rexxit

Not me, but I think that the fundamental argument is quality / quantity.

The quantity side aligns with capitalism and growth for the sake of growth. More consumers. More labor. Supporting the top-heavy aging populace (admittedly a problem) by whatever means necessary. Quantity is an argument favoring people not yet born, or favoring a pyramid scheme by which there needs to be an ever-expanding base of young, productive people to support the old. Nonexistent people's "wants" should not be considered in any way. If they are not born, they can not suffer. We should not consider what hypothetical people might have wanted. The elderly need to be supported, but by some other means. We cannot continue growth forever simply to support all those who came before us.

The quality side is benefit for the existing populace. As a person who exists, it's basically the only thing I care about. I prefer my quality of life over sacrifice for the potential existence of not-yet-existent lives. I think any sane person would want there to be more quality of life for themselves and other people living. Quantity of life directly impedes this goal.

The previous poster may not have stated the case as such, but I believe that it is self-evident.

everyone on the planet can fit in Manhattan if they just squeeze tightly

But god damned ask yourself what kind of world you want to live in, not min maxxing the number of people alive for some absolutely incomprehensible reason.

Totally with you on these points. Having lived in NYC it is my conception of ultra-urban hell. Sure, there are worse places. Cairo comes to mind. But this idea that we just have to warehouse people to keep them from having massive sprawling impact on the planet is absolutely the most wrong way to think about it, IMO. I hate when people argue that if we just tighten our belts and accept a lower standard of living, everyone can be accommodated with low environmental impact. I go the other way: if there were few enough people (and hoarding/profiteering was curtailed), beachfront and slopeside real estate would be cheap.

I'm not arguing against concentration of wealth and hoarding by the ultra-rich, which is obviously a problem, but I have said recently: everyone could live like a modern-day billionaire if there were fewer people.

Too often the argument pivots the other way and turns into: if we all eat plants, live in ultradense cities with dystopian warehousing of people, and nobody has a car, we could be in ecological harmony with 8B+ people. I don't like that angle.

If "Westerners", or "the global North", or "developed countries" are consuming more than "our fair share" of resources while some significant fraction of the 8B+ humans are in poverty, that's not ideal. On the other hand I want my standard of living to increase, not decrease, and I find making concessions a hard sell.

We could easily support our current population and quite a bit more if we actually respected and shared our resources responsibly.

I think this is a monumentally bad argument. Statistically, you are typing this from a computer or smartphone, with internet access, and are probably part of the segment of humanity that consumes the most resources (as am I). You are saying that if we want to have 15, 20, 30 billion people, we can all just live like the most impoverished people in the world and it will be fine.

It's a quality vs. quantity problem. Maximizing human numbers means we must have very low per-person consumption to minimize impact. Maximizing quality of life means we can all eat/travel/live/consume how we want and the environmental impact will still be low (but with fewer people). I think that's far more desirable.

EDIT: to distill down the argument further - you support voluntarily decreasing your standard of living, so that we can grow the population more, for the benefit of.... ? Creating lives that have not yet been born and can't care?

Whatever you want, I personally do not want a decrease in my standard of living, and especially not to feed the capitalist machine that requires growth at all costs. I presume, if faced with a real and present choice of the same kind, most people would choose to uphold their standard of living instead of sacrificing, only so that more billions of people can be born. When is it enough? Do we really NEED 8B+ people? I wouldn't mind living in a world of <1B people where everyone has luxury and plenty without destroying the planet in the process. We can't get there, but the principle still holds. Put resources into solving the problem of elder care, and just let the population decline naturally.

I mean, I’ve always said that the population is a real problem with no good solutions. People are uncomfortable talking about it because there are no good solutions, but that’s no reason to pretend it doesn’t exist. But people act like even mentioning it is the same as proposing or supporting an unethical solution.

I agree with mostly everything you wrote in that, except to say that the problem is mostly manmade and is economic in nature.

Problem: demographic collapse causes a top-heavy (old-heavy) population pyramid whereby there aren't enough young people to take care of the aging population. This is a real problem that we should engineer ourselves out of. Maybe a higher % of the workforce is redirected to healthcare, in part by automating away bullshit jobs like fast food and retail workers. Maybe we make advances in automation/robotics/AI that allows some of the caregiving labor in hospitals and nursing homes to be done by machines instead of people (extending the productivity of the human labor). Those are problems we should be working towards solving, and plausibly could solve if the political and economic will were there. I hope Japan and South Korea get really far into solving this before it becomes a problem everywhere.

Problem: our entire economy is predicated upon infinite growth, and the nanoinstant that belief in future growth falters, the stock market and entire economy collapses in a way that makes the Great Depression look like a quaint blip. This is unsolvable. All of the wealthy, powerful, and political factions would revolt if anything threatened their prospects of unlimited future growth. The entire world economy is a ponzi scheme that requires new markets, new consumers, and perpetual growth even to exist at its current level. When you hear "growth is priced in", that's basically the fundamental corner we've painted ourselves into. The markets assume untenable growth now as the baseline, and if the mirage falters, the economy will tank shockingly quickly. This is the Faustian bargain of late stage capitalism.

As it stands, the population growth has peaked, and the population will naturally peak and then decline. Nobody needs to be killed or sterilized to make this happen - it will happen on its own. The reason seems to be rooted in the education level of women, and the availability of reliable birth control. As someone once eloquently put it: "the average woman would choose to give birth fewer than 2.1 times" (replacement rate).

As a final thought, I will never agree with people who assert that the "carrying capacity" of Earth is far higher than the present population - double or more. This entire premise is based on living like an impoverished person in India or Africa. They will freely admit that the "carrying capacity" is much lower if the baseline living standard is the middle class of developed countries. Most of North America and Western Europe is wildly rich by global standards (fact). I'm here to say that still higher standards are desirable and attainable, at low global impact with lower global populations. We should all be filthy, filthy resource-rich, and to deprive us of that because the Earth "should" have 10-20 billion humans is fucking bollocks.

It's like clockwork - you can almost set your watch by someone responding like that to pointing out the obvious that human population is straining global resources and making life worse for everyone.

I like to phrase it as this: who is the ecofascist? The person advocating for sustainable human population, or the person telling everyone we need to tighten our belts, give up meat, eschew fossil fuels and personal transportation, and live like a pauper in a cheap cookie-cutter dystopian apartment complex to prevent overconsumption? I would argue it's very much the latter.

Personal ethics aside (not everyone wants to eat meat and burn gas), everyone could live like a modern-day billionaire if there were fewer people. Everyone could have beachfront and slopeside property. Can't do that with 8.3 billion people. Isn't that the goal of fully-automated luxury gay space communism?

Yes, but what about Bubb Rubb?

Keep pushing to advertise it and I'll have more work, thanks.

For a layperson, you are unbelievably, stubbornly confident in your incorrectness. You cannot possibly know the depths of your ignorance. I am an expert, and I will continue fixing the problems caused by bad international dentistry for a healthy fee. You don't need to believe it for it to be true, and your denial does nothing to change my daily reality in practice. Good luck.

With all due respect, you don't know what you don't know. In case you missed it, I am a US dentist. I spend every working day dispelling laypeople's misconceptions about dental work. What work they have, what work they need, benefits and drawbacks, etc. Your post hits on some of the many very common misconceptions.

Fortunately, there are plenty of ways to check the efficacy of medical procedures.

You can get x-rays, MRIs and all sorts of after-care examinations performed by your choice of trusted doctors and dentists if you are unsure of the quality of care you received.

Not all work can be evaluated, even with x-rays, as restorative materials often hide the most important details. MRI is irrelevant for dental. X-rays are just a tool, not the final word, and they can't reveal certain things. Bacterial ingress and leakage is, for all intents and purposes, invisible. Most docs (in both medicine and dental) are exceptionally reluctant to disparage another's work. It is considered unprofessional and unethical to bad-mouth another professional. That's just how we're trained.

A strong indicator will be how you feel after the procedure, which is why I include patient surveys in all of my posts about medical care abroad. Very importantly, other than the higher-rated equipment, expertise and report accuracy, patient satisfaction regarding care quality in Thailand is rated higher than in the US, for example.

This could not be further from the truth. Discomfort and success are completely different things. Some extremely high quality, ultimately-successful treatments will make you feel like shit afterwards. Often, post op symptoms are more closely a matter of chance than they are of quality. Patient satisfaction and surveys are complete worthless bullshit, as evidenced by hospitals' Press Ganey scores, etc. See Goodhart's law. Docs hate chasing patient satisfaction because it is so poorly correlated with actual quality care. Telling the patient "no, this will have a poor outcome" gets you bad reviews, while doing a slipshod job that is unlikely to last but looks superficially good gets you patient satisfaction. I see it CONSTANTLY. Smooth-talking, kind-seeming, gentle dentists whose skills and ethics are complete trash. Patients can't tell the difference. This is why so many people love Nurse Practitioners, who are poorly trained and often happy to act as a rubber stamp for what the patient is asking for, even if it is not in their best interests. People love "yes men".

Remember, Yelp and Google reviews are both astroturfed by business owners, and used as a weapon by disgruntled people and competitors alike. There's a local dentist office that's still under construction and it already has 30+ 5-star reviews in Google. Hasn't seen a single patient yet. I would not be too trusting of reviews in general.

You have taken your subjective experience and tried to use that to say the work is objectively good. That's not how any of this works.

Now could that work actually be good? It could be. This is not to say that all foreign dentistry is bad, but SO MUCH OF IT IS. I know because I see it. The fact of the matter is, patients generally don't know the difference between good and bad work. I see patients all the time who said some absolute basement-tier-garbage work was done by their previous dentist, who they adored.

Incorrect. This applies to most medical care destinations outside of the US; follow-up care is essential abroad and is usually presented in a contract and verbally confirmed with you before any diagnosis even takes place, let alone a procedure. You have access to all the documents and files your hospital abroad does and are also free to share those or ask your hospital to share the documents with other doctors and clinics of your choice.

Ask any orthopedic surgeon what they think of foreign procedure mills offloading post-op knee-replacement care to an unfamiliar doc in the country the patient is visiting from. This is a huge issue docs discuss in private - patients flying to wherever for cheap, substandard treatment and leaving them to manage the complications. It's a big issue in places like FL and NY, but also broadly everywhere.

Many treatments, you get essentially one chance to get it right, and fixing it is either impossible or 10x as much difficulty. Getting it right the first time is priceless. You can fuck up a tooth in an instant. Destroyed. Cannot be fixed. Some errors are invisible and don't hurt right away. Many infections are painless or hard to diagnose from typical x-rays. Many compromised teeth spend a few years feeling normal before they fall apart. I know this because I see it every day. I'm the one who gets to fix others' mistakes - if they can even be fixed.

As a practicing professional who spent the majority of my training seeing a high % of international dentistry, it's hard to watch.

Dental work is my most common healthcare experience abroad. I cannot recommend Thailand enough, especially for dental work, nothing but 5 out of 5 dentistry for me so far.

What it all boils down to is: how can you know the work done was good? You can't. You can know it looks good superficially. You can know the dentist was nice, or that their office was clean, and that the bill was low. You can't know if the work is actually good. You don't know if they are intentionally overlooking long-term health for doing what the patient/customer wants right now. You don't know if the materials or techniques would be considered substandard in the US. Yes, other countries often have a different "standard of care". I have seen ABYSMAL work from Asia and the Middle East. I have seen appalling work from Mexico, Central America, and Eastern Europe. Yes I also see bad work done by local US dentists - primarily those who advertise themselves as being some kind of affordable, emergency, or discount office -- but consistently the worst dental treatment I see is foreign. How do I know? I'm the one who has to fix it, if it can be fixed.

Dental tourism scares the hell out of me as a dentist in the US, but I understand why it appeals to people when quality care here is expensive. I have seen bad work from every country in the world, including the US, but the trend is you largely get what you pay for. The offices that accept every insurance under the sun are doing work at discounted fees, and usually cutting corners to do more of it. Medicaid? Pays less than the cost of providing the service unless serious corners are cut. Those are the US-side problems, but the dentists working for poverty wages in India are doing much worse things, on average.

Why is it often worse? With dental tourism you get no follow-up care. You also have no recourse if they fuck up your mouth. Good luck suing a dentist in Mexico or Thailand for malpractice. Turns out, the more financial incentive you have to practice high-quality care, the more you have to lose from fucking up and losing your license.

EDIT: This is "Work Reform", not "Fuck Everyone Who Has More Skills And Makes More Money Than Me", although you wouldn't know it from the types of responses sometimes. Quite frankly dentists are workers, whether employees or practice owners. They only earn what the work of their hands allows. They are not exploiting other workers to do the billable labor, because legally they cannot allow non-dentists to do the vast majority of billable work (there are small exceptions that account for a tiny % at most practices). They are not capitalists. The downvoters just hate the message and would rather shoot the messenger than listen to someone who knows from the inside.

All this boils down to is that there is nothing more expensive than first-world human labor. Without a doubt, nursing homes are increasingly run by sleazy profiteers, but the reason you can't easily do better (i.e. find a high-quality nursing home) is because it's simply expensive to employ enough people, who have sufficient skill and work ethic, to give the elderly care.

Yes, PE in healthcare is destroying the country in every imaginable way. The answer in this case is more complicated than get the for profit companies out of nursing homes, which is necessary but not sufficient to solve the problem. The scariest thought is that there may be no good solution.