4 ms·

From an outsider perspective the obvious goals to fix is health care, homelessness and housing. For some reason people jump into completely tangential things li

by 127 4y ago

From an outsider perspective the obvious goals to fix is health care, homelessness and housing. For some reason people jump into completely tangential things like UBI. America has both the strength and intelligence. Does it have the will? If not, why?

fwip 4y ago
American systems (both governmental and corporate) are really complex. Much of the call for UBI is based on the recognition that living in America only really works if you have money. Giving everybody "enough" money seems simpler than reforming all of our broken systems. (Opinions are divided on whether UBI should replace, or only supplement, existing welfare schemes). Supporting quote from the article: > Americans who fall on hard times can access a panoply of different schemes, at both a local and a federal level. There are disability benefits; food stamps; section 8 housing vouchers; Medicaid; and unemployment insurance (which is paid for and administered by states, but in crises often expanded federally). Most of this comes with an extraordinary amount of bureaucracy, however, and many people fall through the cracks—for example, because they do not have a permanent address, or they fail to file the right forms, or they do not qualify. Local governments generally do not have the data to even identify the people most in need.
- treis 4y ago
  UBI is the recognition that what we pay in services to the poor is more than enough money for them to buy what they need on the open market. The problem is that money is locked up by the bureaucracy who pilfers most of it. Or at least that's what the argument is. I also think this is country thing. Europe tends to have job markets where private jobs aren't much different than government ones. In the US the difference is stark. Government jobs are basically for life while private ones can fire you the next minute. For all it's drawbacks the ability to fire quickly has a marked effect on business efficiency. There's potentially a large efficiency gain by moving employment from government to private sector. Or at least so the argument goes.
nradov 4y ago
Healthcare can't be fixed. We are headed over a demographic cliff with an aging population and an increasing incidence of chronic metabolic diseases caused by lifestyle factors. Those patients have effectively infinite demand for healthcare. Switching to a single-payer system or nationalizing provider organizations or whatever won't fix the root cause. So, we are going to end up with longer queues, lower service quality, and more explicit rationing no matter what we do. If we want to maintain a high-quality healthcare system, then the only option will be to reduce demand through incentivizing people to make healthier lifestyle choices. That will require sweeping, systemic changes and may not be politically feasible.
- cudgy 4y ago
  Changing the world’s behavior is the most feasible solution? That seems like the least feasible solution. Also, what good is a high quality healthcare system if it is only accessible to a fraction of society?
  - wizofaus 4y ago
    I'd think COVID demonstrated that people's behaviour at a society-wide scale can be changed surprisingly easily.
  - nradov 4y ago
    I didn't claim that changing the world's behavior is feasible. It may not be. But given the horrific human cost of having so many people become obese and diabetic I think we ought to try. What's the alternative? It's not going to be politically or economically practical to devote a larger share of GDP to healthcare, and minor improvements from increasing automation or reducing waste won't be sufficient.
- midoridensha 4y ago
  Over here in reality, other countries with even more aging populations have little trouble providing good healthcare for everyone at reasonable cost. The problem in the US isn't old people, it's a horribly-designed system.
hackerlight 4y ago
> Does it have the will? If not, why? Because of corruption of politics by vested interests that will vote out politicians that actually try to change things (e.g. by allowing insulin to be imported, or by allowing home construction). A UBI is more widely palatable because it isn't threatening to stop anyone's unjust gravy train.
- dsfyu404ed 4y ago
  >A UBI is more widely palatable because it isn't threatening to stop anyone's unjust gravy train. Except everyone who peddles the existing programs UBI is supposed to be replacing.
wizofaus 4y ago
A meaningful UBI means everyone has enough to purchase all essentials, including health care and housing. So why consider it tangential? The only thing UBI won't help with is if the difficulties of providing adequate healthcare and housing are down to supply-side blockages that injecting more money into the system can't solve (e.g. the limited ability of colleges & universities to train sufficient healthcare professionals might be something that's unlikely to improve much on its own, but if one of the main reasons for this is the lack of students willing to take on the necessary financial commitment, the provision of a UBI to said students would surely help. Of course, the easier solution, which Australia relies heavily on, is to explicitly attempt to attract such professionals from overseas, but that's hardly sustainable unless other countries are already producing a surplus. But in fact many of the countries we attract healthcare professionals from already have their own shortages).
- erik_seaberg 4y ago
  Med schools have more graduates than there are residency positions for (which is required to be licensed to practice). For historical reasons the residency system mostly relies on federal funding, rather than supply and demand.
  - naveen99 4y ago
    There are 50% more us residency spots than there are us medical graduates. the situation is likely the opposite in countries that send their medical graduates to U.S. residencies. License to practice in most us states only requires a 1 years internship and passage of usmle step3. Most residencies are 3-4 years, but those are required to pass board exams and usually required for hospital credentials. But you already have a license to practice while in residency (where in fact you are already practicing medicine (although with some supervision)).
    - erik_seaberg 4y ago
      Really? I keep hearing stories about graduates who gave up on the field because all the residency programs were full. The training license is for a limited time, right?

by 127 4y ago

fwip 4y ago

American systems (both governmental and corporate) are really complex. Much of the call for UBI is based on the recognition that living in America only really works if you have money. Giving everybody "enough" money seems simpler than reforming all of our broken systems. (Opinions are divided on whether UBI should replace, or only supplement, existing welfare schemes). Supporting quote from the article: > Americans who fall on hard times can access a panoply of different schemes, at both a local and a federal level. There are disability benefits; food stamps; section 8 housing vouchers; Medicaid; and unemployment insurance (which is paid for and administered by states, but in crises often expanded federally). Most of this comes with an extraordinary amount of bureaucracy, however, and many people fall through the cracks—for example, because they do not have a permanent address, or they fail to file the right forms, or they do not qualify. Local governments generally do not have the data to even identify the people most in need.

treis 4y ago
UBI is the recognition that what we pay in services to the poor is more than enough money for them to buy what they need on the open market. The problem is that money is locked up by the bureaucracy who pilfers most of it. Or at least that's what the argument is. I also think this is country thing. Europe tends to have job markets where private jobs aren't much different than government ones. In the US the difference is stark. Government jobs are basically for life while private ones can fire you the next minute. For all it's drawbacks the ability to fire quickly has a marked effect on business efficiency. There's potentially a large efficiency gain by moving employment from government to private sector. Or at least so the argument goes.

nradov 4y ago

Healthcare can't be fixed. We are headed over a demographic cliff with an aging population and an increasing incidence of chronic metabolic diseases caused by lifestyle factors. Those patients have effectively infinite demand for healthcare. Switching to a single-payer system or nationalizing provider organizations or whatever won't fix the root cause. So, we are going to end up with longer queues, lower service quality, and more explicit rationing no matter what we do. If we want to maintain a high-quality healthcare system, then the only option will be to reduce demand through incentivizing people to make healthier lifestyle choices. That will require sweeping, systemic changes and may not be politically feasible.

cudgy 4y ago
Changing the world’s behavior is the most feasible solution? That seems like the least feasible solution. Also, what good is a high quality healthcare system if it is only accessible to a fraction of society?
- wizofaus 4y ago
  I'd think COVID demonstrated that people's behaviour at a society-wide scale can be changed surprisingly easily.
- nradov 4y ago
  I didn't claim that changing the world's behavior is feasible. It may not be. But given the horrific human cost of having so many people become obese and diabetic I think we ought to try. What's the alternative? It's not going to be politically or economically practical to devote a larger share of GDP to healthcare, and minor improvements from increasing automation or reducing waste won't be sufficient.
midoridensha 4y ago
Over here in reality, other countries with even more aging populations have little trouble providing good healthcare for everyone at reasonable cost. The problem in the US isn't old people, it's a horribly-designed system.

hackerlight 4y ago

> Does it have the will? If not, why? Because of corruption of politics by vested interests that will vote out politicians that actually try to change things (e.g. by allowing insulin to be imported, or by allowing home construction). A UBI is more widely palatable because it isn't threatening to stop anyone's unjust gravy train.

dsfyu404ed 4y ago
>A UBI is more widely palatable because it isn't threatening to stop anyone's unjust gravy train. Except everyone who peddles the existing programs UBI is supposed to be replacing.

wizofaus 4y ago

A meaningful UBI means everyone has enough to purchase all essentials, including health care and housing. So why consider it tangential? The only thing UBI won't help with is if the difficulties of providing adequate healthcare and housing are down to supply-side blockages that injecting more money into the system can't solve (e.g. the limited ability of colleges & universities to train sufficient healthcare professionals might be something that's unlikely to improve much on its own, but if one of the main reasons for this is the lack of students willing to take on the necessary financial commitment, the provision of a UBI to said students would surely help. Of course, the easier solution, which Australia relies heavily on, is to explicitly attempt to attract such professionals from overseas, but that's hardly sustainable unless other countries are already producing a surplus. But in fact many of the countries we attract healthcare professionals from already have their own shortages).

erik_seaberg 4y ago
Med schools have more graduates than there are residency positions for (which is required to be licensed to practice). For historical reasons the residency system mostly relies on federal funding, rather than supply and demand.
- naveen99 4y ago
  There are 50% more us residency spots than there are us medical graduates. the situation is likely the opposite in countries that send their medical graduates to U.S. residencies. License to practice in most us states only requires a 1 years internship and passage of usmle step3. Most residencies are 3-4 years, but those are required to pass board exams and usually required for hospital credentials. But you already have a license to practice while in residency (where in fact you are already practicing medicine (although with some supervision)).
  - erik_seaberg 4y ago
    Really? I keep hearing stories about graduates who gave up on the field because all the residency programs were full. The training license is for a limited time, right?