I've never heard the word "trivet" before. I like it.
Why, what do you put your ramekins on?
If my kitchen were full of her stuff, I would have to give up eating at home or self-medicate heavily every waking minute.
2: I have a ramekin skywalker that floats around my kitchen. Duh.
Serious question, Stanley: What did your parents call the thing they put down on the table to protect it from getting scorched when a hot serving dish was put on it? A potholder? A corkboard? A hotplate? I've heard all those terms used, but they all have primary meanings that make the secondary one confusing.
What did your parents call the thing they put down on the table to protect it from getting scorched when a hot serving dish was put on it?
My parents used potholders as trivets so they never actually called them trivets.
We used a table cloth to protect the table, a placemat to protect the table cloth, a trivet to protect the placemat, a potholder to protect the trivet, and ate cold food to protect the potholder.
I'm so glad all of you discerned the real point of the post, and were not distracted by the giant erection on the kitty-cat.
I also wonder if there is some regionalism to the word trivet. While I know what it is I have never actually heard anyone use the term in person. I have only seen it in writing.
8 made me laugh.
On topic, have I ever mentioned the guy I met whose parents had kept their furniture covered in clear plastic for many years, to make sure the upholstery stayed nice? They were surprised* when it turned out that none of the adult children wanted to inherit it.
*I'm not being snarky here; I think they really did view it as "keeping nice things nice" and were genuinely puzzled that their offspring didn't share the same taste and preferences.
9: We have an asbestos condom to protect that.
have I ever mentioned the guy I met whose parents had kept their furniture covered in clear plastic for many years, to make sure the upholstery stayed nice?
My parents do this. With blankets, but like with tons of blankets, so that not a square inch of couch is visible. For that express purpose.
14: Uncomfortable thought #17: What are they doing on the couch that would ruin the upholstery?
Huh. We have a blanket tucked all over our couch, but it's so the stuffing doesn't escape from where the dog dug through the back of the couch. That's cool, right?
14: That sounds like a middle ground between 12, which I'd call scarily eccentric, and my own home, where we kept blankets on couches (but not every inch of the couch, just the parts one would sit on, and not on chairs, even leather ones), specifically because of all the cats we had. This never seemed odd to me.
scarily eccentric
Dude, I have some lovely neighborhoods I'd like to introduce you to.
(Seriously, if it wasn't clear from my original comment, the funny-to-me part was that the parents thought the adult children would share their preferences, not that the parents did it at all. vinyl-covered furniture is a super-common phenomenon among certain class/ethnic-religious groups where I grew up.)
I've certainly heard the word "trivet", but I've never shared a house with one. Plenty of potholders: we had the looms growing up.
I find now that the placemat suffices to protect the table from the microwaved bowl of soup.
The depressing thing about vinyl-covered furniture is that you'd think it's intended to save the furniture for special events, like parties or holidays. But during those events they don't remove the vinyl either. Maybe they don't even consider it, because the real intent is to keep it "in the packaging", so to speak, so it can never actually be comfortable but in theory it remains in an ideal state. Or maybe they consider removing the ugly vinyl on special occasions, but then decide not to because there is a greater chance of spills and stains.
16: I was trying for a 'mom and dad having sex on the couch joke'.
CAT ERECTION! CAT ERECTION! WILL NO ONE SPEAK OF THE CAT ERECTION?
19: Well, "scarily" might have been putting it too strongly, but I'd stand by "eccentric". I've definitely never seen furniture in use in a home in clear plastic in real life before.
23: Eh, find us a duck erection and maybe we'll get somewhere.
I recall trivets as one of our possible school woodshop projects. I instead made a chopping block, a jewelry box and a letter opener. The first two are still in use at my parents' house! Artisanally-crafted semi-antiques. My extended childhood nostalgia function appreciated having don't-really-give-shit-about -their-things parents. Growing up, our neighborhood had a lot of covered furniture/no one ever really goes in there much less sits there living rooms. A practice brutally mocked by my parents.
I find the cat pseudo-erection insufficient to override the other, lamer features of the cat.
Serious question, Stanley: What did your parents call the thing they put down on the table to protect it from getting scorched when a hot serving dish was put on it? A potholder?
Yes, a potholder. We had a whole drawer dedicated to them, pretty much all cloth versions IIRC.
23: The internet is properly treated as a found object, my dear.
This Metafilter thread gets at all of the traditional explanations I've heard (keep it clean from children and pets, keep it clean for important visitors like the clergy or prospective in-laws, OCD, Depression-era frugality).
But it also adds another one, which I am chagrined to have forgotten: The idea of keeping an expensive asset in good condition in case you ever hit hard times and have to sell it. This happens with things like electronics too, which may seem odd to those of us who grew up in the era of minimal secondhand use, but it actually makes perfect sense to me when I think back over people I knew.
And then there's this blog, which hits on an ethnic stereotype that I've literally never heard of, even tongue-in-cheek.
I don't think anyone noticed the erection except you, Heebs.
The word "trivet" was a constant in my house. My mother probably used it every time she made dinner and told us to set the table.
My parents have a lot of lame cat paraphenalia. It's nice that there's one item that makes me laugh.
Growing up, I always thought my parents - my mother would have been the active force behind this, but my dad did his part too - were really, really meticulous about household cleanliness and stuff. I mean, we had blankets on the furniture to keep cats from shedding on them! It's just cat hair! But maybe I've been wrong all along and we were just a tiny bit less casual about keeping the house tidy than most people.
I don't think anyone noticed the erection except you, Heebs.
On the off-chance that this is true, I'd like to say that this trivet was purchased and given to my parents solely because everyone found the unintentional erection so hilarious.
Sometimes I think you all were raised on planet Conehead and are doing your best impression of homo sapiens, after years of meticulous study.
Wait, isn't "Trivet" the name of one of the Palin children?
35: "Triptych" I think (or maybe just Triptik).
Molly uses the word 'trivet" a lot, to the extent that I think she consciously tries to work it into conversation. I had never heard the word before we got married. I don't even think she used it while we were dating. It was, like, she didn't want to scare me off with her massive lexicon of words for common household items.
Like many here, my parents used placemats as trivets, sometimes doubled up. Houses that use trivets seemed very grandmotherly to me at first.
34 I'm curious. What reaction did you expect you would get? Discussion of other intentional/unintentional art boners? The Little Mermaid cover?
38: Oh, a person here or there saying "That's funny!" or "Heh" or anything. Ignore me, I'll probably wish I'd shut up sooner, later.
35: I thought it was "Trog".
34: I'd like to say that this trivet was purchased and given to my parents solely because everyone found the unintentional erection so hilarious.
But the pointyish shape doesn't look like an erection; it looks like a strange cat-colored dildo. Or a Hamas-friendly small missle. Or possibly a trivet for aliens.
max
['Come to mention it, it doesn't look like a cat. It looks like an poor copy of a cat made by slightly clueless... coneheads.']
41: But it's supposed to be the cat's stomach, back behind the legs. It's not supposed to look like any silo-esque launching object.
I don't think that's an erection, heebie.
43: Boy do I feel silly for humping it.
If your cat's erection persists for more than four hours or is more than half the length of his body, please contact your veterinarian.
44 is self-referential and self-stimulating.
I don't think that's an erection, heebie.
Of course not. A cat's penis has a barbed tip.
Unfortunately, I rendered 46 confusing.
I thought it was the stomach too at first, but there's an extra stripe. Tail?
I laughed, heebie. Upon very first sight.
Also, trivets are lovely things. I don't believe I say the word very often but I use mine often and wished I had another.
48 was a reference to my life in general. Not the shifting of 44.
50: I think it's just poorly drawn, or resting on the assumption that stripes sometimes merge and disappear.
On a serious note, lately I have been demanding more verbal acknowledgement and applause from Jammies and everyone in general, in an obnoxious fashion. Like I did here. I'm probably redirecting general life stress through this channel. But it's obnoxious and I'll move on to a different mechanism now.
I just saw it as the cat's stomach. Just like the rabbit which is not a duck.
57: Only if you yell "CAT ERECTION!" again. That was funny.
59: And it's comforting.
CAT ERECTION! CAT ERECTION!
CAT ERECTION! CAT ERECTION!
So you've seen the new Eve Ensler play too?
An ex-boyfriend of mine told me that I was much easier to be around the times I was teaching. Getting attention from students filled some of the need, so that he didn't have to provide as much.
63: I've always tried to be with people whose goal is to ignore me as often as possible. That way I can spend more time on the internets.
I love heebie, too, but there's no getting around the fact that her cat erection post hasn't generated the same level of comment activity as ogged's offhand remark about dog erections.
Yikes, I killed the thread cold.
OK, how about "McMegan: now more of a jackass than ever"?
66.2: Is that physically possible?
67: RTL and be the judge. Keep a vomit-proof vessel handy for when you get to the cutesy self-indulgence about killing orphans in her spare time.
68: But she's just telling the difficult truths that you don't want to accept, isn't she?
Gah, did you have to go and link to McMegan? Her comment threads are like flypaper for fuckwits.
OT: Holy shit, makes Forks look like the Sahara:
Morakot moved very slowly as it passed over Taiwan, dumping near world-record amounts of rain. Alishan in the mountains of southern Taiwan recorded 91.98" of rain over a two-day period, one of the heaviest two-day rains in world history. The world 2-day rainfall record is 98.42", set at Reunion Island on March 15 - 17, 1952. Alishan received an astonishing 9.04 feet of rain over a 3-day period. The highest 1-day rainfall total ever recorded on Taiwan occurred Saturday at Weiliao Mountain in Pingtung County, which recorded 1.403 meters (4.6 feet or 55 inches) or rain.
70: It traps them and they die there? I can get behind that.
Wow, JeffMasters does not have any blog entries! The flood must have got him.
I used to enjoy disagreeing with McMegan more. Now I just get confused -- I generally have a hard time finding a clear point to disagree (or agree, it could happen) with.
74: Moving from The Economist to The Atlantic was, I believe, the trigger for that shift. The post I linked to is a case in point. By her own lights, she is attempting to argue against more government involvement in health care (1) without resort to a priori unease with state interference in individual liberty, and (2) by arguing that it will be destructive to ends that liberals cherish.
This attempt runs up against the insurmountable problem that there is no empirical case to be made for (2), at least not at the level of generality that McMegan wants to make it at (i.e. that it applies to ANY increase in government involvement).
Back at the Economist, she could have hit ctrl-V and pasted in some boilerplate about free market good, government bad, and her audience, broadly speaking, would have sympathized. That's not possible with the readership of The Atlantic, which doesn't mind a conservative provocatrice, but won't be satisfied with glibertarian bromides. Her attempts to finesse the transition have left her much less coherent.
Heebie, you'll be happy to know my first reaction to your post went something like "AAAH! SCARY CAT PENIS!"
I stopped in on a McMegan thread a week ago where she appeared to be arguing that sick people were just as likely to be able to get insurance as well people were, based on data that showed exactly the opposite, but she was too stupid to interpret. I'm actually thinking the perennial confusion, "McMegan, stupid or evil or both" sort of works to her advantage, like squid ink. As LB says, it's hard to know where to begin with her, so people just give up. Plus she herself seems too dim to really understand whether she's arguing in good or bad faith.
Recently, one of her own libertarian compadres actually called her out on her standard research method of just making shit up. Apparently he had one of those what-the-fuck? experiences you have when she's talking about a topic you actually know something about, and couldn't resist pointing out the falsehoods.
The title made it pretty much inevitable that this thread would end up with McMegan.
I think the abuse of McMegan has driven Becks away from posting on the blog, which is a shame. But doesn't McMegan deserve abuse? It's unfortunate.
Wow, I did not spot the giant cat erection before perusing this thread.
They should use this trivet as one of those optical illusion examples. Stare at it with a puzzled frown until...
PGD-pwned on preview, but:
By her own lights, she is attempting to argue against more government involvement in health care (1) without resort to a priori unease with state interference in individual liberty, and (2) by arguing that it will be destructive to ends that liberals cherish.
and (3) without offering any evidence that she knows what she's talking about. As DeLong pointed out, why the hell can't the Atlantic hire someone who actually understands the issue?
my first reaction to your post went something like "AAAH! SCARY CAT PENIS!"
verus
I did not spot the giant cat erection before perusing this thread
Perhaps it's meant to be ambiguous, like the old hag / beautiful lady drawing.
Maybe some of y'all have filthy, filthy minds.
79: Eh, I love my parents, but their politics suck. If they had a big megaphone on the internets I'd have a hard time seeing how my friends were duty-bound to pretend they made sense.
Oh, I don't think there's ever been any pressure from Becks not to vehemently disagree with McMegan, just not to be personally unpleasant.
Wow, that first paragraph is a gem.
Where that gets tricky is that it's often worthwhile to point out that someone is not merely wrong but wrongheaded.
Wow, that first paragraph is a gem.
The curious thing about the first paragraph is that, while it sets an improbably high bar for asininity, McMegan nonetheless manages to clear it without breaking a sweat in the very next paragraph.
84
Eh, I love my parents, but their politics suck. If they had a big megaphone on the internets I'd have a hard time seeing how my friends were duty-bound to pretend they made sense.
That's not the problem. The problem is when your friends start claiming your parents are so irredeemably evil that no decent person could possibly associate with them.
74
I used to enjoy disagreeing with McMegan more. Now I just get confused -- I generally have a hard time finding a clear point to disagree (or agree, it could happen) with.
She always has had a tendency to ramble on. Perhaps her health care posts are worse than usual. Although I did think she had some clear points in the obesity posts what no one seems interested in discussing.
90: Which I don't recall seeing around here in reference to McMegan. Are you suggesting otherwise?
91: It's not the rambling on, it's the cluelessness.
Such as? That mostly seemed pointless to me too. But if you got something concrete enough to agree or disagree with out of it, that's something.
It seems like there is a spectrum of complaints here, and it is hard to tell what is appropriate.
I see the spectrum like this.
1. Your opinion on this issue is wrong and your arguments are fallacious or non-existent.
2. Your basic political philosophy is wrong, and your arguments are across the board fallacious or non-existent.
3. Your basic political philosophy and all of the arguments you give attract believers because they appeal to the baser elements of human nature.
4. You are not arguing in good faith.
5. You deliberately try to hurt people because of flaws in your character.
6. You colossal bitch, I hope they torture you slowly when the revolution comes.
Right now, I willing to go as far as (4) with McMegan. I hope that doesn't alienate anyone.
92
Which I don't recall seeing around here in reference to McMegan. Are you suggesting otherwise?
IIRC Becks got abused for being friendly with McArdle.
92: For me, lately, it's the rambling. I used to be able to get a good "No, that's wrong, because of X, Y, and Z" out of McM's blog. I still read it out of habit, and to get a sense of what the current right-wing line is, but mostly I find myself thinking "What's your point?"
90
That's not the problem. The problem is when your friends start claiming your parents are so irredeemably evil that no decent person could possibly associate with them.
Meh, we excuse a lot more within families than in those relationships we choose for ourselves. If one befriended an actual Nazi, or continues to be friends with someone after they become a Nazi, I think that would reflect badly to at least a small degree on one's own character. (Guilt by association is bad legal doctrine, but the standards are different for interpersonal judgements.) But we don't expect people to cut ties to their own family in the same way.
This is why analogies are banned.
On preview, "abused" is putting it far more strongly than I noticed, but then it's not the kind of thing I would notice. Link?
94: I wouldn't go as far as 6 (not being a revolutionary myself), or even 5, but I would insert (4a) your deliberate obtuseness with respect to the real world consequences of your policy positions reflects poorly on your moral character; and (4b) if you got really sick and then had your health insurance rescinded, I would likely be unable to completely suppress the Schadenfreude.
we use obesity as a proxy for health/fitness, when, except in the extreme, it's actually much more accurately understood as a proxy for class.
aside: I was interested in how McArdle's commentariat wouldn't buy her argument even though it was clearly articulated in libertarian/anti-statist terms; it turned out that the libertarian freedom they were most committed to was the not-so-elevated freedom to mock the less fortunate....
but mostly I find myself thinking "What's your point?"
This is what tempts a person to reach no. 5 on rob's contempt-o-meter.
99.1: I keep trying to drop down into UMC weight, but I can't seem to swing it. I'm a bit short, so I think I'd have to get down to a 30 inch waist to be convincing. Also, I'd need a bigger house.
(4b) if you got really sick and then had your health insurance rescinded, I would likely be unable to completely suppress the Schadenfreude.
I still read it out of habit, and to get a sense of what the current right-wing line is, but mostly I find myself thinking "What's your point?"
I'm actually don't think she's a good source for the right-wing line, I think she sees herself as trying to independently think it out for herself, but she's too dim and too ensnared in glibertarian ideology to really get anywhere so it just comes out confused.
Usually the right-wing line is very sharp and smart in a short-term political/propagandistic way, I can always see why they're arguing what they're arguing given their goals of ruling the world. Not so with McMegan.
A political problem the right faces with health care is that the current system is indefensible from either an ideological or a practical standpoint, but the true free-market alternative is completely unpalatable to the public. It's even worse than single-payer politically. Hence they are reduced to fear-mongering.
94: Somewhere in there (and in line with the title of the post) is having a Backpfeifengesicht, which apparently means "a 'look' or smile which makes one want to slap it". Probably about 4d or 5a. Saw it originally used with regard to Bill Kristol. (via some commenters at Bérubé's place and The Poorman).
102: Not if you can design cat-themed household goods that have erections that are obvious enough for internet jokes and subtle enough to give to mom with her noticing.
PGD, you should totally try to get a date with McArdle.
93
Such as? That mostly seemed pointless to me too. But if you got something concrete enough to agree or disagree with out of it, that's something.
As I recall (and I may be conflating with the LGM posts) she was claiming that:
1.) The health risks of being fat have been exaggerated.
2.) Given unlimited access to food your body has a natural weight and it is very difficult to maintain a weight which is significantly lower.
3.) Being fat is not a moral failing.
4.) Attempts to improve public health by stigmatizing obesity are wrongheaded.
Didn't she just get married? Not that that precludes dating, but usually people at least slow down until after the honeymoon.
107: Claims (1) and (2) are the sort of empirical issue that people frequently say McMegan handles badly. At the very least (1) is badly phrased, since it confuses fat being an indicator of health problems and fat being a cause of health problems.
Yeah, she got married. I was very disappointed. Dating me could have substantially improved the intellectual coherence of her blog. The idea of being the anonymous influence behind a right-wing blog gives me a perverted little frisson.
Also (2) is somewhat spurious. It hints at the claim that many or most of the people who are currently obese are at their "natural" weight level, and couldn't lose weight if they tried. But this claim is obviously false, because just 50 years ago, we had much lower levels of obesity, and it is almost impossible that so many people's "natural" levels have changed so quickly.
But if she is not making a claim about the recent rise in the numbers of obese people, why is she making this remark? It is either a red herring or false.
It is either a red herring or false.
Which would make an excellent mouseover text for her blog.
107: What made Megan's obesity argument so objectionable was not any of the points you list, but that she pivoted from there to saying that liberals don't care about public health anyway, but just want to reify their class-warped aesthetic preferences. This was, even by McMegan standards, a forray into lunacy.
I should say that McMegan is far from the only person I have seen raise the point made in (2) in reference to the current obesity/diabetes* epidemic. A lot of feminists concerned with fat acceptance make it, too. It is still a crappy move in an argument.
____
* I heard someone on the radio say that the obesity epidemic is really a diabetes epidemic. I didn't stay tuned in to hear her argument, but the proposition was very appealing to me.
93: Thing is, though, none of those things seem to engage with anyone else's arguments. (1) is probably straight-up true, but perfectly consistent with obesity still being a significant public health problem -- to the extent that she's claiming it isn't, that's poorly supported. (2) all rests on what 'natural' means -- if all she's saying is that it's extraordinarily difficult for anyone to lose a significant portion of their body weight, and policy aimed at significant weight loss by a significant part of the population is probably doomed to ineffectuality, that's also probably true. But of course policy can affect the level of obesity in the population without causing anyone to lose a pound if it affects the propensity of people to gain weight -- the thinner population fifty years ago wasn't starving or malnourished, they just hadn't lived in the environment where they initially got fat. (3) and (4): sure thing. Who is she arguing with?
A political problem the right faces with health care is that the current system is indefensible from either an ideological or a practical standpoint, but the true free-market alternative is completely unpalatable to the public. It's even worse than single-payer politically. Hence they are reduced to fear-mongering.
Indeed. For a particularly pathetic example of this, see the comments thread at McMegans, in which self-proclaimed libertarians lay out elaborate schemes for far-reaching government intervention in the health financing market in order to save us from the horror of socialized medicine.
It's amusing to see how the talismanic properties of the free market lead them to these embrace these bizarre constructs. I mean, you have to squeeze your eyes really tightly shut to act like there are no existing models for successful provision of health care, and that all it takes is a dash of libertarian genius to devise the solution that has eluded the world for so long.
I should say that McMegan is far from the only person I have seen raise the point made in (2) in reference to the current obesity/diabetes* epidemic.
To be fair to McMegan, it's a genuinely confusing set of facts. It seems to be really well supported by the evidence that (1) significant weight loss is unrealistic for most people, and also that (2) there's an environmental explanation for the increase in overweight in developed countries over the last half-century. At first glance, those two facts look very contradictory.
They can be reconciled if you assume that weight gain is much more easily environmentally influenced than weight loss, but that's counterintuitive.
If only it weren't for that tiny little problem that we're not willing to let people die in the streets, a libertarian solution would work splendidly. The problem isn't that markets don't work, it's that we're just too squeamish to let them do their magic with health care.
97
On preview, "abused" is putting it far more strongly than I noticed, but then it's not the kind of thing I would notice. Link?
The real problem with McArdle's obesity argument, as summarized by JBS, is that (1) and/or (4) are close to strawmen. Or maybe not strawmen, but even if not, too indeterminate to be meaningful. Who exaggerating the health risks of being fat? Who is trying to improve health by stigmatizing obesity? The media? Sure, no one will defend "the media", but that's also a very broad critique. And I very much doubt they're doing the stigmatizing with the intent of improving health. The government? Probably yes to (1), probably not (2), unless she can point to a CDC publication titled "fat people suck" or "Communists ate a lot too" or something. Liberals?
Sorry to pile on, but.
118 is spot on. Almost all of the complexity of the free market adders etc. that pp mentions in 116 spring from trying to compensate for avoiding the straightforward scheme of allowing humans to receive goods and services in strict accordance with their ability to pay.
118 is exactly what I was getting at. I have no doubt that if you just removed government entirely from the market, we would see a significant drop in costs and some interesting innovation (see the laser eye surgery market, which is sort of a little libertarian health utopia). But the rationing by wealth would make government rationing look like the most wonderful thing ever. This is why *every single advanced country* has chosen a health care system that is basically publicly financed.
111
Also (2) is somewhat spurious. It hints at the claim that many or most of the people who are currently obese are at their "natural" weight level, and couldn't lose weight if they tried. But this claim is obviously false, because just 50 years ago, we had much lower levels of obesity, and it is almost impossible that so many people's "natural" levels have changed so quickly.
The claim is that food is much cheaper (relative to income) than it was in the past. Another claim is we evolved in food scarce environments and aren't all well adapted to plentiful food.
too indeterminate to be meaningful
Yes, exactly. The sort of argument she's making is clear, but what exactly it would mean for her to be right isn't -- that's what I've been complaining about.
123: That may be the claim, but what's the point?
120
... And I very much doubt they're doing the stigmatizing with the intent of improving health. ...
Isn't that the impetus behind requiring menus to list calories?
125
The point is cheap food means more fat people.
So (1) and (4) are straw men. Point (2) is either a red herring or false. Can we say that (3) is a straw man, too?
Listing calories on a menu is stigmatizing obesity? That's a jump, isn't it?
129: Depends on who you are dining with, I suppose.
The claim is that food is much cheaper (relative to income) than it was in the past. Another claim is we evolved in food scarce environments and aren't all well adapted to plentiful food.
Indeed, these two observations are frequently made by people concerned about rising rates of obesity. But if human genetics are (broadly) the same the world over, and food has become cheaper in other countries as well, why has the U.S. seen obesity grow so much more quickly than, say, Denmark, or Canada, or Australia? There's nothing inevitable about prosperity making us all fat.
127: I'd gotten that far. But we're talking about public policy here, or I thought we were. Did you figure out what she thought the policy consequence was of "cheap food means fat people"?
I had heard that some Asian country (maybe Hong Kong) did just let people die in the street.
I was writing about my deeper opposition to the entire project of providing, paying for, or otherwise guaranteeing health care.
Wow. Just wow. I know that ad hominem attacks are generally frowned on, but I really wish that these sorts of statements could only be made by people who are 70 or older and have declined all Medicare coverage---if that's possible. Preferably, they skipped the employer-based stuff too.
Young people who have never had to deal with the health care system and a personal illness should be barred.
129
Listing calories on a menu is stigmatizing obesity? That's a jump, isn't it?
Consider the Doonesbury cartoons.
Actually maybe listing calories isn't itself stigmatizing. It is supposed to help already stigmatized fat people lose weight (and thereby improve their health).
She does say that she was uninsured with some serious health problems for a while, and it only steeled her resolve.
134: More practically, not gain weight, rather than lose weight. Partially through individual choice, and partially through consumer pressure making grotesquely caloric options less lucrative for restaurants.
Still not getting how that stigmatizes obesity.
132
I'd gotten that far. But we're talking about public policy here, or I thought we were. Did you figure out what she thought the policy consequence was of "cheap food means fat people"?
That other policy interventions intended to reduce obesity are likely to be ineffective.
131: You are absolutely right. Saying cheap food causes obesity is somewhere between an oversimplification and false. In most of the developed world, obesity has not accompanied cheap food. The real correlation is not with cheap food, but with the American diet and food culture in particular. When that gets exported, obesity goes with it. And immigrant groups in this country avoid obesity to the extent that they avoid acculturation.
119: Wow, yeah, that was shitty of Martin. Fair enough.
120
Isn't that the impetus behind requiring menus to list calories?
"The media" is pushing for calories being listed on menus now? Since when?
Certainly some people are providing impetus for calorie labelling requirements for reasons other than shaming, like Yglesias.
Just today I was at a sandwich shop trying to choose between two sandwiches; they both sounded good and not-especially-healthy. My preference would have been to order the less-caloric of the two but I had no idea which one that was and this kind of thing happens all the time.
That other policy interventions intended to reduce obesity are likely to be ineffective.
This doesn't follow. Even if you thought that cheap food was a cause of obesity in the absence of other factors (and it isn't) you can always remove that cause by raising the price of food. It is the most subsidized industry on Earth.
In fact, I'd go so far as to say that if you eliminated the corn subsidy, the average American would lose 10 pounds.
That last one might be a little hard to prove.
137: It's not very strong support for that conclusion, is it? Getting from a pretty good guess at the cause of a phenomenon to a conclusion that it can't be affected by anything else isn't a good argument. Which is, I think, the point of the indeterminate waffling -- if she made an argument with a point, it would be weak. Waffling on about vaguely connected stuff on the other hand, you can kind of see where the argument would be going if it existed, and its weakness are less apparent.
"just because that in..." s/b "just because he believes that in..."
I gained some weight in the past year or so and have found it hard to lose. I think that some of it may be medication related, but it's also the case that at WF I was constantly moving around.
I do have more food around me now (that I can eat, that is), and when there's really good food, I have a bit of a hard time stopping. I'm sure that some of this is evolutionary, but it's also a learned behavior. My Mom was a very bad cook when I was a kid, so I often wouldn't eat much when she was cooking. I got used to eating lots at lunch. Similarly, in ls I didn't have much money, so I skimped a bit on food. Whenever there was a reception or free soup supper, I always ate a lot, because I really didn't know when my next complete meal was coming.
136
Still not getting how that stigmatizes obesity.
Listing calories is more aimed at helping people improve their health by reducing their weight. But there is a stigmatizing effect by encouraging the beliefs that being overweight is voluntary and unhealthy. Similarly anti-smoking campaigns stigmatize smoking.
135: Do you remember when she talked about navigating the health system without insurance.
Aside from removing food subsidies, I would like to see the negative externalities of farming internalized into food prices.
140
This doesn't follow. Even if you thought that cheap food was a cause of obesity in the absence of other factors (and it isn't) you can always remove that cause by raising the price of food. It is the most subsidized industry on Earth.
By "other" policy interventions I meant other than restricting calories.
She does say that she was uninsured with some serious health problems for a while, and it only steeled her resolve.
Inspiration to write Kid Rock parody "Libertarian Badass" rising....
146: By that standard, any policy at all intended to affect population rates of obesity stigmatizes obesity. Surely it's possible to recognize that obesity/diabetes is a public health problem without stigmatizing it -- heart disease is recognized as being undesirable without being stigmatized in that sense.
150: What does "restricting calories" mean as a policy intervention?
153: The extension of Obama Death Panels from health care to food.
It's an okay phallic joke, heebie, but the background-foreground interpretation could go farther. You just have too much activation and not enough inhibition right now.
One of the commonly cited but often ignored facts in this debate is that we don't actually generally consume more calories now than in the past. We consume much more of our calories as sugar, but the main thing is that we are much less physically active.
148: She mentions it in this post, but with no details.
157: Really? I suppose I'd believe that with a cite (that is, I believe we're much less active, but not without seeing some support that we don't consume more calories), but I'm surprised if it's true.
139
He supports it mainly just because that in marginal cases people want to make the healthier choices and more information will make that easier. That doesn't read like shaming to me.
There is a general belief that deliberately making unhealthy choices is shameful.
And the larger argument is that these marginal decisions are irrelevant as if your body doesn't think it is getting enough calories it will nag you with hunger pangs which are difficult to resist in the long run. So if MY chooses the smaller portion this time he will likely choose the larger portion next time and vice versa.
158: Wow. That's the first McArdle link I've clicked in a while. My god, it's full of stupid!
153
What does "restricting calories" mean as a policy intervention?
Restricting access to food via higher prices or rationing or whatever.
re: 159
Certainly in the UK it's true. I've read several articles on the topic. I'll try to find a cite.
Here's one on children's diets:
http://news.bbc.co.uk/1/hi/health/542205.stm
But I gather the same basic facts hold true for adults. We now eat excessive calories relative to energy expenditure, but our actual intake is, on average, not higher.
And the larger argument is that these marginal decisions are irrelevant as if your body doesn't think it is getting enough calories it will nag you with hunger pangs which are difficult to resist in the long run
This is again assuming that no environmental cues can affect calorie consumption, which is evidently, given the population changes over time, false. Price cues can -- people fifty years ago had excess income they chose to spend on things other than food; they bought less food because it was expensive, but not because it would have been impossible to buy enough food to get fat.
152
By that standard, any policy at all intended to affect population rates of obesity stigmatizes obesity. Surely it's possible to recognize that obesity/diabetes is a public health problem without stigmatizing it -- heart disease is recognized as being undesirable without being stigmatized in that sense.
It is hard to get people to change their behavior without stigmatizing the unwanted behavior.
Restricting access to food via higher prices
Higher prices, within the realm of the discretionary income people have available, isn't 'restricting access to food'.
re: 159
A bit of googling finds some research showing increased calorie intake in the US over the past 20 years or so. So perhaps it doesn't hold in the US.
it depends on what you mean by 'in the past', since in the preindustrial world malthusian pressures would probably have avoided large calorie intake unless you were elite or living somewhere with a recent plague or genocide. not true though for the recent past.
on this pdf linked by SexyHealthBlogger Klein the other dya, look at the fig.5 at the end, for most countries including the USA!USA!, they both are a problem in terms of what turned us from 50's olympians into current mortals.
not that they aren't complementary goods; its most likely you'll snack if you're sitting on the sofa than if you're out playing ball.
hm the html ate my link. http://www.nutrinfo.com/pagina/info/whyisthedevelopedworldobese.pdf
165: You now seem to have moved from 'it is impossible for policy to affect population levels of obesity' to 'it is wrong to attempt to affect population levels of obesity because it can't be done without stigmatizing obesity.'
I can imagine someone holding the latter position (I could probably find people who do fairly easily), but it seems to ignore the fact that obesity is stigmatized now, and it's not easy to see how to eliminate that stigma. If there were a policy intervention that would reduce population levels of obesity without increasing the level of stigma, would you be morally opposed to that?
re: 168
I had in mind the fairly recent past, since there's been a spate of articles that I've happened to read recently on nutrition in WII and immediately after. I wasn't thinking of centures ago.
164
This is again assuming that no environmental cues can affect calorie consumption, which is evidently, given the population changes over time, false. Price cues can -- people fifty years ago had excess income they chose to spend on things other than food; they bought less food because it was expensive, but not because it would have been impossible to buy enough food to get fat.
This is why I qualified 2) in 107 with "Given unlimited access to food ... ". Sure given sufficient levels of coercion you can get people to eat less.
And the argument is not just that food now is cheaper, it is that it is more palatable.
if your body doesn't think it is getting enough calories it will nag you with hunger pangs
Ob ob/ob mouse.
Most people, I think, are not obese mouse in terms of where their natural set point lies.
re: 169
That's a good link, thanks!
It is hard to get people to change their behavior without stigmatizing the unwanted behavior.
Since when?
172: Where did coercion come into this? I mean, I knew I was planning to put the population of the US on a strict 1500 calorie a day diet with firing squads for illicit snacking, but I hadn't brought that plan out yet -- is someone else talking about coercion, as opposed to adjusting subsidies and putting calorie counts on menus?
166
Higher prices, within the realm of the discretionary income people have available, isn't 'restricting access to food'.
Give me a break. Suppose we put a big tax on birth control or abortion. Are you claiming this would not be restricting access as long as people could somehow scrounge up the cost?
More/less active fits as an explanation for the demographic I see a lot of. I don't see a good demographic way to identify the rates that seem most important-- fast food consumption per capita ( Applebee's is fast food for this to make sense) and fraction of population that are completely sedentary (Slanket sales or something). Fast food calorie labelling might work, but it's ugly social engineering. And do you need a label to learn that a big gulp is a month's supply of sugar?
That's interesting, the paper in 160. The articles I had read were covering a longer time-span, when the change in expenditure was clearly a larger factor. Over the 1991-2002 period for England in that study they place the blame 50% on increased caloric intake and 50% on reduced expenditure, whereas the longer time period papers I'd read put the balance on expenditure much higher. Which would make sense if most of the decline in energy expenditure happened in the 50s, 60s and 70s.
I've linked this before, but whatever.
Seth Roberts has a rather convincing theory about the mechanism behind weight gain. He hypothesizes a set point, and that the set point gradually decreases over time, but increases every time you eat tasty food, especially when the taste of the food has been "learned" by the body as being high calorie. He hypothesizes that one cause of obesity in America is the preponderance of places to get food that always tastes exactly the same, thus increasing the set point more than it would be otherwise.
His support for the hypothesis is that when people consume significant calories with little to no taste, they consistently lose weight over a period of months.
121: the free market adders vipers
Ahhh, much better!
177: IIRC, gas consumption didn't rise significantly from the $1.50/g price to the $2.50 price, but starting decreasing above that.
Are you claiming this would not be restricting access as long as people could somehow scrounge up the cost?
For anyone who could, in fact, pay, that's right -- it's not restricting access. My point is that in the past when people were skinnier and food was more expensive, while people were more money-conscious in terms of their food expenditure, most of the population wasn't working to get the maximum number of calories out of their food budget (by, e.g., living primarily off rice). Americans in the 50's could easily have purchased and eaten more calories than they did, but somehow they chose not to.
170
You now seem to have moved from 'it is impossible for policy to affect population levels of obesity' to 'it is wrong to attempt to affect population levels of obesity because it can't be done without stigmatizing obesity.'
First this is all my interpretation of McArdle's argument. Which would be the benefit in health terms of reducing obesity (particularly by moral exhortations) is less than the cost in unjust stigmatization of people who are naturally fat by people who are naturally thin.
... If there were a policy intervention that would reduce population levels of obesity without increasing the level of stigma, would you be morally opposed to that?
I have no moral objections to a safe and effective drug which reduces obesity. Too bad there doesn't seem to be one.
Americans in the 50's could easily have purchased and eaten more calories than they did, but somehow they chose not to.
Maybe Jello molds suppress appetite.
(particularly by moral exhortations)
Which no one's advocating. Claiming that putting the calorie count of a muffin on the menu is a moral exhortation doesn't make it so.
re: the 1950s
There's also the magic slimming effect of booze and cigarettes!
There's also the magic slimming effect of booze and cigarettes!
As good an excuse as any to link this.
Cigarettes and heroin for some real 50s-style hipster slimming cred.
re: 191
I was half kidding, but certainly in the times in my life when I've drunk more heavily I was much slimmer than I am now. And that isn't just because I was younger, my weight tends to go up and down, and usually when it's been up has been when I've drunk less. I suspect it's appetite supression, or just having a busier social life or something.
184
For anyone who could, in fact, pay, that's right -- it's not restricting access. ...
I doubt that is the majority view. In any case I meant to include higher prices as a way of restricting access.
... My point is that in the past when people were skinnier and food was more expensive, while people were more money-conscious in terms of their food expenditure, most of the population wasn't working to get the maximum number of calories out of their food budget (by, e.g., living primarily off rice). Americans in the 50's could easily have purchased and eaten more calories than they did, but somehow they chose not to.
Cheaper and more palatable (addictive if you prefer).
185: But back to McArdle -- do you notice how much work you have to do to get the argument you're making (which, while it's mostly wrong, is recognizably an argument) from her posts? She spent lots of time saying weight loss was impossible and stigma was bad, but left the policy consequences of those facts mostly up in the air.
187
Which no one's advocating. Claiming that putting the calorie count of a muffin on the menu is a moral exhortation doesn't make it so.
How about putting CO2 emitted while manufactured on products? You think there isn't an implied moral position?
In simplest form, isn't the argument that highly subsidized corn, soybeans, and sugar skew food budgets toward more energy-dense foods (meat, snack foods, etc.) and away from fruits and vegetables and other DFH fare?
re: 196
What about putting the price on things?
His support for the hypothesis is that when people consume significant calories with little to no taste, they consistently lose weight over a period of months.
There's nothing stopping him from doing some proper studies to test the theory, but he doesn't. Self reporting from his own experience and his forums does not constitute a well designed or controlled study. His one peer-reviewed publication on the subject discusses the hypothesis in the course of a general discussion of his self-experimentation methods, not a full presentation of the results as publishable findings in themselves.
more palatable
I don't like 'more palatable', because it implies that most people given a choice between the 'more palatable' food you're talking about, and a more complex, less processed diet, would choose the former out of considerations of taste alone, which I think is false and I'm sure hasn't been established. But yes, there's something different about the food available now that makes it more likely to lead to obesity beyond its cheapness.
What's your basis for saying that this difference in our current diet is impervious to being affected by policy changes?
181 Seth Roberts has a rather convincing theory about the mechanism behind weight gain. He hypothesizes a set point, and that the set point gradually decreases over time, but increases every time you eat tasty food, especially when the taste of the food has been "learned" by the body as being high calorie.
There's definitely evidence in rats that the tastiness of food affects the set point, going back at least to the seventies: e.g. this and this, in which rats given bitter-tasting food developed lower set points.
"ut there is a stigmatizing effect by encouraging the beliefs that being overweight is voluntary and unhealthy. Similarly anti-smoking campaigns stigmatize smoking."
sounds like a parody of liberal belief in structural causes
I've also seen articles pushing the opposite line. That rich, strongly flavoured food consumed slowly suppresses apppetite. Aryuvedic guys often push that line, and I've seen some pop-science articles reporting research that backs some of that up.
I don't know, "palatable" to me appropriate evokes the language on the bag of our cat's prescription cat food. "Exceptionally palatable!" they proclaim, which means "Fear not, cat will scarf this shit down without thinking twice!" Quite a lot like a Dorito or a carefully food-engineered P. F. Chang's somethingorother.
203: I've head many anecdotes from people that Roberts' diet doesn't work for them for some reason, but I'm convinced by the existing evidence that there's something to the theory. My guess is that is a puzzle piece to a much more complete theory of weight gain/loss.
you don't think people losing weight on untasty calories might ahve something to do with people just not wanting to eat them as much? self-reports on food intake are wildly inaccurate.
|| I just ate a day-old breadstick (the soft kind). It was good. Surprising. |>
207: Well, that's basically the idea, except that they also don't want to eat the tasty food as much either.
Actually, now that its mentioned, I would like to see some research done on whether the public health push to stop people smoking had a significant effect on weight gain. Nicotine is a very good appetite suppressant, as well the fact that having a smoke is a good substitute for having a snack, in terms of a pleasurable experience & something to keep your hands and mouth occupied
198
What about putting the price on things?
There is a bit of "thrift is good" implied (particularly for unit pricing). Why do fancy restaurants leave the price off?
Has anyone ever tried to make cigarettes that are just nicotine and filler? Sure, there are patches, but they're not quite the same. Wouldn't they be much healthier and have basically the same effects?
Why do fancy restaurants leave the price off?
Does this actually happen in 2009? I've never encountered it, but there are many places I've never eaten.
195
But back to McArdle -- do you notice how much work you have to do to get the argument you're making (which, while it's mostly wrong, is recognizably an argument) from her posts? She spent lots of time saying weight loss was impossible and stigma was bad, but left the policy consequences of those facts mostly up in the air.
I though she was reasonably clear if longwinded. And you can discuss empirical facts independent of policy implications.
212: I asked a similar question here once. Didn't get a useful answer.
200
What's your basis for saying that this difference in our current diet is impervious to being affected by policy changes?
Once again I am just giving my interpretation of McArdle. Which would be, impervious is a strawman overstatement but people in general prefer palatable dies and will resist policy changes intended to make their food taste worse.
When did snacking become common? When did it become socially acceptable? Because my grandmothers knew it was tacky to eat on the street, or to eat between meals (although meals involving more utensils than food might have been OK); and my mother could eat between meals but it was only 'OK' if hungry; and from the 80s on, it's been normal to have emergency chocolate and a bottle of drink at all times. Just the triumph of advertising?
217: Possibly the same time people took up the shameful, doglike activity of licking ice cream cones in public.
Does this actually happen in 2009? I've never encountered it, but there are many places I've never eaten.
Every "fancy" restaurant I've ever been in, save one, had prices clearly listed on the menu. This sounds like something from the 1950s.
I had dinner at a fancy restaurant recently and the menus we got had no prices, but that's because the person hosting the menu had selected a limited range of things in advance from which we could choose—I think that was actually the restaurant's policy for parties of more than six.
The regular menu did have prices.
As far as the whole obesity debate goes, McMegan's not terribly interesting; the person who I can't figure out wrt the issue is P/aul C/ampos. His posts at LGM on the subject hurt my brain.
||
208:I have been on Atkin's since the first of August, If you value your life, don't wave that day-old breadstick around me
|>
that day-old breadstick
Well, there's a new interpretation of the cat's unusual appendage.
Maybe someone gave Shearer the "ladies' menu"?
Just kidding. I've been to restaurants where there were no prices other than the prix fixe, though, or where we weren't given menus at all except for dessert (no prices).
I was not raised to "snack," and found the act appalling when I started babysitting. What, the kid can't wait until the family eats dinner? Ridiculous!
But now my parents are both snackers of the highest order. Not two hours go by without one of them demanding "some little thing" to gnaw on. They simply cannot believe that I am not hungry two hours after lunch and three hours before dinner, or an hour after dinner. Mom demands this is some kind of weight-loss strategy, to eat all the time, but she's been doing it for ten years and it hasn't seemed to have been effective yet.
I wish food labels would stop stigmatizing people allergic to selected contents of the food product labeled.
What, the kid can't wait until the family eats dinner?
Heh. Never had to deal with the delightful temperament of a hungry child, eh?
218: I think that can be dated (to the St. Louis World's Fair).
230: I'm not saying my family was right. I had low blood sugar and was a pissed-off anemic child myself. Snacks are reasonable!
I wish labeling laws hadn't stigmatized companies making false claims about the contents of their food products.
I wish price labels hadn't stigmatized sellers who switch up the prices at the register.
But there is a stigmatizing effect by encouraging the beliefs that being overweight is voluntary and unhealthy.
Just out of curiosity, James, do you have a dog in this fight, or are you just trying to encourage conflict between nanny-state liberals and fat-acceptance liberals?
230: I can certainly remember being told to wait for dinner lest I spoil my appetite by snacking, and I don't think that was unusual. Even my own kid hasn't created all that much trauma when told to put the damn crackers back in the cupboard and wait for dinner.
Anyway, hungry spouses are the real threat.
234: "Fat Nanny Liberals" must be a pr0n site somewhere.
228.2: Many small meals are supposed to be better for controlling the appetite. I think the problem with that message is that generally our sense of small proportions is completely out of whack.
I don't get weight loss. I've been steadily losing weight as I age, which, from what I understand, is completely contrary to how it works for most women in their 20s. It also seems completely disconnected from exercise levels and what I eat.
233: I wish dead rock stars hadn't stigmatized heroin use.
I am pro snacking, because I am a ravenous beast. Lately my favorite after-school snack is a little homemade granola, dried cherries, and yogurt. Soon I will need to make more granola. Often I also have a snack between lunch and leaving campus, and a little something at about 10 pm. Greedy!
I wish certain agencies of my federal government had a fucking clue what it's reasonable to ask for in a legal opinion. Hint: "we are of the opinion that our client has the legal authority to enter into and fully perform whatever agreement you put in front of us if you decide to award this grant" does not qualify.
234
Just out of curiosity, James, do you have a dog in this fight, or are you just trying to encourage conflict between nanny-state liberals and fat-acceptance liberals?
Personally I can maintain "normal" weight without much effort (when I was younger I was quite thin) so I benefit from anti-fat prejudice. And I find extreme obesity unattractive. So I am not naturally inclined to be sympathetic to the problems of the obese.
On the other hand I am suspicious of much of the healthy diet propaganda and am unconvinced that there is a readily available major public health benefit from getting people to change their diets.
It's possible that enough food to keep us from being cranky is more than we need to maintain weight. When it was normal and accepted, yea required, to send the kids out to play all afternoon, the parents bore little burden of the crankiness.
Somebody who was trying to quit smoking told me that there are now nicotine inhalers. It's much better for your lungs, but I guess that the nicotine can cause mouth cancer.
244: Parents also used to have strategies for displacing costs of crankiness back onto the kids.
A quick hit off the nicotine inhaler can also ward off crankiness.
I've been steadily losing weight as I age
Tapeworm.
the person who I can't figure out wrt the issue is P/aul C/ampos. His posts at LGM on the subject hurt my brain.
Well, he wrote a book called The Obes/ty Myth, so he's kind of all-in on the topic. He's definitely not susceptible to any evidence about the subject.
He's also written some pretty stupid things on other topics there; I actually have no idea why they brought him on.
Since my fleshy friends are probably sick of hearing about it and I can't really blow up at work, can I just say here how incredibly depressing the current healthcare discussion is?
I mean... Shit. I was a kid when people were seriously accusing Clinton of murdering people or savaging their healthcare plan; I just haven't seen public discourse break down like this ever.
Were liberals ever this bad, in this quantity? Yeah, there were the Code Pink people and some grossly exaggerating puppet-people-types, but it never seems like they were ever a violent threat, or as omnipresent as the current people shouting out town hall meetings, nor would they disrupt entire meetings. I thought even those shouty, disruptive lefties tended to leave or be escorted out fairly quickly and (almost never) squeezed out entire conversations.
How has no representative or senator blown up yet at one of these town hall meetings? Or been witheringly sarcastic about these people's stupidity/mendacity? How do they do it?
And how, really just how, does there seem like a decent chance this won't happen? That we won't get the foot in the door? That the shouting lying fucks will win? AARRRRGGGHHHHH!!!
Sorry everybody.
I'm on board with 210, unless someone has some countervailing evidence.
Humans seem to self-medicate. Medieval peasants with their weak beer, drunk all day long. 20th C types with nicotine. Now 21st C Americans with cheap, empty calories. I don't know that there's a viable way out of the cycle.
I've been steadily losing weight as I age.
You're a cheese, or possibly a tun of wine. Do angels visit you?
250: Amen.
I'm avoiding going to the healthcare reform discussion nearby tomorrow night. It's at a pretty liberal church but I think it's going to be highly unpleasant nevertheless.
The whole thing just makes me tired and sad. I cannot believe the number of people whose baseline philosophy seems to be, as someone on Pandagon put it, "I'll live in the mud as long as I can be assured that the [despised minority of choice] lives in $^@$."
my fleshy friends
What do you have against the obese?
Sometimes I snack when I'm bored. Other times I read Unfogged threads. Sometimes I even do both.
It does seem odd that LGM is an all-purpose law and politics blog where 5% of the posts are about how fat people are analogous to gay people in every relevant way and therefore people who think increases in obesity correlate with increases in ill health are blatantly prejudiced in a way that will become embarrassingly obvious in the inevitable fat-loving future.
But I guess there's also the all-purpose political blog where 5% of the posts are about the Washington Wizards, and the all-purpose outraged and jaded leftist political blog where 5% of the posts are about the placid beauties of classical music, and so on.
And then there's the Agonist, where most of the posts are by a reliably group of commentators about how we're all doomed because of our plutocratic oligarchs, 8% of the posts are about how wonderful it is to vacation in the Third World among people who aren't in a hurry, and then 2% of the posts are by someone named "adrena" writing about how all men hate all women.
254: Obviously nothing, as I'm protecting them from more of my ranting and raving!
253: Yep, basically. I mean, I've loved the coverage by The Daily Show, but between the laughter I can't help but think that this is some of the darkest humor I've heard in a long time. We're talking about the lives of tens of thousands, and the health of millions... But the opposition seriously thinks that a Congress which can't bring itself to enforce the metric system will impose Logan's Run-style "death panels" on the populace. And somehow the straight-faced reporters cover every disrupting person shouting the lies without saying "By the way, what they say is not remotely true." Instead they just pull in someone from the liberal side who will never be believed by the shit-stirrers to say it's a lie, thus shrugging off all responsibility as a source of information even in the face of the most egregious lies. HOW?!
On the other hand, a part of me really wants a media gig now, just to see exactly how far I can take straight-faced lies without anyone else calling me out on it.
2nd note: I'm really amazed that guests on talk shows haven't started having research assistants with laptops and mobile wireless sitting just off camera as a matter of course. They're stuck saying "I'm pretty sure that's not true" to cover themselves, when they could instead have their assistant passing over a piece of paper with the exact journal article / poll / think tank white paper that shows the other person was talking bullshit. Sure, it would get shut down quickly, but I'm still amazed no one seems to have tried it yet.
and the all-purpose outraged and jaded leftist political blog where 5% of the posts are about the placid beauties of classical music
Link, please. AFAIK, Stirling is homeless.
257:I really enjoy the Agonist series by Don the farmer. Wonderful stuff.
How has no representative or senator blown up yet at one of these town hall meetings?
Claire McCaskill scolded a little bit.
250 can I just say here how incredibly depressing the current healthcare discussion is?
It really is. The Bush years were infuriating, but at least I could be angry and there were clear targets for the anger. Now I just feel a sort of resigned sadness. If half the population wants to drown civilization in a bathtub, what the fuck do you do?
Sen. McCaskill's quotes in 261 are great, pushing the disappointed grandmother angle full force (impressive for someone who's only in her 50s). She sounds like she was one step from threatening that she wouldn't bring brownies next time she visited Hillsboro if they insisted on greeting their guests like this.
And thanks again, venting really helped. I'm breathing somewhat easier now, even if I'm not really any more optimistic.
I suspect that P-MP's reactions in this thread are becoming pretty common. Over the weekend, I had a good friend who's usually up for political discussions beg off when health care came up. She said something like, "Stanley, you know normally I'd love to talk about this sort of thing. But I can't do it two nights in a row. It's just too depressing."
The page linked in 261 also links to an article about how a group calling itself "Scientists for Truth" is hosting a meeting of "climate change skeptics" in Springfield, MO, and uncritically quotes Marc Morano of all people as saying that it's a "grassroots" movement. What the hell, news media? Sigh.
I have the exact same reaction, but I have to wonder if it's the desired effect. If they can get us demoralized, then maybe they can win.
This is a political movement that's trying to overturn the results of a democratic election. There's only one argument that applies: We won, and you lost. If you don't like our policies, then win an election.
The main way I'm depressed is that I am wondering if the opposition to the Bush administration could have worked better if it had relied entirely on transparently false and terrifying lies, rather than trying to simplify the complicated truth.
The wacko right has terrifying lies + infrastructure.
267
This is a political movement that's trying to overturn the results of a democratic election. There's only one argument that applies: We won, and you lost. If you don't like our policies, then win an election.
That's what the Democrats in Congress are afraid will happen.
The election showed people were sick of Bush not necessarily that they favored the entire liberal wish list.
The election showed people were sick of Bush not necessarily that they favored the entire liberal wish list.
"The entire liberal wish list"? I would be happy to start out with the "any vaguely rational human being can see these things are necessary" list and work from there.
We won, they lost. (To HC:) Let's do lunch.
--- The Hon. Michael Cullen during the second reading debate on the ERA. (Eating & politics wa-hey.)
You're a cheese, or possibly a tun of wine. Do angels visit you?
Possibly also brandy.
256: where 5% of the posts are about how fat people are analogous to gay people in every relevant way and therefore people who think increases in obesity correlate with increases in ill health are blatantly prejudiced in a way that will become embarrassingly obvious in the inevitable fat-loving future.
Gosh, why would anyone even think that the discussion on this subject is a bit skewed when there exists such trenchant and spot-on satire as CN exhibits in this comment.
Admittedly 274 written before I did a bit of "research" and saw the two latest Campos posts making the analogy. So I pull back a bit. But really, a pattern like that in the map in clew's 178 (even if you don't click on links in comments, click on that one) certainly calls for a different discussion than the one the country is having or the one we just had in this thread. And I'll give some credit to folks like Campos and McArdle for trying to at least change the discussion.
certainly calls for a different discussion than the one the country is having or the one we just had in this thread.
I'm interested, but unclear on what that discussion is. It's a tricky area, because as the map in 178 indicates, we really do seem to have a significant public health problem here, but as Campos reasonably says (leaving aside a certain amount of hyperbole) addressing that public health problem by stigmatizing individual fat people is pointless and cruel.
What makes sense to me is a discussion like the one Ezra and Yglesias seem to be trying to have -- looking at the society-wide changes that have led to the map in 178, and seeing if there are policies that can roll those changes back, or counter their effects (not that such policies have been identified with surety, but that's the effort being made). And I understand McArdle to be saying (unclearly, but saying) that that policy discussion is doomed to failure, and an expression of classism, which strikes me as absolute bullshit.
I still wonder why people persist in endlessly discussing McArdle and her opinions. It's like picking a scab.
I think of people who find her convincing as people who might possibly be converted to sanity: who at least think their opinions come from reasonable argument. And so she seems worth refuting.
But she doesn't argue in good faith. I know people always go on about how vile she is, but it remains true nonetheless. This blog and CT are engaged in discussions of what are, after all, the poorly argued opinions of a manifest idiot. I suppose on one level she's very good at what she does, i.e. trolling.
It's not whether she's arguing in good faith, but whether there are people listening to her in good faith and being convinced, and what to say to people like that.
I had to walk my reasonably lefty and not stupid father through "Social Security really isn't a Ponzi scheme" last weekend (we had a long car ride to do it in). His brother in law, a finance type, had convinced him, and it took a fair amount of effort to pick it back apart. Talking about McArdle is good practice for that sort of thing.
I doubt McMegan has thought it through this far, but she might really be onto something.
Imagine you are a right-wing political strategist of the Ailes-Atwater-Rover stripe. You realize that the classic GOP polarization strategies--the overtly racially based Southern strategy and its less overtly racial successors ("culture wars", "values issues") are nearing the end of their useful life. You're looking for a new fault line on which to split the electorate in two, with your side getting the larger half.
You become the voice of fat people. It's perfect. They are a large and growing (tee-hee) portion of the electorate. They feel condescended to by elite opinion. Major media ignore them or sneer at them. They see their way of life--the only one they know and the only one they can imagine--becoming the target of social engineering by pointy-heads in a remote bureacracy.
But wait, there's more! You can neatly couple the visceral resentment of this group to the economic agenda of a wealthy business interest (Big Food). And you can position both in opposition to Hollywood, the Liberal Media, and Ivy League liberal elitists. And best of all, the fault line plows straight through the middle of FOUR core Democratic constituencies: women, African-Americans, poor people, and midwestern industrial union members.
If you aspire to be the next generation's Roger Ailes or Karl Rove, you should really be figuring out how to (1) co-opt the fat acceptance movement; and (2) turn obesity into a political wedge issue against liberals.
Seen in that light, Campos may be doing the Lord's work in heading them off.
276: I should certainly catch up on the broader discussion before weighing in to heavily (pp did it first!) ... It is in fact a personally interesting discussion to me. I am that map. At some level as a nation we have lost our way to eating, lost our way to death, lost our way to civil political discourse. These are all, not unrelated, psycho-social problems of the first degree.
Too heavily, too heavily, too heavily for fuck's sake.
Can I just observe that even if you think weight is intrinsically class linked etc and that there's a fundamental taste-in-the-Bourdieu sense aspect to the very notion of the obesity epidemic, why the fuck would you listen to Megan McArdle about it?
It isn't like she's a very deep thinker on class, is she? So why would you expect her to say anything at all interesting about it?
You become the voice of fat people. It's perfect.
Well, you've got me. I shall immediately move to the United States and riot against health care.
285: The liberals want to take away your sausage rolls, OFE! They think you should only be permitted to eat organic free range carrots. And no more pints of lager for you, if those svelte elitists get their way!
They'd never dare. The minute they touch the sausage rolls the Pasty Horde will begin to cross the border heading south at Carlisle and Berwick, Irn Bru and chib in hand.
When I was doing triathalons I carried a working book title in my head of On Being a Thunder Lizard in an Age of Gazelles. (And what did I know of the parameters of personal Thunder Lizardness at the time?) Now I realize it should have been, How Can 200 Million Thunder Lizards Be Wrong?
The theory in 281 yields at least three testable predictions:
Rush Limbaugh will adopt a "fat pride" stance.
Haley Barbour will do better than Mike Huckabee in the 2012 GOP primary
Jonah Goldberg will replace Rich Lowry as editor of the National Review
PICKING SCABS IS THE BEST
Are chib and shiv effectively the same word?
According to wiktionary the etymology is the same. It's from Romani.
293: Aha, yeah. Thanks, ttaM. The v/b switch is common enough that it seemed likely.
lw's link to the map, not mine. To be scrupulous.
One thing I noticed years back, when reading Irvine Welsh, is that the dialect he puts in his characters mouths contains more words derived from Romani than the dialect I'd be familiar with coming from 25 miles or so west of Edinburgh. So words like 'gadge' and 'radge' aren't words I remember being used growing up. Although 'minge' was used and that's also Romani in origin.
296: Heh. I just looked up "minge" to see the etymology and my dictionary said "From the Scottish dialect "ming": excrement."
re: 297
That's wrong. That's not what it means. They are confusing ming and minge.
Oh, I don't doubt it's wrong. It's just the crappy desktop dictionary. Although now I am fascinated about the distinction, because I apparently looked up minging and not minge. So ming and minge are different?
re: 299
Yes.
http://en.wikipedia.org/wiki/Minge
http://en.wiktionary.org/wiki/ming
Minging is straight from the latin! Mingo, mingere, minxi, mictum -- to p!ss (or "micturate" if you eschew the vulgate.)
It means "looks as if she smells of wee"
281: pain perdu's theory is disturbingly convincing.
Another prediction: the right wing will either gradually ease off on Michael Moore or will condemn him as a lipotraitor, a fat man doing the thin man's dirty work. An Uncle Tum.
301: That may be my favorite Latin verb. Or rather, its compound form circumingo, which occurs in the beyond fabulous werewolf story in the Satyricon. The fellow in question goes into a graveyard (where he "fecit" behind a tombstone), takes off all his clothes, "circuminxit" them, turns into a wolf and runs away.
Simple planning could do a lot to reduce obesity and improve health. The Texan diet may not be the greatest, but part of why a lot of people there weigh more is that people don't walk anywhere. Getting more exercise without really going to "exercise" is a good thing. (Of course the heat there in summer doesn't help matters.)
The thing about the health care debate that really depresses me is that the people who are supposed to be on my side, like Obama, are pushing policies that don't do much for me or a lot of people I know with illnesses.
They talk about the stability of the employer-based system and how you can keep your insurance if you like it, but if you don't like it--you can't actually change to one of the insurers in the exchange. I really want my health insurance to be portable from job to job so that I can keep my doctors.
People who are managing chronic illnesses don't like it when their companies switch plans, and they rarely have much choice--PPO or HMO, but you're stuck with Cigna or whoever else.
They talk about the stability of the employer-based system and how you can keep your insurance if you like it, but if you don't like it--you can't actually change to one of the insurers in the exchange.
There is the idea, which appears in at least some versions of the bill, that this option will phase in over the next several years.
Speaking of healthcare town halls. how do find out where they are. I e-mailed my Congressman a while ago and Senator Kerry, but my Congressman's office didn't even send a boilerplate on-topic response. All it said was, "Thank you for contacting our office. We will review your comments."
The thing about the health care debate that really depresses me is that the people who are supposed to be on my side, like Obama, are pushing policies that don't do much for me or a lot of people I know with illnesses.
Unfortunately, BG, you're just not a very popular constituency, electorally speaking.
The good news is, you don't need to judge the reform package by the rhetoric used to sell it to the public (see also "Iraq War, selling of").
It's hard to make definitive pronouncements because no one knows what the final bill will look like, but it looks certain that we're going to get guaranteed issue and community rating, pretty likely that we will get out of pocket limits and subsidies up to at least 250% of the FPL, and at least a reasonably likely that we will get a public option (by the time the conference committee is done). Taken together, that's going to do a lot for people in your situation.
308: Digby has had links to people who are keeping track - maybe FDL?
The public option is good. If I stay in MA, I already get guaranteed issue and community rating--as do the people I know. Funny thing is that the subsidies pan out abruptly, so if you don't qualify you have to buy an expensive plan with less coverage. And in MA, you have to take your employer-provided option.
If a job didn't provide coverage, but it paid just enough to put me over the subsidy level, I probably wouldn't take it, which is, you know, retarded from a policy standpoint.
can I just say here how incredibly depressing the current healthcare discussion is?
Amen. A conservative friend of mine has started hyperventilating over Obama on Facebook. I've stopped reading what she writes, usually, because, well, it's Facebook and it seems petty to argue with her over it, but it's disappointing because while she's always been a Republican, she used to be (or at least I thought she was) more, say, Conor Friedersdorf and less Glenn Beck.
#281 is evilly brilliant.
The public option is good.
The public option is damn near necessary for any of this to have lasting improvement, as far as I can see.
Thanks for the suggestion, JRoth, Firedoglake does indeed have a nifty tool. Nikki Tsongas is having something. My Rep., Markey is going to "talk about security, nuclear proliferation and energy independence." I was willing to go to Boston to pretend to still live in my old district, but Capuano isn't doing anything.
Kerry is so lame.
My fear, soup, is that they'll wind up keeping you from joining the public option if your employer offers some insurance. So, you'll still be in the situation of having to switch plans.
These damn town hall meetings were such a bad idea. How was this not foreseen?
A conservative friend of mine has started hyperventilating over Obama on Facebook.
I recently learned that "no private insurance plan can compete with a public option that makes you wait three years for a hip replacement and kills your grandmother" in the same venue.
My fear, soup, is that they'll wind up keeping you from joining the public option if your employer offers some insurance.
The main proposals for the public option do seem to try to restrict access in order to keep down the on-budget cost. But here's the thing: companies are going to be tempted to drop coverage and dump people into the public option. In some cases, employees might even push them to do so. That's why the pending proposals all bar large companies from the public plan in the initial years.
So taking the long view, I agree with the Werewolf that any decent public plan will irresistably lead us to a single-payer system or something very much like it. Certainly the health insurers' lobby gets this, which is why they've made opposition to the public option their one non-negotiable line in the sand.
These damn town hall meetings were such a bad idea. How was this not foreseen?
It's a sekret plot: each one of these morons who show up to yell are being quietly radio tagged for easy later disposal.
I recently learned that "no private insurance plan can compete with a public option that makes you wait three years for a hip replacement and kills your grandmother" in the same venue.
And that's not the worst of it! The public plan will also bankrupt the treasury by succumbing to the pressure to spend ever higher sums of taxpayer money on callously denying care to those who desperately need it.
So taking the long view, I agree with the Werewolf that any decent public plan will irresistably lead us to a single-payer system or something very much like it.
Which is exactly where we want to be.
These initial positions give the insurance industry a way to release their chokehold on the system with some grace and over a longish period. Decent people would jump at the chance, but we are talking about health insurance execs.
each one of these morons who show up to yell are being quietly radio tagged for easy later disposal
Nonsense! Some of them are able-bodied adults who can be put to work in the slave labor camps, manufacturing DIY abortion machines or printing school-issue Korans. Under the harsh discipline of gay atheist illegal aliens, of course.
#317. Then there's money to be made in a private insurance plan that makes you wait only two years and kills both grandparents.
Will the "Fat People" movement predicted in 281 lead to a new religious iconography?
Fat Jesus. That could be interesting.
These initial positions give the insurance industry a way to release their chokehold on the system with some grace and over a longish period. Decent people would jump at the chance, but we are talking about health insurance execs.
I was chatting with a friend the other day who has, errmm, a very close-up view of the health insurer perspective, and his take was something like this.
1. We're being unfairly singled out as the whipping boys here. We've been willing to deal. We've accepted the Grand Bargain whereby the public gets guaranteed issue and community rating, and we get an individual mandate. Fair's fair. So why do you want to run us out of business?
2. So we make a profit out of the system? So what? We're not the only ones. And remember, it's our buying power and tough negotiating that has kept costs from exploding even faster than they have.
3. While we get the shit kicked out of us in public, no one is willing to touch the real issue, which is that doctors in the US make way too much money.
I have to concede that they have a valid point about #3. But pragmatically speaking, there's no way that Obama could get this done in the face of strong opposition of the AMA, so it's probably best to betray them somewhere down the road, once the public plan is solidly in place.
281 is indeed very plausible, but we're saved by the reality that, culture war tropes to the contrary, rightwingers are, in fact, incredibly judgmental and classist, and are at least as fat-phobic as the skinniest of skinny-jeans hipsters. Think of the fratty Young Republican types you knew in college; were they more or less likely than others to wear No Fat Chicks t-shirts?
The bottom line is that, while (certain) liberals have a (morally bogus) distaste for the "obesity lifestyle"*, just as many conservatives have a distaste for actual obesity. IIRC, El Lardo himself, Rush, has made fun of women for being fat. The mind boggles, but it's part and parcel of the beloved worldview of his listeners/traditionalist men.
* fast food, no exercise, no walking
Patently, this notional conservative fat identity politics movement would be implicitly in favor fat men only. I can't imagine it going down any other way.
The best hope on #3 is that it is not equally true across all classes of doctorhood. The opportunity exists to wedge off the family practitioners and GPs who have not kept up with the specialists and surgeons. Despite having the tougher job. Let's face it, brain surgery is brain surgery, but it's not like it takes an effective primary care medical worker to do it right.
325: Yeah, I've seen a lot of disgruntlement coming from AHIP, and it's justified - they're cooperating, but they're still made to play the Bad Guy.
OTOH, I'm not sure they're actually helping in a way that should let them off the hook. IOW, they own a lot of the Blue Dogs and Baucus-types who are holding up reform. If they really wanted Obama to win on this, he would have won by now. Instead, they're "cooperating" to get a seat at the table so that they can get a better deal. But nothing they're doing is proactively making reform more likely; they've simply agreed not to fund the dead-ender opposition.
327: On the veldt, the alpha male got huge like a silverback gorilla and then picked the skinny babes for sex. Nature's way I'm afraid; no profit in fighting it.
I type good.
OTOH, I'm not sure they're actually helping in a way that should let them off the hook. IOW, they own a lot of the Blue Dogs and Baucus-types who are holding up reform. If they really wanted Obama to win on this, he would have won by now. Instead, they're "cooperating" to get a seat at the table so that they can get a better deal.
This seems totally right to me, and really, the insurance industry has more than earned its Bad Guy status by being a fucking bad, bad guy all the time. Just because they are willing to cooperate up to a degree, right this minute, doesn't mean they don't deserve to be pilloried.
Everything about the existence, self-naming, and behavior of the Blue Dogs irritates the shit out of me.
325
3. While we get the shit kicked out of us in public, no one is willing to touch the real issue, which is that doctors in the US make way too much money.
I have to concede that they have a valid point about #3.
Really? They do? What percentage of medical spending goes to doctors' salaries? And a lot of treatments are unnecessary, a lot of appointments are busywork, etc., and if those preliminary appointments and specialists' referrals were eliminated then docs would make less money, but that's not the same problem as the amount doctors make per hour/patient/whatever.
Another problem is that specialists command higher fees than GPs, which encourages more doctors to become specialists, which creates a glut of specialists and a dearth of GPs, which encourages more procedures requiring specialists to be performed. Still, though, my understanding is that isn't as big a problem as all the insurance industry's shenanigans, no offense to your friend.
The opportunity exists to wedge off the family practitioners and GPs who have not kept up with the specialists and surgeons.
I think Ezra talked about this the other day. The deal seems to be that the (large group of) doctors who think the current system is broken and could live with lower income in the context of a functional system don't want to see "reform;" they want single-payer, because they know that that's what would actually work and fix the mess. So they're keeping off the barricades. What's being proposed would represent them (likely) taking a hit while seeing marginal systemic improvements. That's not the kind of promise that will get you 10,000 GPs marching on Washington.
Having said that, I wonder whether single payer types have reached out to that constituency? It would be incredibly powerful if part of the conversation was a large, vocal group of PCPs arguing for single payer. I know that single payer is easily ignored by pols and the media, but PCPs are simultaneously so authoritative and so sympathetic. "I just want to help the people in my community, but our current system won't let me. Single payer will help me make sure that all my patients are healthy [cue pic of Dr. with recently-delivered baby]."
pp-- re: No. 3. Primary care doctors don't make too much money. My view is that the best doctors ought to make more money. In fact radiologists should be paid for consulting on whether a test is really necessary and not just for doing the test. Crappy doctors should get paid a lot less and some of them should be driven out of business.
I am currently enthralled by Hal Luft's proposals which would let primary care doctors charge what they want and pay hospital doctors a lump sum along with the hospital, what he calls an expanded DRG. Then they can fight out how much each specialist should be paid.
Charlie Baker of Harvard Pilgrim was complaining that without the 60 day waiting period in MA, people were signing up for insurance, getting expensive procedures and then dropping it. I guess the tax penalty isn't yet enough to compare to the cost of getting insurance.
Going back a ways, and sorry if someone said this and I missed it, but the point about the caloric labeling isn't to make people walk out the door in search of a celery cart: it's to help in making relative decisions. Yggles (or was it Ezra) gave an example of a putatively healthy salad that was, in fact, 1500 calories. The person ordering that salad thinks he's making a healthier choice. If the calorie label tells him otherwise, he can choose otherwise - maybe the (presumptively more desirable) burger is actually fewer calories! Or maybe the restaurant trims off some calories so people will still order the salad but not be made fat by it.
Portion control seems to be more important for weight control than food content or anything else. At home it's a matter of changing habits and self-control, but at a restaurant - esp. fast food - there's no portion control as such - you're ordering units. And right now there's only heuristic methods of controlling portion, but the restaurants have no interest in giving you correct guidance to your heuristics. Frex, IIRC* a Big Mac is like 2/3 the calories of a Quarter Pounder - who would guess that? The Big Mac has 2 patties, Special Sauce, the works. At best you would guess it's a wash, but it's actually a big difference. And calorie labeling lets you have the right information for decision-making.
* I'm 90% certain I saw this recently, but the point remains even if the specific example is wrong
we're saved by the reality that, culture war tropes to the contrary, rightwingers are, in fact, incredibly judgmental and classist, and are at least as fat-phobic as the skinniest of skinny-jeans hipsters
You're way overestimating the role that good faith belief plays in the formulation of Republican electoral strategy. I don't believe George H.W. Bush was a racist, but he was happy to run on Willy Horton. I also doubt that Karl Rove hates gays, but he sure saw the utility in putting his party on record as hating them. And every bit of available evidence suggests that Reagan didn't give a rat's ass about abortion or school prayer; he just pretended to when it was useful.
Think of that self-same Republican frat boy, the one with the "no fat chicks" teeshirt in his drawer, and imagine all things he has said or pretended to believe in order to get into a girl's pants. Now extrapolate to a national-scale polity.
Regarding doctors vrs insurers here is a recent NYT article on doctors charging exhorbitant fees whenever they get a chance.
Fat Jesus. That could be interesting.
Shearer, you might really like Luft's proposal. So, basically an independent universal coverage pool pays for hospital care and chronic illness.
You buy prepaid healthcare from your doctor through their payment processing company--which would smooth out your costs over the year. This you pay out of pocket or are subsidized in such a way that the doctor doesn't need to know who's on the subsidies. Each doctor's annual premium is posted and patients can get info on who's cheaper and who's better. Some will be encouraged to change their practice patterns.
Primary care doctors don't make too much money.
I wasn't endorsing the most extreme interpretation of #3 above. The pay differential between primary care physicians and specialists is a big problem. An even bigger problem--and here the friend is indisputably correct--is the way specialists earn so much money, i.e. by ordering/performing more procedures. Since it is probably a political non-starter to reduce physician incomes in any meaningful way, the path of salaried physicians and capitation is probably the only way to solve it.
That said, physician incomes in the US are in fact strikingly high in international comparison, and that's true across the board (notwithstanding the examples of noble GP's taking low-paid jobs in poor areas). I'm too lazy to google the study, but a report by the McKinsey Global Institute on the relative productivity and cost drivers of national medical systems has good data on this.
There is a counterargument that high physician salaries in the US are just a symptom of the more general phenomenon of unequal income distribution, and can be justified on that basis. But the underlying facts are that the US doctors earn much, much more on average (even after malpractice premiums) than their counterparts in other countries.
The UK recently changed the ways in which GPs salaries were calculated and they went up considerably. Average GP income is now absurdly high, even by the standards of other professions.
I basically agree with you, pain. I'm just arguing that doctors ought to be able to make money from their expertise and thinking and not just from procedures. My friend who works at Children's makes plenty of money, but he's always getting hassled for not billing more. He can't bill for time spent thinking about which drug should be used or whether a mechanical device or a transplant is the best option or whether he should just wait and see. He can only bill for actual appointments.
So, I basically support some form of capitation too.
Alain Enthoven has a good for a non-economist paper that he authored for the Committee on Economic Development.
I have some selfish concerns about the integrated delivery system model of large group practices. I'd like to see more integration and less fragmentation, but I think that some of that could be virtual. In the mental health realm, I worry about providers, with whom one has built up a relationship, leaving clinics and being pushed onto a new person.
If we're going to talk about doctors' salaries, let's use some actual data, OK?
(Yes, I am being sarcastic. No, I don't think 325.3 has much of a leg to stand on. Yes, Cyrus's question in 332 is right on.)
342: The UK overdid it slightly. They're getting bonuses for ticking off that they performed certain protocols. The Government didn't realize that it was going to be as expensive as it turned out to be, but the UK system has always given the GP an important role.
The AMA requires two things-- that very few doctors are produced each year, and that nearly all significant medical care comes from MDs.
Relaxing both would have huge economic impact; nurse-practicioners or something to dispense antibiotics for flu but not cold, stitch cuts, maybe set bones and maybe do periodic checkups for people with chronic conditions.
Also allow more Bulgarian and Brazilian MDs in.
Both tweaks are politically toxic, but logistically straightforward without huge adverse impact on public health.
A friend went to a town hall meeting last night with a sign that said "First Socialized Medicine, Next Socialized National Defense." I haven't heard the full report, but it sounds like he was the guy everyone hated.
Re: 347.2.: I haven't paid enough attention to the specifics of the healthcare legislation, but does it increase funding for Federally-Qualified Health Centers? I've seen some awesome nurse-managed clinics that are wildly popular -- there just aren't nearly as many of them as there should be.
The other big issue is medical care structured around pay-per-procedure, which leads to unecessary tests. That consumers love.
The fancier and harder-to-schedule the device, the more competitive type A people will fight to get in line for the scan, with a Harvard MD at the controls so they can brag about it later.
GPs in this country don't really get enough respect from the medical profession. I'm not sure that that is completely caused by the fact that they make less; it may be caused by the fact that the formal training takes less time.
Elite institutions aren't doing their part. Harvard Medical School is about to drop its primary care division.
I have to concede that they have a valid point about #3.
No, this is bullshit. The only reason that physicians are so overpaid in the US is because of the health care insurance game. And physician salaries are not what is driving inefficiency really, that's a combination of insurers and pharma. The physicians got in bed with them, and accepted a payoff to play along. But they aren't the fundamental problem. They absolutely deserve a share of the blame, but insurance types hiding behind that is a joke.
Overall, I read your friends approach as a whiny "don't pick on us". The two biggest poles in the tent are insurance and pharma companies. Without fixing them, the system stays broke.
Point number two is largely bullshit too. By keeping individual sizes fairly small, their "buying power and tough negotiating" looks good as against the farcicle billing rates you might might see from a specialies, but they actually do pathetically when compared to the rates negotiated in places like, say, Canada.
Your friend also carefully avoided points like:
4) rescission as practiced in the US is purely the domain of scumbags.
5) the reimbursement code game is broken, non responsive to technology changes, and often operating counter to the public interest.
6) ...
I don't think that driving the insurance companies out of their (current) business model is any sort worthwhile goal. However, I don't think that explicitly preserving them is either. They've been a large part of the problem, and if they don't, can't, or choose not to fit into an improved system, well, that's a perfectly acceptable cost.
I see that some of 352 was rendered redundant during the phone call that interrupted my typing it.
352: I hereby turn over my entire comment-quota for this thread to soup.
I suppose that we should have more nurse practitioners, but my experience has not been great with them. For the most part, they don't seem very bright. They tend to rely on the computer to tell them about drug interactions, and they aren't able to say things like, "This drug slows the metabolism of this drug, so just cut your dose in half for a couple of days while I treat this infection." So, then I have to go back for another visit with the doctor. They just see the interaction and go with something else. They haven't been able to answer most of my questions either. (That's in a team group practice at a hospital. She was good enough to remember that she'd prescribed my BC when I went in for something else and asked me how it was going.) And they're not prepared to customize their recommendations. I might as well research my problem myself.
There are awesome nurses at some community health clinics running vaccination programs and the like.
They tend to rely on the computer to tell them about drug interactions,
Then they are doing a better job than a lot of doctors from what I have heard.
CJB-- That's true, but they don't actually understand the mechanisms. This is supposed to be a top hospital, and I'm unimpressed. If they can't explain the mechanism of the interaction and why that applies to my particular case, then that's really appalling.
I really think that a lot of medical professionals are shite.
I want my NP or doctor to know more about something than I do, since s/he is the professional, and I want them to give me information that amounts to more than what's on the web for patients.
I'm just ranting, CJB. It's perfectly rational to have more NPs, and I will see them for fairly minor things, but I don't want to talk about my 1st degree heart block (now gone) with them.
Seriously, is it too much to ask someone to talk to you about comparative effectiveness studies? (And most doctors are unfamiliar with them too.)
If we're going to talk about doctors' salaries, let's use some actual data, OK?
Exactly what does that link purport to prove, Witt? I contended that physician incomes in the US are very high by international comparison. You provided a link to median physician salaries in the US by speciality. Thanks.
What percentage of medical spending goes to doctors' salaries?
According to the McKinsey study, over two thirds of the difference between the actual and expected (i.e. international norm) cost of health care in the US is attributable to outpatient services (which is to say, mostly physician compensation). (Higher insurance and administrative expense accounts for about 14% of the gap.)
As for soup's 352: easy, tiger. I don't hold any brief for the health insurers. I'm certainly on the record as favoring their extinction on the shortest possible timetable. But I don't kid myself that just passing single payer will give us a cost-effective provision of health care. As long as physicians are dining on the fee-for-service buffet, economic incentives will do what economic incentives will do. The nobility of medical practice doesn't automatically make doctors into selfless heroes or passive victims of greedy insurers.
I'm a bit surprised by the numbers from Witt's link in 345. I would have guessed average doctor earnings were much higher. But the number they quote for average lawyer earnings is even more surprisingly low, so I guess I'm systematically biased by my social milieu.
I've had perfectly nice interactions with NPs, and interactions with GPs where all they had to do was write a scrip that could easily have been written by an NP. Which doesn't mean I wasn't very glad that there were fancy specialists available when I needed them.
essear, lawyers can make much, much more than doctors, but they can also make very little. The minimum doctor's salary is a lot higher.
PP, Normally I would trust your data, but my understanding was that the big money was spent on hospital-type care. That's why high deductible plans are so stupid as a cost controlling measure. 20% of the population gets 80% of the care, and those people are price insensitive, since they've already blown through their deductible.
Bave, I was ranting somewhat unfairly.
Not sure you were being unfair, BG; you may have been treated by an NP in a situation where a real doctor should have seen you or at least consulted about drug interactions, etc. In any case, you're right about comparative effectiveness studies, from what I can tell.
my understanding was that the big money was spent on hospital-type care
About 6% of the difference, according to McK. Keep in mind though, that a lot of what gets done as an outpatient procedure in the US would involved a multiday hospital stay in countries with cushier systems. So the distinction between the two isn't clean-cut.
In any event, I don't really share the point of view of the friend cited in 325. I was just offering it up as a different perspective from an intellectually honest representative of that side of the debate.
I have a different friend whose views on the topic I unreservedly support, and he was kicking ass on the Colbert Report last night.
Briefly, since lunch is ending:
I contended that physician incomes in the US are very high by international comparison.
I interpreted you as relaying an argument from "the health insurance perspective," which included the claim that "the real issue" is that doctors make too much money.
I heard that as being shorthand for "The real issue behind increasingly high healthcare costs that are not going to be slowed or held steady by healthcare reform is [doctors' salaries]." But maybe your friend meant something else?
I am very dubious of such claims because they seem to overstate doctor salaries, particularly given other factors such as administrative costs, software and regulatory-compliance costs, and even med school loans. That's why I linked to the BLS page, because I thought seeing that even people a couple of years out of school are still making $160,000 or whatever is germane to the debate.
AFAICR annual household income in the US still hovers around $50K, so doctors are absolutely in the elite. But I didn't want this thread to go down a path of "Doctors are making a million dollars a year!" when I just don't believe that most of them are.
(I didn't catch the "doctors in the US" part of your claim on my initial read-through, but I still don't really see that your insurance friend was making an international comparison argument, although I can see that you elaborated one in 341.)
My primary care is a PA-C (Physician's Assistant-Certified) rather than an MD, and he's the best "doctor" I've ever dealt with - engaged, knowledgeable about much and happy to research the rest. For a lot of young people with few chronic or complex problems (I'm 39, exercise-averse, hypertensive), not much more is needed.
I was just offering it up as a different perspective from an intellectually honest representative of that side of the debate.
Yeah, see I don't think it actually is intellectually honest position, although I'm perfectly willing to believe your friend offered it in good faith and just doesn't have a particularly accurate overall picture for whatever reason.
This:
The nobility of medical practice doesn't automatically make doctors into selfless heroes or passive victims of greedy insurers.
I never claimed. I have worked with enough of the industry to have an extremely jaded view of physicians nobility and make no claims of hero status. Quite the contrary. I even understand an insurance exec feeling frustrated that it is very hard to throw mud at them and have it stick, while the reverse is easy.
However.
My point was the the compensation system that currently exists in the US practice was fundamentally shaped by the Insurance industry. So it's a bit rich for the Insurance industry to point at physicians and say "see, they're the bad guys".
Insurance guys saying "we're not the bad guys here" is a complete joke. At best they can try "we're not the only bad guys here" and hope to claim any sort of sympathy for the view.
Do Physician's Assistants rank above nurse practitioners in the hierarchy? I don't really think of them the same way that I think of nurse practitioners.
Ham-Love, my sample is biased, because people tend to talk more about their bad experiences, but I've heard bad things about psychiatric nurse practitioners in Boston. Of course we need them, because there's a major shortage of people in rural areas, but I'd like to see them consulting more than they do.
To the argument about physician incomes, I would add that the debt load is substantially higher for graduates of US med schools (specialists especially) than for their counterparts in most (all?) other countries.
As an aside, sometimes doctors really do blow you away.
I was totally cynical about doctors, and for the most part I still am, but I still maintain that my psychiatrist is pretty much a saint. He has a staff job at a hospital and one at a state agency doing research, but he maintains a small private practice. He doesn't take any insurance, because it is so small and the billing would be too much of a pain, but when he took me on as a private patient, he said what do you think you could afford? When I suggested $10, he agreed immediately. Obviously, he's not living off of that, and he's borrowing someone else's office in the evening, so his expenses are for prescription pads, but still.
And access to mental health care is a serious problem even in a place like MA where there are a lot more mental health professionals than in other places.
I actually sort of wonder about how squeezing fees in this area would work. A lot of psychiatrists have dropped out of Medicare completely. And many more established doctors and even therapists stop taking insurance. Some of this is because of the hassle, but it's partly because of the reimbursement levels. No system in the US is going to outlaw the provision of private health care, so more and more of the lower-paid physicians could leave the third party payer system entirely.
There's little risk that the cardio-thoracic surgeons will.
371 is true, although it doesn't come close to justifying the salary spread amongst specialists. The bottom end of starting salaries is entirely sensible, but the top end is 4-5x that, for no really sensible reasons.
physician debt load is actually a significant problem, helping to shape the entire system in ways that are probably not int he public interest. That's more of a feedback loop though, it didn't start the problems.
Semi-OT
I think that dob was struggling with some confusing medical bills. There's a NY Times article about medical billing advocates who will help you sort through the morass.
it doesn't come close to justifying the salary spread amongst specialists
Does anything? It definitely helps create a lopsided system with a shortage of PCPs and a wealth of specialists, with consequences for the nature and cost of care. True, it's not the ultimate source of the problem, but it's increasingly a contributing factor.
I think it's the war on drugs that leads toa shortage of PCP.
You're way overestimating the role that good faith belief plays in the formulation of Republican electoral strategy.
My point is that I don't think it will resonate with the birther-types who are the actual electoral force behind the fratboys who run the party.
First they demagogued about race, and I voted for them because I don't have a race.
Then they demagogued about hairy feminists, and I voted for them because I hate hairy feminists.
Then the demagogued about gays, and I voted for them because I ain't no queer.
Then they demagogued about fatties, and I didn't care, because fatties deserve what they get.
378: Yes, my instincts tell me that JRoth is right about this.
Do Physician's Assistants rank above nurse practitioners in the hierarchy? I don't really think of them the same way that I think of nurse practitioners.
I asked my pediatrician's wife this very question yesterday, and her understanding (which sounds right to me) is that NP and PA represent two paths to the same ultimate job.
My point is that I don't think it will resonate with the birther-types who are the actual electoral force behind the fratboys who run the party.
Really? My admittedly unsubstantiated impression is that obesity is pretty highly correlated with Republican attitudes in most of the country.
obesity is pretty highly correlated with Republican attitudes in most of the living in this country.
381: That doesn't fit with what I've seen/heard. For starters, African-Americans have higher than average rates of obesity and far, far higher than average rates of voting Dem. Even if you limit to white people, I'm guessing that it isn't true because of the union/civil servant voters.
Does anything? It definitely helps create a lopsided system with a shortage of PCPs and a wealth of specialists
Right, but it wasn't the training cost than created the skew to specialists, it was the skew to specialists that created the cost, and negative feedback exaggerated it.
I'm guessing that it isn't true because of the union/civil servant voters.
plumbers butt for Obama, you're saying?
385: I was thinking of the AFSCME crowd. Work at desks, live in the 'burbs, etc.
In Fat America, these guys should be the new poets laureate.
378-379: My original comment was intended to be more tongue-in-cheek than not. But I'm still going to stand up for it, because I'm not sure I made the point quite clearly enough.
The point is not whether today's Republican coalition can be said to be fat-friendly, or even predisposed to fat-friendliness. The membership of the Republican party of 1965 was not, on average, very friendly to segregationists (Goldwater's victory notwithstanding). By 1975, the majority of the crypto-segregationist vote went to the GOP.
The point is that the GOP has historically been very effective at identifying groups that represent a numerical majority, but perceive themselves to be an aggrieved minority: first white people, then Christians, and more recently heterosexuals. As white people and Christians decline in relative electoral weight (along with heterosexuals who are actively hostile to gays), Republicans need a new group to fill the gap. Stoke their grievances skillfully, and obese people could become that group.
383: Maybe. African-Americans are still a fairly small part of the population, so might not affect the overall correlation much if it's very strong. Beyond that, as I said, my sense is not very well substantiated. Google isn't turning up anything relevant. (The closest I've found is some survey indicating that Democrats are somewhat more likely to say that they take seriously the opinions of experts about obesity and its health effects.)
388: I'm still going to object. Obesity is associated with lower incomes. So is being a Democrat, especially in the chunkier middle and southern regions of the U.S.
388: This is well-argued (even if not actually believed!) -- but I still think JRoth is right.
There is always an aspirational element in politics -- I just don't think there enough obese people that are happy and proud about it for it to become a viable mass movement.
I would add that the debt load is substantially higher for graduates of US med schools (specialists especially) than for their counterparts in most (all?) other countries.
392. Why did it do that?
My question was: is there any reason for the high debt level beyond expectations of earning? Or is it just that US student debt levels are generally high and medical school takes longer?
I don't think I've ever met an MD in Britain who wasn't primarily academic. Most doctors are MB/BCh, which is a five year undergraduate course.
388: I'm still going to object. Obesity is associated with lower incomes. So is being a Democrat, especially in the chunkier middle and southern regions of the U.S.
Both of these correlations are too weak to draw any conclusion about whether obesity is correlated with being a Democrat.
394: I think it's intended to show that the reverse (obese == Republican) is not likely true, by showing that there's too much overlap between generally obese groups and generally Dem groups for the obese to mostly be R. Far from definitive, but suggestive.
That said, I appreciate the clarification of 388. I'm still not sure I buy it - what "fat pride" there is is certainly not right-leaning - but as an idea for a new coalition, there's some merit there.
My question was: is there any reason for the high debt level beyond expectations of earning?
I'd guess this is reason is more than sufficient. You need to go to medical school to become a doctor, the supply of medical schools is kept limited via the AMA, the more you can make as a doctor the more the medical school can charge.
395: Yeah, as I said, my impression is unsubstantiated. I tried to Google real information but haven't found any. I'm just pointing out that your objection is not an argument, so at this point there's no argument either way.
398: I also failed at googling anything useful.
There is always an aspirational element in politics -- I just don't think there enough obese people that are happy and proud about it for it to become a viable mass movement.
Again, the genius of GOP wedge politics is creating a sense of shared group grievance among people who don't actually identify as members of the group. No Republican president since Eisenhower could have won without the votes of racists, religious nuts, and homophobes. Yet very few people actually identify themselves as such.
The key--and this is why some smart future Karl Rove needs to get working on it--is to find the appropriate code words that stoke the grievance and polarize the electorate without coming out and stating the issue that's really at play.
Just off the top of my head, I can think of these:
"Liberals want to tax your soda pop; how about we raise the tax on white whine and wheat grass juice instead."
"The Democrats want to ban your ATV from national parks [note: actual controversy!] and force your poor old granddad to WALK to his treestand."
"If this mandatory labelling / minimum wage / EFCA / HFCS subsidy cut bill passes, the average cost of a McDonalds value menu will go up by $2.75. Of course, the elitist liberals eating at fancy restaurants won't notice a thing."
"Democrats promised they wouldn't let health insurers discriminate against you if you had a pre-existing condition. Well guess what. If you're carrying a couple of extra pounds, maybe 'cuz you've been raisin' a bunch of kids, or you've got an old football injury that keeps you from exercising as much as you'd like, they're perfectly happy to let you be charged twice as much as some stick-figured fasion model for the same policy [note: actual controversy!]."
I'm an amateur at this. Just think what the reincarnation of a Lee Atwater could come up with.
My question was: is there any reason for the high debt level beyond expectations of earning? Or is it just that US student debt levels are generally high and medical school takes longer?
Both, and tuition has increased sharply over the last 20 years or so. Average debt from med school alone is something like $150k.
The point is that the GOP has historically been very effective at identifying groups that represent a numerical majority, but perceive themselves to be an aggrieved minority: first white people, then Christians, and more recently heterosexuals.
Actually, though, I have an objection to this. The GOP base has been the same people through all these years of shifting Kulturkampf rhetoric. They didn't first appeal to segregationists, then appeal to Christianists, and then appeal to homophobes. Nixon identified his group - aggrieved, small-minded whites - and the GOP has spent the last 40 years appealing to them (plus a sliver of the larger populace in order to reach 50%+1) using shifting language & tropes. But I don't think they've changed their target audience at all. Shifted the center of gravity, maybe*, but it's the same mindset to which it appeals.
* Fr'instance, the 1972 coalition was more racist and less Catholic than the 2004 one. But the coalitions overlap enormously, and are completely contained in the group "aggrieved, small-minded whites." If you shift to a group of the aggrieved obese, I don't think you get to keep very much of the old coalition at all.
397's reasoning also applies to law school debt.
I don't think I've ever met an MD in Britain who wasn't primarily academic. Most doctors are MB/BCh, which is a five year undergraduate course.
The undergraduate career supposedly preparatory to entering med school in the U.S. has very little to do with practicing medicine, and is presumably required as a way of further limiting supply and increasing prestige.
403: And keeping non-science undergrad classes full. Won't you think of the poor humanities and social sciences faculty.
Since this is the politics thread....
Paging Bostonian Girl, your ultimate nightmare editorial is featured in the Wall Street Journal today!
400: Yes, I could see this workiing.
"They're going to make you eat tofu!" would get people very riled up.
Sorry. Just a shout out to the strict construction of the OP.
Yeah, PGD, the man's a complete loon. Whole Foods bought otu Bread and Circus a long time ago, but they kept the name for a while. Now Bread and Circus was a touchy-feely company which treated its crunchy granola workers well, so people could feel good about paying high prices, and they got great service. I think that some people still feel this way. Itr's good that Mackey's getting his name out there. This is my favorite line:
While all of us empathize with those who are sick, how can we say that all people have more of an intrinsic right to health care than they have to food or shelter?
Now, I don't believe that the government should grow food or turn all housing public, but you know this sounds an awful lot like, let them die in the streets, forage for food and live in a box.
410: In a wealthy country like the United States people should have a basic right to food, shelter, and healthcare. Of course!
The GOP base has been the same people through all these years of shifting Kulturkampf rhetoric.
The core may have been the same, the GOP base has shifted with the demographic realities and needs of the time. The '68 Nixon coalition was traditional Republican strongholds plus southern Goldwater Democrats (minus those that went for Wallace). The '72 Nixon coalition added the "hardhats" and "ethnics" from the Northeast. The Reagan coalition added more Catholics, plus the Reagan Democrats from the industrial midwest. The GWB coalition of '00 added (arguably--there is some debate about this) a sliver of culturally conservative Hispanics. And so on.
405: You know, Mackey's op-ed actually makes perfect sense, if you look at the issue strictly from the perspective of a corporation procuring group coverage on behalf of its employees. That's one more reason I'd like to see the link between employment and health coverage disappear--if not right away, then at least over time.
That said, I think Obama's read of the situation is correct: if his plan called for eliminating people's employee sponsored coverage, even if you propose to replace it with gold-plated Medicare and your choice of a free pony or a pot-crapping dog, the opposition will be impossible to clear.
plus the Reagan Democrats from the industrial midwest. The GWB coalition of '00 added (arguably--there is some debate about this) a sliver of culturally conservative Hispanics.
Well, except that Bush lost a lot of "Reagan Democrats" (perhaps more accurately, those actual people moved and/or died, but the places where they were, and the class they represented, didn't vote for Bush in '00 or '04). But the rural racists were still there.
Don't forget that there's enormous overlap between "Southern segregationists" and "religious right" - all those Christian academies are de facto white schools established when the public schools were integrated*. IOW, there was no real shift between appealing to Wallace voters and appealing to the Moral Majority, just a change of rhetoric to keep up with the times.
I suppose that the GOP could add a sliver of the self-righteously obese using the kind of rhetoric you've outlined; I just don't think that they could activate large numbers of obese Americans without turning off big chunks of their current base. One reason they've had the success they have is that their core group is fine with all of the individual targets/grievances up til now - there's no GOP red meat in 2004 that would offend a 1972 GOP voter. Add Fat Rights, and you start dropping voters who disdain fat people as morally suspect.
* I know you must know this; sorry to be didactic
Mackey doesn't limit his argument to the problem of employer offering insurance. He makes sweeping, unsupported claims too. He claims that Canadians' desire to get extra health care benefits is proof of terrible rationing under their socialist system which is hogwash. In Canada, unlike the UK, those are non-taxable benefits, and the employees probably want a way to pay for their prescriptions.
Further, he claims that it's all your own fault if you get sick. Hell, everyone should live to 90 if they eat right.
413.2: Agreed, although I worry about how many people who would be angry about Obama smashing employer-based care are angry anyway, due to the disinformation. It seems that you've got millions of non-crazy people who are scared and a bit angry because they think that Obama is doing the very thing he's so careful not to do.
So what has he gained by keeping the big change off the table? I suppose he's kept the votes of some Representatives who would draw that line, but I think a lot of lukewarm Reps are being scared off by bye ill-informed popular reaction.
I dunno. It's all very discouraging. Put me in the "This system is irretrievably broken" camp.
Further, he claims that it's all your own fault if you get sick. Hell, everyone should live to 90 if they eat right.
well, if you want to be intellectually consistent when opposing aid to sick people who can't afford care, this is the way to do it. It's actually remarkable how quickly even reasonable conservatives slide toward this obviously whack position.
if his plan called for eliminating people's employee sponsored coverage, even if you propose to replace it with gold-plated Medicare and your choice of a free pony or a pot-crapping dog, the opposition will be impossible to clear.
I'm sure this is true, but … why? Who wants his health insurance to depend on his employment? I don't see how this benefits either employees or employers.
My question was: is there any reason for the high debt level beyond expectations of earning?
Coming back late but yes, it is primarily this. Earning potential is high, so banks are happy to loan (practically nobody fails out of med school once they are in, aiui) . Banks are happy to loan, so professional schools are happy to raise tuition rates. Makes the university/med school happy, makes the banks happy, doesn't piss off the students too much because, hey, earning potential is high. So long as you go into a specialty and/or work for a hospital.
I've known med school students to just have pre-approved tuition loans for whatever tuition ends up being, because it was increasing every term.
418
I'm sure this is true, but ... why? Who wants his health insurance to depend on his employment? I don't see how this benefits either employees or employers.
It benefits employers because it keeps employees loyal, hardworking, and generally lashed to work with the hounds of hell at their heels. Employees like it because it's a known quantity. Better the devil you know than the devil you don't, and even if objectively you know that the devil you don't know is probably somewhat better for you, you don't want to try to figure out the intricacies of it while you have a broken arm or something.
In Canada, unlike the UK, those are non-taxable benefits, and the employees probably want a way to pay for their prescriptions.
Precisely. Overall, I think the Canadian system works notably better than the US system. It always surprises me a bit that people here can seemingly successfully hold up the Canadian system as a worrisome comparison. Most people in the US would do better under it, some strikingly so, most significantly so. I suppose things like evidence aren't that important when you've got PR and cherry picked anectdotes on your side.
419: When my BF moved to the US, he couldn't get a car loan, because his entire credit history was in Canada, and the agencies won't talk to eachother (with a few exceptions). His brother is a doctoral student in cellular biology, but because he's part of the faculty of medicine somebody at the bank there just thought that that meant that he was a med student. So, he had a credit line of $100k. Eventually, that was reduced when they figured out the mistake, but still. We're not even talking about regular loans for tuition. So my BF has been paying his brother, and even though the interest is only 2.5% it's kind of steep.
418: Well, it doesn't, but the transition is problematic. To take a completely random case that has absolutely nothing at all to do with anyone I know, some people work for large non-profit institutions that have gotten away with below market wages on the basis of having very good benefits and because it is hard to switch jobs if you need the health care or retirement benefits. Those big employers are at least a bit nervous about losing the status quo, especially if, in a completely random example, they gave raises of 0% this year. And the employees will be a bit nervous about having to pay higher taxes on a stable income.
418
I'm sure this is true, but ... why? Who wants his health insurance to depend on his employment? I don't see how this benefits either employees or employers.
This is sort of besides the point. I would be happy to keep the insurance I had as an employee and pay for it myself. This does not appear to be on the table and I don't see how what is on the table will benefit me in any way.
426: Man without any Telemundo access is grumpy.
Since I called her a jackass earlier in this thread, I feel obliged to point out that McMegan is making sense in this post.
It benefits employers because it keeps employees loyal, hardworking, and generally lashed to work with the hounds of hell at their heels.
I was imagining a la-la land in which employers preferred to have employees that they didn't have to intimidate into working for them.
And still, most of her commenters continue to be jackasses. (What if we eliminated mass transit funding and replaced it with vouchers for jitneys?) Maybe the US could buy Ellesmere Island or some such place for glibertarians to create their utopia.
Why would employers want to have employees who aren't constantly afraid to be fired?
I am strongly, emphatically in favor of more jitneys here.
430, 432: I think that's a bit too cynical, at least when you are talking about the sorts of positions that are most likely to come with good benefits. Employeers don't want people constantly in fear of being fired. They want a way to stop somebody from leaving because the shop in the next town is willing to give $200/month more. Or at least to make sure you negotiation before you go.
Don't forget that there's enormous overlap between "Southern segregationists" and "religious right" - all those Christian academies are de facto white schools established when the public schools were integrated
True...and yet, GWB loses in both 2000* and 2004 without the overwhelming support of the religious right outside the states of the Old Confederacy (specifically, Colorado, Ohio, Iowa ['04], Missouri).
*Yeah, I know, don't remind me.
The bottom end of starting salaries is entirely sensible, but the top end is 4-5x that, for no really sensible reasons.
Yeah, the difference between $150K and $300K is quite a bit of money, especially when you spread it across an entire population of specialists. The ceiling on what doctors make isn't particularly out of whack, but the floor for specialists is, and there are a lot of specialists.
436: right, and I've seen direct evidence of closer to a 120k - 450k range, although those are probably relatively extreme cases at either end.
433: But are you in favor of funding them by killing mass transit?
Why would employers want to have employees who aren't constantly afraid to be fired?
Well, I don't know, maybe because people do better work when they're satisfied and, like, treated with dignity?
433, 438: With our cadre of superheroes, jitneys will become the new mass transit!
439: Wrong. Studies show people do their best work when they are terrified and have no self-respect.
437: Makes sense. I was just looking at the numbers Witt linked.
My occasional professional involvement in such things is from a different angle, but I have been surprised by the degree to which physician compensation is treated as a given even by other (non-payor) players in the system that are getting squeezed.
Well, I don't know, maybe because people do better work when they're satisfied and, like, treated with dignity?
I thought you were a grad student, neb. What would you know about that?
I think peep mostly pawned me there.
439, 441: Since when does getting people to do good work play any part in the incentive structure? Employers don't have interests, supervisors do.
434
Employeers don't want people constantly in fear of being fired. They want a way to stop somebody from leaving...
In this economy, it's the same thing. Nobody is leaving a job without getting fired these days except for twentysomethings with college degrees and zero debt. (Sure, in boom times when the shop in the next town was hiring, your rationale would come into play.)
Nobody is leaving a job without getting fired these days except for me, looks like.
444: No, you were making a valid point.
I was just making stuff up.
448: These aren't mutually exclusive statements.
447: Then you must be a twentysomething with not very much debt, right? See?
446: We're loosing all sorts of entry level people. They keep going to graduate school (and I'm not close enough to that they tell me in time for me to warn them about that).
I'm a twenty-something with zero debt!
448: I was too - I really can't complain.
451: That explains much.
449: Really? I can make a valid point by making stuff up?
Or maybe I can't, but somebody else could?
I think the employment-insurance connection mainly just exists because private risk pooling is impossible without it. Both employers and employees wouldn't mind seeing it go, but everyone is afraid of change. And the only way to do risk pooling without tying insurance to employment is some form of single payer.
I'm a twenty-something with zero debt!
451: That explains much.
You see, in my rich fantasy life, this is you teasingly flirting with me.
Then you must be a twentysomething with not very much debt, right? See?
But I'm not! On the other hand, I've got zero debt and couple extra degrees (cheaper in bulk, they say) , so I don't know how that factors in.
429: admit it, you're a secret McMegan fan.
We're loosing all sorts of entry level people.
After you loose them, do they chase a fox or something?
456: I understand that it exists because, historically, unions insisted on it. I don't really know why, though - as perks go, it's just such a basic and important one? Or maybe it began in a unionized industry with high risk of injury, and spread from there?
Pain perdu should break up mcmegan's marriage by wowing her with his in-depth knowledge of improbable aspects of various industries (maybe start with architecture or steel-making). Then PGD can swoop in.
461: Loose the worker, then the hounds.
459: I was carving out an exception for myself, since I did leave a job (a year ago, but the economy was little better at the time) (actually, wow, more than a year ago now) without any prospects lined up in advance, but my circumstances are unusual enough that I thought I could make an exception. Clearly, though, persnickety accuracy is important in this context. Forgive me.
456, 462: IIRC the history is that employers started providing health coverage during WWII as a way of working around wage controls. Agree that the risk pooling issue is a big deal now, but doesn't guaranteed issue and community rating go a long way toward addressing that?
Pain perdu should break up mcmegan's marriage by wowing her with his in-depth knowledge of improbable aspects of various industries
As if McMegan would be impressed by actual knowledge. PP will have to bone up on his glibertarian bromides if he wants to have a chance there.
But I bet McM would love some stories of thrillingly counterintuitive changes made to some process or other.
Knowing nothing about McMegan's marriage, I imagine it to be a Hannity/Colmes sort of affair in which he's a shorter, vaguely liberal milquetoast; he provides her with an easy, reliable target for ill-informed mockery, thereby making her happy.
"milquetoast" is such a pleasing word.
466
... Agree that the risk pooling issue is a big deal now, but doesn't guaranteed issue and community rating go a long way toward addressing that?
Not really. Unless I am confused my former employer's plan under COBRA will cost me about $4000/year whereas buying the same plan as an individual (with community rating and guaranteed issue) will cost me about $16000/year.
470: I had always assumed it was some kind of bland food, and the usage as a description of a person derived from that. Wrong again, peep!
Isn't she married to Peter Suderman? He writes about culture for National Review and American Scene. He is a mighty Pixar defender, with politics not terribly discernible beyond his choice of mastheads.
I'll be leaving my job in two years without getting fired, just because the job has a fixed term. But then, I'll be a twenty-something with almost no debt, so I guess that's not a counterexample. Still, aren't there a lot of jobs out there that run for a fixed number of years and then stop? Maybe not.
I had always assumed it was some kind of bland food, and the usage as a description of a person derived from that. Wrong again, peep!
Not far wrong, though. It's a Frenchified (=pusillanimified!) spelling of "milk toast", which is some kind of bland food, for those in their dotage and those in their nonage, and the usage as a description of a person arguably did derive from that—it's just that the first person it was used to describe was a cartoon character, and the description came in the form of an aptronym.
471: I think that would imply that your employer plan isn't community-rated. If only the individual pool is community-rated, it makes sense that you'd still have a big adverse selection problem driving costs up. But I don't know whether everything, including all employer plans, is supposed to go into the community-rated pool under whatever it is that the sausage factory is trying to produce.
Unless I am confused my former employer's plan under COBRA will cost me about $4000/year whereas buying the same plan as an individual (with community rating and guaranteed issue) will cost me about $16000/year.
Isn't COBRA time-limited?
Also, I assume that the individual buy has "community rating and guaranteed issue" from the state? Because there's no such thing at the federal level. And every advocate of these things as federal requirements has said that it would level the costs between individual plans and company/group plans. So I'm not sure what's going on, but the federal implementation of community rating is largely targeted at exactly the problem you're seeing.
479
Isn't COBRA time-limited?
Yes, 18 months. There were proposals in early versions of the stimulus package to extend this in various ways but they were eliminated from the final version.
Moby, Even in a world where health care is portable, there will still be a role for employers in providing pensions/retirement. 5 year vesting periods will encourage people to say if the upside doesn't look a lot better somewhere else. Who knows, maybe the defined benefit plan will make a come back in academia?
Who knows, maybe the defined benefit plan will make a come back in academia?
IMO the only employers that can really be trusted to provide defined benefit pension plans are governments. The others really can't be trusted to remain stable on a 50-year horizon.
(Yeah, Harvard, whatever.)
471, 479: the problem is that community rating and guaranteed issue without a mandate for everyone to purchase insurance sends costs through the roof. Because unless you have to buy in, sick people will tend to select in, and your insurance pool is disproportionately expensive people. You have to get healthy people to pay in too. The risk pooling problem is really at the center of everything, and is a big part of the logic of single payer. The easiest way to get healthy people in is just to collect their damn taxes and have the government pay.
Harvard never had to pay much in unemployment insurance, because they never laid people off, but now they are.
Umm, I suppose you could buy insurance to cover costs should you go out of business. I think that early pensions from less than gigantic firms worked this way. I still don't get why Federal employees lost their DB pensions.
There was a gubernatorial candidate I didn't care for here who did make one really good point that the AG didn't get. Getting rid of defined benefit pensions was a bad idea, since many of the good state employees had taken lower salaries because of the guarantee of a secure retirement.
Umm, I suppose you could buy insurance to cover costs should you go out of business.
You could if you trusted life insurers. Which, maybe, but then they get all boomy and busty with the securities markets and then get bailed out , and it seems like it might be simpler to cut out the middleman and just beef up
Sociable Security + create better annuitization options for DC plans at retirement.
The link in 366 is indeed great. I have forwarded it to many people.