>> So your list is community functionality, akin to medics saving lungs before limbs. <<
Close. Survival and functionality first, then things required for a healthy community. People need public spaces and entertainment, especially over the long term, because without those things society and mental health start breaking down.
That's why some "small town business" idea lists are so much longer. You can batch those. You don't need a dance hall, a sport field, a community center, and an exercise gym all in the same small town -- but you do need at least one place for people to get out of their homes and move around interacting with each other. Ideally, each small town in a county will have different extras: this one has a used book store, that one has a pet store, over here is a makerspace. Then folks can drive -- or even bike, in some areas -- around the county to do different things.
Do take a look at boomtowns in the wild west. They had a very consistent cluster of essentials followed by some other random stuff as they grew. They almost always started with a saloon, a general store, and usually a church. The whorehouse could be part of the saloon or separate. Often the more civilized bits, like a post office and police station, didn't emerge until later. Many things depended on who decided to move in. If you were lucky, you could attract and keep a doctor. If someone knew how to sew, or make ceramic, they might set up a shop. And so on.
Comparing with medics, they have a very unfortunate tendency to make devastating mistakes while pursuing their own interests. This includes saving people who would be better off dying (e.g. drowning victims after 5 minutes under warm water) and not caring how much damage they do in less-visible areas (if PTSD from medical abuse kills the patient 2 months after the bad car crash, you have not actually saved them, just extended the period of suffering). Then other people pay the price. Too much focus on survival at the expense of life quality is a bad thing.
And we see a very similar problem in education, where it turns out that cutting things down to the most essential academics while abandoning art and playtime reduces learning dramatically and causes mental illness sometimes leading to suicide at younger and younger ages. Children need diverse learning opportunities to thrive or even survive.
Of course, I have ulterior resources. After you've led first contact missions or explorations that got cut off, you damn well learn what it takes to keep civilization and sentient beings going over the long term.
>> (Big gov seems to have something involving investments/big finance...I must say that I like your idea better.) <<
I'm happy I could help.
>>Try 'We're working on getting an assessment for your obviously developmentally delayed kid, but we can't do that for several months bc paperwork, school registration, etc,...' So cue several months of stabilizing other problems, and patch-solving urgent kid issues with no professional training.<<
That kills people. There are a lot of physical conditions that can get harder or impossible to treat quickly, where if you start as soon as the problem is noticed, most are salvageable but waiting runs up the rate of disability and/or death. The same is true of some psychological problems. If someone is depressed, that is urgent (needing care the same day or next day) because it could get worse rapidly. Suicidal ideation is an emergency (needing care within minutes or hours) because it threatens life and limb. We already have enough problems with damaging delays; we don't need to go all-government and make those universal.
>> Most folk I know with disabilities have people helping them in some way (supportive but not patronizing); but given that we're all only human and have limited ability to do certain things some of the solutions we come up with are kind of hilariously pitiful. And it's also kind of hilariously pitiful how much stuff gets offloaded onto various social networks.<<
It would work fine if people made mindful distributions of responsibility. Let's take travel, which should be a protected right instead of a paid privilege, as it is necessary to survival in current conditions.
* The national government should be responsible for things like interstate highways, long-distance rail, and high-speed rail.
* States should be responsible for intrastate highways, city-to-city rail, and intrastate transportation for citizens who can't drive.
* Cities should be responsible for providing mass-transit suited to local needs, which might include bus, commuter rail, subway, ferry, etc.
* You can either extend city responsibility in a penumbra around the city, or use the county level, to accommodate people in rural areas.
* Everyone who cannot drive deserves free access to public transportation, which must A) be respectful, and B) provide equivalent service to modes enjoyed by drivers. It is not okay to force blind people to make travel plans 24 hours in advance, which denies them freedoms enjoyed by the sighted and impairs their ability to socialize; nor to leave them stranded, mock them, or otherwise disrespect them.
* Much weight can be taken off the fully public system by developing semi-public options as much as possible -- what's sometimes called microtransit. Every business that sells alcohol should either have a vehicle to drive drunks home or a deal with the local taxi service or saferide for same. Every medical establishment should have a pickup service or connect with a charity that does medical transport, for free, to make sure all their clients can reach medical care reliably. A medium business like a garden center should have a van to pick up elderly customers for classes or make deliveries to disabled customers. Every medium or larger apartment building should have a shuttlebus for community trips. Every large business like an office park should have a fleet of vehicles suited to its employee pool for things like shuttling to the nearest apartment complex or driving staff to training sessions. Neighborhoods or clubs can arrange carshares, bikeshares, barter exchanges, volunteer ride services, and other ways to cover travel for their area or membership. The distribution across much of society reduces the expense to the tax base for fully public transportation, reduces individual need for cars, and promotes social activity thus reducing loneliness and saving money on health costs.
* Individuals should be responsible for deciding what level of transportation they want and can use. They should get a car or a bicycle, learn to use the bus or navigate while walking, etc. They also need to network in their social circle to trade rides when someone's planned transportation breaks down.
A logical and comprehensive plan distributes responsibility over a wide area, according to the resources for each level, and minimizes the tendency for people to try fobbing off responsibilities on someone else. It creates fault tolerance so that small problems don't snowball into big problems.
>>I'll betcha that women and queerfolk in Terramagne will set up an alternate healthcare system if they havent already... <<
Actually that was the supervillains. On a small scale, most good-sized gangs have a "patch room" of moderate medical equipment and at least one member who knows how to handle minor emergencies. You don't really need to hit the ER every time someone needs 3 stitches. On a large scale, Kraken invented the health nexus -- and when they decloaked, Thalassia started out universal health care and education, no poverty or unemployment or hunger. Because the supervillains were fucking tired of getting shut out, so they fixed it.
Also worth mentioning is T-America's distributed health care system. Community clinics and small doctor offices handle routine care and minor emergencies. Hospitals typically have an urgent care entrance for things like migraines or broken arms that need prompt attention but aren't life-threatening. That reserves the emergency entrance for things like heart attacks or heavy bleeding where someone could die if they got lost in the crowd for 5 minutes. Similarly most hospitals have a tiered ambulance service: Advanced Life Support for major problems, Basic Life Support for moderate ones, and Light Transport for "just in case" things or picking up possible alcohol overdoses. That way you aren't mopping out your ALS from a drunk puking in it while a guy dies of a heart attack.
>> I should read up on this. Usually I favor socialized medicine, at least as a fallback, bc it seems to be the easiest way to make stuff affordable. (Folk who object to the socialized part are invited to suggest alternate options; so far no one in meatspace has suggested a good alternate.) <<
There are many alternatives, most people just can't be arsed to study the field they're talking about. I'll give a couple of examples.
* Medieval Hospitalers. Once upon a time, Christian monks decided that leaving sick or injured people to die was bad, and they had been ordered by Jesus to care for the needy. So they invented hospitals. Most monasteries had a large herb garden for making medicines. While religious health care is now far behind other options, at its dawn it was miles ahead of most competition. Plus they didn't charge for it because it was part of their vocation and they took vows of poverty. That system worked for centuries.
* Planned Parenthood. Some women got together and said, "Gee, it really sucks that women can't get decent health care from men, have their lives ruined by unwanted or dangerous pregnancies, and don't even get included in medical studies. Let's fix that." They created clinics where women could get some basic health care, all kinds of reproductive care and advice, birth control supplies, information about domestic abuse, and so on. They lobbied hard for the right to have an abortion, to use birth control without a husband's permission, and for medical studies to include women in testing new drugs or procedures. This made an enormous difference to many women. The very fact that it empowers women is why PP is so often attacked by men -- from banning clinics to bombing them. Men are literally willing to commit mass murder to keep control of vaginas. Also, most PP clinics use a sliding scale of prices so more women can afford to go there. It varies whether the clinic can afford to offer a no-charge option for the poorest women, but most of them at least give out free condoms if nothing else.
Planned Parenthood is a good example of a modern system that is nonprofit / nongovernment, works to improve public health, and could easily be expanded to cover more territory. If nutjobs weren't trying to murder their way to total control of vaginas. >_<
Frankly, I think the ghastly statistics for black people indicate that people of color need their own hospitals again. We used to have segregated hospitals and it sucked. But now we have unified hospitals where doctors let black patients die. Black people are more likely to be sent home with a heart attack. Black mothers and babies die 3x as often as white ones. They never get as much pain care. Money and status are no protection against this death and destruction. What is? A black doctor! So we need enough of those that every black patient who wants a black doctor can have one, to avoid needless suffering and death. And we need a way to fund that which isn't based on local wealth, since black people typically live in poor areas.
>> And I know the world is more complicated then that...but I'd like to live somewhere that folk aren't asking me how to pay hospital bills a year after the visit... <<
I agree. If healthcare isn't affordable, it is not accessible. If it ruins people's lives, it is worse than useless. A large portion of bankruptcies involve people who had health insurance and it screwed them. One round of predatory financing is enough to teach most people to avoid anything they can't pay out of pocket, and then doctors bitch that women don't come to the ER with heart attacks. Why would they? They just get sent home with Motrin and a huge bill. Nobody needs that.
>>And if cash is getting more awkward, the comparative awkwardness/inconvenience of barter would go down. At the very least, we could have two systems and trade off - economic code-switching, if you will.<<
That's exactly how it works. Cash outcompetes older systems as long as it's plentiful. The less there is, the less competitive it is. Every situation that is cash-poor or absent spawns alternative economies. I actually set up a complete framework of this for A Conflagration of Dragons, in which the dragons hoarded most treasure, so each of the Six Races developed a different replacement economy.
You can read about alternative economies and community currencies.
![[personal profile]](https://www.dreamwidth.org/img/silk/identity/user.png){kind=small}
dancing_serpent
Re: Thoughts
Date: 2021-01-31 08:01 pm (UTC)Close. Survival and functionality first, then things required for a healthy community. People need public spaces and entertainment, especially over the long term, because without those things society and mental health start breaking down.
That's why some "small town business" idea lists are so much longer. You can batch those. You don't need a dance hall, a sport field, a community center, and an exercise gym all in the same small town -- but you do need at least one place for people to get out of their homes and move around interacting with each other. Ideally, each small town in a county will have different extras: this one has a used book store, that one has a pet store, over here is a makerspace. Then folks can drive -- or even bike, in some areas -- around the county to do different things.
Do take a look at boomtowns in the wild west. They had a very consistent cluster of essentials followed by some other random stuff as they grew. They almost always started with a saloon, a general store, and usually a church. The whorehouse could be part of the saloon or separate. Often the more civilized bits, like a post office and police station, didn't emerge until later. Many things depended on who decided to move in. If you were lucky, you could attract and keep a doctor. If someone knew how to sew, or make ceramic, they might set up a shop. And so on.
Comparing with medics, they have a very unfortunate tendency to make devastating mistakes while pursuing their own interests. This includes saving people who would be better off dying (e.g. drowning victims after 5 minutes under warm water) and not caring how much damage they do in less-visible areas (if PTSD from medical abuse kills the patient 2 months after the bad car crash, you have not actually saved them, just extended the period of suffering). Then other people pay the price. Too much focus on survival at the expense of life quality is a bad thing.
And we see a very similar problem in education, where it turns out that cutting things down to the most essential academics while abandoning art and playtime reduces learning dramatically and causes mental illness sometimes leading to suicide at younger and younger ages. Children need diverse learning opportunities to thrive or even survive.
Of course, I have ulterior resources. After you've led first contact missions or explorations that got cut off, you damn well learn what it takes to keep civilization and sentient beings going over the long term.
>> (Big gov seems to have something involving investments/big finance...I must say that I like your idea better.) <<
I'm happy I could help.
>>Try 'We're working on getting an assessment for your obviously developmentally delayed kid, but we can't do that for several months bc paperwork, school registration, etc,...' So cue several months of stabilizing other problems, and patch-solving urgent kid issues with no professional training.<<
That kills people. There are a lot of physical conditions that can get harder or impossible to treat quickly, where if you start as soon as the problem is noticed, most are salvageable but waiting runs up the rate of disability and/or death. The same is true of some psychological problems. If someone is depressed, that is urgent (needing care the same day or next day) because it could get worse rapidly. Suicidal ideation is an emergency (needing care within minutes or hours) because it threatens life and limb. We already have enough problems with damaging delays; we don't need to go all-government and make those universal.
>> Most folk I know with disabilities have people helping them in some way (supportive but not patronizing); but given that we're all only human and have limited ability to do certain things some of the solutions we come up with are kind of hilariously pitiful. And it's also kind of hilariously pitiful how much stuff gets offloaded onto various social networks.<<
It would work fine if people made mindful distributions of responsibility. Let's take travel, which should be a protected right instead of a paid privilege, as it is necessary to survival in current conditions.
* The national government should be responsible for things like interstate highways, long-distance rail, and high-speed rail.
* States should be responsible for intrastate highways, city-to-city rail, and intrastate transportation for citizens who can't drive.
* Cities should be responsible for providing mass-transit suited to local needs, which might include bus, commuter rail, subway, ferry, etc.
* You can either extend city responsibility in a penumbra around the city, or use the county level, to accommodate people in rural areas.
* Everyone who cannot drive deserves free access to public transportation, which must A) be respectful, and B) provide equivalent service to modes enjoyed by drivers. It is not okay to force blind people to make travel plans 24 hours in advance, which denies them freedoms enjoyed by the sighted and impairs their ability to socialize; nor to leave them stranded, mock them, or otherwise disrespect them.
* Much weight can be taken off the fully public system by developing semi-public options as much as possible -- what's sometimes called microtransit. Every business that sells alcohol should either have a vehicle to drive drunks home or a deal with the local taxi service or saferide for same. Every medical establishment should have a pickup service or connect with a charity that does medical transport, for free, to make sure all their clients can reach medical care reliably. A medium business like a garden center should have a van to pick up elderly customers for classes or make deliveries to disabled customers. Every medium or larger apartment building should have a shuttlebus for community trips. Every large business like an office park should have a fleet of vehicles suited to its employee pool for things like shuttling to the nearest apartment complex or driving staff to training sessions. Neighborhoods or clubs can arrange carshares, bikeshares, barter exchanges, volunteer ride services, and other ways to cover travel for their area or membership. The distribution across much of society reduces the expense to the tax base for fully public transportation, reduces individual need for cars, and promotes social activity thus reducing loneliness and saving money on health costs.
* Individuals should be responsible for deciding what level of transportation they want and can use. They should get a car or a bicycle, learn to use the bus or navigate while walking, etc. They also need to network in their social circle to trade rides when someone's planned transportation breaks down.
A logical and comprehensive plan distributes responsibility over a wide area, according to the resources for each level, and minimizes the tendency for people to try fobbing off responsibilities on someone else. It creates fault tolerance so that small problems don't snowball into big problems.
>>I'll betcha that women and queerfolk in Terramagne will set up an alternate healthcare system if they havent already... <<
Actually that was the supervillains. On a small scale, most good-sized gangs have a "patch room" of moderate medical equipment and at least one member who knows how to handle minor emergencies. You don't really need to hit the ER every time someone needs 3 stitches. On a large scale, Kraken invented the health nexus -- and when they decloaked, Thalassia started out universal health care and education, no poverty or unemployment or hunger. Because the supervillains were fucking tired of getting shut out, so they fixed it.
Also worth mentioning is T-America's distributed health care system. Community clinics and small doctor offices handle routine care and minor emergencies. Hospitals typically have an urgent care entrance for things like migraines or broken arms that need prompt attention but aren't life-threatening. That reserves the emergency entrance for things like heart attacks or heavy bleeding where someone could die if they got lost in the crowd for 5 minutes. Similarly most hospitals have a tiered ambulance service: Advanced Life Support for major problems, Basic Life Support for moderate ones, and Light Transport for "just in case" things or picking up possible alcohol overdoses. That way you aren't mopping out your ALS from a drunk puking in it while a guy dies of a heart attack.
>> I should read up on this. Usually I favor socialized medicine, at least as a fallback, bc it seems to be the easiest way to make stuff affordable. (Folk who object to the socialized part are invited to suggest alternate options; so far no one in meatspace has suggested a good alternate.) <<
There are many alternatives, most people just can't be arsed to study the field they're talking about. I'll give a couple of examples.
* Medieval Hospitalers. Once upon a time, Christian monks decided that leaving sick or injured people to die was bad, and they had been ordered by Jesus to care for the needy. So they invented hospitals. Most monasteries had a large herb garden for making medicines. While religious health care is now far behind other options, at its dawn it was miles ahead of most competition. Plus they didn't charge for it because it was part of their vocation and they took vows of poverty. That system worked for centuries.
* Planned Parenthood. Some women got together and said, "Gee, it really sucks that women can't get decent health care from men, have their lives ruined by unwanted or dangerous pregnancies, and don't even get included in medical studies. Let's fix that." They created clinics where women could get some basic health care, all kinds of reproductive care and advice, birth control supplies, information about domestic abuse, and so on. They lobbied hard for the right to have an abortion, to use birth control without a husband's permission, and for medical studies to include women in testing new drugs or procedures. This made an enormous difference to many women. The very fact that it empowers women is why PP is so often attacked by men -- from banning clinics to bombing them. Men are literally willing to commit mass murder to keep control of vaginas. Also, most PP clinics use a sliding scale of prices so more women can afford to go there. It varies whether the clinic can afford to offer a no-charge option for the poorest women, but most of them at least give out free condoms if nothing else.
Planned Parenthood is a good example of a modern system that is nonprofit / nongovernment, works to improve public health, and could easily be expanded to cover more territory. If nutjobs weren't trying to murder their way to total control of vaginas. >_<
Frankly, I think the ghastly statistics for black people indicate that people of color need their own hospitals again. We used to have segregated hospitals and it sucked. But now we have unified hospitals where doctors let black patients die. Black people are more likely to be sent home with a heart attack. Black mothers and babies die 3x as often as white ones. They never get as much pain care. Money and status are no protection against this death and destruction. What is? A black doctor! So we need enough of those that every black patient who wants a black doctor can have one, to avoid needless suffering and death. And we need a way to fund that which isn't based on local wealth, since black people typically live in poor areas.
>> And I know the world is more complicated then that...but I'd like to live somewhere that folk aren't asking me how to pay hospital bills a year after the visit... <<
I agree. If healthcare isn't affordable, it is not accessible. If it ruins people's lives, it is worse than useless. A large portion of bankruptcies involve people who had health insurance and it screwed them. One round of predatory financing is enough to teach most people to avoid anything they can't pay out of pocket, and then doctors bitch that women don't come to the ER with heart attacks. Why would they? They just get sent home with Motrin and a huge bill. Nobody needs that.
>>And if cash is getting more awkward, the comparative awkwardness/inconvenience of barter would go down. At the very least, we could have two systems and trade off - economic code-switching, if you will.<<
That's exactly how it works. Cash outcompetes older systems as long as it's plentiful. The less there is, the less competitive it is. Every situation that is cash-poor or absent spawns alternative economies. I actually set up a complete framework of this for A Conflagration of Dragons, in which the dragons hoarded most treasure, so each of the Six Races developed a different replacement economy.
You can read about alternative economies and community currencies.
https://documents.uow.edu.au/~/bmartin/pubs/01nvc/nvcp12.pdf
https://www.treehugger.com/philosophies-challenge-gdp-arbiter-human-well-being-4853531
https://en.wikipedia.org/wiki/Local_currency
Best postapocalyptic currency anywhere that has them: tampons!
https://en.wikipedia.org/wiki/Commodity_money
https://tradebank.com/what-is-a-barter-exchange-and-how-can-it-increase-your-cash-flow/