> the black people there seem so positively surprised and very kind when you ask them something as a white dude

Where were you? I live and grew up in the south east, and have always chatted with my black neighbors / clerks / coworkers / etc when out and about. It’s so normal that I can’t imagine a response of surprise.

I'm here in the south too, and the way my friends up north and out west talk, they seem almost more segregated than the south.

I am European, I have stayed in the US many times and I think some parts of Europe have more racial problems than the US. For example, I have some Asian friends who used to work with me in Scandinavia and moved to the East Coast as they felt like second class citizens.

Another big problem in Europe is the way talent is valued. It is much more important to have good connections and to belong to the upper class. Simply compare the salaries between engineers here and there. Only management gets a good compensation. This explains why innovation is somewhat stifled.

Things are changing and there are some exceptions. For example, Switzerland shares many of the desirable traits of EU and US, but few of their issues. Stockholm and Berlin have nice startup scenes, and so on. However, the rate of change has slowed down dramatically due to COVID, the housing bubble and inflation rates.

Private schools--or neighborhoods with a good school system--are basically about segregation. Every single black child I've ever seen--with one notable exception--had a super arrogant streak, in one case it was a one-time thing, in every other case like holy shit (though another one I sometimes had good conversations with, it just varied). Like out of nowhere, spitting in my path in US--that's racial bullying on their part, they're trying to impress white boys--literal white boys, white males under the age of 18--that they can even intimidate white men. So then what? What's the endgame of those underage black boys? What are they trying to accomplish? Whom else are they trying to impress?

And so then you just want to avoid them, because nobody can punish them without undergoing that which Americans and especially Californians are most afraid of--being accused of racism.

California is built with this form of segregation in mind--highways, no sidewalks, no public bathrooms, extortionate rent (huge percentage of income, 40% is common) with the homelessness that is its direct consequence, crazy zoning (you could economically build 60-story skyscrapers anywhere in Palo Alto), concrete everywhere with many places inaccessible except by car, hospitals out to fuck you, firmatage, terrible public transport--all out of fear of harm from minorities which can believe it or not be out to get whites--have that specific intent of harming whites, and they get convicted for hate crimes but those crimes never make the news--which they never punish, only prevent.

We have really good insurance and now that my partner needs treatment for a chronic illness, they are denying the treatment. It’s lowering her quality of life, may lead to her death, and it’s absolutely standard operating procedure for insurance companies. It’s a delaying tactic.

Healthcare is hard here.

The only reason insurance would (legally) be able to deny treatment is if there is no good efficacy data.

If your doctors say there is supporting data for the treatment they are recommending, then filing and appeal is an option.

https://www.healthcare.gov/appeal-insurance-company-decision...

I believe it works similarly in countries with taxpayer funded healthcare. Some group of people at some point in the process decide what is eligible to be paid for by the government.

Federal government literally spends over $1T on healthcare for the elderly.

The healthcare issues in the country have never been about the old.

What are you talking about, health care for the elderly is terrible! I guess you've never had to take care of an old person in the US? And never been exposed to northern European healthcare?

You bring up a good point, even though the US spends the most per capita on health care we actually have the worst outcomes

https://www.pgpf.org/chart-archive/0252_health_outcomes_spen...

Every time this stat is brought up I always think it doesn't convey the full context. Even though its in terms of per capita, it's still an absolute amount, I think a better data point to illustrate if the US was overspending compared to outcomes would be what % of disposable income is spent on healthcare vs outcomes.

For example, let's say the US spent 2x on healthcare as some country, but had 4x the disposable income, would this still be overspending or would it be more efficient given the amount relative to income? The closest I can find is health spending as % of GDP but that doesn't capture what a person's income, since it includes government spending too, so it obfuscates whether or not the inefficiency (if any) lies in private or public healthcare in the US.

Why would that even matter?

Let's say the US spent 2x on healthcare as some country, but had 4x the disposable income, would this still be overspending or would it be more efficient given the amount relative to income?

Healthcare spending in $ per capita doesn't capture how much people earn in that country or how much of a burden it is relative to their income so its kinda meaningless without more context. It's like saying the US economy is better than 85% of the OECD because its in the top 5 gdp per capita.

"Disposable income" is undefined, its super vague and we can't determine anything with that phrase

Most people in the US don't have "disposable income" from my perspective

There's a very consistent definition for what that means with plenty of papers and institutions that use use roughly the same definition. Here's one phrasing of it by the OECD[1]. Basically it's just income minus taxes, what part of that is remotely vague?

Discretionary income might be an even better measure but that has more wiggle room on defining what is a necessity and not.

https://data.oecd.org/hha/household-disposable-income.htm [1]

I still don't see how that's a good metric, in any way, for judging health care costs. "Disposable income" takes nothing else into account such as other costs or predatory behaviors in the healthcare system

Its literally just money after taxes, and most people are living paycheck to paycheck

You can't judge how much of a burden healthcare costs are unless you account for how much of a person's income or some proxy of it healthcare is. Just saying that the US spends more per capita than other OECD countries doesn't say anything without more context. IF you want to show that the healthcare spending isn't efficient in the US you have to at least show that it's not just because everything costs more there or that everyone earns more in the US (gdp/capita is higher than ~85% of OECD in US).

It spends more per capita with worse outcomes

That's the point, where is that extra spending going? What good is it doing? Why is any other question the topic of discussion?

You haven't shown its extra spending with just that one stat. Does $50 USD buy you the same things in the US as $50 USD in Venezuela?

That's exactly what I'm talking about, it doesn't. Why not?

Does Venezuela have a bunch of leeching middlemen at every possible point in their systems due to the massive push for privatization?

Things cost more in some places so you need to account for that variation. A million could pay for 3 / 4 doctors in the US or 30 / 40 in Africa.

You say this like the profit seeking in the US is some sort of natural phenomenon that we can't avoid. We can adjust costs based in cost of living and local currency, profiteering is what sucks resources out of the system

Physicians in the US are protected, there's only a limited number of slots every year in med schools. This is fake scarcity

I bet sugar has a lot to do with it

I think the issue isn’t the wilingness to spend. It’s the lack of willingness to make it effective.

The reason its not effective is because most of the money doesn't actually do anything, that's literally what profit is

Profiteering leeches resources from a system to benefit a small number of people at the expense of the rest of the healthcare system

In my opinion, please excuse my language, but it's fucking insane

In my experience, it’s often even worse - there often isn’t even any significant profit, at least not in any coherent, centralized way. There are a lot of individual players who can be pointed out, but none of them individually is ‘the problem’.

Absolutely massive amounts of value is destroyed (and patients harmed) just doing super inefficient shitty processes because no one has the ability or incentive to do any better at a systemic level.

Everyone in the system who has a degree of control gets paid very well keeping the wheels turning and consuming cash.

You're 100% on the nose. A big part of it is unnecessary middleman companies leeching at every point in the process.

That's why the profit is so minimal, because there are just so many people providing little to no benefit all taking their piece and spreading it over a bunch of salaries while people get denied treatment

Unfortunately it's starting to happen here too. I'm not sure how much longer I'll be able to make these arguments at the rate we're privatizing and contracting out things... Might end up just as bad here in the long term.

It's the whole reason for the UK tube strikes right now too, and the media is trying to paint the union guy as some Marxist villain when they just want decent wages

The whole thing is totally absurd and short sighted, it's damaging to society. This is why there's more stability in some EU countries. We shouldn't be sacrificing stability for profits, that's a terrible idea. We need a stable populace to make stable progress and have a robust system that lasts for generations

They will just send you home to die when you become a burden to them. Happens all the time, old folks just get told to pound sand and die and no one does shit about it.

Medicare still has costs to the policyholder and it also requires supplemental insurance for coverage of things like eyes, teeth, hearing aids, long term care, etc.

Oh that’s good to hear, I got the impression it was only good as a veteran.

> the black people there seem so positively surprised and very kind when you ask them something as a white dude

In ~1999 I was in New York, walking around with a sizeable backpack and asked around in Harlem where to find the Sugar Hill hostel. I'd asked two men about where to find it when I was approached by two young women who advised me not to ask these questions here as that would not be safe. I was rather surprised by this since I thought that time was past. Maybe it was the location, maybe it was the backpack but it was not what I'd expected. I found the hostel by myself and came to no harm in any way or shape.

I'm "white" (more of a shade of tan, really), everyone else in this narrative is "black" (more of a shade of brown, really).

Funny, I (as white as it gets, melanin deficit disorder) stayed at the Sugar Hill Hostel for a couple of days (around labour day -- found it difficult then to leave the city on bus or train) in '98. An African American man walked me to the hostel in an apparent effort to ensure my safety. He pointed out that there are different shades of black skin, which I found a bit sad (the pointing out part). The area seemed actually fairly safe, but the fellow was nice enough to chat with.

The Hostel itself was not all that remarkable (other than the lack of air conditioning at that time of the year), but the crowd there was interesting, quite an experience. Thanks for jogging my memories ;-)

After my stay in the hostel I went for a long hike in the Catskills - where a porcupine ate my candles during a night in a lean-to - after which I returned there to pick up a friend from JFK with whom I proceeded to hike around and over Mt. Washington - where a squirrel found the bag of food which I hung in a tree to keep it from the bears, it ripped my sleeping bag stuffing bag to shreds - to return to NYC. From the long night conversations with an 19yo Israeli girl who I managed to talk out of hitch-hiking solo through the US through staying in a rather rickety apartment in the Bronx (large cockroaches in the sink in the morning, etc) with a Brazilian, an Irishman, an American woman and (another) Dutchman, it was an interesting trip. I've staid there on other trips as well, it being (at least back then) an affordable and relatively central location. Never missed the AC, maybe 'cause I'm not used to it being present?

I wouldn't try the same thing today.

Odd comment given how that area of Harlem is much much safer today than it was in the 90s