Sounds like some surplus value generated from labour is being extracted by the people owning the means of production
I think this is the first time i heave read an entire sentence written in corporo-management-speak that has made sense logically without falling in a hole of words that ‘mean nothing but sound business’.
That’s commuspeak not corpospeak, as in, it is a central tenet of communism
Fair enough mate, it all just sounds like a zoom/teams meeting nightmare to me
It’s economics jargon either way (this sentence, not Das Kapital as a whole lol)
Nursing homes are often owned by investment trusts who have to pay out to their investors based on profits, so the managers of the trust take it upon themselves to outsource the maintenance, management, and labor to other entities they control. At a healthy upcharge, the menials who perform the tasks associated are not even an afterthought. They work for a faceless corporation that is puppeteered by the same people who own the nursing home, who rents it’s facility from a real estate trust they also own, allowing them to extract as much value as possible from each level of the operation while limiting liability.
Worked in them for about 7 years.
You are correct.
We had one where could never get ANY supplies 1 year in despite a 25k lump sum buy in by residents. even before paying month to month rent.
My expeince is management will play the “heroes work here” type behavior and take advantage of people’s passion for elderly to then underpay then and mistreat them to the degree they do.
Why don’t good people start nursing homes
They’re run out of business if they even start. Otherwise it has to be a non-profit, which is reliant on fundraising and outside funding.
Remember the people running these are the landlords. Owners of commercial properties and the only entities with resource rights to able to develop. You know: the same entities that have been capable for generstions, but unwilling, to construct adequate housing.
This is what they build instead.
The daycare analysis is a bit different: that’s mostly just sheer insurance liability. Childcare centers need so much licensing and insurance, so it’s mostly done by backyard operations and church basements.
It takes enormous capital as property prices are high due to real estate speculation (the priority with real estate is not use but financial value), regulatory capture (excessive regulations are pushed by the largest companies to make it impossible to start a competitive business), and high insurance costs (very appealing to the biggest investors as they mean the largest investors can be self insured).
Daycare is a crazy one. Insanely expensive, yet the workers are damn near indentured servants.
It’s honestly a major contributor to the labor shortage. For anyone with a decent job, it’s significantly cheaper for the spouse to just stay home until the kids are old enough to take care of themselves.
Don’t let the media force you to twist your words-- it is not a labor shortage, but a wage and cost of living crisis.
“Nobody wants to work anymore” == “I pay so shitty wages that no one can even afford to come work for me.”
I’ve run into dozens of people who are complaining about how they have applied to literally everything and never heard back or get rejected for things like gas station cashier and yet those places always put up the help wanted signs. Shortage seems like a fabrication when these places hire nobody and keep the ad up
When I.T and nurses are complaining that they keep getting ghosted and can’t find work? That feels like a major economic failure signal to me. It’s freaking mad.
nurses, usually shouldnt have a problem, i think they are desperate enough to fill spots. but its likely things like mandatory hours or whatever is required.
It’s still the same as what they’re saying.
Why do the hours suck and how can they fix it? Hire more full time nurses. Why are they denied sick and vacation leave? Under staffing.
Why can’t/don’t they? Broken system
they keep the ad up sothat when roxy and joe walk in in the morning, the employer can tell them “uhm, unfortunately we can’t find any other hire, so you 2 people will have to do the work of 3”, effectively cheaping out of paying another person’s wages.
Also because they need a person on standby when Roxy and Joe inevitably quit
You know what your life is when you are out of work; and when you do have a job, how the fear of losing it hangs over you. You are also aware what a danger the standing army of unemployed is to you when you are out on strike for better conditions. You know that strikebreakers are enlisted from the unemployed whom capitalism always keeps on hand, to help break your strike.
‘How does capitalism keep the unemployed on hand?’ you ask.
Simply by compelling you to work long hours and as hard as possible, so as to produce the greatest amount. All the modern schemes of ‘efficiency’, the Taylor and other systems of ‘economy’ and ‘rationalization’ serve only to squeeze greater profits out of the worker. It is economy in the interest of the employer only. But as concerns you, the worker, this ‘economy’ spells the greatest expenditure of your effort and energy, a fatal waste of your vitality.
It pays the employer to use up and exploit your strength and ability at the highest tension. True, it ruins your health and breaks down your nervous system, makes you a prey to illness and disease (there are even special proletarian diseases), cripples you and brings you to an early grave — but what does your boss care? Are there not thousands of unemployed waiting for your job and ready to take it the moment you are disabled or dead?
That is why it is to the profit of the capitalist to keep an army of unemployed ready at hand. It is part and parcel of the wage system, a necessary and inevitable characteristic of it.
It is in the interest of the people that there should be no unemployed, that all should have an opportunity to work and earn their living; that all should help, each according to his ability and strength, to increase the wealth of the country, so that each should be able to have a greater share of it.
But capitalism is not interested in the welfare of the people. Capitalism, as I have shown before, is interested only in profits. By employing less people and working them long hours larger profits can be made than by giving work to more people at shorter hours. That is why it is to the interest of your employer, for instance, to have 100 people work 10 hours daily rather than to employ 200 at 5 hours. He would need more room for 200 than for 100 persons — a larger factory, more tools and machinery, and so on. That is, he would require a greater investment of capital. The employment of a larger force at less hours would bring less profits, and that is why your boss will not run his factory or shop on such a plan. Which means that a system of profit-making is not compatible with considerations of humanity and the well-being of the workers. On the contrary, the harder and more ‘efficiently’ you work and the longer hours you stay at it, the better for your employer and the greater his profits.
You can therefore see that capitalism is not interested in employing all those who want and are able to work. On the contrary: a minimum of ‘hands’ and a maximum of effort is the principle and the profit of the capitalist system. This is the whole secret of all ‘rationalization’ schemes. And that is why you will find thousands of people in every capitalist country willing and anxious to work, yet unable to get employment. This army of unemployed is a constant threat to your standard of living. They are ready to take your place at lower pay, because necessity compels them to it. That is, of course, very advantageous to the boss: it is a whip in his hands constantly held over you, so you will slave hard for him and ‘behave’ yourself.
from Now and After, by Alexander Berkman, Chapter 5: Unemployment. Available to read for free here.
A perfectly apt analysis. Thank you for the link. Anarchist Library has some good gems in there!
it’s not a crisis. companies have to pay more if they want to find employees. that’s higher wages.
that is if there was an actual labor shortage. sadly, there is not.
or depending on the field, have these BS listing on the job sites, or if thier AI/software is even looking at a cv/resume at all.
agreed, if you look at specific industry, or different stem industry. its shortage, but its artificially caused one. its the underhanding gatekeeping by keeping out entry level and choosing people already magically having years of experience in a low level position. all sorts of things like ghost listings, "internal hire but make claims of “not being able to find candidates” on the job sites. or its academically suppressed, for CLS(clinical labs) very limited amount of universities teach this program(1 year grad program) but im hearing they have shortages. and where do you think people will try to apply(california, most of them zeroed in on norcal) and only 9 schools teacch it in cali, you are competing with out of the state people.
We started by doing dual income as an optional lifestyle and the rich saw that they could make more money that way, and then it became mandatory.
The dual income trap
I read an interview, probably from NPR, but I can’t find it at the moment. The upshot was that caring for infants is insanely expensive, since they need one-on-one care pretty much continuously.
But parents can’t afford that cost, so, essentially, the price they charge for infant care is a loss-leader, and parents of older children (who need less supervision and thus more favorable staffing ratios) subsidize the cost of caring for infants. Daycare operators are barely keeping afloat.
Edit: Ah, here it is: Baby’s first market failure
They may require 1-on-1 interaction, but generally the ratio for 0-2’s is around 1:4.
And many childcare companies are owned by huge multi-billion dollar investment firms because they are cash generators.
yucky, just like with MDs/nurses, MDs are being snatched up by teledoc and PE firms. so there is less private or specialists out there. the only other “common” one is based on a scam condition(chronic lyme)
This is the only answer that is not just a hand waiving “investors bad”.
Feels like this would be solved with longer parental leave, but what do I know?
Are they required to provide for the more costly babies?
It’s almost like somebody pays the workers much less than the revenues and pockets the difference
You would think, but for the most part daycare is a very low profit industry. The problem I think is that all the costs tend to scale with size. So having a lot more clients just means a lot higher costs.
There are exceptions of course, but all of those that I’ve seen also have some other luxury additions to basic care.
I can’t see it as being a high expenditure business. Majority of spending should be towards rent/mortgage and repair and maintenance. It’s not like there is a lot of consumables or anything. All that money has to go somewhere.
Cleaning supplies alone are a huge consumable. Arts & crafts materials. Toys are basically consumables because kids play rough. Same for books. Some daycares include breakfast, lunch, and snack. First aid supplies, kids hurt themselves all the time.
But yeah, definitely also lots of diverting profits up to the CEO 😓
I appreciate your realistic assessment here.
When we consider all that reasonably goes into running such a service, we can rationally figure out how much is being diverted to the wrong pockets and make it better.
probably not as much as employee salaries, if they offer benefits. and managment or administration costs(they claim)
Not sure if we are talking about daycare or elder care at this point in the thread, but it applies to both: they work with vulnerable populations and entail a lot of risk / legal liability, thus have significant insurance costs and regulations to comply with.
i assume its for some type of insurance but I also don’t run a day care.
probably bs things like admin, or managment fees.
My wife and I had to pay $1600 a month for daycare as things opened up after the pandemic. The teachers there would have made more working at the Burger King across the street.
im not surprised. thats why people dont want to join the services, why bother when you can make more at walmart, target,etc. and they have a higher min wage.
Run by private equity?
No, not really at all. Some of the more expensive ones are, but that’s only because there is a profit margin on the wealthiest kids and aged. The floor for cost of care is ridiculously high for both groups, so there’s no margin to be made at anything below the crème de la crème facilities.
Most are, the investors need to make their money too! /s
mostly but its a cost-cutting measure to avoid paying MD, and RN prices.
The responses:
most are
no not at all
🤔
I’ve served on the board of non-profit daycares and I [vaguely] know at least one person who actually owns a for profit daycare.
Only a complete idiot would think they were going to make any money on a daycare. The overhead is nuts – even when paying really shitty compensation – and the competition is relentless.
What kind of things does the overhead go to?
Cheesy poofs
if its corporate is likely Large admin/managment fees. minus the staff salary, and benefits if they even provide it. other thing like maintaing the facilities.
And, here’s the kicker, they’re not even very profitable. This is the case for both for the same reason caring for the elderly and the young is insanely expensive.
It’s a weird one because it’s a huge expense but it’s also completely concentrated to a subset of the population for a subset of their life. I think it should have a public option. 2 toddlers, not infants, could cost us 50k/year
I feel like half these problems would be fixed if everyone woke up and unionized. Corpos would have no leverage left.
The Pinkerton agency has entered the chat.
If you’re curious, yes they’re still around, yes they’re still doing it, and they’re owned by Securitas now.
I am very aware. Fuck them.
Yeah they’re the cucks who bullied some kid over magic cards.
They also bitched about being villains in Red Read Redemption 2.
id be happy to see you stomp them flat like your country did last time.
I get what you’re saying, but even when the Pinkertons lost, the strike action was ultimately broken by force anyway. At one point the local sheriff was literally bombing coal miners.
Because those nursing aids aren’t working on wealthy people. The circumstances of a worker is proportional to the level of threat and inconvenience it presents to the elite if they aren’t in good shape.
We need more friction against the corporations, be it the implication of force, strikes, or quiet quitting.
0000
Should America’s economic system be replaced in the future, a key thing to do is to eliminate most of the difference between the poorest and wealthiest. That would require standardizing incomes, capping wealth accumulation, workers voting for leadership, and using universal benefits such as free shelter and food to prevent coercive workplaces.
Our current economy is an creature that inherited the properties of feudalism, and wasn’t explicitly designed to be good for civilization. Creating a whole new system with deliberate intent & mechanisms is the best path forward.
What’s funny in a sad-not-haha way, is that labor for caretaking of small human beings is the enormous untenable driving cost here.
Parents can’t afford the rates, daycares can’t afford living wages for the caretakers. This is an endeavor, like many, that the Hand of the Market™ is OBVIOUSLY unsuitable for solving.
The “funny” part: Parents would gladly do this job for free as they have for centuries and millennia. This problem was already solved, and wouldn’t be an issue if every member of the household wasn’t forced into full-time 40+ hour work plus hunting for side-hustles, and being taken away from their loved ones for most of their waking friggin lives, just to survive.
How many generations deep are we now? Where so many kids spend so long in daycare from infancy that they never even get to form a decent bond with their own parents? How healthy is that, for anybody, much less larger society?
“Parenting as a Service” is peak capitalistic hellscape…
Edit: spelling
My wife is starting her own home daycare Monday for many of the reasons you listed. Almost a decade at a YMCA run Montessori, ~18/hr.
And the poor kids! The caregivers are all burnt out by terrible management and shit pay, have no motivation to provide anything beyond the necessities, and God bless them, at least a few spend their own money on supplies to at least try and enrich the time the kids spend there.
I’m really proud of her, taking a huge step into somewhat unknown water. I know the kids she cares for are going to get so much more value from her, here in her space, on her terms, than they ever would have at the center.
That sounds daunting but also incredibly noble of her. Prayers and well wishes to both you and your wife, especially in the early days of this endeavor!
I love hearing about when someone sees a need they can fill in their community and they’re passionate about solving it. That’s so awesome. :)
My wife is starting her own home daycare Monday for many of the reasons you listed. Almost a decade at a YMCA run Montessori, ~18/hr.
good luck. the regulatory hurdles are not fun, but regulations are written in blood. they don’t go to the trouble of setting regs unless someone had been seriously harmed.
If you want to keep her employees (if she has any) happy, don’t push the limits of the caregiver:child ratios. I’m not sure what [the amount of money you want to have saved up so your business doesn’t fail] in early childhood education is, but a good rule of thumb is start with 2 years worth of expenses saved as most businesses take at least that long to break even. Restaurants, 5 years.
[BOILERPLATE CYA WARNING]
i did accounting for 25 years and virtually all of my clients were small businesses and their owners, so while this is arguably professional advice, it is not tailored to your specific situation. it is general advice and not intended for you to rely on. if you want advice tailored to you and your situation that is intended for you to rely on, hire an accounting consultant.
well we have that situation in germany right now where supposedly daycare is good because it allows women to work more hours (full time instead of half time)
it’s … let me tell you, it’s a shitshow. i have come to understand that the internet is largely a propaganda apparatus. they install the thought in you that a certain way of seeing things is “normal”, because everybody sees it that way. in other words, the other bots or paid influencers (idk which one) that the algorithm then pushes sothat everybody sees it.
you got 1 crazy person saying things like “actually, we should all work more, i like it, it’s fun” and you know what, they can say that. anyways, that’s 1 person in 1000. then the algorithm pushes it on everybody’s front page sothat now everybody thinks “ah, that’s a normal thing to think”. and since most people follow group-think, that’s now society’s opinion.
internet exists to cause a shift in public opinion by astroturfing. the illusion that the thought comes from within society organically.
WHO guidelines say children should stay with mother until 3 to bond and go to childcare from 3 to get social skills. But germany only pays up for like 1 yr and even that only limited. Grandparents have to work until they are barely fit enough to help too.
Makes you wonder, with all those technical advances we have, why we work more and more having worse living conditions down the drain.
the illusion that the thought comes from within society organically.
Hmm so I both agree and disagree with you here. Hustle culture arises from societal things here such as hyperindividualism, Puritan work ethic and toxic masculinity that grifters package and push (where I agree with you). But it’s metastasizing from us to you all so it seems alien.
I agree with you - if you need to pay someone a full time wage to go out and earn a full time wage, the sum will be nearly zero. The same issue applies for long term care facilities where a team of multiple specialized providers is needed to care for someone around the clock. The assumption that care should be cheap implies that care work is less valuable than whatever the worker themself does.
Much like mail delivery, daycare and elder care would be better as publicly funded services. They can’t necessarily turn a profit, but still need to exist for the betterment of society
The irony is that this causes birth rates to plummet, which eliminates the future workforce for the very companies forcing childcare to be untenable. One of the major contradictions of capitalism is that it does not reproduce its own labor force. I guess the resolution is to replace human workers with AI.
On global level population is still growing. With globalization, companies couldnt care less if a worker is from US or Africa. ChatGPT’s training was supervised by kenia workers for laughable wages.
For sure, but the growth rate is rapidly decreasing in the developing world too. If that continues eventually there will be nobody left to run the machines.
Society’s hyper-competitiveness to “get an edge” is ultimately self-cannibalizing.
This is something that drives me so mad, and it’s exactly why corporations need to be strictly regulated on a global scale.
If people are granted any voluntary dignity, someone out there is always willing to “undercut” their fellow workers to get an “edge” on the market or whatever and prove what a sweaty exploitable tryhard they can be, then it races to the bottom for all.
If a company wants to pay its workers a living wage, their competition will undercut them by stepping on their employees’ necks for an “advantage in the market.”
You’re right, it’s simply not a system that solves for human well-being, it solves solely for hoarding and growing large numbers of imaginary value.
no we just need to import workers from outside the environment.
“Parenting as a Service” is peak capitalistic hellscape…
JFC, I could see someone unironically marketing this.
“Parenting as a Service” is peak capitalistic hellscape…
bullshit
these are some strong opinions right there without much substance
i called my childcare guardians “comrade teacher” and i gladly pay half of my salary for a childcare in the “capitalist dream” now. neither has anything to do with the real reasons why we have childcare nor why it is expensive somewhere or free somewhere else.
childcare enables parents to do more with their life than just have kids and as such is good both for parents and for the society in general. it also enables children to access early childhood education and community that their parents wouldn’t be able to provide otherwise so - if done right - is also great for the kids.
but of course, as with everything with life, things can be messed up by the people. parents or teachers can screw up in many different ways or even the whole childcare might be organised for an entirely wrong reason… that doesn’t mean childcare is a bad idea in general.
Woah there, friend. Aren’t we being a little bit aggro here? I’m happy to hear your perspective.
I never meant to come off that childcare is bad as a concept! That was never the point.
What I am decrying is the requirement of families being coerced to put their children into a very expensive facility, because if everyone else in the house isn’t working a 5x40+ fulltime job, they can’t afford a reasonable quality of living. THAT is where it’s broken.
Childcare as an option is fantastic for all the reasons you mentioned. Childcare as “the market raises your children with underpaid and exhausted, overhelmed wageslaves unless you’re insanely privileged” is not cool.
I’m happy you’ve had a good experience though, and hope we can reach a solution where it’s done right for more folks.
well if childcare as an option is fantastic and all you are angry about is the childcare as an unaffordable necessity then we are totally in agreement…
the way you wrote your original comment didn’t entirely hit me that way though. it definitely gave me more of an impression that you consider childcare as bad (see the quote) and your solution to people struggling is traditional family values and housewives.
Sorry, no I don’t believe I conveyed myself in that way, updoots seem to agree.
I do think we’re in alignment here, but also I understand nuance is often lost over Internet posts so let me clarify my position. “Family values and housewives” as you put it being a great example:
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Women having the opportunity to leave the home of their own volition and be in a career the same as a man? Awesome. Progress.
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Women AND men alike, in a family unit, forced simultaneously into the career-style workforce or multiple garbage jobs because the family goes bust and destitute otherwise? Bullshit.
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Programs for kids to safely socialize and learn as a community? Fantastic!
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Overwhelmed daycares staffed by burned out underpaid care workers, costing half of everyone’s salary, because otherwise the only alternative is literally child abandonment, thanks to everybody needing to leave the home and devote a majority of their time to wage labor? Capitalistic nightmare.
That’s basically a systemic form of indentured servitude to pay ransom for one’s own children. It isn’t right.
Parents should be free to choose parenting their children over creating shareholder value without starving. Parenting is already a full time job, and outsourcing it entirely to someone else’s employees every “business day” sounds like a great way to wreck a society’s future adults.
Especially in the U.S when maternity leave is laughably short for many, and paternity leave is a fanciful myth from faraway lands, and those early years spent with one’s family are CRITICAL for a child’s early development.
So when I satirically said “parenting as a service” (mocking ‘software as a service’ / rent-seeking behavior), I wasn’t referring to “Watch our kids and enrich them a little occasionally.”
I literally meant “A paid service has to raise our children because we aren’t rich enough to spend much time with them besides breakfast and bedtime.”
That sounds pretty horrible to me.
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childcare enables parents to do more with their life than just have kids and as such is good both for parents and for the society in general. it also enables children to access early childhood education and community that their parents wouldn’t be able to provide otherwise so - if done right - is also great for the kids.
WAIT HOLD ON I GOTTA SHOW THIS TO MY WIFE (teaches kinder) she’s gonna love you
How have you been alive long enough to write this post but not see why? People exploit each other for power and wealth and so not care that they hurt people or the suffering they cause. Those best at that are the CEOs and senators and leaders of nations, the most powerful positions there are, are held by psychopaths, sadists and narcissists. They convince us all that fighting back is futile, immoral or illegal. We could topple it all and every day we choose to get a latte and spend another 9 hours grinding away our time on this earth just to stay alive.
It’s all a fucking scam by rich ppl who are the most capable of the worst kinds of human beings.
Capitalism cannot function without paying workers less than their labor is worth, thus creating “profit” margins for rich people to steal from
What’s not to understand? The owning class owns the facilities and sets both the prices and the wages, and they will do this in the way that maximally benefits themselves, i.e., maximizes profits. It’s a really, really basic feature of capitalism (yes, also whatever super duper special unicorn flavor of capitalism you think works better than “crony” capitalism).
It’s a rhetorical device I forgot the name of. If I say “I don’t understand X”, that will have one of two effects on most people: either they also don’t know, realise that and hopefully get curious, or they do and know the point I’m aiming for. If they offer that explanation, it creates a Socratic approach to making an argument: Framing it as an explanation of a question the rest of the audience is hopefully also curious about.
You explanation is the second part of the argument.
So, I know of the existence of this rhetorical device, but I’ve been around enough people who operate in a theoretical framework where this statement cannot be taken as anything other than genuine, namely that of capitalist realism. This has two implications:
- the original tweet could’ve been written with this mindset (which, I should add, is the dominant mindset, btw), and should be taken at face value
- many of the readers will have this mindset, and will not have the theoretical tools on their belt to appreciate it for the rhetorical device it is, much less take advantage of it and learn something (they might walk away with anything ranging from “huh that is weird” to “it’s those darned republicans/democrats”)
In either case, making an explanation (there’s more than one) explicit is useful, if only to open up space for people to disagree with the explanation. (In fact I’d be willing to bet that the person who wrote the tweet disagrees with my explanation, specifically the part involving flavors of capitalism. I bet they’re advocating for something like the nordic model.)
- the original tweet could’ve been written with this mindset (which, I should add, is the dominant mindset, btw), and should be taken at face value
- many of the readers will have this mindset, and will not have the theoretical tools on their belt to appreciate it for the rhetorical device it is, much less take advantage of it and learn something (they might walk away with anything ranging from “huh that is weird” to “it’s those darned republicans/democrats”)
Those are good points I didn’t consider.
On the first, I tend to lean towards assuming the best of people where possible, mostly because it helps stave off defeatism. That doesn’t make it likely, just less depressing.
On the second, I genuinely didn’t see that angle. Thanks for pointing it out. They don’t need to appreciate it as rhetorical device (and in fact, it may be more effective if they’re not conscious of it), but if it leads them to make up their own conclusions to reinforce existing assumptions, instead of being curious and open-minded, that would indeed miss the mark.
I guess to some degree, it’ll be a “shotgun” approach to hopefully get some people curious, even if you’ll never get everyone. I’m not sure a more direct statement of facts would have gotten the others either.
In either case, making an explanation (there’s more than one) explicit is useful, if only to open up space for people to disagree with the explanation.
That’s the conclusion I was aiming for, yes. In thr context of the device, the question is a setup and framing for the answer. By “prompting” for it, it seems less like preaching (which may turn people away) and more like a “genuine” and natural conversation. Interviews are occasionally framed in a similar way, but with an open question on the internet, it may seem less “staged” if that makes sense?
(I’m not sure those are the best words to describe it, but I can’t put my finger on the nuances so I’ll just call it a vocab/language barrier)
In fact I’d be willing to bet that the person who wrote the tweet disagrees with my explanation, specifically the part involving flavors of capitalism. I bet they’re advocating for something like the nordic model.
The Nordic model tends to be idealised to some degree. I understand how it would look like a significant improvement over some other forms, particularly the US, and I’ll freely admit I’m also subject to bias, but it can’t cure all the problems baked into the system.
From the glimpses I’ve caught, it doesn’t seem to solve all social issues either. The specific example I’ve heard of is racism, but I didn’t do a thorough investigation about other effects. Then again, I’m not sure I have a good solution on hand to effectively shift cultural stances like that either.
Boomers built an economy based around raping the wealth and futures of their children, to fund their retirement.
They consistently voted for politicians and policies that would benefit themselves at the expense of everyone else, in basically every economic sector.
Of course they don’t pay their orderlies well either.
That would mean their 401ks wouldn’t go up by as much.
Only now that the most grotesque frontman conceivable is helming the logical conclusion of their mindset turned into policy, are they starting to regret it all.
The pathological narccisist gerontocracy society.
Healthcare is the only sector with actual job growth now.
Everything else is collapsing.
The turned the entire country into basically a big retirement home supercomplex that you can’t opt out of.
My friend was the director of a daycare, and she’s leaving because she works 60 hour weeks, has no help from above, and her pay is literally canceled out by sending her kids to camp over the summer. And obviously they won’t pay her more. And she’s the head of the daycare. It’s insane.
It’s because private equity capitalists took over daycares, nursing homes, funeral services, and veterinary clinics. They’re leeches on even the most indispensable aspects of society.
Just based on the outrageous “strata” fees on “owned” lots for pre-fab/trailer parks (not the rental pad lots, totally different(same?) Story)
More per month just to get your (wife’s, ass) grass mowed than to maintain my ancient building…
Private Equity got anywhere you could move also
As a nursing aide, it’s because not enough of us are unionized.
Why would you want to be ionized? Wouldn’t that lead to radiation sickness!?
nah ionization is an important part of organic chemistry sothat molecules can form new bonds. it’s the basis of metabolism.
That’s fair.
it’s pronunced onionized, not uneyeohnized.
There are certain jobs that people really want to do. No matter how little the job pays, there will be people willing to do that job. Often these are the most important jobs.
That’s not a good match for a purely capitalist system where someone can’t survive on their salary. Unions are one way to fight this. Traditionally nurses had strong unions, but these days no union seems to be particularly strong. The other way is for the government to get involved and say that certain jobs are important enough that they get special exemptions from the purely capitalist system. That could mean different minimum wages, special tax exemptions, or all kinds of other things.
You don’t understand, the CEO needs a lot of money, to bribe cops when he rapes children.
the US lost so many battles against corporate monopolies that now 4 companies own the majority of the US healthcare system.
i suggest medical care abroad if you’d like similar or better healthcare at a much lower price. travel offers much more than a vacation.
Thinking of going abroad for dental implants. An oral surgeon said it used to be an issue with poor-quality knock off parts, but that the manufacturing has gotten really good.
Countries keep cost low by subsidizing doctors’ education, by the way, which is even more expensive for them when those doctors cash out to come to the US where doctors graduate with a debt of $250,000 from schools where graduation class size hasn’t changed in decades.
By the by, intensive and indiscrimnate care by specialists–where doctors want to end up instead of low-paid primary care–is definitely more expensive without necessarily leading to better outcomes.
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.
3rd-party analyses and patient surveys rating Thailand higher than the US in health care these days are included in the link above. and here, why not?
i had a co-worker who went there, he had a thai wife which would help with potential language barriers or noticing scammy situations.
That works, although the Thai medical field is so heavily regulated that scams are uncommon. They want our medical dollars to keep rolling in.
If you have any concerns, go to an international clinic. Heavily regulated, highest-tier equipment/care, everyone is at least bilingual, transparent total fee charts available before anything takes place, they are totally worth the slight fee bump.
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.
I agree with much of what you said, particularly:
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.
The reason it may be enticing for many is because of the enormous disparity in cost such that it becomes a risk assessment. Sometimes the alternative to medical tourism may be long-delayed or no treatment at all, though I realize that low-quality treatment is very often worse than no treatment.
how can you know the work done was good? You can’t.
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.
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.
With a poorly molded crown in the US, because the fabs are often located outside of the clinic or hospital, it can be 2-3 weeks before I get to try the next crown, which someone unfamiliar with my case is creating from specs without a personal consult from my dentist.
I see where you are coming from, it is the most frequent response to high-quality medical care abroad:
Dental tourism scares the hell out of me
This anxiety about the unknown often colors how people react to any situation outside their experience, but there are plenty of ways to ease yourself into receiving higher quality medical care abroad: translators, medical insurance, expat meetups so you can get used to an idea you are unfamiliar with.
This next part though, is simply wrong.
With dental tourism you get no follow-up care
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.
With Thai dental care as an example, they explained the bullet points of my diagnosis, proposed treatment and after care, and then I had a twenty-minute discussion with my doctor before choosing a gold crown. We did a scan, 3 days later I went in for a fitting. My crown wasn’t seated perfectly, so my dentist quickly made the call to send it back downstairs(in Thailand, their fabs are located in the same building as your dentist) and told me to come back tomorrow for a now highest-priority new printed gold crown at no extra charge. I returned 18 hours later, they scanned my medical ID card, cemented my new gold crown which fit like a glove, and I was out in 15 minutes free of charge. after again receiving the highest quality of care from a doctor and hospital i trusted and appreciated.
You can purchase as many extra bells and whistles as you want with your chosen care package, but the basic warranties have been more than enough for me; my crowns have lasted more than a decade(knock on wood with me).
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.
you don’t know what you don’t know
Exactly.
… some of the many very common misconceptions…
I dispel travel misconceptions spread by anyone, even US dentists.
Not all work can be evaluated…
All work can be evaluated, some evaluations will draw indeterminate conclusions regardless of which country the evaluation is performed in. That is the nature of diagnosis.
Patient satisfaction and surveys are complete worthless bullshit
Patient surveys are very good supplemental indicators of the professionalism and quality of an institution and their provided medical care.
…your subjective experience and tried to use that to say the work is objectively good.
These are facts, not your feelings.
Transparent fee charts, equipment audits, contracts, insurance, warranties, international accreditation, consults, the increase in medical care abroad itself are relevant medical quality data.
Ask any orthopedic surgeon…
I’ve consulted with dozens of dentists and doctors about many aspects of medical care in at least a dozen countries.
…what they think of foreign procedure mills…
Ask anyone what they think of manipulative healthcare practices in any country. They don’t like them.
Ask the banned women dying in parking lots in the US, the bounty hunted pregnant women from Texas, US kidney stone sufferers permanently damaged because they were waiting in the ER for 14 hours, US patients denied dentistry or other care because they cannot afford fabricated fee schedules dictated by healthcare monopolies that do not guarantee quality care.
The US healthcare system leans profit-driven, not patient-focused, and that is reflected in the low quality and accessibility of care in the US, regardless of the talent of some US medical professionals. They work in a broken, predatory system.
…one chance…fixing it is either impossible…
Yes, and this has no bearing on the quality of medical care internationally.
Yes, health care is risky everywhere ,and many countries provide the same or better healthcare than the US at a more affordable cost with easier access to care. Yes, health care can be difficult for doctors to perform everywhere, and many countries provide the same or better healthcare than the US at a more affordable cost with easier access to care.
You can fuck up a tooth in an instant. Destroyed. Cannot be fixed.
All the more reason to receive the highest quality medical care as soon as possible at a reasonable cost. The US cannot provide that type of care to most of its citizens. Wait times are harmful or fatal to many US patients. Other countries can provide the highest quality medical care without delay at a reasonable cast to both their citizens and disadvantaged foreigners like US patients. Other healthcare infrastructures function better and can help more people at a lower cost.
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.
It needs to be more than education. For instance, I know a county that subsidizes nursing school. But the nurses are paid a terrible salary and many leave to work in higher paying countries.
If they would just pay their nurses more, they wouldn’t need to subsidize the education and maybe skilled people would stay.
I did mention brain drain in my comment. The US is giving up a huge economic advantage being hostile to immigration. Raising & educating children is hugely expensive and having young educated people come to work a life time (and have more children) is an enormous boon.
Consider Los Algodones Mexico directly across the border from Yuma, Arizona. It’s been known as the ‘Dental Capital of the World’ due to the number of Dental practices catering to American snowbirds.
Thinking of going abroad for dental implants.
Just don’t go to Turkey to hit up an Instagram dentist. That stuff is terrifying. <_<
Do wake up in a bathtub filled with ice and stitches over where a kidney used to be?
LOL almost. They basically take out all your teeth and replace them with synthetics, I guess?
I’m sure there’s plenty of good dentists in Turkey, but what’s with this trend of people getting MAJOR medical work or body modification done ANYWHERE by whoever’s got a flashy Instagram or TikTok reel? Nuts.
https://www.mirror.co.uk/news/health/turkey-teeth-leaving-brits-toothless-35327173
you just have to know which countries, and cities. maybe INDIA, some places in mexico, or thailand. i knew people who went to thailand for dental care.
MDs from abroad trying to become a doctor in the us, is in for a rude awakening. its pretty hard to become in the us as a foreigner even if you have md, they have some sort of equivalency requirement for the courses you took. and other certification tests, and certain amount of time, because the AMA controls the supply of licensure for MDs, they probably dont wan too many MDs from abroad taking all the licenses. and some MED schools apparently arnt equivalent to western ones. canada, UK, some EU are more likely to have easier time.
I live in Prague. It’s full of Americans who come to do IVF becauee they would rather pay $3,000 than $30,000 for it. They get a nice European vacation too.
that’s great!
thank you, I’m always interested in hearing firsthand accounts to pass on to all the Americans and travelers who ask me about healthcare in different countries.
yup thailand for dental care, india you probably should go to main cities for different surgeries.
I hear India is good for cardiac surgeries, although at this point I plan to continue going to Thailand for everything until something changes.
