Can psychedelics make you a better person? - <AUTHOR> http://www.philosophyforlife.org/can-psychedelics-make-you-a-better-person/ <comment><USER2> If I hadn't taken LSD, I never would've started my recovery from alcohol. Nothing in my life is as valuable to me as my sobriety is and has been, and I don't see myself ever making the painstaking effort to get sober without that trip.

I don't want to turn this thread into a trip report, however I will share that my trip led my thoughts to my last actions, some bad decisions and some bad habits I had formed.

Real talk, I tripped my nuts off. Obviously.

But the real impact was during the several days after that, nothing seemed to be the same, every little detail seemed laced with a new tinge of awareness, and the drinking I was doing at the time suddenly revealed itself to me as incredibly dangerous and unhealthy.

Now, LSD didn't work my program for me. It didn't get me sober, it didn't stop my cravings, it didn't bring my family back or apologize to previous employers or pay my tickets or talk to my mentors or any of that. It's not a wonder drug by any means. I'm definitely no expert, but I think hailing lsd in particular could have bad consequences for certain people. A trip can go south sometimes if you're not meticulous and exerting some fortitude against your emotions during the trip.

Also, who says I'm a better person? That's a hard thing to measure. I've done a lot of awful things in my drunk past. Choosing better behavior doesn't make the consequences of those things go away. Understanding who you are and who you were doesn't magically wipe the slate clean for the old you. And that's humbling, to go back and clean up all those messes and face those people with the new knowledge and growth, but on behalf of the toxic person I was.

Anyways, LSD definitely changed my life for the better. I'd do it again in a heartbeat. Honestly, most people would say I AM a better person now. But to claim that as the effect of LSD is crazy. For people just wanting to justify their psychedelic adventuring, give up on it. If you like to trip just for fun, just accept it and do it. Be glad you're not hurting yourself!

<comment><USER3> The entire Alcoholics Anonymous regimen is the result of the insights gained on an LSD trip.

<comment><USER4> Please don't spread unsubstantiated claims. You'll need to provide a source for this claim.

This sounds genuinely interesting. However if it's not backed up by evidence then you're just spreading misinformation.

<comment><USER3> Here's a few links to explore further:

"This is some rare TV footage of LSD research conducted in Los Angeles in 1956 by Dr. Sidney Cohen, which included an interview with Gerald Heard, an Anglo- Irish philospher who turned on a number of influential Americans in the 1950s. Among them was AA co-founder Bill Wilson, who thought LSD could help some drunks have a spiritual awakening. Wilson's first trip was in this very room in summer of 1956 and was supervised by Dr. Cohen and guided by Mr. Heard. The whole story, and much more, is told in "Distilled Spirits -- Getting High, Then Sober, with a Famous Writer, a Forgotten Philosopher, and a Hopeless Drunk" by Don Lattin, the author of the bestselling "The Harvard Psychedelic Club." The "Famous Writer" in this blend of memoir and group biography is Aldous Huxley, the author of "Brave New World" and "The Doors of Perception."

[https://www.youtube.com/watch?v=XeO2BOdmkEg](https://www.youtube.com/watch?v=XeO2BOdmkEg)

and

[https://aabeyondbelief.org/2015/10/21/the-lsd- experiments/](https://aabeyondbelief.org/2015/10/21/the-lsd-experiments/)

</comment></comment></comment></comment><comment><USER5> For me, definitely. The first time I took psilocybin 22 years ago shaped my views on consciousness, among other things, and led to profound personal growth. I don't think I would be where I am today without it.

</comment><comment><USER6> Bit of a meta comment, but I wonder why none of the ~30 posts here seem to actually be discussing the article. Something about the subject that motivates people to state personal opinions/experiences?

<comment><USER7> When the author said that Demeter was the goddess of corn, I nearly stopped reading. Facts: Demeter was a goddess of grain and harvest. Ergot (Claviceps species), and specifically ergot growing on rye (Secale cereale) has psychoactive properties; this ergot is liekly the source of psychedelic experience in the Elusinean Mysteries. Corn (Zea mays) was not introduced to Europe until the Columbian exchange; the fungus that grown on corn (smut, huitalacoche) is edible and not obviously psychoactive.

Whether psychedelic/unity experience makes one a better person, is an interesting question. As, too, is the question the author asked in the second half of essay, exploring the meaning of "better person" in relation to contemporary Western and Shipibo Indian cultures.

<comment><USER8> The author is from the UK, so they are probably using the British definition of corn[1] which can refer to many different kinds of grain. Using that definition of corn, the article doesn't seem to be inaccurate.

[1] [https://en.wiktionary.org/wiki/corn#Etymology_1](https://en.wiktionary.org/wiki/corn#Etymology_1)

<comment><USER9> Right, remember that when Middle English was around, the New World hadn't been discovered, so the word definitely was not applied to maize originally. This British usage still remains in place as far as I know. Those darned Brits - you'd think they invented the language, the way they sling it around any way they want!

<comment><USER10> > Right, remember that when Middle English was around, the New World hadn't > been discovered

Well, Middle English starts a couple centuries after the Norse settlement in North America, so that's not strictly true, even with the implict "by Europeans" restriction.

<comment><USER9> Point taken, and worth noting, the English hadn't discovered the New World, but other Europeans, including Portugal, had. But maize wasn't grown anything like that far north!!! Maybe as far north as Missouri, where there were dense populations, but not further. So, yes, it is strictly true that maize would be unknown in England then.

But c'mon man, "the Oxford English Dictionary specifies the period of 1150 to 1500" so when the usage was established in England only Vikings had reached the New World, in Newfoundland, etc.

<comment><USER10> > So, yes, it is strictly true that maize would be unknown in England then.

Yes, it's strictly true that maize would (almost certainly) be unknown, just not because North America hadn't been discovered by cultures in contact with England prior to the point of time in question.

<comment><USER9> You could simply have said "we now agree," I believe.

</comment></comment></comment></comment></comment></comment></comment></comment><comment><USER11> Can? Sure. I've heard from plenty of people that feel that way.

Just to give an alternate perspective, I'm not sure doing 'shrooms at 16 made me a better person. It definitely altered my perception of what is real, but it wasn't a useful improvement. Mostly it just made me more prone to having panic attacks. I think I _could_ be a better person today if I had never gone through that door, at least at that point in my life. On the other hand, it's hard to say whether it was the 'shrooms or not, as many of the terrifying existential questions it drove in me are thoughts that can be found elsewhere. I'd like to try them again sometime, just a few, to test the waters, but I'm also somewhat terrified of the consequences if my reality is shaken too much at this point in my life. So it goes.

<comment><USER12> The idea of taking psychedelics at 16 terrifies me. I believe pretty strongly that psychedelics are best once you've already tried pretty hard at the classical life script. Only then will you be able to see it's actual weaknesses and it's actual strengths.

I would not advise anyone much below 25 to take em, and I was very grateful I was scared into not taking them until my early-mid twenties.

</comment></comment><comment><USER13> ctrl+f ego... no hits? I've never done a psychedelic other than a very spiritual moment with salvia divinorum, but I have read up on them extensively, (they are often touted to help with ptsd), and the one major common factor is their ego-busting nature.

Ego is a good thing in many ways, but due to societal and cultural strangeness, it is sometimes warped into overdrive (arrogance, etc) and sometimes too puny (low self-esteem, etc). Psychedelics seem like a path to showing you just how big... and small... you are in the universe.

That said, I have two warnings about this subject. First, I personally think synthetic psychedelics are potentially the most dangerous, which is why (especially after finding out it's CIA origins) I never intend to do LSD, for example. Second, these are things that my native-american brothers tell me _must_ be done as a spiritual journey, and not as recreation. Those who approach these powerful things recreationally are the most likely to have bad trips.

<comment><USER14> From my completely inexpert perspective, and keeping in mind I've never taken any psychedelics, I'd guess that 'ego-busting' as you call it is almost certainly the component of value here. Our traditional notions of self are ridiculously naive and very poorly model reality, and I think working from poor models of reality is part of why we suffer like we do, which leads us to being worse people. Psychedelics allow people to more easily shift their perspective and see the world differently, hopefully expanding their conception of it and enlightening their understanding of their place within it, but they are not the only way to do that.

<comment><USER15> > Psychedelics allow people to more easily shift their perspective

This is a fairly accurate summary, from my personal experience.

Psychedelics help to partially peel back the immense layers of mental models and perspectives that we slowly build up over the many years of our life. These layers are usually fairly inscrutable -- most people don't think about them much. As the mental model of one's self is perhaps the most deeply rooted of them all, this process is how "ego death" occurs.

It is possible to gain some insight into our deeply rooted mental structures through years of careful self-observation and/or meditation, but psychedelics are an incredibly powerful tool for getting a different view of your own mind in single day (integrating the experience takes much longer).

I should say, though, due to the sheer power and novelty of the experience, it can feel as if the most simple thought is deeply profund -- so this is something one has to watch out for, if they care about genuine insight.

Warning: Psychedelics should be used with great caution -- they are not toys, and can cause significant harm if used improperly or under the wrong conditions.

<comment><USER14> > it can feel as if the most simple thought is deeply profund -- so this is > something one has to watch out for, if they care about genuine insight.

Maybe I've gone off the deep end, but I think a lot of the deepest and most meaningful truths I've realized are actually tautological. It's as though it's all just one giant circle, you start with a simple tautological statement like "it is what it is" and think it's silly, spend years thinking about, observing, and modeling reality, and come to the profound conclusion that it is indeed what it is. The only difference is that having walked the circle and observed the statement from all sides you finally understand what it means.

I'm starting to wonder if all truths aren't tautologies. Take evolution: in very simple form it could be stated as "Things that self-replicate self- replicate. Things that are better at it are better at it".

</comment></comment></comment></comment><comment><USER16> Psychedelics (LSD, shrooms) made me a better person.

I don't know anyone who became less caring, less respectfull, more violent or more greedy after doing those drugs.

I would argue that psychedelics make you more human, in the good sense of the word.

<comment><USER17> I know of one guy, a brilliant man, who after a period of a month taking shrooms practically every day had a personality shift that is easiest described as "like Rick" from "Rick & Morty" \- he became convinced he was the smartest man in the universe, dangerously smart and people would kill him if they knew how incredibly smart he was. That attitude stayed with him, and destroyed him; about a decade later he died due to alcohol poisoning as a result of his overwhelming rejection by others from his elevated behavior insisting his superiority over others. Clearly, he had original issues the shrooms simply magnified out of his control.

<comment><USER18> I'm not going to bash on psychedelics, but there does seem to be a lot of selection bias around the positive benefits of them. Like your example they can, for some people, trigger an extreme expression of latent psychological problems.

Of course the response is always to use them with guidance. Unfortunately here your options are often limited to pseudo-religious practitioners who will inadvertently prime you to have the same cliche experience most people in those circles have.

It's for these two reasons I have avoided psychedelics completely. If I could have a guided experience from an agnostic and trained professional I would consider trying them. I'm definitely hoping the goals MAPS has come to fruition over the next few decades.

<comment><USER19> > If I could have a guided experience from an agnostic and trained > professional I would consider trying them

That would be the dream.

I personally got curious about it and talked it over with a good friend and we read a lot about LSD. After studying it a lot from the most credible possible sources and reading arguments for both sides, we decided to try it responsibly; a medium-high dose of 150ug, each on a bright lazy Saturday with the other one sober through the whole trip.

It was very fun and mind-opening and I think it's an experience pretty much everyone should have at least once in their lives. We have done it recreationally a few more times since then (and alone with lower doses and together with both tripping on lower doses) and it has been nothing but positive things; it's exhilarating to discover the world in new ways.

I think it would be fantastic if we could have professional guiders and spaces specifically designed for responsibly tripping. Not only is it fun, but I believe it would lead to a healthier culture as it's not unusual in my experience to see a lot of things wrong with our society and personal behavior when looking at them from a different perspective.

I think it's really a shame that it's not possible due to the substance being illegal (wrongly, IMHO).

</comment></comment></comment></comment><comment><USER20> 4 months of working with ayahuasca with some of the best shamans in the amazon cured my depression, anxiety and panic attacks. During that time I have seen so many people get cured from all sorts of different issues. It's an amazing medicine.

If you decide to do it, make sure you do some proper research on which centers are good before you go.

<comment><USER21> For those wanting to go down this road, where do you even start?

<comment><USER22> I have never taken ayahuasca, but I have seen many videos on youtube, and read many articles about to understand the nature of an "ayahuasca shaman ritual", as I might call it. I would start with diligent research, and you will probably naturally discover the next steps "down this road" yourself. I understand that the "sanctity" of ayahuasca is revered by many people that are privy to it's "powers", and is not to be taken with any sort of cavalier attitude, as one might see with other psychedelics.

<comment><USER23> Can YouTube videos be considered research? Are they build on empirical data and peer reviewed?

Don't get me wrong, go right a head and drink the funky tea, just don't call monetized experiences of random content producers "research". If you do that, then you'll be telling me weed cures broken bones next, or warn me not to vaccinate my children.

<comment><USER24> Yes, YouTube videos can be considered research, because that word itself does not imply peer review. You may have misunderstood how the word research is being used in this thread.

[https://www.merriam-webster.com/dictionary/research](https://www.merriam- webster.com/dictionary/research)

Definitions 1 "careful or dilligent search" and 3 "the collecting of information about a particular subject" are the forms that were being used in this thread. When @acetoxy suggested doing some research on which centers are good, the idea was to get some info in advance, not to perform perform and publish double blind peer reviewed studies of their effectiveness.

I feel like adding, only because it seems funny & totally apropos to this thread & article on LSD, not to patronize you: try to open your mind to the alternative possibilities.

<comment><USER23> I don't think watching YouTube videos qualifify as gathering information, even if it fits within the definition of the word research.

Feel free to do it though, and I take no offense if you disagree with me, but I'd be careful trusting strangers on the internet, especially if you're considering going to South America to do drugs.

<comment><USER24> Sure, I totally agree one should be careful about their info & travel & drugs. But, that's what both @acetoxy and @cbluth were already saying.

I assume what you meant to say is that you personally wouldn't trust YouTube as a source of high quality or trustworthy information about drugs in South America, because it's demonstrably and absolutely true that YouTube videos contain information. Millions and millions of people successfully use YouTube to share and gather information on a wide variety of topics.

If you actually wanted to help someone who's trying to be careful, perhaps suggest some more trustworthy sources, or how to find them? What makes a book or person or pamphlet or phone call or any other source any more trustworthy than YouTube? Even if there were scientific research, what makes it trustworthy? Peer reviewed papers are proven wrong all the time. How does one go about being careful?

</comment></comment></comment></comment></comment></comment></comment><comment><USER25> There is so much introspective thinking going on when you do mushrooms...you're engrossed the next day in thinking about all the things you discovered about yourself and who you are. Whether that makes you a better person or not, I don't know.

</comment><comment><USER26> Anything can make you a better person, depending on the type of person you are. Personally I have panic disorder and would probably go full schizo.

</comment><comment><USER27> It's a pity that research on MDMA was stopped due to the drug war.

<comment><USER28> Yeah just anecdotally, it did make me a better person. Not at first, but the experience of being unequivically, obviously _happy_, for the first time in my life, understanding that I was going to be okay, that I could just like talk to people and make friends, and so on — even if it was mediated by drugs, made me realize how much of my perception of how the world was, lived only inside my head. Nothing about the world had changed, but suddenly it felt beautiful and safe to me in a way that it never had before.

My perception of the world was obviously distorted in some way by the drug, but my perception while sober was also distorted by a lifetime of traumatic experiences that molded how I felt about myself and other people. I forged new relationships with people, I cut off relationships with other people that were bad for us both. It wasn't an immediate change, I took years for me to dig myself out of the hole that I was in— but I genuinely believe that mdma saved my life.

And this was in a totally unregulated environment, where I pretty much exclusively took it at raves and all the therapeutic talking sessions were with random strangers on ecstasy that happened to be around when the mood to talk struck me. I have to believe that a professional therapist would have accelerated the process significantly.

<comment><USER29> This was my experience as well, way back in the 90s-- it was like all the 'walls' dividing me from others came down.

I would add that another aspect which could have been helped by the presence of a therapist is the comedown. I went from one of the most elated & connected experiences of my entire life to one of the worst depressions, as I realized that 95% of the good feelings were fading away and my walls were involuntarily coming right back up. The only silver lining was the belief (which I still hold) that at least parts of that connectedness could be revisited by being more dedicated to cultivating moments where it was likely to occur.

</comment></comment></comment><comment><USER30> I've never used them, but everyone I've met who has, has spoken along similar lines that dropping acid opens up another part of your mind. So I think if it does unlock another part of your mind, then absolutely it could make you a better person.

"Doing LSD was one of the two or three most important things I have done in my life." -Steve Jobs

<comment><USER31> Based on the Walter Isaacson bio, acid didn't seem to make Jobs a better person, in terms of treating other people well, regardless of whatever else he got from it.

</comment></comment><comment><USER32> > There is a strong claim here that has never been tested: can psychedelics > make you a better person?

Never been tested !? Is this person on drugs or something !? Ahahahaha!

But seriously, homo sapiens quite obviously happened from a collision of apes with psychedelics (most probably psilocybin mushrooms)... So without psychedelics there would never have been any people! Terrence McKenna very thoroughly explained this theory many times. Its easy to find on faceboogle. All his other theories are nowhere as solid as this one, imo.

On another note, drugs are foods, and different foods are good for some people, in some situation, some of the time, at some dose. Finding those perfect variables is the real trick. Opium, for me (and almost anyone I believe), at a certain dosage, has tremendously improved my life, on all levels - but if I increase the dosage even slightly or don't take enough breaks, it begins to have negative repercussions. People who do endurance sports are all craving endorphines. Marathon runners could preserve their health by dosing opium properly. LSD is definitely a must-do for everyone, but in the right settings. Nobody is driven insane by LSD - they had to _already_ be insane, and it would bring it out more (which is really the quickest path to a cure). Iv met someone who cured acute autism with psilocybin. MDMA is renowned for treating victims of PTSD. I mentioned opium - opium isnt (really) a psychedelic but its certainly the most bewitched beneficial substance I know of - very good for older people or alcoholics. It takes away all cravings for alcohol, tobacco and coffee (3 most detrimental drugs on earth, with refined sugar). But be careful not to increase your tolerance. I agree with Eliot in MrRobot - you can take 30mg of morphine-equivalent per day forever and youll be able to run out without waking up in the ninth circle of hell. Given the choice I'd much rather incarnate a hardcore morphine user than a roaring alcoholic; at least I'll still be able to have a successful career, a thriving social circle and a very long life.

<comment><USER33> > Nobody is driven insane by LSD - they had to already be insane, and it would > bring it out more

I really, really, don't want to write this because I'm a very drug friendly person. I personally don't do drugs except alcohol (I know how horrible it is, but I have anxiety problems) but I am ok with all sorts of drugs as long as there is scientific evidence it improves your life.

Having said that, your quote up there is wrong, I know at least one datapoint. In my freshman semester in Berkeley my roommates tripped with LSD (I was sober and their sitter). Everything went well. However, the second time we did the same thing unfortunately one of my roommates absolutely berzerk and did things I cannot even begin to write here without getting banned. It involved violence, nudity, disgusting human fluids, you name it... Cops were ultimately involved since we couldn't stop him and he was about to harm himself by harming strangers. He ended up fine because he didn't harm anyone, just embarassed himself deeply. In fact, he had no repercussions other than having to live with the fact that he did all that stuff.

Was this person insane in the first place? No, I lived 4 years of my life with this guy and he was one of the smartest, most intelligent people I've ever met. I don't know what it means to be "crazy" maybe he had psychological problems inside his head, but as far as we know he didn't have such problems. He went to a psychologist, but as far as we know, it was a fabrication to be prescribed Ritalin and Adderall. So, overall, it did not seem like he had any psychological problems.

His experience affected me really deeply. I never got to do drugs I wanted (LSD and psilocybin).

I don't want to give the message that "LSD is bad". No LSD is probably an awesome drug. But I really don't think "LSD can't make you crazy if you weren't in the first place". It's probably 1 in a million chance, but not impossible.

<comment><USER32> > "LSD can't make you crazy if you weren't in the first place"

It can't. There have been some very good research done which show that the society we currently live in is completely insane, which implies that almost anyone living in this society is mad. I really enjoyed 'Characer analysis' by Wilhelm Reich - very good stuff - in which he showed that the facist society we live in has turned us against ourselves. LSD and its brothers will break the 'emotional armor' that people have build up to supress their emotion to survive the facism of their family/classroom/workplace. Releasing too much emotion at once can very easily harm people. So I am not backing off my claim, but I'll admit that since mose people are insane, LSD is potentially dangerous for most people.

Did you friend have a very rich sexual life when the incident happend? I'm not asking you to answer here obviously, but I'm almost certain he did not.

<comment><USER33> > Did you friend have a very rich sexual life when the incident happend? I'm > not asking you to answer here obviously, but I'm almost certain he did not.

No I don't think he had sex before that incident. But how would that affect his trip. As I wrote above, his first trip (which was about 6 months before the second one) was really fun for him.

<comment><USER32> You can read the book I mentioned, it's all in there.

</comment></comment></comment></comment></comment><comment><USER34> For anybody interested in experimenting I recommend reading about LSD microdosing as an alternative to high doses that make you trip. Look for James Fadiman's research.

<comment><USER35> "Research". Fadiman is a quack, there is no research in to "sub-perceptual" dosing. It's the homeopathy of psychedelics. See [https://www.gwern.net/LSD- microdosing#fadiman-comments](https://www.gwern.net/LSD-microdosing#fadiman- comments)

The research actually being done is in "perceptual" low dose and high dose psilocybin/MDMA and so on, where are the results so far are promising.

<comment><USER34> "Research" because it cannot be done officially as LSD is illegal, so he relies on subjective reports of people who microdose, which cannot be precise and standardized, of course. Have you tried it? What I can recommend to you is to go and try it yourself, then tell me if it is homeopathy. Nothing can replace your own experience.

<comment><USER35> It doesn't matter if it's illegal. Psilocybin and MDMA are illegal but there's research being done there.

Microdosing is homeopathy because of the emphasis on "sub-perceptual" doses. There's no such thing, when it comes to psychedelics. You either perceive it, or it didn't work. Fadiman could do blind testing to try to prove me wrong, but he won't. Why not?

I'm sure there are lots of people who report "benefits" from microdosing, just like there are lots of people who report benefits from energy crystals and reiki.

Note that I'm not saying psychedelics are worthless for the things microdosing claims to help with, just that you need to actually take an active dose to get any of those benefits. 3ug of LSD is going to do jack shit.

<comment><USER36> Homeopathy and 3% of a standard dose of one of world's strongest drugs are very very different things.

Even setting aside the massive, proven, perceptual effect that placebos have -- which means that if you do believe in homeopathy, it could actually have a strong effect -- this is analogous to saying that a couple of sips of beer is going to do "jack shit". It won't do much -- but your liver will still process it, and it will provide some energy, and it will have a very mild affect on your nervous system. Is a couple of sips of beer an "active dose"? What's an active dose here?

In contrast with homeopathic solutions, which are diluted down to figures like 1 PPM (presumably a very very low % of what would be an "active dose" of its chemical), this is a 3% dose we're talking about! It's intellectually dishonest to assert that there would not be an effect on the nervous system at that level, and it is a strange position to assume that because the effect on the nervous system does not rise to obvious perception, that it has no effect on the experience of the subject.

<comment><USER35> Beer commonly comes in 8oz cans. 8oz is about 237mL, 3% of which is about 7mL. I would absolutely say that 7mL of beer is going to do jack shit.

The experience of the subject is linked directly to obvious perception. If it isn't affecting perception, it's not affecting experience! It could affect other things, like your liver or whatever, but it really does need to affect your perception in order to have the benefits people claim microdosing has, which are all linked to moment-to-moment experience.

<comment><USER36> I was basing my analogy on the idea that a standard dose of beer, for someone drinking beer, is probably 2 12 oz. bottles of beer.

"If it isn't affecting perception, it's not affecting experience!" I think this is the main point on which we disagree. I'm curious why you assert this so strongly.

If we agree that there is an effect on the nervous system, then the question is, at what point does that effect "matter". And you are saying that it only matters at the point that the subject can detect the shift in their own perception from baseline. You also argue that any purported benefits of the substance are only realized as a result of the detection in this change of state.

I can think of a few examples of cases where we would not be consciously aware of a change from baseline, but would effect our experience. Do you need to be aware of your change from baseline for the painkilling and pleasantness of endorphins released after a mild walk to have an effect? Do you need to be aware of your own difference from psychological baseline for the little bit adrenaline released before an important meeting to have an effect on your alertness?

Our recognition of our own perception is a fallible signal detector. There can be effects on the nervous system that have effects on other systems, regardless of whether the conscious mind detects a signal.

And if you agree with me so far, then the question is if the effect on the nervous system and in turn its effects on other internal systems has any therapeutic effect. That's a different discussion, I reckon. But unless a requirement of all the purported therapeutic effect is that the subject has consciously observed their altered perception, then it is possible for there to be an effect on people's lives from sub-perceptual doses of chemicals. (for example: non-psychoactive drugs, heavy metals, viruses, etc.)

</comment></comment></comment></comment></comment></comment></comment><comment><USER37> In my experience no it can't. Only your own willpower can do that.

But it can make you see things you were not seeing, or refusing to see before.

</comment><comment><USER38> Not sure if they can make you a better person but I'm fairly certain they can help you know the difference.

Seeing the reality of who you are (or closer to the reality of who you are) can potentially propel you toward making changes.

</comment><comment><USER39> Be interesting to see the stats that might indicate some kind of rational answer for this question. Personal anecdotes, interesting though they may be, are irrelevant.

</comment><comment><USER40> Can they also make you a worse person?

<comment><USER41> i'm a moderately anxious person that grew up around people who were really ok with psychedelic use. i did it in college with pretty much no baggage going in... multiple times... i've basically never had a positive experience, and i've had two really bad trips that i kept getting flashbacks to in the months after. i got over both eventually.

to me acid, peyote and mushrooms just make you feel kinda sick, maybe giddy for a while and you see weird stuff. by the end you always want to go back to normal before it's done, or at least i did. that's why they're not addictive usually

</comment></comment><comment><USER42> Definitely yes!

</comment><comment><USER43> ibogaine

</comment><comment><USER44> yes.

<comment><USER45> Can? Yes. Will? _Maaybe._

</comment></comment><comment><USER46> Is you need drugs to become more open minded and empathetic, the source of the problem is your upbringing, and by proxy the culture. The contemporary liberal western culture actively works towards shaping us into selfish materialistic consumerist narrow minded soulless beings. Half a trillion dollars per year go towards this effort, and the solution is start drugging ourselves with LSD? Bet, if that ever became common, advertisers would find some way to exploit that too, so that instead of enlightenment your mind starts flashing ads all throughout the high.

<comment><USER47> you're painting "drugs" with a broad brush

psychedelics are not like cocaine, despite what the 'gubbmunt' would like you to believe - rather they are like a window into your 'self' \- if you think of psychedelics in terms of frequency, you might better understand the tremendous potential they hold with regard to a laundry list of ailments, including depression, PTSD, etc.

<comment><USER48> Your comment doesn't address what he wrote. The answer to anything as far as the modern consumer is concerned seems to always be "Buy more stuff!" In this case, what's being pedaled is the cure to consumerism. And the irony that the proposed solution is to buy yet another product seems lost on most people here.

Enough is enough. I agree with the original poster. Our solutions to every problem shouldn't be to buy yet another thing.

<comment><USER35> I downvoted you because psychedelic culture is about as anti-consumerist as it gets, and it takes a pretty incredible reversal to try and paint it as a product being pushed for people to buy.

<comment><USER48> I don't understand psychedelic culture, admittedly, but I can't wrap my head around why you think it's anti consumerist. Drugs are being bought and consumed, right? Isn't that the core of the culture? "Do this one thing, that costs money, to improve your life." I don't see the fundamental difference between that and purchasing any other product.

Thanks for saying why you downvoted, anyway.

<comment><USER49> Because drug culture isn't about buying things you don't need with money you don't have to distract yourself from the now so you wouldn't feel existential dread or have to face your runaway thoughts. Psychedelics take you to the NOW and almost force you to deal with YOUR shit.

It's impossible to try to convey what it is like to someone who hasn't taken them. You just won't know what you're missing or how it is until you try because it works on your core being and whatever it is that filters the reality that is experienced.

<comment><USER48> If that is the definition of consumerist, I'm not one in any way. I'm in my 40's, retired and living abroad in a small apartment. I have no car, and live well within my means.

I've met a lot of people who have done a lot of drugs, including, but not limited to psychedelics, including close family members who I knew well and could watch their descent. The ones I know are depressed, some have suicided, others are in huge amounts of debt.

If psychedelics are such a cure all, why have I never met anyone who took them who had their shit together?

Writing in a diary, talking to a therapist, and opening up to people can also be ways of dealing with your own problems in a direct manner, without so much risk.

<comment><USER49> I think I meant to write a couple lines at first but the text just kept increasing and then I went into notepad to really put a spin on it. Oops.

I can't say for the whole psychedelic using population what their motivations are but as far as I can tell there is a clear distinction between users who are doing spiritual practices or trying to find meaning in their lives and so on versus slamming the heroin needle or hitting the crack pipe to get the craziest dopamine rushes you have ever experienced. Not to mention the latest meme to hit the mainstream, the microdosers, who use it as performance enhancer.

Psychedelics as a broad group of chemicals all with similar action in the brain and body contribute to thinking patterns and removing filters on your consciousness. Some people find after one or more trips that they've uncovered something that gave them a new lease on life or something. Some junkies who 'take anything they can get' even avoid psychedelics because it puts into focus the state they are in. They don't want to face that for whatever reason. Maybe that's why they are there in the first place.

One meme in the psychedelic culture goes "when you get the message hang up the phone". You don't need all the pleasures in the world. You certainly don't need to get those huge dopamine rushes daily and you don't need to or likely want to keep constantly tripping in search of the craziest visions and highest peaks, especially if you don't take the hint and start working on bettering your 'sober' self.

Of course there is a whole scale of motivations in between and it's reasonable to except people can function in society despite occasionally using catalysts to trigger pleasurable experiences, as long as their whole existence does not become only that at the expense of maintenance. There is some science on that when your other needs are covered and you're doing pretty well you don't end up in a downward spiral like that and won't get addicted or at least not in the same proportion as when you're trying to fill a void with external catalyst induced neurotransmitter rushes.

I'm not the one to overtly preach or advertise indiscriminant psychedelics use because they can reveal or really put into focus all the bad shit you've been avoiding or traumas you have pushed deep down that you kinda forgot they existed or never dealt with. If you're unprepared or already on the edge bad trips might push you past it and you may end up with something that seems like permanent mental problems. Instead of increased clarity and awareness you may end up at least temporarily in the shitter, and if you have no coping mechanisms you could be fucked.

In my experience I think they contributed to giving me an ability to 'see beyond' the every day reality and from that the motivation to really pay attention to and hone the way I live and act towards myself and others. It's as if for a long time I was a hostage to the depression in this body and couldn't take the steps to fixing the situation back when it was less dire. I used to hit the bong every day all day and slowly cause ruin to my body in many other ways. I became more aware of what I was doing wrong and where my anxiety was coming from.</comment></comment></comment></comment></comment></comment></comment></comment>


Massive Twitter Botnet - <AUTHOR> http://cryptome.org/2014/03/massive-twitter-botnet.htm <comment><USER2> Don't really understand the implied connection to NSA or GCHQ. My theory as to why Snowden is popping up in some of the tweets is because the bots are probably using something like Markov Chains to generate real sounding (as far as Twitter spam detection is concerned) tweets sourced from trending content.

The accounts would then be sold as followers, which is an attractive service to some for a variety of reasons

<comment><USER3> The Markov stuff seems like such a poor approach. Though you can get by with it in 140 characters better than other places.

Twitter provides a public stream of tweets. Simply pull tweets out of that, if it doesn't contain another users name or url, etc. Distribute out to one of your bots, weighted by chattiness. Get fancy and have some sort of baysian filtering for what category bucket it falls into and give your bots interests.

<comment><USER4> Wouldn't that be trivial to detect for their spam filters?

<comment><USER3> Maybe? They never did anything with the proof of concept ones I worked up, but I never did anything with them other than basic interactions with the network.

I'd guess there are enough duplicate tweets. "Another crappy day at work", "looking forward to dinner tonight", "going to see my sister this weekend!", etc. That I doubt it'd be a very useful heuristic.

<comment><USER5> I actually did that and let it run for a week. It got flagged for spam pretty quickly. I suspect because it was a pretty similar tactic to avoid filters.

</comment></comment></comment></comment></comment><comment><USER6> I run several Twitter "Bot Nets".

First, They aren't really nets, they all run on a single server (ok they run on appengine so they aren't quite a single but they aren't a "bot net"). But they control about 7500 accounts, and I have about 80k accounts I own.

Second, Some of them do have real uses. They respond to certain events when they happen. Might be a keyword in a news story, might be something else. Sometimes that is to get the word out for good, sometimes for bad.

Let's say you have a company you like, and you want to drive readership of good new. My bots would provide positive reinforcement to the authors and sharers of those articles. Like giving HN karma, but on twitter. The person who shared the article sees "imaginary bot favorited your tweet" and suddenly thinks "I should tweet about that company more often".

Other times I use the bots to do things like "pruning" bad ideas. I have a bot that looks like a Nazi. Acts like a nazi and talks like a hick. When certain racist remarks or bits of misinformation are shared it responds with positive reinforcement. Many people then re-evaluate if they want to say thing the Nazi agrees with.

Rarely do I use my "bots" for nefarious purposes. Sometimes for personal gain, but not for anything "evil".

-Brandon Wirtz

The NSA knows where to find me too.

<comment><USER7> > _Rarely do I use my "bots" for nefarious purposes. Sometimes for personal > gain, but not for anything "evil"._

I can't tell if you actually believe that, or if you're just trolling.

</comment></comment><comment><USER8> 35000 was the tip of the iceberg, it was a small sampling, not an exhaustive list. I'm only one guy with no power-toys. In all honesty, this is probably a million-account-plus botnet.

There is a possibility that this was a botnet that sells followers. I know that this one wasn't into retweeting or linking to anything, though such botnets do exist.

I wasn't able to prove that is the case with that particular network, as there were a number of "following nobody, and nobody follows" accounts. But I've found another that for sure is in the business of so doing. How does one person with only four very banal tweets get 4000 followers? It turns out that his followers are indeed bots. This network I will be collecting too. Maybe it will turn out to overlap.

@paulmd199

PS: I won't insist on the theory that it's government sponsored bot. it could well be commercial, or just run by some jerk.

<comment><USER9> I fail to see the reason behind your panicked verbiage. You seem genuinely upset by this discovery, care to explain why?

Also, it'd be interesting to read some of your reasons for believing this is in any way, shape, or form a "government sponsored bot". By saying that without any reasoning, you're placing yourself squarely in the "tinfoil hat" camp.

<comment><USER10> Look, I agree that this is probably commercial spamming, not government, but let's cut out the "tinfoil hat" bullshit accusations, OK? It's ad hominem _and_ it's often meant to suppress speculation about possible government misdeeds.

Many of those who were accused of wearing tinfoil hats because of their views on government surveillance turned out to be pretty reasonable after all, no?

<comment><USER9> By definition, "tinfoil hat" has to do with a poorly supported argument, e.g. a conspiracy theory. If anything, it's begging the question.

At any rate, no, I will not stop it. This guy is crying wolf and he needs to be called on it.

<comment><USER10> >At any rate, no, I will not stop it.

Fine, keep pulling that term out on HN and you will be seen as a provocateur, whether or not you actually are one.

Edit: And in case it's not clear, I actually do agree that the "botnet" likely has no connection to the government.

<comment><USER9> Seen by _you_ as a provocateur, which frankly I'm alright with, Internet stranger.

</comment></comment></comment></comment></comment></comment><comment><USER8> Update on this: I can now firmly say that this is a retweet scam.

See:

[https://twitter.com/MarissaTanyat](https://twitter.com/MarissaTanyat)

Who also tweeted the following:

#GetInShape with my online #training [https://twitter.com/Obi_Obadike/status/443220721888546816](https://twitter.com/Obi_Obadike/status/443220721888546816)

Snowden Haarp.... (which connects it to the same botnet) [https://twitter.com/MarissaTanyat/status/443534242820001792](https://twitter.com/MarissaTanyat/status/443534242820001792)

So officially, they're only spammers, not spooks.

PS: Did I mention that I still despise spammers?

<comment><USER11> Scammers, too, assuming that whoever paid for the retweet wasn't told that the only followers were other bots.

</comment></comment><comment><USER12> I feel like I am missing something, I don't see why this is interesting. It doesn't sound like the "botnet" has any objective beyond being annoying. No propaganda, no ads, etc.

Waste of resources sure, but interesting results have come out of these accounts like [https://en.wikipedia.org/wiki/Horse_ebooks](https://en.wikipedia.org/wiki/Horse_ebooks)

<comment><USER13> I thought @horse_ebooks was an experimental art thing and not a bot at all

<comment><USER12> Oddly it was first a bot then an ARG of some sort (the account was sold).

</comment></comment></comment><comment><USER14> This is not a particularly informative article but I see great value in owning a Twitter botnet. As one example, imagine negative news about a major public company starts trending. That would certainly be a money-making opportunity. There are also hard-to-disprove rumors that you could blackmail high profile people with. Celebrities probably don't want to be trending on Twitter for having an affair, even if it is a fake report.

So I am not at all surprised that people are investing in building up tons of what appear to be legit, active accounts.

<comment> at-fates-hands >>> There are also hard-to-disprove rumors that you could blackmail high profile people with.

This is exactly how the GCHQ use Twitter:

[http://www.techdirt.com/articles/20140224/17054826340/new- sn...](http://www.techdirt.com/articles/20140224/17054826340/new-snowden-doc- reveals-how-gchqnsa-use-internet-to-manipulate-deceive-destroy- reputations.shtml)

"Among the core self-identified purposes of JTRIG are two tactics: (1) to inject all sorts of false material onto the internet in order to destroy the reputation of its targets; and (2) to use social sciences and other techniques to manipulate online discourse and activism to generate outcomes it considers desirable"

</comment></comment><comment><USER15> I saw a post about textfile stenography, maybe linked from here or reddit. It used a source text (the example might've been from textfiles.org or a site like that) to hide messages, which looked like the text with glitches or typos or something. I don't not where it is. Here is something that encodes messages so that they look like spam: [http://www.spammimic.com/](http://www.spammimic.com/)

Y'know how people control botnets with irc or webposts? Maybe it is something like that, as other have speculated. But them why would they be posting messages lots of times? That's a problem in my ideary.

<comment><USER11> Kind of like a modern version of a numbers station[1]. I love to think that this is the explanation, but it's probably more mundane.

[1] [http://en.wikipedia.org/wiki/Numbers_station](http://en.wikipedia.org/wiki/Numbers_station)

<comment><USER16> the FSB got caught using YouTube comments.. I'ts only a german source (but a legit newspaper, afaik): [http://www.op-marburg.de/Lokales/Marburg/Youtube- Kommentare-...](http://www.op-marburg.de/Lokales/Marburg/Youtube-Kommentare- und-tote-Briefkaesten)

FTA (Google Translate, slighty modified): However, there were still "other channels" as Attorney Siegmund said: In the "Line D1" the spies took simply Youtube-videos on the Internet. Under harmless videos they put under collusive usernames hidden messages. And then there was, according to the investigators nor the agent Vintage bounce points, mainly in North Rhine-Westphalia. There, hidden mechanical engineer Andreas stop documents that were picked up by members of the Russian headquarters.

They were even links to accounts.. can't find a better source at the moment.

</comment></comment></comment><comment> UVB-76 I wouldn't call 35,000 accounts "massive"

Fake accounts are literally everywhere on Twitter. I have no doubt there are "botnets" out there that are far more sophisticated, more difficult to detect, and contain many more accounts than this.

<comment><USER17> He said 35,000, in a small sample

</comment></comment><comment><USER18> Twitter Fake profile research: [http://barracudalabs.com/2013/07/twitter- underground-economy...](http://barracudalabs.com/2013/07/twitter-underground- economy-still-going-strong/)

<comment><USER8> Thanks, this is very informative.

</comment></comment><comment><USER19> It would be interesting to speculate on what is achieved by this botnet. Perhaps an overall traffic metric? Or air-cover for legitimate traffic? Tin foil hatters probably can find a covert comms network in there somewhere.

<comment> UVB-76 Selling followers.

The accounts make tweets to appear active and legitimate; they are given profile pictures lifted from other accounts, etc.

<comment><USER20> OK, maybe I'm dense. So I buy 10,000 nonexistent Twitter followers. How does that benefit me?

<comment><USER21> Makes you look more credible to the next 10,000, who will hopefully be real people.

</comment></comment></comment></comment><comment><USER22> Looks like a boot camp for bots, which will be sold for retweets or as followers. After the customer pays for N retweets, the bots usually get slaughtered by Twitter team.

</comment><comment><USER23> Not to sound flip, but my programmatic experience with Twitter, leads me to believe most of it seems to be one big botnet. Do any largish API crawl of Twitter and you'll be amazed by the large % of inactive accounts or non- sensical accounts (which I assume to be bots)

My personal experience (where I mostly follow news organization feeds) is different.

In short, in my experience it seems Twitter is great as a broadcasting medium and not so great as a two way communications medium.

</comment><comment><USER24> Its just someone selling followers - he's overlapping his network to follow each other and then follow external. Maybe waiting to build legitimate followings for business, or selling followers for vanity.

He has automation for content generation but the algorithms/spinning sucks so less unique content is generated. There are many many botnets of larger and smaller sizes, but same shit applies on Facebook, Instagram and Tumblr (x100).

</comment><comment><USER25> This could just be a university research project. I read about a similar one last year that was focused on how to create bots that mimic human behavior. Obviously this one would be a much larger scale, but think that knee-jerk reaction of "shut it down!" is overly aggressive without knowing all the facts.

<comment><USER26> My initial reaction was that there's either some sort of stenography going here (command and control?), or the botnet owner's having some fun.

<comment><USER25> "Spurned botnet employee left with access to Twitter accounts, tweets millions of times"

</comment></comment></comment><comment><USER27> If I was socks I'd definitely be steering the discussion in a direction that made you think psychological manipulation through social media platforms was purely the realm of fantasy, then give you all kinds of other suedo-reasons that a massive botnet could be used for.

</comment><comment><USER28> There was speculation that the social networks will outplace the traditional media, but to some extent, this will not happen. Fake social accounts and handles are already everywhere nowadays, and they indeed cause good poisoning on search results.

</comment><comment><USER29> I tried some of those twitter handles and they're already suspended.

</comment><comment><USER30> Why hasn't Twitter shut it down yet? There has to be some sort of reason for it--unless it's the same reason why spammers keep spamming blogs...

<comment><USER31> Growth hacking.

<comment><USER32> Hanlon's razor would offer another conclusion.

</comment></comment></comment><comment><USER33> That all the bots say much the same thing is a bit sloppy. If I had a bot net, I'd add some automated variety to the messages.

</comment><comment><USER34> Would be interesting if Twitter created their own bot to make it seem like they have more active users than they actually do.

<comment><USER35> That reminds me of the payola concept where record labels would buy CDs to bolster first week record sales.

<comment><USER36> This is a well known way to get on to the New York Times Best Seller List.

[http://en.wikipedia.org/wiki/The_New_York_Times_Best_Seller_...](http://en.wikipedia.org/wiki/The_New_York_Times_Best_Seller_list#Criticisms)

</comment></comment></comment><comment><USER24> You caught me!</comment>


AMD Posts A Horde Of New 3D GPU Documentation - <AUTHOR> http://www.phoronix.com/scan.php?page=news_item&px=MTQ3NDU

<comment><USER2> Direct links from [http://www.botchco.com/agd5f/?p=58](http://www.botchco.com/agd5f/?p=58):

AMD R6xx/R7xx 3D Register Reference: [http://www.x.org/docs/AMD/R6xx_3D_Registers.pdf](http://www.x.org/docs/AMD/R6xx_3D_Registers.pdf)

AMD R6xx/R7xx Acceleration: [http://www.x.org/docs/AMD/R6xx_R7xx_3D.pdf](http://www.x.org/docs/AMD/R6xx_R7xx_3D.pdf)

AMD Evergreen 3D Register Reference: [http://www.x.org/docs/AMD/evergreen_3D_registers_v2.pdf](http://www.x.org/docs/AMD/evergreen_3D_registers_v2.pdf)

AMD Cayman/Trinity 3D Register Reference: [http://www.x.org/docs/AMD/cayman_3D_registers_v2.pdf](http://www.x.org/docs/AMD/cayman_3D_registers_v2.pdf)

AMD Evergreen/Northern Islands Acceleration: [http://www.x.org/docs/AMD/evergreen_cayman_programming_guide...](http://www.x.org/docs/AMD/evergreen_cayman_programming_guide.pdf)

AMD Southern Islands 3D Register Reference: [http://www.x.org/docs/AMD/SI_3D_registers.pdf](http://www.x.org/docs/AMD/SI_3D_registers.pdf)

AMD Sea Islands 3D Register Reference: [http://www.x.org/docs/AMD/CIK_3D_registers_v2.pdf](http://www.x.org/docs/AMD/CIK_3D_registers_v2.pdf)

AMD Southern Islands/Sea Islands Acceleration: [http://www.x.org/docs/AMD/si_programming_guide_v2.pdf](http://www.x.org/docs/AMD/si_programming_guide_v2.pdf)

AMD HDA audio verbs: [http://www.x.org/docs/AMD/AMD_HDA_verbs_v2.pdf](http://www.x.org/docs/AMD/AMD_HDA_verbs_v2.pdf)

</comment><comment><USER3> I bought an ATI 5870 a few years ago. At the time, it was a pretty beefy card, and drives my three 23" monitors really well... in Windows.

Late 2012 is when I found that enough bugs were fixed in the [now AMD] proprietary drivers to where I could get serious work done in Linux. The crashes were mostly fixed, but there are still lots of performance issues, as well as a lot of fun bugs (like my cursor randomly turning into a 20x50 block of randomly colored pixels when moving between monitors).

It's been a dreadful experience. The AMD driver releases stopped coming with changelogs for about 6 months, and they still don't always release them (or when they do, they leave a lot out). When a new version of Xorg comes out, it takes them at least two months to add support (while nvidia often has support ready before release, or very shortly after). nvidia, even with their own issues, shows them up enough to make me envious. Intel is really taking things to a higher level with their drivers + OpenGL performance lately, too.

If you have to use proprietary drivers (like I do for 3D/OpenGL), stay the heck away from AMD. They do an awful job with their Linux drivers. Linus likes to bitch at nvidia, but their binary Linux drivers are leagues better than AMD's. They've got issues, too, but are by far the lesser of two evils for higher end GPUs + Linux.

<comment><USER4> Just use the in-kernel free drivers. They have improved immensely the past few years. The Radeon HD 5870 is called 'Evergreen', you can check out the feature support here:

[http://xorg.freedesktop.org/wiki/RadeonFeature](http://xorg.freedesktop.org/wiki/RadeonFeature)

In my experience the free drivers have slightly slower 3d performance and much faster 2d performance.

<comment><USER5> Still hit and miss though. Bought a laptop that even had somewhat decent 3d acceleration, but would horribly lag on 2d terminal output.

Returned it and been using Intel and Nvidia exclusively now - no problems whatsoever.

<comment><USER6> There are some things that can be done to fix that -

[https://wiki.archlinux.org/index.php/Radeon#Slow_performance...](https://wiki.archlinux.org/index.php/Radeon#Slow_performance_with_open- source_drivers)

<comment><USER5> I tinkered around for a few hours and gave up. Not worth my time.

</comment></comment></comment></comment></comment><comment><USER7> I wonder how much of this is "business as usual" for AMD's GPU team, and how much of it is in reaction to nVidia recently beginning to open up? My limited understanding is that AMD/ATI has been far more more open than nVidia for much longer, but if they see nVidia starting to open up, maybe they're lengthening their stride on these efforts?

Either way, my inner optimist/FOSS fanboy is really hoping that there's a convergence of things happening right now (championed by Valve, I think) that will make GPUs become as open and well-documented as main processors. It's rare to see, but I get all excited any time openness is even a minor basis for competition.

<comment><USER8> I'd assume "business as usual"; preparing a publication like this takes far, far longer than the time delta to nVidia's announcement allows for.

<comment><USER7> I think the lead-time issue depends on how they document internally. If they provide 'first-class' documentation for their partners to consume which has already been sanitized of NDA-restricted disclosures, maybe all they need to do is remove the 'CONFIDENTIAL' header.

Though to be fair, I'd be shocked if this was the case. Most companies don't do the IP sanitization bit, which is why NDAs in those types of industries are viral in the same way as the GPL.

<comment><USER9> > If they provide 'first-class' documentation for their partners to consume > which has already been sanitized of NDA-restricted disclosures, maybe all > they need to do is remove the 'CONFIDENTIAL' header.

What partners? The only ones writing AMD GPU drivers is AMD, and internal documentation tends to universally be crap.

<comment><USER10> _> What partners? The only ones writing AMD GPU drivers is AMD, and internal documentation tends to universally be crap._

Don't quote me on this, but it was my impression that vendors AMD's GPUs should have source access to the drivers.

</comment></comment></comment></comment></comment><comment><USER11> A hoard, surely, rather than a horde.

Hacker News readers are a horde. The newly-released documentation is a hoard.

Assuming this is correct: [http://grammarist.com/spelling/hoard- horde/](http://grammarist.com/spelling/hoard-horde/)

</comment><comment><USER12> Anyone else disappointed that the GPU documentation isn't somehow rendered in 3D?

<comment><USER13> No.

</comment></comment><comment><USER14> Thanks Valve.</comment>


The US spends more on healthcare for no gain says new report from Johns Hopkins - <AUTHOR> https://www.jhsph.edu/news/news-releases/2018/us-health-care-spending-highest-among-developed-countries.html <comment><USER2> The book _The Healing of America_ by T.R. Reid, 2010 was a phenomenal look at this subject and the conclusion was this: we are the only developed nation whose government allows for-profit health insurance companies to exist with ZERO regulation to cap healthcare prices. Because of this, we spend 20% of every dollar on "administrative" costs compared to 3%-7% in the European and Asian countries. The goal for American healthcare companies is increasing shareholder value, not reducing costs. IMO healthcare is an obvious example of where a "free market" approach has failed and government oversight is critical.

[https://www.amazon.com/Healing-America-Global-Better- Cheaper...](https://www.amazon.com/Healing-America-Global-Better- Cheaper/dp/0143118218)

<comment><USER3> I read that book too, and agree it's phenomenal. It's not just about capping insurance profits. The countries doing the best also have price controls on the healthcare providers. Doctors make a lot less money. On the other hand they generally don't have to pay for medical school.

France, Germany, and Japan all have similar systems, according to the book. They have private nonprofit insurance, some kind of mandate to purchase it, a government price list on services, guaranteed coverage of anything on the list, and digital medical records.

A lot of German primary care doctors don't even hire office staff. They prescribe whatever they want, swipe your medical card, and they're guaranteed to be paid in a week, no questions asked.

Japan has a clever way to handle the mandate. If you don't pay your premiums, nothing happens, but if you need healthcare you're not covered until you pay your back premiums.

I wish all the Americans who think the rest of the developed world runs on single payer would read this book. None of the three countries I just mentioned use single payer. The book also covers Canada and the UK, both of which are single payer (and single provider in the UK), and while their results are pretty good, they're not as good as the other three.

<comment><USER4> One of the main reasons why I gave up career in the States and came back to my home country (Japan) was healthcare. I had a day surgery in the US and the whole experience (i.e. bills) just scared heck out of me. I am very happy with the system here. Everything is extremely efficient compared to the US. A little while ago, I had this mysterious headache and went to an orthopedist, dentist, psychiatrist, neurosurgeon then took an MRI. All within one week. My Canadian friend told me that it would be a half-year ordeal in Canada. By the way, I'm not rich.

<comment><USER5> Just got hemoroids frozen and cut with laser. Cost here in USA under premium insurance was $12,000. Went to Germany got it done on the same equipment in luxury stay for 14 days at $870. Plus $800 plane tickets. Meanwhile a friend of mine had a heart attack. As a Bank of America emplyee he had somewhat goog insurance that paid some. He was left with $180,000 bill.

<comment><USER6> > As a Bank of America emplyee he had somewhat goog insurance that paid some. > He was left with $180,000 bill.

Forgive my ignorance but how is that possible? The highest out of pocket maximums for Marketplace plans is $15700 for an entire family.

<comment><USER7> There are interesting cases, where doctors prescribe stuff they get no valuable information from.

I had this in US. Shoulder pain, that was diagnosed via an XRay... But the doctor decided he wanted an MRI. That's no unusual, but unnecessary in my case. Got charged extra $500 for the pleasure. Thankfully I was on an HDHP, so the HSA savings got hit.

<comment><USER8> That's not an unreasonable charge for an MRI and I'd argue that you got off quite lightly. You can't diagnose many of the potential problems shoulders have from an x-ray but a good clinical examination will catch many of them, with an MRI for confirmation. Labral tears would be an example of this.

<comment><USER9> For a second I read your comment as liberal tears, and had to do a double- take. :)

Speaking to the 500$ charge, are you saying that is a typical cost around the world for a MRI? Is there something about the machine's cost that justifies this or are you just saying that a 500$ charge is typical in the american system?

<comment><USER10> And here I thought my last 120 EUR MRI was very expensive... (in France, of course)

<comment><USER8> That's impressive. The purchase price and running cost are high. Then there are expensive labour costs (doctor, probably 2x techs and admin/reception staff. Often a nurse is around for more complex procedure too). Peripheral equipment isn't cheap, with defib, contract injectors, RIS/PACS, reporting stations etc. Scans are slow relative to CT and x-ray so I have no idea how they make that work. Did you pay the whole bill? I am an MR tech.

</comment></comment></comment></comment></comment></comment></comment></comment></comment></comment><comment><USER11> It's worth noting that the U.S. market does pay for the lion's share of patented drugs, effectively funding a significant portion of R&D that benefits the whole world years later when generics come into market (at least for those drugs which are not costly to manufacture, which happen to be the majority).

I'm not saying this model is right. I'm just saying that doing away with it will have fundamental consequences to healthcare R&D

EDIT: To be clear, a minority of drugs are either very hard to manufacture (It's been a while for me so I don't recall their exact name, but I think they may be called "biosynthetics" – please correct me if I'm wrong) or researched for a very small number of patients (so-called "orphan drugs"), which confers them additional protection from generics and competitors. These generally have much higher prices than the "standard" drug.

<comment><USER12> It does appear to be the case that the US funds most pharma R&D due to Americans overpaying relative to the rest of the word. In some cases (China, India) this is due to weak IP protection, but in other cases (Canada, UK, Europe) it's more to do with our governments having a stronger negotiating position and setting hard limits on what they'll spend for a given benefit to patients.

Some characterise this as freeloading, but looking at the NHS for example, they set relatively clear limits for how much they will pay per quality- adjusted life year that a drug provides. If a drug costs more than this limit, financially more people will lose out if our healthcare system purchases this drug over something else (more doctors, hospital beds, etc.).

Does this make us immoral for "freeloading", because we prefer putting our limited money into cost effective treatments?

Also, is it not worth looking at why pharma R&D costs so much? The pharma industry seems to run at a very healthy profit margin compared to most other industries. Maybe the lack of market pressure is allowing the pharma industry to remain fatty? Obviously there's a fear that cutting US pharma revenue would hurt global medical R&D, but I don't see this as being a foregone conclusion. It could just as possibly be market failure and regulatory capture keeping pharma R&D expensive.

<comment><USER13> > Does this make us immoral for "freeloading", because we prefer putting our > limited money into cost effective treatments?

It doesn't make you immoral, but it is important in understanding the tradeoffs of suggesting that the US switch to an NHS-style system.

> Also, is it not worth looking at why pharma R&D costs so much? The pharma > industry seems to run at a very healthy profit margin compared to most other > industries. Maybe the lack of market pressure is allowing the pharma > industry to remain fatty? Obviously there's a fear that cutting US pharma > revenue would hurt global medical R&D, but I don't see this as being a > foregone conclusion. It could just as possibly be market failure and > regulatory capture keeping pharma R&D expensive.

They may be doing well, but you may not be seeing all the little pharma companies that die trying. At the end of the day, investors are allocating capital where they think they can get returns. If you reduce the returns of pharma, you reduce the attractiveness of investing there.

<comment><USER7> I try investing a lot in smaller pharma companies... and they are hammered by the big ones. Not on innovation, but on marketing.

I disagree about NHS type system, that reduces access. A healthy mix is required, though.

A lot of upfront costs are also footed by users and government/non-government funds. And a lot more of those costs are due to government regulation and essential insurance at development.

Pharmaceutics researchers aren't exactly rich, btw. Your dentist probably makes more than many researchers of life saving drugs.

<comment><USER14> How does an NHS type system reduce access? Everyone is covered and can go to the doctor without worrying about paying thousands in copays.

<comment><USER15> And also if people wish to pay for private care (whether out of pocket or using insurance) they're free to do that too.

</comment></comment></comment></comment></comment></comment><comment><USER16> It's worth noting that a recent analysis of S.1804, the Medicare for All Act, "could reduce total health care spending in the U.S. by nearly 10 percent" [1]. Even conservative analysis [2] has the program project to save in the trillions over a decade.

All while providing comprehensive, universal healthcare, free at the point-of- service.

Also, Medicare For All would theoretically be able to command substantially lower drug prices by nearly monopolizing demand.

Notably, given the study's analysis focus on OECD countries, the United States is (said to be [3]) the only of the top 25 wealthiest countries and one of two total member countries to not provide universal healthcare coverage.

[1] [https://www.peri.umass.edu/publication/item/1127-economic- an...](https://www.peri.umass.edu/publication/item/1127-economic-analysis-of- medicare-for-all) [2] [https://www.mercatus.org/system/files/blahous-costs- medicare...](https://www.mercatus.org/system/files/blahous-costs-medicare- mercatus-working-paper-v1_1.pdf) [3] [https://www.politifact.com/virginia/statements/2015/sep/01/d...](https://www.politifact.com/virginia/statements/2015/sep/01/dan- gecker/dan-gecker-says-us-only-wealth-nation-without-univ/)

<comment><USER17> Why would I be excited about a proposal to totally restructure an industry that every American comes into contact with and that represents something approaching 20% of our economy just for the prospect of a _ten percent savings_? Take any family complaining today about the cost of a Silver plan on an ACA exchange, offer them a 10% savings, and see if they're OK with what they're paying.

<comment><USER18> Because it covers millions more, while spending less. Is this difficult to understand?

<comment><USER17> It leaves us overspending on health care by a huge amount, raises everyone's insurance, and ultimately takes away everyone's employer-provided care, which the majority of Americans who have it like. If it was cutting our expenses in half, the cost savings might sell it. But 10%?

<comment><USER19> > ultimately takes away everyone's employer-provided care

Really? Even the NHS system allows a parallel employer provided system to run alongside it, it's just only common for higher-paying jobs and those with US parent companies.

<comment><USER17> Right, the rich will retain private care no matter what. The challenge is what happens to the middle class, the majority of whom have employer-provided care that they _actually like_ (this is a major challenge with any health reform in the US: the status quo has powerful support). There's a near-consensus that the impact to the market for these insurance products will, within a few years, be eliminated by M4A.

</comment></comment></comment></comment></comment></comment><comment><USER20> PSA: As of 2019, federal law requires all hospital & doctors to post prices in a machine-readable format.

The results are pretty striking, esp here in the Bay: eg UCSF ( [https://www.ucsfhealth.org/about/pricing- transparency/](https://www.ucsfhealth.org/about/pricing-transparency/) ) charges $2600 for 1-way and 2-way chest X-rays, but charges $220 (that's two _hundred_) for 3-way chest X-ray. The difference? How many angles they take of your body -ie, a 3-way includes the 2 & 1-way; and, more notably, the 3-way was used as a chargemaster item used in pricing estimators. So eg when I went in for a routine chest x-ray, I've expected a $300-ish bill, and got charged with a $2600 one. Knowing these prices now allows me to ask specifically from my doctor to select the diagnosis&intervention with the highest benefit/cost ratio.

I'm really curious seeing consumer reactions to this, because current medical billing practices must die.

<comment><USER21> This is astounding. It used to be that doctors were not allowed to post their prices! Openness is needed to fix medical billing.

<comment><USER7> Why would you care, when your copay is $30 flat?

<comment><USER22> Every time I use my health insurance in the USA I peel back another layer of this onion of a scam. I've started doing most of my health care abroad even though I'm insured just so I don't have to deal with this industry. I doubt posting prices online will do much because it seems like a quick fix to a systemic issue.

1\. Go for a 3 minute, 30 second ENT appointment about earwax. Think I'm just paying a co-pay. Receive an extra bill for "Charges in excess of negotiated amount"

2\. Go for appointment and be told: "If you just pay us now and bypass your insurance it will be cheaper than your copays." This happened twice without any prompting.

3\. Be told by another office that my insurance doesn't cover a service and that it would be better if I paid out of pocket. Learn later that that service should have been covered 100%. Struggle for months to get insurance to pay instead all the while being told by the office "we can't guarantee you won't end up paying more in the end, even if it does say 100%"

<comment><USER23> It surprises me that that behavior is even legal. It shouldn't be in a modern democracy.

</comment></comment></comment></comment></comment><comment><USER24> I speak for myself, but I'm pretty sure many people would share the thought: healthcare is the number one reason for which I'd never move to America.

And there are a billion things for which you might want/not want to move to another country. And I'm healthy, and there are many other things that might seem crazy about America. I don't know, maybe I'm just paranoid, but I do seriously hope for the sake of everyone (and I don't mean to be meddlesome), that US citizens stop accepting this as normal and the situation changes soon.

<comment><USER25> This is odd. If you have a decent job and health insurance coverage, there's nothing better in terms of healthcare than living in cities such as Boston. I can't think of another city where you have access to multiple world-class hospital systems. Quality of care is simply unmatched.

<comment><USER26> Have you see the discussions above where people talk about being hit with bills for hundreds of thousands because of Out Of Network charges?

</comment></comment></comment><comment><USER27> I think it would be worthwhile to discuss more than just per capita cost. The way that these costs are distributed is important and, I believe, problematic. The problem here is not just that per capita cost is high, it's that for reasons that are partly structural, and partly demographic, healthy young payers with lower incomes can be burdened with the full, un-subsidised, costs of insurance, while others consume services without seeing the price. Some people have tax subsidized employer sponsored health care, some people have socialized health care, some people pay for insurance out of pocket with post- tax income, and some people have nothing and have to negotiate costs under duress after they have already consumed services. Doctors will not commit to a price in writing in advance. If you think will, try it sometime ;)

I'm currently paying more then %100 of my annual income into an insurance pool, because I need insurance to protect my assets. (It's complicated...) Moreover, the cost is not tax exempt because it is not employer sponsored. I'm healthy and don't really consume much in the way of services. Meanwhile, others in the same insurance pool I'm paying into never see the price of their premiums, and don't pay taxes on them. I understand that the point of insurance is to pool risk for insurable events, but how can we ever have an efficient market without price information?

As Milton Friedman put it "No one is as careful with other people's money, as he is with his own."

<comment><USER28> I'm confused, do you have low income and a fairly large amount of assets? I can see this if you retired early or something, and in this case the comparison with your income really isn't particularly interesting.

</comment></comment><comment><USER29> Like the article says, previous research has come to the same conclusion.

We pay much more, and are ranked nowhere near the top for lifespan, childhood mortality, and other measures.

Obamacare was a great first step. Define what basic healthcare is and form markets that encourage apples-to-apples comparison. Let the free market work.

Sucks that one party used this as a weapon to wrestle power.

Oh well.

Not going to argue here about healthcare reform, though. So if you disagree, don't expect a response.

<comment><USER30> > Let the free market work

Respectfully, enough with this free market garbage. The healthcare industry is not a free market, it can never be. It's not possible for the consumer to be educated.

Even if you put emergencies aside, when an unconscious person can't start price shopping emergency rooms, you still have regular office visits that are impossible to price shop.

Ask yourself when the last time you asked your physician how much a service cost. I asked my physician and they had no clue. They finally gave me an estimate of "it'll be nominal", so I accepted the procedure. Turned out to be ~$200. I'm currently disputing it and refuse to pay based on their original quote of "nominal".

Imagine your at the doctor and need to get a blood test. What do you do? Start calling around local labs to ask which one has the best price? Maybe check Groupon for a discount? All this while your doctor waits to see if the price is within your budget, so they could continue the test.

Pricing in the medical industry is not even opaque. It's solid black.

<comment><USER31> > They finally gave me an estimate of "it'll be nominal", so I accepted the > procedure. Turned out to be ~$200. I'm currently disputing it and refuse to > pay based on their original quote of "nominal".

This is a case of expectations. $200 is nominal as far as medical procedures go. Based on my last couple encounters with healthcare, $200 barely gets you in the door. I paid $2000 on my last ambulance ride. My last stay was $14,000 for a couple days. That's _with_ insurance.

<comment><USER30> I was having an office visit getting tested for the flu, not on my way to the emergency room.

The person who gave me the "nominal" quote also said my insurance would likely even cover the test. She was wrong.

I spoke to the office manager and she seems to agree with my take on the situation.

If you give a vague subjective word like "nominal" for a service, it's on you to hope the consumer agrees.

</comment></comment></comment></comment><comment><USER32> It seems to me the US never outgrew it's frontier mentality.

Before, if you felt too hemmed in you could always move west and get free land, get together with other locals and form a small town.

Better to be the founder of your town than a random nobody in your previous town.

Back in the 18th-19th centuries, medical care was primitive and sometimes dispensed by the barber.

For toothaches and broken limbs, you might see a dentist or a doctor, for anything life threatening you toughed it out and died at home.

We don't do that anymore of course, but it's almost as if attitudes about self sufficiency have lagged behind.

</comment><comment><USER33> Are there any measures of how America does compared to Europe if you only count Americans that have good health insurance?

It seems to me that many people who are opposed to socialized medicine don't necessarily disagree that it would give the poor better care; rather they fear that it will result in them receiving worse care.

<comment><AUTHOR> > _Are there any measures of how America does compared to Europe if you only > count Americans that have good health insurance?_

Anecdotally, I'd say they do crap.

Friends outside LA are upper-middle class. Extremely good health insurance for the last 20+ years. Had a baby, emergency C-section. Less than 12 hours later they were told they must move hospital or else pay the $60,000 per day out of pocket because their insurance wouldn't cover it anymore. They had to drive themselves, in their own car, less than 12 hours after an emergency C-Section, with the infant.

Of of this after paying through the nose for 20+ years for excellent health insurance.

As an Australia/Canadian this is barbaric, and utterly unacceptable.

<comment><USER34> I think the commenter was asking about quality regardless of cost, especially for the upper tier.

<comment><AUTHOR> Yes, and I was saying the quality is very low.

</comment></comment></comment></comment><comment><USER35> The title is inaccurate.

It shouldn't be "spends more for no gain"... it should be "spends more for worse healthcare."

"No gain" implies that we are getting the same level of healthcare as other countries, when in fact we have worse outcomes, less nurses/doctors, worse wait times, and always get stuck with the bill. Only in America do people regularly end up in bankruptcy for medical expenses.

</comment><comment><USER36> I saw an interesting article a while back. It looked at the benefits adjusted income of workers in the US since 1980 or so. Basically, the "disappearing wage growth" at of the last part of the 20th and early 21st century fir the bottom of the income curve is largely (although entirely) explained by the increasing cost of health care as a component of compensation.

<comment><USER37> Is this averaged across all industries and income levels?

</comment></comment><comment><USER38> I wonder how long other industries will let the healthcare companies get away with this.

The first Fortune 500 company to give it's employees free travel to Mexico, Canada, or Cuba for affordable care will cause quite a few waves.

Or a smart country could open up "embassy clinics" throughout America, offering affordable healthcare and taking the profits back home.

<comment><USER17> Fortune 500 companies already frequently self-insure their employees.

</comment></comment><comment><USER39> Where does the money go? Aside from the waste and fraud, two places. First, we pay for convenience. We want to see a doctor _now_. We want immediate access to all the best equipment, and specialists, and drugs, and we don't want to wait around or travel far. And we increasingly want it for every citizen. Second, over treatment of the dying - no subject is more uncomfortable. When asked what the biggest problem Kaiser Permanente faced, Charlie Munger, board member, responded over treatment of the dying. Various estimates are half of all healthcare spending takes place in the final two years of peoples' lives. In both cases, we've essentially deemed care as "cost no object", and when that happens, things get sideways fast.

I'm not saying what is right or wrong, just what the problem is. Fast, cheap, good - you can always only pick two.

<comment><USER40> > We want to see a doctor now. We want immediate access to all the best > equipment, and specialists, and drugs, and we don't want to wait around or > travel far. And we increasingly want it for every citizen.

Australians can get these at a fraction of US prices though

<comment><USER41> Can they?

 _Mr Meschemberg's cancer is HER 2-positive (HER 2 is a protein found on the surface of some cancer cells). HER 2-positive cancer cells tend to be far more aggressive, as they divide and grow faster than normal. "That makes [my cancer] a bit different," he said. "There are drugs that are available to help but they're not on the PBS."_

[https://www.news.com.au/lifestyle/health/health- problems/mee...](https://www.news.com.au/lifestyle/health/health- problems/meet-the-aussies-whose-cancer-treatment-isnt-covered-by-the- pharmaceutical-benefits-scheme/news-story/d264fe3c6510bbed33d3e84bc8f351e2)

<comment><USER40> It takes a few extra years for new drugs to get added to the PBS, but even if they are not, there's a cap on how much 'out of pocket' you'll pay for treating serious medical conditions. It's maybe $3000 per year depending on your situation. Medicare will cover the bulk of it even if it's not on the PBS.

</comment></comment></comment></comment><comment><USER42> Reading through this thread is proof enough that the system is relentlessly complex. Medicine itself is incredibly complex, payment is complex, the system is nearly 20% of the economy, and not even 100 world-class experts could provide us with a fool-proof plan to solve this mess. Whatever the solution is to our healthcare systems' problems, it is not going to be simple, easy, quick, or cheap.

</comment><comment><USER43> Here's a simple, free-market solution that no one seems to have thought of: start a health insurance company that pays for medical tourism. That would provide consumers a cost-effective alternative and put pressure on the American hospital systems to bring down costs. Why wouldn't this work?

<comment><USER44> Even better: a billionaire philanthropist to start a non-profit health insurance company that only works with its own chain of evidence-based providers and hospitals, combined with medical tourism. That would provide consumers with a cost-effective alternative and put pressure on the American hospital systems to bring down costs. Why wouldn't this work?

</comment></comment><comment><USER45> It's a simple economic argument:

In a single payer system, providers compete but buyers don't, so prices are kept low.

Prioritization is based on need.

</comment><comment><USER46> These studies never seem to differentiate between different types of care. We left Canada for the US because of the healthcare. Autism care and support is far better in the US then Canada. Even if this is costing us more as a whole (it's far cheaper in my out of pocket costs), there are gains. So in general, we might be doing worse in general, but that doesn't mean we aren't doing amazingly betting in certain areas. I realize I'm talking about one specific area, but knowing how much was spent in the US vs Canada in terms of care, yes, more was spent on my child in the US instead of Canada, but the results were so much better.

Basically, it's easier to spend less when you just don't do certain things that are much more expensive.

</comment><comment><USER47> They spend more on healthcare because a corporation presented a bill with a larger total at the bottom. NO human goes to the hospital and says, "...please charge me 37 dollars more than last visit for that generic aspirin..." All you international geniuses, help us out, stop investing in the for profit US healthcare system. Sell your holdings today, don't invest your retirement in funds that invest in for profit healthcare companies. That would get the ball rolling. Same goes for for profit prison management.

Trivia: What percentage of for profit healthcare corporations are directly or beneficially controlled by foreign investors who reside in countries that do not have our healthcare cost problems?

<comment><USER7> We will not. USA is the global piggy bank.

Honestly - it is.

</comment></comment><comment><USER48> Many are not going to trust such studies any more than they trust climate- change research, and would rather the market "fix" the problems than a gov't-centric approach.

</comment><comment><USER49> Why do people keep thinking about this in the terms "who should pay for that" while in the market economy, it won't change anything? It's about supply and demand, just force medical schools prepare more doctors, for example threatening them with automatic diploma recognitions and green cards on arrival, for medical professionals from every first world country who could speak decent English.

</comment><comment><USER50> If you want to read more on this topic, I highly recommend An American Sickness ([https://www.goodreads.com/book/show/31253737-an-american- sic...](https://www.goodreads.com/book/show/31253737-an-american-sickness)). It's written by the current Editor in Chief of Kaiser Health News.

</comment><comment><USER51> Interestingly, I just read this last night on Factfulness by Hans Rosling so it's certainly not a new finding. I highly recommend the book.

</comment><comment><USER52> I was in a cancer center picking someone up and overheard the staff ordering a dose of medicine.

A single dose was billed at $100k US

</comment><comment><USER53> I believe there is an economic analysis I saw mentioned by Scott Alexander that basically the cost of healthcare can be predicted as a function of the quality of care and the wealth of the country.

Allegedly healthcare in the United States costs exactly as much as that formula would predict.

I don't have a citation here, and if anyone has one that would be great.

But if it is true, we might be trying to fix something that isn't broken in any of the ways people intuitively conclude.

<comment><USER54> I don't give a shit even if we ultimately have to pay more than we are now on healthcare (spoilers, we won't) as long as we can have universal coverage.

</comment></comment><comment><USER55> It's always for someone's gain but as with other things in the US it's the shareholders who gain.

</comment><comment><USER56> I think it's hard to compare these numbers across countries. For example, a richer country could choose to spend more on stuff that ultimately makes little difference in outcomes. For example, fewer people per hospital room or better hospital food or shorter wait times for a non threatening disease.

<comment><USER57> I'm not sure this holds up to scrutiny. Why don't other rich countries (e.g. Canada, which lets you pay for your own healthcare if you want) have this problem?

<comment><USER56> Canada has equivalent of Medicare for all. And Canada has at least some of these problems, for example longer wait times. These long wait times don't ultimately affect average outcomes.

<comment><USER57> I think you misread my post. By "these problems" I meant "overspending on things that don't improve outcomes."

But if paying for extra care is illegal in Canada then my argument doesn't work.

<comment><USER56> Being able to see my doctor for a health problem on short notice improves my quality of life but it probably doesn't change outcomes as there is a very low likelihood that my problem is both life threatening and urgent. But choosing to pay doctors more to reduce wait times is not right or wrong - it's just a different preference.

<comment><USER57> My point is that you don't see people spending extra to see private doctors in Canada despite it being a generally wealthy nation. There is more at play than the original suggestion that high spending is simply a function of being a richer nation with more money to spend on "extras" like short waiting times.

<comment><USER56> You do actually - Canadians sometimes go across the border to US for surgeries, etc.

</comment></comment></comment></comment></comment></comment></comment><comment> d--b These studies serve no purpose. Everybody knows this.

The usual debate follows: yes but US funds research - yes but doctors, insurance and pharmaceutical companies get paid a lot more than anywhere else - yes but that's the market, I want to pay more to have a top notch doctor / insurance - blah blah blah.

</comment><comment><USER58> Judging by the comments, there are a lot of us here who already know this. _So what are we going to do about it, now?_ The system is broken but there are a number of entrenched interests who want to keep it that way and an electorate willing to buy whatever they say.

I am short on hope.

</comment><comment><USER59> Everyone wants to blame drug prices but let's not ignore the problems of obesity, diabetes, etc. Much of which is a result of urban sprawl, poor diet (both in food culture, and in crop subsidies), and poor work culture.

<comment><USER11> As a U.S. immigrant who struggles to find truly healthy food choices in Manhattan of all places, I couldn't agree more.

<comment><USER60> Most really healthy people cook for themselves.

<comment><USER11> That's what I do too, but every once in a while you have to buy prepared food and the portion size, calorie count and amount of sodium / sugar in American food is simply staggering

</comment></comment></comment></comment><comment><USER61> one of the mysteries for me is always: economists love it when the government spends more money because of money multiplier effects (the old Keynesian idea of burying wads of hundred dollar bills in millions of bottles and then pay someone to dig them up and spend it).

but then, when you have this HUGE industry which literally spends hundreds and hundreds of billions on all kinds of nonsense like wasteful billing administration, unnecessary defensive medical tests, overpriced drugs, etc, the same economists are unhappy.

</comment><comment><USER62> The name of the school is `Johns Hopkins`. Carry on!

<comment><USER63> Fixed the title, thanks.

</comment></comment><comment><USER64> In the US, the most heavily regulated industries are health care and education. They have the highest prices.

The least regulated industry is software, with the lowest prices (most software is literally free).

</comment><comment><USER65> I see people saying that drugs in the US are twice as expensive as other countries in the comments. I'll summarize [0] which is one of the sources for that number.

People in the United States spend roughly 2x per capita compared to Germany, Canada, and the UK. This does not mean that drugs in the United States are twice as expensive.

The US tends to use newer molecules in the drugs that are purchased -- particularly ones that are still patented and more expensive. Other countries like Germany and the UK tend to use older drugs (e.g. molecules over 30 years old).

A naive analysis would notice that the US spends more on drugs for a lower number of sales and would conclude it's because prices are high, but that ignores the fact that US doctors tend to prescribe newer on-patent drugs which are -- _drumroll_ \-- more expensive and not necessarily more effective. I'd argue this is the fault of the doctors prescribing the drugs more than any drug company's fault.

If you examine Exhibit 6 in the study, you'll see that, yes, the United States does tend to have more expensive drugs than most other countries but it is NOT an outlier. For example, Japan and Mexico pay more than the US for the same drugs on average. Drug prices are not nearly as big of a problem as people make it out to be.

Also, to its credit, the US also has significantly cheaper generics and over- the-counter drugs.

[0] [https://www.healthaffairs.org/doi/full/10.1377/hlthaff.27.1....](https://www.healthaffairs.org/doi/full/10.1377/hlthaff.27.1.221)

</comment><comment><USER66> The reason healthcare costs so much more in the US than other countries, is health insurance. When insurance pays for everything patients don't care how much the medical providers are charging, or whether they are providing unnecessary services. When somebody else (i.e., insurance) is paying, the individual consumer is encouraged to consume without any restraint. When all consumers behave this way, healthcare providers are able to charge sky-high prices and unnecessary services, which in turn causes insurance premiums to go up. (Look up "tragedy of the commons").

The solution is to make the consumer participate in driving costs down. One employer I know of has an excellent solution to the problem: Make employees pay 100% of the bill up to a certain amount, such as $6000. That's a large amount, but the employer then contributes a large amount to your Health Savings Account (HSA), such as $4000. This amount is for you to keep regardless of whether you have any health bills or not. (This money can be used for medical expenses only, but can be used any time, including after retirement). So the maximum you will spend out of pocket per year is $2000. How does this encourage the consumer to scrutinize and control medical expenditure? Because the first $6000 of medical spending in a year is "your money". This is money you'd be able to keep in your HSA if you didn't have any medical expenses. This gives the consumer a strong incentive to reduce costs, question charges, avoid unnecessary services, and so on.</comment>