The Fora: A Higher Education Community

This topic managed to shut down the Libraries thread.

As someone who has been recovering so long that my recovery could have earned tenure by now, and as someone who saw a great many problems and failures among friends and family because of alcohol, and as someone who lost a sibling to meth addiction, I see no easy answers.

I am just wondering what you all think.

What should we realistically do about the plague of addiction eating away at our culture?

Take down the firewall between mental health treatment and addiction treatment. The USA's wealthcare industry divides them into two completely separate services that can't be integrated.

I recognize that the above says nothing about the prevalence of mental illness and addiction in the USA, the causes of which are quite complex but that to a large degree boil down to: 1) widespread poverty, and 2) lack of access to effective treatment.

I live in a meth/oxy county, and have two cousins who died from addiction.  We have completely inadequate public treatment resources.  Law enforcement is too often complicit and/or closes its eyes.  Well known community figures are involved.  Local pharmacies knowingly accepted prescriptions from pill mill doctors.

60 odd people were recently arrested, most of them for meth.

It's hopeless.

In other developed countries, they don't seem to have this problem.

First, they build affordable housing in and around cities. No tolerance for NIMBYism.

They have a public health infrastructure so people can be treated when they are ill, and a reasonably good social safety net.

Not to mention day care, schools, and activities to keep kids busy and out of trouble.

Yes, taxes are high and unemployment isn't great. Still beats the alternative...

Quote from: nebo113 on June 25, 2023, 06:04:40 AMI live in a meth/oxy county, and have two cousins who died from addiction.  We have completely inadequate public treatment resources.  Law enforcement is too often complicit and/or closes its eyes.  Well known community figures are involved.  Local pharmacies knowingly accepted prescriptions from pill mill doctors.

60 odd people were recently arrested, most of them for meth.

It's hopeless.

I think we are expecting too much.

Like education, even with all the government support programs, charitable non-profit support, family support, and cultural de-stigmatization, there will still be some that cannot be reached--some because they simply don't want to change.

It's true with education. It's true with those suffering from drug addiction and alcoholism.

But that doesn't mean we should beat up ourselves because we're not reaching everybody. Likewise, the lack of the ideal unattainable success rate does not mean that we give up and de-fund these public programs and walk away from the private non-profit programs.

We have to give up the idea that it is possible to have a perfect society. That only leads to an increased perception of failure and an excuse for the fiscal hawks to cut support programs.

Quote from: ciao_yall on June 25, 2023, 09:07:48 AMIn other developed countries, they don't seem to have this problem.

First, they build affordable housing in and around cities. No tolerance for NIMBYism.

They have a public health infrastructure so people can be treated when they are ill, and a reasonably good social safety net.

Not to mention day care, schools, and activities to keep kids busy and out of trouble.

Yes, taxes are high and unemployment isn't great. Still beats the alternative...

Taxes are just as ridiculous in the USA, when you add up sales tax, state tax, & property tax, into the federal income tax & payroll taxes. (And, I have not even mentioned the informal "tipping" tax where North Americans are compelled to pay a 20% service charge whenever they engage the services of a service sector employee.) The problem in the USA is that we get a much lower return on the public investments. For the kinds of taxes most people in the USA pay, Medicare for all, including coverage for addiction treatment, should be a no-brainer. Instead, some go without health care and addiction treatment and most of the rest of the population pays for shi**y private health care. And, it's not like these relatively high taxes are properly supporting other things like educational institutions, infrastructure, policies that incentivize development of affordable housing, etc.

Full disclosure, I have largely insulated myself from people with drug and alcohol problems. I've had my fill of trying to intervene and help out. I'm tired of it. But, I try my best to support programs that serve the public good. Most of all, I don't harbor impossible-to-meet expectations of these programs and the human beings that they serve.

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Quote from: lightning on June 25, 2023, 12:15:11 PMI think we are expecting too much.

Like education, even with all the government support programs, charitable non-profit support, family support, and cultural de-stigmatization, there will still be some that cannot be reached--some because they simply don't want to change.

It's true with education. It's true with those suffering from drug addiction and alcoholism.

But that doesn't mean we should beat up ourselves because we're not reaching everybody. Likewise, the lack of the ideal unattainable success rate does not mean that we give up and de-fund these public programs and walk away from the private non-profit programs.

We have to give up the idea that it is possible to have a perfect society. That only leads to an increased perception of failure and an excuse for the fiscal hawks to cut support programs.

By most metrics the US does have a worse illegal drug problem than almost any other country. Add in alcohol and things looks less clear. Rates of alcohol us in the US are lower than in western Europe and in some parts of eastern Europe, alcohol use is off the charts. Americans sometimes have this imagined idea of sophisticated europeans sipping alcohol in responsible ways, but the reality is often pretty different.

It's true that nothing is going to completely eliminate substance addiction, but we actually do have a pretty good idea of what works, from harm reduction to treatment programs to anti-addiction medications. None of these things are perfect, but if you provide funding for this kind of support it's pretty clear you give people a much better chance. 

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 but we actually do have a pretty good idea of what works, from harm reduction to treatment programs to anti-addiction medications. 
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The area where I live has been a one horse economy for over 100 years.  Boom or bust.  Now, it's pretty much bust, so many people, especially young men, feel hopeless.  Local pill mills and pharmacies supported their drug usage, but with few exceptions, those enablers made money and were not charged or jailed.  Only the users.

 but we actually do have a pretty good idea of what works, from harm reduction to treatment programs to anti-addiction medications. 
[/quote]

The area where I live has been a one horse economy for over 100 years.  Boom or bust.  Now, it's pretty much bust, so many people, especially young men, feel hopeless.  Local pill mills and pharmacies supported their drug usage, but with few exceptions, those enablers made money and were not charged or jailed.  Only the users.
[/quote]

Right, there's a different discussion about the larger causes of drug abuse, but lots of people want help and can't get it.

Step one: Don't say "Addict" since that's no longer recommended by experts since it applies an essentialist label to the person. And we know that stigma only makes things worse.

Substance Use Disorder cuts across class lines, but it's not the great equalizer because most of the worse possible outcomes are caused by lack of resources.

So like others have said, create a health care system that one, actually cares about helping people over profits and two, make sure it covers mental health thoroughly.

Have a social safety net that is at least in the same ballpark as all other developed rich countries.

End the completely failed War on Drugs and move those resources to Harm Reduction programs.

Article in the New York Times (https://www.nytimes.com/2023/06/25/nyregion/mentally-ill-homeless-nyc.html?unlocked_article_code=nPcYvRQPYw0KeOlynUMdo7DVtiv6G9YdvWT7bHdXMJ8S_yGyy2spzg_v60mgwhke1eqBPLScj6T1EYKRekeQoh8fNwo4NCrH8sdgCkuLTZvBJyS5pVG_ptgmr-xAxnhJz1yebChIFdrJ5qap9LW5-x4Lblk33GA1u04fpMDJ2udyNEcjWLnWfer8QqzDTGOb6QuFUAf62L8aPJq6Y8OhfnO_VHXa8WQm-KqN_qaalpQdlo-994qKbENaLrA7crgqhLbPV47ey2cmSLDEBgiAMDIMXYDURYiHJJtcr1fu2M7ZsAz1XTmkOkUVpRSVPyVvY05yRaHlnC3FPkPhidjRRVZwQuw&smid=url-share) about how help does work.

People need more than just a shelter bed.

Also, where I live, a lot of the homeless people prefer the "stability and safety" of their own tent or car to the shelters.

If they go into a shelter, they are separated from the friends and pets. They lose their spot on the street, park, wherever. They might lose their tent to the street cleanup or car to towing/impound. They risk having things stolen. It can be hard to get a good night's sleep if it's noisy. And they get rousted from bed at 7 AM and have to clear out.

So, when they are "refusing help" they are actually making the best decision for themselves.

Awright, I am going to say some things which may seem harsh, and which in some cases *reflexively* run contrary to the views of secular liberals who live, in many/most cases, in places where, like it or not, addicts and the drugs they use are not visible, and the addicts are more or less shown the door, sometimes quite harshly, by the local constabulary (heck, in very blue Mass. here, where we have legalized weed emporia, the decision to allow such establishments is wholly up to the local communities, and which communities do you think do NOT allow such places, requiring those desirous of purchasing their wares to come to places like Rusty City, where politicians want the tax revenues the weed shops provide, and where the local population, such as it is, is much much more supportive of the presence of such places in their midst.)   But facts are stubborn things.

1) 'Harm reduction' is a moral choice, and a bad one, because such actions a) allow addicts to remain addicts, stuck in their addiction, with all the attendant life debiitations appartaining thereto, and b) society (which does have some rights) is stuck with dealing with the addicts, which, even with 'harm reduced', still means these people will be... well.

2) As I have noted, it is necessary for Americans to be willing to pay a lot of taxes to get ourselves back into the mental hospital businesss, and to establish the sound, evidence-based rehab facilities needed to address narcotics addiction.  And then, once these places are up and running, those properly served by them must be forced to go there.  Not asked, not bribed, cajoled, etc., just forced.  *for their own good*, and, again, for the good of society, which, again, *has some rights*.

3) Now to the very easy part-- what to do with the scumbags who sell drugs, import them, write and fill peddled prescriptions for unnecessary narcs, etc.-- don't let the door hit you in the butt as you are frogmarched off to the greybar hotel for hard hard time.  And for cops who take bribes, look the other way as these aforementioned dirtbags do their dirtbaggery, well... I suspect you can guess what I think.   These people are at war with the people, and should be treated as such.

These are big social issues. It is useful to distinguish between helping people who have existing problems with substance use, and moving to become a society where people don't become so hooked in the first place.

Drug and alcohol treatment in the US has been mostly ideological and political rather than evidence based. The dominance of AA and abstinence approaches rather than harm reduction has caused a lot of trouble. Maybe things are improving but it's two steps forward and one step back.

I am all for giving out free opiates to addicts.  They won't have to steal for drug money.  They can hold down a job with a stable clean dose at a regular time and location.  They won't have anything left over to share or sell.  I am not sure what to say about cocaine and methamphetamine. 

I am also upset that the response to the opioid crisis means that is harder for us to get needed pain medicine.  At one time you could call a dentist at their own home and get a prescription phoned in for you.  Now you have to see them in person.  Those of us without a history of abuse should not have to worry about getting pain relief.  A tooth infection will keep me awake through the night which then will cause heart rhythm problems. 

Quote from: kaysixteen on June 26, 2023, 09:51:10 AMAwright, I am going to say some things which may seem harsh, and which in some cases *reflexively* run contrary to the views of secular liberals who live, in many/most cases, in places where, like it or not, addicts and the drugs they use are not visible, and the addicts are more or less shown the door, sometimes quite harshly, by the local constabulary (heck, in very blue Mass. here, where we have legalized weed emporia, the decision to allow such establishments is wholly up to the local communities, and which communities do you think do NOT allow such places, requiring those desirous of purchasing their wares to come to places like Rusty City, where politicians want the tax revenues the weed shops provide, and where the local population, such as it is, is much much more supportive of the presence of such places in their midst.)   But facts are stubborn things.

1) 'Harm reduction' is a moral choice, and a bad one, because such actions a) allow addicts to remain addicts, stuck in their addiction, with all the attendant life debiitations appartaining thereto, and b) society (which does have some rights) is stuck with dealing with the addicts, which, even with 'harm reduced', still means these people will be... well.

2) As I have noted, it is necessary for Americans to be willing to pay a lot of taxes to get ourselves back into the mental hospital businesss, and to establish the sound, evidence-based rehab facilities needed to address narcotics addiction.  And then, once these places are up and running, those properly served by them must be forced to go there.  Not asked, not bribed, cajoled, etc., just forced.  *for their own good*, and, again, for the good of society, which, again, *has some rights*.

3) Now to the very easy part-- what to do with the scumbags who sell drugs, import them, write and fill peddled prescriptions for unnecessary narcs, etc.-- don't let the door hit you in the butt as you are frogmarched off to the greybar hotel for hard hard time.  And for cops who take bribes, look the other way as these aforementioned dirtbags do their dirtbaggery, well... I suspect you can guess what I think.   These people are at war with the people, and should be treated as such.

I am a professor of biopsychology. So I know a thing or two about this. Stop saying "Addicts" I know some groups like AA still use it, but in your case, you are stigmatizing. Moral questions aside, the research is pretty clear on a number of different points:
- It's cheaper to house someone and give them fairly intensive support than have them sit in a jail cell. This is partly why even very right-wing politicians like Mike Lee and Rand Paul have supported a shift from just jailing drug offenses to supporting things like Housing First initiatives and prison education programs.
-The claims about institutions being too expensive simply are not true, at least not anymore. But out-patient is more effective and humane anyway (but still far cheaper than the prison system we have in place now)
-We already have a Harm Reduction mentality around legal drugs like alcohol, nicotine, and caffeine. Why draw the line there?
-Harm Reduction also reduces harm to non-drug users. Clean needle exchanges keeps needles out of your public parks. Housing First keeps excrement off your sidewalk.
-It is an agreed upon fact that drug criminalization over history was racist and politically motivated.
-Rates of drug use are actually mostly constant across race and class. It's just that you don't see the cocaine being used inside the walls of that frat house. And you don't see the rich man passed out drunk on expensive whiskey in his study.
-Wanna get rid of the seedy black market? Legalize and regulate! Alcohol prohibition has shown that criminalization only increases harms to users and society at large. We will never get rid of all harms (hence the reduction part) but it's evident we are actually increasing harms right now.

Agreed on the need to give people with drug problems help beyond just locking them up in jail.  Strongly disagree that taking an anything-goes approach to drug use and counting on "harm reduction" to save us from the consequences of that is a viable approach.  Harm reduction for traditional drugs like alcohol and tobacco use hasn't really worked.  Alcohol-related deaths have skyrocketed in recent years.  Tobacco-related deaths are down, but that's because tobacco use is far less socially acceptable than it once was. 

Meanwhile use of pretty much everything else is going nowhere but up, because it is now socially acceptable, and "harm reduction" isn't working.  California has let the streets flood with drugs while spending billions on harm reduction, and their city streets have turned into slaughterhouses of addiction and drug deaths.  Maybe harm reduction has saved some lives here and there, but it hasn't begun to make up for the consequences of unchecked drug use.

I've known several people here in our town who have successfully gotten beyond drug use.  Two in particular.  One is the woman I mentioned on another thread who works for our local Salvation Army and other efforts.  The other is one of our staff members.  In each case getting jailed for drug offenses served as a wake-up call for them, and they finally stopped pushing the snooze button. They each were able to leave the drugs behind because they found something that worked in their lives.  Following Jesus gave them hope, gave them support, and gave them access to a supportive community.  Their lives have changed so that they don't feel that same need for drugs.  I've mentioned those two in particular, but I've known a number of others.

Quote from: kaysixteen on June 26, 2023, 09:51:10 AM1) 'Harm reduction' is a moral choice, and a bad one, because such actions a) allow addicts to remain addicts, stuck in their addiction, with all the attendant life debiitations appartaining thereto, and b) society (which does have some rights) is stuck with dealing with the addicts, which, even with 'harm reduced', still means these people will be... well.

"Harm reduction" is about meeting people where they are at. For example, there is a needle exchange right outside my condo building once a week.

They give out free needles so users aren't reusing dirty ones and getting infected. They give out sandwiches, snacks, and offers for services.

Maybe it takes a few tries but eventually they do decide to accept services. It's not realistic for the outreach team to expect someone to accept help if they don't know or trust whomever is offering the help. 

I like to say it is the safest evening of the week because only the civilized junkies show up.

I keep seeing so many myths pushed here. Nothing is black and white, right? Same thing with this. Again, Reduction is the name of the game. It is not in any way "anything goes" that's a bad strawman argument.

There will never be zero drug and alcohol deaths, just as there with never be zero car or airplane deaths. The point is to put safeguards in place to drop those numbers. Without it, deaths skyrocket, including with the legal drugs like nicotine and alcohol. You can't point at alcohol deaths currently and claim attempts to minimize them failed. What you can do is be a good academic and scientist and do the darn research. Harm Reduction is evidence-based. It works. Prohibition does not.

How do you do the research? Admittedly, it's difficult but you can see natural quasi-experiments like Portugal and in the US the state-by-state cannabis legalization, then compare similar municipalities that still follow prohibition. 

Also, the research is clear that the vast majority of people who use even the "hardest" drugs, don't continue into problematic use, and/or grow out of it.

Another case in point is D.A.R.E. a prohibition based education campaign for kids at best did not work. And a couple of studies suggest, made things worse! It may have increased drug use and got kids to try drugs earlier!

I speak from firsthand experience and observation.  The biggest problem with getting people off mind-altering-substances (definitely including alcohol, one of the worst drugs there is) is the person with an addiction problem.  Unless we can absolutely guarantee that we can staunch the flow of illegal drugs, which we can't, then people will get their hands on illegal drugs if they really want to.  If addicts (sorry, that is what we are, obviously including myself, labeling or not) cannot get their drug-of-choice, most will default to legal, easily obtained drugs like alcohol or pot. This is true even if you lock them up.  And it is a lot harder to lock up the purveyors of illegal substances than one might think, and very hard to get the kingpins.  It is easy to arrest and convict to the street-level dealers, who are often drug addicts themselves.

In other words, one really needs to volunteer for sobriety and really, really want it to achieve it. I really wanted my life back, so I was motivated. And I had a wide, warm support network of people who were rooting for me.  I don't know how we motivate addicts to overcome their addiction.

Most people recover from their addictive behavior on their own, without psychiatric intervention or rehab. There's a strong phenomenon of aging out or maturing out of addiction. Of course, a significant proportion don't, especially when there are other mental illnesses involved.

I think the first thing is to stop looking down on people who use drugs, and instead offer support to reduce harm and help them stop when they want to. 

This include legalization to provide a clean safe drug supply chain.  Most people overdosing on fentanyl did not intend to consume it in the first place.  We have thousands of people dying because we are allowing organized crime to supply drugs.  The whole supply chain should be legal and regulated to ensure that people who decide to use drugs are actually consuming what they think they are. 

The reality is that many drugs are not the devil, and are actually much less harmful than many legal options.  A good example is MDMA, which in itself is not that bad, but if you buy it on the street you are likely consuming other, much worse drugs.

After that, there should be no criminalization, and instead those resources should be exclusively put toward outreach to help people. 

One thing that has really surprised me in Canada with legalization of cannabis is the shift in public attitude.  I assumed that the stigma around cannabis was separate from laws and legalization would not change this.  I was wrong, while there is still some stigma, it has decreased dramatically while usage rates have not really changed (maybe some increase in adults, but some decline in youth, which is more important).

 I believe legalization of all drugs would follow a similar path and benefit society.

Ok, let's run  with this:

1) if we engage in a 'harm reduction' (=legalization and providing of safe spaces, free drugs/ paraphernalia , etc., program), how does this action act positively in the lives of the users?

AND

2) how does a harm reduction program help/ act posiitively, on society as a whole?

One of the reduced harms is overdose deaths. Another is disease transmission. A third is the number of needles and things lying around. It also acts as a pathway to treatment and builds trust.

Not criminalizing drug use also helps those who are ready to transition out to do so, since they aren't dogged by a criminal record. It's a lot easier to stay clean when you have enough money to stay off the street.

A big part of what's missing, of course, is stable housing. To my mind, there is no good reason for us to accept that anyone should be unhoused unless it's by explicit choice. The homeless population here is only around 4000 people. That's a lot, but not so many that adequately housing them would be prohibitively expensive.

Quote from: Parasaurolophus on June 27, 2023, 10:25:38 AMA big part of what's missing, of course, is stable housing. To my mind, there is no good reason for us to accept that anyone should be unhoused unless it's by explicit choice. The homeless population here is only around 4000 people. That's a lot, but not so many that adequately housing them would be prohibitively expensive.

Certainly less expensive than all the hospital emergency rooms, prisons, and social workers that keep them just on the edge of permanent housing. Because if everyone had stable supportive housing who wanted it, well, where would the incentive be to work? /s

Quote from: Kron3007 on June 27, 2023, 06:38:51 AMOne thing that has really surprised me in Canada with legalization of cannabis is the shift in public attitude.  I assumed that the stigma around cannabis was separate from laws and legalization would not change this.  I was wrong, while there is still some stigma, it has decreased dramatically while usage rates have not really changed (maybe some increase in adults, but some decline in youth, which is more important).

On the other side, illegal cannabis hasn't disappeared. In fact, the legal cannbis industry is now claiming they need government support to survive. So mush for legal drugs making illegal drugs unprofitable...

Also, now in our building (where people aren'\t supposed to smoke ANYTHING) we smell pot in the elevators, the parking garage, etc. Legalization of cannabis has made people feel like they have a right to stink up everyone else's atmosphere, even where it's explicitly forbidden.

There's also more date now on the adverse effects of cannabis on brains, especially of teenagers, and its addictive properties.  (before legalization, one of the arguments was that it wasn't addictive like tobacco.)

In many ways, legalizing cannabis has been like Brexit. The reality after the fact hasn't lived up to the hype of the people promoting it.

 

Having had clients / patients with addiction problems, provide them with safe supply, supply them with easy to access alternatives (methadone for example, but don't make it a burden), provide them with preferably free but at least low cost other treatment options. Incarceration only makes things worse, from clients I've had.

Quote from: marshwiggle on June 27, 2023, 12:24:13 PM

Quote from: Kron3007 on June 27, 2023, 06:38:51 AMOne thing that has really surprised me in Canada with legalization of cannabis is the shift in public attitude.  I assumed that the stigma around cannabis was separate from laws and legalization would not change this.  I was wrong, while there is still some stigma, it has decreased dramatically while usage rates have not really changed (maybe some increase in adults, but some decline in youth, which is more important).

On the other side, illegal cannabis hasn't disappeared. In fact, the legal cannbis industry is now claiming they need government support to survive. So mush for legal drugs making illegal drugs unprofitable...

Also, now in our building (where people aren'\t supposed to smoke ANYTHING) we smell pot in the elevators, the parking garage, etc. Legalization of cannabis has made people feel like they have a right to stink up everyone else's atmosphere, even where it's explicitly forbidden.

There's also more date now on the adverse effects of cannabis on brains, especially of teenagers, and its addictive properties.  (before legalization, one of the arguments was that it wasn't addictive like tobacco.)

In many ways, legalizing cannabis has been like Brexit. The reality after the fact hasn't lived up to the hype of the people promoting it.

 

The legal market now accounts for over 50% of total sales, meaning the black market has shrunk by more than half.  That is pretty substantial and represents billions of dollars no longer flowing through back channels.  It will continue to drop and eventually illicit cannabis will be a small percentage of total sales. I really doubt bootleggers just closed shop as soon as alcohol prohibition ended, it likely took many years.  Anyone who thought the black market would disappear overnight was naive.  As for the cannabis industry needing government support, that is really just a matter of too much hype, investment, and expectations that have led to a massive oversupply.  Once some of them go under and stop flooding the market, the industry will balance itself.

Regarding information about the negative effects on brains etc., that is somewhat irrelevant since use in young people has stayed level or declined, and there has only been a moderate increase in older adults (which is also questionable).  If legalization had caused a significant increase in use, especially in the younger group, you may have a point, but since it didnt, it hasn't caused increased harm.   In fact, a lot of this new information has come because of legalization, allowing researchers to more readily conduct the necessary studies and help guide best practices.  Additionally, from what I have seen, legalization of cannabis leads to lower alcohol sales, so even if use did go up the picture is more complex.

As for your building, smells are part of apartment living.  Some people complain about tobacco small, some about boiling cabbage, others about curry.  All potentially valid I suppose, but not really a big deal in the grand scheme.     

Personally, I see cannabis legalization as a huge success and it has proven what many have been saying about the futility and counter-productivity  of the war on drugs for decades.

     

Quote from: marshwiggle on June 27, 2023, 12:24:13 PM

Quote from: Kron3007 on June 27, 2023, 06:38:51 AMOne thing that has really surprised me in Canada with legalization of cannabis is the shift in public attitude.  I assumed that the stigma around cannabis was separate from laws and legalization would not change this.  I was wrong, while there is still some stigma, it has decreased dramatically while usage rates have not really changed (maybe some increase in adults, but some decline in youth, which is more important).

On the other side, illegal cannabis hasn't disappeared. In fact, the legal cannbis industry is now claiming they need government support to survive. So mush for legal drugs making illegal drugs unprofitable...

Also, now in our building (where people aren'\t supposed to smoke ANYTHING) we smell pot in the elevators, the parking garage, etc. Legalization of cannabis has made people feel like they have a right to stink up everyone else's atmosphere, even where it's explicitly forbidden.

There's also more date now on the adverse effects of cannabis on brains, especially of teenagers, and its addictive properties.  (before legalization, one of the arguments was that it wasn't addictive like tobacco.)

In many ways, legalizing cannabis has been like Brexit. The reality after the fact hasn't lived up to the hype of the people promoting it.

 

Alas, Marsh, the evidence is not what it seems, for it is skin deep. Well over a year ago we had a disquisition about whether legalization would lower the prices of formerly illicit drugs, or raise them. You pointed out that in Canada the price of illegal cannabis was lower than legal cannabis. This threw me off my perch, so I investigated. Your facts are correct, and the same is true in various US States.

What's going on is that nothing has been completely legalized anywhere. Legalization is just a woid. Thus, in various Canadian provinces one needs to jump through hoops to get a license to sell this stuff. Same in New York, where the legal market is disappearing. In the US more broadly, legal dealers have no access to banks. Great help in doing business!

At least as bad is that what's called legalization in many places in merely "decriminalization". That just raises the demand for illicit drugs without cleaning up the quality of the supply. Decriminalization of carrying drugs thus contributes to the rising death rate.

I'm pleasantly surprised how insightful the comments are on this thread. Any defects of the health system in mind, right now doctors are surveilled on their prescription practices for opioids. An addict can't get his stuff under the care of a doctor! Same for pharmacists. At least illicit supply by pharmacies will be pure in content and come with  dosage instructions.

This is no longer just an addiction problem; it's a death rate problem. Legalization would do a lot to lower the death rate.

Quote from: marshwiggle on June 27, 2023, 12:24:13 PM

Quote from: Kron3007 on June 27, 2023, 06:38:51 AMOne thing that has really surprised me in Canada with legalization of cannabis is the shift in public attitude.  I assumed that the stigma around cannabis was separate from laws and legalization would not change this.  I was wrong, while there is still some stigma, it has decreased dramatically while usage rates have not really changed (maybe some increase in adults, but some decline in youth, which is more important).

On the other side, illegal cannabis hasn't disappeared. In fact, the legal cannbis industry is now claiming they need government support to survive. So mush for legal drugs making illegal drugs unprofitable...

Also, now in our building (where people aren'\t supposed to smoke ANYTHING) we smell pot in the elevators, the parking garage, etc. Legalization of cannabis has made people feel like they have a right to stink up everyone else's atmosphere, even where it's explicitly forbidden.

There's also more date now on the adverse effects of cannabis on brains, especially of teenagers, and its addictive properties.  (before legalization, one of the arguments was that it wasn't addictive like tobacco.)

In many ways, legalizing cannabis has been like Brexit. The reality after the fact hasn't lived up to the hype of the people promoting it.

 

As with Brexit, we've only begun to see the unintended harms, which should have been entirely anticipateable.  It's too late now, I'm afraid.  Our societies have drunk deeply of the (heavily spiked) Kool-Aid.  As with so many other bad policy decisions (Afghanistan, bank deregulation, gun deregulation--any number come to mind), we're going to be seeing massive denial and efforts to prove that "no, really, things are moving forward," even as our streets and our cemeteries keep filling up.

Quote from: dismalist on June 27, 2023, 01:49:22 PM

Quote from: marshwiggle on June 27, 2023, 12:24:13 PM

Quote from: Kron3007 on June 27, 2023, 06:38:51 AMOne thing that has really surprised me in Canada with legalization of cannabis is the shift in public attitude.  I assumed that the stigma around cannabis was separate from laws and legalization would not change this.  I was wrong, while there is still some stigma, it has decreased dramatically while usage rates have not really changed (maybe some increase in adults, but some decline in youth, which is more important).

On the other side, illegal cannabis hasn't disappeared. In fact, the legal cannbis industry is now claiming they need government support to survive. So mush for legal drugs making illegal drugs unprofitable...

 

Alas, Marsh, the evidence is not what it seems, for it is skin deep. Well over a year ago we had a disquisition about whether legalization would lower the prices of formerly illicit drugs, or raise them. You pointed out that in Canada the price of illegal cannabis was lower than legal cannabis. This threw me off my perch, so I investigated. Your facts are correct, and the same is true in various US States.

What's going on is that nothing has been completely legalized anywhere. Legalization is just a woid. Thus, in various Canadian provinces one needs to jump through hoops to get a license to sell this stuff. Same in New York, where the legal market is disappearing. In the US more broadly, legal dealers have no access to banks. Great help in doing business!

As I understand it, part of the reason legal cannabis is more expensive than illegal cannabis is Canada is that there are strict quality controls imposed by governments that raise the cost of legitimate production.

It is a fascinating test of the mantra "legalize and tax!", since the fact is that it's not so simple- the higher the taxes, the more room for competition from the black market. So the government can try to generate revenue or undercut the black market, but not both.

Quote from: apl68 on June 27, 2023, 03:07:01 PM

Quote from: marshwiggle on June 27, 2023, 12:24:13 PM

Quote from: Kron3007 on June 27, 2023, 06:38:51 AMOne thing that has really surprised me in Canada with legalization of cannabis is the shift in public attitude.  I assumed that the stigma around cannabis was separate from laws and legalization would not change this.  I was wrong, while there is still some stigma, it has decreased dramatically while usage rates have not really changed (maybe some increase in adults, but some decline in youth, which is more important).

On the other side, illegal cannabis hasn't disappeared. In fact, the legal cannbis industry is now claiming they need government support to survive. So mush for legal drugs making illegal drugs unprofitable...

Also, now in our building (where people aren'\t supposed to smoke ANYTHING) we smell pot in the elevators, the parking garage, etc. Legalization of cannabis has made people feel like they have a right to stink up everyone else's atmosphere, even where it's explicitly forbidden.

There's also more date now on the adverse effects of cannabis on brains, especially of teenagers, and its addictive properties.  (before legalization, one of the arguments was that it wasn't addictive like tobacco.)

In many ways, legalizing cannabis has been like Brexit. The reality after the fact hasn't lived up to the hype of the people promoting it.

 

As with Brexit, we've only begun to see the unintended harms, which should have been entirely anticipateable.  It's too late now, I'm afraid.  Our societies have drunk deeply of the (heavily spiked) Kool-Aid.  As with so many other bad policy decisions (Afghanistan, bank deregulation, gun deregulation--any number come to mind), we're going to be seeing massive denial and efforts to prove that "no, really, things are moving forward," even as our streets and our cemeteries keep filling up.

You think cemeteries are filling up because of marijuana legalization?

Quote from: marshwiggle on June 27, 2023, 04:01:47 PM

Quote from: dismalist on June 27, 2023, 01:49:22 PM

Quote from: marshwiggle on June 27, 2023, 12:24:13 PM

Quote from: Kron3007 on June 27, 2023, 06:38:51 AMOne thing that has really surprised me in Canada with legalization of cannabis is the shift in public attitude.  I assumed that the stigma around cannabis was separate from laws and legalization would not change this.  I was wrong, while there is still some stigma, it has decreased dramatically while usage rates have not really changed (maybe some increase in adults, but some decline in youth, which is more important).

On the other side, illegal cannabis hasn't disappeared. In fact, the legal cannbis industry is now claiming they need government support to survive. So mush for legal drugs making illegal drugs unprofitable...

 

Alas, Marsh, the evidence is not what it seems, for it is skin deep. Well over a year ago we had a disquisition about whether legalization would lower the prices of formerly illicit drugs, or raise them. You pointed out that in Canada the price of illegal cannabis was lower than legal cannabis. This threw me off my perch, so I investigated. Your facts are correct, and the same is true in various US States.

What's going on is that nothing has been completely legalized anywhere. Legalization is just a woid. Thus, in various Canadian provinces one needs to jump through hoops to get a license to sell this stuff. Same in New York, where the legal market is disappearing. In the US more broadly, legal dealers have no access to banks. Great help in doing business!

As I understand it, part of the reason legal cannabis is more expensive than illegal cannabis is Canada is that there are strict quality controls imposed by governments that raise the cost of legitimate production.

It is a fascinating test of the mantra "legalize and tax!", since the fact is that it's not so simple- the higher the taxes, the more room for competition from the black market. So the government can try to generate revenue or undercut the black market, but not both.

Never, ever, ever, pursue two competing goals with a single instrument [Jan Tinbergen]. This is not about raising revenue; it's about saving lives.

Let's face it.  Humans have been looking to get a buzz on since the first Australopithecus stumbled upon some fermenting grapes and accidentally discovered wine.

I've spent a substantial amount of time in Australia which has historically had a quite large problem with heroin addiction.  If the po po finds you with it in your pocket, you will still be arrested, but beyond that, they do have a large harm reduction approach.

For decades, family practice docs with a bit of extra training have been able to prescribe methadone, and later, buprenorphine.  Patients can get their methadone in many local pharmacies for about $5 a day.  Since most addicts are just trying to avoid getting dope sick from withdrawal and are not seeking a high, their prescribed medicine keeps them from having to shoplift or engage in sex work to pay for drugs.  It's quite a good system.

More recently, safe injection rooms have opened.  So if you get a hot dose and nod off, there's someone there to notice and blow some Narcan up your nose.

Here in the Land of Screed and the Home of the Depraved, we insist on seeing this as a legal problem.  I've talked to addicts desperate to get into a methadone program only to find their way blocked by a thousand pages of regulations that make getting treatment impossible.

None of this will work for meth but at least the Aussies have some kind of program in place beyond jail and hoping they find religion.

I have been cogitatin' more on this and will allow that legalization of drugs with a harm reduction focus, providing things like free needles, safe injection spots, etc., will almost certainly reduce OD deaths.  You gots me on that.

Now let's consider the other, less, ahem, positive effects of what is, after all, essentially surrendering to drug addiction.   Addicts (nothing will convince me to avoid use of this descriptive term... I will refrain from using 'junkie' here) will use their safely provided junk in their safely established shoot up spaces, and they will not OD, but they will continue to destroy themselves on the slow burn.  Meanwhile their families, society as a whole, etc., will pay a great price for their addicthood.   Who really thinks that this is a good thing?

Quote from: kaysixteen on June 27, 2023, 09:32:45 PMI have been cogitatin' more on this and will allow that legalization of drugs with a harm reduction focus, providing things like free needles, safe injection spots, etc., will almost certainly reduce OD deaths.  You gots me on that.

Now let's consider the other, less, ahem, positive effects of what is, after all, essentially surrendering to drug addiction.   Addicts (nothing will convince me to avoid use of this descriptive term... I will refrain from using 'junkie' here) will use their safely provided junk in their safely established shoot up spaces, and they will not OD, but they will continue to destroy themselves on the slow burn.  Meanwhile their families, society as a whole, etc., will pay a great price for their addicthood.   Who really thinks that this is a good thing?

It's not giving in to drug addiction if you think it will result in better outcomes and lower impacts.  If there was any evidence that being tough on drugs reduced access, use rates, or negative outcomes, maybe you would have a point, but that is not the case.  Being tough on drugs appeals to the base gut feelings, but it not built on the facts.

What I find more interesting here is that the religious types seem to share your view, despite preaching love and compassion.  What do you think Jesus would do?  This is a real question, how do you think Jesus would approach drug addiction and rehabilitation?

Quote from: Kron3007 on June 28, 2023, 02:53:02 AM

Quote from: kaysixteen on June 27, 2023, 09:32:45 PMI have been cogitatin' more on this and will allow that legalization of drugs with a harm reduction focus, providing things like free needles, safe injection spots, etc., will almost certainly reduce OD deaths.  You gots me on that.

Now let's consider the other, less, ahem, positive effects of what is, after all, essentially surrendering to drug addiction.   Addicts (nothing will convince me to avoid use of this descriptive term... I will refrain from using 'junkie' here) will use their safely provided junk in their safely established shoot up spaces, and they will not OD, but they will continue to destroy themselves on the slow burn.  Meanwhile their families, society as a whole, etc., will pay a great price for their addicthood.   Who really thinks that this is a good thing?

It's not giving in to drug addiction if you think it will result in better outcomes and lower impacts.  If there was any evidence that being tough on drugs reduced access, use rates, or negative outcomes, maybe you would have a point, but that is not the case.  Being tough on drugs appeals to the base gut feelings, but it not built on the facts.

What I find more interesting here is that the religious types seem to share your view, despite preaching love and compassion.  What do you think Jesus would do?  This is a real question, how do you think Jesus would approach drug addiction and rehabilitation?

First of all, there's a variety of opinion among religious types. Nevertheless, one of the reasons conservative religious types tend to be skeptical of hanging everything on the "harm reduction" approach is that many (most?) of peoples' negative outcomes are the result to at least some extent of their own choices. (In religious language, "sin".) So, beating drug addiction is always  going to require dedicated action of the part of the individual. (There are lots of ex-addicts who make this claim as well.) Much of the "marketing" for the harm reduction approach seems to suggest that keeping people from infection and overdose without any significant effort to get people to quit is sufficient. That, I believe, would be the sticking point for many people.

Compassion for people means helping them to lead the most fulfilling life, which is going to be impossible as long as they are addicted to drugs. Allowing people to live in perpetual limbo, alive but unable to be productive members of their community, isn't the most compassionate response.

Quote from: marshwiggle on June 28, 2023, 05:53:53 AM

Quote from: Kron3007 on June 28, 2023, 02:53:02 AM

Quote from: kaysixteen on June 27, 2023, 09:32:45 PMI have been cogitatin' more on this and will allow that legalization of drugs with a harm reduction focus, providing things like free needles, safe injection spots, etc., will almost certainly reduce OD deaths.  You gots me on that.

Now let's consider the other, less, ahem, positive effects of what is, after all, essentially surrendering to drug addiction.   Addicts (nothing will convince me to avoid use of this descriptive term... I will refrain from using 'junkie' here) will use their safely provided junk in their safely established shoot up spaces, and they will not OD, but they will continue to destroy themselves on the slow burn.  Meanwhile their families, society as a whole, etc., will pay a great price for their addicthood.   Who really thinks that this is a good thing?

It's not giving in to drug addiction if you think it will result in better outcomes and lower impacts.  If there was any evidence that being tough on drugs reduced access, use rates, or negative outcomes, maybe you would have a point, but that is not the case.  Being tough on drugs appeals to the base gut feelings, but it not built on the facts.

What I find more interesting here is that the religious types seem to share your view, despite preaching love and compassion.  What do you think Jesus would do?  This is a real question, how do you think Jesus would approach drug addiction and rehabilitation?

First of all, there's a variety of opinion among religious types. Nevertheless, one of the reasons conservative religious types tend to be skeptical of hanging everything on the "harm reduction" approach is that many (most?) of peoples' negative outcomes are the result to at least some extent of their own choices. (In religious language, "sin".) So, beating drug addiction is always  going to require dedicated action of the part of the individual. (There are lots of ex-addicts who make this claim as well.) Much of the "marketing" for the harm reduction approach seems to suggest that keeping people from infection and overdose without any significant effort to get people to quit is sufficient. That, I believe, would be the sticking point for many people.

Compassion for people means helping them to lead the most fulfilling life, which is going to be impossible as long as they are addicted to drugs. Allowing people to live in perpetual limbo, alive but unable to be productive members of their community, isn't the most compassionate response.

Perhaps the "marketing" needs to improve, but I think you are off base that harm reduction proponents do not want to include effort to help people quit.  In fact, a big component of safe consumption sites is the availability to resources to help people quit.  Helping people quit is really at the core of this approach.

From my perspective people against the harm reduction strategy seem to be less inclined to want to help people quit, they are more interested in punishing people for their choices.  I really doubt sending people to jail contributed to recovery, in fact I believe it does the opposite.

As for compassion, do you really think criminalizing people for drug use is compassionate?  Where is the forgiveness?  Where is the understanding?  You do realize how a drug charge can impact someone's entire future right? 

I really think that if Jesus came down to Earth, he would likely support harm reduction strategies and supporting those that need it no?   
 

Let's use a parallel hypothetical here-- in what definition of 'compassion' would it ever be seen as compassionate to offer free cigarettes to homeless smokers?  And yet cigs do not cause people to become intoxicated, and ruin their lives and those of their families. 

I am sick to death of hearing that we should be waiting for the addict to be 'ready' to get off the junk-- being a narcotics addict (even a weed addict, and certainly anything harder) alters your brain, and in what sense could it be that someone in this state should be considered able to make such a rational choice?

That said, I will be saving my Jesus-like 'compassion' for the families, esp the children, of the addicts, the neighbors in the areas where homeless addicts congregate, etc.

I am also forced to acknowledge that things have changed for me physically.  I am not a tall man (5'7''), but I am a big dude, well north of 200lbs, and traditionally as I have been living here in Rusty City, I have more or less not worried about being physically assaulted by some 150lb hophead.  Because, if so assaulted, I would have been able to thump him, via simple poundage.   But my health, stamina, and strength has declined, and I have to admit that I am now actually afraid when I near or see nearing me, such folks.  I am not sure what I could do about this.

Well, if street cigarettes were often laced with cyanide and might kill the homeless smoker, it would be compassionate to give them a safe supply to prevent their death, while using this opportunity to offer them help to quit.  This is the case with street drugs.

In the end, the real question is what leads to the best outcomes.  If you think putting people in jail reduces the number of addicts on the street, I think you are wrong.  The criminalization of drugs only makes the situation worse and is counterproductive.

As for saving your compassion for others and not for all, I don't remember that part of the bible.  Addicts need help, and many of them know it. 

I am also forced to acknowledge that things have changed for me physically.  I am not a tall man (5'7''), but I am a big dude, well north of 200lbs, and traditionally as I have been living here in Rusty City, I have more or less not worried about being physically assaulted by some 150lb hophead.  Because, if so assaulted, I would have been able to thump him, via simple poundage.   But my health, stamina, and strength has declined, and I have to admit that I am now actually afraid when I near or see nearing me, such folks.  I am not sure what I could do about this.

At the risk of being accused of an ad hominem position, might I suggest that you focus on improving your own health, so you might no longer fear those you pass on the sidewalk and so that you might no longer feel the need to use unpleasant rhetoric in describing them.  (Mods...Delete if you feel I am out of bounds.)

It occurred to me that many of the goals of "safe supply" and "harm reduction" we already have in place for our most common drug - alcohol.

Consider:

• Alcohol can only be bought (or served) by government approved vendors (i.e. safe supply).
• Places that serve alcohol are required to cut people off who have consumed too much (i.e. supervising dosage/overdose prevention) and they are required to take car keys, call a cab, etc. so that people don't drive drunk (i.e. harm reduction).

While those measures of harm reduction have some effect, I've never heard anyone claim that those measures actually directly lead to preventing or curing alcoholism. Based on the experience of 12 step programs, which have about the best track record in the long term for treating alcoholism, ultimately it's necessary for the alcoholic to stop going to bars and stop consuming alcohol completely.

The contrast between what is seen as necessary for alcohol versus other drugs is striking, given that many of the medical and psychological issues around addiction are the same.

Quote from: marshwiggle on June 29, 2023, 05:23:43 AMIt occurred to me that many of the goals of "safe supply" and "harm reduction" we already have in place for our most common drug - alcohol.

Consider:

• Alcohol can only be bought (or served) by government approved vendors (i.e. safe supply).
• Places that serve alcohol are required to cut people off who have consumed too much (i.e. supervising dosage/overdose prevention) and they are required to take car keys, call a cab, etc. so that people don't drive drunk (i.e. harm reduction).

While those measures of harm reduction have some effect, I've never heard anyone claim that those measures actually directly lead to preventing or curing alcoholism. Based on the experience of 12 step programs, which have about the best track record in the long term for treating alcoholism, ultimately it's necessary for the alcoholic to stop going to bars and stop consuming alcohol completely.

The contrast between what is seen as necessary for alcohol versus other drugs is striking, given that many of the medical and psychological issues around addiction are the same.

Well, what if...

• Anyone could brew up bathtub gin, moonshine, with no standards for how much alcohol was in there? High risk of alcohol poisoning or other toxins. Or that they might enjoy being really wasted and seek that out.
• Bars could overserve and the result was someone getting into a car accident, fight, etc? The cut-off laws probably at least keep someone's head clear enough that they might realize "hey, I'm getting a little out of hand here" and at least learn to moderate or cut back in the future.

Also note that the legal drinking age is 21, so at least (theoretically) someone is old enough to handle alcohol when they (theoretically) start drinking.

With illegal drugs, there is no way to control effective dosage, usage, or age of the user.

Quote from: ciao_yall on June 29, 2023, 07:45:47 AM

Quote from: marshwiggle on June 29, 2023, 05:23:43 AMIt occurred to me that many of the goals of "safe supply" and "harm reduction" we already have in place for our most common drug - alcohol.

Consider:

• Alcohol can only be bought (or served) by government approved vendors (i.e. safe supply).
• Places that serve alcohol are required to cut people off who have consumed too much (i.e. supervising dosage/overdose prevention) and they are required to take car keys, call a cab, etc. so that people don't drive drunk (i.e. harm reduction).

While those measures of harm reduction have some effect, I've never heard anyone claim that those measures actually directly lead to preventing or curing alcoholism. Based on the experience of 12 step programs, which have about the best track record in the long term for treating alcoholism, ultimately it's necessary for the alcoholic to stop going to bars and stop consuming alcohol completely.

The contrast between what is seen as necessary for alcohol versus other drugs is striking, given that many of the medical and psychological issues around addiction are the same.

Well, what if...

• Anyone could brew up bathtub gin, moonshine, with no standards for how much alcohol was in there? High risk of alcohol poisoning or other toxins. Or that they might enjoy being really wasted and seek that out.
• Bars could overserve and the result was someone getting into a car accident, fight, etc? The cut-off laws probably at least keep someone's head clear enough that they might realize "hey, I'm getting a little out of hand here" and at least learn to moderate or cut back in the future.

Also note that the legal drinking age is 21, so at least (theoretically) someone is old enough to handle alcohol when they (theoretically) start drinking.

With illegal drugs, there is no way to control effective dosage, usage, or age of the user.

My point about all of that was that there seem to be a lot of assumptions about how "safe supply" and "harm reduction" will automatically get many people off drugs, whereas the experience with alcohol is that no-one suggests those sort of measures are getting people off alcohol. And that's without alcohol being served for free, which is what is promoted for "safe supply". Arguing that somehow free alcohol was part of the way to cure alcoholics would be a very hard case to make based on experience.

Quote from: Kron3007 on June 28, 2023, 08:57:49 AMI really think that if Jesus came down to Earth, he would likely support harm reduction strategies and supporting those that need it no?   

I don't know.  It's not like I or probably most other Christians who've seriously thought about the issue are set against harm reduction strategies in principle.  I know that my greatest concern with current approaches to harm reduction is that they seem in danger of normalizing and encouraging drug abuse, and making it more socially acceptable.  And that legalization is making them even more readily available than they were already.  Things that have the effect of encouraging more drug use of all sorts are going to lead to more harms, even with more harm reduction efforts in place.  It reminds me of those whose response to the epidemic of gun crime in our nation is to let everybody carry firearms openly so that ordinary citizens can shoot back.  Reducing gun crime by encouraging even more guns is more than a little counterintuitive.  So is reducing our drugs problems by having even more drugs.

Jesus' message is fundamentally one of responsibility and change.  We may like to think of ourselves as good people whose only problem is that we can't catch a decent break and other people don't treat us right.  Maybe we even are good people by most people's definitions, and have had bad breaks and been treated wrong by others.  But no matter how "good" we are or think we are, no matter how much our problems may seem beyond our control, we're still, individually caught up in sin.  We still don't live right, and aren't right before God, and our collective wrongness is why the whole world is as messed up as it is. 

Each and every one of us is part of the problem.  We can't stop being part of the problem through our own effort.  Jesus' teaching calls on us admit as much, stop making excuses, and turn to him to help us get right with God and with each other.  We have to take responsibility, and we have to change.  It's a change that only God can enable, but that doesn't exempt us from responsibility to strive to work with God.

That's why so many Christians take a "no excuses" approach to drug use, however much compassion we may feel and extend toward those who are dealing with them.  We all have something about who we are that we have no excuses for, whether it's sexual immorality, bad ethical choices (which includes things like racism and a lack of compassion toward those in need), selfish attitudes, and the list goes on and on.  None of us has an excuse.  We all have something we need to work on.  Jesus can give us the strength to work on those things.  That includes drug addiction, as the lives of people I know have demonstrated.

What are the right balances and blends involving law enforcement, and drug treatment programs, and harm reduction?  I confess that I don't know.  There aren't any simple and easy answers.  I admit it.  What concerns me about the emerging consensus on drug use is that society and policy are moving toward a simple answer that says "Let's just legalize everything, let everybody do what they feel like doing, and spend billions and billions of dollars trying to clean up the messes."  That's what I fear we see developing, and I fear we're going to have abundant reason as a society to regret it.

Quote from: marshwiggle on June 29, 2023, 07:53:31 AM

Quote from: ciao_yall on June 29, 2023, 07:45:47 AM

Quote from: marshwiggle on June 29, 2023, 05:23:43 AMIt occurred to me that many of the goals of "safe supply" and "harm reduction" we already have in place for our most common drug - alcohol.

Consider:

• Alcohol can only be bought (or served) by government approved vendors (i.e. safe supply).
• Places that serve alcohol are required to cut people off who have consumed too much (i.e. supervising dosage/overdose prevention) and they are required to take car keys, call a cab, etc. so that people don't drive drunk (i.e. harm reduction).

While those measures of harm reduction have some effect, I've never heard anyone claim that those measures actually directly lead to preventing or curing alcoholism. Based on the experience of 12 step programs, which have about the best track record in the long term for treating alcoholism, ultimately it's necessary for the alcoholic to stop going to bars and stop consuming alcohol completely.

The contrast between what is seen as necessary for alcohol versus other drugs is striking, given that many of the medical and psychological issues around addiction are the same.

Well, what if...

• Anyone could brew up bathtub gin, moonshine, with no standards for how much alcohol was in there? High risk of alcohol poisoning or other toxins. Or that they might enjoy being really wasted and seek that out.
• Bars could overserve and the result was someone getting into a car accident, fight, etc? The cut-off laws probably at least keep someone's head clear enough that they might realize "hey, I'm getting a little out of hand here" and at least learn to moderate or cut back in the future.

Also note that the legal drinking age is 21, so at least (theoretically) someone is old enough to handle alcohol when they (theoretically) start drinking.

With illegal drugs, there is no way to control effective dosage, usage, or age of the user.

My point about all of that was that there seem to be a lot of assumptions about how "safe supply" and "harm reduction" will automatically get many people off drugs, whereas the experience with alcohol is that no-one suggests those sort of measures are getting people off alcohol. And that's without alcohol being served for free, which is what is promoted for "safe supply". Arguing that somehow free alcohol was part of the way to cure alcoholics would be a very hard case to make based on experience.

"Harm reduction" is just that. It recognizes that alcohol, tobacco, drugs, etc when misused can cause harm.

The goal is to put in place safeguards such as supply, usage norms, age limits, and punishment for misuse to recognize that while these products exist, they need to be treated with respect.

Prohibition did not work, even though well-meaning people thought that getting rid of alcohol would get rid of all the related social ills they blamed on booze. Actually it was a Puritan, anti-immigrant response to the Irish, Germans, and Italians who showed up on Ellis Island with their favorite firewater, but that's another conversation.

Can someone enjoy a glass of wine, a cigarette, and a quick shot of heroin after work to relax, without waking up in the gutter, chainsmoking, or comatose from an OD?

 

So I've had patients who are substance users (callling them drug addicts is not the preferred term at all). What to do: if people are in pain provide them adquate pain relief, provide a safe supply, offer programs like methadone treatment, offer counselling, offer in-patient treatment. Above all, treat people with humanity and respect.

Other things harder to implement: provide an adequate social safety net. Reduce racism. In Canada, implement the Calls to Action of the Truth and Reconciliation Commission. Decriminalize drugs.

Quote from: MarathonRunner on June 29, 2023, 08:49:46 AMSo I've had patients who are substance users (callling them drug addicts is not the preferred term at all). What to do: if people are in pain provide them adquate pain relief, provide a safe supply, offer programs like methadone treatment, offer counselling, offer in-patient treatment. Above all, treat people with humanity and respect.

Other things harder to implement: provide an adequate social safety net. Reduce racism. In Canada, implement the Calls to Action of the Truth and Reconciliation Commission. Decriminalize drugs.

Beware weasel words -- legalize drugs, do not merely decriminalize. The latter means that users don't face imprisonment or fines when found with small quantities of "contraband". That increases demand, raising price, but provides no incentive for producers to sell only uncontaminated product. One gets more dangerous stuff.

What's wanted is to call forth a safe supply of drugs. As I said upthread, doctors cannot prescribe opioids in the quantity addicts need. Here, policy is having the opposite effect of that intended.



 

Quote from: ciao_yall on June 29, 2023, 08:15:33 AMCan someone enjoy a glass of wine, a cigarette, and a quick shot of heroin after work to relax, without waking up in the gutter, chainsmoking, or comatose from an OD?

I'm guessing the people who have that much control over their usage don't need harm reduction facilities; they're able to choose what and when they consume.

Quote from: MarathonRunner on June 29, 2023, 08:49:46 AMSo I've had patients who are substance users (callling them drug addicts is not the preferred term at all). What to do: if people are in pain provide them adquate pain relief, provide a safe supply, offer programs like methadone treatment, offer counselling, offer in-patient treatment. Above all, treat people with humanity and respect.

For people with cancer, there are two options: treatment and palliative care. When a person's death is imminent and unavoidable, palliative care is the compassionate choice as it allows them to live their remaining time with minimal pain. However, if their cancer is treatable, and possibly even curable, then offering them palliative care is irresponsible if not downright cruel.  Their best life will be lived if they are cured, rather than just being pain-free for their remaining days. In fact, treatment, be it surgery, chemo, or radiation, is likely to be very uncomfortable, or even painful, in the short term, but with the promise of a vastly better life in the long run.

It's this sense that "offering" treatment to drug users is almost an afterthought that makes me skeptical. It is, by far, the best chance for improved life that most drug users have, but not being up front about this seems as irresponsible as a doctor not telling a patient that their cancer could be treated.

Quote from: marshwiggle on June 29, 2023, 09:52:37 AM

Quote from: ciao_yall on June 29, 2023, 08:15:33 AMCan someone enjoy a glass of wine, a cigarette, and a quick shot of heroin after work to relax, without waking up in the gutter, chainsmoking, or comatose from an OD?

I'm guessing the people who have that much control over their usage don't need harm reduction facilities; they're able to choose what and when they consume.

The point is that by having controlled substances with structure around them, there is reduced risk of addiction and abuse.

And, for those who slide into abuse, there is a graceful path off besides "cold turkey" and the related distress.

People seem to be deliberately misinterpreting what I have been saying.

I did not say 'lock 'em up'... I did say, 'give em a carrot-and-stick choice between rehab and jail.'   I meant it.   It seems difficult to understand how a bunch of academics could not understand how it is not showing 'compassion' to an addict, by allowing him to remain a drug user.  Really, it does.

Now as to my own heatlh, I suppose there are some things I could be doing that I have not been doing, though I have numerous docs, meds, etc., but one thing I certainly could never do is stop being 55 in favor of again becoming 30.  My own apt bldg is a 50+ unit, and at 55 I am probably 10+ years younger than the average resident here.  Many of these people would have *no hope whatsoever* of defending themselves against hopheads who attempted to commit crimes against them, and would undoubtedly feel great pressure to donate money to aggressive doper panhandlers, etc.  Such indivuduals, therefore, should simply not be allowed to congregate around the building.   It is not being uncompassionate to these folks to say this, largely because it is being compassionate to the elderly folks who live here, to provide them with a safe environment here.   Put simply, sometimes one cannot be 'compassionate' to two people whose interests and behaviors simply contradict each other.

Quote from: marshwiggle on June 29, 2023, 09:52:37 AM

Quote from: ciao_yall on June 29, 2023, 08:15:33 AMCan someone enjoy a glass of wine, a cigarette, and a quick shot of heroin after work to relax, without waking up in the gutter, chainsmoking, or comatose from an OD?

I'm guessing the people who have that much control over their usage don't need harm reduction facilities; they're able to choose what and when they consume.

Quote from: MarathonRunner on June 29, 2023, 08:49:46 AMSo I've had patients who are substance users (callling them drug addicts is not the preferred term at all). What to do: if people are in pain provide them adquate pain relief, provide a safe supply, offer programs like methadone treatment, offer counselling, offer in-patient treatment. Above all, treat people with humanity and respect.

For people with cancer, there are two options: treatment and palliative care. When a person's death is imminent and unavoidable, palliative care is the compassionate choice as it allows them to live their remaining time with minimal pain. However, if their cancer is treatable, and possibly even curable, then offering them palliative care is irresponsible if not downright cruel.  Their best life will be lived if they are cured, rather than just being pain-free for their remaining days. In fact, treatment, be it surgery, chemo, or radiation, is likely to be very uncomfortable, or even painful, in the short term, but with the promise of a vastly better life in the long run.

It's this sense that "offering" treatment to drug users is almost an afterthought that makes me skeptical. It is, by far, the best chance for improved life that most drug users have, but not being up front about this seems as irresponsible as a doctor not telling a patient that their cancer could be treated.

So, what is the best way to encourage a drug user to quit or seek help?  Is it being thrown in Jail and forced, or is it more effective to present treatment options in a not judgmental environment?

Your example of alcohol is interesting, but I think it demonstrates the benefits of safe consumption.  We tried prohibition, it didnt work, resulted in more dangerous tainted supply lines, and fueled organized crime.  While having bars dosnt directy help people quit, the fact that drinking is not illegal makes it much easier and more acceptable for people to join AA. 

Regarding free drugs, that is not necessarily the goal.  A legal supply line would not be free, but it would be as safe as possible for the drug in question.  You would be assured the purity and it would prevent overdoses.  It would save lives. 
 

Quote from: kaysixteen on June 29, 2023, 10:30:15 AMPeople seem to be deliberately misinterpreting what I have been saying.

I did not say 'lock 'em up'... I did say, 'give em a carrot-and-stick choice between rehab and jail.'   I meant it.   It seems difficult to understand how a bunch of academics could not understand how it is not showing 'compassion' to an addict, by allowing him to remain a drug user.  Really, it does.

Now as to my own heatlh, I suppose there are some things I could be doing that I have not been doing, though I have numerous docs, meds, etc., but one thing I certainly could never do is stop being 55 in favor of again becoming 30.  My own apt bldg is a 50+ unit, and at 55 I am probably 10+ years younger than the average resident here.  Many of these people would have *no hope whatsoever* of defending themselves against hopheads who attempted to commit crimes against them, and would undoubtedly feel great pressure to donate money to aggressive doper panhandlers, etc.  Such indivuduals, therefore, should simply not be allowed to congregate around the building.   It is not being uncompassionate to these folks to say this, largely because it is being compassionate to the elderly folks who live here, to provide them with a safe environment here.   Put simply, sometimes one cannot be 'compassionate' to two people whose interests and behaviors simply contradict each other.

What do you believe the long term success rate is for someone that is forced into rehab to avoid jail?  In the end, we should be following data to develop policy that results in the least harm to public health.  I dont think there is any evidence that criminalization is the best approach in any metric.     

Quote from: Kron3007 on June 29, 2023, 10:32:50 AM

Quote from: marshwiggle on June 29, 2023, 09:52:37 AM

Quote from: ciao_yall on June 29, 2023, 08:15:33 AMCan someone enjoy a glass of wine, a cigarette, and a quick shot of heroin after work to relax, without waking up in the gutter, chainsmoking, or comatose from an OD?

I'm guessing the people who have that much control over their usage don't need harm reduction facilities; they're able to choose what and when they consume.

Quote from: MarathonRunner on June 29, 2023, 08:49:46 AMSo I've had patients who are substance users (callling them drug addicts is not the preferred term at all). What to do: if people are in pain provide them adquate pain relief, provide a safe supply, offer programs like methadone treatment, offer counselling, offer in-patient treatment. Above all, treat people with humanity and respect.

For people with cancer, there are two options: treatment and palliative care. When a person's death is imminent and unavoidable, palliative care is the compassionate choice as it allows them to live their remaining time with minimal pain. However, if their cancer is treatable, and possibly even curable, then offering them palliative care is irresponsible if not downright cruel.  Their best life will be lived if they are cured, rather than just being pain-free for their remaining days. In fact, treatment, be it surgery, chemo, or radiation, is likely to be very uncomfortable, or even painful, in the short term, but with the promise of a vastly better life in the long run.

It's this sense that "offering" treatment to drug users is almost an afterthought that makes me skeptical. It is, by far, the best chance for improved life that most drug users have, but not being up front about this seems as irresponsible as a doctor not telling a patient that their cancer could be treated.

So, what is the best way to encourage a drug user to quit or seek help?  Is it being thrown in Jail and forced, or is it more effective to present treatment options in a not judgmental environment?

Not requiring jail time for possession of small quantities doesn't require giving people access to drugs. (And even for alcohol, people can be arrested for "drunk and disorderly" when their conduct puts other people at risk. That should also apply to drug users.)

 

QuoteYour example of alcohol is interesting, but I think it demonstrates the benefits of safe consumption.  We tried prohibition, it didnt work, resulted in more dangerous tainted supply lines, and fueled organized crime.  While having bars dosnt directy help people quit, the fact that drinking is not illegal makes it much easier and more acceptable for people to join AA. 

Regarding free drugs, that is not necessarily the goal.  A legal supply line would not be free, but it would be as safe as possible for the drug in question.  You would be assured the purity and it would prevent overdoses.  It would save lives. 
 

So the safe supply advocates would turn someone away if they didn't have the cash for their dose of heroin?

Quote from: marshwiggle on June 29, 2023, 11:13:58 AMSo the safe supply advocates would turn someone away if they didn't have the cash for their dose of heroin?

"Safe supply" sources do not give heroin away for free. Where did you get this idea? The person shows up to a safe injection site with the heroin they have in their possession, no questions asked.

Quote from: marshwiggle on June 29, 2023, 11:13:58 AM

Quote from: Kron3007 on June 29, 2023, 10:32:50 AM

Quote from: marshwiggle on June 29, 2023, 09:52:37 AM

Quote from: ciao_yall on June 29, 2023, 08:15:33 AMCan someone enjoy a glass of wine, a cigarette, and a quick shot of heroin after work to relax, without waking up in the gutter, chainsmoking, or comatose from an OD?

I'm guessing the people who have that much control over their usage don't need harm reduction facilities; they're able to choose what and when they consume.

Quote from: MarathonRunner on June 29, 2023, 08:49:46 AMSo I've had patients who are substance users (callling them drug addicts is not the preferred term at all). What to do: if people are in pain provide them adquate pain relief, provide a safe supply, offer programs like methadone treatment, offer counselling, offer in-patient treatment. Above all, treat people with humanity and respect.

For people with cancer, there are two options: treatment and palliative care. When a person's death is imminent and unavoidable, palliative care is the compassionate choice as it allows them to live their remaining time with minimal pain. However, if their cancer is treatable, and possibly even curable, then offering them palliative care is irresponsible if not downright cruel.  Their best life will be lived if they are cured, rather than just being pain-free for their remaining days. In fact, treatment, be it surgery, chemo, or radiation, is likely to be very uncomfortable, or even painful, in the short term, but with the promise of a vastly better life in the long run.

It's this sense that "offering" treatment to drug users is almost an afterthought that makes me skeptical. It is, by far, the best chance for improved life that most drug users have, but not being up front about this seems as irresponsible as a doctor not telling a patient that their cancer could be treated.

So, what is the best way to encourage a drug user to quit or seek help?  Is it being thrown in Jail and forced, or is it more effective to present treatment options in a not judgmental environment?

Not requiring jail time for possession of small quantities doesn't require giving people access to drugs. (And even for alcohol, people can be arrested for "drunk and disorderly" when their conduct puts other people at risk. That should also apply to drug users.)

 

QuoteYour example of alcohol is interesting, but I think it demonstrates the benefits of safe consumption.  We tried prohibition, it didnt work, resulted in more dangerous tainted supply lines, and fueled organized crime.  While having bars dosnt directy help people quit, the fact that drinking is not illegal makes it much easier and more acceptable for people to join AA. 

Regarding free drugs, that is not necessarily the goal.  A legal supply line would not be free, but it would be as safe as possible for the drug in question.  You would be assured the purity and it would prevent overdoses.  It would save lives. 
 

So the safe supply advocates would turn someone away if they didn't have the cash for their dose of heroin?

Which is why I support full legalization.  Decriminalization makes sense, but doesn't address some of the core problems.

Just as you mentioned earlier about religious people having many different stances so do people that support safe supply.  In my version, it would be legal and they would need to pay.  I. Addition, there would likely p
Be locations in larger cities for people to use it and access information about rehab etc. 

Quote from: dismalist on June 29, 2023, 09:17:56 AMBeware weasel words -- legalize drugs, do not merely decriminalize. The latter means that users don't face imprisonment or fines when found with small quantities of "contraband". That increases demand, raising price, but provides no incentive for producers to sell only uncontaminated product. One gets more dangerous stuff.

Fair enough. A lot of the work being done at community health centres is to advocate for at least decriminalization, as that is more palatable to politicians that legalization. But I do agree, legalization would be ideal.

Quote from: ciao_yall on June 29, 2023, 11:26:37 AM

Quote from: marshwiggle on June 29, 2023, 11:13:58 AMSo the safe supply advocates would turn someone away if they didn't have the cash for their dose of heroin?

"Safe supply" sources do not give heroin away for free. Where did you get this idea? The person shows up to a safe injection site with the heroin they have in their possession, no questions asked.

What you're talking about is "safe injection". Safe supply (https://www.catie.ca/prevention-in-focus/safe-supply-what-is-it-and-what-is-happening-in-canada) actually involves providing the drugs themselves, produced in (presumably) government-approved facilities.

QuoteThe Canadian Association of People Who Use Drugs (CAPUD) defines safe supply as "a legal and regulated supply of drugs with mind/body altering properties that traditionally have been accessible only through the illicit drug market." This covers many drugs that are currently illegal, including heroin, fentanyl, cocaine, methamphetamines and MDMA. The goal of safe supply is to enable people who use drugs to access regulated substances from a legal source, rather than toxic versions from illicit markets — ultimately saving lives.

Quote from: marshwiggle on June 30, 2023, 10:14:25 AM

Quote from: ciao_yall on June 29, 2023, 11:26:37 AM

Quote from: marshwiggle on June 29, 2023, 11:13:58 AMSo the safe supply advocates would turn someone away if they didn't have the cash for their dose of heroin?

"Safe supply" sources do not give heroin away for free. Where did you get this idea? The person shows up to a safe injection site with the heroin they have in their possession, no questions asked.

What you're talking about is "safe injection". Safe supply (https://www.catie.ca/prevention-in-focus/safe-supply-what-is-it-and-what-is-happening-in-canada) actually involves providing the drugs themselves, produced in (presumably) government-approved facilities.

QuoteThe Canadian Association of People Who Use Drugs (CAPUD) defines safe supply as "a legal and regulated supply of drugs with mind/body altering properties that traditionally have been accessible only through the illicit drug market." This covers many drugs that are currently illegal, including heroin, fentanyl, cocaine, methamphetamines and MDMA. The goal of safe supply is to enable people who use drugs to access regulated substances from a legal source, rather than toxic versions from illicit markets — ultimately saving lives.

From the article...

=====
So far, safe supply has been happening through a medical model where a person needs to obtain a prescription for a regulated substance from a healthcare provider. This is because, in the context of drug prohibition, a prescription is the only legal way to access many substances with mind/body altering effects. Some of the prescriptions for safe supply are provided within primary care-based programs, which involve ongoing assessments, monitoring and engagement in healthcare and case management services.29 To provide safe supply, hydromorphone can be prescribed as an alternative to illicit opioids such as fentanyl. Hydromorphone is commonly chosen because it is legal, it is covered by most provincial and territorial public drug plans and it is acceptable to people who use opioids.31,32 Other drugs that may be used as safe supply include methylphenidate (a stimulant), diazepam (a benzodiazepine) and diacetylmorphine (heroin).20,26
=====

The government is not making and giving away whatever party drug anyone wants for free.

Quote from: ciao_yall on June 30, 2023, 12:02:55 PM

Quote from: marshwiggle on June 30, 2023, 10:14:25 AM

Quote from: ciao_yall on June 29, 2023, 11:26:37 AM

Quote from: marshwiggle on June 29, 2023, 11:13:58 AMSo the safe supply advocates would turn someone away if they didn't have the cash for their dose of heroin?

"Safe supply" sources do not give heroin away for free. Where did you get this idea? The person shows up to a safe injection site with the heroin they have in their possession, no questions asked.

What you're talking about is "safe injection". Safe supply (https://www.catie.ca/prevention-in-focus/safe-supply-what-is-it-and-what-is-happening-in-canada) actually involves providing the drugs themselves, produced in (presumably) government-approved facilities.

QuoteThe Canadian Association of People Who Use Drugs (CAPUD) defines safe supply as "a legal and regulated supply of drugs with mind/body altering properties that traditionally have been accessible only through the illicit drug market." This covers many drugs that are currently illegal, including heroin, fentanyl, cocaine, methamphetamines and MDMA. The goal of safe supply is to enable people who use drugs to access regulated substances from a legal source, rather than toxic versions from illicit markets — ultimately saving lives.

From the article...

=====
So far, safe supply has been happening through a medical model where a person needs to obtain a prescription for a regulated substance from a healthcare provider. This is because, in the context of drug prohibition, a prescription is the only legal way to access many substances with mind/body altering effects. Some of the prescriptions for safe supply are provided within primary care-based programs, which involve ongoing assessments, monitoring and engagement in healthcare and case management services.29 To provide safe supply, hydromorphone can be prescribed as an alternative to illicit opioids such as fentanyl. Hydromorphone is commonly chosen because it is legal, it is covered by most provincial and territorial public drug plans and it is acceptable to people who use opioids.31,32 Other drugs that may be used as safe supply include methylphenidate (a stimulant), diazepam (a benzodiazepine) and diacetylmorphine (heroin).20,26
=====

The government is not making and giving away whatever party drug anyone wants for free.

No, but they are giving away prescription drugs for free. So cost is no barrier to maintaining a drug habit.

Quote from: marshwiggle on June 30, 2023, 01:45:30 PMNo, but they are giving away prescription drugs for free. So cost is no barrier to maintaining a drug habit.

That's fine by me. Much better than the person needing to steal, rob, undertake sex work, or sell drugs to feed their addiction.

Quote from: marshwiggle on June 30, 2023, 01:45:30 PM

Quote from: ciao_yall on June 30, 2023, 12:02:55 PM

Quote from: marshwiggle on June 30, 2023, 10:14:25 AM

Quote from: ciao_yall on June 29, 2023, 11:26:37 AM

Quote from: marshwiggle on June 29, 2023, 11:13:58 AMSo the safe supply advocates would turn someone away if they didn't have the cash for their dose of heroin?

"Safe supply" sources do not give heroin away for free. Where did you get this idea? The person shows up to a safe injection site with the heroin they have in their possession, no questions asked.

What you're talking about is "safe injection". Safe supply (https://www.catie.ca/prevention-in-focus/safe-supply-what-is-it-and-what-is-happening-in-canada) actually involves providing the drugs themselves, produced in (presumably) government-approved facilities.

QuoteThe Canadian Association of People Who Use Drugs (CAPUD) defines safe supply as "a legal and regulated supply of drugs with mind/body altering properties that traditionally have been accessible only through the illicit drug market." This covers many drugs that are currently illegal, including heroin, fentanyl, cocaine, methamphetamines and MDMA. The goal of safe supply is to enable people who use drugs to access regulated substances from a legal source, rather than toxic versions from illicit markets — ultimately saving lives.

From the article...

=====
So far, safe supply has been happening through a medical model where a person needs to obtain a prescription for a regulated substance from a healthcare provider. This is because, in the context of drug prohibition, a prescription is the only legal way to access many substances with mind/body altering effects. Some of the prescriptions for safe supply are provided within primary care-based programs, which involve ongoing assessments, monitoring and engagement in healthcare and case management services.29 To provide safe supply, hydromorphone can be prescribed as an alternative to illicit opioids such as fentanyl. Hydromorphone is commonly chosen because it is legal, it is covered by most provincial and territorial public drug plans and it is acceptable to people who use opioids.31,32 Other drugs that may be used as safe supply include methylphenidate (a stimulant), diazepam (a benzodiazepine) and diacetylmorphine (heroin).20,26
=====

The government is not making and giving away whatever party drug anyone wants for free.

No, but they are giving away prescription drugs for free. So cost is no barrier to maintaining a drug habit.

The point of the prescription drug is to help the person get off the illegal drug.

I can't believe you are really this stupid obtuse.

Quote from: Kron3007 on June 29, 2023, 10:32:50 AMSo, what is the best way to encourage a drug user to quit or seek help?  Is it being thrown in Jail and forced, or is it more effective to present treatment options in a not judgmental environment?

SAMSA: Does Mandating Offenders to Treatment Improve Completion Rates? (https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3578041/)

QuoteThe participants were enrolled in an intensive outpatient program and were recruited into the study between July 2007 and October 2010. All offenders received weekly therapy sessions using a cognitive problem solving framework and 45% completed the six month treatment program. Interestingly, those who were mandated demonstrated less motivation at treatment entry, yet were more likely to complete treatment compared to those who were not court-ordered to treatment. While controlling for covariates known to be related to treatment completion, the logistic regression analyses demonstrated that court-ordered offenders were over ten times more likely to complete treatment compared to those who entered treatment voluntarily (OR = 10.9, CI = 2.0–59.1, p = .006). These findings demonstrate that stipulated treatment for offenders may be an effective way to increase treatment compliance.

I also found a number of websites that claim court-ordered rehab is as effective as voluntary rehab, but I did not feel like going to Ebscohost and chasing these down. 

This is interesting to me because I went through rehab with two fellas who were court-ordered into the program.  I don't know what happened to them long-term, but neither was particularly resentful that they were there.  In fact, both fellas took it very seriously and worked the program; both were avoiding criminal prosecution, and if you are faced with jail or rehab, rehab looks pretty good.  When we get the point of needing rehabilitation and sobriety, most of us are grateful for the opportunity.  We want out of that lifestyle.

Random points:

1) Is this Canadian drug user org a serious legit organization, or some sort of internet troll thing?   If it is, is there anything comparable on this side of the border?   I say this because, like NAMBLA, this sounds like a bunch of people advocating something that is likely very much opposed by the overwhelming majority of their countries' population (Canadian politics are supposed to be somewhat to the left of ours, but they cannot be that much to the left).  And passing out narcotics free/ at cost, well... let's just say that at least on this side of the border, the *overwhelming majority of Americans would stridently oppose any such idea.  Similarly, I get that the housing crisis here contributes to the opioid epidemic, but giving free housing to able-bodied working-age people who would not work, but rather just indulge in narcotics use in said free housing, well, good luck getting that through Congress too.

2) Someone noted that, in their view, these safe injection sites should simply be places where addicts can shoot up safely, with oversight (presumably), but using drugs they have purchased off-site-- where are they supposed to get the money to purchase said pharmaceuticals, legal or otherwise?

Quote from: kaysixteen on June 30, 2023, 09:20:51 PMRandom points:

1) Is this Canadian drug user org a serious legit organization, or some sort of internet troll thing?   If it is, is there anything comparable on this side of the border?   I say this because, like NAMBLA, this sounds like a bunch of people advocating something that is likely very much opposed by the overwhelming majority of their countries' population (Canadian politics are supposed to be somewhat to the left of ours, but they cannot be that much to the left).

I can't tell you about the polling, but I can tell you you might well be quite surprised by how much further left most of the country is, though this of course varies significantly by province and, to an extent, by issue. You should perhaps know that Brtitish Columbia had the first supervised injection site in North America, which was established in 2000; since then, I think we now have around 40 supervised injection sites across the country. It's been a phenomenal success, and is well known internationally. Way back in 2010ish, when the Conservative government was trying to shut downInsite (the supervised injection site), polling showed that just a quarter of the population wanted it shut down; in BC, nearly three-quarters supported its existence. And recently, the federal government decriminalized possession of a small amount of certain hard drugs (opioids, coke, meth) in BC.

Quote from: kaysixteen on June 30, 2023, 09:20:51 PMCanadian politics are supposed to be somewhat to the left of ours, but they cannot be that much to the left

You would be surprised then. Most Canadians, from the polls I've seen, support supervised injection sites and a safe supply. The majority support things like methadone programs. Don't have access to links right now, but that's what I recall.

Canadians believe in things like single-payer health care, an adequate social safety net, funding public schools (we pay taxes in Ontario to support the local school board, I"m not sure about other provinces), we pay teachers a decent salary, we don't let insurance decide what medical treatments someone can get physicians or other health care professionals make that decision, and the like, except in Alberta, which is often called Canada's Texas. We also had legal same-sex marriages long before the U.S., allowed women in combat trades in the military long before the U.S., and allow women to serve in every single trade, combat or not, in the military. We have members of the military who are homosexual and transgender, with absolutely no issue. Sadly, with the conservatives being in power in many provincial governments right now, things like our health care system and our social support systems are being torn apart. :(

Quote from: MarathonRunner on July 01, 2023, 04:17:28 AM

Quote from: kaysixteen on June 30, 2023, 09:20:51 PMCanadian politics are supposed to be somewhat to the left of ours, but they cannot be that much to the left

You would be surprised then. Most Canadians, from the polls I've seen, support supervised injection sites and a safe supply. The majority support things like methadone programs. Don't have access to links right now, but that's what I recall.

Canadians believe in things like single-payer health care, an adequate social safety net, funding public schools (we pay taxes in Ontario to support the local school board, I"m not sure about other provinces), we pay teachers a decent salary, we don't let insurance decide what medical treatments someone can get physicians or other health care professionals make that decision, and the like, except in Alberta, which is often called Canada's Texas. We also had legal same-sex marriages long before the U.S., allowed women in combat trades in the military long before the U.S., and allow women to serve in every single trade, combat or not, in the military. We have members of the military who are homosexual and transgender, with absolutely no issue. Sadly, with the conservatives being in power in many provincial governments right now, things like our health care system and our social support systems are being torn apart. :(

Canadians are also less extreme than Americans. Compare the trucker convoy to the Jan. 6 insurrection. The truckers were noisy and obnoxious, and it lasted longer, but there was no bloodshed. Similarly, we didn't have anything like the George Floyd riots. So there's a much smaller militant faction on both ends of the spectrum. And, because we have more than two parties, it's not just an Us vs. Them dynamic. (If you look at provincial elections, it isn't even the same top two parties everywhere; this reflects that the issues are more complex than  just "left vs. right".)

(And, as noted above, things like universal healthcare are strongly supported across the spectrum. Virtually no-one wants an American-type system. A couple of decades ago there was a survey of Canadians' raking of important government services. National defence came second. Healthcare was first.)

A question came to my mind-- is there anything resembling the current American 'opioid epidemic' going on in Canada?  If not, why not?

Quote from: kaysixteen on July 01, 2023, 09:25:11 PMA question came to my mind-- is there anything resembling the current American 'opioid epidemic' going on in Canada?  If not, why not?

Yes. It's a huge problem in British Columbia in particular, especially in Vancouver and its environs.

Prescription opioids were a big driver, as in the US. Some of these effects were and are mitigated by a health system that's not run for profit, however. And by the 40+ supervised injection sites across the country. And the fact that here, Naloxone is available free and over the counter.

As I recall, Canada is the world's second-highest consumer of opioids, after the US (not surprising, really, since shit tends to roll downhill, so to speak; we are a client kingdom, after all). BC has the highest death rate, and it's about half of West Virginia's (the US's highest when last I checked).

BC, Ontario, and Alberta have the highest death rates. Both Ontario and Alberta are far more conservative (and so have fewer supports like safe injection sites) than the lower mainland of BC.
Govt of Canada summary (https://health-infobase.canada.ca/substance-related-harms/opioids-stimulants/)

It might be useful to distinguish between a baseline share of the population that is addicted and an explosion of deaths upon the opioid "epidemic".

Here are death rates from alcohol and drug misuse 1990 - 2019

Death Rates (https://ourworldindata.org/grapher/death-rates-substance-disorders-who?tab=chart&country=CAN~SWE~DEU~GBR~USA)

Note the explosion in death rates is limited to the United States, with Canada  having about half as rapid a rise, and the other countries shown, having almost no rise. This last is not just due to nice social programs but also to effective law enforcement.

If one worries mainly about the sharp increase in the death rate, there may be a silver bullet available -- Naloxone, an anti-opioid -- now available OTC in the US in the form of a nasal spray [previously prescription IV]. Medicare and medicaid pay for it, as does private insurance. In addition there are many State and charitable enterprises that give this stuff away free. OTC it would cost < $25 per dose. That's incredibly cheap to save a life!

It's also free in Canada, though its availability in pharmacies, including especially the nasal spray, varies by province.

OK, so how is BC different from say, Saskatchewan, that might make BC more likely to go for the smack?  IOW, Sask. is more conservative politically, right, and so likely to be much less amenable to free injection sites, etc.-- or am I missing something?

How is opioid addiction correlated to homelessness in Canada, and how does that differ from here?   Does one see a large quantity of obviously addicted homeless people panhandling, living in tent squatter camps, etc., like we do even in liberal states like mine?

Quote from: kaysixteen on July 02, 2023, 08:17:16 PMOK, so how is BC different from say, Saskatchewan, that might make BC more likely to go for the smack?  IOW, Sask. is more conservative politically, right, and so likely to be much less amenable to free injection sites, etc.-- or am I missing something?

In the Vancouver area (and on Vancouver Island), the temperature barely drops below freezing in the winter, and that, just for a couple weeks. It's a temperate rainforest. In Saskatchewan, by contrast, you're looking at -20 - -40 for months.

People migrate over because it's easier not to die, because it's a major population centre (unlike the prairies), so employment prospects are decent, and yes, because Vancouver was the main hub of the Canadian drug trade. Unfortunately, it's also the second least affordable city to live in in the world.

QuoteDoes one see a large quantity of obviously addicted homeless people panhandling, living in tent squatter camps, etc., like we do even in liberal states like mine?

Run a Google image search for 'East Hastings'. It's the poster child for homelessness and drug addiction in Vancouver. Imagine 3000+ homeless or addicted people smashed together into a few city blocks.

My entirely unscientific experience is that East Hastings is significantly worse than anywhere I've seen in the US, including anywhere in Hawai'i, Philadelphia, New Orleans, San Francisco, Portland, etc. (One possibility is that the concentration of misery is just higher on East Hastings, and more widely distributed in US cities.) On East Hastings, more people just seem to be having a much harder time of life than the people I've seen and spoken to on American streets. Not that they were having an easy time, by any means.

Yeah, if I found myself homeless I would definitely head west.  I can't fathom being homeless in Toronto, Montreal, etc. During the winter, let alone Saskatoon.

Also, when I was young it was pretty common for people to head west after high school to be ski bums or whatever.  A lot of dudes I knew that headed west were into drugs, and many still are from what I can tell.  The west coast seems to be a beacon for a variety of reasons.

I believe this is also true in America though, no?

Quote from: kaysixteen on July 02, 2023, 08:17:16 PMlike we do even in liberal states like mine?

Reflexively seeking a sectarian political answer is a little silly, my friend.

The answer, as someone has pointed out, for the large homeless population in some parts of the country is west coast weather.  We have relatively few homeless where we live despite a rabid drug abuse problem, poverty, and crime because the summers are miserably humid and the winters deadly. 

Quote from: kaysixteen on June 30, 2023, 09:20:51 PM1) Is this Canadian drug user org a serious legit organization, or some sort of internet troll thing?   If it is, is there anything comparable on this side of the border?   I say this because, like NAMBLA,

I never thought to equate NAMBLA child sex advocates with drug users.  Where in the world do you get these ideas, K16?

Quote from: nebo113 on July 03, 2023, 04:10:51 PM

Quote from: kaysixteen on June 30, 2023, 09:20:51 PM1) Is this Canadian drug user org a serious legit organization, or some sort of internet troll thing?   If it is, is there anything comparable on this side of the border?   I say this because, like NAMBLA,

I never thought to equate NAMBLA child sex advocates with drug users.  Where in the world do you get these ideas, K16?

I hate to always beat this dead horse, but these sorts of gratuitous comparisons are a sign that real logic or factual reasoning are not present.  The point is misdirection and demagogy.

NAMBLA, BTW, is utterly powerless and largely pointless unless we pay attention to it.

Did you read what I said or are you just interested in dismissing me because you do not like the implications of my remarks?   NAMBLA is a real group, and they do advocate a position that the vast majority of Americans find disgusting and unacceptable.   This Canadian 'people who use drugs' outfit is *just a wee bit less outre* than NAMBLA is, and would be even more similar to NAMBLA here.   IOW, most Americans do not now and will almost certainly *never* believe in the positions that the Canadian junkie association advocates.   It does not take a PhD in logic to see the connections.  I for one will *never* vote for anyone who advocates passing out free drugs to addicts, legalizing recreational opioids, etc., and my experiences here in Rusty City only have hardened me in this thinking. 

BTW, I have also noticed that no one who advocates free injection sites to be used by addicts who will be expected to BYO drugs has answered my question regarding where said users are to get the funds to acquire such pharmaceuticals?

Quote from: kaysixteen on July 03, 2023, 07:22:41 PMDid you read what I said or are you just interested in dismissing me because you do not like the implications of my remarks?   

I simply find your comments false equivalencies. 

Quote from: kaysixteen on July 03, 2023, 07:22:41 PMBTW, I have also noticed that no one who advocates free injection sites to be used by addicts who will be expected to BYO drugs has answered my question regarding where said users are to get the funds to acquire such pharmaceuticals?

If it were up to me, they wouldn't need to pay for them.

You know, most of them are not particularly happy about being addicted, and don't particularly enjoy it. They're just trapped.

Quote from: Wahoo Redux on July 03, 2023, 07:50:27 PM

Quote from: kaysixteen on July 03, 2023, 07:22:41 PMDid you read what I said or are you just interested in dismissing me because you do not like the implications of my remarks? 

I simply find your comments false equivalencies. 

Because they are....

Quote from: Parasaurolophus on July 03, 2023, 11:00:16 PM

Quote from: kaysixteen on July 03, 2023, 07:22:41 PMBTW, I have also noticed that no one who advocates free injection sites to be used by addicts who will be expected to BYO drugs has answered my question regarding where said users are to get the funds to acquire such pharmaceuticals?

If it were up to me, they wouldn't need to pay for them.

You know, most of them are not particularly happy about being addicted, and don't particularly enjoy it. They're just trapped.

This also isn't a black and white decision.  In a legal framework, where drugs need to be paid for, there would be charitable agencies (private or public) that give them out for those in need, along with helping access various services.

The really messed up part of all this is that many opiates are actually legal (with prescription) and there is a safe supply structure in place.  We just don't allow users to access the safe supply, instead leaving them to buy contaminated street drugs to prop up organized crime. Even in the case of fentanyl (a legal pharmaceutical) which is causing tons of death, the primary reason is inaccurate labelling and dosage.  If users knew what was in their drugs, we would have far fewer overdoses and deaths.  It is all quite backward.

Quote from: kaysixteen on July 03, 2023, 07:22:41 PMDid you read what I said or are you just interested in dismissing me because you do not like the implications of my remarks?  NAMBLA is a real group, and they do advocate a position that the vast majority of Americans find disgusting and unacceptable.  This Canadian 'people who use drugs' outfit is *just a wee bit less outre* than NAMBLA is, and would be even more similar to NAMBLA here.  IOW, most Americans do not now and will almost certainly *never* believe in the positions that the Canadian junkie association advocates.  It does not take a PhD in logic to see the connections.  I for one will *never* vote for anyone who advocates passing out free drugs to addicts, legalizing recreational opioids, etc., and my experiences here in Rusty City only have hardened me in this thinking. 

What is so terrible about the North American Marlon Brando Lookalike Association? If people want to dress up and quote The Godfather they are more than welcome to do so.

Quote from: Parasaurolophus on July 03, 2023, 11:00:16 PM

Quote from: kaysixteen on July 03, 2023, 07:22:41 PMBTW, I have also noticed that no one who advocates free injection sites to be used by addicts who will be expected to BYO drugs has answered my question regarding where said users are to get the funds to acquire such pharmaceuticals?

If it were up to me, they wouldn't need to pay for them.

You know, most of them are not particularly happy about being addicted, and don't particularly enjoy it. They're just trapped.

Thunder Bay paramedics report naloxone use jumped 5 times over previous year (https://www.cbc.ca/news/canada/thunder-bay/2017-2018-naloxone-administration-1.4989956)

Quote'Russian roulette'
Even five years ago, Ross said paramedics weren't called nearly as often to deal with overdoses as they are now, even with naloxone — also known under the brand name Narcan — much more prevalent in the community.
"The harm reduction in that regard may be working in keeping people out of the hospital but may be not necessarily the best for these people because you know there's underlying addiction issues or mental health issues that aren't being assessed or treated," he said.

"So they're just continuing to use narcotics like they normally would and giving themselves Narcan and nothing's really changing, it's kind of just a big loop."

That means some cases where people are overdosing multiple times in a single day — or other dangerous behaviours.

"We've even had issues where there'd be a couple people taking, seeing how much opiates they can take before they go unconscious and then reviving themselves, or having their friend revive them, with Narcan," he said. "Almost like a Russian roulette-type of game, which is completely ridiculous."

That sounds like they're enjoying it quite a bit.

"Harm reduction" = "Moral hazard"

QuoteMoral hazard can lead to personal, professional, and economic harm when individuals or entities in a transaction can engage in risky behavior because the other parties are contractually bound to assume the negative consequences.

In other words, when people perceive something as "safer", they push the boundaries farther.

Quote from: marshwiggle on July 06, 2023, 08:18:07 AM...

"Harm reduction" = "Moral hazard"

QuoteMoral hazard can lead to personal, professional, and economic harm when individuals or entities in a transaction can engage in risky behavior because the other parties are contractually bound to assume the negative consequences.

In other words, when people perceive something as "safer", they push the boundaries farther.

Careful, moral hazard does not imply that behavioral changes overcome the benefits. They merely reduce the benefits.

Otherwise, we'd have to be against fire insurance [more smoking in bed], seat belts [more reckless driving], condoms [more sex in spite of STD's] and so on.

Charging for nalaxone helps, just as condoms are not free, but in the end, no one, certainly no medic, is gonna let somebody go down the tubes to save $25.

Quote from: marshwiggle on July 06, 2023, 08:18:07 AM

Quote from: Parasaurolophus on July 03, 2023, 11:00:16 PM

Quote from: kaysixteen on July 03, 2023, 07:22:41 PMBTW, I have also noticed that no one who advocates free injection sites to be used by addicts who will be expected to BYO drugs has answered my question regarding where said users are to get the funds to acquire such pharmaceuticals?

If it were up to me, they wouldn't need to pay for them.

You know, most of them are not particularly happy about being addicted, and don't particularly enjoy it. They're just trapped.

Thunder Bay paramedics report naloxone use jumped 5 times over previous year (https://www.cbc.ca/news/canada/thunder-bay/2017-2018-naloxone-administration-1.4989956)

Quote'Russian roulette'
Even five years ago, Ross said paramedics weren't called nearly as often to deal with overdoses as they are now, even with naloxone — also known under the brand name Narcan — much more prevalent in the community.
"The harm reduction in that regard may be working in keeping people out of the hospital but may be not necessarily the best for these people because you know there's underlying addiction issues or mental health issues that aren't being assessed or treated," he said.

"So they're just continuing to use narcotics like they normally would and giving themselves Narcan and nothing's really changing, it's kind of just a big loop."

That means some cases where people are overdosing multiple times in a single day — or other dangerous behaviours.

"We've even had issues where there'd be a couple people taking, seeing how much opiates they can take before they go unconscious and then reviving themselves, or having their friend revive them, with Narcan," he said. "Almost like a Russian roulette-type of game, which is completely ridiculous."

That sounds like they're enjoying it quite a bit.

"Harm reduction" = "Moral hazard"

QuoteMoral hazard can lead to personal, professional, and economic harm when individuals or entities in a transaction can engage in risky behavior because the other parties are contractually bound to assume the negative consequences.

In other words, when people perceive something as "safer", they push the boundaries farther.

Increased use of Naloxone dosnt necessarily mean there is an increased use of opiates, overdoses, or deaths.  It could simply be that we have made it more available as a tool to treat the problem that already existed.  The timeline f this article is shortly after the requirement for a prescription for naloxone was removed, so all is shows is that making naloxone more available has increased its use, as intended.  Likely, this prevented deaths, as intended.

I find it bizarre that you are implying treating overdoses is a bad thing.  Should we just let people die?

 

Quote from: dismalist on July 06, 2023, 09:15:26 AM

Quote from: marshwiggle on July 06, 2023, 08:18:07 AM...

"Harm reduction" = "Moral hazard"

QuoteMoral hazard can lead to personal, professional, and economic harm when individuals or entities in a transaction can engage in risky behavior because the other parties are contractually bound to assume the negative consequences.

In other words, when people perceive something as "safer", they push the boundaries farther.

Careful, moral hazard does not imply that behavioral changes overcome the benefits. They merely reduce the benefits.

That's right; to put it another way, lowering perceived risk will actually make some people engage in more risk than they would have previously.

Quote from: Kron3007 on July 06, 2023, 09:38:07 AMI find it bizarre that you are implying treating overdoses is a bad thing.  Should we just let people die?

No, but we need to acknowledge that any attempt to reduce harm will result in some people doing things that are more undesirable than they would have previously.

That's a criticism of the approach that cannot be simply ignored.

In a calculus of lives, while reducing harm induces moral hazard, it at the same time saves more lives than possible before the development of an amelioration device.

There are some addicts who are dying all the time on account of accidental overdoses. An amelioration device will induce some of them to behavior more riskily. More of those will die. More of the rest will survive.

Proof: The risk lovers could have increased their risk without the amelioration device. Just OD, man and see what happens!

More lives saved is better than fewer lives saved.

Ok, I am all for paramedics having Narcan and using it to save the lives of ODing junkies.   But giving the junkies dope a/o needles will certainly increase their usage of junk, and this is, in the long run, not going to save their lives, and even in the short-/mid-term, it is going to mess up those lives, *and* the lives of their loved ones, and hurt society in general.   What exactly is hard to understand about this, and who thinks it is a good thing?  And why?

Quote from: kaysixteen on July 06, 2023, 09:06:57 PMOk, I am all for paramedics having Narcan and using it to save the lives of ODing junkies.  But giving the junkies dope a/o needles will certainly increase their usage of junk, and this is, in the long run, not going to save their lives, and even in the short-/mid-term, it is going to mess up those lives, *and* the lives of their loved ones, and hurt society in general.  What exactly is hard to understand about this, and who thinks it is a good thing?  And why?

Giving dope away free is not a good idea at all. Cheaper drug, more consumption. Like alcohol and McMansions and Higher Ed.

What is useful in the extreme is making sure that the supply of drugs available is not compromised in quality and dose. Legalization does that. At the moment, doctors are scared out of their brains to prescribe this stuff on account the DEA is after them, insurance or no insurance.

Not all druggies are suicidal. Many live normal lives. Legalization would help them. Narcan is for the others.

The needle exchanges help us! Fewer dangerous needles lying around to hurt non-addicts.

Legalization saves lives.

Quote from: kaysixteen on July 06, 2023, 09:06:57 PMOk, I am all for paramedics having Narcan and using it to save the lives of ODing junkies.   But giving the junkies dope a/o needles will certainly increase their usage of junk, and this is, in the long run, not going to save their lives, and even in the short-/mid-term, it is going to mess up those lives, *and* the lives of their loved ones, and hurt society in general.   What exactly is hard to understand about this, and who thinks it is a good thing?  And why?

Do you have any loved ones whose addiction has had an impact on you?

Just in my immediate family, I told you about two of my brothers. I also had a long-term partner who became addicted to a bad one, and sank her entire salary (twice mine at the time) into it.

Quote from: dismalist on July 06, 2023, 09:20:37 PM

Quote from: kaysixteen on July 06, 2023, 09:06:57 PMOk, I am all for paramedics having Narcan and using it to save the lives of ODing junkies.  But giving the junkies dope a/o needles will certainly increase their usage of junk, and this is, in the long run, not going to save their lives, and even in the short-/mid-term, it is going to mess up those lives, *and* the lives of their loved ones, and hurt society in general.  What exactly is hard to understand about this, and who thinks it is a good thing?  And why?

Giving dope away free is not a good idea at all. Cheaper drug, more consumption. Like alcohol and McMansions and Higher Ed.

What is useful in the extreme is making sure that the supply of drugs available is not compromised in quality and dose. Legalization does that. At the moment, doctors are scared out of their brains to prescribe this stuff on account the DEA is after them, insurance or no insurance.

Not all druggies are suicidal. Many live normal lives. Legalization would help them. Narcan is for the others.

The needle exchanges help us! Fewer dangerous needles lying around to hurt non-addicts.

If only.

Is Vancouver becoming 'syringe city'? (https://www.cbc.ca/news/canada/british-columbia/vancouver-syringes-just-symptom-of-crisis-1.4269196)

QuoteThe number of needles being left on city streets is on the rise, but the problem with drugs goes deeper.
The number of needles showing up in parks, on sidewalks and elsewhere is on the rise. It's prompted complaints and concerns in neighbourhoods near the Downtown Eastside.
"There are more needles being distributed to make sure that [drug users are] using clean needles and not reusing dirty needles, which leads to infectious diseases and other problems," said Jang. "Unfortunately a lot of [the needles] are showing up in our parks and waterways, for example," he said.

This is in Vancouver, where Insite (A "safe injection" site) is famous.

Quote from: marshwiggle on July 07, 2023, 05:34:13 AM

Quote from: dismalist on July 06, 2023, 09:20:37 PM

Quote from: kaysixteen on July 06, 2023, 09:06:57 PMOk, I am all for paramedics having Narcan and using it to save the lives of ODing junkies.  But giving the junkies dope a/o needles will certainly increase their usage of junk, and this is, in the long run, not going to save their lives, and even in the short-/mid-term, it is going to mess up those lives, *and* the lives of their loved ones, and hurt society in general.  What exactly is hard to understand about this, and who thinks it is a good thing?  And why?

Giving dope away free is not a good idea at all. Cheaper drug, more consumption. Like alcohol and McMansions and Higher Ed.

What is useful in the extreme is making sure that the supply of drugs available is not compromised in quality and dose. Legalization does that. At the moment, doctors are scared out of their brains to prescribe this stuff on account the DEA is after them, insurance or no insurance.

Not all druggies are suicidal. Many live normal lives. Legalization would help them. Narcan is for the others.

The needle exchanges help us! Fewer dangerous needles lying around to hurt non-addicts.

If only.

Is Vancouver becoming 'syringe city'? (https://www.cbc.ca/news/canada/british-columbia/vancouver-syringes-just-symptom-of-crisis-1.4269196)

QuoteThe number of needles being left on city streets is on the rise, but the problem with drugs goes deeper.
The number of needles showing up in parks, on sidewalks and elsewhere is on the rise. It's prompted complaints and concerns in neighbourhoods near the Downtown Eastside.
"There are more needles being distributed to make sure that [drug users are] using clean needles and not reusing dirty needles, which leads to infectious diseases and other problems," said Jang. "Unfortunately a lot of [the needles] are showing up in our parks and waterways, for example," he said.

This is in Vancouver, where Insite (A "safe injection" site) is famous.

This sounds like municipal incompetence to me.

The US CDC likes so called Syringe Services Programs and claims they reduce needles lying around. But there have been flops of individual county programs. One gave out a lot more needles than were collected, e.g. Not hard to guess what happened then.

Quote from: kaysixteen on July 06, 2023, 09:06:57 PMOk, I am all for paramedics having Narcan and using it to save the lives of ODing junkies.  But giving the junkies dope a/o needles will certainly increase their usage of junk, and this is, in the long run, not going to save their lives, and even in the short-/mid-term, it is going to mess up those lives, *and* the lives of their loved ones, and hurt society in general.  What exactly is hard to understand about this, and who thinks it is a good thing?  And why?

Perhaps giving free drugs would, but I dont see why free needles would increase use. It would just prevent people from re-using and sharing needles, thereby reducing the spread of various infections and improving safety.

As for increased use, there are situations were increased use of a drug sourced from a safe supply chain would be safer and better for all involved than lower use of tainted drugs.  As mentioned earlier, many overdoses are not because the user injected too much based on what they thought was in it, but street drugs are often contaminated with more toxic drugs that are easier to overdose on.  So, even if giving people free drugs increases their consumption, it could still reduce over doses and related costs and deaths.

Further, if you give someone drugs, they are less likely to mug you on the street to fund their habit, which you should appreciate since you identified this as a concern. 

I dont know if I would support free drug programs, but I also wouldn't rule them out.  I suppose the devil is in the details.  In the end, we should support programs that have a positive impact on public health.   

Quote from: dismalist on July 07, 2023, 09:03:34 AM

Quote from: marshwiggle on July 07, 2023, 05:34:13 AM

Quote from: dismalist on July 06, 2023, 09:20:37 PM

Quote from: kaysixteen on July 06, 2023, 09:06:57 PMOk, I am all for paramedics having Narcan and using it to save the lives of ODing junkies.  But giving the junkies dope a/o needles will certainly increase their usage of junk, and this is, in the long run, not going to save their lives, and even in the short-/mid-term, it is going to mess up those lives, *and* the lives of their loved ones, and hurt society in general.  What exactly is hard to understand about this, and who thinks it is a good thing?  And why?

Giving dope away free is not a good idea at all. Cheaper drug, more consumption. Like alcohol and McMansions and Higher Ed.

What is useful in the extreme is making sure that the supply of drugs available is not compromised in quality and dose. Legalization does that. At the moment, doctors are scared out of their brains to prescribe this stuff on account the DEA is after them, insurance or no insurance.

Not all druggies are suicidal. Many live normal lives. Legalization would help them. Narcan is for the others.

The needle exchanges help us! Fewer dangerous needles lying around to hurt non-addicts.

If only.

Is Vancouver becoming 'syringe city'? (https://www.cbc.ca/news/canada/british-columbia/vancouver-syringes-just-symptom-of-crisis-1.4269196)

QuoteThe number of needles being left on city streets is on the rise, but the problem with drugs goes deeper.
The number of needles showing up in parks, on sidewalks and elsewhere is on the rise. It's prompted complaints and concerns in neighbourhoods near the Downtown Eastside.
"There are more needles being distributed to make sure that [drug users are] using clean needles and not reusing dirty needles, which leads to infectious diseases and other problems," said Jang. "Unfortunately a lot of [the needles] are showing up in our parks and waterways, for example," he said.

This is in Vancouver, where Insite (A "safe injection" site) is famous.

This sounds like municipal incompetence to me.

The US CDC likes so called Syringe Services Programs and claims they reduce needles lying around. But there have been flops of individual county programs. One gave out a lot more needles than were collected, e.g. Not hard to guess what happened then.

From the article:

QuoteAccording to George McPhee, who supervises the OPS site, more than 1,000 needles will be used at the clinic each day, but many users also take a handful of syringes home with them to use later.

"A lot of people, they'll use, they'll sit for a bit and then once they're ready to go, they'll take some to go," said McPhee.

OPS is far from the only group distributing free, clean needles to the drug user community. Many local organizations have syringes available for drug users.

Just like after dinner mints at a restaurant. Grab a handful on your way out!

QuoteMcPhee says the staff at OPS will give users sharps containers to take home, and they do regular needle sweeps in the alley and on the sidewalk in front of the site.

No problem then. Users will always use the sharps containers, or at least drop their used needles right in front of the site.

Back to homelessness, this article was in the LA Times about the right to sleep outside. (https://www.latimes.com/california/story/2023-07-06/in-scathing-dissents-9th-circuit-conservatives-say-homelessness-is-paralyzing-u-s-west)

If someone is tired and has nowhere to go, the authorities would have to take them someplace. If the person is unwilling for whatever reason, how much force should they be allowed to use? How much disturbance of the peace should they allow?

Quote from: ciao_yall on July 07, 2023, 10:01:38 AMBack to homelessness, this article was in the LA Times about the right to sleep outside. (https://www.latimes.com/california/story/2023-07-06/in-scathing-dissents-9th-circuit-conservatives-say-homelessness-is-paralyzing-u-s-west)

If someone is tired and has nowhere to go, the authorities would have to take them someplace. If the person is unwilling for whatever reason, how much force should they be allowed to use? How much disturbance of the peace should they allow?

From the article:

Quote"There are stretches of the city where one cannot help but think the government has shirked its most basic responsibilities under the social contract: providing public safety and ensuring that public spaces remain open to all," Smith wrote. "One-time public spaces like parks — many of which provide scarce outdoor space in dense, working-class neighborhoods — are filled with thousands of tents and makeshift structures, and are no longer welcoming to the broader community."

Lower income people, including working class people and recent immigrants often rely on places like parks as they have little or no backyard space like wealthier people do, so wealthy elites favoring letting these spaces be taken over by homeless encampments show disregard if not complete contempt for the working class.

Quote from: marshwiggle on July 07, 2023, 12:00:08 PM

Quote from: ciao_yall on July 07, 2023, 10:01:38 AMBack to homelessness, this article was in the LA Times about the right to sleep outside. (https://www.latimes.com/california/story/2023-07-06/in-scathing-dissents-9th-circuit-conservatives-say-homelessness-is-paralyzing-u-s-west)

If someone is tired and has nowhere to go, the authorities would have to take them someplace. If the person is unwilling for whatever reason, how much force should they be allowed to use? How much disturbance of the peace should they allow?

From the article:

Quote"There are stretches of the city where one cannot help but think the government has shirked its most basic responsibilities under the social contract: providing public safety and ensuring that public spaces remain open to all," Smith wrote. "One-time public spaces like parks — many of which provide scarce outdoor space in dense, working-class neighborhoods — are filled with thousands of tents and makeshift structures, and are no longer welcoming to the broader community."

Lower income people, including working class people and recent immigrants often rely on places like parks as they have little or no backyard space like wealthier people do, so wealthy elites favoring letting these spaces be taken over by homeless encampments show disregard if not complete contempt for the working class.

So, in your mind, what is worse?

• "Wealthy elites" not being willing to pay their fair share of taxes to ensure affordable housing, healthcare and drug treatment?
• "Wealthy elites" going on and on about the "right to sleep outside" but of course, not in their own backyard. Public parks and freeway overpasses? Not their problem.

How it came to be that a perfectly well functioning heroin dispensing system, the so-called "British System", was destroyed by American pressure long predating the War on Drugs. A fascinating bit of history that is in danger of being forgotten:

When Boots Prescribed Heroin (https://www.vice.com/en/article/yw4nnk/when-boots-prescribed-heroin-the-uk-did-drug-policy-right)

The British System could be implemented anywhere for numerous drugs, including synthetic opioids.

Quote from: ciao_yall on July 07, 2023, 01:12:32 PM

Quote from: marshwiggle on July 07, 2023, 12:00:08 PMLower income people, including working class people and recent immigrants often rely on places like parks as they have little or no backyard space like wealthier people do, so wealthy elites favoring letting these spaces be taken over by homeless encampments show disregard if not complete contempt for the working class.

So, in your mind, what is worse?

• "Wealthy elites" not being willing to pay their fair share of taxes to ensure affordable housing, healthcare and drug treatment?
• "Wealthy elites" going on and on about the "right to sleep outside" but of course, not in their own backyard. Public parks and freeway overpasses? Not their problem.

From what I see in the news, the cities in the US with the worst homeless problems are in states with the highest taxes, i.e. where the wealthy elites are paying a higher share of taxes. So the "right to sleep outside" seems to be the bigger problem.

Quote from: marshwiggle on July 08, 2023, 05:50:58 AM

Quote from: ciao_yall on July 07, 2023, 01:12:32 PM

Quote from: marshwiggle on July 07, 2023, 12:00:08 PMLower income people, including working class people and recent immigrants often rely on places like parks as they have little or no backyard space like wealthier people do, so wealthy elites favoring letting these spaces be taken over by homeless encampments show disregard if not complete contempt for the working class.

So, in your mind, what is worse?

• "Wealthy elites" not being willing to pay their fair share of taxes to ensure affordable housing, healthcare and drug treatment?
• "Wealthy elites" going on and on about the "right to sleep outside" but of course, not in their own backyard. Public parks and freeway overpasses? Not their problem.

From what I see in the news, the cities in the US with the worst homeless problems are in states with the highest taxes, i.e. where the wealthy elites are paying a higher share of taxes. So the "right to sleep outside" seems to be the bigger problem.

Are you sure about that?

Quote from: ciao_yall on July 08, 2023, 10:10:42 AM

Quote from: marshwiggle on July 08, 2023, 05:50:58 AM

Quote from: ciao_yall on July 07, 2023, 01:12:32 PM

Quote from: marshwiggle on July 07, 2023, 12:00:08 PMLower income people, including working class people and recent immigrants often rely on places like parks as they have little or no backyard space like wealthier people do, so wealthy elites favoring letting these spaces be taken over by homeless encampments show disregard if not complete contempt for the working class.

So, in your mind, what is worse?

• "Wealthy elites" not being willing to pay their fair share of taxes to ensure affordable housing, healthcare and drug treatment?
• "Wealthy elites" going on and on about the "right to sleep outside" but of course, not in their own backyard. Public parks and freeway overpasses? Not their problem.

From what I see in the news, the cities in the US with the worst homeless problems are in states with the highest taxes, i.e. where the wealthy elites are paying a higher share of taxes. So the "right to sleep outside" seems to be the bigger problem.

Are you sure about that?

Which cities in the US have the most homelessness? (https://usafacts.org/articles/which-cities-in-the-us-have-the-most-homelessness/)

QuoteLos Angeles City & County   65,111
New York City   61,840
Seattle/King County   13,368
San Jose/Santa Clara City & County   10,028
Oakland, Berkeley/Alameda County   9,747
Sacramento City & County   9,278
Phoenix, Mesa/Maricopa County   9,026
San Diego City and County   8,427
San Francisco   7,754
Metropolitan Denver   6,884

Almost all of those are, as far as I know, in "blue" states.

Here are the stats per capita:

QuoteBetween 2014 and 2018, homelessness increased in Minneapolis / St Paul, Sacramento, Amarillo and Los Angeles. Cities that experienced significant falls of homelessness include Savannah, Fresno, Denver and Battle Creek.
City (State)
Homeless people
per 100,000 residents*
Rise / Fall between
2014-2018
Eugene (OR)   
432
-12.4%
Los Angeles (CA)   
397
+37.4%
New York City (NY)   
394
+16.9%
San Jose (CA)   
363
-6.5%
Seattle (WA)   
349
+23.0%
Anchorage (AK)   
274
+6.6%
Las Vegas (NV)   
273
-24.8%
San Francisco (CA)   
261
+12.1%
Savannah (GA)   
259
-26.9%
San Diego (CA)   
257
-2.0%

Now we get to homelessness as a result of drug addiction! I guess drug addiction is the source of all evils!

For an individual, any of many characteristics -- no cash, onset of mental illness, whatever -- can lead to homelessness.

Aggregating across individuals, these individual causes are subsumed into the overarching cause

Homelessness is a Housing Problem (http://homelessness%20is%20a%20housing%20problem)

It cannot be otherwise.

I mentioned bits of the book earlier. More homeless where more housing is absent. The link above is an interview of the authors. Well worth understanding.

Quote from: dismalist on July 08, 2023, 12:20:34 PMNow we get to homelessness as a result of drug addiction! I guess drug addiction is the source of all evils!

For an individual, any of many characteristics -- no cash, onset of mental illness, whatever -- can lead to homelessness.

Aggregating across individuals, these individual causes are subsumed into the overarching cause

Homelessness is a Housing Problem (http://homelessness%20is%20a%20housing%20problem)

It cannot be otherwise.

I mentioned bits of the book earlier. More homeless where more housing is absent. The link above is an interview of the authors. Well worth understanding.

Absolutely. Homelessness occurs due to many factors. If you read the Canadian news, there are plenty of homeless individuals with no substance or alcohol use issues. There's an article on the CBC website, today, about a guy who earns $75,000 CDN/year in Vancouver, but can't find a place to live, so he'll be homeless at the end of the month. Vancouver is insane (a TT job that my background addresses perfectly was advertised at UBC, but I could never afford to live there, so didn't apply), but not all who are homeless are unemployed or use substances (please don't use outdated terms like "junkies" - that only increases stigma and impedes recovery. I would think academics could educate themselves, but I guess not.)

We need to differentiate between different homeless demographics.

Many people are homeless for a brief period in their lives because of foreclosures, job losses, poor choices, fleeing abusive relationships, or people who will eventually overcome substance abuse problems. 

Many other people are the chronically homeless, and these are the folks with the severe mental health issues or debilitating substance abuse illnesses.  And yes, Big-D, people are often homeless because they become so ill they cannot function well enough to even pay rent or the mortgage; it is a real thing.

The challenges facing these two groups overlap but are different.  They each require different options.

I found this helpful. (https://www.fccdinc.org/homeless)

QuoteBased on the most recent data , on any given night there are roughly 86,962 chronically homeless individuals in the U.S., representing 24% of the total homeless population. Typically, these individuals are older, have complex, long-term health issues and often live on the street, in a car, park, or other location that is not suitable for human habitation.

Episodic homelessness refers to individuals who are currently homeless and have experienced at least three periods of homelessness in the previous year. These individuals are often younger and suffer from some type of disabling condition, such as substance abuse, mental illness, and/or medical problems.

Transitional homelessness is actually the most common type of homelessness. These individuals are also likely to be younger and generally enter a shelter or temporary housing system for only one brief stay. This situation could be the result of a catastrophic event or sudden life change.

There is also a fourth type of homelessness that often goes unreported and undocumented. These individuals are known as 'provisionally occupied' and are experiencing what is known as 'hidden homelessness.' This specifically refers to individuals temporarily living with others (or 'couch-surfing') without a guarantee that they will be able to stay long-term and without immediate prospects for acquiring permanent housing. This often describes people staying with friends or relatives because they lack other housing opportunities.

Sometimes it is little or no available housing (two of the demographics with high rates are Samoans and Hawaiian's), lack of money (see the latest data set an analysis of California's homeless), or weather. By state two of the top five are Florida (3) and Texas (5), hardly blue states.

Here is a pretty fleshed out description: https://usafacts.org/articles/which-states-have-the-highest-and-lowest-rates-of-homelessness/

I am weary of simplistic explanations from a couple of us. For marshwiggle, it seems to be the Dem's are causing it. It is way more complicated.

Quote from: marshwiggle on July 08, 2023, 11:46:15 AMHere are the stats per capita:

QuoteBetween 2014 and 2018, homelessness increased in Minneapolis / St Paul, Sacramento, Amarillo and Los Angeles. Cities that experienced significant falls of homelessness include Savannah, Fresno, Denver and Battle Creek.
City (State)
Homeless people
per 100,000 residents*
Rise / Fall between
2014-2018
Eugene (OR)   
432
-12.4%
Los Angeles (CA)   
397
+37.4%
New York City (NY)   
394
+16.9%
San Jose (CA)   
363
-6.5%
Seattle (WA)   
349
+23.0%
Anchorage (AK)   
274
+6.6%
Las Vegas (NV)   
273
-24.8%
San Francisco (CA)   
261
+12.1%
Savannah (GA)   
259
-26.9%
San Diego (CA)   
257
-2.0%

Do we need to explain that correlation =/= causation to you? These are also some of the most expensive cities in the country. Simple cost of living and economic inequality explains these numbers far more than "blue v. red"

The Marshman has an agenda.

Quote from: Wahoo Redux on July 08, 2023, 05:56:42 PMWe need to differentiate between different homeless demographics.

Many people are homeless for a brief period in their lives because of foreclosures, job losses, poor choices, fleeing abusive relationships, or people who will eventually overcome substance abuse problems. 

For years there has been a huge community of techies living in RVs in the parking lots of their employers such as Google, Facebook, Yahoo, and others.

They have free food, locker rooms with showers, and WiFi. Why pay rent?

para asked if I had any loved ones who had substance abuse issues and their concomitant consequences-- yes, I did, not drugs, but booze, and lots of it.   Lives ruined, and massive effects on non-user family members.   

I have been doing more cogitatin' on this thread and remained, quite frankly, *stunned* that anyone, even perhaps half-seriously, could contemplate giving non-medically prescribed opiates to anyone, or even legally allowing their use.   Nothing good comes of their use in this context.  I have also been thinkin' in general about *why* it is that use of narcotics seems to be gaining cache amongst educated, upper-middle class folks, either by using them themselves or looking the other way at those doing so.  This seems a reflex of the not-so quaint adolescent attitudes of the late 60s-70s, where young people seemed to think that drug use was reflexively cool, and the grown-ups who didn't get it were hopelessly unenlightened squares. This attitude was lame enough 50 years ago... now, with all we know, both in terms of what drugs actually do to their users, and what their larger social and societal consequences are, it is just pathetic.

Drugs suck.  I will never tire of saying this.  Earlier this week, a 40-ish woman came up to me in BigBox Land, with the sad news that she had just discovered some junkie needles in the ladies' room stall.   I had to immediately get maintenance to glove up and deal with this problem.   But what if the finder had been an 8yo girl instead?

Quote from: kaysixteen on July 08, 2023, 08:40:18 PMI have also been thinkin' in general about *why* it is that use of narcotics seems to be gaining cache amongst educated, upper-middle class folks, either by using them themselves or looking the other way at those doing so. 

Huh.  I am aware that all socioeconomic levels of society use drugs.  I was not aware that there is "cache" among wealthier people.  Opiates have a pretty bad name these days everywhere.  Who have you been hanging out with?

Quote from: kaysixteen on July 08, 2023, 08:40:18 PMpara asked if I had any loved ones who had substance abuse issues and their concomitant consequences-- yes, I did, not drugs, but booze, and lots of it.  Lives ruined, and massive effects on non-user family members. 

I have been doing more cogitatin' on this thread and remained, quite frankly, *stunned* that anyone, even perhaps half-seriously, could contemplate giving non-medically prescribed opiates to anyone, or even legally allowing their use.  Nothing good comes of their use in this context.  I have also been thinkin' in general about *why* it is that use of narcotics seems to be gaining cache amongst educated, upper-middle class folks, either by using them themselves or looking the other way at those doing so.  This seems a reflex of the not-so quaint adolescent attitudes of the late 60s-70s, where young people seemed to think that drug use was reflexively cool, and the grown-ups who didn't get it were hopelessly unenlightened squares. This attitude was lame enough 50 years ago... now, with all we know, both in terms of what drugs actually do to their users, and what their larger social and societal consequences are, it is just pathetic.

Drugs suck.  I will never tire of saying this.  Earlier this week, a 40-ish woman came up to me in BigBox Land, with the sad news that she had just discovered some junkie needles in the ladies' room stall.  I had to immediately get maintenance to glove up and deal with this problem.  But what if the finder had been an 8yo girl instead?

I don't know why you have a hard time understanding that supporting legal access to drugs or other harm reduction strategies does not mean you are supporting drug use.  There really isn't any evidence suggesting that these approaches increase drug use, and even if drug use increases, that is irrelevant if their harms are reduced.  In contrast, there is plenty of evidence showing that the war on drugs has failed and only causes more harm in a variety of ways.

If you could show that being tough on drugs reduces addiction rates, deaths, etc., you would have a point, but that's just not reality.  It may meet the base need to feel you are doing something about the problem, but you are really just making it worse. 

Quote from: jimbogumbo on July 08, 2023, 06:12:25 PMI am weary of simplistic explanations from a couple of us. For marshwiggle, it seems to be the Dem's are causing it. It is way more complicated.

Quote from: Diogenes on July 08, 2023, 06:20:22 PMDo we need to explain that correlation =/= causation to you? These are also some of the most expensive cities in the country. Simple cost of living and economic inequality explains these numbers far more than "blue v. red"

Quote from: Wahoo Redux on July 08, 2023, 06:34:27 PMThe Marshman has an agenda.

What is odd is that the places with the most government (and therefore, presumably public) support seem to have some of the worst problems. If that is because people are coming from elsewhere because of that public support, then it should be easy to survey people about their origins and establish this. If, on the other hand, the vast majority of these people are of local origin, then that implies that the local conditions, including the history of government actions, have contributed to these problems.
(Since "economic inequality" is mentioned above, what makes the inequality worse in these places where there are presumably the strongest government efforts to reduce it?)
 

Usually government support is a response to a problem, not the cause.  Again, I think California has the most government support because they have the most homeless because the weather is conducive to living outside.

California would and probably should have even higher taxes, but it's put-near impossible to pass any sort of tax increase due to laws put in place years ago that set significant constraints on the legislature and even local municipalities.

So, these leaves the State relying upon Federal tax pass-throughs - hahahahahahahahaha.

Quote from: marshwiggle on July 09, 2023, 06:33:54 AM

Quote from: jimbogumbo on July 08, 2023, 06:12:25 PMI am weary of simplistic explanations from a couple of us. For marshwiggle, it seems to be the Dem's are causing it. It is way more complicated.

Quote from: Diogenes on July 08, 2023, 06:20:22 PMDo we need to explain that correlation =/= causation to you? These are also some of the most expensive cities in the country. Simple cost of living and economic inequality explains these numbers far more than "blue v. red"

Quote from: Wahoo Redux on July 08, 2023, 06:34:27 PMThe Marshman has an agenda.

What is odd is that the places with the most government (and therefore, presumably public) support seem to have some of the worst problems. If that is because people are coming from elsewhere because of that public support, then it should be easy to survey people about their origins and establish this. If, on the other hand, the vast majority of these people are of local origin, then that implies that the local conditions, including the history of government actions, have contributed to these problems.
(Since "economic inequality" is mentioned above, what makes the inequality worse in these places where there are presumably the strongest government efforts to reduce it?)
 

When I look up overdose deaths per capita by state, this is what comes up:

The CDC reports that the states hardest hit by drug overdose in 2015 are:

West Virginia: 41.5 per 100,000 people
New Hampshire: 34.3 per 100,000 people
Kentucky: 29.9 per 100,000 people
Ohio: 29.9 per 100,000 people
Rhode Island: 28.2 per 100,000 people
Pennsylvania: 26.3 per 100,000 people
Massachusetts: 25.7 per 100,000 people
New Mexico: 25.3 per 100,000 people
Utah: 23.4 per 100,000 people
Tennessee: 22.2 per 100,000 people

Hardly a list of dem states. 
California doesn't even make the top ten.

Quote from: Wahoo Redux on July 09, 2023, 09:36:57 AMUsually government support is a response to a problem, not the cause.  Again, I think California has the most government support because they have the most homeless because the weather is conducive to living outside.

Sure, but then Florida (and potentially lots of southern states) should have a homeless problem at a similar scale, but it doesn't seem like they do.

The obvious fact that has been ignored: More than anything else, homelessness correlates with how expensive housing is.

I have no evidence that I'm right, but at least a theory that seems to fit all the obvious facts:

First, I think, at least in this context, the narrative that Democrats care more about inequality isn't useful.  We should think that the Democrats are the party of the industries where intelligence (by which I basically mean the ability to design and write computer programs and correlated skills - I realize this is a narrow slice of intelligence but that's what matters here) is more useful, and the Republicans are the party of the industries where intelligence is less useful.

Second, inequality can come in different forms.  One billionaire and ninety-nine people making $20K a year is inequality.  So is fifty people making $200K and fifty people making $25K.  I'll call the first extreme inequality and the second broad-based inequality.

The second form of inequality is what breaks housing markets.  In a normal market, demand curves slope downwards - there is more demand for cheaper stuff.  But in a market where there is broad-based inequality, housing market demand curves slope upwards.  There is (relative to the supply of land) more demand for one large house (not quite a mansion) than a half dozen small cheap apartments.  The moderately well-off buy up all the land and leave the less well-off homeless.  In the worst case, the demand curve slopes upwards more than the supply curve and the market breaks completely.  (Extreme inequality doesn't cause this problem because one billionaire can only want so much land.)

Without getting into debates about whether intelligence is innate, we can at least observe that the gap in intelligence is persistent.  In an industry where intelligence is not determining, one can make a worker more productive by getting them better machinery, reorganizing how they work, training them, and so on.  All this requires capital but can be solved with capital.  In an industry where intelligence is determining, we don't know how to (with a high likelihood of success) make an unproductive worker more productive with any amount of investment!  Hence, inequality is broad-based and persistent.  People who have intelligence have a persistent advantage over those who don't, and both groups are fairly large.

So - that makes areas that lean Democratic more likely to have broad-based inequality (rather than extreme inequality), and broad-based inequality is what breaks housing markets and causes expensive housing and large amounts of homelessness.

Quote from: marshwiggle on July 09, 2023, 03:20:38 PM

Quote from: Wahoo Redux on July 09, 2023, 09:36:57 AMUsually government support is a response to a problem, not the cause.  Again, I think California has the most government support because they have the most homeless because the weather is conducive to living outside.

Sure, but then Florida (and potentially lots of southern states) should have a homeless problem at a similar scale, but it doesn't seem like they do.

Florida ranked third in homelessness in the U.S. (https://www.wjhg.com/2023/03/31/florida-ranked-third-homelessness-us/)

USN: States With the Largest Homeless Populations (https://www.usnews.com/news/best-states/articles/states-with-the-most-homeless-people)

QuoteFour states accounted for more than half of the nation's homeless population, according to the Annual Homeless Assessment Report.

QuoteCalifornia (171,521)
New York (74,178)
Florida (25,959)
Washington (25,211)
Texas (24,432)
Oregon (17,959)
Massachusetts (15,507)
Arizona (13,553)
Pennsylvania (12,691)
Georgia (10,689)

Quote from: quasihumanist on July 09, 2023, 04:40:05 PMThe obvious fact that has been ignored: More than anything else, homelessness correlates with how expensive housing is.

Here in SF and other big cities, housing is expensive. This is exacerbated by:

(1) AirBnB has converted a lot of residential housing into hotel equivalents which drove up the price of homes and rental rates, though this article  (https://finance.yahoo.com/news/housing-market-2023-viral-tweet-113009741.html) suggests it might be turning around.
 
(2) A certain amount of the housing is empty. A lot of second/third/plus homes and absentee owners who moved out but didn't want to rent, haven't gotten around to selling, hung up in the family estate, etc. I'd love to see a bunch of squatters take over some long-empty Pacific Heights mansion(s).

People complain about the impact of rent control, mandated supply of affordable housing, etc I would look at # 1 and # 2 as something that can be managed more directly.

Quote from: ciao_yall on July 09, 2023, 05:35:07 PM

Quote from: quasihumanist on July 09, 2023, 04:40:05 PMThe obvious fact that has been ignored: More than anything else, homelessness correlates with how expensive housing is.

Here in SF and other big cities, housing is expensive. This is exacerbated by:

(1) AirBnB has converted a lot of residential housing into hotel equivalents which drove up the price of homes and rental rates, though this article  (https://finance.yahoo.com/news/housing-market-2023-viral-tweet-113009741.html) suggests it might be turning around.
 
(2) A certain amount of the housing is empty. A lot of second/third/plus homes and absentee owners who moved out but didn't want to rent, haven't gotten around to selling, hung up in the family estate, etc. I'd love to see a bunch of squatters take over some long-empty Pacific Heights mansion(s).

People complain about the impact of rent control, mandated supply of affordable housing, etc I would look at # 1 and # 2 as something that can be managed more directly.

High rents are a symptom of inadequate new supply, not increased new demand. The cause is NIMBYism, us, in other words.

"Rent control appears to be the most efficient technique presently known to destroy a city—except for bombing." --Assar Lindbeck

Certain places like San Francisco and Manhattan will always be expensive due to geographic and economic factors.  If the middle class can't afford to live there then it is hopeless for the poor folks. I just picked up an old book by Gore Vidal.  He wrote that in 1970 England had 1800 heroin addicts while the USA had 500,000.  The UK treated it as a medical problem and allowed the addicts to get opiates from a doctor. 

What should we do?  We have countless examples of social experiments from around the world and some workable solution should be known by now.

As an aside, have any of you seen the interviews at the Youtube channel called Soft White Underbelly?  The creator has some fascinating interviews with addicts living on the streets.

Quote from: dismalist on July 09, 2023, 06:00:58 PM

Quote from: ciao_yall on July 09, 2023, 05:35:07 PM

Quote from: quasihumanist on July 09, 2023, 04:40:05 PMThe obvious fact that has been ignored: More than anything else, homelessness correlates with how expensive housing is.

Here in SF and other big cities, housing is expensive. This is exacerbated by:

(1) AirBnB has converted a lot of residential housing into hotel equivalents which drove up the price of homes and rental rates, though this article  (https://finance.yahoo.com/news/housing-market-2023-viral-tweet-113009741.html)suggests it might be turning around.
 
(2) A certain amount of the housing is empty. A lot of second/third/plus homes and absentee owners who moved out but didn't want to rent, haven't gotten around to selling, hung up in the family estate, etc. I'd love to see a bunch of squatters take over some long-empty Pacific Heights mansion(s).

People complain about the impact of rent control, mandated supply of affordable housing, etc I would look at # 1 and # 2 as something that can be managed more directly.

High rents are a symptom of inadequate new supply, not increased new demand. The cause is NIMBYism, us, in other words.

"Rent control appears to be the most efficient technique presently known to destroy a city—except for bombing." --Assar Lindbeck

And yet, European and Asian cities are filled with affordable housing, rent control and no homeless people.

Quote from: ciao_yall on July 09, 2023, 06:43:38 PM

Quote from: dismalist on July 09, 2023, 06:00:58 PM

Quote from: ciao_yall on July 09, 2023, 05:35:07 PM

Quote from: quasihumanist on July 09, 2023, 04:40:05 PMThe obvious fact that has been ignored: More than anything else, homelessness correlates with how expensive housing is.

Here in SF and other big cities, housing is expensive. This is exacerbated by:

(1) AirBnB has converted a lot of residential housing into hotel equivalents which drove up the price of homes and rental rates, though this article  (https://finance.yahoo.com/news/housing-market-2023-viral-tweet-113009741.html)suggests it might be turning around.
 
(2) A certain amount of the housing is empty. A lot of second/third/plus homes and absentee owners who moved out but didn't want to rent, haven't gotten around to selling, hung up in the family estate, etc. I'd love to see a bunch of squatters take over some long-empty Pacific Heights mansion(s).

People complain about the impact of rent control, mandated supply of affordable housing, etc I would look at # 1 and # 2 as something that can be managed more directly.

High rents are a symptom of inadequate new supply, not increased new demand. The cause is NIMBYism, us, in other words.

"Rent control appears to be the most efficient technique presently known to destroy a city—except for bombing." --Assar Lindbeck

And yet, European and Asian cities are filled with affordable housing, rent control and no homeless people.

Understand my first sentence above before you disagree with my second.

Quote from: dismalist on July 09, 2023, 06:00:58 PM

Quote from: ciao_yall on July 09, 2023, 05:35:07 PM

Quote from: quasihumanist on July 09, 2023, 04:40:05 PMThe obvious fact that has been ignored: More than anything else, homelessness correlates with how expensive housing is.

Here in SF and other big cities, housing is expensive. This is exacerbated by:

(1) AirBnB has converted a lot of residential housing into hotel equivalents which drove up the price of homes and rental rates, though this article  (https://finance.yahoo.com/news/housing-market-2023-viral-tweet-113009741.html) suggests it might be turning around.
 
(2) A certain amount of the housing is empty. A lot of second/third/plus homes and absentee owners who moved out but didn't want to rent, haven't gotten around to selling, hung up in the family estate, etc. I'd love to see a bunch of squatters take over some long-empty Pacific Heights mansion(s).

People complain about the impact of rent control, mandated supply of affordable housing, etc I would look at # 1 and # 2 as something that can be managed more directly.

High rents are a symptom of inadequate new supply, not increased new demand. The cause is NIMBYism, us, in other words.

"Rent control appears to be the most efficient technique presently known to destroy a city—except for bombing." --Assar Lindbeck

You do the counting, and realize that AirBnBs and empty mansions are a drop in the bucket.  They account for a tiny fraction of the need.

NIMBYism is part of the problem, but there are some indications that, in the Bay Area, it (or at least its classic form) is not the real problem.  In places where zoning has been relaxed and the other legal and regulatory hurdles to building more housing have been reduced, there has been very little effort to build much denser housing.  This suggests it's just not (as) profitable.  Indeed, if you look at the real estate market, you'll find that, in many places, a single family home on one lot goes for almost the same price as a duplex or a triplex on a similarly sized lot.  (Certainly, the higher costs of construction for extra units doesn't cover any difference.)

The tech workers want to live in less dense neighborhoods, and they make enough more money than everyone else to buy up all the available land for the lower density they want.  Broad-based inequality at work.

Maybe the tech industry in the Bay Area should be analyzed as a Dutch Disease.

Quote from: quasihumanist on July 09, 2023, 08:45:54 PM

Quote from: dismalist on July 09, 2023, 06:00:58 PM

Quote from: ciao_yall on July 09, 2023, 05:35:07 PM

Quote from: quasihumanist on July 09, 2023, 04:40:05 PMThe obvious fact that has been ignored: More than anything else, homelessness correlates with how expensive housing is.

Here in SF and other big cities, housing is expensive. This is exacerbated by:

(1) AirBnB has converted a lot of residential housing into hotel equivalents which drove up the price of homes and rental rates, though this article  (https://finance.yahoo.com/news/housing-market-2023-viral-tweet-113009741.html)suggests it might be turning around.
 
(2) A certain amount of the housing is empty. A lot of second/third/plus homes and absentee owners who moved out but didn't want to rent, haven't gotten around to selling, hung up in the family estate, etc. I'd love to see a bunch of squatters take over some long-empty Pacific Heights mansion(s).

People complain about the impact of rent control, mandated supply of affordable housing, etc I would look at # 1 and # 2 as something that can be managed more directly.

High rents are a symptom of inadequate new supply, not increased new demand. The cause is NIMBYism, us, in other words.

"Rent control appears to be the most efficient technique presently known to destroy a city—except for bombing." --Assar Lindbeck

You do the counting, and realize that AirBnBs and empty mansions are a drop in the bucket.  They account for a tiny fraction of the need.

NIMBYism is part of the problem, but there are some indications that, in the Bay Area, it (or at least its classic form) is not the real problem.  In places where zoning has been relaxed and the other legal and regulatory hurdles to building more housing have been reduced, there has been very little effort to build much denser housing.  This suggests it's just not (as) profitable.  Indeed, if you look at the real estate market, you'll find that, in many places, a single family home on one lot goes for almost the same price as a duplex or a triplex on a similarly sized lot.  (Certainly, the higher costs of construction for extra units doesn't cover any difference.)

The tech workers want to live in less dense neighborhoods, and they make enough more money than everyone else to buy up all the available land for the lower density they want.  Broad-based inequality at work.

Maybe the tech industry in the Bay Area should be analyzed as a Dutch Disease.

I think a big part is the commodification of housing.  In Canada, the biggest group of people buying homes now is people who already own at least one house, showing that housing has really shifted to an investment opportunity.  20% of real estate here is now owned by investors. 

When people discuss the supply demand dynamics, they usually imply that housing hasn't kept up with population growth, but that is questionable and I think only explains a small part of what happened.  In reality, the housing/population rates were fairly steady for a while, but housing prices went through the roof in the last few years.  The two trends do not match.

More supply would help, but I think there is a lot the government could be doing to dissinsentivize real estate as an investment that would have more impact and should be done.  It won't, because a lot of people with a lot of money wouldn't want that, but affordable housing is really essential for a functional society...

Back to the dynamics among states, preople like to invest in desirable areas, driving up prices even more. 

Quote from: quasihumanist on July 09, 2023, 08:45:54 PMThe tech workers want to live in less dense neighborhoods, and they make enough more money than everyone else to buy up all the available land for the lower density they want.  Broad-based inequality at work.

Maybe the tech industry in the Bay Area should be analyzed as a Dutch Disease.

I'd like to point out that tech company owners, (with few exceptions like Elon Musk), are progressive, and their employees are largely very progressive, and are in favour of things like "socialism (https://www.youtube.com/watch?v=G2y8Sx4B2Sk)" and "social justice". So these people should be hugley in favour of low cost housing and other social supports in their own neighborhoods (and the higher taxes to finance them).

Quote from: Kron3007 on July 10, 2023, 05:17:03 AMI think a big part is the commodification of housing.  In Canada, the biggest group of people buying homes now is people who already own at least one house, showing that housing has really shifted to an investment opportunity.  20% of real estate here is now owned by investors. 

But that still leaves open the question of where all of the people come from who those investors can rent to. For those properties to not sit vacant, there need to be people who can pay the carrying costs on those places. Rent is not going to be less than the owners' financing costs. There can't be an infinitely deep pool of wealthy potential tenants that is bigger than the supply of housing. At some point, when everyone of a certain income level is housed, there's not going to be a market for more housing at that price point.

Quote from: marshwiggle on July 10, 2023, 05:18:43 AMI'd like to point out that tech company owners, (with few exceptions like Elon Musk), are progressive, and their employees are largely very progressive, and are in favour of things like "socialism (https://www.youtube.com/watch?v=G2y8Sx4B2Sk)" and "social justice". So these people should be hugley in favour of low cost housing and other social supports in their own neighborhoods (and the higher taxes to finance them).

Really? Aside from the obvious fact one of them is running for the Republican nomination as a Trump clone, my daughter works for a seriously red Larry Ellison (Oracle), and Peter Thiel has not exactly hung out with a bunch o progressive tech CEOs. Below is from 2017, but still applies. Almost certainly undercounts.

https://www.theguardian.com/technology/2017/feb/10/silicon-valley-right-wing-donald-trump-peter-thiel

Quote from: marshwiggle on July 10, 2023, 05:27:07 AM

Quote from: Kron3007 on July 10, 2023, 05:17:03 AMI think a big part is the commodification of housing.  In Canada, the biggest group of people buying homes now is people who already own at least one house, showing that housing has really shifted to an investment opportunity.  20% of real estate here is now owned by investors. 

But that still leaves open the question of where all of the people come from who those investors can rent to. For those properties to not sit vacant, there need to be people who can pay the carrying costs on those places. Rent is not going to be less than the owners' financing costs. There can't be an infinitely deep pool of wealthy potential tenants that is bigger than the supply of housing. At some point, when everyone of a certain income level is housed, there's not going to be a market for more housing at that price point.

Some people are perfectly happy to have a home in XYZ that they maintain but only visit a few times a year.

There are a lot of people who are now going to be lifetime renters. Rent keeps going up with the market, and they can't afford to save for a down payment.

Quote from: dismalist on July 09, 2023, 07:00:14 PM

Quote from: ciao_yall on July 09, 2023, 06:43:38 PM

Quote from: dismalist on July 09, 2023, 06:00:58 PM

Quote from: ciao_yall on July 09, 2023, 05:35:07 PM

Quote from: quasihumanist on July 09, 2023, 04:40:05 PMThe obvious fact that has been ignored: More than anything else, homelessness correlates with how expensive housing is.

Here in SF and other big cities, housing is expensive. This is exacerbated by:

(1) AirBnB has converted a lot of residential housing into hotel equivalents which drove up the price of homes and rental rates, though this article  (https://finance.yahoo.com/news/housing-market-2023-viral-tweet-113009741.html)suggests it might be turning around.
 
(2) A certain amount of the housing is empty. A lot of second/third/plus homes and absentee owners who moved out but didn't want to rent, haven't gotten around to selling, hung up in the family estate, etc. I'd love to see a bunch of squatters take over some long-empty Pacific Heights mansion(s).

People complain about the impact of rent control, mandated supply of affordable housing, etc I would look at # 1 and # 2 as something that can be managed more directly.

High rents are a symptom of inadequate new supply, not increased new demand. The cause is NIMBYism, us, in other words.

"Rent control appears to be the most efficient technique presently known to destroy a city—except for bombing." --Assar Lindbeck

And yet, European and Asian cities are filled with affordable housing, rent control and no homeless people.

Understand my first sentence above before you disagree with my second.

I agree that lack of supply is an issue. Somehow they get things built in other countries. Less NIMBYs, public transportation and services, etc.

I don't agree that rent control is a problem. Rent control keeps places affordable. If housing is considered a public good, then investors will just have to live within the constraints or the government will need to subsidize the cost.

Quote from: marshwiggle on July 10, 2023, 05:27:07 AM

Quote from: Kron3007 on July 10, 2023, 05:17:03 AMI think a big part is the commodification of housing.  In Canada, the biggest group of people buying homes now is people who already own at least one house, showing that housing has really shifted to an investment opportunity.  20% of real estate here is now owned by investors. 

But that still leaves open the question of where all of the people come from who those investors can rent to. For those properties to not sit vacant, there need to be people who can pay the carrying costs on those places. Rent is not going to be less than the owners' financing costs. There can't be an infinitely deep pool of wealthy potential tenants that is bigger than the supply of housing. At some point, when everyone of a certain income level is housed, there's not going to be a market for more housing at that price point.

That's kind of my point, I don't feel the issue has that much to do with the ratio of people to housing (maybe in part), rather that people and corporations are using housing as an investment that drives up prices.  We are just shifting from a country where individuals own homes and accumulate the equity, to one where that is concentrated with the wealthy.

People who would like to buy, and would have been able to a decade ago, are forced to rent and have to pay the market rate.  Some will be forced into homelessness, but many will make it work by making sacrifices in other areas.  Many will never be able to buy, or likely save for retirement, etc.



 

Quote from: ciao_yall on July 10, 2023, 09:37:29 AM

Quote from: dismalist on July 09, 2023, 07:00:14 PM

Quote from: ciao_yall on July 09, 2023, 06:43:38 PM

Quote from: dismalist on July 09, 2023, 06:00:58 PM

Quote from: ciao_yall on July 09, 2023, 05:35:07 PM

Quote from: quasihumanist on July 09, 2023, 04:40:05 PMThe obvious fact that has been ignored: More than anything else, homelessness correlates with how expensive housing is.

Here in SF and other big cities, housing is expensive. This is exacerbated by:

(1) AirBnB has converted a lot of residential housing into hotel equivalents which drove up the price of homes and rental rates, though this article  (https://finance.yahoo.com/news/housing-market-2023-viral-tweet-113009741.html)suggests it might be turning around.
 
(2) A certain amount of the housing is empty. A lot of second/third/plus homes and absentee owners who moved out but didn't want to rent, haven't gotten around to selling, hung up in the family estate, etc. I'd love to see a bunch of squatters take over some long-empty Pacific Heights mansion(s).

People complain about the impact of rent control, mandated supply of affordable housing, etc I would look at # 1 and # 2 as something that can be managed more directly.

High rents are a symptom of inadequate new supply, not increased new demand. The cause is NIMBYism, us, in other words.

"Rent control appears to be the most efficient technique presently known to destroy a city—except for bombing." --Assar Lindbeck

And yet, European and Asian cities are filled with affordable housing, rent control and no homeless people.

Understand my first sentence above before you disagree with my second.

I agree that lack of supply is an issue. Somehow they get things built in other countries. Less NIMBYs, public transportation and services, etc.

I don't agree that rent control is a problem. Rent control keeps places affordable. If housing is considered a public good, then investors will just have to live within the constraints or the government will need to subsidize the cost.

Lack of supply is not an issue, it's the only issue!

Rent control keeps places affordable for those already living in the existing housing stock. Unless a South Bronx 1970's happens, when rent control made it profitable to burn down buildings.

Bronx Burning (https://www.youtube.com/watch?v=AtI-En92Xso)

To keep housing prices and rents down you need more damned houses! After all, a surge in demand for bubble gum drives up quantity, not price. 

Careful throwing around terms like "public good". An eminently useful definition is a good that can be consumed by more than one person at the same time. My flat is a private good. You can't consume it at the same time I consume it.

Restrict the return on investment in housing, and presto, you get no additional houses. Try to find a flat in Paris.

Government subsidies for housing? No, we have a safety net that is far more generous than usually thought. We need more houses, not more subsidies.

Quote from: dismalist on July 10, 2023, 12:10:12 PM[. . .]

Careful throwing around terms like "public good". An eminently useful definition is a good that can be consumed by more than one person at the same time.

[. . . ]

I'd say that is a non-rival good. A public good is both non-rival and non-excludable.

Quote from: spork on July 10, 2023, 01:49:40 PM

Quote from: dismalist on July 10, 2023, 12:10:12 PM[. . .]

Careful throwing around terms like "public good". An eminently useful definition is a good that can be consumed by more than one person at the same time.

[. . . ]

I'd say that is a non-rival good. A public good is both non-rival and non-excludable.

Yes, Spork. The non-excludable part was added by Musgrave early after the Samuelsonian pure public good was posited.

The addition doesn't help analytically, though: First, you don't want to exclude from a pure public good, for the cost of adding a consumer is zero. Second, excludability is a function of technology. Radio used to be not excludable, now it's excludable.

To get back to the housing scarcity, people get in my way if they inhabit my flat, and I can exclude them by locking the door. A flat is a pure private good no matter how you slice the cake.

Anyway, definitions are not true of false, just more or less useful.

Quote from: dismalist on July 10, 2023, 12:10:12 PMLack of supply is not an issue, it's the only issue!

Rent control keeps places affordable for those already living in the existing housing stock. Unless a South Bronx 1970's happens, when rent control made it profitable to burn down buildings.

Bronx Burning (https://www.youtube.com/watch?v=AtI-En92Xso)

To keep housing prices and rents down you need more damned houses! After all, a surge in demand for bubble gum drives up quantity, not price. 

Careful throwing around terms like "public good". An eminently useful definition is a good that can be consumed by more than one person at the same time. My flat is a private good. You can't consume it at the same time I consume it.

Restrict the return on investment in housing, and presto, you get no additional houses. Try to find a flat in Paris.

Government subsidies for housing? No, we have a safety net that is far more generous than usually thought. We need more houses, not more subsidies.

That is assuming that supply will meet demand to level out to "market rates."

Out in the 'burbs it is more profitable to build large homes that are too expensive for first-time homebuyers. "Starter" homes are bought, all-cash by investors who then rent them out at a rate that grows with the market.

In the cities, lots of one-bedroom one-bathroom apartments that are too small for couples or families but the perfect size for an AirBnB!

The cost to build in the City is at least $500 per square foot. There is no way to supply affordable housing at those prices. Materials, earthquake safety, and making sure the construction workers can earn a living wage means it all adds up. Subsidies are a must, whether it's housing assistance or a higher minimum wage.

Quote from: spork on July 10, 2023, 01:49:40 PM

Quote from: dismalist on July 10, 2023, 12:10:12 PM[. . .]

Careful throwing around terms like "public good". An eminently useful definition is a good that can be consumed by more than one person at the same time.

[. . . ]

I'd say that is a non-rival good. A public good is both non-rival and non-excludable.

I think of a "public good" being one that disproportionately benefits society (roads, education, utilities, parks) and how we are better off as a society spreading out the costs evenly to make sure all have access rather than letting some people irrationally skip out. I don't want to pay my road tax so I'll travel on the dirt path, even though it takes me longer. I'd rather buy a new TV than send my kids to school so they will grow up illiterate.

So are health care and housing "public goods?" We are better off if everyone is well and thus able to contribute to society. We are better off if everyone is safely housed and thus rested, stable and able to access jobs, education, and the like. Some might decide they would rather spend their money on something other than medicine. Or prefer to live for free in a tent/RV and spend their money on whatever else. But as a society we take that choice away by charging taxes and making health care and housing so easily accessible that it's a no-brainer decision.

Quote from: ciao_yall on July 10, 2023, 02:23:06 PM

Quote from: spork on July 10, 2023, 01:49:40 PM

Quote from: dismalist on July 10, 2023, 12:10:12 PM[. . .]

Careful throwing around terms like "public good". An eminently useful definition is a good that can be consumed by more than one person at the same time.

[. . . ]

I'd say that is a non-rival good. A public good is both non-rival and non-excludable.

I think of a "public good" being one that disproportionately benefits society (roads, education, utilities, parks) and how we are better off as a society spreading out the costs evenly to make sure all have access rather than letting some people irrationally skip out. I don't want to pay my road tax so I'll travel on the dirt path, even though it takes me longer. I'd rather buy a new TV than send my kids to school so they will grow up illiterate.

So are health care and housing "public goods?" We are better off if everyone is well and thus able to contribute to society. We are better off if everyone is safely housed and thus rested, stable and able to access jobs, education, and the like. Some might decide they would rather spend their money on something other than medicine. Or prefer to live for free in a tent/RV and spend their money on whatever else. But as a society we take that choice away by charging taxes and making health care and housing so easily accessible that it's a no-brainer decision.

No. I can't consume my neighbor's health.

Quote from: ciao_yall on July 10, 2023, 02:16:12 PM

Quote from: dismalist on July 10, 2023, 12:10:12 PMLack of supply is not an issue, it's the only issue!

Rent control keeps places affordable for those already living in the existing housing stock. Unless a South Bronx 1970's happens, when rent control made it profitable to burn down buildings.

Bronx Burning (https://www.youtube.com/watch?v=AtI-En92Xso)

To keep housing prices and rents down you need more damned houses! After all, a surge in demand for bubble gum drives up quantity, not price. 

Careful throwing around terms like "public good". An eminently useful definition is a good that can be consumed by more than one person at the same time. My flat is a private good. You can't consume it at the same time I consume it.

Restrict the return on investment in housing, and presto, you get no additional houses. Try to find a flat in Paris.

Government subsidies for housing? No, we have a safety net that is far more generous than usually thought. We need more houses, not more subsidies.

That is assuming that supply will meet demand to level out to "market rates."

Out in the 'burbs it is more profitable to build large homes that are too expensive for first-time homebuyers. "Starter" homes are bought, all-cash by investors who then rent them out at a rate that grows with the market.

In the cities, lots of one-bedroom one-bathroom apartments that are too small for couples or families but the perfect size for an AirBnB!

The cost to build in the City is at least $500 per square foot. There is no way to supply affordable housing at those prices. Materials, earthquake safety, and making sure the construction workers can earn a living wage means it all adds up. Subsidies are a must, whether it's housing assistance or a higher minimum wage.

Subsidies increase demand, raising price.

It's supply that's the problem.

Quote from: ciao_yall on July 10, 2023, 02:16:12 PM[. . . ]

Subsidies are a must, whether it's housing assistance or a higher minimum wage.

Read Janos Kornai on the shortage economy. Subsidies decouple demand from price, and scarce resources, because they are scarce, are held in reserve rather than utilized. Shortage generates slack, which in turns worsens shortage.

Quote from: ciao_yall on July 10, 2023, 09:37:29 AMI don't agree that rent control is a problem. Rent control keeps places affordable.

Rent control is a problem when owners don't keep a place properly maintained. If they sell the property, the new owner can't raise rents to do the necessary repairs, so the only economically sensible thing to do is to tear it down and sell the land.

The maintenance legacy of a rent-controlled property is the albatross around its neck.

Quote from: ciao_yall on July 10, 2023, 09:32:50 AMSome people are perfectly happy to have a home in XYZ that they maintain but only visit a few times a year.

How big a portion of the population can afford this? (Vacation properties don't really count, since they are rarely properties that were occupied year-round at some time in the past.) Properties previously occupied full-time being sold to sit empty most of the time can't be a very common scenario.

Random thoughts and questions:

1) I never did say that I think harm reduction/ drug legalization strategies/schemes will increase the number of drug users.   Maybe they will, but there has been little research done on this question.  But it is unambiguously true that such schemes will make it much less likely that existing drug users will stop using drugs, because the lion's share of their incentives to do so will be taken away.

2) The housing shortage/ affordability crisis is real, and clearly multifaceted and multicaused.  Obviously however it does exist, and it is a public evil.  As such, it must needs be addressed, and properly doing so will be expensive, AND will almost certainly require us to be willing to accept certain limitations on absolute 'freedom' rights traditionally held by and espoused as good by numerous Americans.  We need to consider not only things like rent control, and vast increases in housing subsidies and public housing construction, but also laws that limit the number of houses and apt units that can be owned by people not planning on making these residences their primary residence, laws limiting speculating and investing in housing stock, as well as more or less laws forbidding or at least severely attenuating most incidences of NIMBYism. 

3) People have noted that various Euro and Asian (and perhaps also Canada) countries have much less of NIMBYism, and housing supply issues, etc., even though they do impose rent control and various other policies that seem certain to attenuate a housing shortage scenario.   What is it that makes these places less susceptible to NIMBYism, and more amenable to such actions?

Quote from: kaysixteen on July 10, 2023, 07:20:09 PM3) People have noted that various Euro and Asian (and perhaps also Canada) countries have much less of NIMBYism, and housing supply issues, etc., even though they do impose rent control and various other policies that seem certain to attenuate a housing shortage scenario.   What is it that makes these places less susceptible to NIMBYism, and more amenable to such actions?

Canada is certainly not immune to NIMBYism, but one big difference between Canada and the U.S. is in their origins; the U.S. was founded on a revolution, while Canada was founded on a compromise. So the U.S. has a militant "my way or the highway" streak in their political DNA, while Canada has a "it's not perfect, but we can live with it" streak in their political DNA.

Quote from: marshwiggle on July 11, 2023, 05:45:18 AM

Quote from: kaysixteen on July 10, 2023, 07:20:09 PM3) People have noted that various Euro and Asian (and perhaps also Canada) countries have much less of NIMBYism, and housing supply issues, etc., even though they do impose rent control and various other policies that seem certain to attenuate a housing shortage scenario.  What is it that makes these places less susceptible to NIMBYism, and more amenable to such actions?

Canada is certainly not immune to NIMBYism, but one big difference between Canada and the U.S. is in their origins; the U.S. was founded on a revolution, while Canada was founded on a compromise. So the U.S. has a militant "my way or the highway" streak in their political DNA, while Canada has a "it's not perfect, but we can live with it" streak in their political DNA.

I would add to this that other countries/cultures seem more willing to give up a little bit for the greater good. So they don't mind paying more taxes because health care is a necessity. They don't mind losing their view or "open space" because people gotta live somewhere. They ride public transportation because they don't mind sharing spaces.

Quote from: dismalistNo. I can't consume my neighbor's health.

But if your neighbor has a treatable illness yet cannot afford treatment, you are paying for their government assistance for them to stay home instead of their working and paying taxes. If they die, you are paying to support their children while they grow up, or their elderly parents.

Or their grieving loved ones turn to drugs and alcohol to ease the emotional burden of their loss and they end up homeless. And the cycle continues.

Quote from: ciao_yall on July 11, 2023, 08:14:42 AM

Quote from: marshwiggle on July 11, 2023, 05:45:18 AM

Quote from: kaysixteen on July 10, 2023, 07:20:09 PM3) People have noted that various Euro and Asian (and perhaps also Canada) countries have much less of NIMBYism, and housing supply issues, etc., even though they do impose rent control and various other policies that seem certain to attenuate a housing shortage scenario.  What is it that makes these places less susceptible to NIMBYism, and more amenable to such actions?

Canada is certainly not immune to NIMBYism, but one big difference between Canada and the U.S. is in their origins; the U.S. was founded on a revolution, while Canada was founded on a compromise. So the U.S. has a militant "my way or the highway" streak in their political DNA, while Canada has a "it's not perfect, but we can live with it" streak in their political DNA.

I would add to this that other countries/cultures seem more willing to give up a little bit for the greater good. So they don't mind paying more taxes because health care is a necessity. They don't mind losing their view or "open space" because people gotta live somewhere. They ride public transportation because they don't mind sharing spaces.

Quote from: dismalistNo. I can't consume my neighbor's health.

But if your neighbor has a treatable illness yet cannot afford treatment, you are paying for their government assistance for them to stay home instead of their working and paying taxes. If they die, you are paying to support their children while they grow up, or their elderly parents.

Or their grieving loved ones turn to drugs and alcohol to ease the emotional burden of their loss and they end up homeless. And the cycle continues.

The first sentence about the neighbor is a non sequitur. Me paying for my neighbor's medical bills doesn't make health care a public good. It's OK to call it a publicly financed good. Actually, it's charity or forced charity. To clarify, while my neighbor's cancer treatment is a strictly private good -- I don't benefit  -- his flu vaccine is a public good -- his shot protects him and me.

As for "other cultures" health policy, tomes have been written about this. The US is the outlier and that can be traced to the influence of the AMA. Other countries tax themselves to provide the private good called health care. The use of force is justified because they would not let the uninsured die, so the uninsured cannot exploit the society.

Quote from: dismalist on July 11, 2023, 09:47:32 AMThe first sentence about the neighbor is a non sequitur. Me paying for my neighbor's medical bills doesn't make health care a public good. It's OK to call it a publicly financed good. Actually, it's charity or forced charity. To clarify, while my neighbor's cancer treatment is a strictly private good -- I don't benefit  -- his flu vaccine is a public good -- his shot protects him and me.

As for "other cultures" health policy, tomes have been written about this. The US is the outlier and that can be traced to the influence of the AMA. Other countries tax themselves to provide the private good called health care. The use of force is justified because they would not let the uninsured die, so the uninsured cannot exploit the society.

Is the fire department a private good? It would seem so, at least in cases where one building burning poses no serious danger to any other buildings nearby.

Much of police service would also be a private good. So would public education. Almost any service provides vastly more benefit to the people who have to use it than to the rest of society.
 

Quote from: marshwiggle on July 11, 2023, 10:42:26 AM

Quote from: dismalist on July 11, 2023, 09:47:32 AMThe first sentence about the neighbor is a non sequitur. Me paying for my neighbor's medical bills doesn't make health care a public good. It's OK to call it a publicly financed good. Actually, it's charity or forced charity. To clarify, while my neighbor's cancer treatment is a strictly private good -- I don't benefit  -- his flu vaccine is a public good -- his shot protects him and me.

As for "other cultures" health policy, tomes have been written about this. The US is the outlier and that can be traced to the influence of the AMA. Other countries tax themselves to provide the private good called health care. The use of force is justified because they would not let the uninsured die, so the uninsured cannot exploit the society.

Is the fire department a private good? It would seem so, at least in cases where one building burning poses no serious danger to any other buildings nearby.

Much of police service would also be a private good. So would public education. Almost any service provides vastly more benefit to the people who have to use it than to the rest of society.

So imagine a society with no fire service, public safety or public education. Would you be willing to live there if you had (1) a garden hose to put out a fire, (2) a gun to shoot any intruders, and (3) the benefit of your existing education?

Quote from: ciao_yall on July 11, 2023, 10:47:20 AM

Quote from: marshwiggle on July 11, 2023, 10:42:26 AM

Quote from: dismalist on July 11, 2023, 09:47:32 AMThe first sentence about the neighbor is a non sequitur. Me paying for my neighbor's medical bills doesn't make health care a public good. It's OK to call it a publicly financed good. Actually, it's charity or forced charity. To clarify, while my neighbor's cancer treatment is a strictly private good -- I don't benefit  -- his flu vaccine is a public good -- his shot protects him and me.

As for "other cultures" health policy, tomes have been written about this. The US is the outlier and that can be traced to the influence of the AMA. Other countries tax themselves to provide the private good called health care. The use of force is justified because they would not let the uninsured die, so the uninsured cannot exploit the society.

Is the fire department a private good? It would seem so, at least in cases where one building burning poses no serious danger to any other buildings nearby.

Much of police service would also be a private good. So would public education. Almost any service provides vastly more benefit to the people who have to use it than to the rest of society.

So imagine a society with no fire service, public safety or public education. Would you be willing to live there if you had (1) a garden hose to put out a fire, (2) a gun to shoot any intruders, and (3) the benefit of your existing education?

That's my point. I'm curious (as many others are) at how many people in the U.S. seem to be OK with public funding of these things while feeling public funding of healthcare is unreasonable because it's a "private good". In countries with universal healthcare most people view it a lot like fire service; some people are unlucky enough to need treatment vastly beyond the capacity of their own finances, so everyone gets the service they need at public expense. By making the service publicly provided, it's much more efficient and uniform than it would be if it were handled by a patchwork of private providers.

Quote from: marshwiggle on July 11, 2023, 10:53:26 AMThat's my point. I'm curious (as many others are) at how many people in the U.S. seem to be OK with public funding of these things while feeling public funding of healthcare is unreasonable because it's a "private good". In countries with universal healthcare most people view it a lot like fire service; some people are unlucky enough to need treatment vastly beyond the capacity of their own finances, so everyone gets the service they need at public expense. By making the service publicly provided, it's much more efficient and uniform than it would be if it were handled by a patchwork of private providers.

You could take a "follow the money" approach.

Police and fire personnel can get paid better by the government/taxpayers because people recognize these services are essential. So they lobby for their unions, pensions, etc to get to the deepest pockets.

Doctors believe they can get paid better by insurance companies or grateful patients, so they lobby hard to keep health coverage "private" by telling horror stories about public health systems in which doctors are paid a professional-but-not-outlandish salary by the government. 

These days, doctors are getting squeezed by private health practices and insurance companies, so who knows what will happen next?

Quote from: ciao_yall on July 11, 2023, 11:32:12 AM

Quote from: marshwiggle on July 11, 2023, 10:53:26 AMThat's my point. I'm curious (as many others are) at how many people in the U.S. seem to be OK with public funding of these things while feeling public funding of healthcare is unreasonable because it's a "private good". In countries with universal healthcare most people view it a lot like fire service; some people are unlucky enough to need treatment vastly beyond the capacity of their own finances, so everyone gets the service they need at public expense. By making the service publicly provided, it's much more efficient and uniform than it would be if it were handled by a patchwork of private providers.

You could take a "follow the money" approach.

Police and fire personnel can get paid better by the government/taxpayers because people recognize these services are essential. So they lobby for their unions, pensions, etc to get to the deepest pockets.

Doctors believe they can get paid better by insurance companies or grateful patients, so they lobby hard to keep health coverage "private" by telling horror stories about public health systems in which doctors are paid a professional-but-not-outlandish salary by the government. 

These days, doctors are getting squeezed by private health practices and insurance companies, so who knows what will happen next?

Good.

Actually, fire and police services are private goods with a strong element of publicness. Putting out my fire, spillovers aside, and preventing me from getting robbed, deterrence aside, helps me, not anyone else. But preventing the spillovers and providing deterrence helps everybody.

Both are publicly financed goods. Why?

A monopoly is better than competition in providing such services. I remember when I moved to Northern Virginia 30 years ago I played tourist and took a tour in Washington, D.C. In the preserved Georgetown neighborhood we were told that originally fire services were private and subject to competition. When a fire was reported competing companies would send their equipment, and fist fights would break out over which crew would get to douse the fire!

If you have to have a monopoly you must either regulate it or provide it through the government. The difference sometimes matters.

The reason health insurance in the USA became an outlier was indeed the control by the AMA of State medical boards, but the reason the US stays an  outlier has a not so subtle political cause: Most people are happy with their private health insurance.

The high earnings of doctors in the US are ensured by the AMA through its influence on the Liaison Committee on Medical Education, which serves to cap the number o doctors. The US has an extraordinarily low ratio of doctors to population by civilized country standards.

It's almost like housing, really!

https://www.cnn.com/2023/07/11/us/california-homeless-spending/index.html

I find the whole talk of the lack of affordable housing issue as a particularly American problem bizarre. Housing is insanely expensive compared to people's incomes almost anywhere anyone actually wants to live in, from Seoul to Vancouver to Moscow to London to Mexico City. Maybe Canada suffers from less Nimbyism, but definitely not from less unaffordable housing - Vancouver is one of the least affordable cities on the planet.
To me it seems blindingly obvious at some point almost every government on the planet stopped building, or subsidizing the building of, affordable housing. Combined with increasing requirements and restrictions (it's not enough to comply with health & safety requirements, you also have to please the Karens on the local HOA, for example), which increases costs, as a basic illustration you get soaring house prices. Making it easier for buyers to borrow makes it worse, as it means increasing demand (much like federal student loans allow tuition to go higher).

On the problem of drug use, it seems to me obvious different drugs require very different approaches, because some are much more harmful than others, and some are more addictive than others. An alcoholic can remain functional (able to hold a job and generally keep themselves alive) for years - there's at least one such alcoholic on my department. It's also possible to consume alcohol regularly but in small amounts that cause relatively little damage. It makes sense to keep alcohol legal because the costs of making it illegal outweigh the benefits - alcoholism is still a problem, but at least alcohol suppliers aren't shooting each other on the streets. For the "hardest" drugs, I'm not sure there's a better answer than giving addicts a rehab or jail choice.

This distinction between public and private goods seems a little Symantec.  Perhaps this is a technical definition, but it hardly seems black and white as there is often overlap.

There are no services that everyone benefits from equally, nor services that only impact one person without any public good.  Roads are a public good, but not everyone drives.  How my neighbour is doing impacts me.  If everyone in my neighbourhood is suffering, it impacts my life very much.

This is the whole point of harm reduction, public healthcare, etc.  It is also one of the major differences I see between the more libertarian minded American public and the Canadian public.

When I was younger I was conservative, largely on libertarian principles.  What shifted my view to being the bleeding heart liberal you now see was living in the Southern USA and seeing the results of it in practice.  This is why I completely understand the stance of many who think drug users, homeless, etc. should reap what they sow from a philosophical basis, but don't think it leads to the best outcomes for society. 

Public healthcare provides better care to the most people, for less money.  From a societal point of view it is better, but when I was in the USA people seemed more concerned about people taking advantage of it and having to pay for others.  Sometimes gut feelings get in the way of the best policies.

Likewise with drug use.  It may feel good for people to think we should crack down on them, and they should take personal responsibility, but none of the evidence suggests this has the best societal outcome.  Creating policy based on your gut is no way to run a country.

Quote from: Kron3007 on July 12, 2023, 04:55:25 AMThis distinction between public and private goods seems a little Symantec.  Perhaps this is a technical definition, but it hardly seems black and white as there is often overlap.

There are no services that everyone benefits from equally, nor services that only impact one person without any public good.  Roads are a public good, but not everyone drives.  How my neighbour is doing impacts me.  If everyone in my neighbourhood is suffering, it impacts my life very much.

Picking up on this, consider this:
Would you rather live in a mansion in a war zone, or in a small apartment in a peaceful city?


I think many, if not most, people would choose the apartment, even though the mansion leaves them with more of what might be called "private goods". "Goods" are not (or should not be thought to be) simply economic. The psychological, emotional, and spiritual "goods" of living in a society with less wealth inequality and suffering are worth higher taxes for many people. In many American cities I've visited, I've seen more people begging, showing signs of chronic illness (like limping), homeless, etc. beyond anything normal for Canadian cities. That experience lessens my enjoyment of life when I'm there. So the taxes I pay here that pay for all of those social programs actually does provide a "good" for me, namely my ability to be comfortable in my environment.

So public healthcare is a public good because we don't have to see nearly as much suffering as is common in places without it, and that is personally valuable.

Quote from: Kron3007 on July 12, 2023, 04:55:25 AMThis distinction between public and private goods seems a little Symantec.  Perhaps this is a technical definition, but it hardly seems black and white as there is often overlap.

There are no services that everyone benefits from equally, nor services that only impact one person without any public good.  Roads are a public good, but not everyone drives.  How my neighbour is doing impacts me.  If everyone in my neighbourhood is suffering, it impacts my life very much.

Well, not everyone drives. But they do receive mail that is delivered over public roads. Thy buy groceries that were trucked in over public roads at a much lower cost than if they were schlepped across dirt trails. So we all benefit from roads.

Playing with definitions is unhelpful for analyzing anything. The precise technical distinction between public and private goods is useful  precisely for determining the best way of financing its provision, by taxation or by user fee [price]. They do constitute extremes, however. Between them are capacity constrained services. A classroom is a public good until it is full. Then it is a private good.

For combating poverty, we have a safety net that is far more generous than usually appreciated. Some people care more about this and some not at all. It is charity or forced charity, not a public good. I am for poverty alleviation not for what it does for me, but for what it does for the recipient. Hence, purely private good.

When the concept is bandied about with reckless abandon it seems that a public good is a good that I like, so I put the adjective public in front of it to justify the government paying for it. Well, it's public. All true by definition.

Picking up on this, consider this:
Would you rather live in a mansion in a war zone, or in a small apartment in a peaceful city?

Interesting, since I have this same option in my meatpacking town.  This year I could have bought a 4500 s.f. home in the historic district for $280K, near the limits of what I can afford.  It is also close to some problematic homes based on published arrest reports.  The home today would cost $2M to build. 

Zoning laws today forbid affordable housing.  One example is New Lenox, Illinois where a single family home must be at least 1800 s.f.  There are many other factors involved with the federal government and lending practices.  In my cynical view, nothing substantial will change in our lifetimes.  Your only option is to live where housing is affordable and give up on the American obsession with owning the traditional single family home.

Quote from: dismalist on July 12, 2023, 09:42:17 AMPlaying with definitions is unhelpful for analyzing anything. The precise technical distinction between public and private goods is useful  precisely for determining the best way of financing its provision, by taxation or by user fee [price]. They do constitute extremes, however. Between them are capacity constrained services. A classroom is a public good until it is full. Then it is a private good.

For combating poverty, we have a safety net that is far more generous than usually appreciated. Some people care more about this and some not at all. It is charity or forced charity, not a public good. I am for poverty alleviation not for what it does for me, but for what it does for the recipient. Hence, purely private good.

When the concept is bandied about with reckless abandon it seems that a public good is a good that I like, so I put the adjective public in front of it to justify the government paying for it. Well, it's public. All true by definition.

There's an interesting amount of behavioural economics in all this, illustrated by amenities. Simply put, are amenities "public goods" or "forced charity"?

In my building, the marketing materials identified amenities like a pool, gym, etc. This is pretty typical. Since I've lived here, from my observations only a small percentage of residents have actually used the pool or the gym. Developers build what will sell. So, if there were many people who didn't want to pay for amenities that they wouldn't use, there should be some buildings designed without these amenities. The reality is that the best-selling properties are the ones with the most extensive amenities. Why are people willing to shell out definite cash for access to services which they may use? In purely economic terms, people should opt for not buying into all of these communal benefits which they may not use, and instead just purchase their own gym  memberships and so on if and when they actually use them.

So, are amenities "public goods" or "forced charity"? And why do people choose those over only paying for things they themselves actually use?

Quote from: dismalist on July 12, 2023, 09:42:17 AMPlaying with definitions is unhelpful for analyzing anything. The precise technical distinction between public and private goods is useful  precisely for determining the best way of financing its provision, by taxation or by user fee [price]. They do constitute extremes, however. Between them are capacity constrained services. A classroom is a public good until it is full. Then it is a private good.

For combating poverty, we have a safety net that is far more generous than usually appreciated. Some people care more about this and some not at all. It is charity or forced charity, not a public good. I am for poverty alleviation not for what it does for me, but for what it does for the recipient. Hence, purely private good.

When the concept is bandied about with reckless abandon it seems that a public good is a good that I like, so I put the adjective public in front of it to justify the government paying for it. Well, it's public. All true by definition.

Perhaps it is, but I don't think there is a black and white separation between public and private goods.  As with most things it seems more like a gradient.  Trying to bin them makes things easy, but misses the nuance. 

Quote from: ciao_yall on July 12, 2023, 09:03:44 AM

Quote from: Kron3007 on July 12, 2023, 04:55:25 AMThis distinction between public and private goods seems a little Symantec.  Perhaps this is a technical definition, but it hardly seems black and white as there is often overlap.

There are no services that everyone benefits from equally, nor services that only impact one person without any public good.  Roads are a public good, but not everyone drives.  How my neighbour is doing impacts me.  If everyone in my neighbourhood is suffering, it impacts my life very much.

Well, not everyone drives. But they do receive mail that is delivered over public roads. Thy buy groceries that were trucked in over public roads at a much lower cost than if they were schlepped across dirt trails. So we all benefit from roads.

True, but this argument can be made for most items.  You may not go to university, but you benefit from the skilled labour they provide.  You may not have a cell phone, but our entire system relies on it.  Etc.

Quote from: Stockmann on July 11, 2023, 04:02:29 PMI find the whole talk of the lack of affordable housing issue as a particularly American problem bizarre. Housing is insanely expensive compared to people's incomes almost anywhere anyone actually wants to live in, from Seoul to Vancouver to Moscow to London to Mexico City. Maybe Canada suffers from less Nimbyism, but definitely not from less unaffordable housing - Vancouver is one of the least affordable cities on the planet.
To me it seems blindingly obvious at some point almost every government on the planet stopped building, or subsidizing the building of, affordable housing. Combined with increasing requirements and restrictions (it's not enough to comply with health & safety requirements, you also have to please the Karens on the local HOA, for example), which increases costs, as a basic illustration you get soaring house prices. Making it easier for buyers to borrow makes it worse, as it means increasing demand (much like federal student loans allow tuition to go higher).

On the problem of drug use, it seems to me obvious different drugs require very different approaches, because some are much more harmful than others, and some are more addictive than others. An alcoholic can remain functional (able to hold a job and generally keep themselves alive) for years - there's at least one such alcoholic on my department. It's also possible to consume alcohol regularly but in small amounts that cause relatively little damage. It makes sense to keep alcohol legal because the costs of making it illegal outweigh the benefits - alcoholism is still a problem, but at least alcohol suppliers aren't shooting each other on the streets. For the "hardest" drugs, I'm not sure there's a better answer than giving addicts a rehab or jail choice.

Sure, every drug is unique, but I think the general principles of how we approach them can be similar.  There are a lot of functional drug users, you just apparently don't know about it.  Alcohol use is just more open. As with alcohol, some people can use drugs and remain productive members of society, while others develop problem use.  The reality is that alcohol is among the worst drugs by almost any measure.

As for alcohol suppliers not shooting each other on the street, that was not necessarily true during prohibition.  Organized crime was a major benefactor of prohibition, and I'm sure there were related murders and other crimes.  This is one of the main arguments for legalization, it would reduce crime related to the drug trade.   

Quote from: marshwiggle on July 13, 2023, 04:58:59 AM

Quote from: dismalist on July 12, 2023, 09:42:17 AMPlaying with definitions is unhelpful for analyzing anything. The precise technical distinction between public and private goods is useful  precisely for determining the best way of financing its provision, by taxation or by user fee [price]. They do constitute extremes, however. Between them are capacity constrained services. A classroom is a public good until it is full. Then it is a private good.

For combating poverty, we have a safety net that is far more generous than usually appreciated. Some people care more about this and some not at all. It is charity or forced charity, not a public good. I am for poverty alleviation not for what it does for me, but for what it does for the recipient. Hence, purely private good.

When the concept is bandied about with reckless abandon it seems that a public good is a good that I like, so I put the adjective public in front of it to justify the government paying for it. Well, it's public. All true by definition.

There's an interesting amount of behavioural economics in all this, illustrated by amenities. Simply put, are amenities "public goods" or "forced charity"?

In my building, the marketing materials identified amenities like a pool, gym, etc. This is pretty typical. Since I've lived here, from my observations only a small percentage of residents have actually used the pool or the gym. Developers build what will sell. So, if there were many people who didn't want to pay for amenities that they wouldn't use, there should be some buildings designed without these amenities. The reality is that the best-selling properties are the ones with the most extensive amenities. Why are people willing to shell out definite cash for access to services which they may use? In purely economic terms, people should opt for not buying into all of these communal benefits which they may not use, and instead just purchase their own gym  memberships and so on if and when they actually use them.

So, are amenities "public goods" or "forced charity"? And why do people choose those over only paying for things they themselves actually use?

Amenities? There's a good motto, addressed to professionals -- If you don't understand something about pricing, it's probably price discrimination! :-)

Here it take the form of bundling. Nothing special.

Quote from: marshwiggle on July 13, 2023, 04:58:59 AMThere's an interesting amount of behavioural economics in all this, illustrated by amenities. Simply put, are amenities "public goods" or "forced charity"?

In my building, the marketing materials identified amenities like a pool, gym, etc. This is pretty typical. Since I've lived here, from my observations only a small percentage of residents have actually used the pool or the gym. Developers build what will sell. So, if there were many people who didn't want to pay for amenities that they wouldn't use, there should be some buildings designed without these amenities. The reality is that the best-selling properties are the ones with the most extensive amenities. Why are people willing to shell out definite cash for access to services which they may use? In purely economic terms, people should opt for not buying into all of these communal benefits which they may not use, and instead just purchase their own gym  memberships and so on if and when they actually use them.

So, are amenities "public goods" or "forced charity"? And why do people choose those over only paying for things they themselves actually use?

Neither - they are conspicuous (non)-consumption.

People pay for amenities because it enhances their (feelings about their) status to have a gym and pool they never use.  It's another form of the "I have money I can afford to waste on this certificate" certificate.

Quote from: quasihumanist on July 13, 2023, 08:40:53 AM

Quote from: marshwiggle on July 13, 2023, 04:58:59 AMThere's an interesting amount of behavioural economics in all this, illustrated by amenities. Simply put, are amenities "public goods" or "forced charity"?

In my building, the marketing materials identified amenities like a pool, gym, etc. This is pretty typical. Since I've lived here, from my observations only a small percentage of residents have actually used the pool or the gym. Developers build what will sell. So, if there were many people who didn't want to pay for amenities that they wouldn't use, there should be some buildings designed without these amenities. The reality is that the best-selling properties are the ones with the most extensive amenities. Why are people willing to shell out definite cash for access to services which they may use? In purely economic terms, people should opt for not buying into all of these communal benefits which they may not use, and instead just purchase their own gym  memberships and so on if and when they actually use them.

So, are amenities "public goods" or "forced charity"? And why do people choose those over only paying for things they themselves actually use?

Neither - they are conspicuous (non)-consumption.

People pay for amenities because it enhances their (feelings about their) status to have a gym and pool they never use.  It's another form of the "I have money I can afford to waste on this certificate" certificate.

Some people go to a college with a football team but never attend a game. They are broadcasting that they are wasting money or buying status?

Some people don't eat all the meals served on a cruise. They are broadcasting that they are wasting money or buying status?

No, bundling exists wherever people have different willingness to pay for the components of the bundle. You like academics, but not football. I like football, but not academics. A college that offers both appeals to more customers. What the deepest motive for liking different components of the bundle to different degrees isn't important for practicing bundling. What matters is only that people differ.

Quote from: dismalist on July 13, 2023, 08:23:26 AM

Quote from: marshwiggle on July 13, 2023, 04:58:59 AM

Quote from: dismalist on July 12, 2023, 09:42:17 AMPlaying with definitions is unhelpful for analyzing anything. The precise technical distinction between public and private goods is useful  precisely for determining the best way of financing its provision, by taxation or by user fee [price]. They do constitute extremes, however. Between them are capacity constrained services. A classroom is a public good until it is full. Then it is a private good.

For combating poverty, we have a safety net that is far more generous than usually appreciated. Some people care more about this and some not at all. It is charity or forced charity, not a public good. I am for poverty alleviation not for what it does for me, but for what it does for the recipient. Hence, purely private good.

When the concept is bandied about with reckless abandon it seems that a public good is a good that I like, so I put the adjective public in front of it to justify the government paying for it. Well, it's public. All true by definition.

There's an interesting amount of behavioural economics in all this, illustrated by amenities. Simply put, are amenities "public goods" or "forced charity"?

In my building, the marketing materials identified amenities like a pool, gym, etc. This is pretty typical. Since I've lived here, from my observations only a small percentage of residents have actually used the pool or the gym. Developers build what will sell. So, if there were many people who didn't want to pay for amenities that they wouldn't use, there should be some buildings designed without these amenities. The reality is that the best-selling properties are the ones with the most extensive amenities. Why are people willing to shell out definite cash for access to services which they may use? In purely economic terms, people should opt for not buying into all of these communal benefits which they may not use, and instead just purchase their own gym  memberships and so on if and when they actually use them.

So, are amenities "public goods" or "forced charity"? And why do people choose those over only paying for things they themselves actually use?

Amenities? There's a good motto, addressed to professionals -- If you don't understand something about pricing, it's probably price discrimination! :-)

Here it take the form of bundling. Nothing special.

Then I'd say universal healthcare is just more "bundling". Everyone is going to need some form of healthcare periodically; it's just not easy to predict in advance.

Quote from: marshwiggle on July 13, 2023, 10:25:24 AM

Quote from: dismalist on July 13, 2023, 08:23:26 AM

Quote from: marshwiggle on July 13, 2023, 04:58:59 AM

Quote from: dismalist on July 12, 2023, 09:42:17 AMPlaying with definitions is unhelpful for analyzing anything. The precise technical distinction between public and private goods is useful  precisely for determining the best way of financing its provision, by taxation or by user fee [price]. They do constitute extremes, however. Between them are capacity constrained services. A classroom is a public good until it is full. Then it is a private good.

For combating poverty, we have a safety net that is far more generous than usually appreciated. Some people care more about this and some not at all. It is charity or forced charity, not a public good. I am for poverty alleviation not for what it does for me, but for what it does for the recipient. Hence, purely private good.

When the concept is bandied about with reckless abandon it seems that a public good is a good that I like, so I put the adjective public in front of it to justify the government paying for it. Well, it's public. All true by definition.

There's an interesting amount of behavioural economics in all this, illustrated by amenities. Simply put, are amenities "public goods" or "forced charity"?

In my building, the marketing materials identified amenities like a pool, gym, etc. This is pretty typical. Since I've lived here, from my observations only a small percentage of residents have actually used the pool or the gym. Developers build what will sell. So, if there were many people who didn't want to pay for amenities that they wouldn't use, there should be some buildings designed without these amenities. The reality is that the best-selling properties are the ones with the most extensive amenities. Why are people willing to shell out definite cash for access to services which they may use? In purely economic terms, people should opt for not buying into all of these communal benefits which they may not use, and instead just purchase their own gym  memberships and so on if and when they actually use them.

So, are amenities "public goods" or "forced charity"? And why do people choose those over only paying for things they themselves actually use?

Amenities? There's a good motto, addressed to professionals -- If you don't understand something about pricing, it's probably price discrimination! :-)

Here it take the form of bundling. Nothing special.

Then I'd say universal healthcare is just more "bundling". Everyone is going to need some form of healthcare periodically; it's just not easy to predict in advance.

No, unable to predict in advance is most usefully called uncertainty. Tomes have been written about that, too. To cope with uncertainty somebody invented insurance.

The thing to be careful about with respect to the term "universal health care" is that the "universal" hides as much as it reveals. The NHS [and the Swedish and Italian systems, and only those systems]  combines insurance for all [and payment by all, or almost all] with government production. This is the Bevanian system. The rest of the civilized world forces everyone, or almost everyone, to purchase private or public health insurance. There is some redistribution, of course. This is the Bismarckian system. Health care is not produced by the state, but the state helps finance it.

What is important is that though both systems look different what they have in common is that both systems require each person to be insured. There is good reason for that: Moral hazard! If I know that I will not be allowed to die, I will not voluntarily insure. Then everybody else pays to save me when I threaten suicide. The required schemes, both Bevanian and Bismarckian, prevent exploitation by moral hazardeurs.

So, compulsion is necessary for efficiency. Without compulsion such insurance degenerates toward pre-paid medicine.

Anyway, playing with definitions does not help us. 



 

Quote from: dismalist on July 13, 2023, 08:23:26 AM

Quote from: marshwiggle on July 13, 2023, 04:58:59 AM

Quote from: dismalist on July 12, 2023, 09:42:17 AMPlaying with definitions is unhelpful for analyzing anything. The precise technical distinction between public and private goods is useful  precisely for determining the best way of financing its provision, by taxation or by user fee [price]. They do constitute extremes, however. Between them are capacity constrained services. A classroom is a public good until it is full. Then it is a private good.

For combating poverty, we have a safety net that is far more generous than usually appreciated. Some people care more about this and some not at all. It is charity or forced charity, not a public good. I am for poverty alleviation not for what it does for me, but for what it does for the recipient. Hence, purely private good.

When the concept is bandied about with reckless abandon it seems that a public good is a good that I like, so I put the adjective public in front of it to justify the government paying for it. Well, it's public. All true by definition.

There's an interesting amount of behavioural economics in all this, illustrated by amenities. Simply put, are amenities "public goods" or "forced charity"?

In my building, the marketing materials identified amenities like a pool, gym, etc. This is pretty typical. Since I've lived here, from my observations only a small percentage of residents have actually used the pool or the gym. Developers build what will sell. So, if there were many people who didn't want to pay for amenities that they wouldn't use, there should be some buildings designed without these amenities. The reality is that the best-selling properties are the ones with the most extensive amenities. Why are people willing to shell out definite cash for access to services which they may use? In purely economic terms, people should opt for not buying into all of these communal benefits which they may not use, and instead just purchase their own gym  memberships and so on if and when they actually use them.

So, are amenities "public goods" or "forced charity"? And why do people choose those over only paying for things they themselves actually use?

Amenities? There's a good motto, addressed to professionals -- If you don't understand something about pricing, it's probably price discrimination! :-)

Here it take the form of bundling. Nothing special.

Remember this guy? (https://www.teenvogue.com/story/congressman-says-men-shouldnt-pay-maternity-insurance)

Quote from: ciao_yall on July 13, 2023, 07:09:21 PM

Quote from: dismalist on July 13, 2023, 08:23:26 AM

Quote from: marshwiggle on July 13, 2023, 04:58:59 AM

Quote from: dismalist on July 12, 2023, 09:42:17 AMPlaying with definitions is unhelpful for analyzing anything. The precise technical distinction between public and private goods is useful  precisely for determining the best way of financing its provision, by taxation or by user fee [price]. They do constitute extremes, however. Between them are capacity constrained services. A classroom is a public good until it is full. Then it is a private good.

For combating poverty, we have a safety net that is far more generous than usually appreciated. Some people care more about this and some not at all. It is charity or forced charity, not a public good. I am for poverty alleviation not for what it does for me, but for what it does for the recipient. Hence, purely private good.

When the concept is bandied about with reckless abandon it seems that a public good is a good that I like, so I put the adjective public in front of it to justify the government paying for it. Well, it's public. All true by definition.

There's an interesting amount of behavioural economics in all this, illustrated by amenities. Simply put, are amenities "public goods" or "forced charity"?

In my building, the marketing materials identified amenities like a pool, gym, etc. This is pretty typical. Since I've lived here, from my observations only a small percentage of residents have actually used the pool or the gym. Developers build what will sell. So, if there were many people who didn't want to pay for amenities that they wouldn't use, there should be some buildings designed without these amenities. The reality is that the best-selling properties are the ones with the most extensive amenities. Why are people willing to shell out definite cash for access to services which they may use? In purely economic terms, people should opt for not buying into all of these communal benefits which they may not use, and instead just purchase their own gym  memberships and so on if and when they actually use them.

So, are amenities "public goods" or "forced charity"? And why do people choose those over only paying for things they themselves actually use?

Amenities? There's a good motto, addressed to professionals -- If you don't understand something about pricing, it's probably price discrimination! :-)

Here it take the form of bundling. Nothing special.

Remember this guy? (https://www.teenvogue.com/story/congressman-says-men-shouldnt-pay-maternity-insurance)

The congressman has a particular attitude dependent upon his opinion about sex. His position is not interesting.

I thought the article would be about the brilliant Steven Landsburg,  author of the great Armchair Economist (https://www.thriftbooks.com/w/armchair-economist-economics-and-everyday-experience_steven-e-landsburg/255079/item/3689569/?utm_source=google&utm_medium=cpc&utm_campaign=high_vol_backlist_standard_shopping_customer_aquistion&utm_adgroup=&utm_term=&utm_content=659174113139&gclid=CjwKCAjwwb6lBhBJEiwAbuVUSghQxjCHvrowmoP0x5uMZLfhI__HXkqsvy8kYRa0XUJKSy6DaVNRkBoCuf0QAvD_BwE#idiq=3689569&edition=2333094) and More Sex is Safer Sex (https://www.amazon.com/More-Sex-Safer-Unconventional-Economics/dp/1416532226), and germanely, the perpetrator of the Sandra Fluke controversy.

The issue illustrates the problem well. Preventing pregnancy is not an insurance problem because it is so certain to prevent pregnancy with current technology. Proof is that women routinely purchase birth control devices. Paying for health insurance to cover birth control cannot amount to less than pre-paid medicine. It's like having your car insurance cover oil changes. You can avoid the middleman -- the insurance company and its costs -- by paying out of pocket. It's stuff you need with certainty. There is no uncertainty involved, so it's not an insurance problem.

However, the question of who pays out of pocket for this medicine is perfectly legitimate on distributional grounds and can always be raised! For hook-ups the female will pay voluntarily, because she bears the costs of an unwanted pregnancy, but the male has no incentive to pay, and the female can't monitor. In long term relationships the cost of birth control is shared in some way.

It seems some States require birth control to be included in insurance plans. This is mere redistribution from some men who have insurance  to some women who have insurance. The redistribution is likely small, and it doesn't go to the women who would be much better off with birth control, uninsured young women. And it has nothing to do with insurance.

Surely medicine should not cover only uncertain things. Insulin is a certain need for type 1 diabetics, but it should not be omitted from insurance. Vaccines for childhood diseases are a foreseeable event. In the U.S., health insurance is also about making medical care affordable by distributing the costs, not merely about covering unforeseen medical events. If we had a more rational medical system, costs would be covered in other ways (eg by a single-payer system), but we do not, and so insurance has to perform the duty of making medical care affordable.

And if we are merely talking "paying out some money so insurance doesn't have to pay out more money later" — which is arguably why insurance covers childhood vaccines — paying for birth control now so as not to pay for expectant mother care, labor, delivery, and childhood medical care later is probably a pretty reliable savings.

Quote from: dismalist on July 13, 2023, 10:52:39 AM

Quote from: marshwiggle on July 13, 2023, 10:25:24 AM

Quote from: dismalist on July 13, 2023, 08:23:26 AM

Quote from: marshwiggle on July 13, 2023, 04:58:59 AM

Quote from: dismalist on July 12, 2023, 09:42:17 AMPlaying with definitions is unhelpful for analyzing anything. The precise technical distinction between public and private goods is useful  precisely for determining the best way of financing its provision, by taxation or by user fee [price]. They do constitute extremes, however. Between them are capacity constrained services. A classroom is a public good until it is full. Then it is a private good.

For combating poverty, we have a safety net that is far more generous than usually appreciated. Some people care more about this and some not at all. It is charity or forced charity, not a public good. I am for poverty alleviation not for what it does for me, but for what it does for the recipient. Hence, purely private good.

When the concept is bandied about with reckless abandon it seems that a public good is a good that I like, so I put the adjective public in front of it to justify the government paying for it. Well, it's public. All true by definition.

There's an interesting amount of behavioural economics in all this, illustrated by amenities. Simply put, are amenities "public goods" or "forced charity"?

In my building, the marketing materials identified amenities like a pool, gym, etc. This is pretty typical. Since I've lived here, from my observations only a small percentage of residents have actually used the pool or the gym. Developers build what will sell. So, if there were many people who didn't want to pay for amenities that they wouldn't use, there should be some buildings designed without these amenities. The reality is that the best-selling properties are the ones with the most extensive amenities. Why are people willing to shell out definite cash for access to services which they may use? In purely economic terms, people should opt for not buying into all of these communal benefits which they may not use, and instead just purchase their own gym  memberships and so on if and when they actually use them.

So, are amenities "public goods" or "forced charity"? And why do people choose those over only paying for things they themselves actually use?

Amenities? There's a good motto, addressed to professionals -- If you don't understand something about pricing, it's probably price discrimination! :-)

Here it take the form of bundling. Nothing special.

Then I'd say universal healthcare is just more "bundling". Everyone is going to need some form of healthcare periodically; it's just not easy to predict in advance.

No, unable to predict in advance is most usefully called uncertainty. Tomes have been written about that, too. To cope with uncertainty somebody invented insurance.

The thing to be careful about with respect to the term "universal health care" is that the "universal" hides as much as it reveals. The NHS [and the Swedish and Italian systems, and only those systems]  combines insurance for all [and payment by all, or almost all] with government production. This is the Bevanian system. The rest of the civilized world forces everyone, or almost everyone, to purchase private or public health insurance. There is some redistribution, of course. This is the Bismarckian system. Health care is not produced by the state, but the state helps finance it.

What is important is that though both systems look different what they have in common is that both systems require each person to be insured. There is good reason for that: Moral hazard! If I know that I will not be allowed to die, I will not voluntarily insure. Then everybody else pays to save me when I threaten suicide. The required schemes, both Bevanian and Bismarckian, prevent exploitation by moral hazardeurs.

So, compulsion is necessary for efficiency. Without compulsion such insurance degenerates toward pre-paid medicine.

 

What puzzles me is how this is different than other service like police and fire departments. I've never heard of any community choosing to forgo those services to lower everyones' taxes. (Although I have heard of the services contracted out, but still at community expense.)

Who (other than a billionaire) would choose to have no health insurance even if that meant potentially having to pay for things like cancer treatment out of pocket?

Quote from: ciao_yall on July 13, 2023, 07:09:21 PMRemember this guy? (https://www.teenvogue.com/story/congressman-says-men-shouldnt-pay-maternity-insurance)

This article demonstrates how deeply entrenched this attitude is in the U.S.

QuoteA Republican in Congress said he takes issue with the Affordable Care Act because it forces men to pay for maternal insurance in order for pregnant women to be healthy. While at first blush it might seem like common sense that someone doesn't want to pay for something they won't use, the point unravels when you look even a little closer — mostly because paying for something you don't use is kind of how health insurance works.

The bolded part about "common sense" is what sets the U.S. apart in all kinds of discussions about the role of government.

Quote from: Hegemony on July 14, 2023, 05:10:44 AMSurely medicine should not cover only uncertain things. Insulin is a certain need for type 1 diabetics, but it should not be omitted from insurance. Vaccines for childhood diseases are a foreseeable event. z

[. . .]

We basically agree, but risk of infection by a contagious disease is a probability, not a certainty. Same for efficacy of a vaccine. Or for that matter, risk of Type II diabetes. People who are sedentary and whose breakfasts consist of Cheetos and Coke are at higher risk than those who exercise and eat apples.

Risk of becoming a drug addict varies with family history, occupation, etc. Not everyone whose mom was a crackhead becomes a crackhead, and not every crackhead had a mom who was a crackhead. 

Quote from: dismalist on July 13, 2023, 08:26:07 PM

Quote from: ciao_yall on July 13, 2023, 07:09:21 PM

Quote from: dismalist on July 13, 2023, 08:23:26 AM

Quote from: marshwiggle on July 13, 2023, 04:58:59 AM

Quote from: dismalist on July 12, 2023, 09:42:17 AMPlaying with definitions is unhelpful for analyzing anything. The precise technical distinction between public and private goods is useful  precisely for determining the best way of financing its provision, by taxation or by user fee [price]. They do constitute extremes, however. Between them are capacity constrained services. A classroom is a public good until it is full. Then it is a private good.

For combating poverty, we have a safety net that is far more generous than usually appreciated. Some people care more about this and some not at all. It is charity or forced charity, not a public good. I am for poverty alleviation not for what it does for me, but for what it does for the recipient. Hence, purely private good.

When the concept is bandied about with reckless abandon it seems that a public good is a good that I like, so I put the adjective public in front of it to justify the government paying for it. Well, it's public. All true by definition.

There's an interesting amount of behavioural economics in all this, illustrated by amenities. Simply put, are amenities "public goods" or "forced charity"?

In my building, the marketing materials identified amenities like a pool, gym, etc. This is pretty typical. Since I've lived here, from my observations only a small percentage of residents have actually used the pool or the gym. Developers build what will sell. So, if there were many people who didn't want to pay for amenities that they wouldn't use, there should be some buildings designed without these amenities. The reality is that the best-selling properties are the ones with the most extensive amenities. Why are people willing to shell out definite cash for access to services which they may use? In purely economic terms, people should opt for not buying into all of these communal benefits which they may not use, and instead just purchase their own gym  memberships and so on if and when they actually use them.

So, are amenities "public goods" or "forced charity"? And why do people choose those over only paying for things they themselves actually use?

Amenities? There's a good motto, addressed to professionals -- If you don't understand something about pricing, it's probably price discrimination! :-)

Here it take the form of bundling. Nothing special.

Remember this guy? (https://www.teenvogue.com/story/congressman-says-men-shouldnt-pay-maternity-insurance)

The congressman has a particular attitude dependent upon his opinion about sex. His position is not interesting.

I thought the article would be about the brilliant Steven Landsburg,  author of the great Armchair Economist (https://www.thriftbooks.com/w/armchair-economist-economics-and-everyday-experience_steven-e-landsburg/255079/item/3689569/?utm_source=google&utm_medium=cpc&utm_campaign=high_vol_backlist_standard_shopping_customer_aquistion&utm_adgroup=&utm_term=&utm_content=659174113139&gclid=CjwKCAjwwb6lBhBJEiwAbuVUSghQxjCHvrowmoP0x5uMZLfhI__HXkqsvy8kYRa0XUJKSy6DaVNRkBoCuf0QAvD_BwE#idiq=3689569&edition=2333094) and More Sex is Safer Sex (https://www.amazon.com/More-Sex-Safer-Unconventional-Economics/dp/1416532226), and germanely, the perpetrator of the Sandra Fluke controversy.

The issue illustrates the problem well. Preventing pregnancy is not an insurance problem because it is so certain to prevent pregnancy with current technology. Proof is that women routinely purchase birth control devices. Paying for health insurance to cover birth control cannot amount to less than pre-paid medicine. It's like having your car insurance cover oil changes. You can avoid the middleman -- the insurance company and its costs -- by paying out of pocket. It's stuff you need with certainty. There is no uncertainty involved, so it's not an insurance problem.

However, the question of who pays out of pocket for this medicine is perfectly legitimate on distributional grounds and can always be raised! For hook-ups the female will pay voluntarily, because she bears the costs of an unwanted pregnancy, but the male has no incentive to pay, and the female can't monitor. In long term relationships the cost of birth control is shared in some way.

It seems some States require birth control to be included in insurance plans. This is mere redistribution from some men who have insurance  to some women who have insurance. The redistribution is likely small, and it doesn't go to the women who would be much better off with birth control, uninsured young women. And it has nothing to do with insurance.

Because men have nothing to do with pregnancy. /nothowgirlswork.

Quote from: marshwiggle on July 14, 2023, 05:38:10 AM...

What puzzles me is how this is different than other service like police and fire departments. I've never heard of any community choosing to forgo those services to lower everyones' taxes. (Although I have heard of the services contracted out, but still at community expense.)

Who (other than a billionaire) would choose to have no health insurance even if that meant potentially having to pay for things like cancer treatment out of pocket?

...

This article demonstrates how deeply entrenched this attitude is in the U.S.

QuoteA Republican in Congress said he takes issue with the Affordable Care Act because it forces men to pay for maternal insurance in order for pregnant women to be healthy. While at first blush it might seem like common sense that someone doesn't want to pay for something they won't use, the point unravels when you look even a little closer — mostly because paying for something you don't use is kind of how health insurance works.

The bolded part about "common sense" is what sets the U.S. apart in all kinds of discussions about the role of government.

One must distinguish rhetoric from reality. There is not much difference between the share of government expenditures in the US and other rich countries. The outliers are France and Italy, not the US, which is only a tad below the UK.

Government Share of GDP (https://www.imf.org/external/datamapper/exp@FPP/USA/FRA/GBR/SWE/ITA/DEU/CAN)

It should also be kept in mind that 92% of US residents have health insurance, and most are quite happy with it.

Quote from: ciao_yall on July 14, 2023, 09:07:50 AM...
Because men have nothing to do with pregnancy. /nothowgirlswork.

That misses the point. One can make arguments for forcing men to contribute to women's birth control costs, they just can't be an insurance argument.

Quote from: Anselm on July 12, 2023, 12:58:44 PMPicking up on this, consider this:
Would you rather live in a mansion in a war zone, or in a small apartment in a peaceful city?

Interesting, since I have this same option in my meatpacking town.  This year I could have bought a 4500 s.f. home in the historic district for $280K, near the limits of what I can afford.  It is also close to some problematic homes based on published arrest reports.  The home today would cost $2M to build. 

Zoning laws today forbid affordable housing.  One example is New Lenox, Illinois where a single family home must be at least 1800 s.f.  There are many other factors involved with the federal government and lending practices.  In my cynical view, nothing substantial will change in our lifetimes.  Your only option is to live where housing is affordable and give up on the American obsession with owning the traditional single family home.

Here is a (non-paywalled!) article about LA issues. Not with homes, but residential hotels: https://www.propublica.org/article/meet-people-uprooted-by-american-hotel-los-angeles

Quote from: dismalist on July 14, 2023, 01:01:26 PM

Quote from: marshwiggle on July 14, 2023, 05:38:10 AM...

What puzzles me is how this is different than other service like police and fire departments. I've never heard of any community choosing to forgo those services to lower everyones' taxes. (Although I have heard of the services contracted out, but still at community expense.)

Who (other than a billionaire) would choose to have no health insurance even if that meant potentially having to pay for things like cancer treatment out of pocket?

...

This article demonstrates how deeply entrenched this attitude is in the U.S.

QuoteA Republican in Congress said he takes issue with the Affordable Care Act because it forces men to pay for maternal insurance in order for pregnant women to be healthy. While at first blush it might seem like common sense that someone doesn't want to pay for something they won't use, the point unravels when you look even a little closer — mostly because paying for something you don't use is kind of how health insurance works.

The bolded part about "common sense" is what sets the U.S. apart in all kinds of discussions about the role of government.

One must distinguish rhetoric from reality. There is not much difference between the share of government expenditures in the US and other rich countries. The outliers are France and Italy, not the US, which is only a tad below the UK.

Government Share of GDP (https://www.imf.org/external/datamapper/exp@FPP/USA/FRA/GBR/SWE/ITA/DEU/CAN)

It should also be kept in mind that 92% of US residents have health insurance, and most are quite happy with it.

Quote from: ciao_yall on July 14, 2023, 09:07:50 AM...
Because men have nothing to do with pregnancy. /nothowgirlswork.

That misses the point. One can make arguments for forcing men to contribute to women's birth control costs, they just can't be an insurance argument.

Interesting link, but if you add more developed countries to the list, it becomes clear that France and Italy are not actually outliers.  Many other European countries are in that range.

The USA is on the low end for developed countries.  They also spend a higher proportion on military, so teg government spending on social programs is likely  relatively low compared to other developed countries.

As for 92% of Americans having health insurance, that also means 8% don't.  That is nearly 1 in 10, and represents tens of millions of people. 

Yes, but filthy rich Switzerland is pretty low on government share of GDP. The original question raised was about government as a whole, when we were talking about health care. But that broader question was interesting in the sense that much of government spending is for public goods, such as defense. The US of A is paying for an international public good, the West's safety!

To get back to health care, we can talk about ways of including the 8% not insured. But that's a far cry from what politicians actually talk about. That's an opposition of "you will get more free stuff" and "they are taking away your money". Rhetoric, not reality.

QuoteIt should also be kept in mind that 92% of US residents have health insurance, and most are quite happy with it.

Either Big-D leaves in a much, much different part of the country that I and everybody I know does...

or Big-D is falling into the hyperbole trap in an effort to win a debate.

I know which I think.

Quote from: dismalist on July 15, 2023, 03:24:55 PMYes, but filthy rich Switzerland is pretty low on government share of GDP. The original question raised was about government as a whole, when we were talking about health care. But that broader question was interesting in the sense that much of government spending is for public goods, such as defense. The US of A is paying for an international public good, the West's safety!

To get back to health care, we can talk about ways of including the 8% not insured. But that's a far cry from what politicians actually talk about. That's an opposition of "you will get more free stuff" and "they are taking away your money". Rhetoric, not reality.

The west's safety, American hegemony, a two for one deal I suppose.

Regardless, that was not my point.   My point was simply that America is on the low end of government spending as a % GDP, while also using a larger portion of this for military.  Mathematically, this means they have a lower % left for social programs.  Just because military spending is a public good, doesn't mean it fills the same role as other public goods.  This is one of the problems of binning services based on this.

I don't want to say that any particular level of government spending is the correct. I have a more rhetorical aim than a substantive one.

Yes, of course the US is at the low end of government expenditure share, but it's a lot bigger than Switzerland's, and close to the UK's. The point here is that the share is not absurdly low. [I don't want to get into it, but what the hell are France and Italy spending their governments' money on?] Thus, one can't use "Americans are against government spending" or "against public goods" as an explanation of anything.

If one identified new services that are useful -- such as provision of needles -- one must argue the benefits and costs and not automatically claim "it's a public good" or "it's insurance", or even it's "social spending" as justification for more spending. It all too easily bogs down to "I want more."   

Quote from: dismalist on July 16, 2023, 08:07:05 AMI don't want to say that any particular level of government spending is the correct. I have a more rhetorical aim than a substantive one.

Yes, of course the US is at the low end of government expenditure share, but it's a lot bigger than Switzerland's, and close to the UK's. The point here is that the share is not absurdly low. [I don't want to get into it, but what the hell are France and Italy spending their governments' money on?] Thus, one can't use "Americans are against government spending" or "against public goods" as an explanation of anything.

If one identified new services that are useful -- such as provision of needles -- one must argue the benefits and costs and not automatically claim "it's a public good" or "it's insurance", or even it's "social spending" as justification for more spending. It all too easily bogs down to "I want more."   

The US spends nearly twice as much (~17% of GDP when I last looked) on healthcare as other OECD nations, with equal or worse outcomes. Channeling dismalist, I'd say that what one wants is effective or efficient spending. There's no point spending more on any given public measure if a significant portion of that spending is going to be wasted.

In that vein, it's worth asking whether that military spending is efficient. From where I stand, it looks like it diverts an awful lot of funds to (1) private profit, and (2) a large-scale but morally suspect work program with dubious returns.

Quote from: Parasaurolophus on July 16, 2023, 10:54:36 PM

Quote from: dismalist on July 16, 2023, 08:07:05 AMI don't want to say that any particular level of government spending is the correct. I have a more rhetorical aim than a substantive one.

Yes, of course the US is at the low end of government expenditure share, but it's a lot bigger than Switzerland's, and close to the UK's. The point here is that the share is not absurdly low. [I don't want to get into it, but what the hell are France and Italy spending their governments' money on?] Thus, one can't use "Americans are against government spending" or "against public goods" as an explanation of anything.

If one identified new services that are useful -- such as provision of needles -- one must argue the benefits and costs and not automatically claim "it's a public good" or "it's insurance", or even it's "social spending" as justification for more spending. It all too easily bogs down to "I want more."   

The US spends nearly twice as much (~17% of GDP when I last looked) on healthcare as other OECD nations, with equal or worse outcomes. Channeling dismalist, I'd say that what one wants is effective or efficient spending. There's no point spending more on any given public measure if a significant portion of that spending is going to be wasted.

In that vein, it's worth asking whether that military spending is efficient. From where I stand, it looks like it diverts an awful lot of funds to (1) private profit, and (2) a large-scale but morally suspect work program with dubious returns.

It's absolutely about efficiency!

Healthcare in the US is muchly about prices. Those prices are high because of an historical anomaly, the successful political entrepreneurship of the American Medical Association. And they stay that way because most voters are content. Outcomes are actually good, given the patient population. It just costs too much.

Defense spending is the best example for the problematic invocation of "public good" to justify spending or more spending. Defense is in fact the perfect example of a pure public good -- all of us have to consume all that defense. Once produced, we have no choice. But some of us don't like all that defense spending, perhaps to the point that at least some of it is a public bad!

So, we must argue on the merits, not with labels.

Anyone who is interested in the subject of health care costs should read:

• Overtreated: Why Too Much Medicine Is Making Us Sicker and Poorer by Shannon Brownlee.
• The Price We Pay: What Broke American Health Care by Marty Makary.

I'll go back to what I first posted when this thread began: remove the firewall between treatment for mental illness and treatment for drug addiction. Since it would really only require a bureaucratic swipe of the pen, it's much easier to accomplish than ensuring that everyone has housing.

Quote from: dismalist on July 16, 2023, 11:13:39 PM

Quote from: Parasaurolophus on July 16, 2023, 10:54:36 PM

Quote from: dismalist on July 16, 2023, 08:07:05 AMI don't want to say that any particular level of government spending is the correct. I have a more rhetorical aim than a substantive one.

Yes, of course the US is at the low end of government expenditure share, but it's a lot bigger than Switzerland's, and close to the UK's. The point here is that the share is not absurdly low. Thus, one can't use "Americans are against government spending" or "against public goods" as an explanation of anything.

If one identified new services that are useful -- such as provision of needles -- one must argue the benefits and costs and not automatically claim "it's a public good" or "it's insurance", or even it's "social spending" as justification for more spending. It all too easily bogs down to "I want more." 

The US spends nearly twice as much (~17% of GDP when I last looked) on healthcare as other OECD nations, with equal or worse outcomes. Channeling dismalist, I'd say that what one wants is effective or efficient spending. There's no point spending more on any given public measure if a significant portion of that spending is going to be wasted.

In that vein, it's worth asking whether that military spending is efficient. From where I stand, it looks like it diverts an awful lot of funds to (1) private profit, and (2) a large-scale but morally suspect work program with dubious returns.

It's absolutely about efficiency!

Healthcare in the US is muchly about prices. Those prices are high because of an historical anomaly, the successful political entrepreneurship of the American Medical Association. And they stay that way because most voters are content. Outcomes are actually good, given the patient population. It just costs too much.

Defense spending is the best example for the problematic invocation of "public good" to justify spending or more spending. Defense is in fact the perfect example of a pure public good -- all of us have to consume all that defense. Once produced, we have no choice. But some of us don't like all that defense spending, perhaps to the point that at least some of it is a public bad!

So, we must argue on the merits, not with labels.

Outcomes in the US are good for some, probably the best...but as a population not so much. I know there is more to it, but life expectancy in Canada is about three years longer, largely attributed to access to health care.

I don't think it is so much that most Americans are content with the medical system, just that someone has done an excellent job convincing them that socialized medicine is the devil and/or it would never work in the US. 

As a Canadian, when I lived in the US south this would come up often (not by my choosing).  Most people down there had a pretty twisted view on single payer healthcare (well done, propagandists).  Even in principle many were against it simply because "people take advantage of social programs".  I get this view for welfare programs and such, but healthcare?
 I don't think people are going to break their arm to score a free cast, but there you have it

Quote from: Kron3007 on July 17, 2023, 05:32:05 AM[. . . ]

 someone

[. . .]

The AMA, the executives and shareholders of private insurers and hospitals, and the craven politicians beholden to them.

Per our discussions about legalization...

Alcohol Poisonings Rise in Iran, Where Bootleggers Defy a Ban (https://www.nytimes.com/2023/07/14/world/middleeast/iran-alcohol-deaths.html?unlocked_article_code=FgZaCOAzy-XKJR53F7sOYbTJJLPCeONpo79cjMbzMeWwOPImz-P6p8iL5bn15ygDFIiyt7D6VqtzHFkWd7HYbZ5CgxJSpF95bdXQLsNjjV4cPdnEwR0c_MDAK-WGViFNwc7di6LAWLxuL_-oMZlJKiJ71fJzz2qb5DmlBdKkaA7CvwCFJSZHB3GRhbWF9Jou2A9QDl8w-hODQOXHu3OBs0IZjjL3dgp326vRu8i4S9AAaOJlSQjHyIDXxBZqdrdO5t2AtIJo_SAtvNKck7yaM-_qXTG928RucMMSRg8-SwQGG2hbBffTtdN7kz1yD6AjFG69VM_CbMVsO9GZpgwWOsuL0xezcQ&smid=url-share)
Iran's prohibition of the drinking and selling of alcohol has led to a flourishing underground market. But even officials have acknowledged a wave of hospitalizations and deaths in recent months.

Quote from: ciao_yall on July 17, 2023, 11:20:12 AMPer our discussions about legalization...

Alcohol Poisonings Rise in Iran, Where Bootleggers Defy a Ban (https://www.nytimes.com/2023/07/14/world/middleeast/iran-alcohol-deaths.html?unlocked_article_code=FgZaCOAzy-XKJR53F7sOYbTJJLPCeONpo79cjMbzMeWwOPImz-P6p8iL5bn15ygDFIiyt7D6VqtzHFkWd7HYbZ5CgxJSpF95bdXQLsNjjV4cPdnEwR0c_MDAK-WGViFNwc7di6LAWLxuL_-oMZlJKiJ71fJzz2qb5DmlBdKkaA7CvwCFJSZHB3GRhbWF9Jou2A9QDl8w-hODQOXHu3OBs0IZjjL3dgp326vRu8i4S9AAaOJlSQjHyIDXxBZqdrdO5t2AtIJo_SAtvNKck7yaM-_qXTG928RucMMSRg8-SwQGG2hbBffTtdN7kz1yD6AjFG69VM_CbMVsO9GZpgwWOsuL0xezcQ&smid=url-share)
Iran's prohibition of the drinking and selling of alcohol has led to a flourishing underground market. But even officials have acknowledged a wave of hospitalizations and deaths in recent months.

I have an Iranian tech, who has told me about their home distilling activities back home.  I assume they were knowledgable enough to do it safely, but doesn't mean everyone is.  Prohibition dosn't stop it, just makes it riskier for all involved.

Quote from: dismalist on July 14, 2023, 01:01:26 PMIt should also be kept in mind that 92% of US residents have health insurance, and most are quite happy with it.

Quote from: Kron3007 on July 17, 2023, 05:32:05 AMOutcomes in the US are good for some, probably the best...but as a population not so much. I know there is more to it, but life expectancy in Canada is about three years longer, largely attributed to access to health care.

Putting these two stats together is interesting.
Canada life expectancy is about 83; U.S. is about 80. If all of the difference is due to the uninsured in the U.S., (so that insured people have a life expectancy of 83, like Canada), then it means the uninsured have a life expectancy of about 46 to shift the average.  That's praticaly medieval.

If it's not all due to the uninsured, then it means that insured people in the U.S. have a lower life expectancy that average Canadians. No-one argues that the U.S. doesn't have world-class medical facilities; the problem is that even insured people clearly don't have as ready access to them as people in other countries do to their facilities.

Quote from: marshwiggle on July 18, 2023, 07:11:56 AM

Quote from: dismalist on July 14, 2023, 01:01:26 PMIt should also be kept in mind that 92% of US residents have health insurance, and most are quite happy with it.

Quote from: Kron3007 on July 17, 2023, 05:32:05 AMOutcomes in the US are good for some, probably the best...but as a population not so much. I know there is more to it, but life expectancy in Canada is about three years longer, largely attributed to access to health care.

Putting these two stats together is interesting.
Canada life expectancy is about 83; U.S. is about 80. If all of the difference is due to the uninsured in the U.S., (so that insured people have a life expectancy of 83, like Canada), then it means the uninsured have a life expectancy of about 46 to shift the average.  That's praticaly medieval.

If it's not all due to the uninsured, then it means that insured people in the U.S. have a lower life expectancy that average Canadians. No-one argues that the U.S. doesn't have world-class medical facilities; the problem is that even insured people clearly don't have as ready access to them as people in other countries do to their facilities.

Yes, but there are obviously other differences than health care.  Ever seen the size of a small order of fries at Hardees?

When I was in the US south, they had converted the university cafeteria to an all you can eat model.  A lot more going on down there impacting life expectancy....