The Decline and Fall of the American Empire

The authors viewpoint would be that the “American Empire” is the large amount of political, military, and economic influence that America wields internationally. You can infer from the article that he believes this empire is what keeps regional powers in check. This is a good thing because a lot of those nations (China, Russia, Turkey, Saudi Arabia just from the article) are much more autocratic and illiberal compared to the USA. Additionally, even if you believe that’s not true of these societies, growing regional ambitions in the absence of the “American Empire” leads to destabilization and more conflict.

If we're going to pick arbitrary metrics to fit our world views, the world 's largest democracy is France [1].

[1] Measured in quality of cheese and wine [2]. [2] Suck it, Italy.

This entire line of argument distracts from the real issues and makes progress harder to achieve. Physician salaries are one of the worst possible places to start addressing this issue.

US doctors apparently earn about 2x the average for other comparable nations. That's not a small number, but doctor's salaries in toto are only about 8% of US healthcare spending. A 50% reduction would bring our salary spending in line with everyone else, but only save $100 billion out of a $3,300 billion cost.

Meanwhile, outright waste in medical supply spending costs $765 billion per year. That's drugs discarded at expiration dates which are known to be too restrictive, spending on combination drugs which are identical to the sum of cheaper components, and supplies thrown away by hospitals for non-sanitary reasons (e.g. vendor change, or drugs allotted for a patient but never issued or opened). Changing some parts of this would involve challenging the profits of drug companies, but in many cases not even that would be required. A handful of regulatory changes could save enough to offset the entire cost of paying doctors.

The situation with unnecessary or ineffective medical treatments is comparable. Some of the most common surgeries performed are known not to work, suspected not to work, or known to be more risky than inaction for standard patients, but they're still carried out at enormous expense. Adjustments to medical publication standards, physician statistical training, and and malpractice risk profiles could massively reduce the number of unnecessary and even net-harmful surgical procedures performed every year, cutting costs while directly improving care.

Framing medical expenses as a conflict between consumer expenses and doctor's salaries is false and harmful. It literally can't solve the problem, but it's excellent at derailing the work that could.

https://www.propublica.org/article/the-myth-of-drug-expirati...

https://www.propublica.org/article/what-hospitals-waste

https://www.theatlantic.com/health/archive/2017/02/when-evid...

Each fall of civilization is a tale of N cities... there’s rarely “the one magic” factor.

US has:

- situations leadership cannot (ie no immediate benefit for them) or will not (ie blind tradition) correct the rules of the current system in a way founders, whom understood human-nature, could adjust to make it work better.. instead the ship is falling apart:

- essentially unlimited private campaign financing.. resulting in corruption metastasizing into all three branches, from POTUS down to sheriff and district attorneys, which leads elected officials to dismiss the public good to mostly consider the rich’es and their good.

- disengagement through manufactured consent, learned helplessness, divide-we-fell polarized animosity and non-participation.. yes, and celebrity chefs.

- mass-media oligopoly.

- insane student debt bubble, just the latest bubble.

- largely morally- and ethically-unmoored, unregulated market chicanery leveraging complexity, obscurity and trade volume speculating to alter the worth of real capital.

- large, diffuse official workforce participating in inverted totalitarian wage-slavery and living in their vehicles. more co-ops employee ownership, shorter work weeks, higher pay relativr to the cost of living and workers on boards-of-directors are needed.

- “excess” labor due to automation and outsourcing. those “better jobs elsewhere” rarely materialized, hence opioid crisis.

- opiod crisis.

- undocumented workforce which subsidizes costs of many essential goods for the lower-income classes with their cheap labor.

- complex geopolitical situation in an ever-flattening, connected and population-stabilizing work (sans Africa).

Maybe in a million years Bezos will be the first quintillionaire Morlock and feast on the marrow of the Eloi while paying for everyone’s UBI since there’s no jobs left except Scruffy, the Janitor.

I know this is an unpopular view, but who are you to decide what level of risk should a patient accept? Literally every step, including inaction has risks. Can patients decide independently what should be done with their own body, or are they presumed to be too dumb and must obey your decisions?

Should patients be consigned to disability immediately without even attempting some procedure, simply because the chance of success is too small in your arbitrary definition?

You have never been seriously sick.