Seriously thoughtful US/Europe Cultural Divide -- Musings

[dreams]

Originally Posted by nekokami

Very true. For those interested in regional and cultural differences in the US, I highly recommend The Nine Nations of North America, by Joel Garreau.



Summary:



Reading this book (years ago) helped me understand why my views, as a New England citizen, differ so much from those of someone like Ralph, from a completely different part of the country with its own values. Both of us are surrounded by people with similar backgrounds to our own, and it is easy to fall into the assumption that the rest of the country is the same, but this is an illusion, I believe. When Ralph speaks of what "Americans" believe or "American culture," he does not and cannot speak for all of the US. Different parts of the US were settled by different groups with different reasons for being here, and our culture is no more homogeneous than that of the EU.

Edit: Another interesting reference is The 10 Regions of US Politics.

Wow! Being gone for a while and trying to catch up on all the posts around here is giving me a headache I feel like I'm back in university and having to "critical think" through every post.

I think that the title of this thread is a slight misnomer as it should probably be called "The Various US Cultural Divides/The Various EU Cultural Divides--Musings

Neko's post with map is a very good example of what a variety of cultural divides we have in such a large land mass of the USA. I've lived for over 10 years in each of 3 different areas and felt like an alien each time I moved in. I've found that there is a comfort zone derived from all my experiences.

Setting the US up as just one entity with just one belief is not technically correct as there is such a wide divide among ourselves (as I've noted even among the EU posts). Our beliefs and strong opinions as formed through our separate cultural upbringings and outside influences. Even amongst those of us living in the same area and / or family.

I've learned that you will not change anyone's beliefs through discussion unless they are open to change.

O.K., that was my two little, bitty cents worth. All I wanted to really say was thanks Neko for mentioning something that kept going through my head as I read through the posts.

[zerospinboson]

Originally Posted by Harmon

Pournelle was an intellectual protege of Russell Kirk (Kenneth C. Cole, Pournelle's mentor at the University of Washington, was co-founder with Kirk of Modern Age) and Stefan T. Possony with whom Pournelle wrote numerous publications including The Strategy of Technology, onetime textbook at the United States Military Academy (West Point) and the United States Air Force Academy (Colorado Springs). His work in the aerospace industry includes editing Project 75, a 1964 study of 1975 defense requirements. He worked in operations research at Boeing, The Aerospace Corporation, and North American Rockwell Space Division, and was founding President of the Pepperdine Research Institute.

Neat list. However, I don't really see how that makes him qualified in the area in which you're using him as "authority", or why he would "know" that government will make a worse mess of everything over time, etc., nor how this somehow invalidates the second point of my post. And "refuting" my statement that I don't really see how that guy's opinion is relevant by introducing some facts about how he co-authored a military manual into the discussion is not an answer to that part, they're just red herrings.

[zerospinboson]

Originally Posted by Xenophon

Cite, please? I'd be thoroughly shocked if the percentage was anywhere near that high.

In the United States a 2005 independent report stated that 11% of women and 5% of men in the non-institutionalized population (2002) take antidepressants[27] A 1998 survey found that 67% of patients diagnosed with depression were prescribed an antidepressant.[28] A 2007 study purports that 25% of Americans were overdiagnosed with depression, regardless of any medical intervention.

wiki
most data seems to rely on a 2002 aggregate for the then-past decade
news articles say silly stuff like this about it:

Between 1995 and 2002, the most recent year for which statistics are available, the use of these drugs rose 48 percent, the CDC reported.
Many psychiatrists see this statistic as good news -- a sign that finally Americans feel comfortable asking for help with psychiatric problems.
"Depression is a major public health issue," said Dr. Kelly Posner, an assistant professor at Columbia University College of Physicians and Surgeons in New York City. "The fact that people are getting the treatments they need is encouraging."

So yes, not quite 20% (a figure I put down more to express my disbelief over the fact that so many people would be depressed nowadays than to be accurate.), but still between 20-35 million people.

[Harmon]

Originally Posted by zerospinboson

Neat list. However, I don't really see how that makes him qualified in the area in which you're using him as "authority", or why he would "know" that government will make a worse mess of everything over time, etc., nor how this somehow invalidates the second point of my post. And "refuting" my statement that I don't really see how that guy's opinion is relevant by introducing some facts about how he co-authored a military manual into the discussion is not an answer to that part, they're just red herrings.

It's not an "opinion" and I am not using him as an "authority." It's an aphorism. It is one which I find validated by my professional experience. That experience tells me that if we let government take over providing our health care, we will suffer the usual and predictable outcome stated by the aphorism.

The reason your statement was "refuted" was not to answer anything at all, but rather, to try to fill a gap in your knowledge.

[zerospinboson]

Originally Posted by Harmon

It's not an "opinion" and I am not using him as an "authority." It's an aphorism. It is one which I find validated by my professional experience. That experience tells me that if we let government take over providing our health care, we will suffer the usual and predictable outcome stated by the aphorism.[snipped nonsense]

Amazing. The fact that the most privatized health "care" system - yours - is in reality the most expensive one in the world (50% more expensive per capita than the next-most expensive system, and costing more than double what the average western health care system costs, with absolutely no higher life expectancy whatsoever) - doesn't even make you wonder if that one-liner is at all accurate? Or is it that your religion/"work experience" forbids you to acknowledge such doubts?

[Harmon]

Originally Posted by zerospinboson

Or is it that your religion/"work experience" forbids you to acknowledge such doubts?

No point in spending any more time on you.

[wodin]

Originally Posted by Harmon

No point in spending any more time on you.

You lasted longer than I would have.

[zerospinboson]

Originally Posted by Harmon

No point in spending any more time on you.

*shrug*. I wasn't asking you to spend time on me, I was asking you to consider relevant information.
But seeing how you steadfastly refuse to engage directly with (or even acknowledge) anything I quote and refer to here, and instead only keep talking about "me" or that other guy whom you like so much, I suspect there is little more to be said, yes. You believe in anecdotes about the US system, I believe in comparisons of health care systems done by the OECD and others. Not much overlap between those two spheres.

[tompe]

Originally Posted by zerospinboson

*shrug*. I wasn't asking you to spend time on me, I was asking you to consider relevant information.
But seeing how you steadfastly refuse to engage directly with (or even acknowledge) anything I quote and refer to here, and instead only keep talking about "me" or that other guy whom you like so much, I suspect there is little more to be said, yes. You believe in anecdotes about the US system, I believe in comparisons of health care systems done by the OECD and others. Not much overlap between those two spheres.

I was very surprised that you did not get an answer to your arguments since what you claimed is consistent with what I have read about this.

[Harmon]

Originally Posted by tompe

I was very surprised that you did not get an answer to your arguments since what you claimed is consistent with what I have read about this.

One of the reasons (the other being that he's really only interested in arguing) he didn't get any answers is that he doesn't even know enough to understand the relevant inquiry. He is operating under the misapprehension that health care costs and life span have a meaningful correlation. They don't, except at the margins of life, where it turns out, for example, that a great deal of expense is incurred by American hospitals to try to save premature babies which Europeans don't even count as live births for purposes of computing longevity.

Longevity is primarily a function of genetic heritage, diet, and exercise. Health care has very little to do with those things, and so anyone who links them doesn't know what he's talking about. Anyone who bothers to think for a minute will understand that. I don't feel like wasting time on willfully ignorant people.

On the other hand, health care expense does bear some relationship to what kind of system one is under. Socialized medicine normally substitutes rationing for expense. So non-socialist system will inevitably be more expensive - you get what you pay for.

But even that is not always the case in specific situations. Here's an instructive article which I am posting in its entirety because it is no longer available at the site of origin, which is the Wall Street Journal.

The odd thing about it is that it appears that the result of the socialized system in this particular case is both rationing and increased expense, although I can't be entirely sure about that since the costs aren't mentioned. I'm just judging from the extremity of the operation which would have occurred under the British system. Those who are impatient with long posts can skip to the final two paragraphs & get most of it:

A Joint Venture Is the New Hip Thing
A visit to the factory where part of this columnist was made.
By JAMES TARANTO
(Note: We're fishing today. This column appears on today's Taste page; Best of the Web Today returns Monday. To read yesterday's column, click here.)

Warwick, England

I am a natural-born American, but part of me was made in England. I've come to this town, 25 miles southeast of Birmingham, to find out how.

The hum of machines is ubiquitous in the Smith & Nephew factory, where the floor is divided into "cells" the size of small rooms, each a self-contained assembly line making a particular part. Workers in a cell transform a dull-gray metal piece, cast at another facility, into a gleaming, perfectly shaped finished product, measured to an accuracy of a few microns. Every part is numbered, so that it can be tracked throughout its lifetime, and inspected and cleaned multiple times before shipment. I am grateful for this precision and care. Two of these parts -- a ball and a matching socket -- are now my right hip.

In 2007 I saw the doctor for a mild but persistent pain in my thigh. After two months of physical therapy, my hip was so stiff that I could barely bend over. An MRI revealed avascular necrosis, a localized degenerative condition in which an insufficiency of blood causes bone loss and eventually arthritis. Friedrich Boettner, an orthopedic surgeon at New York's Hospital for Special Surgery, informed me ominously that X-rays of my femoral head -- the ball of the hip joint -- showed "signs of collapse," meaning that my hip was too far gone to save. Before the advent of joint replacement, this condition would have meant a lifetime of worsening pain. As it was, within eight months of the diagnosis, I needed a cane and struggled to walk a few city blocks.

A decade earlier, I would have had a total hip replacement, which entails amputating the head and neck of the femur and inserting a stem into what's left of the bone. This is a proven therapy, but it is problematic for younger patients. Most total hip replacements use a plastic socket, which works very well at first but tends to wear out within a decade or two. To slow the socket's deterioration, the ball is smaller than a natural hip, but that poses a risk of dislocation. Total-hip patients are ambulatory and pain-free, but if they are young -- I was in my early 40s -- they face restrictions on their physical activity and the likelihood that they will outlive the prosthesis and need more surgery.

Now there is an alternative with none of these drawbacks: the Birmingham Hip Resurfacing, named for England's second city, where inventor Derek McMinn practices orthopedic surgery. More than 100,000 BHRs have been implanted world-wide since 1997, with an overall failure rate of less than 4%. Because the BHR preserves most of the femur, it is easier to replace with a total-hip implant if it does fail. Dr. McMinn tells me that among his patients who were under 55 at the time of surgery, "92% play sport, and 62% play impact sport."

The BHR consists of a full-size cap mounted over the existing bone and fitted into a metal socket. Dr. McMinn developed it by combining two previously abandoned technologies. Hip resurfacing had been tried and found wanting, because the large ball caused very rapid wear of the plastic socket. But some early total hip replacements used metal sockets, and in the late 1980s Dr. McMinn noticed that they continued to function well in patients who got them decades before. He persuaded a small company to build a prototype metal-on-metal resurfacing device, and in 1991 he implanted the first one.

After six years of small-scale experimentation, he and fellow hip surgeon Ronan Treacy formed Midland Medical Technologies to mass-produce what became the BHR. They enlisted metallurgist Tim Band, now an executive at Smith & Nephew, who reverse-engineered the decades-old metal implants and helped the two surgeons refine the new device's design. One notable innovation was to coat the inner surface of the socket with tiny spherical beads that allow it to bond directly to the pelvic bone, obviating the need for cement, which can come loose.

By 1998, Midland Medical was marketing the BHR in Continental Europe and Australia as well as Britain. But America was a laggard, because of the Food and Drug Administration's laborious approval process. London-based Smith & Nephew acquired Midland Medical in 2004, in part because the larger firm had the wherewithal to deal with the FDA. Meanwhile, determined Americans traveled as far away as India to get a BHR before the FDA finally approved it in 2006.

When I ask Dr. McMinn to describe the FDA process, he answers in one word: "Hell." The agency put him through an "arduous" series of audits before agreeing to accept his existing data in lieu of clinical trials in the U.S. Yet although the procedures were burdensome, they were not rigorous: "It's a crazy process, because in effect what they're looking for is two-year data. Two-year data is completely inadequate," because serious complications from orthopedic implants often develop later. "We were presenting five-plus-year data. They didn't know what to do with that."

For a patient, though, the U.S. medical system has its advantages. "In Europe, of course, long delays for health-care-provision reasons are terribly common," Dr. McMinn says. While patients wait, they relieve the pain with anti-inflammatory drugs, the regular use of which causes bone damage. "By the time you come back, it's all destroyed, so you're forced into a total hip replacement as the first option, even though on age reasons you may well have wanted to do a resurfacing."

By contrast, when Dr. Boettner decided last May that I was ready for surgery, I had to wait only until he was available to perform it. I received my new hip July 18, and it was the best medical experience of my life. The pain was gone immediately. I was walking on crutches the next morning and using my cane 11 days later. By the last week of August, I was striding unassisted through Denver, where I had gone to cover the Democratic National Convention. The implant sets off airport metal detectors, but otherwise my life is back to normal. Being born in America was a lucky break after all.

[tirsales]

Originally Posted by Harmon

Longevity is primarily a function of genetic heritage, diet, and exercise. Health care has very little to do with those things, and so anyone who links them doesn't know what he's talking about. Anyone who bothers to think for a minute will understand that. I don't feel like wasting time on willfully ignorant people.

This is actually not correct - without health care many people would die before being adults (there is a freaking large number of possible fatal diseases out there) - it would impact longevity quite heavily.

[netseeker]

Originally Posted by Harmon

Longevity is primarily a function of genetic heritage, diet, and exercise. Health care has very little to do with those things, and so anyone who links them doesn't know what he's talking about. Anyone who bothers to think for a minute will understand that. I don't feel like wasting time on willfully ignorant people.

I wonder how you could substantiate this allegation.

The following graph comes from the "Wuppertal Institute for Climate, Enviroment and Energy". They use longlivety as one logical interlinkage indicator between social (eg. healthcare) and economic (eg. growth rate) indicators.



The full essay ("Sustainability indicators - A compass on the Road Towards Sustainability") is available at: http://www.wupperinst.org/de/publika...itrag/WP81.pdf.

Now you might wonder why a well known scientific institute can be so ignorant and dumb to think healthcare could have something to do with longlivety...

[Harmon]

Originally Posted by netseeker

I wonder how you could substantiate this allegation. .

Mainly common sense and observation, plus paying attention to what I read about the subject over time. For example, the single most important thing that government does in enhancing longevity is building and maintaining public sanitation systems. Sewer systems, garbage collection, and providing clean water. Note: that's not health care.

The following graph comes from the "Wuppertal Institute for Climate, Enviroment and Energy". They use longlivety as one logical interlinkage indicator between social (eg. healthcare) and economic (eg. growth rate) indicators.



The full essay ("Sustainability indicators - A compass on the Road Towards Sustainability") is available at: http://www.wupperinst.org/de/publika...itrag/WP81.pdf.

Now you might wonder why a well known scientific institute can be so ignorant and dumb to think healthcare could have something to do with longlivety...

The paper you cite is not about health care and longevity. It is about economic sustainability and profitability in developing countries. It's DRMed (evil! evil!) so I can't copy & paste portions of it for the "fair use" of mocking its virtually impenetrable jargon. Damn near put me to sleep.

It has one paragraph mentioning health care as one of several factors impacting longevity in developing countries. (In developing countries, health care is important in connection with infant mortality.) Bottom line - red herring.

There's no question that in particular instances, specific health care has something to do with whether specific people survive & get some longevity (although I like your coinage, "longlivety." My mother died of cancer at 45. These days, she would probably have survived it, and lived to 68, like her mother (overweight, died of a heart attack) or 75 (father, suicide from depression.) These days, he probably would have been treated for it.

But overall, once you get past infant mortality, longevity is not what health care is about, till the last six months of life - which has very little impact on computing longevity. No matter how much money you spend, you can't substitute health care for good genes. And most people don't die young, or even in middle age, from dread disease. It's accidents that do them in. Believe me - when you hit my age, you pay attention to the obituaries.

I said it before - health care is implicated in longevity at the margins. In Europe, Canada, America, Austrialia, & New Zealand, health care is about quality of life, not length of life.

[netseeker]

Originally Posted by Harmon

The paper you cite is not about health care and longevity. It is about economic sustainability and profitability in developing countries.

I never said it would be about anything else. It just shows a linkage between health care and other factors and longevity. The point is, the paper shows what happpens in developing countries and reflects what happened in the past in the so called "industrial countries".

Originally Posted by Harmon

It's DRMed (evil! evil!) so I can't copy & paste portions of it for the "fair use" of mocking its virtually impenetrable jargon.

Unfortunately i can't offer you an DRMfree version. I didn't recognize this "obstacle".

Originally Posted by Harmon

There's no question that in particular instances, specific health care has something to do with whether specific people survive & get some longevity (although I like your coinage, "longlivety." My mother died of cancer at 45. These days, she would probably have survived it, and lived to 68, like her mother (overweight, died of a heart attack) or 75 (father, suicide from depression.) These days, he probably would have been treated for it.

My warmest condolences. (My grandfather died last year of cancer too)
Actually "longlivety" wasn't a coinage, just a typo. But maybe i will retain it.

Originally Posted by Harmon

But overall, once you get past infant mortality, longevity is not what health care is about, till the last six months of life - which has very little impact on computing longevity. No matter how much money you spend, you can't substitute health care for good genes.

Agreed.

Originally Posted by Harmon

And most people don't die young, or even in middle age, from dread disease. It's accidents that do them in. Believe me - when you hit my age, you pay attention to the obituaries.

Without good health care much more people would die because of (treatable) diseases. This is what happened in past, life spans were much shorter just some hundreds years ago because of a lack of health care (and other factors).

Originally Posted by Harmon

I said it before - health care is implicated in longevity at the margins. In Europe, Canada, America, Austrialia, & New Zealand, health care is about quality of life, not length of life.

Partially agreed. I agree that health care doesn't primarily targets length of life but i disagree that it's only implicated at the margins. We don't need to agree on this point but please don't call me "ignorant" just because i don't share your opinion.

[zerospinboson]

Originally Posted by Harmon

But overall, once you get past infant mortality, longevity is not what health care is about, till the last six months of life - which has very little impact on computing longevity. No matter how much money you spend, you can't substitute health care for good genes. And most people don't die young, or even in middle age, from dread disease. It's accidents that do them in. Believe me - when you hit my age, you pay attention to the obituaries.

I see. So by your logic, health care doesn't matter even though the main reason people die at a young or middle age is
1. getting into accidents, because of the fact that every accident kills. So they won't be needing/getting any follow-up health care, (e.g. immediate care setting your leg and later on rehabilitation) as accidents either kill you or you survive them entirely on your own.
2. contracting age-related diseases (through bad eating etc.). Never mind that those diseases like diabetes (or heart/vein/yada disease (which also won't kill you unless you continue eating Loads of Pork™ etc.)) won't kill you for at least 20-30 years after you get it, provided you take care and get insulin treatments (which doesn't happen in developing countries and has nothing to do with sanitation).
All here-mentioned diseases aren't "good gene" diseases, they're "bad (eating) habits" diseases, which is something that is hitting the US, and particularly the lower socio-economic status-ed, very hard. And all those people can live a "qualitative[ly acceptable, at least to their own standards] life" for at least 20 years after first being diagnosed with obesity, (or its sometime consequent) diabetes etc. in the western world, but won't be able to do so in developing countries, as they won't have access to health care, or dietitians. (Mind you, these "wealth-related diseases" are starting to be a problem there as well.) Yet without access to health care they'll never be able to pay for any of these treatments.
The reason you see so many accidents in obits is because the age-related diseases aren't doing them in in sufficient numbers yet, and the difference between yes/no sanitation etc. is having most people live until 60, not until 80-85, and it has everything to do with proper health care.