I’m from a country where you are mailed things like a free bowel cancel screening kit every two years unsolicited from the time you turn 50 (Australia). The reason is that the kit and test cost a few cents and detecting it early saves the socialised medical system so much money this sort of thing is a no brainer. There’s a direct economic incentive for socialised medicine to integrate preventative care into day to day life.
There SHOULD be the same incintive in private health care like the US to also lower costs. but when we voted in the ACA (Obamacare) there was a well meaning clause that said insurers had to spend 85% of their premiums on care. That should also re-inforce the cost savings part, but then the largest companies started buying Pharmacies, Pharmacy Benefit Managers, Doctors offices, and even whole Hospitals.
Now they can still spend 85% of the INSURANCE premiums on care, but then those costs are going to their other divisions which can raise prices at will, and make massive profits for the whole group.
Nobody's twirling their mustaches hoping people get sick, but they don't need to be for fee-for-service incentives to bias standard practice towards responses to conditions rather than prevention. On the other hand: you can go too far the other direction (and some cardiologists would point to CAC tests as an example). Preventative care can be bad if the tests drive unnecessary procedures.
Because people are unable to conceptualize the idea of government-funded voluntary preventative campaigns, despite these showing success in the past.
This may be partially due to the many all-or-nothing crusaders who would prefer to use force in their quest for full protection of the citizen. Many people overcorrect because they fear that even voluntary programs are steps in this direction. Trust is low.
We have a long and sordid history with extreme and failed prevention (prohibition, the Mann Act, war on drugs).
Much of the US doesn't think of it in terms of proactive vs reactive governance but instead in cultural/moral expectations of how you should "pull yourself up from your bootstraps" to be great. This view is often to the point many see removing the need to pull oneself up from their own bootstraps as removing the ability for them to better themselves (& wasting everyone else's money/freedom/whatever to do so). A soldier and an obese person are examples at polar opposites of that moral spectrum.
The policies just follow that. This comes up in all sorts of areas such as prison as punishment vs rehabilitation.
I think you're looking at an effect instead of a cause. The main reason for the desire for a small government is not some inherent and absolute obsession with smallness, but because of the belief that larger governments are incapable of effectively utilizing their power (for reasons beyond just incompetence), are prone to inevitable abuses, and so forth. And that belief itself is not simply ideological, but based on history through most of all time.
Even with rehab versus punishment - it's the same story. The view isn't that punishment is inherently superior, but simply that rehabilitation is more of an ideal than a reality, and that typical appeals to places like Norway - a relatively homogenous and extremely wealthy microstate - don't necessarily translate well to large diverse societies, especially ones where there are substantial chunks of society that adopt cultures that glorify criminality.
My views on this subject are far too detailed to want to get into here, but I am confused at your choice to call Norway a "microstate". It's certainly on the smaller side of countries, but there are over 5 million residents and 300,000km2 in size. It's just a normal country.
"Microstate" is a term generally reserved for tiny geographical locations that can't even support their own defense.
It has a lower population than e.g. Wisconsin, in an area about twice as large. You could fit 61 Norways (in terms of population) into the US. I think there's a lot of things that work really well at smaller scale, but just don't work at larger scale. It's not really possible to say where 'smaller scale' ends because it's going to depend on factors other than just population, but I think Norway is comfortably far into the very small side of things in part because of population and in part because of those other factors.
A microstate is not just "one smaller than another" though, and nobody lists Norway as a microstate of Europe/the EU.
But with what you had meant - it means Norway is pretty comparable to a typical US state division or, in other words, something US states could be expected to implement successfully in their state prison systems if there weren't other reasons than scale they do things differently.
And you'll find that a number of states of a comparable makeup as Norway have comparable and even lower recidivism rates than Norway. Oregon is the lowest in the US, with a recidivism rate of 12%, contrasted against Norway's ~20%. [1] And that has nothing to do with punishment vs rehabilitation.
Similarly, Asia is another interesting counter-example to Norway. For instance the Chinese penal system makes the US look like a trip to Disney Land. Beatings, physical+psychological torture, and more are regular aspects of their prison system which is not only punitive but borderline sadistic. And their recidivism rate? One of the lowest in the world, around 8%. And perhaps even more important than the recidivism rate is their crime rate, which is also one of the lowest in the world.
[1] - https://usasymbol.com/rankings/crime/recidivism-rates-by-sta...
As a former resident of Oregon, I would strongly suggest that the low recidivism rate is likely due to Oregon’s far above average level of available social services compared to most other states.
I would also loosely suggest that social services should be considered part of the rehabilitation pipeline.
This got me wondering, because I find the topic interesting but haven't really dug deeply into it in a while, and it's so much easier to get data (especially foreign language) now a days thanks to LLMs. It turns out that there's one huge factor that most people don't consider. That is - what is recidivism? Definitions vary radically between areas, and that goes a long way towards explaining the difference.
So for instance in both Norway and Oregon somebody isn't considered a recidivant unless they are arrested, prosecuted, and receive a minimal standard of punishment. In locations where you see much higher rates of recidivism it's because they use a more intuitive definition - if somebody's convicted of a crime, then they are a recidivant. By contrast here [1] you can see Oregon's raw data. And about 50% of people released from prison will be convicted for another crime within 5 years. In Norway 55% will face criminal charges within 4 years, and 42% will be convicted again!
So the whole point about Norway having an exceptional recidivism rate comes down, in large part, to statistical definitions! It'd be interesting to dig more into China/etc and see if there's some similar 'nuance' there. It often seems that so many things that 'everybody knows' just end up wrong upon closer inspection.
[1] - https://www.oregon.gov/cjc/CJC%20Document%20Library/2018SACG...
[2] - https://www.ssb.no/sosiale-forhold-og-kriminalitet/artikler-...
I don't think there is a clear cause and effect (or even separation) of those two things. The early views/situations of those who made America are largely the same force which drove the desire for small government and vice versa. I.e. what you believe is ideal in reality is going to be based on the way you weigh things morally just as much as the way you weigh things is going to be based on what ideal is held.
There is, of course, more than one reason people hold the views they do, but I do believe things like rugged individualism & the Protestant work ethic definitely played a major role in why the majority of Americans hold the desires and fears about government they do - particularly in the aspect of these examples. Without those influences, I think what America has tried vs what it has feared would be a very different list today (which is not to say whether it'd've been more successful or not).
Did you know that you can be sentenced to life imprisonment in the UK for suggesting that the monarchy should be abolished? [1] That's quite progressive, since it used to be the death penalty. Now in reality you probably won't be, but that law is an echo, still ongoing, of the sort of systems everybody used to live under. That directly leads to ideals of a smaller government. So I don't think these sort of values we're speaking of are abstract or moralistic in nature.
It's also not just in the past. We continue to live in the era of mass domestic surveillance, Patriot Act, Snowden leaks, regular oppression for political views (see: pro-Gaza protests), two tier legal systems, and much more. All the while governments with vast resources plunge sizable chunks, verging on a majority of discretionary spending, into militarism flirting with WW3 and the viable end of humanity it would entail. And I'm not even going to get into the insanity that's going on, worldwide - including the West, with the treatment of political candidates and elections. Suffice to say that's also enough to make a lot of people quite concerned.
So again all of this makes one begin to think 'perhaps governments shouldn't have this much power or wealth' at a point that I imagine you would say is, itself, already relatively low. I think that should all be fairly reasonable, even if one might disagree at some point. But I'm not entirely sure what the comparable evidence for the alternative is.
[1] - https://www.theguardian.com/uk-news/2013/dec/13/calling-abol...
Well, again, it's not that these things take place of each other it's that they influence each other. Taking the first example, America only exists because individuals went to settle and conquer new lands and then pulled themselves up by their bootstraps to defeat the tyranny of the monarchy. There is no way in which this can happen without these cultural traits in the same way there is no way it could have happened and not driven these cultural traits further. The other examples follow the same line.
That's not arguing small government is supposed to be good or bad, it's just saying what the American mindset considers important when judging things - which is on traits which align with its mindset over its history, not on whether or not the application of policy seems evenly distributed to all.
I'm not going to debate the history beyond observing that most people were fleeing persecution or seeking a better life for themselves and their families. Scarcely few set out to conquer anything. But I think the most important point is that now a days I think if you put just about anybody in the current state of America, you'd see a trend towards desiring smaller government.
The exact phrase 'smaller government' is triggering because it's been so politicized into being a left vs right concept, but when left leaning individuals seek to decrease the strength of ICE, decrease the rights/capacity/scope of law enforcement, limiting executive powers especially as related to war, and other such things they are themselves also directly appealing for a smaller government, in at least some ways.
I think this hypothesis (that 'anybody' would trend towards seeking smaller government) is even testable with things like Asian Americans. Many/most have roots from more social type societies, and predictably trend towards voting liberal in America as a result of such, to say nothing of historical issues. But they are leaning more and more conservative over time, to the point that at current trends they will likely be a majority conservative bloc within a few decades.
It's simply that once one sees what 'big government' amounts to in the US and the current state of the US government, it quickly leads many people to start running in the opposite direction. And once you start running from such, the opposite (self responsibility/reliability/etc) inevitably grows in proportion simply because there is no other choice.
> in cultural/moral expectations of how you should "pull yourself up from your bootstraps" to be great
Another word for that is freedom. With freedom comes personal agency and personal responsibility.
The primary purpose of prison is neither punishment nor rehabilitation, but rather to protect the general public. Whether incarceration is the best approach to accomplish that goal is a separate issue, but the reality is there are a lot of dangerous and antisocial people who can't be running around loose.
From Kurt Vonnegut in Slaughterhouse-Five:
To put it in context, the poor elsewhere were poor by class. No attempt to become rich was permissible by law so it was key that this supermajority of the population did not believe they were downtrodden, and unfairly opposed.
Claiming the poor have more virtue, but only in their class status, is one way to do it.
Consider how many caste systems claim the farmer is the highest status, the wisest, the most virtuously hard working … but well still needs a good noble king to lead them.
Things have changed a lot since Kurt Vonnegut wrote Slaughterhouse Five in 1969. Now even people in the poorest US state have higher incomes than the UK. America is the wealthiest nation on Earth, and its people are mainly rich (relative to global standards).
We should do more to help the underclass and remaining desperately poor citizens to lift themselves up. But it's amazing what we've accomplished since 1969. Let's celebrate that.
> Now even people in the poorest US state have higher incomes than the UK.
Higher income does not mean higher quality of life.
I'm an American who has spent the majority of my adult life living abroad, and much of that time has been in developing countries.
I have no illusions about poverty and am not going to pretend that the US isn't a "rich" country. But I've also noticed a very stark trend in the past decade: fewer and fewer people express interest in emigrating to the developed world.
I currently live in one of the fastest-growing countries in the world. Its per capita GDP PPP is about a fifth of the America's and...the number of people I meet who say they'd want to live in the US is tiny.
People around the world are increasingly hip to the reality: the US is still the land of opportunity. But opportunity is more and more difficult to come by. The country is expensive, has massive social problems and lacks attributes (such as safety nets provided by family) that make life in poorer countries feel better to many people.
Even your idea that the "underclass and remaining desperately poor citizens" need to "lift themselves up" is a distinctly American idea. There are tons of working poor in the US. They are trying to "lift themselves up" but can't afford a $1,500/month apartment, $30,000 starter car, $5+/gallon gas, $5,000 health insurance deductibles, etc.
Hear, hear. It would be good for more people to travel abroad and experience firsthand how much better we have it in the US than most other places. The concern is that we actually have it better than most yet too many actually want to replace our current system with something else that has a horrible track record.
If many of our welfare programs actually helped their intended recipients we would be able to help those in need get to being self sufficient instead of the fraudsters stealing all that money.
Everything is America is about race
America does a better job at assimilating immigrants than most of the rest of the world. It’s just a very hard problem, and the US does more of it than anyone.
Not everyone in this country who isn't white has ancestry from an immigrant (or at least not a willing one).
Also, non white immigrants face discrimination.
People facing racial discrimination can and have overcome it, throughout our history.
People hold out willing non-white immigrants succeeding as proof there is no significant racial discrimination. But this ignores a large selection bias. People who voluntarily immigrate almost always have a great deal of drive and often some resources. Most of them would have been more successful then average if they had stayed in their home country.
I definitely wouldn't say my lineage had any call in "immigrating" into the US.
And yes, don't underestimate how such maneuvers are very indirect means of white flight. African Americans could only (legally) own a home in much of the US for 50 years. At the very best, that is 2 generations of wealth to accrue, which puts that demographic a good century behind what potentially could have been economically.
50 years would be 1976. Perhaps you're confusing it with the myth about women being legally prohibited from opening bank accounts. (1972 was when sex discrimination by businesses was outlawed at the Federal level, though there was never a law that prohibited a women from having a bank account, not directly, and not indirectly since the 1800s. Some banks discriminated against married women, but unless they lived in a one-bank town there were others that were happy to have their business.)
My timeline was loose, but I was specifically talking about the Fair Housing act of 1968: https://www.justice.gov/crt/fair-housing-act-1
So 58/59 years if we want an exact date. But a law passed de jure doesn't mean everyone throws their hands up and willingly complies, so the sand will still be shakey for a good decade.
Of course, YMMV per state, so it's not like the Midwest or west coast had the same level of discrimination as the deep south. But that's the line that this policy became federal.
Okay, but like with the banking myth there was no law or official government policy that specifically prohibited black ownership. And the only legally enforceable impediment after the 14th Amendment were racial covenants on private property (drawn up by property owners themselves by private agreement), which became void in 1948 after SCOTUS said it was unconstitutional for courts to enforce racial covenants.
Notwithstanding that they were examples of extra-legal discrimination (in the sense of not being direct legal prohibitions), racial covenants and red lining also didn't just effect black Americans, though nationwide they were disproportionately impacted. I only point that out because most people would say it was incongruous to claim Jews or Polish or Asians were legally prohibited from owning land in many areas.
I think it's an important distinction because there are vestiges of redlining that persist today. First time homeowner mortgage subsidies, the first major stepping stone for building wealth for most people, effectively exclude many kinds of multiunit housing, such as condos and, IIRC until recently, attached housing like duplexes. This disproportionately impacts prospective urban black homeowners, and quite deliberately. Likewise, IIUC prefabbed homes or similar are excluded, which disproportionately impacts poor rural whites and blacks alike. There are legitimate concerns behind those restrictions, such as developer and rental fraud, just as nominally there were legitimate concerns behind redlining, namely sustainability of property valuations. Though in all these cases it's obvious the reason they persist(ed) as-is is for largely discriminatory reasons, as the legitimate substance of the concerns could be addressed. At the same time, we wouldn't say they legally prohibit ownership; if you're wealthy enough they're no impediment at all, just like redlining and covenants were no impediment if you were wealthy enough (racial covenants could be overcome by just buying up all the adjacent property so there was no other property owner to enforce the covenant; the government couldn't by itself enforce such covenants, only adjoining property owner "beneficiaries").
Perhaps counterintuitively, black letter property law was one of the legal areas most resilient to both racial and sex discrimination. The 1800s saw some regression, but that didn't last long, often because courts themselves couldn't tolerate the illogic. People criticize it, but property is indeed sacrosanct to American legal and political culture, and it was very difficult to carve out exceptions that permitted blacks and women to be excluded without threatening the underlying principles of the system that secured owners' rights. That's why prejudiced treatment tended to come in the form of private, regulatory, or extra-legal discrimination, which arguably persists today in the form of restrictive zoning and related development policies which not coincidentally are impediments to free & clear property ownership, just enough to be tolerable to the well-off while disproportionately impacting the real targets.
This kind of thinking is how you get trump 3.0 after you blame and alienate people who want their lives to improve.
I don't know why you got downvoted. If you don't believe this, read "Dying of Whiteness" by Jonathan Metzl. Something like 30% of this country will reject quality of life improvements for themselves if they see that it will also benefit people of other races who "don't deserve it".
The entire social structure of the south was (and mostly still is) based on wealthy whites convincing poor whites to accept the situation because blacks are even worse off.
And those that haven’t lived in the south can’t comprehend that it really is the core animating belief behind the entire apparatus of government.
You shouldn't have to believe, because the various poor white guys who died for the south wrote plenty about how their driving motivation was that a black guy having the same social status as them was worse than death.
They literally wanted to kill northerners for daring to make them equal to black people.
Still do.
Then really shouldn't it be "everything is about money"? After all, it's clear that the actual lie is convincing a big group of people that they don't share a common cause. Racism has many causes, but using it as a divide and conquer tactic has to be one of the most disgusting ones.
It’s super easy to get whatever survey results you want by careful tweaking of wording.
Not to mention how often people misinterpret a survey and add their own bias to the results.
*Everything in America is about class, with race as a frequent proxy for class
Fixed that for you
Judging by the color of one's skins is one of the easiest and oldest ways to discriminate. Only behind by the contents of one's genetalia. But the latter at least has a biological need to care for one another.
It's a bit of a chicken and egg situation. At least when someone looks at someone who "looks like them" but is poorer, they see "potential" (there's a name for this effect, but I forget). But the end goal is getting theirs first and foremost.
True, but this effect tends to diminish at the highest levels of wealth.
At lower levels you have the “labor aristocracy” effect, which gives the more well-off workers a material stake in racism. And this division is useful to prevent organization.
> the end goal is getting theirs first and foremost
Seconded
Its also about language and colloquialisms. If you grow up poor, but go to a school with many wealthy children, you will learn to speak the "language" of the wealthy, which is, in my opinion, what mostly explains the "having potential" that the ruling class will see in your as you enter adulthood.
In the US there's an extreme attitude of "I'm not paying for someone else...", and any sort of preventative care, like a heart score test, would fall into that category. This attitude is grounded on the personal responsibility mindset, that every person is responsible for taking care of themselves. So, for the 800K people that had heart attacks, the attitude in the US is largely, "They should've been proactive on their own, gotten the $100 test. Their heart attack is their own fault."
I don’t entirely agree, but it’s not inconsistent. The idea is that government is supposed to protect you from bad guys (criminals or enemy countries) but it’s not their job to protect you from yourself. If somebody wants to shoot you, the government is supposed to stop them. If you want to eat an entire cake for lunch every day, that’s your own business.
> What I've never understood is the weird dichotomy of preventive and reactive governance in the minds of US citizens.
When the underlying economic model of CONSUMPTION = GOOD is viewed as a religion or universal law of nature, it's actually not surprising that people are irrational about this.
People being free to destroy their bodies with food has nothing to do with everything else you mentioned.
Big assumption that the average citizen’s opinion has any effect on what the government spends money on. It’s pretty easy to campaign on not doing X and then proceed to do X once you’ve won the election.
If you keep in mind that the median voter in a primary is 65, then the government we have seems to do a pretty good job of reflecting the opinions of the politically engaged subset of the population.
I’d argue government investments are extremely exposed!
Consider that the majority of Americans do in-fact vote. In doing so, they literally delegate the power of the purse to the representative was most supported in their local community.
Look at the work put into ‘communication’ about those budgets also. In addition to having comptrollers to monitor the auditors or whatever.
The UK Expenses Scandal was funny, but Thatcherism is still doing too much residual harm to laugh about.
Promising x and doing y is a winner-takes-all democracy problem. Coalition governments solve this by sexing-up y as the natural outcome of the public vote. This also makes technocracy easier / more normalized.
Follow the money; lots of wiggle room for fraud and quid pro quo in an emergency
So we have to perpetually live in emergency mode to create liquidity
If we could all just live our lives there would be no reason to shift large sums of capital around for the usual hands to get their cut
Historically post office and social security ran surpluses; boring and predictable. All that was phased out to create the current shit show of a virtual economy for the youth
Sam Altman isn't concerned with efficiency except his own line go up
This is just a longer version of "If we can spend so much on defense, why can't we do X?". The OP is compelling enough in understanding the tradeoffs of medical prevention vs. treatment. No need to rope in your pet peeve du jour.
I won't speak for other countries, but in the US, the answer to "Why do we spend so much on X" is typically because X is in large part a jobs program for special interests who are really good at lobbying, whether it is healthcare or defense or any other industry.
Representatives like high employment in their districts and employees of X like high salaries. It's an incentive-compatible equilibrium.
Fine. So your pet peeve is waste and you'd reframe it as "If we can waste so much money, why can't we do X?".
Overconsumption means enormous profits, that's the whole logic to it. Gotta keep numbers going up and shareholders happy.
It's easy to understand. US optimizes for whatever helps with more overall spending. They can print money and export inflation to others. All this new money then goes to the companies that hold power through lobbying.
> and project a presence of power to deter acts of terror/war
uh? That's literally what causes terror and wars lmao
While I agree the US meddling in the Middle East has caused wars/terrorism, the general US military presence globally is a massive benefit for the entire world. Once the US starts pulling back more (as they seem to want to do) we'll see more and more regional chaos that grows into trade disruptions and wars. Regional tomfoolery like the South China Sea stuff will occur all over the world and will escalate into wars.
> we'll see more and more regional chaos that grows into trade disruptions and wars
Every accusation is a confession, as they say. How can you say this with a straight face given the current situation in Iran lol? They keep pulling the same shit and NPCs keep licking the boots, it's insane...
It's because of racism. No, seriously.
If something disproportionately affects black people negatively, it has a significant amount of support from certain voters. The whole origin of the anti-abortion movement in the 19th century was double-pronged to displace midwives (who were often minorities) and that too many white women were getting abortions, which was labelled "race suicide" [1].
Need more? Infant mortality skews heavily by a state being red or blue and by the racial makeup [2]. Iowa is a red dot in a sea of blue because it's particularly white. Compare the US to other developed nations [3].
So this particular issue is with heart disease. And guess what? Black people are disproportionately affected and have worse outcomes [4]. Shocking.
Many people have a shallow view that racism is using slurs. It is not. Racism is systemic. And it's not as direct and nefarious as people in a smoke-filled room getting together to try and create worse heart disease outcomes for black people. It's a series of steps taken such that this problem isn't solved. It's just not prioritized.
You see the same thing with medical misogyny and medical racism. Symptoms are downplayed and ignored. This has been thoroughly tested where doctors have been given a file genders changed and there are statistically different outcomes.
[1]: https://sociology.northwestern.edu/documents/faculty-docs/fa...
[2]: https://en.wikipedia.org/wiki/List_of_U.S._states_and_territ...
[3]: https://www.americashealthrankings.org/publications/reports/...
[4]: https://pmc.ncbi.nlm.nih.gov/articles/PMC9310198/
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In the limit, one would expect that to be the case: at some point the marginal cost curves will intersect. I’m quite surprised that we are already at that point. I suppose more things are at the efficiency frontier than I had imagined.
Thanks for the link. Will have to read it later.
From the article:
> "As an example, consider a hypothetical 2-year wellness program that costs $400 per month per person (say, $13 per day for healthy food) and reduces the risk of heart failure by 1 percentage point, from 5% to 4%. For the first 90 days alone, heart failure treatment is much more expensive at $22 000 than the wellness program, but that doesn’t mean that the wellness program saves money. In this case, 100 people must participate in the 2-year program to reduce the incidence of heart failure by 1, from 5 people to 4 people. In other words, the number of people who must be treated with the prevention program to avoid 1 heart failure is 100 (NNT = 100)"
1. Why is the person's food cost attributed to the wellness program, instead of the person's food budget?
2. Most people are overweight or obese. I would expect $400/person/month of healthy food to lead to weight loss as part of the intervention. This skim-read study of 5000 people[1] concludes that "Modest weight losses of 5 to <10% were associated with significant improvements in CVD risk factors at 1 year". The hypothetical uses 1 percentage point, which sounds insignificant.
3. This Novo-Nordisk page[2] says: "According to a post-hoc analysis from the Look AHEAD trial, individuals with type 2 diabetes who lost ≥10% body weight had a 21% decrease in 4-point MACE incidence (defined as CV death, non-fatal acute myocardial infarction, non-fatal stroke, or hospitalisation for angina). A weight loss of 5% has significant health benefits". Again relatively small weight loss shows significant improvements.
(Comparison: someone 300lbs losing weight at 1 lb per week takes eight months to lose ten percent of their bodyweight. Healthy weight loss is often discussed at twice that rate or 2 lbs per week. In the TV show My 600lb Life Dr Nowzaradan gives morbidly obese people targets of 5-10lbs/week initially. The hypothetical wellness program is two years?).
The improvements from healthy diet which leads to weight loss ought to be more than just reduced risk of heart attack. Reducing hypertension (high blood pressure) leads to reduced risk of stroke and chronic kidney disease. Reduced body fat and healthier diet leads to reduced risk of Type 2 Diabetes and its complications (vision loss, neuropathy, slowed wound healing, worse immune function). Reduced weight leads to reduced risk of back pain, knee pain, sleep apnoeia, non-alcoholic fatty liver disease. Reduced body fat leads to reduced risk of some cancers, better diet reduces risk of other cancers. The hypothetical only considers treatment for heart attack in the savings but there should be a lot more savings.
The hypothetical only considers the treatment cost of a heart attack for 90 days but is that all the treatment they need? Are they not on regular drugs and checkups long term? And someone who survives a heart attack is at increased risk of another heart attack from all the same reasons they had the first one. American Heart Association says "about one in five people who have had a heart attack will be readmitted to the hospital for a second one within five years"[3].
And avoiding the prodcutivity loss from all the time off work from heart attack, back pain, sickness, medical appointments and treatments over years and decades. Intervention may not save money, but it may lead to increased ability for the economy to generate more money than it cost.
There's probably a point in that article, but why use such an easily criticised hypothetical to try and make a point? Not even going into $13/day vs 'beans and rice' or saving a person money on takeaway, cigarettes, alcohol, gasoline, or the costs to a person of moving to a walkable area or joining a gym, or all that kind of lifestyle intervention.
[1] https://pmc.ncbi.nlm.nih.gov/articles/PMC3120182/
[2] https://pro.novonordisk.com/disease-area/cardiovascular-dise...
[3] https://www.heart.org/en/news/2019/04/04/proactive-steps-can...
I would read the comments on that article. The conclusion you've come to seems murky at best.
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