There must be more than two alternatives, though? Surely we can have a 21st century economy to match 21st century challenges?
I don't know what that might look like yet - but I think we will know in a decade or so. Currently there's a storm of protest from those being left behind (Trump in the US, Brexit in the UK), and it won't be long before different solutions will be tried for these - eg UBI, direct democracy, charter cities, etc. Eventually, one of these solutions will stick and look obvious in hindsight.
Also there is an argument that even if everyone objectively does better under a particular system, increasing inequality is still a bad thing. To take just one example, access to money may be correlated to access to better outcomes from the criminal justice system (eg rather than the facts of the case).
If we're examining it from the perspective of advancement, and we know that political restrictions on economic development (i.e., regulation) slow development (compare the development delta of periods in 19th century with today), what we end up with is an infinite number of mixtures between freedom and controls.
What I'm telling you is that there are some controls we have in place today that are helping to kill me, and it is almost perceptually obvious that an alternative (freedom) is possible, and that is what we should move toward.
Freedom from political and economic controls is good for those that want to work and think. It doesn't do much for those who can't or won't, but so what? Those people that work and think are the source of everything, and they have the right to priority. (Consider the effects on societies where the complete opposite principle is in action: the Soviet Union, Dark Ages Europe, Nazi Germany, Chavismo in Venezuela, Maoist China, ... possibly America in 20-40 years?)
On the one hand you argue for a free market approach (less regulations and hence more doctors) but then you also argue for a meritocracy (those who work and think should get priority). Both of these are definitely not democratic, and for the time being democracies are the preeminent social construct with massive momentum behind them. Changing that abruptly would be seriously destabilizing for the entire world.
Changing that abruptly would be seriously destabilizing for the entire world.
You're absolutely right about this point, which is why benefits need to be removed over time. (People that have expected a Social Security check, and have paid into it their entire lives can't be expected to react just as they reach retirement. However, a 25-year-old can be told, "save for your own retirement, because this won't be there for you.")
Having said that, controls can be removed instantly, and to very positive effect. Even a partial relaxation could massively improve things! Imagine how much better my situation would be if the federal government had, in 1999, decided not to keep restricting the number of medical residents allowed to enter/be funded each year. (https://www.aamc.org/advocacy/gme/71178/gme_gme0012.html)
Disingenuously left out of your arguments here is the fact that a medical education costs a hell of a lot of money, and your economic measures would remove the ability to study medicine from a lot of people who might be willing to learn, but don't have massively rich parents. Deregulating university fees, getting rid of social security, and so fourth massively reduces the number of people who are able to study medicine.
First, this is way out of line. I'm going to reply anyway, but please don't do this kind of thing in your next reply.
Second, instead of treating it like a black box that has a fixed cost that we have to accept, take a medical education apart the way Musk would do when figuring the ultimate cost of one his cars or rockets:
Putting people in a room, books in their hands, and having them sit in front of a lecturer is not actually that expensive. I won't name names, but two medical students I knew in the last fifteen years actually skipped most of their lectures, studied straight out of the book and did just fine.
It is true that the hands-on aspect of medical training is more expensive, but people in much poorer countries manage to do it.
Even if you managed to show that this education outlined above is inferior to the ones available today, right now I'd still be overjoyed to see a doctor educated in this manner. It's better than waiting two months (note that this is not even for treatment - it's just a biopsy!) while I can feel this thing getting bigger, with sharper pain as time goes on.
Finally, what is the point here? An more economically "equal" society, or a society where people like me don't die waiting in line for care? I stridently advocate for the latter.
> Finally, what is the point here? An more economically "equal" society, or a society where people like me don't die waiting in line for care? I stridently advocate for the latter.
So only the amount of economic value a person can produce should decide the value of the persons life, is that what you are saying? The more money you have, the more your life is worth? This kind of neoliberal ideology sounds absolutely horrible to me. Just because you have the ability to produce more than some other person doesn't mean that your life is more important. What you are experiencing now with the wait is nothing compared to what poor people would have to endure in the system you advocate.
What you are experiencing now with the wait is nothing compared to what poor people would have to endure in the system you advocate.
First, you do realize that not everyone that goes into the hospital today comes back out alive, right? There are a lot of things medicine can't yet cure - today - for any price.
Second, if you block high-priced medical advances, you are also blocking the low-priced ones that inevitably follow in a free market.
Just as UNIX workstations sold for tens of thousands in the early 1990s, and were supplanted by desktop computers costing a tenth as much in the following decade, expensive medical technology would become cheap quickly under freedom.
We haven't seen this happen with most of medicine because of the controls placed on it. For example, I learned (via this thread) of a new machine that administers anesthesia. Its use would make my biopsy $1800 cheaper, in addition to reducing my wait time (you can't have an endoscopy without general anesthesia): https://www.washingtonpost.com/business/economy/new-machine-...
This device was ready to go six years ago, but the FDA rejected it initially (under pressure from anesthesiologists). Three years later, after much foot-dragging, it finally approved it. And yet today it's not available in most places because the American Society of Anesthesiologists lobbied hard for a "narrow indication" and "restrictive guidelines."
Note that it's not up me or my doctor as to whether or not I might opt-in to this. Nor is it even a choice that can be made by any of the local hospitals around me (I would shop around if it would help, believe me!) What happened here is a direct and inevitable consequence of regulatory control over which innovations are permitted to enter medical use. (The only tool the government has in regulatory matters is more regulation or less. Therefore there is no way to prevent regulatory capture in a mixed economy except to steadily de-control it.)
What good is it to me that the device has been vetted more? Every minute I wait allows my condition to worsen, increasing my risk of death.
The facts I've outlined here are not just some "neoliberal ideology" intended to offend you. This is a thing that I (and hundreds of thousands of other people like me) need desperately. All I'm advocating for is a society that recognizes the life-saving role of freedom in medicine. And I'm advocating for that only because nothing else could possibly work.
You can't just throw your hands up in the air and say "to heck with early adopters, they shouldn't be allowed to pay more to be a year ahead!" If the government forced all the tech companies to do that, tech would be about as slow to improve as medicine currently is. This is because there would be no money put into the right hands (and it is a constantly changing group of people and organizations), at the right time to make the technology steadily improve.
I don't have enough knowledge in this area to say if the current regulations have done any good, but I'm sure there are legitimate reasons for those regulations in many cases.
But my problem isn't really with freedom in the medical field, I can support that if it really saves more lives. What I don't agree with is the way you propose to make this freedom happen. Determining who is worth saving and who is not by the amount of money they have is something I can't support, and it's what would happen with a free market approach. You say that is the only way to achieve what you want, but I don't believe so. We could increase public funding, for example.
By the way, have you looked into getting what you need from abroad?
"Finally, what is the point here? An more economically "equal" society, or a society where people like me don't die waiting in line for care? I stridently advocate for the latter."
this is a false dichotomy. To get more doctors you need more people who can afford the education. Not less. I'd say check your privilege- Any of those options you listed for getting an education still take a vastly greater amount of resources, than you are giving credit for. You can't study out of a book if you don't have a house to live in.
as for whether my comment was out of line, I'd say if your argument is to take away government subsidy for infrastructure, force people to pay for their own education, leaving out the basic costs of the education is a critical part of the argument you left out, and for a transparently self serving purpose.
That is not the right advice for any human being, no matter where they start.
I'm fighting for my life right now - a life I had to strive for. I don't take a moment for granted, even with the pain and the uncertainty that I'm under right now.
I paid for my education (UW-Madison, class of 2011). I've never wanted anything but to earn my place in the world.
You say that I'm motivated by a self-serving purpose? You're goddamned right that I am. I have the moral right (like anyone else) to strive for existence, your ideas be damned.
Sorry, I misread your original post. 180 degrees off from what I thought you wrote. In your link, it looks like putting a cap on residents that can join educating hospitals is in place as a measure to save on medicare costs.
it seems like training doctors is the sort of thing a country should be pouring more money into, as an investment in the future.
The problem with SS is that if the 25 year olds don't keep paying, there's no money to give to the 75 year olds who paid their whole working life. The money THEY contributed is long ago spent.
It's much harder to tell the 25 year olds to keep paying FICA and save for their own retirement.
If 25-year-olds are in a booming economy (a result of decreasing the economic controls), the taxes won't hurt nearly as much. Also, the knowledge that those are getting phased out and are a one-time thing will help a great deal.
The end result is a society where entire generations of people stop viewing each other as burdens and resources (young and old), and instead as individuals, with their own lives and responsibility to lead them to be the best they can be. That is a just society.
(Hat tip to Don Watkins for the phrase "burdens and resources")
IMO, it would take a very strong economy and very selfless generation to contribute 12.4% of their earnings over a lifetime and get nothing. They'd have to save well over a third of their earning power to have a hope of retiring. (12.4% that FICA is taking and giving to someone else, 12.4% for their own private replacement version of it, and at least 10% to replace what would today be their own supplemental retirement [today's 401k/403b/IRA/investments].) That's seriously into Mr Money Mustache territory!
IME with people, knowing that they are the only ones in history getting so screwed and this is a one-time thing will NOT make it OK nor reduce the feelings of burdens and resources.
(I do like that phrase a lot. I also wish you a good medical outcome, ofc.)
Nope. It isn't just, it is the jungle. A wise man once told me, "you must push the cart when you are young, so that you may ride it when you are old."
Our older generations must be looked after by the younger, instead of just discarded when their utility is below market average.
Your scenario works when everyone is on a fair and equal playing field, however for those that are disadvantaged, you are quite literally saying they must starve or be killed for the good of society. That my friend is a cruel world, and not one which I wish to strive for.
That's true only in the case of economic scarcity. If there aren't enough jobs around (because of automation) then scarcity is no longer the driving force and we need to look to economic systems that were not scarcity constrained (for example, the potlach societies of papua new guinea).
Even the scraps of giants make me better off than I'd be in either of those places.