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It's probably only available in some locations because every state has rapidly different scope of practice and prescribing rights for PAs / NPs.


Having worked in an ED I can tell you it's much more like "when you make ED the only place that can't turn away patients, patient goes there for everything including the common cold."

It's not so much a minor thing turned into an emergency (that is a problem of course) but rather the patient has no other venue for minor needs without money or insurance.


This is the big thing.

If triage were able to turn away non-emergency cases legally it would gradually change, but for people with more time than money the ER basically ensures you'll be seen.


Does Chinese history show they are any more immune than others to our weaknesses in living together?


China is about 10x older than the US. We're like a six year old thinking they knowing better than grandpa.


I find this perspective pretty amusing. The United States is in fact more than 3 times older than China (i.e. the PRC). The idea that modern China is wise because its ancestors were ruled by Chinese emperors seems to me basically the same as saying the west is wise because its ancestors ruled by Roman emperors. But I guess historical myths and culture are quite powerful ideas for many people.


This is the same logic hawkish American Republicans use when they say they are defending Western Values against the Chinese. What are those values? Where do they come from? Most rural Americans from Alabama who say these things haven't been to England or Germany, and if they did, they sure wouldn't recognize "their culture". Heck, they don't even need to travel to Europe.. try NYC!


I don’t really understand your point. Are you comparing hawkish nationalist Americans to hawkish nationalist Chinese?


No, but they are not comparable because Chinese are not hawkish by any American definition.


In your view, what is "hawkish by an American definition?"

Some research on the subject: https://www.tandfonline.com/doi/abs/10.1080/10670564.2019.15...

Five surveys of Chinese citizens, netizens, and elites help illuminate the attitudes that the Chinese government grapples with in managing international security policy. The results suggest that Chinese attitudes are more hawkish than dovish and that younger Chinese, while perhaps not more nationalist in identity, may be more hawkish in their foreign policy beliefs than older generations.


The febrile public comments about Taiwan recently suggest they are just as hawkish


Oh I see you are comparing countries not cultures. In that case US is older.


The Europeans are not obsessed with taking down China, nor are Europeans ardent individualists as Americans are. Chinese and America have a bigger cultural gap than Europe and China in this respect.


As a Chinese-speaking European, I'm getting the impression that you're using faraway places you know little about as convenient projection surfaces for an ideal contrast with the things you dislike about America.

Dislike of America's recent history of conquest turns thousands of years of warfare on what is now Chinese territory into thousands of years of living on the same land without any invasions.

Dislike of American individualism turns Europeans into... I'm actually not sure whether you associate any specific qualities with not being ardent individualists.

Anyways, I'm quite annoyed by this, so consider yourself officially taken down.


American Individualism is a well studied value w.r.t Europeans, https://www.pewresearch.org/global/2011/11/17/the-american-w...

Of course generalizing like this about groups is a cloudy lens at best but it's the premise of OP and may predict voted policy of respective countries.

That said, it's been a number of years since I lived in Switzerland and I see things have changed measurably regarding official EU policy on Chinese trade, https://wikipedia.org/wiki/China%E2%80%93European_Union_rela...


That's a pretty compelling argument for anarchism.


America just moved their slavery elsewhere and got the CCP to administer it. Out of sight, out of mind, get me my iphone while the plebs desperately jump out 5th story factory windows.


Give us an alternative to our Chinese-made computers, smart phones, etc. that isn't "don't get them," because that's kind of absurd in the modern era. If you have an alternative I'm all ears.

You're destroying the world and exploiting communities every time you turn on a light switch or ride motorized transport. Every package you order online is part of the problem. Should I give you a high-minded lecture with no alternatives as well?


And in some regions of 18th century America there was no reasonable immediate alternative to survive without buying goods produced by negro slaves, so it would have been pointless to point out the situation.

I'm a bad guy too. happier? Maybe the world would be a better place with more high minded lectures now and again, so I'm all ears.


I don't mind being told I'm doing something bad but critique without a solution is pointless. It's easy to tear folks down, it's hard to build. You're taking the easy route while looking down on us as if you don't willingly participate in suffering for the same reasons we do. It's not morally permissible, but let's not pretend you're 1) any better or 2) proposing any meaningful solutions.


If you asked me the solution it starts with the most influenceable and likely allies, such as Uyghurs, who already have armed groups that have a chance of extracting at least one, two people from this kind of tyrannical relationship with the CCP. I don't think the picture starts with saving everyone exploited but rather just one, two persons at a time and let the witnesses decide how to proceed.

Currently they are a designated terrorist organization so if I gave you any actionable advice I would end up in jail. Perhaps the first step is an American may be to solicit these self defense organizations to be removed from the designated list so an American may even discuss what could be done without suffering a long prison sentence.


I am clearly talking about our consumption habits. Not how to start/assist an armed revolution.


When I wanted ISIS gone I flew to Iraq and joined the YPG. I don't think any amount of not buying oil would have solved the problem.

It's fine if you want to box things into consumption, but don't ask for some kind of solution and just shit on it and think you're not a hypocrite for doing the exact thing you accuse me of, which is critiquing with no solution.


Ah a troll, have a good one. Not engaging further.


[flagged]


We've banned this account for repeatedly posting flamewar comments and breaking the site guidelines.

If you don't want to be banned, you're welcome to email [email protected] and give us reason to believe that you'll follow the rules in the future. They're here: https://news.ycombinator.com/newsguidelines.html.


Your solution for our hypocritical use of smart phones/tech built by slave labor is for me to abandon my toddlers/wife/general responsibility, fly to China, and participate in armed insurrection.

If that’s isn’t trolling then the alternative is far more frightening.

I’m done man. Have a good one.


Please stop posting flamewar comments to HN. We ban accounts that do that repeatedly, and we've already had to ask you this.

https://news.ycombinator.com/newsguidelines.html


No my suggestion was for you to solicit your reps to delist these groups frustrating tyrannical efforts of the CCP from the DTO lists, so that someone else without toddlers may have the option.


Parallel evolution? Incredibly unlikely, but possible. I'd like to think my great great grand daddy might be a mollusk with some wicked genetic mutations.


I would argue society-level collectivism is actually a big destroyer of these families.

The phenomenon of say the elderly being disconnected from the younger I theorize is in part due to the fact they extract their social security through violence of the state in taxation rather than through family bonds. The lack of mutual familial reliance destroys the unspoken quid-pro-quo arrangements that held families together. The end effect also is children are a pure cost driver as the support they provide as adults to seniors is equally distributed amongst society rather than mostly directed towards the benefit of the parent who invested in their upbringing. This brings a massive free-rider problem where everyone is incentivized for the other guy to have kids but not for you personally to have one.

I theorize this also has destroyed to some extent inner city poor families. Non-familial nation state social payments to single mothers can actually work against marriage in poor families, as the single mother may be financially penalized for getting married. The resulting lack of father figure inspires more poverty and crime and recycling of the issues.

When my partner and I were first expecting we honestly were not sure whether to get married or not, as a lot of possible government benefits vaporized when you took my partner from "single poor mom" to "married middle of the road family."


no doubt.

take away social security and state pensions and see the birth rate shoot up.

since the benefit and cost is localized. people will be encouraged to have more children i.e spread the risk of getting taken care of in the future by their progeny.

some gvt social programs are necessary - but social security is not one of them. it's one big ponzi


I honestly don't know which is worse though. The 1930s fear and taboo or the 2020 divorce court take you to the cleaners, TRO issued and banned from seeing your kids and your guns taken away and then tossed in jail because you lost your job and the judge says you still owe support. I think I'd actually take the 1930s and I say that as someone who really dislikes those taboos and social pressures you mention.


So the experience I've seen is quite different: Family courts today are actually really focused on joint custody, to the extent that I guarantee you a lot of people have joint custody who probably shouldn't. If someone has a TRO and is banned from seeing their kids, there's a good chance a court has a really strong case to believe that person is violent and abusive.

And I think a lot of the hostility that does come from divorce starts with the belief it shouldn't happen or "isn't fair". If I accept that my wife has the right to divorce me if I'm a bad partner, if she does, the first thing I have to acknowledge is that I failed as a husband at meeting her needs (or perhaps that we are incompatible in a way that I never could do so). That would be absolutely crushing, but I wouldn't blame her for it, and if I blame myself, I am probably not going to end up communicating in that procedure in a way the court would feel I am not safe to share custody with.

Accepting that both parties have the right to exit, and that a relationship is a process of continual consent changes the entire dynamic.

Also: Child support, or even alimony, is a recognition that in a marriage, the income may be produced by a single party, even if the overall roles and responsibilities were divided equally. If someone is a stay-at-home-partner, they may not be bringing in the cash income, but they are still 50% of the effort of operating that family unit as they tend to take on more responsibilities such as cooking and cleaning and child rearing which all need to be done by someone. When a marriage ends, the low-income partner cannot necessarily immediately shift into self-sufficient career mode, and obviously the child should be seeing the necessary financial support they would have, so the income of the two parents needs to be compared with where the child spends most of their time (and hence, incurs the most expenses).


Or she got bored of you, fell out of love, and found someone else to bang. Divorces happen for a variety of reasons. If you failed, that's fine. What if you didn't fail, but she did?

Child support is not bad in theory. It's bad in practice, because divorce is an adversarial process with lawyers, rather than social workers, and designed to inflame conflict. The whole divorce industry is corrupt and rancid.

As a footnote: Expenses with joint custody tend to be pretty equal. If you have a child 3 nights a week, and your spouse has them 4 nights, do you think it makes a real difference to expenses? However, child support in some jurisdictions and income brackets will be about 1/3 of your income. The parent with four nights will have double the income.

That's not designed to support kids. You should consider what that's designed for.


TROs and sexual abuse allegations can be used as a weapon to get concessions from the other person, or simply to hurt them. They are not evaluated adequately in either direction--plenty are granted without evidence, plenty more aren't granted when warranted. The whole situation is a mess that I don't think should be handled by judges in the first place.

I don't mind alimony per se, but we use a radically wrong standard. It should not be the standard to which they are accustomed, but where they likely would have been had they not taken the years out of the labor force.


David letterman had a TRO because a woman claimed he was harassing her with code words over the television on his show. [0] The judge granted it "because she filled the form out properly."

This varies wildly by jurisdiction, but the burden of proof can be pretty slim and the judges in some jurisdiction have been on the record saying they grant them out of fear if something goes wrong when they haven't that they'll be held responsible.

[0] http://www.ejfi.org/PDF/Nestler_Letterman_TRO.pdf

>Also: Child support, or even alimony, is a recognition that in a marriage, the income may be produced by a single party, even if the overall roles and responsibilities were divided equally. If someone is a stay-at-home-partner, they may not be bringing in the cash income, but they are still 50% of the effort of operating that family unit as they tend to take on more responsibilities such as cooking and cleaning and child rearing which all need to be done by someone. When a marriage ends, the low-income partner cannot necessarily immediately shift into self-sufficient career mode, and obviously the child should be seeing the necessary financial support they would have, so the income of the two parents needs to be compared with where the child spends most of their time (and hence, incurs the most expenses).

This is an interesting monologue but we all know the reasoning by child support. I'm merely pointing out it's a real specter. When I'm married if I lose my job there's no court process and if I have to take a shitty one and spend way less money on the kid then we will adapt; but after a divorce you have an "imputed income" which is what the judge expects you could make. The judge also expects you're spending 20% of that imputed income towards the kid even though if when you were married it could be just 5% and the kid was fine. If I have to take up trucking and the judge says I really could be an engineer and I'm slacking then I could end up in jail. Granted most people making an effort probably aren't going to end up in jail but merely the fact you have potential debtor's prison hanging over your head at all times is a very real concern even in the event it is justified.

To point out the absurdity of child support debtor's prison as currently run, see the story of the guy arrested because he was held hostage in Iraq while working the contract job he needed to work to pay his child support... [1]. The reasoning? He did not mail the support while the captors were pointing a gun to his head. IMO any system where you can be jailed because you didn't make payments because you were taken hostage while trying to earn support for your children is just utterly fucked.

[1] https://greensboro.com/ex-hostage-jailed-in-child-support-ca...


People that don't, don't stay married long.

I started out married thinking of it as a nebulous thing. My marriage improved when I realized it was all an exchange and I need to make sure I'm always providing my bit rather than just working towards some nebulous idea of love.


I've been married 24 years and I'm happy my marriage isn't transactional. What happened if you couldn't provide your bit due to an injury? Your marriage ends?


I have family in healthcare so I hear the stories. Serious unfixable medical injuries almost always end with the spouse at the very least getting sex on the side, at least if they're reasonably young.

Getting a long term badly limiting disability in anything but old age is a recipe for divorce. Eventually the loving spouse gets caretaker fatigue and is overloaded from carrying the weight without relief. I fully expect and will not hold it against my spouse if I'm seriously disabled for over a year and the marriage ends. Any high moral ground about love and honor or whatever falls apart when you're grinding in poverty and going to be sucked under yourself with no light at the end of the tunnel.


My wife (in her mid thirties) sustained a nerve injury, couldn't move her leg, lost all mobility, was mostly in bed everyday and needed help standing, a special toilet seat, the whole nine yards. We were told this is a permanent condition.

I never left her side or stopped supporting her. I didn't get fatigued, I got motivated and we found one of the best Neurologists in the world. It took a several years and surgeries for her to get better. She can walk, drive, and work today. I couldn't imagine throwing away my marriage over some ass. Also what kind of father would I be if I left their mother when she needed me the most?

If your entire marriage is built on sex and money transactions, your marriage will eventually fall apart no matter what.


Lol it's hilarious you pretended to ask a genuine question when you already knew the answer for your marriage. In fact you intentionally withheld it as some kind of poorly executed trap. Talk about a bad faith discussion.

Not all marriages involve people with the money to continue supporting the children when both rather than just one parent is bankrupted by medical debt, and not all disabilities end with being able to drive and walk. Usually don't involve people privileged enough to get "best in the world" Neurologists either.

There are people out there that may have to divorce precisely because they can't look their kids in the eyes with the marriage as it stands due to the disability, knowing a divorce will separate the finances and possible allow them to find more support for their child. Every human is susceptible to caretaker fatigue and you yourself can't possibly know you would never get fatigued if the disability never ended. Some people can go a 1 year without cracking, others a decade, others 100 years and until it happens you probably won't know your breaking point.

The fact of the matter is I get to see the people that deal with hundreds of seriously chronically disabled people. My dataset to work with is that it's a bad bet to expect that the counterparty will sacrifice themselves indefinitely for the sake of the marriage.


You walked right into it, that's not my fault. LOL.

First you had family that worked in healthcare "I have family in healthcare so I hear the stories.". Now you're able to draw parallels because you get to see the people that deal with others? It doesn't even make sense. I have people that work in the healthcare industry including doctors too. Your evidence is andetoal at best, hearsay at worst. You don't have a dataset, you have stories. So which is it? Talk about a bad faith discussion...

The reality is there are plenty of people that would love their partner for better or for worse, for richer, for poorer, in sickness and in health.


Yeah just be able to get the world's best neurologist and hope the situation gets better. If it does I'll say after the fact I'm sure no matter what it'd be in sickness and in health and I'm super man who doesn't fatigue. Obviously the impoverished mom who can't even afford to hire a doctor and walks away so the kids won't get bankrupted, well she just doesn't see marriage the same as you. Hell maybe she did all the things you tried and nothing responded, the husband couldn't go back to work after the operations failed and maybe even made things worse, we shouldn't really presume just because someone tapped out that they didn't go as far as you have.

You have even less than an anecdote, and then when you asked me for a response which uses actual anecdotes where it doesn't get better, you suddenly get upset about it.

>You walked right into it, that's not my fault. LOL.

This is just straight up sociopathy. You knew you had an unusual outcome, so you asked for the expected outcome with the trap that yours was a heartwarming but unexpected one. It was never coming from a place of curiosity.

>The reality is there are plenty of people that would love their partner for better or for worse, for richer, for poorer, in sickness and in health.

Marrying someone for this is also transactional if you expect this also of your partner as a condition of getting married. In this case it's like a transaction with an insurance policy built in as par of the transaction. You're just bragging about your particular transaction and terms for insurance.

To anyone else considering this, here's a test if you believe this applies to your situation. Ask your partner if they believe they would "love their partner for better or for worse, for richer, for poorer, in sickness and in health." If they say yes, tell them you think that's all bullshit and you don't reciprocate the agreement. You'll find out fast whether a transaction happened.


I have an unusual outcome? You're grasping at straws, name calling, and making a ton of assumptions with literally zero data. I'll budge an inch, sure, if your partner is going to need long term hospice care, I can understand why you might move on, but that's not the case for most fully disabled people and families. You're basically saying if you lost the ability to walk and it inconveniences me I'm bailing on you. That's a weak marriage, it's might even be the definition of a weak marriage. I don't think sticking with your partner through thick and thin is abnormal.

Do you not understand the premise of the most common wedding vow ever to be spoken? "for better or for worse, for richer, for poorer, in sickness and in health." That's just a fancy way of saying I'll love you for who you are because I'm not transactional.

Honestly, your marriage sounds like a sociopaths dream. How many points and transactions can I earn so my partner thinks I actually care. You also lied about your data for some silly reason. Anyway, I'm gonna take my upvotes and move on. You have a great day.


>You're basically saying if you lost the ability to walk and it inconveniences me I'm bailing on you

Nobody says it like that. Usually it gets to the point where the end-stage symptoms resulting in their leaving is something like suicidal depression and the kids are badly suffering. The impetus is the disability but you're downplaying how it gets there.

It really shows gross ignorance to think you can extrapolate the yes UNUSUAL case that after getting world's best neurologist we did what the doctors said couldn't be done. And then extrapolate all the people other than you that faced disabilities that resulted in dissolved marriage must have started with weaker marriages.

Honestly someone that belittles the plight and hard marital choices of the disabled as much as you have, would be worthy of much worse name calling than anything I've seen here, and it's especially harmful to the disabled who have actually initiated the divorce out of LOVE for their partner.

>I don't think sticking with your partner through thick and thin is abnormal, ad

Yeah investigate a bit people going through the serious disease of chronic addiction. When the husband uses the entire paycheck to keep from getting dope-sick and passes out while the toddler is crawling around after the second, at best third rehab the wife dumps them like a hot potato. Honestly it is rare to find a chronic addict that is still with their family. When push comes to shove when the kids are suffering the wife will drop your ass, even if you're trying your best to overcome the disease and act in love. All that shit about sticking around no matter what goes through the window, and these aint people in hospice care or even acting purposefully with malice against their family. Usually they genuinely and badly want to fulfill their responsibilities.

>"for better or for worse, for richer, for poorer, in sickness and in health."

Again this is just smugness that you like your particular transaction more than others. I seriously doubt you would have entered this without the counterparty also agreeing to same terms as their bit of the transaction. Very few people making these vows are gonna go through with it if the spouse isn't vowing to offer the same in trade.


Tinder is straight up depressing for the median dude. My mind was blown just how much harder it was to get a date on tinder vs getting a date in real life. I can do the latter pretty easily but trying to get one on tinder would be like months of constant effort to then get ditched before the date even starts.

It feels like 90% of women on there are chasing the top 10% of dudes and not settling for anything else.


While the 80/20 stuff is true i think another under-explored aspect is that there just isn't many non-bot women on these dating apps, after all their business is exploiting men for these gold memberships/boosts. Most women i know in their 20s easily get attention on a daily basis through posting on Instagram, working a retail orwaitress job or simply walking into a bar, they also have social groups and hobbies so they aren't really using Tinder.


the wildest part is that the very people who advocate not hitting on people at work will be the first people talk have a nice relationship with a customer who hit on them at work

everyone can perceive that this acts as just gatekeeping for unattractive people

yes, newsflash people would rather not have advances from ugly people, but to masquerade that as trying to vilify advances at all is pure fiction


Those 10% dudes are smart enough not to settle for a 90% woman for more than a few dates when they can pull a new one off the app at a moments notice. In the end they are the only winners in this situation.


Tinder appears to be doing fairly well given it's their situation that they've engineered.


Fair enough, trendy restaurants and bars also probably do well.


I think our generation will be remembered for over-optimization more than anything. We keep chasing the best hotel, the best restaurant, the best partner, not realizing that things that give us meaning and happiness are intangible, unique, weird, and usually right in front of us.


I often wonder exactly how much happier I am having a billion excellent choices for entertainment, versus the small set we might have in the '90s.

I doubt it's that much. Is the very-best movie from last year, uncovered by ten or fifteen minutes of targeted searching and reading, likely to be better than whatever I'd have picked up at the video store based on gut feeling and what a few friends had told me? Oh, god yes, of course it is. Am I happier this way, though? I'm less certain about that. Probably a little? But I don't think it's a large effect.

Ditto having "the world's knowledge at your fingertips" (well, ignore that it's far from all of it and that you're probably still better off hitting the books for a lot of things, but it's good at the trivial stuff anyway). Can I answer most silly little "I wonder..." questions in five to ten seconds? Yep. Am I happier this way? I'm not so sure, since before the Internet was available nearly everywhere nearly all the time I rarely even became consciously aware of such trivial thoughts and they were very easy to dismiss when I did.


I don't know, haven't most people learned by now that all these fine-grained ratings essentially mean either "crap" or "not crap, it depends on your preferences"? In a few cases, "crap but you might like it".


>It feels like 90% of women on there are chasing the top 10% of dudes and not settling for anything else.

It feels that way because it is that way (stats from OKCupid, but I suspect the effect generalizes):

https://archive.is/lGIdO


Yes, but I don't see why everyone is acting like Tinder is the only choice. There are other apps that seem to work differently and better.

I used Tinder for close to a year and had an experience close to what you're describing. I only managed to go on two dates that both went nowhere. At the suggestion of someone on one of the dating subreddits, I switched to Hinge, saw the difference in the amount of attention I was getting, and never looked back. Eventually, I met my girlfriend on there.


Does she know your HN username is sh*tter? :')


> It feels like 90% of women on there are chasing the top 10% of dudes and not settling for anything else.

Sure, and 90% dudes are chasing the top 10% women.


But if they cannot win the competition of the chase, they will easily settle for a lower decile woman. That's the difference.


That's Tinder. I'm told Bumble and Hinge actually work for people.

Of course, what really helps is to be on the favorable end of the gender mismatch if you're somewhere like SF or NYC. It's not nearly as bad as online people say it is though. You only need to find one person!


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