>I understand that some people would look at that list and say I should have never expected some of those, but pardon me for being propagandized at a very young age that we lived in a country that was good and just. That's my bad
I think the problem is that you were raised to think that a "good and just" world is one where there is no risk, no variability, and limited self-reliance. This is a fiction and has never existed.
The default state is for none of these services and protections to exist whatsoever. Everything beyond nothing is an imperfect and unstable solution held together with duct-tape.
Honestly, as a society we should be able to guarantee most if not all of those. Every single one of them is an economic trade-off and when you put for profit companies in the loop, it’s obvious that they will prioritize their profits.
The system is for profit by choice, it is under our control as society to guarantee that list or not, and we have chosen not to.
Might be the right or wrong decision, that’s up to each of you, but denying it’s has been chosen it’s very naive
It's beyond economic trade-off. You're talking about full perfect control over people's behaviours.
> That things that are legal to put in your body will not cause irreparable harm to you
You can get water intoxication by literally drinking too much clean water. How are you going to get anywhere close to controlling that?
> That your medical professional knows what they are talking about
You just lost all medical staff, because they're people and people make mistakes. Even when they don't, people are extremely fuzzy puzzles and we don't have enough tests available to do precise diagnosis of lots of things.
The challenge with medicine, if one is dealing with a known condition, there's a known intervention. And Any number of simple and straightforward tests will make it easy.
It's with the unknown conditions, that doesn't fall into the mental flow chart of a medical professional's mental model are SOL.
The real answer to most folk's chronic conditions are lifestyle interventions, but of course, medical professionals most difficult challenge is ensuring compliance. The only tools available for a medical professional to a patient is to beg, plead, threaten, yell, discuss the interventions till they are blue in the face, but unfortunately, you can lead a horse to water, but can't force them to drink.
The elephant in the room that no one wants to admit is that a lot of health issues are both self-inflicted through lifestyle choices, and it creates an negative feedback loop of demand for professionals to be able to truly have more time to care for the patients that truly need help.
I think a decent number of them are non-economic statements, particularly the motives for doctors, insurance, and interests.
>The system is for profit by choice, it is under our control as society to guarantee that list or not, and we have chosen not to.
The system is for profit by choice, because most people care about themselves. It would very hard to make your doctor care more about your life than theirs, or care about your kids more than their kids.
You can institute harsh criminal penalties for doctors like some suggest in this thread, but even then, they are still putting themselves first.
Im not sure I'm "denying" any choice. Im just stating how it is. I have no doubt the world would be different if people chose different - which is a tautological claim.
I dont think it is depressing. I think it is marvelous and a testament to human engineering, perseverance, and collective spirit that we hold things together.
As I said down thread, it is something to be grateful for, given that we are always one major catastrophe away from robbing and killing each other in the street.
While sure, things could be better, I think it is overly cynical to consider the status quo garbage. If you wanna see some real garbage, go to Haiti, Donetsk, or Liberia and report back about US society isnt "good and just".
I'd challenge you to attack it logically on it's merits. I think parent poster is obvipusly right, civilization exists on a precipice at all times. The natural state of the universe is toward entropy.
That's not to say we can't make it better, just that we should have no illusions about its stability.
> I think the problem is that you were raised to think that a "good and just" world is one where there is no risk, no variability, and limited self-reliance.
I think that children are generally raised to not believe there is "risk" associated with listening to experts. This means specialists like Doctors but also politicians and military officials.
The idea that there could be a grift set up to take advantage of people in the medical space, for instance, which is highly regulated and supposed to be for the benefit of people first and for generating capital second, is not intuitive to children.
In fact a wide array of industries and services in the United States, and the world (to not be political, as some commenter said) are set up to take advantage of children or naive young adults.
Secondary education and student loans is a glaring example of this.
> The default state is for none of these services and protections to exist whatsoever
In all of human history this is mostly untrue. Humans have always formed societies, and those societies have always provided services for their people. In fact, before capitalism, most of these services were provided in-kind as a right of being a part of the tribe.
This idea that every person is born as an individual and nothing is granted to them belongs to a certain political ideology that is designed to make sure people feel entitled to nothing, and keep things in the private industry, and keep government small. But I digress.
Of course someone has to provide the service, and collect the materials for the service. And that person deserves to be compensated for that work. But the idea that the default state of a human is to be alone with nature and subject to pure individualism is simply not true, and never has been the norm, until that idea was used to justify not providing people with anything.
> Everything beyond nothing is an imperfect and unstable solution held together with duct-tape
This idea is also untrue. We've had a lot of time to perfect these things. If we can build skyscrapers and infrastructure to maintain them, we can provide these services. You are conflating political ideology and economic motivation with literal ability. The ability is absolutely there, and was in the past as well. There is something different going on that causes these systems to be "held together with duct-tape" and it's actually other humans actively trying to destroy these systems, not that they are impossible.
I almost completely agree, and think we mainly disagree on the nuances.
>The idea that there could be a grift set up to take advantage of people in the medical space, for instance, which is highly regulated and supposed to be for the benefit of people first and for generating capital second, is not intuitive to children.
The first thing I wanted to touch on is the idea of grift. Just because some has their interests ahead of yours doesn't mean they are a grifter. I think the childish view is the expectation that other people put your interests above their own, like the selflessness of a loving parent. A doctor doesnt put your individual wellbeing above their own, but that doesnt make them a grifter or a bad person. Expecting that kind of selflessness is entirely unrealistic, and is what causes cognitive dissonance when it clashes with reality. Thats not to say that grifters dont exist, who actively manipulate and deceive, but simply having unrealistic expectations for something does not make it a grift.
One example would when a doctor doesn't provide the depth of care and consideration the patient wants or would expect from a selfless caregiver. Most people come to the realization that they need to provide the drive and motivation for their own care, and doctors are just hired experts to help with things you cant do. You have to manage them and tell them what you want them to do. If you dont manage them like hired help, they will do very little indeed.
>Humans have always formed societies, and those societies have always provided services for their people. In fact, before capitalism, most of these services were provided in-kind as a right of being a part of the tribe. This idea that every person is born as an individual and nothing is granted to them belongs to a certain political ideology that is designed to make sure people feel entitled to nothing, and keep things in the private industry, and keep government small. But I digress.
I didnt mean to say that everyone is an island and forever alone. I mean that these things are not guaranteed entitlements, but conditional on human relations, standing, and mutual exchange. That is to say, they took work to maintain and were subject to constant scrutiny and mutual consent. Even in a tribe, goods and services were not provided unconditionally as some human birthright associated with tribal membership. Instead, they were conditional on good standing and mutual consent.
>This idea is also untrue. We've had a lot of time to perfect these things. If we can build skyscrapers and infrastructure to maintain them, we can provide these services. You are conflating political ideology and economic motivation with literal ability. The ability is absolutely there, and was in the past as well. There is something different going on that causes these systems to be "held together with duct-tape" and it's actually other humans actively trying to destroy these systems, not that they are impossible.
Im not arguing that beneficial institutions and functional societies are beyond human ability. Im saying their existence should not be taken for granted.
The quality of the American medical system has deteriorated to such a point that if the Doctors are not the grifters they may at least be culpable for enabling the grift.
That hasn't been my experience. I have never experienced or heard of a doctor deceiving or lying in real life. I dont think I can think of an example from hospitals either.
I've had dentists discover that I needed a filling after they found out how good my dental insurance was. Their justification was that the tooth seemed "soft". They never took an X-ray or provide any other data than that.
I don't know, but in hindsight I would have asked for an X-Ray. I think it was a borderline call and they went on the side of doing it because I had good insurance.
I don't see anything wrong or nefarious with deciding a borderline call based on ability to pay.
Better preventative medicine and proactive treatment is one of the perks of having good insurance, so I would expect a recommendation from a good dentist to take it into account.
Ideally there is some discussion, but at the same time, the idea that someone with great insurance would want to use it seems a reasonable assumption.
> I have never experienced or heard of a doctor deceiving or lying in real life.
Meet Dr. Stella Immanuel who tells her patients that medications are made from alien DNA and that their illnesses are caused by demon sperm. In the USA she gets to keep her medical license/practice. (https://en.wikipedia.org/wiki/Stella_Immanuel)
See also: every doctor that accepted bribes from Purdue Pharma in exchange for knowingly prescribing excessive amounts of opioids to people who never needed them.
I actually really liked that article and how it at least tried to present both sides. However, I tend to agree with the opposing side, but think there are some edge cases that could be improved. I have spent my career working in drug and device development so I probably have a more nuanced view informed by my experience. I have payed millions to doctors, and think my actions are justified.
One thing that the article touched on that I like is the role of non-industry associations, which I think could do a lot more to spread information. However, there's no one that will pay them to do it.
> I have payed millions to doctors, and think my actions are justified.
You aren't at all worried that paying those doctors will result in them prescribing something to a patient when they might not have otherwise or influence their choice for one option over another? I'm not talking about the education or awareness a doctor might get, purely the influence of the money/benefits and perhaps their hope to get more of the same from you later.
The vast majority of the payments are either education or payment for services rendered, like the article mentions.
At a high level, companies actually think their products have value to patients and want doctors to know about what it can do. It is virtually impossible to decouple knowledge sharing from influence. The point of knowledge sharing is to impact choice and behavior.
On the services front, If I want to hire a doctor to fly across the country and do Brian surgery on a pig or cadaver, I expect to have to pay them. Similarly, if they are running a clinical trial, I expect to fly them to the surgical training and feed them, and pay for their time.
>purely the influence of the money/benefits and perhaps their hope to get more of the same from you later.
Direct kickbacks for prescriptions are a thing of the past. It is pretty hard to come up with a situation where future benefits is conditional on the behavior. Like, I suppose you wouldn't invite a doctor that doesnt use your product to give feedback on it or be part of a clinical trial, but that is a niche feedback to worry about.
Lastly, articles like are very misleading when it comes to the details. In their reference for $2B in payments [1], includes things like Royalties.
>The greatest proportion (27.3%) of value was from royalty or license payments (≈$484 million of $1.8 billion) followed by service fees (26.6%), such as faculty lectures ($472 million of $1.8 billion).
If they are claiming paying royalty or license payments for inventions (like developing a hip implant) are a kickback, it frames the whole argument as rhetoric.
I’ve found the “collective common knowledge” regarding pop-culture topics such as this, is much like generals preparing for the last war they fought.
Direct kickbacks were an actual problem decades ago. That has long been “solved” all the way to the typical over correction the industry is known for.
The same holds true for the opioid epidemic and folks still thinking pill mills and the medical industry as a whole are the primary way folks get hooked.
It’s fighting last decades battles that have long since moved on. The zeitgeist seems to “stick” each generation and does not seem to keep up with current reality.
yes. Conflating Perdue Pharma/OxyContin with the larger opiate epidemic is a particularly egregious example.
Perdue engaged in criminal actions, but it did not cause the epidemic. It is just a small part of the story. Deceitful labeling and aggressive marketing of OxyContin in the 90's has zero bearing on people dying from fentanyl laced weed in 2024.
I think the biggest factor in all of this misinformation is a human desire to compress the complexity of life into simple soundbite narratives that make sense.
The more emotionally charged or pressing an issue is, the greater the human desire is to think/feel like they have it all figured out. Even if that means sacrificing truth.
Humans have a compulsion to categorize and explain everything they encounter. Failure to do so is cognitively painful so anything too difficult is simplified until it "makes sense".
In my opinion, this compulsion is at the heart of all human problems, but also all of our achievements.
My dental surgeon refuses to design or install an implant. They will only put in the screw for the implant.
Why? Because of a pyramid scheme.
That might not be a direct "lie," but it is misleading. Doctors mislead constantly. They tend to accept norms that are harmful because they are systems outside of their control.
I think there is a conflation occurring between harm and sub-optimal behavior (from your perspective). Is the doctor harmful or simply less helpful than you would like?
Would you be better off with no dental work or healthcare? Zero harm is being done in this case IMO.
If Im alone in the desert dying, I dont think others are harming me for my lack of water and food. That is simple neutrality and indifference.
I don't think you understand what a pyramid scheme is. There are some unethical providers who optimize for their own profit rather than the patient's best interests but those are a small minority. And it is entirely normal to separate implant design from installation; those things take different skills and equipment.
I love when I am arguing with someone who I secretly agree with. I appreciate your response.
> A doctor doesnt put your individual wellbeing above their own
I think an example we could both agree on, would be something like...let's say you have several indicators that you might have a type of cancer. But the doctor will say, well let's not do a whole biopsy, because it's expensive and it's not covered by your insurance, and there's a low chance you have this cancer anyway. That might seem like a sensible conclusion to draw, but actually if we were simply caring for every person in a real way, like we would wish to be taken care of individually, we would do that biopsy anyway, because the alternative is death.
Now to draw a parallel to ancient tribes as I was doing earlier, the resources of the tribe dictates the care each tribe member can have. Okay. But we live in one of the most abundant eras in the history of the world. And, strikingly, we also have insane wealth inequality. So what I am positing here is that the default resource allocation for you is much lower than you might assume. People are going to make cost-cutting decisions that impact you greatly. And the only resort is for you is to manage your own health. Not that you SHOULDN'T manage your own health anyway, but this cost cutting resource allocation acts as a kind of betrayal. Things being "held together by duct-tape" is not the vision that children are raised with. We don't assume we are still in a period of being "left behind by the herd" because of how great everything is. But in fact, you will realize, when you see someone deny treatment for their advanced cancer due to finances and "the odds of survival" that in fact, you can be left behind by the herd. And the more you look into the way the healthcare system is structured, you realize that there really is no herd at all. At every step you are paying for help from someone who, in many instances, could care less.
What I am also saying is blatantly that these people make mistakes and sometimes do not care. And there is little recourse for that. Which isn't a point that you addressed, but anyway.
> Instead, they were conditional on good standing and mutual consent.
And this good standing has been converted to currency. Which is a much more isolated and cut throat version of good standing. In many ways it is more unfair. And what you don't realize as a kid is also how EXPENSIVE this "good standing" actually is. To receive the benefits of the technological state we purport to be in you usually have to be upper-class. The poor are often much closer to being completely alone. As if no society exists for them at all.
> Im saying their existence should not be taken for granted.
I, on the other hand, think that they don't go far enough. They aren't good enough. I'm actually not so sure what is being "taken for granted" in a for profit system, I pay every fucking dime of it. I am not impressed with its state.
>And this good standing has been converted to currency. Which is a much more isolated and cut throat version of good standing. In many ways it is more unfair. And what you don't realize as a kid is also how EXPENSIVE this "good standing" actually is. To receive the benefits of the technological state we purport to be in you usually have to be upper-class. The poor are often much closer to being completely alone. As if no society exists for them at all
I think this is a supper interesting observation, and a useful way for viewing this whole thing. At some point, people did rely on social currency and their personal memory of interactions to know if someone is "credit worthy".
I'm not sure that it was more "fair" than the hard numerical of financial currency, but I agree that social currencies could have been more forgiving. With social currency, you could go into debt with someone, and start fresh with someone new. The financial currencies, debt/assets follows people through their lives, and even across generations.
Yes, poor people are by parts of society who find they have little to offer. Poor people are free to associate with each other, but often have little use for eachother as well. This
>We don't assume we are still in a period of being "left behind by the herd" because of how great everything is. But in fact, you will realize, when you see someone deny treatment for their advanced cancer due to finances and "the odds of survival" that in fact, you can be left behind by the herd. And the more
I see how that could be jarring realization. If someone thought they had an equal ownership of social wealth, and equal say over the direction of the herd, it would be devastating to learn that it was all a lie at the last minute when it actually matters. I think many people were grifted by those who told them this would be the case, by people who were stating an aspiration as fact, and hoping that enough lies would make it true. Society has a little bit of compassion, but not nearly as much as some want and act as if it does. I do think it is sad and cruel that many people were indoctrinated with this false expectation. It set them up to live their lives thinking the world is a cruel and malicious place, when it is simply indifferent.
>I, on the other hand, think that they don't go far enough. They aren't good enough. I'm actually not so sure what is being "taken for granted" in a for profit system, I pay every fucking dime of it. I am not impressed with its state.
When I say "taken for granted", I mean the little compassion the society and the herd does have, and it is not guaranteed that it stay this way. In fact, it could very easily be much worse, and there are place with no compassion or welfare. There are places even worse than that, without decent rule of law, where being dangerous means you can take what you want or buy and sell humans for their commodity value.
Thats not to say that you cant want and advocate for something better than the current state. Im not sure what you mean by you pay for every dime of it. Is your ideal system one where you dont have to compensate others for what you take?
I think the problem is that you were raised to think that a "good and just" world is one where there is no risk, no variability, and limited self-reliance. This is a fiction and has never existed.
The default state is for none of these services and protections to exist whatsoever. Everything beyond nothing is an imperfect and unstable solution held together with duct-tape.