[Mezzie]

I'd say that would depend on one's point of view in a couple of key respects:

- Are we just discussing the first-world middle class? Obviously if we extend our scope to all of humanity there have been remarkable jumps in standards of living.

- Does the idea of 'standard of living' include only access to goods, services, and information or also intangibles like access to safety and (more pertinently to this particular discussion) security? As a 34 year old American, I feel that my material standard of living is much better than it was in 1992, but my sense of security in said standard of living has taken a nosedive.

[grugagag]

> my sense of security in said standard of living has taken a nosedive.

Doesn’t that imply a decrease in standard of living? Not easy to quantify one. I personally see not living in fear as a staple of standard of living.

[Mezzie]

I agree with you, but a reasonable case could be made for viewing standard of living as material access so I think that's where a lot of us talk past one another.

Also American society is pretty disdainful of security, historically.

[grugagag]

Isn’t housing part of that material access which has become harder to maintain and access by more and more? People living paycheck to paycheck to pay huge rents, people living in tents and so on seems to indicate some decrease in the standard of living.

[Mezzie]

I agree with you.

The argument against this would be things like homes being larger now and housing standards having risen (even slum units have things like fridges and electricity). I don't think those are compelling arguments because often going without those things is not allowed/not an option, but that's what the other side's argument would be.

[kortilla]

The people that live in tents generally used to live in state mandated mental institutions. Their standard of living decreased (well depending on how much you weigh autonomy), but that’s not really relevant to the standard of living for the middle class.

[robertlagrant]

> my sense of security in said standard of living has taken a nosedive

While it's hard to say, that might be the news you read, rather than reality.

[Mezzie]

Eh. Depends on which part. I definitely have fallen into doomscrolling on occasion, but I have reasons to believe our society is less stable than it was. This has good and bad aspects - the 'stability' offered was in many ways the stability of a less rich way of living (think people without plumbing or with dirt floors), but at the same time the lack of security is a major stressor and that's not good for your mental health any more than material deprivation is.

There's also that I am a disabled American and we're generally not in great spots. As an American, your ability to have things like housing is directly tied to your ability to be economically productive, and as someone with MS, I have to roll the dice each morning on whether or not I will be able to work. I don't know how long my career can last which creates a lot of stress. But then that's also true for all Americans: How many of us could survive our main/only earner getting cancer? That's the sort of stability I mean: The ability to be wiped out by things outside of your control is higher (which is partially down to society deciding everything is an individual problem and if a tornado flattens your house that sounds like a you problem) and we're moving towards a lower-trust society and the community bonds that were existent but frayed in the 90s (see Bowling Alone) are pretty torched now. Who and what can you rely on?

Which is more relevant if you consider that a lot of Americans have medical conditions and that things like the move from a single-income to dual-income household as the standard means that losing one adult can cripple a household financially. I'm also basing this on things like my peers' ability to do things like pay for child care since mid-30s are prime 'give all your money to daycare' years.

I also was in school during 2008, so I entered college under the 'get a degree and you'll be fine' years and exited it into the bloodbath of the Great Recession. There are many realities and my personal one is less secure than it was and this is true for many Americans.

[robertlagrant]

Yep, agreed. Well thought through response.

What's your opinion on the following assertion: countries (such as mine) with socialised medicine make sure everyone has a certain standard of care, but that standard only goes so far. The US lets people pay for any possible treatment, and so people who would be put on palliative care in, say, the UK, would be bankrupted in the US by trying to beat cancer with expensive drugs.

It's phrased as an assertion, but it's really just something I've been thinking about. What do you think?

[Mezzie]

It's probably accurate, and of course there are issues with socialized medicine as well. I have an interesting POV because I actually had my first relapse while I was living in Canada - I wasn't allowed to stay due to my disability but I have some experience with both systems. The waiting is definitely a problem - I didn't get into a neuro before I had to leave the country 9 months later, but at the same time I never worried about paying for treatment and I went to the ER when I couldn't feel half my body/couldn't walk without being concerned.

It isn't just socialized healthcare, though. It's also things like the US not mandating time off - for instance, I haven't had my Ocreveus infusion because I literally can't afford to take the time off to go to the infusion center. And the US is also very binary: Either you work full time or you get nothing benefits wise. For those of us who could comfortably work ~25-30 hours a week this results in either us overworking ourselves to the detriment of our health or not working at all. I'd love to work and just have a little bit of help for when I have a bad week or month, but that doesn't happen here.

The other problem with the American healthcare system is that it siphons off wealth from those in their end of life. Good luck planning a good life for your children: The government will take everything you own for your nursing home. That also has major impacts in term of stability.

But of course in socialized healthcare you do need to decide what is and isn't worth treating in some way and when cuts are needed you end up in dark places like Canada is with MAiD.

It's hard to say. I'm inclined to believe there are benefits and drawbacks to each approach.

[robertlagrant]

Yeah, totally agree. The American system seems to have, despite its amazing innovations and advances, that we all benefit from sooner or later, the worst of both worlds: neither an efficient market-driven approach not a particularly socialised one either. And that's despite the US government spending more per head than I think any other country on healthcare.

The ties between government, big pharma, insurance companies and hospital systems must be so entrenched that it's very difficult to see a way out.

[Mezzie]

Yes.

Add that to America disintegrating into a low-trust society where one almost has to assume that any stranger one meets is out to scam you/get your money somehow and it results in a country where it's terrible to be vulnerable. Which is one of the ways we grow as people, thus leading to emotional stunting amongst the populace, which in turn makes us less resilient and willing to act (particularly since we can't cooperate anymore) and therefore in my opinion sow the seeds of our own destruction.

[dragonwriter]

> And that's despite the US government spending more per head than I think any other country on healthcare.

Far more per head — part of which is higher cost of labor and that healthcare is extraordinarily labor intensive. But, its also fairly high as a GDP share, for which excuses like that don’t work. The US just genuinely has a healthcare system that is ludicrously inefficient unless your goal is maximizing the wealth-based quality differential, in which case Mission Accomplished.