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i remember a (somewhat joking) proposal for a delay-line memory implementation that used a laser and optical sensor pointed at the reflector the apollo program left on the moon
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Jul 25, 2023 13:40
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4lokos basilisk posted:the problem is also the tendency of americans to believe that $problem is unsolvable because the usa has spent so much money and resources and $problem still exists and it therefore it is simply unsolvable. its not that the problem is unsolvable its that no current proposal is politically viable. I dont think non-americans really understand that to get us on the level of other countries we'd have to slash payments to providers by a minimum of 40% across the board. I'm 100% behind that, but you can imagine the pushback. Some kind of medicare for all would work if CMS could be trusted to enforce low repayment rates and switch everyone to capitation.
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Jul 25, 2023 14:39
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i wonder what percentage of the surplus in the current american healthcare arrangement is consumed by lobbying, advertising, and administrative activity that protects the existence of the surplus
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Jul 25, 2023 15:00
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Internet Janitor posted:i wonder what percentage of the surplus in the current american healthcare arrangement is consumed by lobbying, advertising, and administrative activity that protects the existence of the surplus But if we got rid of that part of the surplus, how would anyone fund their re-election?
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Jul 25, 2023 15:10
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Shaggar posted:its not that the problem is unsolvable its that no current proposal is politically viable. I dont think non-americans really understand that to get us on the level of other countries we'd have to slash payments to providers by a minimum of 40% across the board. we can probably cut 40% of administration if you do that isn’t malpractice insurance is handled very differently in other countries? from what I understand in the US that can be 6 figures/year for surgeons but more on the order of $12k/year for most types of doctors. that’s a few percentage points of overhead right there
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Jul 25, 2023 15:18
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Internet Janitor posted:i wonder what percentage of the surplus in the current american healthcare arrangement is consumed by lobbying, advertising, and administrative activity that protects the existence of the surplus its gonna be some, but its probably not significant compared to provider administration costs, general provider waste, and other direct costs. Capitation would help significantly by putting a cap on provider revenue which would in turn force them to squeeze the inefficiencies out of their networks. The only problem with capitation is CMS wouldnt be able to resist providing fee for service incentives on top of it, thus ruining the entire concept.
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Jul 25, 2023 15:29
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hobbesmaster posted:we can probably cut 40% of administration if you do that you want to get rid of malpractice insurance? idk how that would work. Doctors are still gonna get sued and they're still gonna have to pay to defend themselves or pay recompense for their gently caress ups. idk enough about it, but im guessing its probably not something you can get rid of without overhauling US civil law wrt providers One administrative overhead thing we should fix is all the little state level regulations and licensing which we should eliminate and replace with a single set of national regulators/licensors. One regulatory and licensing framework makes compliance far easier
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Jul 25, 2023 15:41
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hobbesmaster posted:we can probably cut 40% of administration if you do that AFAIK you don't need such a thing as an individual practitioner (this might not apply to dentists who have some hosed up practice partnership arrangement or consultants doing private work!) In the NHS because that is handled at the level of the organisation itself, and also more generally as criminal/clinical negligence basically if you gently caress up then the recourse is to the NHS, not to you. then the NHS is funded by taxes so really you're just suing yourself here.
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Jul 25, 2023 17:55
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why would you want to reduce healthcare costs? wouldn’t that significantly cut gdp?
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Jul 25, 2023 18:01
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Shaggar posted:you want to get rid of malpractice insurance? idk how that would work. Doctors are still gonna get sued and they're still gonna have to pay to defend themselves or pay recompense for their gently caress ups. idk enough about it, but im guessing its probably not something you can get rid of without overhauling US civil law wrt providers I’m just saying that it contributes to that 40% number. The equivalent of suing an individual doctor in most countries would be suing CMS itself. so even with administration drastically reduced US provider reimbursements would still look high in the comparison you’re doing
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Jul 25, 2023 18:08
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fart simpson posted:why would you want to reduce healthcare costs? wouldn’t that significantly cut gdp? gross, dying patients
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Jul 25, 2023 18:11
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hobbesmaster posted:I’m just saying that it contributes to that 40% number. The equivalent of suing an individual doctor in most countries would be suing CMS itself. so even with administration drastically reduced US provider reimbursements would still look high in the comparison you’re doing that would only work if the providers are nationalized as well which is probably never happening here. i suppose it could be something handled by a national medical licensing board where the board is liable for doctors and responsible for civil cases while the criminal courts handle criminal negligence. Maybe as a middle ground you make the provider's hospital/practice/network responsible for the malpractice liability of the doctors they employ or contract instead of the individual. it looks like canada requires malpractice insurance at the individual provider level as well, but their laws around proving malpractice seem to set a higher bar. They also have a mutual defense fund to pay for doctors legal fees, but not patient compensation. This appears to lead to the same high court costs in defense, but fewer wins and payouts to patients so overall costs are lower. Its certainly a problem but probably not the first thing i'd tackle in a system overhaul
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Jul 25, 2023 19:22
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Shaggar posted:its not that the problem is unsolvable its that no current proposal is politically viable. I dont think non-americans really understand that to get us on the level of other countries we'd have to slash payments to providers by a minimum of 40% across the board. without having absolutely any knowledge of what a proposal should be, i still think that a big issue is that america is convinced that since they are paying a lot for $thing, it necessarily must be the best in the world get rid of that mindset and a lot of things suddenly become politically viable
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Jul 25, 2023 20:08
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4lokos basilisk posted:without having absolutely any knowledge of what a proposal should be, i still think that a big issue is that america is convinced that since they are paying a lot for $thing, it necessarily must be the best in the world i dont think those people are as common as you think because i dont think most people even realize how expensive american healthcare even is. I think if anything there is a large group of people with decent insurance for whom the system works fine and are unswayed by the traditional political messaging around healthcare reform which tends to be anti-insurance. The second you say you're gonna replace their insurance (that works for them) with a government thing created by a congress they hate, they shut down. Its not that they think more money = better they think current = good, government/congress = bad. That gets worse when you also factor in the standard culture war or anti-healthcare/vaccine/science poo poo, providers making a stink, campaign donors lobbying for the status quo, etc... imo the way to go is first force everyone to capitation while remaining on the current payer systems. "This is cost savings for everyone." "Your current insurance stays, it just gets cheaper." Next step, migrate all regulation and licensing to the federal level. "Smaller state government, lower regulatory costs, big win for business and consumers." Then once thats all done you can start bringing more people on to medicaid to ensure everyone is covered.
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Jul 25, 2023 20:34
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If anyone cared about useless costs of government in the US, they'd abolish the TSA. But it's a jobs program for unskilled labor that doesn't also require heavy manual labor.
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Jul 25, 2023 20:38
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Shaggar posted:i dont think those people are as common as you think i mean i am referring to the trend where it takes this thread 2-3 pages of heated discussion until we get to the point where people realize that there are functioning high qol countries where it is normal (cw: i am going to exaggerate) for people not to spend 2h on a car commute each day and have a clothes washing machine in their kitchen and instant money transfers between banks and dogs and cats living together and mass hysteria etc etc imo whether something is politically feasible to change or not comes into play when people at large realize that there is another way of life which also works in a reasonably developed country. having multi page derails about rehashing that actually in the EU it is normal to give your utility and phone company the mandate to withdraw your monthly bills automatically without being scammed 10 ways to sunday (and has been more than a decade iirc) shows that people at large don't realize that different things are not only possible but actually existing in places
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Jul 25, 2023 21:37
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4lokos basilisk posted:i mean i am referring to the trend where it takes this thread 2-3 pages of heated discussion until we get to the point where people realize that there are functioning high qol countries where it is normal (cw: i am going to exaggerate) for people not to spend 2h on a car commute each day and have a clothes washing machine in their kitchen and instant money transfers between banks and dogs and cats living together and mass hysteria etc etc it takes us Very Smart Children 2-3 pages to reach that point and we all already know it ahead of time anyway, how are you supposed to teach it to a bunch of people who both don't know it and have very loud media outlets and other moneyed interests constantly broadcasting at them that it isn't true
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Jul 25, 2023 21:42
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4lokos basilisk posted:having multi page derails about rehashing that actually in the EU it is normal to give your utility and phone company the mandate to withdraw your monthly bills automatically without being scammed 10 ways to sunday (and has been more than a decade iirc) shows that people at large don't realize that different things are not only possible but actually existing in places wait, america doesn't have this?
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Jul 25, 2023 21:42
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BMan posted:wait, america doesn't have this?
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Jul 25, 2023 21:44
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BMan posted:wait, america doesn't have this? we do and have as long as i've been paying utility bills so idk what they're talking about i assume some companies will scam you via it but mine doesn't 
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Jul 25, 2023 21:44
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BMan posted:wait, america doesn't have this? america has this, idk what that dude is talkin about
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Jul 25, 2023 21:45
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i think its an instance of the continental chauvinism goin the other way
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Jul 25, 2023 21:46
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anyway i once had a discussion with my lovely uncle about US healthcare, mostly everything he hated about it, etc. then I brought up how each of the things he mentioned was specifically, measurably better in the UK, and specifically how they did it and how we could do it too (and i wasn't even proposing full socialized healthcare, cuz I know he'd never go for that, just like "we both agree america does x wrong, here's how the UK does it that works better"). and he went along with it and said it made sense, and then at the very end felt the need to tack on "but our healthcare system is still a million times better than theirs!" how do you get my uncle to get it, because there's like 100 million of my uncle and they all loving vote
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Jul 25, 2023 21:50
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keep government out of my medicare!
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Jul 25, 2023 21:52
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Shame Boy posted:anyway i once had a discussion with my lovely uncle about US healthcare, mostly everything he hated about it, etc. then I brought up how each of the things he mentioned was specifically, measurably better in the UK, and specifically how they did it and how we could do it too (and i wasn't even proposing full socialized healthcare, cuz I know he'd never go for that, just like "we both agree america does x wrong, here's how the UK does it that works better"). and he went along with it and said it made sense, and then at the very end felt the need to tack on "but our healthcare system is still a million times better than theirs!" I have a theory about this. minds are made of a bunch of interconnected beliefs and the more interconnections to other ideas, right or wrong, the harder it is to change. more than once I’ve gotten my dad to agree with me on some major point after a loooong discussion - less military spending, or changing school funding from being a local tax, stuff like that, and when I come back a week later he’s right back at the start. I suspect it’s because there’s all these other connected beliefs that I couldn’t replace, and so it’s like a spider web filling in the hole again. it’s simply too much belief replacement to achieve in a short time so it just rebounds to the original belief.
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Jul 25, 2023 21:56
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4lokos basilisk posted:clothes washing machine in their kitchen sorry, what??
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Jul 25, 2023 21:58
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Enderzero posted:I have a theory about this. minds are made of a bunch of interconnected beliefs and the more interconnections to other ideas, right or wrong, the harder it is to change. more than once I’ve gotten my dad to agree with me on some major point after a loooong discussion - less military spending, or changing school funding from being a local tax, stuff like that, and when I come back a week later he’s right back at the start. I suspect it’s because there’s all these other connected beliefs that I couldn’t replace, and so it’s like a spider web filling in the hole again. it’s simply too much belief replacement to achieve in a short time so it just rebounds to the original belief. it's partially that, but imo more significantly media consumption. it's kinda incredible to see the marked change in people that happens if you can get them to do nothing but change the fuckin' channel off of fox news i've been noticing it in reverse with my dad, the whole time growing up my mom (an old socialist) controlled the remote and dad would just watch whatever nightly news she put on, but now they're retired and kinda drifting apart and dad's gone down this fox news rabbit hole and suddenly has a bunch of new and unpleasant opinions about immigrants that were never there before 
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Jul 25, 2023 22:02
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Enderzero posted:I have a theory about this. minds are made of a bunch of interconnected beliefs and the more interconnections to other ideas, right or wrong, the harder it is to change. more than once I’ve gotten my dad to agree with me on some major point after a loooong discussion - less military spending, or changing school funding from being a local tax, stuff like that, and when I come back a week later he’s right back at the start. I suspect it’s because there’s all these other connected beliefs that I couldn’t replace, and so it’s like a spider web filling in the hole again. it’s simply too much belief replacement to achieve in a short time so it just rebounds to the original belief. i think youre overestimating the coherence of peoples beliefs if they were all matched and connected, please wouldnt simultaneously believe immigrants come to steal their job, and immigrants all live on wellfare and are too lazy to work
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Jul 25, 2023 22:05
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Shame Boy posted:it's partially that, but imo more significantly media consumption. it's kinda incredible to see the marked change in people that happens if you can get them to do nothing but change the fuckin' channel off of fox news thats exactly why there’s so much right wing media! because it takes literally a nonstop barrage of these wrong ideas from a 1000 different angles to inculcate it so deeply and overcome the sense of cognitive dissonance. wrap it together with common bigotries people grew up with and you cannot, in a regular conversational cadence, replace these ideas. right wing rags, then am radio, and then Fox News have poisoned them and there’s little chance of reversing it. Enderzero fucked around with this message at 22:13 on Jul 25, 2023 |
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Jul 25, 2023 22:09
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EricBauman posted:i think youre overestimating the coherence of peoples beliefs somewhat, perhaps. there’s usually a few Big ideas that have a larger gravitational pull and they will fall back to that smooth it over. my dad hates the democrats because of taxes. when I take the time to explain that, even if that’s true we could fix it by not spending 10x as much in military spending as the next 10 nations or whatever, he agrees. and yet the next time we talk, democrats and high taxes have somehow become the most important thought once again.
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Jul 25, 2023 22:12
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4lokos basilisk posted:imo whether something is politically feasible to change or not comes into play when people at large realize that there is another way of life which also works in a reasonably developed country. I think this is the core disconnect because its wrong. You have to convince people a system is better beyond just showing "this is what someone else does" and more critically you have to prove that such a system would work for america which critically relies on the perceived political viability of the proposal. you also seem to disregard that there are people who like the current system as it is regardless of if they could save money in another system. They dont want to change because why change if its working? They know how systems work in other countries and they think "ok, thats good for them". You seem to believe theres some eureka moment where the stupid american falls to his knees in total disbelief of how superior non-american country x is. Its just not a thing. Even if they can see merits in another system, the very first thing the american thinks is "ok how would we get the votes for something like that". America has the single largest socialized healthcare system on the planet and its value for money is extremely bad. What non-americans dont really get is how huge our government already is and how bad it is at its job. Not because the concept of government is bad but because the people who run our government in particular are bad at their jobs. Trying to right that ship is incredibly difficult and someone who seriously suggests "oh just do it like country X" is always going to be dismissed with an eyeroll. You need politically viable solutions that will get votes in America.
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Jul 25, 2023 22:21
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Elder Postsman posted:sorry, what?? yeah that shits incredibly hosed up. I cannot comprehend the depravity of a mind that created something like that
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Jul 25, 2023 22:23
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Enderzero posted:I have a theory about this. minds are made of a bunch of interconnected beliefs and the more interconnections to other ideas, right or wrong, the harder it is to change. more than once I’ve gotten my dad to agree with me on some major point after a loooong discussion - less military spending, or changing school funding from being a local tax, stuff like that, and when I come back a week later he’s right back at the start. I suspect it’s because there’s all these other connected beliefs that I couldn’t replace, and so it’s like a spider web filling in the hole again. it’s simply too much belief replacement to achieve in a short time so it just rebounds to the original belief. i wrote that dissertation and that's pretty much how it works
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Jul 25, 2023 23:50
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Achmed Jones posted:i wrote that dissertation and that's pretty much how it works unfortunate because it means the only way this mess in the us gets any better is to get rid of the most excessive propaganda and that’s not happening. Fox News and friends is going to destroy us
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Jul 26, 2023 00:01
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my social influence professor had the best line about the news/mean world/propaganda: "you can't control what people think. you can, however, control what they think about"
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Jul 26, 2023 00:02
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qirex posted:my social influence professor had the best line about the news/mean world/propaganda: "you can't control what people think. you can, however, control what they think about" Barbie is making kids gay with seed oils dagnabbit!
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Jul 26, 2023 00:10
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mystes posted:america definitely does have multi page derails
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Jul 26, 2023 00:10
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Chris Knight posted:and with so few trains!
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Jul 26, 2023 00:11
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Shaggar posted:i dont think those people are as common as you think because i dont think most people even realize how expensive american healthcare even is. I think if anything there is a large group of people with decent insurance for whom the system works fine and are unswayed by the traditional political messaging around healthcare reform which tends to be anti-insurance. The second you say you're gonna replace their insurance (that works for them) with a government thing created by a congress they hate, they shut down. Its not that they think more money = better they think current = good, government/congress = bad. I don't know who the hell likes their health insurance outside of people that just don't interact with it at all beyond a payroll deduction.
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Jul 26, 2023 01:01
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maybe like is a bit strong. more like "fine with how it works". altho there are high end plans for some people that cover everything at any time which i imagine are pretty great
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Jul 26, 2023 01:03
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