Comment by nozzlegear
19 days ago
A less cynical framing is that the US is a much different culture from European countries, and is massively larger in scale. Depending on the problem, some of their solutions simply can't or don't apply.
19 days ago
A less cynical framing is that the US is a much different culture from European countries, and is massively larger in scale. Depending on the problem, some of their solutions simply can't or don't apply.
The scale argument is thrown around a lot as a justification for why the US couldn't possibly implement universal healthcare. The elephant in the room that I'm always surprises at how rarely it's mentioned in these discussions is Brazil, which is a huge country of comparable size (both territory and population wise), and it manages to make UHC work even though it's also a much poorer country.
It's not perfect by any means, but it's definitely much better than nothing. So the US should absolutely be able to at the very least match that, but really most likely it should be able to do much better. That it doesn't is very much a choice.
The elephant in the room is that in every other sphere, scale is the solution, not the problem. The US should find it easier to implement UHC just because of its scale. More tax dollars, more average outcomes, more resources for outliers, more incremental money for research into rarer conditions. That 10x smaller countries like Canada do it effectively is an indictment of America's inability to do it.
America doesn’t do it for political and cultural reasons. It has absolutely nothing to do with scale, economics, or America’s “inability” to do it. Americans (unfortunately imo) have consistently chosen not to do it by not electing politicians who have pledged to do it.
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Did Brazil start with a Byzantine kluge of private and public providers and intermediaries? Genuine question, not snark.
I think the US would prefer a UHC if we were starting from a blank slate. The difficulty is mapping a path from what we have now to that.
> I think the US would prefer a UHC if we were starting from a blank slate. The difficulty is mapping a path from what we have now to that.
Do you remember when Republicans went on and on about how "Democrats rammed through the ACA without a single Republican vote"? As if that represented a problem on the Democratic Party side, and not the Republican one? Despite the similarities to models proposed by Republicans in the past, and the relative conservative step it represented from "Byzantine kludge of often poor-to-no-coverage" to "something with a higher floor"? That's how hard it would be to find a Republican to "prefer a UHC if we were starting from a blank slate."
It's important not to underestimate the distrust of government services and regulation of any sort of the Republican base. The conservative media - talk-radio, then cable, then social/podcasts - has been intentionally undermining the credibility of government services at every opportunity for 40 years. And the politicians hamstring and sabotage whenever they get a chance to try to make sure that services offered in the US are sub-par compared to elsewhere.
It's a well-oiled machine running a cycle that keeps people focused on anything else but the services they actually use all the time so that cognitive dissonance can't creep in. (Granted, sometimes, when necessary to acknowledge those things, they'll fall back to making it clear that YOU earned/paid for the things you use, but those other gross poor people are just freeloaders.)
It's like with abortion - for decades "overturning Roe V Wade" was what Republicans said they wanted to do. And people kept trying to convince themselves "oh they don't really mean that, they wouldn't do that actually anymore." Take their word on it about wanting to tear down government services.
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> The difficulty is mapping a path from what we have now to that.
It's difficult, but not as difficult as it's often presented to be, as long as you're okay with giving the finger to a relatively small number of wealthy health industry executives.
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> Did Brazil start with a Byzantine kluge of private and public providers and intermediaries? Genuine question, not snark.
That's what it still has.
I got a Master's Degree in Education and spent 2 years in Educational Psychology Ph.D. program and absolutely 0 time was spent looking at how other countries do education.
It's baffling how despite numerous other countries outperforming the US in educational outcomes we do not even look at other approaches!
Maybe it's better not to look...
https://www.tiktok.com/@guinnessworldrecords/video/747057742...
ha-ha f....
cause we are the best and when you are the best you simply do not look back :)
Best enough to even sing about it :)
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Which part here exactly cannot work in the US? I am talking about brushing one's teeth with toothpaste containing fluoride, which sounds as plain simple as possible to me. Is it regular brushing teeth that fails in the US for cultural reasons? Fluoride in the toothpaste? Supervising kids while brushing their teeth to make sure they do not swallow? It is an honest question.
In a word: poverty. People do not have free dental care, and poor people aren't guaranteed to have a toothbrush, toothpaste or sometimes even a sink to brush their teeth in. Fluoridated water is one of the few dental protections available to everyone regardless of their income. It's cheap, minimal and cost-effective cavity protection at scale for the entire country.
> poor people aren't guaranteed to have a toothbrush, toothpaste
There is no person in the world who cannot have a toothbrush and toothpaste if they want to. And if you find one such person, they won't have access to any centrally treated water.
> and poor people aren't guaranteed to have a toothbrush, toothpaste
Considering that the number of such people is very low it would be very cheap to solve this issue.
Your less cynical explanation boils down to people being too poor to afford tooth paste (really?). So why are they poor?
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AFAICT most US toothpaste has flouride in it already.
(For now, at least? How long until that gets cracked down on as dangerous?)
You can get fluoride free toothpaste, mainly for babies/young toddlers.
This is exactly the framing. "What worked there can't work here", whether it's firearm control, socialized medicine or education, whatever.
We're either bigger, or denser, or less dense, or ... essentially whatever suits the argument.
The other weird thing in US discourse about other countries is that when it does enter the conversation, the "rest of the world", or at least other developed countries, are often treated as some kind of monolithic entity culturally and politically. For example, a lot of people on both left and right in US believe that the rest of the world is single payer, and generally that "single payer" is synonymous to "public healthcare". Similarly with gun control, there's no recognition of the fact that there are countries in Europe where you can own an AR-15 just fine, and countries (different ones!) where silencers are over the counter items not requiring any special registration.
Most Americans would be shocked to know that in Thailand there are signs at the airport advising you on the correct firearms procedures
https://www.airportthai.co.th/en/aot-reiterates-the-guidelin...
edit: But I will say it works both ways. Most countries do not know what it takes to keep hundreds of millions of people of various backgrounds together under a common way of life with a certain risk vs entitlement balance. Americans as a whole are more risk tolerant AND accepting of failure and reinventing yourself. In most cultures it's a great shame to quit your job with benefits, start a business and not succeed. In the states it's not shameful. You tried? Awesome.
Yes, that's my point. We are literally different people with different cultures, values and problems. Case in point: the firearm control you mentioned. I won't get in a gun control debate here, I have my own complicated views on the matter, but it's an undisputed fact that Americans have a right to own guns (maybe with limitations, maybe not) and many Americans deeply cherish that right. There is no gun control solution we can take from Europe that you could apply to the US, it's simply not compatible with our culture, not to mention our own Bill of Rights. It's not a bad thing to recognize that.
A lot of people are uncomfortable having an opinion without being able to rationalize it.
I have to assume many, maybe most, people that give reasons like you mention just flat out don't want the policy and reach for a reason to justify it.
I can say I don't want gun control laws. Not because it doesn't work elsewhere or couldn't work here. I just fundamentally disagree with it and don't want to live in a place where the only ones with guns are state officials.
Scale is a scapegoat. Take the US region by region and you can find analogs around the world.
The US isn't several countries put together, region by region. It's one big ass country. I really don't see how taking it region by region somehow eliminates scale issues when you still have to apply it to the entire country.
It's a federal country of many states though. The original design of the US is fairly similar to the design of the EU today, US states used to be offered much more independence.
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There shouldn't be a scale issue with regards to fluoride in the water. It is either scientifically shown to be beneficial or it isn't, scale and geography likely have nothing to do with it.
Does it not depend on the chemical composition of local water? The US is vast, geologically diverse, and water quality varies hugely across it. Denmark can likely make a decision that's good for the entire country.
Actually, what most countries seem to do (according to other comments I’ve seen here), is just delegate to local bodies, so country size is a complete non-issue.
It could, what do you have in mind with regards to chemical composition that may require fluoride in some circumstances?
And are those conditions manmade? If so, would we be better off reversing the proximal issues rather than adding fluoride to try to fix it?
a decades long study with a gazillion of potential confounders is never "either scientifically shown to be beneficial or it isn't"...
let alone the precautionary principle in a complex system with a gazillion variables... (i.e. things we don't know we don't know)
You're not wrong in that our culture is different, but that cultural difference is chiefly a self fulfilling prophecy of "the government can't do it," promoted by billionaire owned media, so that those same billionaires can run for-profit industries like healthcare and transportation.
The cultural difference is that our rich people are too rich, our media is too centralized, and none of those in power want to enrich and empower the country, when they could enrich and empower themselves.
This is the excuse all American use about literally every single issue anytime anybody points out that other do things better. Most often without actually having thought about it beyond 'muhuhu US BIGGG! USA! USA! USA!'.
If you want to make that argument, actually make it, because if you try, 99% of the time its not actually true, its simply ignorance.
I'm not sure what point you're trying to make here except that you take a dim view of Americans.
The point is that flouride has the same effect on your teeth no matter how many hectares of lifeless desert happen to be controlled by your government.
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My point is that those that continually point out 'but some things don't apply to the US because X and Y' are mostly themselves just falling into the same trap and almost never actually explain why X and Y change anything, making their 'defense' just more of the same.
I feel like this always comes up in these sorts of arguments, that the US is so unique that solutions that work elsewhere can't work here. And yet this point is always hand-waved in, without and specifics discussed, and is just presented as a given.
I really don't buy it, at least not as a general statement.
This argument works fine for high-speed rail, not so well for insurance and healthcare.
If you focus only on the scale part of my argument, sure. But I think the culture part of my argument is more than enough of an answer for insurance and healthcare:
https://news.ycombinator.com/item?id=43521734
Why is it less cynical, what does the scale of the US have to do with it?
Maybe it's just me, but I find the argument that "Americans won't do X cool thing that Europeans/the rest of the world do because they [are dumb/are corrupt/love money/hate each other/believe in American exceptionalism]" to be a very cynical and lazy argument. Note that the person I was replying to was talking about policies and goals like UHC and High Speed Rail, not specifically about fluoridated water – that was the context in which I was replying.
The simply reality is, culture matters. And if your culture has a strong believe in exceptionalism pointing out how others are better at something often creates backlash and an increase in opposition rather then a decrease.
And this is known by people who do professional advocacy work, on topic I am familiarly with, such as city design and transportation. They take great care to make sure all the examples are from the US, even if those examples aren't nearly as good as others. Because they know, when speaking to American audiences, you lose the audience if you suggest in X town, they should do Y that is done in Europe. In the US selling something as domestic innovation is usually the best, "if people in Indiana can do it, you can do it even better".
To just ignore any explanation that points out that culture matters, and believing that only 'hard' factors matter, is incredibly foolish. Cultural believes, such as exceptionalism absolutely do a play a huge role in determining what happens in the real world. To point that out, is not cynical or lazy.
And this does not just apply to the US, it many countries have different forms of that.