Items tagged with: americans
That's why they don't really try to make health care system which probably whole other worlds have...
Huh? I just googled her name and found that she is #American #politician.
RT Rupert Howe @ruperthowe: RT The Web of Evil @webofevil: This is literally language that rightwingers don't understand.
RT SocialSecurityWorks @SSWorks: "People's lives are not commodities...you cannot ask the question how much will you pay to live, because the answer is everything.
That is what makes the price of medicine different than the price of an iPhone." - @AOC
HN Discussion: https://news.ycombinator.com/item?id=19750667
Posted by enraged_camel (karma: 12353)
Post stats: Points: 104 - Comments: 120 - 2019-04-25T17:48:17Z
#HackerNews #americans #among #are #finds #most #people #poll #stressed #the #world
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Here’s the thing. When #Jesus found #disciples there was one #rule – they had to #walk #away from #everything else. As a young man I always thought this was #ridiculous – what sort of #man would leave behind his #family, #friends and #business? It is only now that I #understand. When you #walk away from all that, then there is #nothing your #enemies can take away from you except your #life and that is the most #defensible #position.Perhaps more #Heritage #Americans need to #understand that all this shit we think is so important – a #career, a shitty #condo, a #car you make #payments on are not things we should worry about #losing, they are the #yokes that keep us #afraid to #speak and #live the #truth.
#freedom #debt #slavery
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HN Discussion: https://news.ycombinator.com/item?id=19653802
Posted by howard941 (karma: 7469)
Post stats: Points: 117 - Comments: 101 - 2019-04-13T16:06:43Z
#HackerNews #americans #are #arrive #care #delaying #health #refunds #tax #until
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HN Discussion: https://news.ycombinator.com/item?id=19584540
Posted by prostoalex (karma: 74316)
Post stats: Points: 230 - Comments: 237 - 2019-04-05T16:58:04Z
#HackerNews #27m #americans #dvds #get #mail #netflix #still #the
The familiar red envelopes have been arriving in customersʼ mailboxes since 1998 and helped earn the company a healthy $212 million profit last year.
Why are so many people still using this old-school service in the age of streaming? There are a number of reasons.
But many rural areas of the country remain without broadband access. The Federal Communications Commission estimates 24 million Americans fall on the wrong side of this digital divide.
The US Postal Service, however, can reach every ZIP code with those red envelopes.
One such customer is Dana Palmateer, who lives in the Black Hills of South Dakota.
"Streaming movies was a no-go, so I just went with the disc service that Netflix offers," she says. "As all of us are doing it in these parts."
But Netflix also has plenty of DVD customers in urban areas who prefer the service for its convenience and selection of movies, spokeswoman Annie Jung says.
"People assume that our customers must either be super seniors or folks that live in the boonies with no internet access," she says. "Actually, our biggest hot spots are the coasts, like the Bay Area and New York."
Streaming offers a limited selection compared with DVDs
All of this year's Oscar-nominated movies are available on DVD Netflix.
Anyone who has perused the digital aisles of their streaming service will know the options can be limited. Netflix streaming reportedly has fewer than 6,000 film and TV titles, while DVD Netflix has about 100,000. (The company wonʼt disclose such figures.)
"The attraction for me is the choice," says Netflix subscriber Rick Byrne, who lives in California and has rented nearly 5,000 discs over the past decade. "There is so much more choice on the DVD service than the streaming."
Netflixʼs streaming service declined to comment for this story.
There is no one-stop shop for streaming
Spotify has nearly every song you could ever want. Amazon has nearly every book.
But there is no equivalent one-stop shop for streaming movies and TV shows. Despite the infinite capacities of the internet, copyright law and economics have precluded this.
Rival media companies such as Disney donʼt want to share their precious content as they plan to launch their own streaming services. Or if they do, they demand a kingʼs ransom. WarnerMedia (the parent company of CNN) reportedly billed Netflix $100 million to carry episodes of "Friends."
As Netflix increases its focus on TV content, movie fans may feel left out. Netflix says movies take up about one-third of customersʼ watch time, no matter how many titles they stock. TV shows are its biggest draw, as evident by the vast quantity of original series it produces.
Movie buffs need multiple streaming subscriptions
Steven Spielberg attends a Netflix event in 2017.
Netflix streams lots of movies. But others are only available on other services such as Amazon or Hulu.
"If you are a film fan, you need to have five or six streaming services," says Matt Booth, who owns the popular video store Videodrome in Atlanta. "Netflix barely has any films from before 2000."
For film buffs, this makes DVD Netflix an attractive option.
"They have the best library of anybody," says DVD Netflix subscriber Andrew Karcher of Whittier, California. "Movies donʼt just disappear without warning," he adds, referring to how movies and TV shows can vanish from streaming services depending on licensing deals.
The titles in Netflixʼ DVD library, on the other hand, pretty much stay forever. "We have a truly deep catalog, and we add new movies and shows every single week," Netflixʼs Jung says.
Some Oscar nominees are not available on streaming
This year's best picture winner "Green Book" is not yet streaming on Netflix but can be rented via Netflix DVD.
You wonʼt find recent Oscar winners such as "Green Book" or "A Star Is Born" currently streaming on Netflix. Movie studios try to rake in as much cash from DVD sales and rental fees before allowing their films to be streamed.
But DVD Netflix subscribers can watch all the latest Oscar-nominated films. The service has all 90 best picture winners.
"You get to see the new movies when they come out," says Bil Alvernaz of Valley Springs, California, who has been a red-envelope devotee since 2004.
Subscription fatigue may be kicking in
Apple's new streaming service was unveiled last month.
With multiple streaming subscriptions, costs can quickly add up. Netflix, Hulu, Amazon, CBS, YouTube, HBO and now Apple all have streaming offerings, while Disney and WarnerMedia are readying their own.
In addition, one-off rentals on iTunes of new releases such as "Green Book" can cost $5.99 a pop.
Considering all this, it seems less surprising that 2.7 million Americans have stuck with Netflixʼs DVD service, which begins at $7.99 per month.
And thereʼs one final reason. A former Netflix employee has said many subscribers still pay for the DVD service, even though they havenʼt ordered a DVD in a long time. Many have apparently forgotten they still have DVD accounts.
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Why Don’t Americans Understand How Poor Their Lives Are? Everything I consume in the States is of a vastly, abysmally lower quality. Every single thing. The food, the media, little things like…
HN Discussion: https://news.ycombinator.com/item?id=19571150
Posted by ptr (karma: 593)
Post stats: Points: 116 - Comments: 152 - 2019-04-04T12:05:34Z
#HackerNews #americans #are #dont #how #lives #poor #their #understand #why
Why Don’t Americans Understand How Poor Their Lives Are?
Everything I consume in the States is of a vastly, abysmally lower quality. Every single thing. The food, the media, little things like fashion, art, public spaces, the emotional context, the work environment, and life in general make me less sane, happy, alive. I feel a little depressed, insecure, precarious, anxious, worried, angry — just like most Americans do these day. So my quality of life — despite all my privileges — is much worse in America than it is anywhere else in the rich world. Do you feel that I exaggerate unfairly? It’s not just an anecdote, of course. Americans enjoy lower qualities of life on every single indicator that you can possibly think of. Life expectancy in France and Spain is 83 years, but in America it’s only 78 years — that’s half a decade of life, folks. The same is true for things like maternal mortality, stress, work and leisure, press freedom, quality of democracy — every single thing you can think of that impacts how well, happily, meaningfully, and sanely you live is worse in America, by a very long way. These are forms of impoverishment, of deprivation — as is every form of not realizing potential that could be. But I don’t wish to write a jeremiad, for I am not a pundit. The question is this: why don’t Americans understand how poor their lives have become? Is it even a fair question to ask?
Let’s bury the hustle
The hustle has become synonymous with the grind. Pushing through pain and exhaustion in the chase of a bigger carrot. Sacrificing the choice bits of the human experience to climb some arbitrary ladder of success. I can’t connect with any of that. The grind doesn’t just feel apt because it’s hard on an individual level, but because it chews people up and spits ’em out in bulk. Against the tiny minority that somehow finds what they’re looking for in that grind, there are legions who end up broken, wasted, and burned out with nothing to show. And for what? Even more insidious about the concept of the hustle and its grind is how it places the failure of achievement squarely at the feet of the individual. Since it’s possible to “make it” by working yourself to the bone, it’s essentially your own damn fault if you don’t, and you deserve what pittance you may be left with. Its origin from a dog-eat-dog world has been turned from a cautionary tale into an inspirational one. It’s not that you need to hustle to survive, it’s that you seek the hustle to thrive, and still at the expense of yourself and others.
How do you know when it’s time to quit?
We all know people all over the spectrum. Someone who’s been working on something forever that’s never going to work out. And someone who quits every project they start before giving it a fair chance. Then we have those friends who seem to have the magical instinct to know when to quit and when to stick with it until it takes off. So how do you know when to quit? 3 months? A year? Is there some signal to look for?
A pretty bleak trio of posts I read last night, as I stared at the seemingly infinite collection of Trello cards in my collection, trying to find something productive to do. I was tired. I took DHH’s advice and went to sleep. I planned on waking up early and revisiting said collection, but slept through my alarm, going from a planned 8 or so hours of sleep to almost 10.
So many of those Trello cards are projects I’ve started and failed to even make reasonable progress on. A new version of SWIM, my career-long project in PIM; a new record (I have a half-written song–my first in nearly a decade–and a potential collaboration in the works); coding and design education projects (I have a lot of new unexecuted ideas in this area). There is a pile of to-dos related to the house (as always), a pile of books to read (as always), relationships to tend to, technologies to learn or at least stay abreast of…and that’s just the non-work related list. I also lead a team at a rapidly growing startup with no plans to slow down. Listing out those initiatives, projects and to-dos would take pages.
As I look back over that last paragraph I realize these are problems of privilege. And I see that almost all are inward-focused. There is some level of service in my work, my education initiatives and my close relationships, but for the most part my efforts are focused on forwarding my own career, finances and creative output.
This is a time of year for taking stock. I’m looking at my symptoms–mostly burnout, which I’m experienced enough to manage on a day-to-day basis, but also old enough to see when I’m just putting my finger in the dam–and wonder if they are a result of a fundamental priority problem.
I try to ask myself a series of questions every night. Perhaps I should take the final questions more seriously:
Were we thinking of ourselves most of the time? Or were we thinking of what we could do for others, of what we could pack into the stream of life?
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The real risks from chemicals in our food—for farmworkers and children, in particular—are being ignored.
Article word count: 1544
HN Discussion: https://news.ycombinator.com/item?id=19484515
Posted by howard941 (karma: 5619)
Post stats: Points: 173 - Comments: 150 - 2019-03-25T17:27:33Z
#HackerNews #americans #bodies #byproducts #have #more #pesticides #than #their
Spraying pesticides on strawberry plants in California. (Todd Bigelow)
Produced with FERN, non-profit reporting on food, agriculture, and environmental health.This story was produced by the Food & Environment Reporting Network, an independent nonprofit news organization. Ad Policy
Every year US farmers use about a billion pounds of chemicals on crops, including the fruits, nuts, and vegetables many parents beg their kids to eat. The Department of Agriculture and the Food and Drug Administration are charged with ensuring that these chemicals don’t endanger consumers, and both agencies test the food supply for pesticide residues each year. They focus on foods eaten by babies and children, whose developing bodies are particularly sensitive to toxic chemicals, and typically report that pesticide residues in these products rarely exceed safety standards.
Yet, experts say, the agencies’ pesticide-monitoring approach suffers from several limitations that make it difficult to draw meaningful conclusions about pesticide risks to the nation’s food supply. What’s more, government agencies don’t monitor risks to farmworkers who labor among those chemicals, or to pregnant women and children who live near agricultural fields.
Since pesticide monitoring began about three decades ago, scientists have learned that even low doses of pesticides and other synthetic chemicals can harm children and that exposure to chemical mixtures, particularly during critical windows of neurodevelopment, may carry serious health risks that take years to emerge. And though crops are often sprayed with multiple chemicals over the growing season, both agencies track pesticide residues one chemical at a time, to determine whether a specific chemical exceeds safety standards set by the Environmental Protection Agency.
That’s why, several years ago, scientists at the Environmental Working Group, a nonprofit consumer-advocacy group, started doing their own analysis of pesticides on produce. The group relies largely on data from the USDA, which tests more produce than the FDA.
About 70 percent of US produce harbors traces of pesticides, the EWG reports in its latest shoppers’ guide to the “ dirty dozen,” those fruits and vegetables with the highest pesticide load. Strawberries topped the list, released this week, for the fourth year in a row, with an average of nearly eight pesticides per sample, followed by spinach and kale. Spinach had more pesticides by weight than any other crop.
Olga Naidenko, the EWG’s senior science adviser for children’s environmental health, says she was surprised to see kale contaminated with a chemical called dacthal, which the EPA classifies as a possible human carcinogen and European regulators banned in 2009. Among the more troubling pesticides found on spinach is permethrin, a neurotoxic insecticide that’s been linked to ADHD.
[IMG]Naidenko says the list is not meant to dissuade people from eating fruits and vegetables, but rather “to call attention to the fact that there are some pretty bad pesticides out there.”
Although the EPA sets thresholds for what it says are acceptable rates of exposure, those bad pesticides have been tied to a long list of adverse health effects, especially among the most vulnerable populations. And the people who bear the highest risks from exposure to these toxic chemicals live and work in the farming communities that feed the nation.
More than 90 percent of Americans have pesticides or their byproducts in their bodies, mostly from eating conventionally grown fruits and vegetables. Health experts worry that the EPA’s pesticide-residue safety levels are too high to protect young children.
Leo Trasande, director of environmental pediatrics at New York University’s Langone Health and author of the new book Sicker, Fatter, Poorer, says many of these pesticides act at extremely low levels that mimic our body’s response to our own hormones. “These synthetic chemicals were not designed with hormonal biology in mind.”
Scientists now know that doses of pesticides once considered safe can harm developing bodies and brains. But regulations have failed to keep up. “We look at how EPA has been approving pesticides and setting those tolerances and find again and again that the agency’s not taking into account children’s heightened susceptibility to pesticides,” says the EWG’s Naidenko.
The most egregious example is chlorpyrifos, which the EPA phased out for home use in 2000, citing health and environmental concerns. As evidence of the growing list of chlorpyrifos’s diverse health effects mounted in scientific journals, the agency proposed prohibiting all uses of the chemical in 2015 under the Obama administration. But two years later Trump’s EPA rescinded that rule, calling chlorpyrifos “crucial to U.S. agriculture,” and citing a return to “sound science in decision-making.”
Regulators also fail to account for risks associated with the scores of pesticides that don’t stay where they’re sprayed, creating a toxic environment for farmworkers and their families. It’s clear that workers have higher exposure, Trasande says, “and kids of workers can be exquisitely vulnerable.”
Pesticide residues can follow workers home from the fields on clothing and shoes, then collect in the dust on floors where babies and toddlers play. Several studies show that children of farmworkers routinely endure higher pesticide exposures than consumers and that mothers living close to fields treated with pesticides, including those on the dirty-dozen list, are more likely to have premature babies and children with autism, impaired cognitive function, and other neurodevelopmental disorders.
Several pesticides have been linked to early puberty, impaired fertility, and increased breast-cancer risk, suggesting that young girls—whose brains and breasts undergo rapid development during puberty—may be particularly vulnerable to pesticide exposures. Researchers at the University of California, Berkeley, recently asked teenage girls living in the intensively farmed Salinas Valley to wear silicone wristbands—which soak up environmental chemicals like a sponge—to gauge their pesticide exposures. Dacthal and chlorpyrifos were among the most frequently detected pesticides for these Latina girls, and concentrations of dacthal and permethrin were three times higher for those who lived close to fields. 
[IMG]Picking strawberries in the fields of Oxnard, California. (Todd Bigelow)
California, the nation’s most productive agricultural region, used close to 210 million pounds of pesticides in 2016, the most recent statistics available, including many classified as probable or possible carcinogens, endocrine disruptors (affecting the hormonal system), and reproductive or developmental toxicants. Farmers applied more than 380,000 pounds of dacthal on kale, broccoli, cauliflower, and other crops in 2015 and 2016. The highest levels recorded in 2016 were in Lamont, a Central Valley town where the vast majority of residents are Hispanic and 35 percent of people live below the poverty line.
California growers applied 11.3 million pounds of pesticides to produce nearly 3 billion pounds of strawberries worth over $1.8 billion in 2016. For decades, the EPA gave strawberry growers an exemption to use methyl bromide, a fumigant banned by international treaty to protect the ozone layer that has also been tied to violation of the federal civil-rights laws. They applied more than 14,500 pounds of methyl bromide—in just 2015 and 2016 alone—within a mile of Oxnard’s Rio Mesa High School, where most students are Hispanic and which California health officials flagged as the school with the most toxic pesticides sprayed nearby in a 2014 report. During the same time, growers also doused fields near Rio Mesa with more than 142,000 pounds of chloropicrin, a choking agent once used in warfare and riot control, and 1,3-Dichloropropene (1,3-D), classified as a probable human carcinogen.
State regulators calculate risk based on averages of exposures to single pesticides over several months, even though growers can spray more than 100,000 pounds of fumigants like 1,3-D and chloropicrin in a single week. As a result, a 2016 study from the UCLA Sustainable Technology & Policy Program reported, “exposure to multiple pesticides occurs at a number of locations in the area, including sensitive sites like schools and daycares.” In addition, the study noted, human health risks from simultaneous exposures to drift-prone toxic chemicals like 1,3-D, chloropicrin, and metam sodium (a methyl bromide replacement) “may be significantly greater than the added risks of the individual components.”
Last year California’s Department of Pesticide Regulation measured the highest levels of 1,3-D the agency ever recorded, at a high school in Shafter, a small Central Valley town, where 83 percent of the population is Hispanic and 25 percent live below the poverty line. The levels far exceeded those the state deemed “unacceptably high” when it issued a temporary ban in 1990. The DPR relaxed its 1,3-D cancer-risk standard in 2015, after the previous risk level was exceeded multiple times, says Anne Katten, director of the pesticide and worker-safety project at the California Rural Legal Assistance Foundation.
Following the 1,3-D spike last year, Katten and members of other advocacy groups met with state officials to discuss the risks to the communities. In a follow-up letter, the group pointed out that the agency’s estimates of air concentrations far exceeded its own safety standards for both acute and chronic risks. “We urge DPR to immediately suspend all uses of 1,3-D,” they wrote in an e-mail, citing risks to nearby homes and elementary schools.
State regulators declined, noting that the monitoring data did not justify action to curb 1,3-D use. They did not acknowledge that residents and workers could be exposed to other pesticides, along with 1,3-D, that might increase their risk. “The reality is that we have a regulatory framework that just assumes that these chemicals are fine and we don’t need to regulate them in agriculture,” Trasande says. “Even when the science tells us to do it.”
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Only by the bizarre logic of the U.S. pharmaceutical industry does this drug count as any kind of generic.
Article word count: 1013
HN Discussion: https://news.ycombinator.com/item?id=19460946
Posted by pseudolus (karma: 14070)
Post stats: Points: 87 - Comments: 132 - 2019-03-22T09:59:08Z
#HackerNews #137 #americans #for #germans #get #grateful #insulin #should #why
Only by the bizarre logic of the U.S. pharmaceutical industry does this drug count as any kind of generic.
CreditCreditAyo888/iStock, via Getty Images Plus
This month, Eli Lilly and Company announced with some fanfare that it was manufacturing a generic version of its own best-selling insulin brand, Humalog, which it would sell for half off — $137.35 versus about $275.
David Ricks, the chief executive of Lilly, said the company was making this seemingly beneficent gesture because “many patients are struggling to afford their insulin.”
But they’re struggling, in large part, because since 2001 Lilly has raised the price of a vial of Humalog to about $275, from $35. Other insulin makers have raised prices similarly.
In Germany, the list price of a vial of Humalog is about $55 — or $45 if you buy five at a time — and that includes some taxes and markup fees. Why not just reduce the price in the United States to address said suffering?
Instead, Lilly decided to come out with a new offering, a so-called authorized generic. This type of product is made by or under an agreement from the brand manufacturer. The medicines are exactly the same as the brand-name drug — often made in the same factory with the same equipment to the same formula. Only the name and the packaging are different.
It is perhaps, a sign of how desperate Americans are for something — anything — to counteract the escalating price of drugs that Lilly’s move was greeted with praise rather than a collective “Huh?”
Imagine if Apple sold a $500 iPhone for $250 if it was called, say, a yPhone, and simply lacked the elaborate white box and the little Apple on back. That would be patently absurd. An iPhone in a brown paper bag is still an iPhone. And Humalog with a new name isn’t a generic — except according to the bizarre logic of the pharmaceutical industry. Like so many parts of our health care system, its existence has more to do with convoluted business arrangements than health.
Generics, as traditionally understood, are copies of brand name drugs made by competing manufacturers once the original patent protection has expired. To be approved by the Food and Drug Administration, they have to have the same active chemical ingredients as the brand drug, and be absorbed equally into the blood, though they could look different and contain different inactive additives.
Historically and in practice they tend also to be far cheaper, because the advent of generics often introduces robust competition into the market. That is why brand manufacturers sometimes produce an authorized generic once they lose patent protection. That way, they can compete at the lower price point, while preserving the original for those with extreme label loyalty.
More recently, authorized generics like Lilly’s stem largely from a different strategy — based on the perverse ways money flows through our health system and who keeps the cash.
Over the last 20 years, drug makers have continuously raised the price of some essential medicines in the United States because, well, they can in a country that doesn’t set drug prices. And they do — until the bad publicity catches up with them.
Mylan got hauled before Congress in 2016 for raising the price of an EpiPen. Now it’s insulin’s turn. The other two major brand makers of insulin products — Novo Nordisk and Sanofi — have raised prices in lock step with Lilly. But they are based in Europe, so the Indiana-based Lilly has been the primary focus of angry protests here.
Part of insulin’s price rise in the United States is because of the middlemen who buy the drugs on behalf of insurers and hospitals and negotiate discounts off the list price for their clients. So Lilly often doesn’t make the full $275 a vial (though, since rebates are secret, we don’t know how much less).
By selling an authorized generic, rather than merely lowering the brand’s price, Lilly is essentially doing an end-run around those middlemen and giving patients who don’t purchase through an insurer another option.
It is also making sure that if and when cheaper versions of Humalog emerge, it will have an offering to compete.
In fact, a “biosimilar” version of Humalog already exists. It was introduced to the United States last year. And yet it costs around the same price as the brand name drug. Why? It is made by Sanofi, which has no interest in starting a price war to lower costs.
Finally, Lilly has generated a few positive headlines. “Eli Lilly Will Sell Half-Price Version of Humalog, Its Best-Selling Insulin,” this paper reported.
Mylan effectively calmed its EpiPen PR crisis by introducing a cheaper authorized generic. Now Lilly, following a similar playbook, is hoping for a similar result.
Will it work? Politicians and patients will decide.
But they might well keep these two thoughts in mind: If the product being sold was electricity or gas for your car, a price rise of more than 600 percent over 15 years would be regarded as price gouging and wouldn’t be tolerated. And in Germany and many other developed countries, there is no need for a $137.35 vial of “authorized generic” for Humalog. At around $50 a vial, Humalog as Humalog costs far less.
Elisabeth Rosenthal, a former New York Times correspondent, is the editor in chief of Kaiser Health News and the author of “An American Sickness: How Healthcare Became Big Business and How You Can Take It Back.”
The Times is committed to publishing a diversity of letters to the editor. We’d like to hear what you think about this or any of our articles. Here are some tips. And here’s our email: email@example.com.
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Correction: March 21, 2019
An earlier version of this article and a headline with it misstated the cost of the generic version of Humalog. It is $137.35, not $137.50.
A version of this article appears in print on , on Page A23 of the New York edition with the headline: Half-Off Insulin? It’s Not as Generous As It Sounds. Order Reprints | Today’s Paper | Subscribe
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#about #americans #analyzes #care #cato institute #don #emily ekins #investigations #most #oan newsroom #paul manafort #pollster #president trump #probes #robert mueller #russia probe #says #special counsel robert mueller #the hill #trump
Doctors’ bills play a role in 60 percent of personal-bankruptcy filings.
HN Discussion: https://news.ycombinator.com/item?id=19409244
Posted by clumsysmurf (karma: 4826)
Post stats: Points: 87 - Comments: 118 - 2019-03-16T18:11:46Z
#HackerNews #americans #are #bankrupt #from #getting #going #sick
Since Chamberlin Edmonds was offering only to help her find government insurance, for which Lockett did not qualify, the company wasn’t able to reduce her hospital bill or work out a payment plan. Lockett assumed this meant she was at a dead end with her nearly $30,000 in hospital bills. “They were saying that there was nothing that they could do,” she told me. She decided to put the bills aside and try to get to them after she found a job.
A year later, Lockett attended a meeting with representatives of Georgia Watch, a nonprofit group, as part of her volunteer work. When one of the Georgia Watch representatives mentioned that the organization has a guide for people who wish to negotiate down their hospital bills, Lockett grabbed a copy. She called the hospital back. This time, she says, they told her her entire bill had been wiped away.
Emory Healthcare told me it could not comment on individual patients, but added, “Patients will sometimes receive two bills for the same date of service: one bill for services rendered by the physician; the other for a hospital stay, supplies, services, and equipment provided. Emory Healthcare’s customer-service department works with patients to establish a mutually acceptable agreement for paying inpatient or outpatient bills.”
Read: Even the insured often can’t afford their medical bills
“The reality is that medical costs are not objective, real costs,” says Berneta L. Haynes, the director of equity and access at Georgia Watch. One day, an MRI can cost $19,000. The next, it can cost nothing.
Though she was still responsible for her reduced ambulance bill, Lockett was lucky. Others aren’t. Dana Peterman, a physical therapist in Forsyth, Georgia, owed more than $4,000, after insurance, when her son was rushed to the hospital with an anaphylactic peanut-allergy reaction in 2017. She tried to negotiate down her bill, but she says the hospital, the ambulance company, and the ER doctors did not give her a discount. She paid in full, not wanting the bills to affect her credit.
To negotiate with a hospital, consumer advocates I spoke with recommended asking about financial assistance, including charity care for the uninsured. If that fails, patients can ask whether they can pay whatever the hospital would have charged someone who was on Medicare—typically a lower rate. Hospitals and even collections agencies will often agree to payment plans, or a discount in exchange for a lump-sum payment.
Still, the current system requires people to independently negotiate on their own behalf with giant corporations over tens of thousands of dollars, often while recovering from a major illness. For those who haven’t done it before, the process can be confounding. “Maybe I didn’t say the right thing before,” Lockett told me.
If the patient fails to pay, a medical debt might be sent to a debt collector. Some patient advocates say small medical debts are now getting sold to debt buyers, companies that try to collect as much as they can on long-past-due debts. “Now we are seeing small-time medical practices get involved in selling their bad debts to debt buyers for pennies on the dollar,” says Sandoval-Moshenberg, of the Legal Aid Justice Center. Rather than medical records or a patient history, these buyers rely on little more than a list of debts in a spreadsheet, making it harder, Sandoval-Moshenberg and others argue, for patients to negotiate a deal or expunge an error. But this practice makes financial sense for doctors, given how many people are unable to pay their bills.
When everything fails, and the person is at imminent risk of having wages garnished because they’ve been sued for medical debt, it might be time to file for bankruptcy, says Sandoval-Moshenberg. The people who do become the tip of a very big debt iceberg.
We want to hear what you think about this article. Submit a letter to the editor or write to firstname.lastname@example.org.
[IMG] Olga Khazan is a staff writer at The Atlantic.
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For the college-educated elite, work has morphed into a religious identity—promising identity, transcendence, and community, but failing to deliver.
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HN Discussion: https://news.ycombinator.com/item?id=19239064
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Post stats: Points: 125 - Comments: 88 - 2019-02-24T16:05:15Z
#HackerNews #americans #making #miserable #workism
A man sleeps at his desk.Nicky Loh / Reuters
In his 1930 essay “Economic Possibilities for Our Grandchildren,” the economist John Maynard Keynes predicted a 15-hour workweek in the 21st century, creating the equivalent of a five-day weekend. “For the first time since his creation man will be faced with his real, his permanent problem,” Keynes wrote, “how to occupy the leisure.”
This became a popular view. In a 1957 article in The New York Times, the writer Erik Barnouw predicted that, as work became easier, our identity would be defined by our hobbies, or our family life. “The increasingly automatic nature of many jobs, coupled with the shortening work week [leads]an increasing number of workers to look not to work but to leisure for satisfaction, meaning, expression,” he wrote.
These post-work predictions weren’t entirely wrong. By some counts, Americans work much less than they used to. The average work year has shrunk by more than 200 hours. But those figures don’t tell the whole story. Rich, college-educated people—especially men—work more than they did many decades ago. They are reared from their teenage years to make their passion their career and, if they don’t have a calling, told not to yield until they find one.
The economists of the early 20th century did not foresee that work might evolve from a means of material production to a means of identity production. They failed to anticipate that, for the poor and middle class, work would remain a necessity; but for the college-educated elite, it would morph into a kind of religion, promising identity, transcendence, and community. Call it workism.
1. THE GOSPEL OF WORK
The decline of traditional faith in America has coincided with an explosion of new atheisms. Some people worship beauty, some worship political identities, and others worship their children. But everybody worships something. And workism is among the most potent of the new religions competing for congregants.
What is workism? It is the belief that work is not only necessary to economic production, but also the centerpiece of one’s identity and life’s purpose; and the belief that any policy to promote human welfare must always encourage more work.
Homo industrious is not new to the American landscape. The American dream—that hoary mythology that hard work always guarantees upward mobility—has for more than a century made the U.S. obsessed with material success and the exhaustive striving required to earn it.
No large country in the world as productive as the United States averages more hours of work a year. And the gap between the U.S. and other countries is growing. Between 1950 and 2012, annual hours worked per employee fell by about 40 percent in Germany and the Netherlands—but by only 10 percent in the United States. Americans “work longer hours, have shorter vacations, get less in unemployment, disability, and retirement benefits, and retire later, than people in comparably rich societies,” wrote Samuel P. Huntington in his 2005 book Who Are We?: The Challenges to America’s National Identity.
One group has led the widening of the workist gap: rich men.
In 1980, the highest-earning men actually worked fewer hours per week than middle-class and low-income men, according to a survey by the Minneapolis Fed. But that’s changed. By 2005, the richest 10 percent of married men had the longest average workweek. In that same time, college-educated men reduced their leisure time more than any other group. Today, it is fair to say that elite American men have transformed themselves into the world’s premier workaholics, toiling longer hours than both poorer men in the U.S. and rich men in similarly rich countries.
This shift defies economic logic—and economic history. The rich have always worked less than the poor, because they could afford to. The landed gentry of preindustrial Europe dined, danced, and gossiped, while serfs toiled without end. In the early 20th century, rich Americans used their ample downtime to buy weekly movie tickets and dabble in sports. Today’s rich American men can afford vastly more downtime. But they have used their wealth to buy the strangest of prizes: more work!
Perhaps long hours are part of an arms race for status and income among the moneyed elite. Or maybe the logic here isn’t economic at all. It’s emotional—even spiritual. The best-educated and highest-earning Americans, who can have whatever they want, have chosen the office for the same reason that devout Christians attend church on Sundays: It’s where they feel most themselves. “For many of today’s rich there is no such thing as ‘leisure’; in the classic sense—work is their play,” the economist Robert Frank wrote in The Wall Street Journal. “Building wealth to them is a creative process, and the closest thing they have to fun.”
Workism may have started with rich men, but the ethos is spreading—across gender and age. In a 2018 paper on elite universities, researchers found that for women, the most important benefit of attending a selective college isn’t higher wages, but more hours at the office. In other words, our elite institutions are minting coed workists. What’s more, in a recent Pew Research report on the epidemic of youth anxiety, 95 percent of teens said “having a job or career they enjoy” would be “extremely or very important” to them as an adult. This ranked higher than any other priority, including “helping other people who are in need” (81 percent) or getting married (47 percent). Finding meaning at work beats family and kindness as the top ambition of today’s young people.
Even as Americans worship workism, its leaders consecrate it from the marble daises of Congress and enshrine it in law. Most advanced countries give new parents paid leave; but the United States guarantees no such thing. Many advanced countries ease the burden of parenthood with national policies; but U.S. public spending on child care and early education is near the bottom of international rankings. In most advanced countries, citizens are guaranteed access to health care by their government; but the majority of insured Americans get health care through—where else?—their workplace. Automation and AI may soon threaten the labor force, but America’s welfare system has become more work-based in the past 20 years. In 1996, President Bill Clinton signed the Personal Responsibility and Work Opportunity Reconciliation Act, which replaced much of the existing welfare system with programs that made benefits contingent on the recipient’s employment.
The religion of work isn’t just a cultist feature of America’s elite. It’s also the law.
Here’s a fair question: Is there anything wrong with hard, even obsessive, work?
Humankind has not yet invented itself out of labor. Machine intelligence isn’t ready to run the world’s factories, or care for the sick. In every advanced economy, most prime-age people who can work do—and in poorer countries, the average workweek is even longer than in the United States. Without work, including nonsalaried labor like raising a child, most people tend to feel miserable. Some evidence suggests that long-term unemployment is even more wrenching than losing a loved one, since the absence of an engaging distraction removes the very thing that tends to provide solace to mourners in the first place.
There is nothing wrong with work, when work must be done. And there is no question that an elite obsession with meaningful work will produce a handful of winners who hit the workist lottery: busy, rich, and deeply fulfilled. But a culture that funnels its dreams of self-actualization into salaried jobs is setting itself up for collective anxiety, mass disappointment, and inevitable burnout.
In the past century, the American conception of work has shifted from jobs to careers to callings—from necessity to status to meaning. In an agrarian or early-manufacturing economy, where tens of millions of people perform similar routinized tasks, there are no delusions about the higher purpose of, say, planting corn or screwing bolts: It’s just a job.
The rise of the professional class and corporate bureaucracies in the early 20th century created the modern journey of a career, a narrative arc bending toward a set of precious initials: VP, SVP, CEO. The upshot is that for today’s workists, anything short of finding one’s vocational soul mate means a wasted life.
“We’ve created this idea that the meaning of life should be found in work,” says Oren Cass, the author of the book The Once and Future Worker. “We tell young people that their work should be their passion. ‘Don’t give up until you find a job that you love!’ we say. ‘You should be changing the world!’ we tell them. That is the message in commencement addresses, in pop culture, and frankly, in media, including The Atlantic.”
But our desks were never meant to be our altars. The modern labor force evolved to serve the needs of consumers and capitalists, not to satisfy tens of millions of people seeking transcendence at the office. It’s hard to self-actualize on the job if you’re a cashier—one of the most common occupations in the U.S.—and even the best white-collar roles have long periods of stasis, boredom, or busywork. This mismatch between expectations and reality is a recipe for severe disappointment, if not outright misery, and it might explain why rates of depression and anxiety in the U.S. are “substantially higher” than they were in the 1980s, according to a 2014 study.
One of the benefits of being an observant Christian, Muslim, or Zoroastrian is that these God-fearing worshippers put their faith in an intangible and unfalsifiable force of goodness. But work is tangible, and success is often falsified. To make either the centerpiece of one’s life is to place one’s esteem in the mercurial hands of the market. To be a workist is to worship a god with firing power.
2. THE MILLENNIAL WORKIST
The Millennial generation—born in the past two decades of the 20th century—came of age in the roaring 1990s, when workism coursed through the veins of American society. On the West Coast, the modern tech sector emerged, minting millionaires who combined utopian dreams with a do-what-you-love ethos. On the East Coast, President Clinton grabbed the neoliberal baton from Ronald Reagan and George H. W. Bush and signed laws that made work the nucleus of welfare policy.
As Anne Helen Petersen wrote in a viral essay on “Millennial burnout” for BuzzFeed News—building on ideas Malcolm Harris addressed in his book, Kids These Days—Millennials were honed in these decades into machines of self-optimization. They passed through a childhood of extracurricular overachievement and checked every box of the success sequence, only to have the economy blow up their dreams.
While it’s inadvisable to paint 85 million people with the same brush, it’s fair to say that American Millennials have been collectively defined by two external traumas. The first is student debt. Millennials are the most educated generation ever, a distinction that should have made them rich and secure. But rising educational attainment has come at a steep price. Since 2007, outstanding student debt has grown by almost $1 trillion, roughly tripling in just 12 years. And since the economy cratered in 2008, average wages for young graduates have stagnated—making it even harder to pay off loans.
The second external trauma of the Millennial generation has been the disturbance of social media, which has amplified the pressure to craft an image of success—for oneself, for one’s friends and colleagues, and even for one’s parents. But literally visualizing career success can be difficult in a services and information economy. Blue-collar jobs produce tangible products, like coal, steel rods, and houses. The output of white-collar work—algorithms, consulting projects, programmatic advertising campaigns—is more shapeless and often quite invisible. It’s not glib to say that the whiter the collar, the more invisible the product.
Since the physical world leaves few traces of achievement, today’s workers turn to social media to make manifest their accomplishments. Many of them spend hours crafting a separate reality of stress-free smiles, postcard vistas, and Edison-lightbulbed working spaces. “The social media feed [is]evidence of the fruits of hard, rewarding labor and the labor itself,” Petersen writes.
Among Millennial workers, it seems, overwork and “burnout” are outwardly celebrated (even if, one suspects, they’re inwardly mourned). In a recent New York Times essay, “Why Are Young People Pretending to Love Work?,” the reporter Erin Griffith pays a visit to the co-working space WeWork, where the pillows urge Do what you love, and the neon signs implore workers to hustle harder. These dicta resonate with young workers. As several studies show, Millennials are meaning junkies at work. “Like all employees,” one Gallup survey concluded, “millennials care about their income. But for this generation, a job is about more than a paycheck, it’s about a purpose.”
The problem with this gospel—Your dream job is out there, so never stop hustling—is that it’s a blueprint for spiritual and physical exhaustion. Long hours don’t make anybody more productive or creative; they make people stressed, tired and bitter. But the overwork myths survive “because they justify the extreme wealth created for a small group of elite techies,” Griffith writes.
There is something slyly dystopian about an economic system that has convinced the most indebted generation in American history to put “purpose over paycheck.” Indeed, if you were designing a Black Mirror labor force that encouraged overwork without higher wages, what might you do? Perhaps you’d persuade educated young people that income comes second; that no job is just a job; and that the only real reward from work is the ineffable glow of purpose. It is a diabolical game that creates a prize so tantalizing yet rare that almost nobody wins, but everybody feels obligated to play forever.
3. TIME FOR HAPPINESS
This is the right time for a confession. I am the very thing that I am criticizing.
I am devoted to my job. I feel most myself when I am fulfilled by my work—including the work of writing an essay about work. My sense of identity is so bound up in my job, my sense of accomplishment, and my feeling of productivity that bouts of writer’s block can send me into an existential funk that can spill over into every part of my life. And I know enough writers, tech workers, marketers, artists, and entrepreneurs to know that my affliction is common, especially within a certain tranche of the white-collar workforce.
Some workists, moreover, seem deeply fulfilled. These happy few tend to be intrinsically motivated; they don’t need to share daily evidence of their accomplishments. But maintaining the purity of internal motivations is harder in a world where social media and mass media are so adamant about externalizing all markers of success. There’s Forbes’ list of this, and Fortune’s list of that; and every Twitter and Facebook and LinkedIn profile is conspicuously marked with the metrics of accomplishment—followers, friends, viewers, retweets—that inject all communication with the features of competition. It may be getting harder each year for purely motivated and sincerely happy workers to opt out of the tournament of labor swirling around them.
Workism offers a perilous trade-off. On the one hand, Americans’ high regard for hard work may be responsible for its special place in world history and its reputation as the global capital of start-up success. A culture that worships the pursuit of extreme success will likely produce some of it. But extreme success is a falsifiable god, which rejects the vast majority of its worshippers. Our jobs were never meant to shoulder the burdens of a faith, and they are buckling under the weight. A staggering 87 percent of employees are not engaged at their job, according to Gallup. That number is rising by the year.
One solution to this epidemic of disengagement would be to make work less awful. But maybe the better prescription is to make work less central.
This can start with public policy. There is new enthusiasm for universal policies—like universal basic income, parental leave, subsidized child care, and a child allowance—which would make long working hours less necessary for all Americans. These changes alone might not be enough to reduce Americans’ devotion to work for work’s sake, since it’s the rich who are most devoted. But they would spare the vast majority of the public from the pathological workaholism that grips today’s elites, and perhaps create a bottom-up movement to displace work as the centerpiece of the secular American identity.
On a deeper level, Americans have forgotten an old-fashioned goal of working: It’s about buying free time. The vast majority of workers are happier when they spend more hours with family, friends, and partners, according to research conducted by Ashley Whillans, an assistant professor at Harvard Business School. In one study, she concluded that the happiest young workers were those who said around the time of their college graduation that they preferred careers that gave them time away from the office to focus on their relationships and their hobbies.
How quaint that sounds. But it’s the same perspective that inspired the economist John Maynard Keynes to predict in 1930 that Americans would eventually have five-day weekends, rather than five-day weeks. It is the belief—the faith, even—that work is not life’s product, but its currency. What we choose to buy with it is the ultimate project of living.
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[IMG] Derek Thompson is a staff writer at The Atlantic, where he writes about economics, labor markets, and the media. He is the author of Hit Makers.
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