People Are Dying Younger Because America Keeps Failing the Bad-Break Test | Hacker News Reader

People Are Dying Younger Because America Keeps Failing the Bad-Break Test

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84 pointsbenevol66 comments

Many people vote against their own self interest---universal healthcare, larger tax credits to the poor, cash welfare---because they think "if I can't afford $15000 to give to the Feds, no one can". This is partly an innumeracy problem; but, partly, I think it's the fact (naturally) those who are taxed the most can mutually align their interests with those who are taxed the least: they both say the same words, but for entirely different reasons: one is because they can't; the other because they wont.

$15k every year is a stupendous amount of money to nearly everyone in the US. There exist people in large numbers for whom this would change their lives quite radically.

No innumeracy there.

We all live with a lot of "s'posed ta-s" and we just won't get to 'em all.

I don't think the cost is as significant as the ineffectiveness of the effort.

If I thought universal health care, more progressive taxes, and cash welfare worked without solving more problems than they create (without causing stagflation, unemployment, loss of personal liberty), I would support them. But I don't so I won't.

We already have universal health care---we just choose to do it in the most expensive possible way (emergency health care), rather than in a less expensive way (urgent, chronic, terminal). I don't know about the rest; although, the EITC (the closest thing we have to cash welfare for non-family citizens in Texas) was actually a pretty important part of my income for the five years when I lived below and near the poverty line.

> We already have universal health care

For the next few months, at least

Emergency care isn't going anywhere, and Obamacare isn't universal health care. It's a compromise which keeps the insurance industry in place.

Well, by that token, ER isn't "universal health care" either. I have knee pain from a soccer injury and need arthroscopic surgery. Emergency/urgent care won't do that.

It is if you have something life threatening, but I generally agree. Even then you won't get the preventative and proactive measures that could have saved you, and your standard of care will be low.

Would you be interested in traveling to Cuba to have that surgery performed inexpensively? I'm working on an agency to match US healthcare consumers with service providers in Cuba, Mexico, Canada, and Thailand who will provide the same service at a fraction of the cost with quality exceeding that available in the US (and am doing market research).

This is my way of hacking a lack of universal healthcare until the US gets its shit together.

If it helps, I recently had surgery in Vietnam at the French Vietnamese hospital in Saigon and was really pleased with the cleanliness of the facilities.

My US doctor so far thinks they did a great job too.

Cost was $3500 US for a broken collarbone, probably would have been > 10x that in the Bay Area.

Thank you, this is helpful!

What do you mean by "worked"? You do realize EVERY other modern, rich country has these things and is doing just fine?

> every

If by "fine" you mean a weak economy (http://www.businessinsider.com/italys-political-and-economic...), perpetual 20% adult and 45% youth unemployment (http://mobile.nytimes.com/2016/05/03/upshot/spains-jobless-n...), riots in the streets over unemployment (http://www.telegraph.co.uk/news/worldnews/europe/5258634/Rio...), a mismanaged centralized health care system in financial straits (https://www.bloomberg.com/news/articles/2013-01-03/frances-h...), and general government insolvency (https://en.m.wikipedia.org/wiki/Greek_government-debt_crisis), then yes every other modern, rich country is doing fine.

Way to cherry pick.

Guilty.

And way for the parent to overgeneralize.

Notably, every single example you cite is from an Euro currency country. The design flaws of the Euro currency area were well understood already 20 years ago, if not, unfortunately, by European politicians.

https://www.foreignaffairs.com/articles/europe/1996-09-01/eu...

If I may propose a different explanation:

Many people vote against measures that are supposedly supposed to help them---universal healthcare, larger tax credits to the poor, cash welfare---because they think "why am I giving $15000 to the Feds when I can barely afford it, and they're just going turn around and give some of the money back but with strings attached".

I think that framing people's political opposition to measures that you support as "voting against their own self interest" isn't helpful because it alienates the people you're trying to convince. Even if you might not think that opposition to universal healthcare, or tax credits, or welfare, is rational or sensible, that opposition may be rational or sensible when viewed from the perspective or someone else.

There is a certain appeal to self-sufficiency that doesn't have to spring from radical individualism. It's extremely stressful feeling like you're not in control of your own life. Globalization and computerization have increasingly centralized power in either corporations or national governments. Some of that loss of control is political; for example, the steady erosion of the first sale doctrine under the guise of protecting "intellectual property". Some of that loss of control is due to the advance of technology, and can't be undone without further technological development; for example, barring significant breakthroughs in at-home manufacturing technology, your average consumer isn't going to be making an x86 CPU in their basement. Increasing people's ability to be self-sufficient should be something we can rally around as technologists---reducing healthcare costs so individuals can diagnose and treat themselves for common maladies, reducing the capital needed to manufacture modern electronics, increasing transparency and access to knowledge so people don't feel trapped by seemingly Kafkaesque bureaucracies and organizations---and I feel that trying to focus on common goals is more likely to result in positive societal change.

Everyone keeps attacking poor people for voting against their interests, suggesting as you have that they are innumerate, or conned by fake news, or short-sighted, or just stupid.

Perhaps these people are voting with their conscience after careful consideration, and doing what they think is morally right, despite knowing that it will hurt them.

You wouldn't get an article about billionaires voting for left wing politics even though it could be against their short-term interests, and laughing at their innumeracy, because it's assumed that they would be doing so for moral reasons.

People don't seem to believe the poor are also capable of making self-sacrificing decisions for moral reasons.

Care to share these moral reasons?

Well you'd have to ask them, wouldn't you.

What I am saying is that you should consider that maybe these people are not innumerate - they could realise that the policies they are voting for will harm them but they believe that it is the correct thing to do.

Some people think that federal taxation in general is morally wrong and should be reduced. Whether you or I agree with that is irrelevant if what we're debating is have these people realised that it could help them but still think it's right to vote against it.

Perhaps they are doing what they consider to be correct according to the information available to them. The question then becomes what information are they being given?

What information are you being given.

How are any of us supposed to vote in our best intetersts, individually or collectively, when all the bastard politicians are pathological liers.

That's just a recipe for giving up.

Read history, read the news, read foreign news sources (since they have less of an incentive to lie to you about your own country's domestic policies), use your brain.

Therein lies the rub. It's all very relative, all one can do is try.

View through all the lenses at your disposal (there are many), apply critical thought and compare theory to fact. If you find your answers change from absolutes to 'it depends which perspective you start from' then you are probably on the right track.

I don't think it is morally right for a majority to enact legislation that targets a select group of people negatively. The extreme metaphor is two wolves and sheep voting on what to eat for dinner.

Many people realize that such legislation would benefit them, but don't feel justified in depriving another individual of their property.

But, your theft is my surcharge.

That is, me and many others don't view taxation as theft but as a charge for providing an ideal environment to amass wealth.

But the point isn't your opinion on this argument, I'm just saying that it's possible that someone could genuinely believe in the argument at all. The original comment suggested nobody possibly could think like that, and suggested instead it must be innumeracy.

Even with the surcharge view, there's the moral question of price discrimination. Because someone can afford to pay more for services and goods, should they be required to? Some say yes, some say no.

As stated elsewhere in this thread, it's not about "the right answer". It's about how individuals often act according to their moral view of the world. Just because you don't share that view, doesn't make their conclusions automatically uninformed and incorrect.

It's news if a poli-sci study doesn't find that a given reasonably-effective public program has very broad public support in all its particulars but is disliked and supposed to be far more wasteful than it actually is when referred to by name (the most comical of these describe the program, warts and all, as the expected results of some proposed reform, and solicit comparison to the current, identical system). The public also tends to judge that we spend a lot more money on programs that have received tons of hate from right-wing pundits over the years than we actually do, e.g. foreign aid.

I think it's entirely fair to say that the average person doesn't have half a clue what the government even does. Hell, a disturbing percentage can't tell you how marginal income tax rates work, even at an ELI5 level, or have no idea to whom the "death tax" they hate so much even applies (usually they believe, incorrectly, that they or someone they know will be subject to it). Crediting them with having some well-considered moral stance on the role of the state is probably far too generous.

Yes, it is an overly-broad generalization. Yet, how can one avoid generalizing when 9 of 10 friends / relatives fit the description with certainty?

This idea that the right is voting against their best interest needs to die. The thing the left forgets is that poor people don't vote[1]. So what you have in these "poor" red states are lower-middle/middle class people who are already being stretched thin voting against their poor neighbors who they can't afford to support.

Like it or not Obamacare did cost middle class people money in the sense that their tax dollars went to pay for subsidies, their employers were required to spend more on health care, more demand for medical services drives prices higher and the individual mandate meant healthy people had to buy something they didn't want or be fined.

Universal healthcare, tax credits for the poor and cash welfare can all be viewed through the same lens.

1. http://www.politifact.com/truth-o-meter/statements/2016/apr/...

>Many people vote against their own self interest---universal healthcare, larger tax credits to the poor, cash welfare---because they think "if I can't afford $15000 to give to the Feds, no one can".

They mostly don't. Poor and lower-middle-class people consistently vote for the Democrats, upper-income people consistently vote for the Republicans. However, the poor are much less likely to actually vote, sometimes because their vote is suppressed, and often because neither party is actually offering them universal social services or cash assistance.

Then, throw in issues like gerrymandering, winner-take-all elections, and the Electoral College, and you've got one of the greatest voter inefficiencies (failure of votes to translate into seats in government) in the Western world.

The problem is not that democracy fails because people are too irrational. The problem is that the people are approximately rational, but the system is designed to shut out the voices of the majority.

This is why real education is so important. The government wants gullible and apathetic citizens. They got what they wanted.

To bad it will destroy the US. We need longer school days to help 2 income families, we need year round schools as well (yes we'll have to buy air conditioning for summer school).

I really disagree.

We need education metrics that reward schools for achieving outcomes with less classroom hours, not ever expanding classroom hours. We need to stop pretending that a single curriculum can serve people that are and people that are not interested in college equally well.

I think inexpensive child supervision is a good thing to make available to people that want to work, but damn anyone to hell that wants to tie it to education.

I don't think the government WANTS gullible and apathetic citizens. I think they get them anyway. I don't know that a government anywhere WANTS anything except continuation.

I see that as an ... (mis)anthropic principle thing.

These things are entangled, in a chicken-or-egg manner. If for some reason that is opaque to us, people are naturally gullible and apathetic, then won't a leadership that reflects that preference emerge?

We expect to be the boss ( the seat of final authority) and be led at the same time.

All else equal, education is good, but education isn't going to make everyone into healthcare policy wonks, nor is that necessarily a good use of everyone's time. Which... is a problem when the programs are designed so that you more or less have to be a healthcare policy wonk to understand them.

Obamacare is unpopular in part because it's incredibly complex. On the political side that makes it an easy target, because you can blame everything on it, and some of that will stick. But it also makes it unpopular for substantive reasons, in that people really hate the experience of interacting with it. You rarely get people who like Obamacare; its supporters, at best, think it's less bad than what was there previously.

I follow the area pretty closely, am quite left-wing politically, clearly think it's better than the alternative, and nonetheless when I was signing up for a marketplace plan last year, even I found the experience frustrating and complicated. You need to understand a pretty big range of things to just understand the baseline terminology and market setup: the subtleties of in-and out-of-network coverage (did you know that in-network hospitals can have out-of-network doctors?), the different kinds of deductibles, out-of-pocket maximums, the subsidy schemes, etc. Then you have to learn how to read the policy documents of each plan in light of this new terminology you've learned, and compare them in order to act as an informed market participant. The healthcare.gov marketplace gives a few tools to try to simplify comparisons, but the overall experience is still overwhelming, and I'm not even sure whether I made a good choice in the end.

I think there's a good argument that simpler, universal programs are actually an easier sell. Centrist Democrats view policy-wonk type programs as "more moderate", because they contain various means-testing and market mechanisms, and believe this will make them an easier sell than universalist entitlements, which are seen as too left-wing. But I'm not sure that's actually true, if you take into account that people really fucking hate policy wonks and their programs, while universalist entitlements like Social Security and Medicare are popular. Frank Pasquale makes that argument at a bit more length here, arguing that of the two early 20th century traditions that the Democrats to some extent inherit, populism and progressivism, they've erred too much in the direction of the latter, promoting "technocratic alliance between corporate and government experts". https://balkin.blogspot.co.uk/2016/11/rebuilding-health-care...

> We need longer school days to help 2 income families, we need year round schools as well (yes we'll have to buy air conditioning for summer school).

What do you mean by "help 2 income families"?

Where both parents work.

I know that. I mean how do you think longer school days help them?

If you think it helps by giving their kids someplace to be when both parents are at work, wouldn't it make much more sense to have some sort of public child care program after school than to extend the school day?

Free mandatory babysitting.

The USA has already started a long-term decline. Peak was 1998/1999 if you go by peak productivity and real GDP/capita.

Unfortunately, not much can be done. We're in a situation similar to that of the British Empire prior to 1915.

I see what you're saying, but the British didn't have metrics like 'broadband access' to work with. Hopefully we can do better.

The internet was supposed to be that new tool to save or even boost democracy. What's been happening lately is the opposite: mass surveillance and using the data to manipulate the population.

The British Empire was completely and totally infeasible at the time. This was largely and widely known, at least in the U.S. I had grandparents who were born around 1900, give or take, and the dominant idea about Europe and Britain was that it was corrupt, that the principle seat of corruption as the royal system and that they could go to hell in their own way.

It took Considerable Doing ( and a lot of John Wayne movies ) to sell WWII to the mothers of America. And you know what? One grandmother had one son of five serve in WWII and two serve (in Germany) after. One in the early '50s, the other in the '60s.

The sort of American Exceptionalism that emerged after WII was ( I would say ) completely unknown prior.

That was a stock bubble. The peak was somewhere between the end of WWII and 1980, when we decided to start funding the country through a continuing trade deficit.

It was the late 1960s and early 1970s, when our trading partners got their bombed-out domestic industries back in working order after a decade or two of producing junk.

Something changed in our global and economic system at the turn of the 70s. The late 70's and early 80's were really a high point for global utopianianism.

Since then the balance of power between the people and the state has shifted towards the latter at quite an incredible speed over the last 30 years.

Concentration of tremendous wealth in the hands of large corporations and a few individuals and the seeming impotence of the political system to keep them in check has always been a recipe for disaster.

The amount of money spent by the state for instance on surveillance just gets millions more 'uniforms' vested in the state. Security deparments keep getting beefed up. And money being throw around by think tanks into the academic sector, especially economics, and cultivating the mainstream press with all of them parroting a similar message and ideology all point towards a fundamental regression of democratic principles. Just the amount of double speak over the last 5 years is astounding.

Sometime arrogance presumes control but its only a shaky interlude before things completely unravel.

The harsh-truth line for situations like this is that these people have been living beyond their means. Right living doesn't just mean that you can cover your expenses day to day. It also means that you have set enough aside to deal with the inevitable occasional hurdles life sets before you. If you can't deal with an illness or a job loss or a serious car repair, you only think you're doing all right, and a hard rain is gonna fall.

Looking at that paragraph, I think it is basically true. Yes, you should set something aside for contingencies. But is it the whole truth? It is well known by now that people, even clever people, tend to discount the future heavily, to the point of unreason. It seems to me this is a case where some sort of institutional intervention is called for, to fight our own worst impulses.

> The harsh-truth line for situations like this is that these people have been living beyond their means. You (should) have set enough aside to deal with the inevitable occasional hurdles life sets before you.

That would require people to not be poor. With exploding 200%+ rise in costs of rent / healthcare / education / childcare / etc, it's no longer feasible to expect people to be saving lots of money for rainy days -- not because they are bad people without the responsibility or fortitude to plan for the future, but because there's literally no money for it.

Drugs. Deaths from opioid overdoses are up by a factor of 4 in the last fifteen years. That's huge.

Is becoming a druggie a "bad break", though? Losing a job, an injury, or an illness is a true bad break. Becoming a druggie is self-inflicted. Do druggies deserve tax-funded support? With limited resources, shouldn't tax money be spent primarily on people who had a bad break that wasn't their fault? We can usually bring people back from a broken bone or a lost job. Druggies, not so much.

[1] https://www.washingtonpost.com/news/wonk/wp/2016/12/08/heroi...

It's incredibly coincidental that our resources always seem to be limited to exactly the amount we need to help people who don't deserve what's happening to them according to the particular ideology of the people who happen to be controlling our resources at the time, and no more.

It's as if they were dividing us by our own interests, and encouraging us to morally condemn and attack people on the other side.

I don't think many people 'choose' to become so dependent on drugs that they cannot function in society and fatally overdose. A doctor prescribing opiates for an injury without a plan for cessation and withdrawal is a very common path to opiate addiction and overdose. I would absolutely classify this as a 'bad break'.

The path out of opiate dependence is so difficult and our society does very little to assist. Saying "i'm addicted to drugs and in a downward spiral" and having society respond in a manner that will actually help you out of the situation is not currently a reality.

[1] http://www.pbs.org/wgbh/frontline/article/veterans-face-grea...

The rest are downvoting you, but that is a really relevant problem. Sometimes you have injure or some other surgery and you get opiods to deal with the (possible severe) pain - and you get addicted and then cut of. Your fault?

Sometimes opiods are even prescribed for chronic pain, but then you need larger and larger dosages.

The amount of normal people who just inject heroin on a lark some morning is probably less than ten. Most slide into it, and a lot of them are mentally ill.

> Becoming a druggie is self-inflicted

In the Phil Katz thread, many felt that alcohol-addiction was related to genetics (at least partially): https://news.ycombinator.com/item?id=13148725

So isn't that genetic trait a "bad break"? Some people found it easy to kick the addiction, while others never could.

Yes this is part of the reason, but people are also dying younger now due to obesity. We are literally digging our graves with our teeth.

It would be interesting to compare and contrast how societies with strong family and extended family bonds do on the bad-break test. In the US and Western Europe a strong individualist ethos has led to societies where government is the fall back for individual and immediate family misfortune. It's not ideal.

> It's not ideal.

...if your government does not allow for solid social security and health care.

> In the US and Western Europe a strong individualist ethos has led to societies where government is the fall back for individual and immediate family misfortune.

I don't understand this. Can you explain?

I agree; but it's important to remember that even in societies with strong, cohesive extended family bonds, there are large numbers of people who lack family, or people whose families are mostly abroad (immigrants) who are really in trouble when the state abdicates due to the assumption of a family safety net.

I'm of the opinion that governments (or any large institutions and networks of institutions, including powerful families and corporations) have an interest in breaking up families, because relationships between peers create a power base that competes against them. I don't think that it's a coincidence that governments tend to be fought over on one side by a party representing traditional large institutions, and on the other a party representing social interest/minority protection organizations and employee unions.

Nothing is ideal, but having government as the fallback seems better than having family as the fallback. Falling back on family only works if some of your family has enough resources to help, and that's not always the case.

The big advantage is that family (and community) usually cares about you, whereas bureaucrats care most about following rules. Because of this, family can usually do more than just give you a few cheques.

What, condolences and sympathy? That's not better than a few checks.

Work, generally. It's a network of people that will vouch for you (with little or no evidence of your worth), or simply employ you.

Oh, it's that easy? I can just ask my poverty-stricken family to bootstrap me out of my poorness because they'll hire me to do the jobs they don't have?

I'm the highest-paid person in my family. You think I can go to my boss and say "Hire my brother, he's been a gas-station attendant for 6 years. Probably he's a great programmer."

It's easy to not be poor when you come from a family with wealth and hiring power. If you are poor, it's probably because you don't have either. You'd think that would be obvious.

What about all the people whose families don't care about them?

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