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With an aging population and increasingly long work lives, individual stressors will increase and societal capacity for healthcare (and overall prosperity) will

With an aging population and increasingly long work lives, individual stressors will increase and societal capacity for healthcare (and overall prosperity) will dwindle. Baby boomers, having lived through some of the most incredible growth in human history, will perhaps turn out to be an anomalous blip in the life expectancy stats. Also, people age differently. There's a difference between living and being alive. Not that it's an easy problem to solve, what with the demographics being what they are. I think we'll have to get used to the thought - and reality - of sinking living standards in the west.

HenryBemis 1y ago
You get downvoted a lot, but I challenge anyone to name a country that hasn't slashed _hard_ social benefits, pensions, % of GDP for healthcare, and similar.. I get it that some countries have had a plethora of scammers (prescribing pregnancy meds to men so docs can hit quotas and get bonuses/bribes from pharmaceutical companies, people trying to fake blindness to get an early retirement, etc. But overall reduction of cost with reduction of salaries will ultimately lead to worse healthcare. A friend was in Germany skiing this past winter. The 10k population town he was staying didn't have a paediatrician and they had to drive 2h to get care for their kid. In Germany, in 2025. I wonder how this very town will be in 2030 or 2050 with that trend..
- arexxbifs 1y ago
  It's a tough reality to face. Problems are piling up for the west that aren't easily solved, and not just with social benefits. Something as mundane as aging sewage systems is starting to become a real problem in many countries.
  - nradov 1y ago
    Demographic collapse is hardly unique to "the west". Have a look at the population age histogram in China, South Korea, and Japan.
    - arexxbifs 1y ago
      Absolutely. I seem to recall South Korea having a TFR well below one last time I checked. That doesn't mean we're not facing problems in the west, and specifically the Nordic countries, which is what TFA is about.
    - HenryBemis 1y ago
      Both to you and the parent: I don't think that in a 10k ski-town there aren't kids. They definitely got 'young' people living there having kids. I was reading the Systemantics yesterday and they discuss how a 'system' does not 'solve' a problem, but it breaks it down to smaller (easier to hide) problems. The book uses as an example the "garbage collection in a town", and how this one-big-problem breaks down to 100-small-problems. So the "we need rebalance our fiscal blah-blah" eventually breaks down to "no extended leave for new mothers", "not every doc-specialization in towns below 50k", and so on.
- devilbunny 1y ago
  > docs can hit quotas and get bonuses/bribes from pharmaceutical companies This is a common thought. It is incorrect. I’m a doctor. I have gotten pharma money for talking for their drug once, which was absolutely game-changing and which I would speak for without money (sugammadex is the generic name, if you want to look it up). I get lunch twice a year. The age of free vacations is long gone.
- kulahan 1y ago
  I have similar concerns. We have nurses watching way more patients, working unbelievable hours. 16 hour shifts with no notice, 60 hour work weeks, and often disgusting work does not make for an attractive field, so I’m not surprised there’s a massive shortage issue. This will probably only get significantly worse in the Certified Nursing Assistant field which mainly involves the most manual of labors - changing bed pans, cleaning patients, etc. with many of the same shortage problems. (And way less pay, of course)
jodrellblank 1y ago
> "societal capacity for healthcare (and overall prosperity) will dwindle" This is not a complete discussion without the elephant in the room - diet and lifestyle are making us sick and much of that is a choice of how we design our world. most Americans and Britons are overweight or obese, and the Coca Cola company and Nestle and all the rest are doing everything they can to encourage their product sales, and society is not doing much to counter it. [smoking deaths halved in the UK between 1990 and 2021 [0]] America and the UK are car-centric, the CDC says less than half of Americans meet the guidelines for physical exercise[1] and UK Gov says 1 in 3 men and 1 in 2 women are not active enough for good health[2]. People say that if the health benefits of exercise could be bottled up and sold, it would be one of the most potent drugs known, and we're designing places and lives which get rid of it as a regular part of life, and make it harder to add in. UK Gov link says "can help to prevent and manage over 20 chronic conditions and diseases, including some cancers, heart disease, type 2 diabetes and depression". There's millions of people with type 2 diabetes, which is reversible for many people with low-carb eating and fasting and exercise. The Lancet[4] paper saying 4.5 million people were diagnosed with liver disease in the USA in 2021 and alcohol is responsible for almost 60% of cirrhosis cases. Then there's cities which build car-dependent suburbs, so they can get money today from new build taxes, but set themselves up for large maintenance bills paying for the sprawling roads and water/sewer/electric infrastructure with such a sparse tax base. This is bankrupting cities in North America, which are having to allow more sprawling suburbs today to pay for yesterday's suburb's maintenance in a pyramid style. Then there's big box stores[3] which sued state governments to stop taxing them as functioning businesses on the grounds that they build their buildings so shoddily they are completely worthless to sell to anyone else or use for anything else, and should be taxed like an empty valueless building. Walmart pays employees so little that many of them need food stamps (SNAP) and those get used at Walmart which then moves the money out of state. Big box stores make cities poorer. When cities and states say there's no money for pensions, care homes, social services, health services, public transport, it's they're busy mismanaging it and spending it all on subsidising wealty car-dependent suburbanites and 'prestigious' big box store developments. Not to mention health insurance middlemen denying treatments and taking money from the sick and wasting the time of healthcare professionals tying them up in paperwork. If things were better, with more long-term thinking, people would be healthier and need less support for that reason, things would be closer and easier for people to walk/use public transport to get there so they could remain independent longer in declining health, healthcare would be a lesser demand on society, and there would be more money available to fund it. Then add the 'missing-middle' of American housing so people who have aged and their kids have left could downsize to a smaller home in the same area with the same community, and they would have a more manageable home and more of their money for healthcare. This is like writing a bubble sort and then declaring that sorting is too expensive so we just can't have sorting in the future. [0] https://ourworldindata.org/smoking https://ourworldindata.org/smoking [1] https://www.cdc.gov/nchs/fastats/exercise.htm https://www.cdc.gov/nchs/fastats/exercise.htm [2] https://www.gov.uk/government/publications/physical-activity-applying-all-our-health/physical-activity-applying-all-our-health https://www.gov.uk/government/publications/physical-activity... [3] https://thecounter.org/how-dark-stores-loophole-helps-retailers-evade-taxes-walmart/ https://thecounter.org/how-dark-stores-loophole-helps-retail... [4] https://www.thelancet.com/journals/lanchi/article/PIIS2468-1253(23)00361-8/abstract https://www.thelancet.com/journals/lanchi/article/PIIS2468-1...

HenryBemis 1y ago

You get downvoted a lot, but I challenge anyone to name a country that hasn't slashed _hard_ social benefits, pensions, % of GDP for healthcare, and similar.. I get it that some countries have had a plethora of scammers (prescribing pregnancy meds to men so docs can hit quotas and get bonuses/bribes from pharmaceutical companies, people trying to fake blindness to get an early retirement, etc. But overall reduction of cost with reduction of salaries will ultimately lead to worse healthcare. A friend was in Germany skiing this past winter. The 10k population town he was staying didn't have a paediatrician and they had to drive 2h to get care for their kid. In Germany, in 2025. I wonder how this very town will be in 2030 or 2050 with that trend..

arexxbifs 1y ago
It's a tough reality to face. Problems are piling up for the west that aren't easily solved, and not just with social benefits. Something as mundane as aging sewage systems is starting to become a real problem in many countries.
- nradov 1y ago
  Demographic collapse is hardly unique to "the west". Have a look at the population age histogram in China, South Korea, and Japan.
  - arexxbifs 1y ago
    Absolutely. I seem to recall South Korea having a TFR well below one last time I checked. That doesn't mean we're not facing problems in the west, and specifically the Nordic countries, which is what TFA is about.
  - HenryBemis 1y ago
    Both to you and the parent: I don't think that in a 10k ski-town there aren't kids. They definitely got 'young' people living there having kids. I was reading the Systemantics yesterday and they discuss how a 'system' does not 'solve' a problem, but it breaks it down to smaller (easier to hide) problems. The book uses as an example the "garbage collection in a town", and how this one-big-problem breaks down to 100-small-problems. So the "we need rebalance our fiscal blah-blah" eventually breaks down to "no extended leave for new mothers", "not every doc-specialization in towns below 50k", and so on.
devilbunny 1y ago
> docs can hit quotas and get bonuses/bribes from pharmaceutical companies This is a common thought. It is incorrect. I’m a doctor. I have gotten pharma money for talking for their drug once, which was absolutely game-changing and which I would speak for without money (sugammadex is the generic name, if you want to look it up). I get lunch twice a year. The age of free vacations is long gone.
kulahan 1y ago
I have similar concerns. We have nurses watching way more patients, working unbelievable hours. 16 hour shifts with no notice, 60 hour work weeks, and often disgusting work does not make for an attractive field, so I’m not surprised there’s a massive shortage issue. This will probably only get significantly worse in the Certified Nursing Assistant field which mainly involves the most manual of labors - changing bed pans, cleaning patients, etc. with many of the same shortage problems. (And way less pay, of course)

jodrellblank 1y ago

> "societal capacity for healthcare (and overall prosperity) will dwindle" This is not a complete discussion without the elephant in the room - diet and lifestyle are making us sick and much of that is a choice of how we design our world. most Americans and Britons are overweight or obese, and the Coca Cola company and Nestle and all the rest are doing everything they can to encourage their product sales, and society is not doing much to counter it. [smoking deaths halved in the UK between 1990 and 2021 [0]] America and the UK are car-centric, the CDC says less than half of Americans meet the guidelines for physical exercise[1] and UK Gov says 1 in 3 men and 1 in 2 women are not active enough for good health[2]. People say that if the health benefits of exercise could be bottled up and sold, it would be one of the most potent drugs known, and we're designing places and lives which get rid of it as a regular part of life, and make it harder to add in. UK Gov link says "can help to prevent and manage over 20 chronic conditions and diseases, including some cancers, heart disease, type 2 diabetes and depression". There's millions of people with type 2 diabetes, which is reversible for many people with low-carb eating and fasting and exercise. The Lancet[4] paper saying 4.5 million people were diagnosed with liver disease in the USA in 2021 and alcohol is responsible for almost 60% of cirrhosis cases. Then there's cities which build car-dependent suburbs, so they can get money today from new build taxes, but set themselves up for large maintenance bills paying for the sprawling roads and water/sewer/electric infrastructure with such a sparse tax base. This is bankrupting cities in North America, which are having to allow more sprawling suburbs today to pay for yesterday's suburb's maintenance in a pyramid style. Then there's big box stores[3] which sued state governments to stop taxing them as functioning businesses on the grounds that they build their buildings so shoddily they are completely worthless to sell to anyone else or use for anything else, and should be taxed like an empty valueless building. Walmart pays employees so little that many of them need food stamps (SNAP) and those get used at Walmart which then moves the money out of state. Big box stores make cities poorer. When cities and states say there's no money for pensions, care homes, social services, health services, public transport, it's they're busy mismanaging it and spending it all on subsidising wealty car-dependent suburbanites and 'prestigious' big box store developments. Not to mention health insurance middlemen denying treatments and taking money from the sick and wasting the time of healthcare professionals tying them up in paperwork. If things were better, with more long-term thinking, people would be healthier and need less support for that reason, things would be closer and easier for people to walk/use public transport to get there so they could remain independent longer in declining health, healthcare would be a lesser demand on society, and there would be more money available to fund it. Then add the 'missing-middle' of American housing so people who have aged and their kids have left could downsize to a smaller home in the same area with the same community, and they would have a more manageable home and more of their money for healthcare. This is like writing a bubble sort and then declaring that sorting is too expensive so we just can't have sorting in the future. [0] https://ourworldindata.org/smoking https://ourworldindata.org/smoking [1] https://www.cdc.gov/nchs/fastats/exercise.htm https://www.cdc.gov/nchs/fastats/exercise.htm [2] https://www.gov.uk/government/publications/physical-activity-applying-all-our-health/physical-activity-applying-all-our-health https://www.gov.uk/government/publications/physical-activity... [3] https://thecounter.org/how-dark-stores-loophole-helps-retailers-evade-taxes-walmart/ https://thecounter.org/how-dark-stores-loophole-helps-retail... [4] https://www.thelancet.com/journals/lanchi/article/PIIS2468-1253(23)00361-8/abstract https://www.thelancet.com/journals/lanchi/article/PIIS2468-1...