I stand by this: Physicians in the US are some of the only people who are paid what they deserve, in terms of authentic human value delivered. And only in the US are they paid what they deserve. They deserve their semi-monopolistic trade union.
Admin bloat is a far larger problem, and so are the pharmaceutical companies which get to charge the government whatever they want to develop new drugs that often are only marginally effective.
I appreciate the defense of doctors wages for great work; I would agree that many doctors absolutely deserve it and more.
But this "semi-monopolistic trade union" not only inflates their wages (which maybe that's a good thing), but it also harms the lives of the population they purport to serve. Many (most imo) people in the US simply cannot afford the monopoly's prices, and the monopoly has little incentive to innovate. This cartel of doctors actively prevents lower-cost, more efficient alternatives from coming to market.
Linking blog articles that bury the lead behind paywall make it impossible to discuss anything.
However, at the core, US insurance system is the problem because it gets compounded by government trying to regulate such a system, so people do not die needlessly, but not destroy these profit seeking enterprises. So, what you end up with is a massive mess that leaves everybody cranky.
I'd have no problem if they were just a trade union. In fact they are a systemic machine of mass violence, capturing the regulatory apparatus of government to use men with guns to enforce their licensing regime which of course you must walk through the pearly gates of their institutions to be blessed under.
Speaking from experience, the only people who can afford to live as nursing home staff (typically LPNs) are the poor. In my metro area, only the presence of a large low-income high-crime area allows for a low enough cost of living for its residents to survive on nursing home pay. I think these folks can make more working at McDonalds. The quality of care is garbage... Less than 10% of nursing homes in my area provide the care I'd want for my relatives.
Oddly enough, even homes that advertise RNs and a high number of staff still don't provide the care I'd want for me relatives. The only homes I've been to where the staff are genuinely great are nursing homes out in the boonies, in rural areas at least an hour outside of my city.
I can echo this statement. My mother is in a nursing home facility for the last 8 years.
She is located in the facility she worked in as a poor laborer before becoming a resident. The facility is over an hour from the nearest metro area.
The care she receives there is pretty good. The staff are mostly locals in the rural town and are comfortable being poor and living that life.
We considered moving her into the city to be close to family who have to drive almost 3 hours to see her but the care is so bad in the city it isn’t worth it.
We have had family members in city nursing homes and they’re abysmal. Which to some level I get. The people there like you stated are underpaid and overworked. They live in bad neighborhoods because of systemic poverty. They bring all the stress of being poor in a metro city with them to work. Quality of care plummets but there’s nothing that can be done because no one is going to pay more than bare minimum to reach mandatory staff minimums.
> locals in the rural town and are comfortable being poor and living that life
> all the stress of being poor in a metro city
Is it generally accepted that people in similar economic circumstances have improved life satisfaction in rural areas? It is counterintuitive to me given any city typically has better low cost amenities like museums, libraries, and parks than rural areas that I have observed.
Think about how often you got to a museum, library, or park compared to how often you eat and pay the monthly bills. The more expensive the area, the higher the routine bills and wages don't always track that, especially at the low end.
Both have significant advantages, shared walls reducing energy costs and the ability to live without a car can make a huge difference at the bottom.
It’s really suburbs that end up the most expensive. You combine higher housing and labor costs vs rural areas without any of the cost savings of cities.
Some people prefer space, privacy, and nature over cultural amenities. It's possible to survive on fairly little income if you own some land and are able to hunt, fish, and grow a bit of your own food. Being poor is still tough anywhere but people get by.
> The quality of care is garbage... Less than 10% of nursing homes in my area provide the care I'd want for my relatives.
As a paramedic who delivered probably thousands of patients to (and picked up patients from) nursing homes, I'd unfortunately absolutely agree. Not always to the point of filing complaints, but not great.
> Oddly enough, even homes that advertise RNs and a high number of staff still don't provide the care I'd want for me relatives.
As that same paramedic, absolutely, you know why?
Many of those homes have ONE RN as the supervisor for a bunch of LPNs and CNAs. And they have policies/insurance/whatever that say "anything larger than a bandaid, call 911 and have them deal with it", which leads to ridiculous situations where you have two nurses standing around while my partner and I bandage a straightforward laceration.
Those are usually the ones advertising out front "Round the clock nursing care" (and absolutely charging for it).
There was an article here in HN how nurses and nursing home staff in a lot of US are basically using an "uber for Nursing" app where you get a request and you can accept it or not......but the company that built it has a "desperation" score on every nurse and the more desperate they are estimated to be, the less money they are offered for the job - the logic being that they are not in a position to refuse.
Honestly, the article literally made me want to vomit. I'm not religious but our society has sacrificed everything human in the worship of mammon.
The apps are ESHYFT, ShiftKey, ShiftMed, and CareRev. CareRev is a YC company (https://www.ycombinator.com/companies/carerev), so maybe the founders are around to explain the technical details of their desperation algorithm or why they allow employers to cancel shifts with 2 hours of notice.
Honest question - are you trying to downplay the absolute horror of our technofeudalistic society, where nurses(!!!) are paid in a gig economy betting on their hours, where (if you read the report) the hospitals are free to cancel their shifts with no or little penalty even during the shift, while nurses are heavily penalized on every side, and things like having a lot of debt means you will be offered less money for your shifts because the app determines you are desperate?
Yes sure, technically that's no different than Uber hiking up your price at 3am because really, what other choices do you have.
But I do hope you spend a minute to wonder what is it doing to our society as a whole, and how the relentless pursuit of profit means we treat people whose job is literally to look after others like disposable trash that can be priced the same way a taxi ride is.
Sure, it's "just a scary way to describe it" - and I hope it's really scary.
What you described is nothing new. Staffing firms for nurses have existed for a long time. These apps are automating the process and making it easier for both sides. I'm open to the idea that it's worse for workers but I haven't seen it. People seem to flock to these apps. To me that means they prefer the arbitrary and capricious nature of an algorithm over the arbitrary and capricious nature of human managers.
I'm sorry, what is your point then. Because I thought it was that the apps and hiring houses for nurses are effectively the same - which is why I'm asking if they also pay less if you have more debt.
For the company the algorithm works for? Yeah, no doubt about it. For the nurses? No, I don't believe that - unless like I asked earlier, the employment agencies also reduce their pay if they think they are desperate. In which case I'm happy to concede this point.
This highlights the problem with privatizing things like healthcare and education, something libertarians don't understand. It works for the Koch's because they can pay for anything. It doesn't work if you're not rich.
I wouldn't say privatizing is the problem. It isn't. Private is often, or generally, good, as it gives you the freedom to pursue good ends without unnecessary involvement of state bureaucracy. It's bad and weird to have the state involved in everything. It's for-profit that is problematic in the mentioned cases.
Healthcare, insurance, banking, education, and so on should be not-for-profits or nonprofits (depending on the case).
All nonprofit means is that you are not organized with profit as a primary goal. It doesn't mean you don't make money, and it doesn't mean that executives don't have outlandish compensation.
Main problem with non profits in my understanding is, that they are often created for tax evasion purposes, but the legit non profits still get the regulatory heat.
What is the incentive for a private entity to engage in non-profit business.. charity?
Nobody want's the state involved because they think they'll do a better job, they want the state involved because it's the last option available with incentives remotely aligned with the benefit of the polity.
I think most people with an understanding of economics would agree that more supply is needed. The problem is, zoning laws are made by the cities themselves, which means they are ultimately made by the people who already live there. People who already live there don't want their neighborhoods bulldozed for luxury high rises, which is what happens when zoning is abolished.
Then, there is the problem of the suburbs. A lot of people suggest moving to the suburbs and embracing a longer commute as the solution. The problem is, suburbs also control their own zoning laws, just like cities, and surprise - they also don't want their neighborhoods bulldozed for luxury apartments.
So the problem is essentially a power issue - who holds the power? Without the political power to make zoning changes, little new housing will be built. I don't see a solution here. So it seems that the local people embrace rent control as the best possible solution among alternatives. Viewed from that perspective, it's not so bad after all. The city's residents will feel the impacts, and if it's not working out, they will eventually repeal the law. Big deal.
I wish someone with a deeper understanding would go to Japan and study how they got this so right. Their zoning laws don't separate uses, only nuisance levels, so you often see residential in commercial areas and small shops in residential neighborhoods. It's amazingly effective at reducing how far you need to go to get places, and gives the whole city a much more organic feel. Plus, there is actually housing if there's demand for it.
Is it just Japanese cultural collectivism that made this work? How did they make this happen when we failed so badly? I have no idea.
There's definitely a cultural element but it's also due to how buildings are used in japan. Black mold makes it where you really don't want to deal with a structure over 40 years old so there's always things being destroyed and new structures being built rather than old structures being renovated; neighborhoods are in a constant turnover and buildings are disposable. All of urban Tokyo was also destroyed during WWII and had to be rebuilt in a new way.
In the U.S. you might have some neighborhoods that have been largely the same for the past 50-100 years. Since there's no absolute need to replace housing stock unless disaster, people are much more emotionally invested in the existing layouts of their neighborhoods, and advocate against their own economic interests by voting down new developments or zoning changes.
I actually thought of both of these and discounted both. Here's why.
Post-WW2 buildings in Japan were crap so I can see why they'd replace those. But I think recent buildings are a lot more long-term. My sense is that they replaced because of the post-WW2 cheap building boom, not because of the climate/mold. It's no warmer or wetter than many places in America, and northern Japan is quite dry and chilly.
For the "never bombed America" argument, I'd just point to Europe, which was bombed. Or to new American cities built 1950 onwards, which suffer the same problems. I'd also point to Kyoto, which wasn't destroyed in WW2, but is still functional in terms of real estate AFAIK (though I'd love to hear otherwise).
It’s actually pretty simple: housing isn’t an investment vehicle like it is in many parts of the West. The social and historical reasons why this is so in Japan are complicated, but the overall circumstances are not.
You can either have affordable housing that’s not an appreciating asset or let finance/real estate Capital run roughshod over everything in speculative flurries, leading to the insane state of affairs in many western cities today. You can’t have both.
I read today that Fortress Investments purchased over 100,000 affordable units from the Japanese government for 60bn JPY in 2017 and plans to spend about as much on renovation. [1] Apparently firms like this usually expect an 18% return on these kinds of investments.
Yes and if all of its housing tilts this way, Japan too will spiral into unaffordability. But most families still live in single family homes that depreciate in value over time.
you can have both as long as productivity is growing, increasing labor's bargaining power and wages
unfortunately productivity is pretty stagnant across developed economies, including japan
if capital and business owners have no need for new/enhanced labor as is the case in many developed economies where offshoring/new hire cycling is rampant, then a housing affordability crisis definitely builds up, unless:
(1) the municipal/federal government steps in to regulate rent as it has done in Berlin
(2) there is a good architectural/geological/tax incentive that prevents NIMBYISM
(3) cultural/work factors allow the younger gen to live at home/work remotely
Wait, housing is socialized in Japan? Or is there some kind of non-socialized-but-non-privatized ownership situation? Do you have any further reading on this?
This is spot-on. Completely agree. Tokyo is an incredibly comfortable, quiet city. Preparing for a three-week trip, I expected it to be like New York — crowded, expensive, uncomfortable — but it completely blew my mind. I had never thought that the constellation of density, quiet, reasonable rent, and a first-class city were collectively possible.
Japan overall or Tokio specifically? Because Tokio would be a bad example as it’s super dense and I think that is exactly what residents try to prevent
The program in question mainly benefits small and medium sized businesses, Amazon was an exception. So no, in fact, Amazon was not playing by any different rules than any other business expanding in or relocating to NY state.
Should be noted while that program was a significant part of the funding, Cuomo promised about 300 million extra ontop, it was not solely from the excelsior program.
Yes! This book also got me to read Walden by Henry David Thoreau, which was also life changing.
I never fully understood what Pirsig meant by Quality though. I could not understand what it really was, but I didn’t need to. I got so much good out of the book. But if someone could explain better I’d love to hear.
My personal understanding is that much of the point of the book is less to give you a direct understanding of Quality itself, which he says is not directly understandable, but to surround the concept, give you the parameters, where it is where it isn't, being able to identify it when you see it.
Also consider that it is important to the people who have read them. Many people claim that reading Dostoevsky changed their lives, gave them much more purpose, and helped them define who they are and want to be.
Great literature helps you understand the world, and yourself. It helps peel back that onion.
Follow your inner voice. Sounds like it’s telling you to look seriously at grad school. Most people I find will tell you to not do it, but I say go for it. Don’t worry about the social risk; it’s just because you’re outside of the academic sphere right now.
Admin bloat is a far larger problem, and so are the pharmaceutical companies which get to charge the government whatever they want to develop new drugs that often are only marginally effective.