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The lucrative business of America’s opioid crisis

nytimes.com

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Re: The lucrative business of America’s opioid crisis

#171

Post by maxxxxx »

krelian wrote: post #116
leakybit wrote: post #47

Earlier quoted context omitted.

There are more people who are dealing with chronic pain who need opioid than people who are using them for "recreational" purposes.

I can't help but feel that these medications are being vastly over prescribed by doctors. Why is this not a problem in other countries? Either the number of people suffering from chronic pain in the U.S is way higher (percentage wise) than in other countries (why?) or the doctors are prescribing extremely dangerous medicine as if it were candy.

From my experience there are two factors I can see:

Due to end user advertising the US a lot of people are tuned into taking drugs. It's just a part of life. I am 50 and people seem to be baffled when I tell them I don't any prescription drugs unless I have something acute. I see tons of people taking antibiotics and pain killers immediately when they have a problem. That starts from childhood on.

Doctors in the US are really quick prescribing hardcore drugs. I have had several occasions when I had an injury like a bruised and got a Cocktail of vicodine and muscle relaxers. They make you feel real good quickly and I can totally see how people can get addicted. In addition people who have withdrawal symptoms get cut off cold turkey and get no help. I guess that's even more so in low income populations that barely get any healthcare.

Re: The lucrative business of America’s opioid crisis

#172

Post by emodendroket »

BurningFrog wrote: post #121
rayiner wrote: post #99

Earlier quoted context omitted.

I think there is a lot of reason to believe that we have a uniquely ineffectual government. Excluding defense expenditures, and counting all levels of government, Canada spends less public money per capita, while having cheaper healthcare, education, better transit, etc. For example, we spend more per capita on education than any OECD country except Switzerland, and get worse results. Our federal system (where states…

Of course, looking only at OECD countries is serious cherry picking good governments to begin with.

But not really unreasonable in context; how much can a comparison with Equatorial Guinea really tell us about US policy?

Re: The lucrative business of America’s opioid crisis

#173

Post by coliveira »

marcosdumay wrote: post #151
coliveira wrote: post #127

Earlier quoted context omitted.

> typical undertone on HN of "regulation is bad by definition" This is pure ancap, "Austrian school" ideology. They define regulation as bad by definition, because supposedly it goes against "freedom". This works as a clutch so that if you say anything bad against capitalism they will retort "it is regulation", even thought nobody ever saw (and never will see) an economic system without laws and regulations.

Well, you can't just blame capitalism for problems happening with government granted monopolies. You must at a minimum get some evidence that it isn't the monopoly causing the problem. And because modern economies are to a large part composed of government granted monopolies, with almost all problems being in that part¹, nearly all "capitalism is bad" commentary is simply bullshit. 1 - Both governments tend to grant…

The BS of this argument is to believe the governments would grant monopolies to random people for no reason. The reason there are monopolies is that capitalists have paid for this privilege, therefore they arise as a result of capital trying to starve competition, as it normally does by several means. The government in this case is simply another tool used by capitalists to keep their privileged position in the markets, not the "source of all evil" as ancaps want naive people to believe. Capitalism and monopolies are just facets of the same thing.

Re: The lucrative business of America’s opioid crisis

#174

Post by pyre »

dahdum wrote: post #75
fzeroracer wrote: post #17

Earlier quoted context omitted.

This seems objectively false after even a brief cursory search and I'm curious as to why you think it has anything to do with this topic.

It's false, but fair to say the family is involved in both political parties. They seem to lean more towards the Democrat side, but that's to be expected given Obama's two terms. The reason it matters is that political clout and general goodwill helps shield them from legislative action and judicial inquiry.

The original comment practically said "they are Democrats, and the media is liberal-controlled, so obviously they get a free pass."

Re: The lucrative business of America’s opioid crisis

#175

Post by hitekker »

fzeroracer wrote: post #17
malchow wrote: post #4

Earlier quoted context omitted.

The family are all Democrats. That isn't the sole reason, but if you compare the "shadowy financier" tone of many stories about right-of-center families to the stories about opioids, you'll see that the "shadowiness" component of the reporting suddenly disappears.

This seems objectively false after even a brief cursory search and I'm curious as to why you think it has anything to do with this topic.

When the truth of one issue goes against a person's political leanings, that person will generally say whatever they can to avoid feeling guilt or shame.

Re: The lucrative business of America’s opioid crisis

#176

Post by geofft »

quantumofmalice wrote: post #154
geofft wrote: post #128

Earlier quoted context omitted.

I am getting the sense that you're saying that New York City is primarily a city of smart people who value cosmopolitanism and not of people who value high social trust and strong social identity. That might be the stereotype of certain parts of Manhattan (especially of people who - and I admit I'm one of them - have voluntarily moved to the city for work), but that's not the majority of New York City at all. Come an…

Well, the neighborhoods you are discussing, which do have higher social trust, do have a strong ethnic identity, so I think that this may reinforce my point rather than hurt it. I must admit that I have a more pastoral and conflict-adverse personality, so the idea of New York as an ideal is difficult for me to comprehend. I'm OK with that: there are obviously many people to whom this idea is obvious as well. My long…

> I must admit that I have a more pastoral and conflict-adverse personality, so the idea of New York as an ideal is difficult for me to comprehend.

I still don't get this. I don't think that NYC is a high-conflict place at all. I'm not sure I'd quite call it "pastoral," really, but the outer boroughs are much closer to medium-sized cities in the rest of the US than to Manhattan - houses with yards and garages, strip malls with large parking lots, etc. Sure, there are areas where you're surrounded by skyscrapers and enough bright lights to ensure the city never sleeps. But that's a pretty small part of the residential population of NYC.

Or in other words, I think you'd be perfectly happy living here, given the preferences you've expressed, as long as you didn't live in Manhattan (and not wanting to live in Manhattan far from unusual!). If you find that merely being in a subway car or in line at a store with someone of a different race/culture uncomfortable, maybe NYC isn't the place for you, but I have no reason to believe from your comments that you're that sort of person.

(And you might still prefer rural areas where there are acres of land between you and your closest neighbor - which is fine! I'm not saying that we should cover the world in New York Cities. I'm just saying that it's empirical evidence that multiculturalism is stable, and not just for people who voluntarily choose in adulthood to move to a dense cosmopolitan city.)

I think you're right that there is a lot more informal, self-directed ethnic/cultural affinity than I was selling. But none of that has any level of structure that gets anywhere close to ethno-nationalism, with independent political entities and representation and policy between the ethnic enclaves. There are things like Hatzolah, yes, but there is one NYPD for all neighborhoods. There's one housing policy (and one affordable housing lottery). There's one minimum wage. There's one policy on how much to cooperate with ICE. And so forth. And there's one set of elections for influencing those things. (I would actually argue that there isn't enough political autonomy for the boroughs, but for the reason that smaller political entities are less prone to corruption and more likely to give opportunities for meaningful representation, not because different boroughs have independent and distinct cultures that require different political goals. I don't think we should have, say, two different police departments in Crown Heights for the black and Jewish communities, but I do think the police department in Crown Heights should be a smaller entity - with a smaller budget and smaller political influence - than the NYPD as it is today, possibly a Brooklyn Police Department, possibly even smaller. So I'd agree with your point above regarding size/scale, but I don't think that division on cultural or ethnic grounds is required.)

I'd believe the argument that NYC doesn't offer evidence that people will voluntarily give up ethnic/cultural identities as a way of living day-to-day. But I think it does offer strong evidence that people with these separate identities can be happy, successful, and peaceful with a single government.

Re: The lucrative business of America’s opioid crisis

#177

Post by rayiner »

emodendroket wrote: post #169
rayiner wrote: post #99

Earlier quoted context omitted.

I think there is a lot of reason to believe that we have a uniquely ineffectual government. Excluding defense expenditures, and counting all levels of government, Canada spends less public money per capita, while having cheaper healthcare, education, better transit, etc. For example, we spend more per capita on education than any OECD country except Switzerland, and get worse results. Our federal system (where states…

I mean I'd blame the role of privatization more than government incompetence for most of those.

There is little privatization in the U.S. in the areas I mentioned. For example, less than 10% of Americans go to private or charter schools. In Denmark, Japan, Spain, Korea, and the Netherlands, that number ranges from 20-65%. Few American roads are privately-operated (mostly some turnpikes). In contrast, all of the French autoroute (highway) system is private. Much of Japan's highway and transit system is private too.

Transit is almost entirely publicly owned and operated in the U.S. For example, Amtrak is both owned and operated by the government. In contrast, Deutsche Bahn and Eurostar are are private companies (though subsidized by the government). SNCF, though owned by the government, is run like a private company. E.g. in contrast to Amtrak, where only a single route produces an operating profit, 80% of SNCF's routes produce an operating profit. Japan's key railroads are privatized, and the biggest one (JR East) receives no public subsidy.

Anti-development housing policies that drive up prices are all done by the government (compare to Japan's lax zoning laws).

Healthcare is really the only thing that's more privatized in the U.S. versus other OECD countries, though it's less than you might think. About 50% of healthcare spending in the U.S. comes from direct public money, comparable to Korea, versus 70% in Canada or Spain, and 75-85% in Italy, Germany, France, and the U.K. However, if you account for indirect expenditures (public subsidies for health insurance), the total comes to about 65%, not much less than in Canada or Spain: http://www.pnhp.org/news/2016/january/government-funds-nearl....

Re: The lucrative business of America’s opioid crisis

#178

Post by rayiner »

euroclydon wrote: post #166
rayiner wrote: post #161

Earlier quoted context omitted.

We also suffer internal transaction costs by having to deal with 51 different legal systems.

And what to do about it? Most conservatives want smaller federal government, which reduces the aggregate size and expenditure for government, but exacerbates fragmentation. On the other hand, progressives want larger federal government, which introduces standardizing layers, but spends way more on aggregate government.

Nothing to do, we're stuck nickle and diming ourselves into irrelevancy.

Re: The lucrative business of America’s opioid crisis

#179

Post by soundwave106 »

nkrisc wrote: post #145
CalChris wrote: post #92

Marijuana should be legal. That it is a schedule 1 narcotic and that we put people in prison for decades and even life is immoral. https://www.dea.gov/druginfo/ds.shtml http://www.motherjones.com/politics/2015/07/life-sentence-ma...

Interesting how legal opioids are fueling a national 'crisis' while illegal marijuana, though widely used, is not.

I personally think the combination of the (legal, or at least government approved) prescription opioid crisis, combined with the relatively successful decriminalization at various levels of cannabis in several states, has really changed the tone of conversation on pharmaceutical compounds, recreational or otherwise.

Old paradigms (particularly ones that are not 100% based on factual / scientific analysis, as drug law tended to be) die hard, and it will take some time to change laws as a result. But the moral panic over "illegal drugs" is way less these days than it was in, say, the 1980s.

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