6 ms·

>But maybe I just don’t understand your country well enough? You really don't. You live in a country that is either 11 million or 6 million people with fully e

>But maybe I just don’t understand your country well enough? You really don't. You live in a country that is either 11 million or 6 million people with fully enforceable border controls and immigration controls. You can control who comes into you country. You can control the goods that come into your country. Your population rivals one of the larger metropolitan areas of the USA. Problems don't scale linearly. At 6 million people you can afford to fund pensions through nothing but an oil extracting operation out of your country. 7.7% Unemployment at 11 million people is, believe it or not, much less debilitating than 4% unemployment at 332 million people. There are more unemployed persons than the entire population of Sweden. And these populations cluster, and they depress local economies, and they drain their local workforce and social services. Then crime happens, and populations move, and housing prices fluctuate, and then this spreads. But here's the trick: You only need so much space to live. So much money to eat. So much space to grow food. You only have so many hours in the day you can work. Any doctor can see 20 patients a day, spending 30 minutes on each consultation. You don't need that many doctors to meet that demand at 6 million people. You need a lot more doctors to meet that demand at 332 million. Costs and living standards are relatively fixed beyond a tolerable level of comfort. Scandinavian countries achieved this comfort. But this comfort doesn't scale. Because problems don't scale linearly. Back to borders and immigration: You control your borders. You can say that drugs don't enter your country. And they won't (at scale, at least). In the USA that's not enforceable because the country is so large. Illinois can say that they ban guns. But that doesn't stop them from going to Indiana and getting them. Or Kentucky. Or Missouri. Your local change can only accomplish so much when you are against the tide of your neighbors. You can say that you want to control your borders. But your neighbors disagree. So they go around you controls and infiltrate your economy anyway. And you don't know how bad it really is. Because statistics are an approximation of a segment of a population that doesn't want to be tracked. But these people still get sick. And some costs are fixed. So your publicly funded hospitals still need money to cover their costs by people who will flee and not pay. So you privatize and offset the burden on the patient. Because people can pay for themselves to get a blood test. You relieve your burden on the system, for the moment. But now companies charge more because they also know that certain costs are fixed and people are willing to tolerate more costs for a relatively inexpensive service. And of course, they optimize. Because there's nothing stopping them. Since you can't tell them not to do something when you can't solve the problem yourself. And here we are.

shrimp_emoji 3y ago
The US is a massive, new, mostly empty frontier nation. It's ridiculous to expect the same level of social support as one has in relatively small, old, well-developed European nations. The GDP difference seems more than enough to counter it, maybe, but socially, geographically, and historically, the US is a relatively libertarian project where "high taxes and free healthcare" are anathema.
- badpun 3y ago
  > the US is a relatively libertarian project where "high taxes and free healthcare" are anathema. Isn't that just the last 4 decades though? Before that, US had very high taxes and was not against spending on social programs. That all changed with Reagan and after, but it's not some set of core American values, but rather just the current, and relatively recent, dogma.
nobodyandproud 3y ago
I want to help this train of thought along because this is interesting to me and I'd love to get a discussion going. > Back to borders and immigration: You control your borders. You can say that drugs don't enter your country. And they won't (at scale, at least). In the USA that's not enforceable because the country is so large. Illinois can say that they ban guns. But that doesn't stop them from going to Indiana and getting them. Or Kentucky. Or Missouri. Short of draconian measures like in China (also a very large country), which nobody wants. > Your local change can only accomplish so much when you are against the tide of your neighbors. You can say that you want to control your borders. But your neighbors disagree. So they go around you controls and infiltrate your economy anyway. And you don't know how bad it really is. Because statistics are an approximation of a segment of a population that doesn't want to be tracked. But these people still get sick. And some costs are fixed. So your publicly funded hospitals still need money to cover their costs by people who will flee and not pay. So you privatize and offset the burden on the patient. Because people can pay for themselves to get a blood test. You relieve your burden on the system, for the moment. But now companies charge more because they also know that certain costs are fixed and people are willing to tolerate more costs for a relatively inexpensive service. And of course, they optimize. Because there's nothing stopping them. Since you can't tell them not to do something when you can't solve the problem yourself. And here we are. This is what I want to dig into. The heart of this argument is that publicly funded hospitals are forced to cover for those who neither contributing to the system nor are paying out-of-pocket for it. > So your publicly funded hospitals still need money to cover their costs by people who will flee and not pay. So you privatize and offset the burden on the patient. Are you certain the EMTALA is really the cause of the problems we see today? I agree that it made it worse, but the cost of medical care was ballooning before the 1980s. I'm not sure what it was so I'd love to hear input from you or others. Still, you do bring up a good point: Given that you have individuals that can't contribute to the system even if they would otherwise and given that it will also balloon costs, how do we solve this? Perhaps its a taxation issue. I doubt this will ever get traction but I'd love to see a compromise where we replace the blanket constitutional right where "you're a citizen if you're born here" with something different but equivalent at the amendment level. Chasing down and returning migrants--this just funds the very problematic human traffickers--is a bandaid solution; it's inefficient; and it doesn't solve the needs of both Americans as well as our neighbors. Instead, why not just ID them on the spot--state level with RealID, to make it palatable--make them pay a fine that is effectively the cost of a tax to fund the public infrastructure; and make such an ID either the requirement of using the triage service. Or if they're undocumented, just treat them once and give them a choice after triage: Deportation or ID. Carelessly thought out, I think that this sets up a two-tier residency system ripe for abuse: If said "temp" residents had children, what's the status of their children, for example.

shrimp_emoji 3y ago

The US is a massive, new, mostly empty frontier nation. It's ridiculous to expect the same level of social support as one has in relatively small, old, well-developed European nations. The GDP difference seems more than enough to counter it, maybe, but socially, geographically, and historically, the US is a relatively libertarian project where "high taxes and free healthcare" are anathema.

badpun 3y ago
> the US is a relatively libertarian project where "high taxes and free healthcare" are anathema. Isn't that just the last 4 decades though? Before that, US had very high taxes and was not against spending on social programs. That all changed with Reagan and after, but it's not some set of core American values, but rather just the current, and relatively recent, dogma.

nobodyandproud 3y ago

I want to help this train of thought along because this is interesting to me and I'd love to get a discussion going. > Back to borders and immigration: You control your borders. You can say that drugs don't enter your country. And they won't (at scale, at least). In the USA that's not enforceable because the country is so large. Illinois can say that they ban guns. But that doesn't stop them from going to Indiana and getting them. Or Kentucky. Or Missouri. Short of draconian measures like in China (also a very large country), which nobody wants. > Your local change can only accomplish so much when you are against the tide of your neighbors. You can say that you want to control your borders. But your neighbors disagree. So they go around you controls and infiltrate your economy anyway. And you don't know how bad it really is. Because statistics are an approximation of a segment of a population that doesn't want to be tracked. But these people still get sick. And some costs are fixed. So your publicly funded hospitals still need money to cover their costs by people who will flee and not pay. So you privatize and offset the burden on the patient. Because people can pay for themselves to get a blood test. You relieve your burden on the system, for the moment. But now companies charge more because they also know that certain costs are fixed and people are willing to tolerate more costs for a relatively inexpensive service. And of course, they optimize. Because there's nothing stopping them. Since you can't tell them not to do something when you can't solve the problem yourself. And here we are. This is what I want to dig into. The heart of this argument is that publicly funded hospitals are forced to cover for those who neither contributing to the system nor are paying out-of-pocket for it. > So your publicly funded hospitals still need money to cover their costs by people who will flee and not pay. So you privatize and offset the burden on the patient. Are you certain the EMTALA is really the cause of the problems we see today? I agree that it made it worse, but the cost of medical care was ballooning before the 1980s. I'm not sure what it was so I'd love to hear input from you or others. Still, you do bring up a good point: Given that you have individuals that can't contribute to the system even if they would otherwise and given that it will also balloon costs, how do we solve this? Perhaps its a taxation issue. I doubt this will ever get traction but I'd love to see a compromise where we replace the blanket constitutional right where "you're a citizen if you're born here" with something different but equivalent at the amendment level. Chasing down and returning migrants--this just funds the very problematic human traffickers--is a bandaid solution; it's inefficient; and it doesn't solve the needs of both Americans as well as our neighbors. Instead, why not just ID them on the spot--state level with RealID, to make it palatable--make them pay a fine that is effectively the cost of a tax to fund the public infrastructure; and make such an ID either the requirement of using the triage service. Or if they're undocumented, just treat them once and give them a choice after triage: Deportation or ID. Carelessly thought out, I think that this sets up a two-tier residency system ripe for abuse: If said "temp" residents had children, what's the status of their children, for example.