5 ms·

The USA is effectively 50 countries with different demographics, geography, culture, and needs. Trying to impose any “one size fits all” solution won’t work bec

The USA is effectively 50 countries with different demographics, geography, culture, and needs. Trying to impose any “one size fits all” solution won’t work because it’s not appropriate for a significant number of them.

minikites 7y ago
Where is "access to clean water" (or frankly, anything on the list) not appropriate?
- pmiller2 7y ago
  I think the charitable interpretation of the comment you're replying to is that we may need ~50 different implementations of "access to clean water," etc.
- chrisco255 7y ago
  In rural communities, you're most often getting your water from a well. I grew up in an area like this, with a pumped well and septic system. There was no need for public water infrastructure because the density did not necessitate it, and the natural aquifer more than provided for those needs.
  - kelnos 7y ago
    That's fine. Those people have "access to clean water". Any guarantee of such needs to take into account the various ways people obtain clean water, and make sure one exists. It might just be someone noting, "nice, they have a functioning well with plenty of capacity, good to go". If they don't then the government should fix that, either by running a public water system to that location, or drilling a well. If that's "socialism", then I'm all for it. The idea that we shouldn't ensure that everyone has access to clean water in this age is ludicrous, and, frankly, reprehensible.
    - chrisco255 7y ago
      Wells and septic systems are often regulated by state and local zoning laws. So, houses are not sellable without these things, as it stands. The initial builder of a house pays for the installation. And then it passes to the next owner as part of the property. Property owners are ultimately responsible. Landlords are responsible for providing clean water in accordance with tenant-landlord law. In U.S. this problem has long been solved. Sometimes you get poor local management like Flint, MI that screws things up. But by and large, solved problem.
- ctdonath 7y ago
  That presumes providing clean water is somebody else’s problem. It’s not. Classic American culture is rooted in independence. I honestly don’t grasp the notion that “access to clean water” involves compelling others to make water clean & available cheap/free in large quantity; don’t ruin what water is commonly available, property rights apply, collect what flows/falls on your property ... otherwise it’s up to you to buy or acquire/purify for your own needs. If an area does not have a suitable source, move. There is no right to live where you like and compel others to alleviate regional inadequacies. “Access to clean water” is not appropriate where there isn’t any (which includes much of the US), or where water has been ruined beyond reasonable reclamation (Flint, Syracuse, etc).
kick 7y ago
The USA is a single country with what's effectively two demographics, and one-and-a-half breeds of politician. "50 countries with different demographics geography culture and needs!" is a complete fabrication. Wyoming doesn't even have a million people in it; implying Wyoming is a country is like implying a go-kart is a jet.
- bumby 7y ago
  I don’t think culture is population dependent. Baltimore and Wyoming have roughly the same population but very different cultural attitudes, beliefs, ways of life etc. Its hard to make a case they should have the same policies and expect the same results
  - pmiller2 7y ago
    It's not so much population per se as the urban/rural divide. Baltimore is a city (arguably a megalopolis of Baltimore + Washington DC + Northern Virginia and nearby areas of Maryland). Wyoming, OTOH, is the 10th largest state geographically, the least populous, and literally has more cows than people [0, 1]. If I had to guess, I would say there probably hasn't been a significant number of cows in Baltimore in over 200 years. --- [0]: https://en.wikipedia.org/wiki/Wyoming https://en.wikipedia.org/wiki/Wyoming [1]: https://www.vox.com/2016/5/3/11504568/states-most-cows https://www.vox.com/2016/5/3/11504568/states-most-cows
    - bumby 7y ago
      I don’t necessarily disagree, my comment was largely based in response to the OP seeming to think population was major discriminator. Even at the city level, I think its is too broad of a generalization. Berkeley and Baltimore have roughly the same population density but very distinct cultures
- leetcrew 7y ago
  wyoming has more than ten times the population of lichtenstein and more than one thousand times the land area.
- 7y ago
misun78 7y ago
The issue with something like “free” healthcare is that proposed policies like Medicare for all only really talks about the demand side of the equation. It purports to expand the coverage without mentioning how we can pay doctors more so there is more of them, incentivize the private sector to produce (and profit from) top-notch drug treatments, reduce personnel and bureaucratic inefficiencies (which mind you implies layoffs which is the inverse of what government controlled sectors are associated with) etc. In the absence of that missing supply side conversation, the proposals do start to resemble as forms of socialism i.e a simple redistribution and reversal to the mean with no major improvement to the overall system. Add assumed inefficiencies with government run systems, and you now have a more evenly distributed system but one that’s fundamentally worse in aggregate than the one before i.e. quite literally socialism of the 20th century that’s been tried and failed over and over again.
- kelnos 7y ago
  > It purports to expand the coverage without mentioning how we can pay doctors more so there is more of them That part of it is actually not complicated: once you dismantle the private health insurance industry, you eliminate billions of dollars of waste and inefficiency that can now go toward actual care. Not saying that there won't be inefficiencies in a government-administrated system, but we actually already know what that looks like (Medicare). Increasing the number of doctors is another issue, as private industry trade groups effectively set a cap on the number of doctors by limiting the number of teaching hospitals and medical school programs, and how many students they're allowed to take. (It's basically a doctor salary protection racket; limit the supply of doctors and the existing ones will make more money.)
  - ctdonath 7y ago
    Yes, we know what Medicare looks like. We don't want "Medicare for all". Really.
kelnos 7y ago
The problem with this thinking is that the states are, for all practical purposes, not able to freely experiment with the things they need to. I agree that there is often no one-size-fits-all solution, but states can't always implement solutions that fit their needs, not because they aren't capable, but because of federal restrictions. For example, the CA legislature was thinking about a single-payer healthcare bill for CA. Unfortunately, they can't do it on their own: they need special dispensation from the US Congress (and possibly the executive branch? I don't recall the details exactly) to use Medicare dollars in a way contrary to federal rules. That's unlikely to happen in the current political climate. A cause of this deadlock is that federal taxes aren't optional. Even if CA wants to handle something for itself, it can't just tell all CA residents to stop paying that particular tax to the federal government. The state does get federal money, but it comes with strings attached. Yes, CA's taxes are already some of the highest in the nation, but I'd be fine with a (big) CA tax hike for statewide universal health care if it also meant that my federal taxes would be lower (and CA would be responsible for raising more of its budget on its own, being cut off from federal healthcare-related money). But that's just not how things work. (Overall, I think this is a good thing: me paying into the nationwide Medicare pool means that states that would otherwise be going through budget shortfalls don't suffer. But it's ridiculous that the federal government is telling my state government what it can and can't do with what's effectively its own money, while I'm subsidizing healthcare for people in other states.) As sort of a meta-point, the USA is maybe more like 10 or 15 different countries. Sure, there's a lot of difference in needs, values, and attitudes between someone living in Wyoming vs. Baltimore, but the people who live in DC, Baltimore, San Francisco, and Chicago have a lot in common. As do people living in Wyoming and Montana. They're not the same, but they likely have enough in common for single solutions to many problems to apply equally, or equally enough. I'm encouraged by states in the same geographic area coordinating their COVID-19 response; it shows that states with similar needs can (and should!) band together to tackle common issues where the solutions are likely to be similar.
nlfwhulsdhouv 7y ago
No it's not, and the US is far from the only country that has a diversity of culture. The Canadian maritime provinces are extremely different from Nunuvut or downtown Vancouver. Paris is significantly difference than Nice. Shanghai is significantly different than Xinjiang province. This is yet another annoying expression of American exceptionalism. Of course, it only ever comes up when someone says, "Maybe we should stop people dying because they can't afford healthcare." The US is probably one of the most culturally uniform countries of any significant size I can think of honestly.
whytaka 7y ago
What's interesting though is that states that reject the notion of safety nets because "one size does not fit all" are doing the worst. Perhaps if they gave it a try, they might see that it does fit. But then we see that the problem is actually that of bought politicians.

minikites 7y ago

Where is "access to clean water" (or frankly, anything on the list) not appropriate?

pmiller2 7y ago
I think the charitable interpretation of the comment you're replying to is that we may need ~50 different implementations of "access to clean water," etc.
chrisco255 7y ago
In rural communities, you're most often getting your water from a well. I grew up in an area like this, with a pumped well and septic system. There was no need for public water infrastructure because the density did not necessitate it, and the natural aquifer more than provided for those needs.
- kelnos 7y ago
  That's fine. Those people have "access to clean water". Any guarantee of such needs to take into account the various ways people obtain clean water, and make sure one exists. It might just be someone noting, "nice, they have a functioning well with plenty of capacity, good to go". If they don't then the government should fix that, either by running a public water system to that location, or drilling a well. If that's "socialism", then I'm all for it. The idea that we shouldn't ensure that everyone has access to clean water in this age is ludicrous, and, frankly, reprehensible.
  - chrisco255 7y ago
    Wells and septic systems are often regulated by state and local zoning laws. So, houses are not sellable without these things, as it stands. The initial builder of a house pays for the installation. And then it passes to the next owner as part of the property. Property owners are ultimately responsible. Landlords are responsible for providing clean water in accordance with tenant-landlord law. In U.S. this problem has long been solved. Sometimes you get poor local management like Flint, MI that screws things up. But by and large, solved problem.
ctdonath 7y ago
That presumes providing clean water is somebody else’s problem. It’s not. Classic American culture is rooted in independence. I honestly don’t grasp the notion that “access to clean water” involves compelling others to make water clean & available cheap/free in large quantity; don’t ruin what water is commonly available, property rights apply, collect what flows/falls on your property ... otherwise it’s up to you to buy or acquire/purify for your own needs. If an area does not have a suitable source, move. There is no right to live where you like and compel others to alleviate regional inadequacies. “Access to clean water” is not appropriate where there isn’t any (which includes much of the US), or where water has been ruined beyond reasonable reclamation (Flint, Syracuse, etc).

kick 7y ago

The USA is a single country with what's effectively two demographics, and one-and-a-half breeds of politician. "50 countries with different demographics geography culture and needs!" is a complete fabrication. Wyoming doesn't even have a million people in it; implying Wyoming is a country is like implying a go-kart is a jet.

bumby 7y ago
I don’t think culture is population dependent. Baltimore and Wyoming have roughly the same population but very different cultural attitudes, beliefs, ways of life etc. Its hard to make a case they should have the same policies and expect the same results
- pmiller2 7y ago
  It's not so much population per se as the urban/rural divide. Baltimore is a city (arguably a megalopolis of Baltimore + Washington DC + Northern Virginia and nearby areas of Maryland). Wyoming, OTOH, is the 10th largest state geographically, the least populous, and literally has more cows than people [0, 1]. If I had to guess, I would say there probably hasn't been a significant number of cows in Baltimore in over 200 years. --- [0]: https://en.wikipedia.org/wiki/Wyoming https://en.wikipedia.org/wiki/Wyoming [1]: https://www.vox.com/2016/5/3/11504568/states-most-cows https://www.vox.com/2016/5/3/11504568/states-most-cows
  - bumby 7y ago
    I don’t necessarily disagree, my comment was largely based in response to the OP seeming to think population was major discriminator. Even at the city level, I think its is too broad of a generalization. Berkeley and Baltimore have roughly the same population density but very distinct cultures
leetcrew 7y ago
wyoming has more than ten times the population of lichtenstein and more than one thousand times the land area.
7y ago

misun78 7y ago

The issue with something like “free” healthcare is that proposed policies like Medicare for all only really talks about the demand side of the equation. It purports to expand the coverage without mentioning how we can pay doctors more so there is more of them, incentivize the private sector to produce (and profit from) top-notch drug treatments, reduce personnel and bureaucratic inefficiencies (which mind you implies layoffs which is the inverse of what government controlled sectors are associated with) etc. In the absence of that missing supply side conversation, the proposals do start to resemble as forms of socialism i.e a simple redistribution and reversal to the mean with no major improvement to the overall system. Add assumed inefficiencies with government run systems, and you now have a more evenly distributed system but one that’s fundamentally worse in aggregate than the one before i.e. quite literally socialism of the 20th century that’s been tried and failed over and over again.

kelnos 7y ago
> It purports to expand the coverage without mentioning how we can pay doctors more so there is more of them That part of it is actually not complicated: once you dismantle the private health insurance industry, you eliminate billions of dollars of waste and inefficiency that can now go toward actual care. Not saying that there won't be inefficiencies in a government-administrated system, but we actually already know what that looks like (Medicare). Increasing the number of doctors is another issue, as private industry trade groups effectively set a cap on the number of doctors by limiting the number of teaching hospitals and medical school programs, and how many students they're allowed to take. (It's basically a doctor salary protection racket; limit the supply of doctors and the existing ones will make more money.)
- ctdonath 7y ago
  Yes, we know what Medicare looks like. We don't want "Medicare for all". Really.

kelnos 7y ago

The problem with this thinking is that the states are, for all practical purposes, not able to freely experiment with the things they need to. I agree that there is often no one-size-fits-all solution, but states can't always implement solutions that fit their needs, not because they aren't capable, but because of federal restrictions. For example, the CA legislature was thinking about a single-payer healthcare bill for CA. Unfortunately, they can't do it on their own: they need special dispensation from the US Congress (and possibly the executive branch? I don't recall the details exactly) to use Medicare dollars in a way contrary to federal rules. That's unlikely to happen in the current political climate. A cause of this deadlock is that federal taxes aren't optional. Even if CA wants to handle something for itself, it can't just tell all CA residents to stop paying that particular tax to the federal government. The state does get federal money, but it comes with strings attached. Yes, CA's taxes are already some of the highest in the nation, but I'd be fine with a (big) CA tax hike for statewide universal health care if it also meant that my federal taxes would be lower (and CA would be responsible for raising more of its budget on its own, being cut off from federal healthcare-related money). But that's just not how things work. (Overall, I think this is a good thing: me paying into the nationwide Medicare pool means that states that would otherwise be going through budget shortfalls don't suffer. But it's ridiculous that the federal government is telling my state government what it can and can't do with what's effectively its own money, while I'm subsidizing healthcare for people in other states.) As sort of a meta-point, the USA is maybe more like 10 or 15 different countries. Sure, there's a lot of difference in needs, values, and attitudes between someone living in Wyoming vs. Baltimore, but the people who live in DC, Baltimore, San Francisco, and Chicago have a lot in common. As do people living in Wyoming and Montana. They're not the same, but they likely have enough in common for single solutions to many problems to apply equally, or equally enough. I'm encouraged by states in the same geographic area coordinating their COVID-19 response; it shows that states with similar needs can (and should!) band together to tackle common issues where the solutions are likely to be similar.

nlfwhulsdhouv 7y ago

No it's not, and the US is far from the only country that has a diversity of culture. The Canadian maritime provinces are extremely different from Nunuvut or downtown Vancouver. Paris is significantly difference than Nice. Shanghai is significantly different than Xinjiang province. This is yet another annoying expression of American exceptionalism. Of course, it only ever comes up when someone says, "Maybe we should stop people dying because they can't afford healthcare." The US is probably one of the most culturally uniform countries of any significant size I can think of honestly.

whytaka 7y ago

What's interesting though is that states that reject the notion of safety nets because "one size does not fit all" are doing the worst. Perhaps if they gave it a try, they might see that it does fit. But then we see that the problem is actually that of bought politicians.