[HN Gopher] Workers who cut countertops are dying of silicosis
___________________________________________________________________
Workers who cut countertops are dying of silicosis
Author : 04rob
Score : 248 points
Date : 2023-09-24 15:49 UTC (7 hours ago)
(HTM) web link (news.yahoo.com)
(TXT) w3m dump (news.yahoo.com)
| thadk wrote:
| According to this podcast, Cass Sunstein, co-author of Nudge,
| used his economist-oriented federal government department to
| delay and block legislated regulation related to protection for
| silicosis during the Obama administration.
| https://podcasts.apple.com/us/podcast/if-books-could-kill/id...
| whimsicalism wrote:
| Jeez - Sunstein has such great work in legal scholarship, but I
| guess power corrupts?
|
| Even more surprising to me was Sunstein and his wife Samantha
| Power attending Henry Kissinger's birthday party after Power
| previously published a book basically pinning 150,000 deaths in
| Cambodia directly on him. They _knew_ this guy is basically a
| war criminal and still went to celebrate his birthday.
| usrnm wrote:
| The US has no war criminals, because no court in the world
| would dare to prosecute Americans for war crimes, the ICC
| tried once, didn't end well for them. So relax, Kissinger is
| one of the good guys.
| [deleted]
| [deleted]
| icegreentea2 wrote:
| I was interested, but also didn't want to scrub through a
| podcast. Summary:
|
| Cass Sunstein was the administer of the White House Office of
| Information and Regulatory Affairs. The OIRA is given the remit
| to review drafted rules (ie regulations) that various federal
| agencies want to enact. The OIRA is supposed to perform an
| external cost-benefit analysis of the proposed regulations.
| OIRA is suppose to turn around rulings in 90 days.
|
| While Cass Sunstein was administrator (2009 to 2012), various
| pieces of regulation were submitted for review, and ended up
| being reviewed for ~3+ years. Examples include:
|
| * Requiring rear-view cameras (submitted for review in 2011,
| regulation finally passed in 2014 with a 2018 deadline for
| compliance)
|
| * The silicosis workplace safety regulations (as mentioned -
| submitted in 2011, finally passed review in 2013)
|
| * Coal ash handling regulations (from the EPA) delayed from
| 2009 to 2014
|
| For the specific case of silicosis specifically, it doesn't
| appear that the OIRA ended up blocking the regulation, though
| it certainly slowed it down.
|
| Some news articles:
|
| * https://www.ucsusa.org/resources/attacks-on-science/white-
| ho...
|
| * https://www.reuters.com/investigates/special-report/usa-
| regu...
|
| * https://www.theregreview.org/2013/11/26/26-verchick-silica/
|
| It is worth noting that these delays continued after Sunstein
| left office, and there's certainly evidence of OIRA
| significantly delaying review processes prior to Suntein's term
| as administrator.
| bagels wrote:
| Thank you for collecting this. A couple years to draft &
| study some proposed regulation doesn't seem that heinous to
| me. It would make sense to not hastily publish a regulation
| that will last decades without really considering it and its
| effects well. They can be a source of lawsuits, and I would
| assume, you want it to be effective which can take some
| study.
| flangola7 wrote:
| No, the delay was artificial. Consider the effects? How
| about the possibility delaying i needlessly ncreases the
| number of humans dying?
| bagels wrote:
| There are already regulations requiring ppe and
| ventilation that aren't followed, they are already dying
| despite regulations.
|
| I'm not saying that we need more delays. I'm also not
| saying that there isn't room for more regulation here,
| but just slapping any poorly considered regulation down
| may not solve the problem.
| username332211 wrote:
| The refusal of politicians to mandate motorcycle helmets
| for car drivers and pedestrians needlessly increases the
| number of humans dying as well.
|
| Since the article is referring to "83 cases among
| countertop workers identified across the state [of
| California] since 2019", it's almost certain helmets
| would save more lives than anything you do about
| engineered stone. So what's the excuse there?
| flangola7 wrote:
| Sorry, I'm confused, where did motorcycles come into this
| discussion?
| zopa wrote:
| These are regulations that have already been studied
| extensively at the agency level. OIRA's cost-benefit
| analysis is a second layer of review on top of that.
|
| It'd be interesting to see a cost-benefit analysis of
| OIRA's cost-benefit analysis. All the delays aren't free.
| Kirby64 wrote:
| This seems largely similar to worker protections for welding...
| the proper protection is essentially heavy shop ventilation and
| full respirators (which, good ones cost something like $1500).
|
| I suspect the problem is that welding related disease/problems
| show up quite quickly in most cases, and welding tends to be a
| higher paid industry. More room for margin on PPE and workers
| have higher demands.
| michaelt wrote:
| Also might help that welders have a culture of PPE use; ain't
| nobody welding without a mask, gloves and sensible clothes.
| dghlsakjg wrote:
| I've known plenty of welders that are happy to weld with less
| than adequate safety equipment.
|
| The "safety squint" is still a thing.
| lifeisstillgood wrote:
| This is why we have trades unions.
|
| I just am astounded, horrified. The answer to abusive management
| is simply rebalance power. The answer to abusive markets is pay
| more (Edit: better supply chain ledgers)
|
| Just horrified
|
| re supply chains - the simple way to stop sales of any product is
| a shelf market like this: "The product X was manufactured by the
| small child who last month was mutilates by a factory accident.
| Nice picture. our product has the following verified supply
| chain. but it's more expensive. your choice of course"
| londons_explore wrote:
| I suspect that stone dust generally will be found to be similarly
| harmful to asbestos.
|
| Asbestos is apparently worse because of the sharp edges of the
| particles, but if I put any angle grinder dust under the
| microscope I see plenty of sharp bits too.
|
| I think the actually harmful thing is that the dust is 'fresh'
| rather than being the result of years of chemical weathering
| which tends to smooth off the sharpest pointiest bits at
| nanometer scale.
| aaron695 wrote:
| [dead]
| charles_f wrote:
| Tangentially related, there's this copper mining museum in BC (1)
| in what used to be one of these corporate towns where you lived
| and died. They do a quick demo of the equipments they used back
| in the day, in a pre cut hole. Even with your hands on your hears
| it's painful, teeth chattering - and they don't even really hit
| the rock.
|
| People working in there weren't wearing any sort of hearing
| protection and became deaf within months. And after introducing
| pressured air driven equipment, they were _all_ dying in a few
| years from silicosis. Until someone added water spraying to
| precipitate the dust into mud (wherein their issue became to
| fiddle caked in mud all day long in the dark, which I guess is an
| improvement over certain death). Which happened years later.
|
| Thinking about the kind of life they had terrorizes me. I don't
| get how, for the longest time, people were fine with that. I mean
| no judgement on the workers, they probably didn't have a choice -
| but the people sending them in probably saw them as kettle.
|
| Makes you think about the sort of progress in worker protection
| that was made since then. But also this kind of story reveals how
| people are still ready to profiteer from such deadly practices,
| if given the opportunity.
|
| 1: https://www.britanniaminemuseum.ca/
| rayiner wrote:
| > Makes you think about the sort of progress in worker
| protection that was made since then. But also this kind of
| story reveals how people are still ready to profiteer from such
| deadly practices, if given the opportunity.
|
| It's not just people "profiteering" though? The story mentions
| workers standing at Home Depot. These are ordinary homeowners
| hiring these shops to custom cut countertops for them. It's not
| some mega-corp mass-manufacturing counter tops.
|
| And now half the people who should be trying to put a stop to
| it are instead talking about how we _need_ low skill, low
| education foreign workers that can easily be exploited to keep
| consumer prices low.
| jerzmacow wrote:
| "it is what it is" plus having a hungry family to feed?
| charles_f wrote:
| Oh yeah absolutely, but being a shareholder in there? I mean
| it's always easy to judge people whose context you don't
| know, but I think you can draw a line and this is past it
| city41 wrote:
| We can still draw those lines today, but mostly ignore
| them. Such as the nets around Foxconn factories, slave
| labor used to create chocolate, lithium mining, etc. Not
| nearly as dramatic as what those copper mine workers went
| through, but still quite bad.
| Robotbeat wrote:
| We mine vastly more copper, coal, etc than lithium.
| AnthonyMouse wrote:
| Today the leading cause of death is heart disease. In that era
| it was infectious disease. You could have a cushy job doing
| numbers work in a city and still die of tuberculosis from being
| in close quarters. People were fine with it because
| _everything_ was terrible.
|
| In the century between the 1850s and 1950s we went from not
| even having radio communications or the germ theory of disease
| to building nuclear submarines and fiber optic data networks.
|
| Once we had penicillin and cities stopped dumping raw sewage
| into the water supply, people started to have better options
| and these kinds of businesses had to improve safety to attract
| workers.
|
| If you had to choose between the job you have now and the ones
| they had then, how much more would they have to pay you to get
| you to choose the latter? More than it costs for the safety
| equipment, right? So they started installing it.
|
| Then governments passed laws requiring it because politicians
| are adept at taking credit for good things that were about to
| happen regardless.
| staz wrote:
| People were definitely not fine with it but whenever they
| tried to do something about it the owner class sent the army
| and massacred them
|
| https://en.m.wikipedia.org/wiki/Ludlow_Massacre
| AnthonyMouse wrote:
| Yeah, the operators of company towns were violent pricks
| who didn't much like it that workers increasingly had
| better options than to die in a mine. That didn't change
| the economics though. Neither did committing violence
| against them, which was not only already illegal even then
| but also wildly unpopular.
|
| There's nothing better for workers than a competitive
| market. What's the boss going to do when the workers have
| the option to quit and get a better job somewhere else?
| conception wrote:
| Get legislation passed like "right to work", conspire
| with other business leaders to suppress worker
| wages/benefits, make striking illegal, etc etc etc.
| AnthonyMouse wrote:
| "Right to work" is not going to stop anyone from quitting
| if some other job provides better working conditions.
|
| The only reason you need to strike is if there _isn 't_
| any other employer offering better terms that you can go
| work for instead. Otherwise you can just threaten to quit
| unless they meet your terms and actually do it if they
| don't.
|
| Conspiracies only work if the market is concentrated
| enough; if there are ten thousand employers and it's easy
| to start a new one then you're not going to be able to
| hold together a secret illegal cartel.
|
| None of those actually work in a competitive market.
| syntheweave wrote:
| The market can de-competitiveize itself through non-
| compete agreements, intellectual property laws, and other
| barriers to entry. The competitiveness occurs around the
| "ruleset", which shifts around according to the
| regulatory environment.
|
| The government tends to default to supporting
| strikebreaking(and still generally does in any era,
| including this one) because industrialists, financiers
| and politicians share lines of mutual support: legal
| ownership of intangibles like a corporation acts as an
| alternative to feudal fiefdoms and warlords, in that it's
| less destructive and lets complex processes evolve.
|
| Corporations are very effective at putting taxable assets
| on the books, which allows a more complex state
| bureaucracy, so politicians end up wanting the support of
| business for government power and expenditures.
| Financiers want their thumb on the scale, for the winners
| they picked to continue winning, rather than to run off
| and form a competitor. And the industrialists themselves,
| though they are often at the forefront of the most
| dramatic reorganizations, tend to get stuck in
| equilibriums where either they're the evil monopolist, or
| someone else is. Once you arrive at the equilibrium, the
| elite players lose their dynamism and are pressured to
| stay within the existing trends or lose their place.
|
| Thus when the Pinkertons or their modern counterparts
| come in, the officials shrug and say "business as usual,
| business as usual". The system convulses when it becomes
| a riot and property is destroyed because that weakens the
| whole premise: less capital to deploy, fewer assets to
| tax, failure to return on investment. And people out of a
| job, but if they were rioting it may have been a crummy
| job. It creates a shock that can break the equilibrium
| and enable a different deployment of labor and capital in
| a new technological environment. That's essentially why
| the industrial era has so many short, distinct periods
| and upheavals within it; the sausage is being made,
| though it's ugly to witness.
| smogcutter wrote:
| No Pinkertons here! Just the invisible hand of the market.
| AnthonyMouse wrote:
| Are you saying you _would_ accept a 19th century mining job
| over your current one?
| thatguy0900 wrote:
| He's saying the miners wouldn't accept it either, but any
| organized attempt to change it was broken up by a private
| army.
| AnthonyMouse wrote:
| That seems like it wouldn't work if you had a government
| capable of anything so basic as enforcing the preexisting
| laws against acts of violence.
| ceejayoz wrote:
| They were plenty capable. They didn't _want_ to.
| AnthonyMouse wrote:
| If the government _is_ enforcing the law, they can 't do
| that because it has been illegal for a thousand years.
|
| If the government _isn 't_ enforcing the law, what good
| is a new law for them to not enforce?
| ethbr1 wrote:
| Historically, it feels like laws _compelling_ the
| government to act for the rights of workers has a mixed
| record.
|
| There's a stronger record of laws _preventing_ a
| government from acting against workers and ones
| permitting workers to take matters into their own hands.
| qwerty_clicks wrote:
| We all live worse lives due to deregulation pressures.
| mbostleman wrote:
| Having been involved in commercial construction in the late 90s,
| OSHA had a lot of regulation and focus on masons - especially
| cutting concrete block. It's surprising that 25 years later that
| understanding of the problem didn't translate to the other
| trades.
| linsomniac wrote:
| ~5 years ago I had a quartz countertop installed. For the final
| install, the workers were out in the front yard making some final
| cuts. My 10yo son comes out to see what's going on, looks at the
| giant cloud of dust, says "Silicosis ain't no joke" and goes back
| inside.
|
| I've taught him well.
| jader201 wrote:
| Not long ago, we had our countertop replaced (from quartz to
| granite). They ended up having to make a cut in it while it was
| sitting in our kitchen. Our home was in a cloud of dust for
| several hours, and when the dust finally settled a day later,
| every surface imaginable was covered in dust.
|
| I'm pretty sure none of them wore masks when doing this. I
| honestly didn't think to wear a mask either (since they weren't
| and never really even warned us how bad it would be), but
| fortunately we were behind closed doors most of the time the
| particles were in the air.
|
| Fortunately it was a granite countertop and not quartz. But I
| still can't imagine that stuff is good to breathe on a recurring
| basis, and it still amazes me that they were fairly casual about
| the whole thing.
|
| My guess is the industry just isn't educating workers about the
| risks.
| trobertson wrote:
| > Fortunately it was a granite countertop and not quartz.
|
| Granites are primarily composed of feldspar and quartz, which
| are both primarily composed of silica. Silica is the thing that
| causes silicosis, and when that granite was cut it was clouds
| of silica dust that covered your home.
|
| You were no more safe in that granite dust than you would have
| been in quartz dust.
| readyplayernull wrote:
| Silica particles won't disolve in water, it's like breathing
| broken glass, and that's the main problem not limited to
| silica, but breathing ANY particle that harms your organs.
| creato wrote:
| Lots of things don't dissolve in water but are still
| effectively contained by water. That said, I wonder what
| happens to the water being used for this purpose. If it
| isn't treated/disposed of somehow, I could see it
| evaporating and allowing the dust to become airborne again.
| If this is in a permanent shop environment, it might
| explain the apparent lack of effectiveness of this
| solution.
| jader201 wrote:
| Do you have a source? Everything I'm reading [1] says that
| granite contains 10-45% silica, compared to quartz containing
| 90%+.
|
| [1] https://www.osha.gov/sites/default/files/publications/OSH
| A37...
| thehappypm wrote:
| Those are pretty much equivalent health-wise. The poison
| cloud is half as dense, but still a poison cloud.
| jader201 wrote:
| Not sure I agree/understand, but it seems like if I'm
| inhaling 2x the poison over the same amount of time, that
| has exactly 2x the impact/risk on your health.
|
| This isn't the same as something like a virus, where it's
| more binary.
|
| To be clear, I'm not arguing to prove I'm right (because
| I'm certainly not an expert and am open to being wrong),
| I'm trying to understand more about how particle
| inhalation can have varying risks (or not) based on
| density.
| mhb wrote:
| TFA article says the stuff gets in your lungs and stays
| there. Are you trying to figure out whether you should
| wear protection for x% silica containing materials? Seems
| like a fool's errand.
| jader201 wrote:
| Not at all, I actually wear a mask when just sweeping the
| garage. :) I certainly think there should be regulation
| requiring masks in industries like this -- and I will
| definitely wear a mask the next time I'm around any sort
| of countertop dust.
|
| I'm mostly just curious about the science, and
| whether/why it is more binary than I'm understanding, vs.
| just taking some random HN strangers' words.
| gpderetta wrote:
| > Fortunately it was a granite countertop and not quartz
|
| A relative of mine died of silicosis after having worked for
| years in the granite industry. Granite is probably as bad
| without adequate protection.
| jader201 wrote:
| I'm sure it's not "good", but from my limited understanding,
| it's not equivalent to risks of quartz.
|
| This article [1] indicates quartz contains about 2x silica
| vs. granite.
|
| [1] https://blogs.cdc.gov/niosh-science-
| blog/2019/10/29/silicosi...
| rightbyte wrote:
| When I do sand blasting a have a little box I do it in. With
| windows. I wonder why they don't have such an arrangement for
| the bench cutting. No matter the health hazard, it doesn't
| sound economical to cover a whole kitchen in dust for a two
| feet cut.
| mabbo wrote:
| > My guess is the industry just isn't educating workers about
| the risks.
|
| My guess is that the companies that did were undercut by the
| ones that didn't.
| jiveturkey wrote:
| surprised they cut it dry. i just had to add 2 holes to my
| granite countertop. used a "well" guide that also has water in
| it. it's meant to keep the cutting edge cool but also there was
| no dust to speak of
| unnouinceput wrote:
| The original article is:
|
| https://www.latimes.com/california/story/2023-09-24/silicosi...
|
| Yahoo news is something I avoid like the plague.
| dmbche wrote:
| "Nearly half of the workers suffering silicosis in the UCLA and
| UCSF study said their workplaces were using water to control
| dust. Roughly a quarter said they always had respiratory
| protection. Fazio said studies have found that in many shops,
| dust is so thick in the air that respirators cannot filter out a
| sufficient amount.
|
| Metzger argued that the kind of sophisticated and costly measures
| that would be needed to reliably protect workers cutting
| engineered stone are not economically plausible in an industry
| where immigrant workers typically labor in small shops and are
| often paid in cash. Engineered stone "is too dangerous to be used
| safely," he said. "If there's any industrial product that should
| be banned, this is the product.""
|
| All this thanks to synthetic stone - important note for
| countertops owners, if you want to make sure you don't support
| the product
| bbarnett wrote:
| Apparently sandblasted jeans are another issue:
|
| https://academic.oup.com/occmed/article/63/5/317/1451439
| bagels wrote:
| Any sandblasting process causes this. Other media might not
| cause silicosis, but may introduce other kinds of particles
| in to the air.
| bagels wrote:
| I wish it was more specific about the materials.
| mhb wrote:
| The materials are a second order effect. Undoubtedly
| breathing granite, soapstone or whatever dust isn't good for
| you either. Maybe it just takes longer to kill you.
| bagels wrote:
| Sure, but the article focuses on "the booming popularity of
| countertops made of engineered stone", without specifying
| what that actually is.
|
| How can I avoid buying these products or reduce exposure to
| these more dangerous materials if I'm a worker? Is
| porcelain "engineered stone"?
|
| They should have ppe for any cutting, regardless, I agree.
| [deleted]
| bafe wrote:
| Isn't soapstone closely related to asbestos? I'd expect it
| to produce the same type of powder that makes asbestos so
| dangerous (and on top of silicosis it can give you
| mesothelioma)
| hackernewds wrote:
| Vote with your wallet is the most effective method. Look at
| plastic straws today.
|
| What kind of countertops should be avoided? Would have been
| nice if the article suggested some solutions as well
| ffgjgf1 wrote:
| Why wouldn't everyone pick plastic straws instead of paper
| ones coated with PFAS if given the choice?
| Tagbert wrote:
| Or why pick any straws unless you have a medical condition
| that prevents you from just drinking.
|
| We typically order water to drink in restaurants and when
| it gets to the table, the servers almost always toss some
| straws on the table. If we say we don't want them or if we
| mention when ordering that we don't want straws, we get
| looks like we must be some weirdos. Why automatically push
| straws for everyone?
| rightbyte wrote:
| Only time I want straws is when the drink is too thick to
| drink by tipping the glass. Like chocolate with quite
| alot of cream as decoration or some smoothies. Soda with
| too much ice crush ... just have too much ice.
|
| I find it quite strange for adults to drink with straws.
| It is a child thing in my world.
| jwiz wrote:
| Drive through soda is a lot easier to drink with a lid
| and a straw.
| rightbyte wrote:
| Sure forgot about that one.
| smeej wrote:
| Plastic straws are still ubiquitous everywhere they weren't
| legislated out of existence. What does that have to do with
| voting with your wallet?
| zolbrek wrote:
| If only. The EU declared exterminatus on them. I saw a few
| in the wild recently in Germany and it reminded me of
| happier times.
| nerdponx wrote:
| I'd like to know as well. When my parents remodeled their
| kitchen they got some kind of simulated granite aggregate
| made of recycled material that I believe was fully heatproof
| and held up very well over the years. But did somebody get
| silicosis in the process?
| LeifCarrotson wrote:
| They might have, you have no way of knowing whether the
| factory in which they were made used PPE or not. If they
| were cheap, probably not, if they were expensive, maybe, or
| maybe the manufacturer was just pocketing more profit.
| rayiner wrote:
| Most of these aren't made in a "factory." Because
| countertops are heavy and pretty much all custom sized
| and shaped, they're being made in small scale local
| businesses.
| Kirby64 wrote:
| It seems that the synthetic stone is not the cause, but
| highlighting the problem: poor enforcement of safety standards
| and inadequate PPE provided to workers.
|
| Just because there's more silica doesn't mean that it's
| suddenly unsafe whereas cutting granite is safe. Even drywall
| or cutting concrete you're supposed to wear PPE.
| Aeolun wrote:
| > Even drywall or cutting concrete you're supposed to wear
| PPE
|
| Yeah, but it doesn't kill you within a few years if you
| don't, right?
| theGnuMe wrote:
| It is dose related although the silica never gets out of
| the lungs.
|
| Demolition, sanding drywall compound all is bad without PPE
| and Hepa filters.
| ethbr1 wrote:
| Cutting cement boards with a diamond blade is pretty god-
| awful for your lungs. On the order of few years.
|
| Effects depend on the particle geometry.
|
| But as a general rule of thumb: if it's biologically inert
| and tough enough to stick around for awhile... it'll just
| stay in your lungs. E.g. fiberglass, cement, rock, paint.
|
| I wear a respirator a LOT more these days than I did when I
| was younger.
| hadlock wrote:
| It never leaves your lungs though. In the last 20 years we
| went from "dust masks are for wimps" to "wow not wearing
| PPE is terrible". One small silver lining of covid is that
| even relatively oblivious home owners even wear PPE for
| small projects now. Smoking OR inhaling large amounts of
| dust might not kill you, but both are bound to make you
| miserable later in life. There is already a steep drop off
| in lung cancer deaths, peaking in the early 1990s. Right
| now we're down to about 1930s level despite having nearly
| triple the population.
|
| You can buy a cheap yet very comfortable 5000 or 7000
| series respirator from 3M for about $20 and the "pink
| pancake" P100 filters are another $12. If you're a hobbyist
| those ought to last you a year, maybe even 5 depending on
| what you're cutting. I do metalwork as a hobby and I can
| definitely feel it in my lungs (and taste it) the next day
| if the garage door is shut and I forgot to wear the
| respirator.
| zolbrek wrote:
| Metalworking apprentice here, I started wearing a
| respirator regularly after seeing the gunk cleaned out of
| my nasal passages by using a neti pot.
| hadlock wrote:
| Just blowing your nose the next day and seeing all the
| black iron shavings was enough for me.
| rowanG077 wrote:
| This is a problem with all rock cutting. With adequate safety
| measures there is no problem.
| toomuchtodo wrote:
| A friend is in the countertop business in Florida. We just
| transitioned his shop to primarily rely on refurbed FANUC
| robotics performing the heavy lifting and cutting ops to
| prevent these health hazards (as he's the one doing the
| cutting). Work areas are operated in lazy negative pressure
| with work atmosphere filtered prior to exhaust out of the
| building.
|
| Regulation is the only way to prevent labor from being treated
| as disposable by these businesses, regardless of the status of
| these workers.
| pixl97 wrote:
| >dust is so thick in the air that respirators cannot filter out
| a sufficient amount
|
| This is not a technology problem, this is an 1880s "Safety
| devices are too expensive problem" along with paid under the
| table workers problem. All kinds of other industries
| manufacture 'dangerous' products with regulations that protect
| the workers. Housing and agriculture are both industries that
| do not and fight ever further for anti-regulations to protect
| the workers even less.
| daniel-cussen wrote:
| [dead]
| willcipriano wrote:
| Limiting the supply of cheap labor may have the side effect
| of creating safer overall workplaces.
| aaomidi wrote:
| Removing the availability of cheap labor by providing more
| worker rights, and less/no criminalization of undocumented
| immigrants alongside an h1b reform would do wonders for the
| general health of this society.
| rayiner wrote:
| How are you going to have "more worker rights" when your
| workforce is desperate, poorly educated immigrants who
| come from countries with no labor or workplace safety
| protections? Counter cutting is a custom business--these
| aren't mega corps you can easily regulate. Did you know
| that this was even a problem until you read this article?
| Do you think do gooders can be everywhere to observe this
| sort of thing and bring it to the authorities? Do you
| think legislators are going to care about this issue when
| it only affects undocumented immigrants who can't vote?
| (Or are you suggesting that people should be able to vote
| the minute they come over the border?)
|
| There is a deep and fundamental link between having a
| native born workforce that is educated in this country
| and socialized to expect certain minimum standards, and
| the ability to legislate and enforce increased worker
| protections.
| dcow wrote:
| Nobody is against cheap workers paying taxes. They're
| against _undocumented_ workers getting paid under the
| table and unfairly competing with documented workers that
| have to pay taxes and thus are more expensive. Gotta
| solve the documentation problem one way or another.
| willcipriano wrote:
| Once illegal immigrants gain citizenship and essentially
| basic civil rights (being a criminal federally isn't
| really freedom no matter if your state is sort of cool
| about it or not) they will no longer be willing to work
| in these conditions. They don't report or sue now due to
| their status, people fear deportation and it's often used
| as a threat by business owners and housewives employing
| cleaners and nannies.
| rayiner wrote:
| Okay, so how long does someone have to be in the country
| illegally before they gain citizenship?
| aaomidi wrote:
| Have you seen how people talk about "others"? "Nobody" is
| a very absolute term in a society that has people out for
| blood for "others"
| mrob wrote:
| Specifically, the problem can be solved with a supplied-air
| respirator:
|
| https://en.wikipedia.org/wiki/Supplied-air_respirator
| bagels wrote:
| Exhaust fans, supplied air respirator, water spray, using a
| waterjet instead of dust producing processes, enclosing the
| cutting blade in a vaccum.
|
| The bulk of the dust hanging in the air could be removed
| with adequate ventilation fans, which seems pretty basic.
| MutableLambda wrote:
| Was searching for "enclosing the cutting blade in a
| vaccum", found this:
|
| https://www.shophacks.com/tablesawdustcollection.html#/
| dml2135 wrote:
| Not surprised. Back in my artist days, the studio I rented was in
| a building with a countertop business on the first floor. The
| extent of their safety measures were blowing the dust out into
| the back alley. Most workers rarely, if ever wore masks, and the
| inside of the shop was absolutely covered in dust. The dust would
| make it up to me on the second floor, everything in my studio
| would accumulate a thin layer just a week or so after cleaning.
|
| Wasn't great but the rent was cheap, until it wasn't
| albert_e wrote:
| > everything in my studio would accumulate a thin layer just a
| week or so after cleaning
|
| I wish I ONLY had to clean the surfaces once a week.
|
| In my country and city unfortunately -- even though I dont live
| near a major road or construction site -- dust is everywhere.
| Within 24 hours or less of wiping clean, you can see a visible
| layer of dust on any horizontal surface in home.
| will5421 wrote:
| Do you know what dust this is? Is it natural? May I ask what
| country you're in?
| jimbob45 wrote:
| _Many went without masks. Some had water spurting from their
| machines, but others had nothing to tamp down the powder rising
| in the air._
|
| Does OSHA not require masks in these cases?
| Zigurd wrote:
| A key insight into things like this is that many regulations
| are like speed limits: loosely enforced. Sometimes because it
| is too hard to inspect every shop handling dangerous materials.
|
| In cases like these you have to ban the dangerous material, or
| essentially kill the market for the products that use it.
|
| BTW, I'm not sure how solid granite, soapstone, marble, etc.
| would be any better. Maybe my 30 year old totally fake Corian
| is back in style. But for the microplastics from scrubbing it?
| icegreentea2 wrote:
| The silica content varies significantly based on the stone
| being cut. Engineered stone is apparently like 90%+ silica,
| with the rest being binders. Granite is apparently ~10-45%
| silica, while marble has a negligible amount.
|
| There's a OSHA/NIOSH pamphlet linked through the original
| article (https://www.osha.gov/sites/default/files/publication
| s/OSHA37...) with table and additional details.
|
| The pamphlet said that in one study, a marble shop performing
| dry grinding (no wetting, nor other engineering controls) had
| airborne silica levels of 39-45 ug/m3, while a granite shop
| which also did not use engineering controls say 89-460ug/m3.
| KennyBlanken wrote:
| They do, just like the ATF requires all sorts of record-keeping
| for gun sales and the EPA has rules about disposal of chemicals
| and the IRS has all sorts of tax regulations.
|
| However, all three organizations have been subject to decades
| of budgetary cuts/freezes/criticism by republican lawmakers and
| thus have a fraction of the inspectors they should.
|
| https://blogs.luc.edu/compliance/?p=4470
|
| https://www.kqed.org/news/11875988/minimal-to-non-existent-s...
|
| https://peer.org/lack-of-scientists-dooms-epa-chemical-revie...
|
| https://www.baltimoresun.com/news/environment/bs-md-drinking...
|
| The Senate also is allergic to appointing a permanent leader of
| the ATF: https://www.pbs.org/newshour/show/why-the-atf-is-
| often-leade...
|
| The way republicans have functioned for a few decades (after
| realizing that legislatively trying to kill the ATF, EPA, OSHA,
| etc is unpopular) is to hamstring the budget for those
| departments, tie up leadership appointments as much as
| possible, and then in hearings shout about how ineffective the
| agencies are.
|
| It's like starving someone and then criticizing them for being
| lazy and inactive.
|
| The same technique is used to attack social services. WIC, a
| food stamp program for mothers with infants and children,
| requires yearly "certification" which involves in-person
| interviews at offices that few and far between, often not
| public transit accessible, and so on. How is a mother who is so
| poor she needs WIC (and thus may not even have a car) supposed
| to afford to take a day off from work and travel to an office
| so someone can verify _that her child still exists?_
|
| Compare that to other government programs that benefit the
| wealthy and corporations. Do people writing off luxury cars,
| entire homes, and bizjets have to show up at a regional IRS
| office (annually) to have their records audited, proving that
| the luxury property is actually being used for business
| purposes and they're entitled to a writeoff (or being given use
| of said property without paying taxes on it)?
| willcipriano wrote:
| > OSHA had only 750 safety inspectors in place at the end of
| FY2021[0]
|
| Contrast that with recent efforts to hire nearly one hundred
| thousand IRS agents to get a sense of the priorities of your
| leadership.
|
| [0]https://www.fisherphillips.com/en/news-insights/workplace-
| sa...
| spankalee wrote:
| Tax cheats are bad, actually. And those taxes are required to
| pay those safety inspectors, among others.
| willcipriano wrote:
| 10% of what went to Ukraine would've hired how many safety
| inspectors?
|
| Ukraine is a life or death situation you say?
|
| Solicosis isn't?
|
| How many tax men do we need before we get the government to
| do the bare minimum here?
| gamblor956 wrote:
| Each IRS audit agent annually recovers more than 10x
| their salary in previously unpaid taxes...
|
| That money is used to pay for things that the government
| does. What exactly is your beef here?
| spankalee wrote:
| He wants to get away with cheating on taxes.
| bluGill wrote:
| Have you ever wore a respirator? Not a mask (which all already
| uncomfortable to wear all day), but the full respirator which
| is what is needed for this dust. I've done it for an hour when
| working with chemicals (different filter from dust, but
| otherwise the same) and I was glad to get it off.it is hard to
| blame someone for not wanting to wear them all day. They still
| should.
|
| If you need to wear a respirator all day i'm told the most
| comfortable is an air supply and dragging a hose behind you.
| eropple wrote:
| I have a wood shop, I wear a respirator constantly unless
| I've got the doors open and the fans on and I'm not going to
| be doing more than a one-off cut that afternoon. A properly
| fitted 3M 6800-series full-face respirator is pretty
| comfortable even for long periods and while wearing glasses.
| A 6200-series half-mask is even more comfortable, though a
| little awkward with glasses.
|
| The only problem is that a 6800-series costs $200, plus
| probably $30 a month in P100 cartridges given the level of
| particulates in the air, and that's more than these companies
| think their workers' lives are worth.
| bagels wrote:
| I find the comfort highly depends on the ambient
| temperature. If it's above 80, it gets pretty sweaty in
| there.
| KennyBlanken wrote:
| Wearing a respirator mask is substantially more pleasant
| when you're just farting around your hobby shop (and only
| when the temperature is pleasant or cool), than it is when
| you're actually working at a productivity level expected of
| laborers, with heavy stone, in an industrial workshop, no
| matter the temperature and humidity.
|
| Try spending an hour in your shop constantly lugging heavy
| tools and wood around wearing that respirator on a humid 80
| degree day, then you can be smug and waggle your finger at
| laborers for not protecting themselves.
| dghlsakjg wrote:
| Used to work full days in a shipyard in the tropics with
| a respirator.
|
| The respirator was actually not an issue.
| blincoln wrote:
| FWIW, I'm not a professional, but I've worn a full-face
| respirator while spending entire days working in
| extremely hot crawlspaces, demo'ing and removing heavy
| antique cast iron drain pipe, running a wet saw for
| large-format tile, etc.
|
| I'm just one datapoint, but my assumption would be that
| if it's truly too much of a burden, their employer should
| be buying better respirators and/or filters.
| eropple wrote:
| I mentioned the wood shop because I have expended
| considerably more energy in that shop and also in
| researching how to do so safely, but I've owned a
| property management company and personally I've done two
| house remodels where I did most of the demolition (and
| most things that weren't framing or plumbing) myself. I
| don't like to _do_ it, but I am no stranger to spending
| hours at a stretch working in a half-mask, over my head,
| in Some Weather, in crawlspaces, attics, and basements.
|
| Yes, I'm extremely fortunate that I can pay for help when
| needed, but I do quite a lot of my own work. So, if
| you're going to invent a guy to be mad at, maybe you
| should pick a softer target.
| blincoln wrote:
| I've got a 3M full-face respirator as well, and I agree.
| I've worn it with P100 filters for 8+ hours (minus breaks
| to drink water) doing hard work in uncomfortable conditions
| many times, and never found the respirator to be a burden.
|
| They're a little pricey up front, but I figured it was
| cheap overall compared to the long-term costs of using
| something less effective. Having eye protection integrated
| as well is ideal, since it never fogs up.
| rainbowzootsuit wrote:
| I got one of their FF400 face shield respirators to do
| lead paint removal and spent dozens of hours in
| unconditioned spaces with a tyvek suit. They are
| extremely well designed and never fog because the inhaled
| air passes first through the face mask area and then
| through one-way valves into the mouth/nose section and is
| exhausted downward at the front of the mouth/nose area.
| eropple wrote:
| Yeah - this is why it wasn't a good idea to use those
| during COVID, but it's amazing for doing work.
| convolvatron wrote:
| how big do you have to be to get an actual OSHA inspection?
| I've worked in lost of small and medium shops of various kinds
| and the local fire department will show an interest sometimes,
| but I've never heard of anyone getting involved with OSHA for
| any reason.
| wcunning wrote:
| Definitely an OSHA requirement, but there's no guarantee that
| 1) management supports the necessary supplies, checks,
| reminders, actions, etc or 2) workers want to wear the
| respirators/masks in general. On top of that, inspectors may be
| instructed (depending on inspection management, training, etc)
| that the water based dust suppression is good enough. Even if
| they want to see masks, management and workers may only
| implement them during inspections. Adherence to rules is
| necessary for rules to do anything anywere, ever.
| WirelessGigabit wrote:
| Even though there are whistle-blower protection laws, they
| aren't good enough. No-one should fear risking their job when
| they stand up for their own health.
|
| Management on the other hand should enforce masks as a means
| to avoid liability.
| Gibbon1 wrote:
| What should happen is if someone sees it they call 911 and
| the cops show up. Followed by the county permit inspector.
| And then the owner gets arrested and the job site shut down
| for 6-12 months. Seriously that's what happened at friends
| workplace when an electrician got fried working on a live
| 440 volt panel. Don't see why a counter top shop should be
| treated any different.
| victorbstan wrote:
| A lot of workers don't wear protective gear. By choice. Nobody to
| blame but themselves.
| Arcanum-XIII wrote:
| I know a bit about the welding industry and and it's a lack of
| education, macho attitude, bad habit "I know by
| smell/touch/sound that it's going well" and of course
| management not making it mandatory. Working with respirator is
| not the fun part of the day, for sure. And mask/gloves slows
| you down. But well being able to breathe and see at the end the
| day without the worst sunburn of your live helps ;)
| will5421 wrote:
| People weld without welding masks?!
| barrkel wrote:
| This is both a collective action problem (people not using the
| right gear will be faster and cheaper than those with, meaning
| bad behavior outcompetes good) and an information asymmetry
| problem - workers are usually not fully aware of the problems
| they're creating for themselves.
| bluGill wrote:
| Also people don't think they care. In high school one kid
| told me 'I don't want anyone to wipe my butt when i'm old, so
| I'm going to commit suicide at 50, therefore my smoking isn't
| going to harm me'. He is now approaching 50, I wonder if he
| still thinks that, but I haven't seen him since.
| bbarnett wrote:
| The company is to blame. It's law to wear protective gear in
| many legal jurisdictions, and that 100% means the company is
| liable, if it does not actively enforce, and create a "culture
| of safety".
| mrweasel wrote:
| The point remain here: The workers are the ones choosing to
| not use the safety gear, in some cases.
|
| I was the safety representative at a previous job. Management
| care a lot about safety and provided everything required, and
| high quality gear as well. Still people would cut corners and
| not use the equipment because it was faster not to. These
| where people paid by the hour, they have zero incentive to
| work faster. If people work on contact however, it's easy to
| create an environment where speed is priorities over safety.
| bbarnett wrote:
| _Still people would cut corners and not use the equipment_
|
| Then they get written up, and eventually fired. Companies
| need to be stomped on(and are where I live), if they don't
| do this.
| alerighi wrote:
| Where I live the company is responsible for safety, so if a
| worker decides to not use the safety equipment the company
| is liable, not the worker, since they must enforce their
| usage and check that the workers comply, and if not take
| measures (that include firing the worker if it refuses to
| use them).
|
| Of course they made so because otherwise it would be
| convenient to the company provide the safety equipment and
| not enforce their usage, this way getting work done faster
| (and thus have more profit).
| pixl97 wrote:
| Exactly. In general companies don't like OSHA hanging around.
| They'd rather run fast and lose even if it costs a finger or
| two. Enforcement of the law is how get compliance.
| pixl97 wrote:
| You see, in many industries when an employee/contractor doesn't
| wear protective gear they are walked off site by security
| because the controlling agent of the property doesn't want OSHA
| fining them.
|
| There are plenty of people to blame, and there is plenty that
| can be done. This dumb ass "No regulations needed, free market
| will take care of itself" is how the rich put the poor or
| ignorant into early, terrible graves.
| fzeroracer wrote:
| Realistically, protective gear (actually protective gear, not
| thin dust masks) is expensive. The workers cant afford it, and
| the businesses want to save the money.
|
| There's some small margin of workers who have access to
| protective gear but don't wear it, but in reality for most
| workers it's the job of the company to provide it and train
| workers to use it.
| aaomidi wrote:
| And low quality protective gear makes your day absolutely
| hell.
|
| You know the when these stores even supply this protective
| gear, they get the cheapest option that's still legal.
| WirelessGigabit wrote:
| Your employer should provide you with all the tools you need
| to do your job safely.
|
| Weirdly enough, that doesn't apply to car mechanics which
| seem to be dead set on bringing their own tools to work.
| eropple wrote:
| Car mechanics have a few cultural things that lead to
| everyone buying a preposterously expensive box of their own
| stuff. First is theft (stuff walks away _a lot_ ) and
| second is flat-rate differentiation. Having the right tools
| can make a flat-rated job take much less time and thus
| incentivizes the mechanic to have their own tools, and
| still would even if the garage provided them.
|
| Not saying it's good or right, but there are incentives
| that push towards it.
| NoZebra120vClip wrote:
| I worked in day labor for less than two days. Day labor is,
| needless to say, low-skill and high-turnover. But there are
| still dangerous jobs to be done. My job involved directing
| a wet-vac to pick up water, inside a store, while the other
| guy was grinding or something that needed to be wet down.
|
| I am a nerd and my glasses were falling off from the sweat.
| I think I was wearing a pair of work boots which may be
| required. But the guy giving me orders on-site was not my
| employer. These clients are well-aware that day laborers
| may not be back tomorrow. So why give us durable safety
| equipment that costs money? The day labor office is my
| employer, but they may not be accurately informed about the
| safety requirements of the client and the site. They may
| require us to purchase safety equipment at own expense, but
| if we don't know what the site requires, or how long we
| will be there, that's an up-front expense we are unwilling
| to part with.
|
| Day laborers are one step up from the guys hanging out in
| Home Depot parking lots, whereby they are legal to work in
| these United States, but can't get a job anywhere else.
|
| So it's a 3-way tug-of-war of vagueness and parsimony, and
| it always just ends up being nod-nod, wink-wink, do the
| best you can.
| GartzenDeHaes wrote:
| Management and the business owner are to blame for non-
| compliance with OSHA regulations.
| michaelt wrote:
| _> Nobody to blame but themselves._
|
| Well, it depends on the situation.
|
| If I, a factory owner, offer optional safety equipment that
| slows workers down a bit, but I also demand such high
| productivity that corners have to be cut - whose fault is it
| when the inevitable happens?
|
| What if I, a factory owner, provide optional basic safety
| equipment costing $30 per person, but the mask makes the
| goggles steam up and the boots aren't comfortable? There's
| better safety equipment available for $300 per person - is it
| my fault for not buying it?
|
| What if I, a factory owner, happened to start my factory by
| hiring macho tough guys who don't like wearing a mask, and
| subsequent hires learn that behaviour from them?
|
| Generally I to listen to the craftspeople I employ on issues of
| safety because keeping them safe is the whole _point_ of
| safety. But they and I have a shared responsibility to make
| sure, if they say the machine is actually safer without the
| guard, that they 're right about that.
| Natsu wrote:
| In my experience, most of what happens is that workers don't
| want to wear the gear because it's hot/uncomfortable and
| they're working really long hours and get tired and sloppy by
| the end of it.
|
| I actually worked in such a factory, so this is based on
| direct experience, and what I saw was people cut corners
| mostly because they were tired after long shifts, though lack
| of comfort was also a factor due to the heat.
|
| The employer did try to make everyone wear the gear and had
| inspections and most people wore most of the stuff most of
| the time, we even won a safety award at one point for going
| so long without any OSHA-recordable injury. But we weren't
| perfect and one day I helped bandage a guy who was airlifted
| after slicing his arm open in a really bad way, something the
| kevlar wrist protectors should have stopped.
|
| So I would say that employers do try, to the limit they can,
| but all accidents happen during gaps. And the employees tend
| to have their own interests in comfort or cutting corners
| that sometimes conflict with their safety. More limited
| shifts and attention to comfort might help, but it's not
| always clear how to provide that.
|
| You can still have things like the guy who got crushed by his
| forklift after rushing to dump a hopper of trash by doing
| something really dangerous while unloading it because he
| wanted to hurry and finish so he could go to his family for
| Christmas vacation. And it's not easy to stop that kind of
| thing, even if you do a lot of warnings and inspections to
| yell at people who don't do things right and pay attention to
| close calls.
| lm28469 wrote:
| Sadly you have to force people into things for their own good,
| we do it all the time, seat belts, vaccines, building codes,
| food regulation, &c.
|
| With that mentality we'd still have 1800s lifespans
| killjoywashere wrote:
| I have had things cut for me and I find myself begging the
| workers to wear ear pro, eye pro, air pro, and they invariably
| smile, nod, and work without it. Even if I point out the
| protective gear sitting near the work area. I too was young
| once. Now I wear the kit.
| ok123456 wrote:
| You could also blame the people who want gaudy countertops for
| their McMansions, or for their 'flip.'
| lotsofpulp wrote:
| What material provides a better value than quartz for
| countertops?
|
| Objectively, it has a very high utility per dollar. Heat
| resistant, water resistant, knife resistant, stain resistant,
| etc.
| bafe wrote:
| If function is your primary concern, then the only material
| to choose is the one professional kitchens use: stainless
| steel. It won't be as good looking depending on your
| tastes, but it will beat most stones on other properties
| lotsofpulp wrote:
| What is the cost though? Is rust a concern? And of
| course, looks are a concern, but I imagine quartz is
| relatively cheap because many, many people can afford it.
| bafe wrote:
| It's not very expensive, though I can't give you a price
| since I live in a rental apartment. As for rust: not a
| concern with stainless steel, our kitchen is almost 20
| years old and the steel countertop and sink still look
| immaculate. A bit of steel wool or polishing paste are
| enough to make it look like new. If it wasn't for the
| look I bet most kitchens would come with stainless steel
| countertops
| shrubble wrote:
| Wouldn't a wet-cut system where you flow water over the area the
| blade is hitting, pretty much cut dust in the air by 99% or more?
| Water is pretty cheap and available ...
| jackvalentine wrote:
| Yes, and I've known plumbers who have to make cuts in stone
| countertops to install taps etc to create a 'dam' out of putty
| to flow water in to the cutting site while doing it.
|
| The solutions exist, the problem is making people invest in
| them and stick to it.
| xyst wrote:
| yet another example of exploitation of people just trying to make
| a living. No regulations or minimal enforcement means
| companies/contractors do the job as cheaply as possible.
| Undercutting companies that actually care about the safety of
| their workers.
| throw9away6 wrote:
| The people who installed my counters used no safety equipment.
| They used consumer grade power tools while spraying them down
| with water and took no safety precautions. I was actually worried
| about what would happen if they injured themselves and if my
| insurance would get sued. They were all Asian and did not speak
| English it seemed like a super shady operation.
| Simulacra wrote:
| How does this compare to asbestos?
| jackvalentine wrote:
| Even if the factory is operated safely these countertops often
| require adjustment on-site to fit properly... typically done dry
| with an angle grinder or similar.
| mabbo wrote:
| What I find interesting when comparing the US the Canada on
| topics like these is that in Canada, there is self-interest in
| demanding workers be protected. Like beyond the fact that it's a
| good thing you do.
|
| Because we have a public health care system, funded by taxes,
| having a large number of young men out of the work force (not
| paying taxes) and using the health care system effectively means
| my taxes, everyone's taxes, are higher.
|
| There's incentives for our government to protect workers from
| risks that will cost a fortune to fix.
|
| In America, there's only the "because it's the right thing to do"
| reason, which is never enough for anyone to actually do anything.
| ilyt wrote:
| The problem is that you generally have to force people to keep
| their own safety. Else the el cheapo company shitting on any
| work safety will be cheaper and quicker, coz workers don't know
| any better, and thus more competitive, at worst killing the
| companies trying to do it properly.
| bushbaba wrote:
| America offers Medicare so we still bear the cost. Just only if
| they live long enough to receive the retirement benefits.
|
| Yeah one heck of a perverse incentive.
| sologoub wrote:
| Since the examples are in CA, there is Medi-Cal for those who
| are too poor to buy subsidized insurance and it's not age-
| related unlike Medicare. It's an expanded form of Medicaid.
| I'd bet CA taxpayers do shoulder the costs if the victims
| know to apply.
| cj wrote:
| Medicare for the elderly, but we also have Medicaid for
| people in poverty (< $15k/yr income for a single person w/o a
| family) which covers most basic medical/dental/ vision needs
| and is taxpayer funded.
|
| Someone taken out of the workforce may qualify for that if
| they don't already qualify for disability insurance or
| similar payments (although I'm not 100% clear if those are
| funded via private disability insurance or public programs)
| lotsofpulp wrote:
| Medicaid is not at all comparable to Medicare.
|
| First, Medicare pays a lot more to healthcare providers
| than Medicaid. Medicare pays more for more medications than
| Medicaid, and has fewer prior authorization requirements
| for those medicines. Fewer providers will accept Medicaid,
| and people using Medicaid will receive less or worse
| healthcare than those in Medicare.
|
| Second, Medicaid is administered by each state, and there
| is a lot of variability on how easy the state makes it so
| people can actually get healthcare. Lots of states straight
| up refuse money simply to punish people of a certain
| socioeconomic class because it happens to win votes.
|
| Bottom line, Medicaid is so leaders can claim they are
| helping poor people get healthcare AND keep taxes low.
| Medicare is for actually delivering healthcare to people
| because that contingent makes up a huge proportion of
| votes.
|
| And yes, even Medicare is not delivering all healthcare, as
| it has multiple tiers to deliver differing amounts of
| healthcare to different socioeconomic classes.
| thomastjeffery wrote:
| The most obvious point: if they were equivalent programs,
| we would just include people under the poverty line with
| Medicare. Instead, we have a completely different
| program, managed by different people with different
| goals. Down to its very core, Medicaid is a political
| football.
| lotsofpulp wrote:
| Exactly, I guess my comment could have been much shorter.
|
| I love how there is even an Additional Medicare Tax. The
| political lines in the US are very much old v young, but
| some of the young, especially politically active ones,
| vote with the old since they are among the wealthy young,
| and the rest do not participate enough, or do not have
| sufficient knowledge about how resources are being meted
| out and how they will be affected now and in the future.
| galangalalgol wrote:
| Incidentally this is also why everyone working in a nation has
| to receive these benefits (and any others guaranteed to
| citizens), otherwise you get migrant workers who suck up this,
| quite literally in this case, but don't receive healthcare.
| lm28469 wrote:
| Only illegal migrants aren't covered, legal ones are. If you
| make it available to everyone regardless of their legality to
| be on the soil you open up a whole bunch of other issues
| morelisp wrote:
| Like what?
| lm28469 wrote:
| Like giving people an incentive to illegally come to your
| country ? If there are no difference between coming
| legally or illegally the choice is easy.
|
| Like I could just book a one way flight to LA and become
| a US citizen because reasons ?
| duped wrote:
| Like how most of our ancestors got here, you mean?
| lazide wrote:
| Well, not since ~1882.
|
| https://www.uscis.gov/about-us/our-history/overview-of-
| ins-h...
|
| That said, overstaying tourist visas (aka just hopping on
| a plane and then not going back) is a _very_ popular form
| of illegal immigration into the US.
| AnthonyMouse wrote:
| You can either provide social benefits to your country's
| poor or you can have open borders. If you try to do both
| at once, you're providing social benefits to the world's
| poor, and the amount of benefits you can provide from a
| given tax base falls through the floor.
| Shaanie wrote:
| How was the wellfare at that point? :-)
| sandworm101 wrote:
| Canada largely avoids this problem by not allowing a subset
| of illegal people to exist in the country. Canadians are
| polite, but working in canada without some sort of legal
| status is far harder than in the US. They have lots of
| immigrants, but vanishingly few illegal ones in comparison
| to the US.
| LordShredda wrote:
| That could also be resolved by having tight border security
| and heavily penalizing anyone involved with their entry
| yjftsjthsd-h wrote:
| > Because we have a public health care system, funded by taxes,
| having a large number of young men out of the work force (not
| paying taxes) and using the health care system effectively
| means my taxes, everyone's taxes, are higher.
|
| The taxes part is the same; only the healthcare half is
| different.
| paulddraper wrote:
| > Because we have a public health care system, funded by taxes,
| _having a large number of young men out of the work force (not
| paying taxes) and using the health care system effectively
| means my taxes, everyone 's taxes, are higher._
|
| That is true with or without publicly funded healthcare.
| grecy wrote:
| You could argue that more sick people is good for the US
| economy, and it helps rich people get richer.
| paulddraper wrote:
| Also, broken windows
| AnthonyMouse wrote:
| > Because we have a public health care system, funded by taxes,
| having a large number of young men out of the work force (not
| paying taxes) and using the health care system effectively
| means my taxes, everyone's taxes, are higher.
|
| The US healthcare system uses private insurance, implying that
| more use of the healthcare system raises everyone's premiums.
| And people without insurance then go to emergency rooms which
| are in turn still passing the cost onto private insurers. So
| voters already have the same incentive in order to avoid their
| premiums going up.
| thomastjeffery wrote:
| That incentive is obfuscated, though. Every insurer exists as
| an invisible boundary where cost is _not_ passed to others.
|
| On top of that, insurance is _optional_. There is no
| guarantee a person will get affordable care. That 's the
| entire point of the system! If there were a guarantee, it
| would be indistinguishable from Canada (and practically every
| other country's) single payer healthcare system.
| AnthonyMouse wrote:
| > Every insurer exists as an invisible boundary where cost
| is _not_ passed to others.
|
| How does that affect issues like this where an increase in
| overall costs would reasonably be expected to apply to all
| insurers?
|
| > On top of that, insurance is _optional_.
|
| More than 90% of the population has health insurance, which
| is well over the majority required to bring about
| legislation.
|
| > If there were a guarantee, it would be indistinguishable
| from Canada (and practically every other country's) single
| payer healthcare system.
|
| That certainly isn't true. Serious problems with the US
| healthcare system include AMA lobbying to maintain a doctor
| shortage, various patent laws and FDA rules that limit
| competition and increase costs and a malicious lack of cost
| transparency. None of that would be improved merely by
| routing the premiums through the government.
| mhb wrote:
| We already have the government involved - OSHA. Why would
| having it more involved be better if its current involvement is
| not solving the problem? It's pretty to think that the
| government has some sort of self-interest and if it can save
| money in the long run by spending money in the short run, it
| will do that. But that's not how things work, is it?
|
| A more plausible conclusion from observing the results of an
| entity's involvement in something is that if it is incompetent
| with the thing you gave it to do, don't give it more stuff to
| do.
| bastawhiz wrote:
| > if it is incompetent with the thing you gave it to do,
| don't give it more stuff to do.
|
| When my code doesn't work, I don't sunset the code, I fix it.
| Why would the best course of action be to stop trying instead
| of fixing the root of the problem?
| mhb wrote:
| When your Maytag dishwasher breaks after a month, do you
| think the best thing to do is to buy a Maytag washing
| machine?
| bastawhiz wrote:
| I don't say "I'm not using a dishwasher anymore" I figure
| out how to get the dishwasher that's in my kitchen fixed.
| mhb wrote:
| Fine. So advocate for fixing OSHA instead of revamping
| the entire health care system.
| zdragnar wrote:
| If your code doesn't work, it could be anything from a
| minor typo to a bad abstraction based on bad assumptions
| that requires a full refactor to get correctness and / or
| minimum acceptable performance.
|
| About 90% of that scale requires sunsetting at least _some_
| of your code and doing something differently.
| cjbgkagh wrote:
| I have ME/CFS and the fact that we're expensive to the general
| public seems to be the only reason there is any public money
| spent on treatments and cures at all. However, Canada and
| others are finding that medically assisted suicide offers an
| even cheaper alternative solution. So instead of money spent on
| treatments and cures we get subtle and not so subtle
| encouragements to kill ourselves, and I expect the problem to
| keep getting worse. I.e. I don't think the actual emergent
| behaviour for shared healthcare costs is as altruistic as you
| appear to except.
| haldujai wrote:
| Canadian data is relatively poor quality (mostly from the 90s)
| outside of Alberta (I expect QC and BC probably have the
| highest rates) but historically and estimates are that we have
| slightly higher incidence than the US.
|
| https://onlinelibrary.wiley.com/doi/full/10.1111/resp.14242
|
| > There's incentives for our government to protect workers from
| risks that will cost a fortune to fix.
|
| There are many examples where this is inaccurate but let's keep
| it simple and delve a little deeper into the silicosis problem
| presented in this specific study.
|
| From the JAMA article:
|
| _Although a substantial number of the patients, including some
| of those who were uninsured or with restricted-scope Medi-Cal,
| likely had an undocumented immigration status, we did not
| directly collect information about whether individuals were
| undocumented immigrants._
|
| Note that public health system in Canada is not "free". Legal
| immigrants, documented workers, citizens and refugees have
| access to provincial or federal health insurance which pays for
| care.
|
| Undocumented or illegal immigrants have neither (and also would
| not get WSIB which would be the payer for most silicosis cases)
| and actually have better coverage in California.
|
| Additionally:
|
| _Ten patients (19%) were uninsured, 20 (38%) had restricted-
| scope Medi-Cal, 7 (13%) had Medi-Cal, 8 (15%) had private
| insurance, and 7 (13%) had workers' compensation._
|
| So 34/52 had some form of government provided or mandated
| insurance.
|
| As an aside while restricted-scope Medi-Cal and uninsured rates
| are the surrogates for undocumented immigrants in this study,
| those over the age of 50 (or 19-25) are also eligible for full
| scope Medi-Cal but were not identified in this study. Medi-Cal
| will also be expanding in January 2024 to cover undocumented
| immigrants aged 26-49.
|
| Even if we assume Canada's silicosis incidence is lower, all of
| the above strongly suggests your public health system cost-
| savings incentive hypothesis is incorrect.
| pupppet wrote:
| > Canadian data is relatively poor quality
|
| Sure, no axe to grind here. Do tell us your impartial take.
| retrac wrote:
| Canadian here who believes our labour safety standards are
| generally better than the USA (based on anecdote and
| experience, not data).
|
| Canadian data is poor quality. On any issue you might care
| to pick, the topic is better studied in the United States.
| I run into this all the time. For example, we make
| allocation decisions at a charity I volunteer at with,
| about what health problems unemployed LGBT people tend to
| have. We use data for American urban populations. The data
| doesn't exist for Canada, AFAIK. It's a smaller country!
| There's simply less research and statistic-taking done!
| It's a reasonable statement.
|
| Besides -- commenting on the lack of good data usually
| implies the exact opposite of what you seem to think -- it
| is an admission by the poster that their argument is based
| on weak evidence.
| haldujai wrote:
| > it is an admission by the poster that their argument is
| based on weak evidence.
|
| Which is exactly why I limited my reply to a discussion
| about the California study and healthcare systems rather
| than reiterating the claims in the 2022 article I
| referenced which states silicosis incidence is 3x higher
| in Canada, based on 20-30 year old data.
|
| Although I live in the US now I'm a dual citizen and
| practiced medicine in both countries, the only axe I have
| to grind with Canada is the harsh winters which are
| incompatible with my fragile desert descent body.
| haldujai wrote:
| Perhaps you are unfamiliar with medical research but
| stating that available data is poor quality is an objective
| assessment. I provided a brief explanation in parentheses
| which you excluded for some reason.
|
| I also provided a reference that is open access but here is
| the relevant section for you:
|
| _In Canada, there are no national data on the incidence or
| prevalence of silicosis. In the province of Alberta, where
| silicosis is a notifiable disease, health insurance data
| revealed 861 cases with at least one reported diagnosis of
| 'silicosis' during a period of 10 years from 2000. These
| results were based on raw data and not a secondary review
| of primary imaging and clinical information. Data from 2000
| through 2009 showed that only 29 workers ' compensation
| claims were accepted for silicosis in Alberta. Data from
| Quebec's compensation system revealed 351 compensated cases
| of silicosis between 1988 and 1998. Of note, workers who
| participated in regular surveillance had milder disease at
| the time of compensation._
|
| The JAMA study is from 2019-2022. Data that is 20-30 years
| old is relatively poor quality.
|
| Changes in medicine, workplace safety rules and
| occupational trends makes it hard to compare to silicosis
| rates in Canada to the US in order to assess the claims of
| the comment I replied to therefore I think the relative
| incidence described in this review article (from 2022) is
| inaccurate.
|
| If you want to disregard my quality assessment, the
| discussion ends with the review article showing silicosis
| rates are 3x higher in Canada.
|
| Can you elaborate on how any of this shows I have an axe to
| grind or that I'm biased?
| PaulDavisThe1st wrote:
| > Note that public health system in Canada is not "free".
|
| I'm enough of a pedant to annoy the fuck out of most anybody
| who knows me, but really? Look, there is no "free" health
| care anywhere, but it's a term that has (perhaps
| unfortunately) become widely used as a synonym for, depending
| on your sensibilities "no charge at the point of service"
| and/or "socialized health insurance and health care
| coverage".
|
| And Canada is certainly one or both of those.
|
| The metric "well, they don't provide it for undocumented
| persons" is a weird one, as is the use of California as a
| counter-example.
| haldujai wrote:
| I think you may be "annoying the fuck" out of yourself
| here. Your reply is full of strawman arguments.
|
| The comment I replied to asserts that the government
| incentive to reduce healthcare expenditures improves
| workplace safety, and consequently in the context of this
| article would have prevented silicosis/PMF in these
| patients.
|
| I highly doubt most HN commenters are aware of whether
| undocumented migrants are covered in the Canadian system as
| they are in California, certainly the person I replied to
| was not, so I explain differences in coverage.
|
| Consequently, the argument doesn't hold water as the
| financial incentive for the government is stronger in
| California than in Canada as it relates to this study
| population.
|
| > The metric "well, they don't provide it for undocumented
| persons" is a weird one, as is the use of California as a
| counter-example.
|
| I'm not providing any counter examples, undocumented
| workers in California are the subjects in the article we
| are commenting on. Where in fact there happens to be
| socialized healthcare that you seem to think I'm arguing
| against.
| PaulDavisThe1st wrote:
| All good, but you still had to get in the jibe about
| '"free" healthcare' for reasons that have nothing to do
| with either TFA or the GP's point.
| haldujai wrote:
| It's not a gibe. I used scare quotes around free because
| it's obvious that a socialized system is funded by taxes,
| what's not obvious a bill is _always_ generated during
| healthcare delivery in the Canadian system.
|
| You yourself seem to not understand this distinction with
| your comment: _" no charge at the point of service"_.
|
| There is _always_ a charge at the point of service and a
| bill is generated. The difference with the US is that the
| Canadian healthcare system, which also functions mostly
| privatized, uses a single payer model so the government
| is the only one legally permitted to pay for insured
| services. In other words, each province runs a large
| insurance company and there is a law that states that no
| one is allowed to charge any person or company other than
| the government insurance plan for anything the government
| has deemed reimbursable for any person covered by the
| plan.
|
| (So you don't misinterpret my statements again: while
| government run hospitals, but not the physicians working
| in them, do get capitation payments they also bill for
| some services. What is billed vs paid through capitation
| varies by province. Services rendered to uninsured
| patients are never from capitation funds and are always
| charged directly to the patient).
|
| If the services rendered or you are uninsured, like the
| patients in the article study, it functions the same as
| the US and you will personally receive a bill in the mail
| with similarly obscene rates much higher than what the
| government insurance company would have paid.
|
| This distinction has everything to do with the article
| and GP's point which asserts that the Canadian government
| will bear some cost for the care of the patients in the
| California study which is flatly incorrect. If there was
| no charge at the point of service none of this would
| matter.
| PaulDavisThe1st wrote:
| > There is always a charge at the point of service and a
| bill is generated.
|
| I was thinking more broadly than just the US or Canada.
| In Scotland, for example, there is literally no charge at
| the point of service.
| haldujai wrote:
| Okay... what does Scotland have to do with anything?
|
| The discussion, and the part of my comment you quoted, is
| specifically about Canada and the US. So I'm not sure
| what you're even arguing or why.
| ChumpGPT wrote:
| >What I find interesting when comparing the US the Canada on
| topics like these is that in Canada, there is self-interest in
| demanding workers be protected. Like beyond the fact that it's
| a good thing you do.
|
| Is there any evidence of this? That the Canadian Gov cares more
| about workers than the US Gov?
|
| >Because we have a public health care system, funded by taxes,
| having a large number of young men out of the work force (not
| paying taxes) and using the health care system effectively
| means my taxes, everyone's taxes, are higher.
|
| What evidence do you have that this is the case?
|
| >In America, there's only the "because it's the right thing to
| do" reason, which is never enough for anyone to actually do
| anything.
|
| Is this your opinion or is this the reality. I don't know if
| you have ever walked by a construction site in Toronto to see
| guys cutting cement or stone. None of them have masks.
| Sometimes they will have a wet saw when cutting cement on the
| street but that is to reduce dust for traffic and pedestrians
| and not so much for their health. The Canadian Postal Union
| fought the Federal Gov for years to provide an environment
| where paper dust was considered a health hazard and workers
| need to be protected. Many postal workers suffered from COPD
| because paper dust was too fine for the Lungs to filter. What
| about farmers and dust? I'm sure they suffer just as much as
| American farmers.
|
| I've come to realize Canadians suffer from an inferiority
| complex and have to constantly try and make comparisons to make
| themselves feel better, it's a strange phenomena.
|
| - Expat....
| Aeolun wrote:
| I don't think cutting in the open air and cutting in tiny
| sweatshops are at all comparable.
| ceejayoz wrote:
| Exposure won't be anywhere near zero outdoors unless
| there's a serious breeze. Over decades that'll add up.
| ChumpGPT wrote:
| Then you have never seen someone cut stone in open air.
| Because it creates such a cloud of stone dust you could
| hide a house in it.
| dghughes wrote:
| Then again my Dad who died of a lung disease said the
| government agency (Coast Guard) he worked for turned a blind
| eye to what he and his co-workers had to do. Dad would tell me
| even as the late 1990s his job was to take a powder, wet it,
| form it into big mats. They were filters for the boiler water.
| The powder used was or maybe just contained asbestos. He said
| the workers on the dock were covered in it he said the place
| looked like it had snowed.
|
| Dad knew but he was stuck in the past of "It had to be done"
| mentality. And really as a high school drop out he really may
| not have understood the danger. For years he and my grandfather
| had a painting business with the paint at that time containing
| lead.
| frozenport wrote:
| Does Canada have a different policy on engineered stone?
| rafaelmn wrote:
| Not agreeing/disagreeing with this you but I wonder how you
| feel about obesity tax ? Low physical fitness tax ? There's
| plenty of evidence that exercise and diet significantly impact
| health (especially on population level) - like you said there's
| an incentive to keep those people healthy contributors instead
| of chronic burdens on the system. Sounds like a logical
| extension but doesn't seem popular/implemented widely.
| mitthrowaway2 wrote:
| Tax on sugar, sure. But having an obesity tax would be like
| having a silicosis tax.
| rafaelmn wrote:
| This is based on the assumption that sugar causes obesity -
| I don't think there's any strong evidence for that, or that
| low carb diets work better for fat loss than low fat, from
| what I've seen both have same effect (calories equated) and
| both have equally terrible long term adherence/outcomes.
| Sugar seems like a nice villain but it's more likely that
| you'd have to tax any high calorie food that tastes good.
|
| And what about physical activity ?
| mitthrowaway2 wrote:
| If not sugar, then other causes should be taxed if the
| evidence supports that such taxes would have an impact.
| I'm not a policy expert myself.
|
| The best public investment to promote physical activity
| is designing cities to enable "the gym of life"!
|
| https://youtu.be/KPUlgSRn6e0?si=GDmrYq-XQtn9SaKx
| rafaelmn wrote:
| Fair enough, guess my problem would be that since these
| things would be implemented by politicians it would end
| up being driven by fads/popular opinion, and without
| strong evidence (of which there's very little) you'd
| essentially be conducting population level experiments
| even if you wanted to be scientific (eg. food pyramid to
| the extreme)
| throwaway8378 wrote:
| What about all the other harmful activities? Recent studies
| about alcohol usage shows that even small amounts can be much
| more harmful than previous estimates. In addition to the
| health issues, we also need to consider all the accidents and
| violence that is connected to drunkeness.
| guraf wrote:
| Alcohol is not only heavily taxed in Canada, but most
| provinces also have a monopoly on selling spirits. That's
| right, the gov is selling the booze, pocketing both the tax
| and the profits.
| mantas wrote:
| Alcohol is usually taxed. Just like tobacco. Although sugar
| and other harmful substances should join the former.
| pydry wrote:
| I feel great about slapping a tax on the profits of companies
| that sell highly processed, sugary, addictive foods so that
| the market selects for healthier alternatives.
|
| Maybe subsidies for selling fresh fruit and veg also.
|
| I guess you could tax their victims instead though... they
| don't have a lobby so theyre probably easier to take
| advantage of.
| plagiarist wrote:
| We are Calvinists down here, so bad people were always
| predestined to be bad and they deserve to be punished.
| Corporations making money must have be good because they
| are succeeding, so why would we hurt them?
|
| I will never be punished for being over- or underweight
| since I am good. The universe would have to be broken for
| me to be taxed.
| echelon wrote:
| > I guess you could tax their victims instead though...
| they don't have a lobby so theyre probably easier to take
| advantage of.
|
| Nobody is the victim of choosing to eat a cake.
| ImHereToVote wrote:
| When you live in poverty and have no prospects for the
| future. Some mass produced cake from the supermarket
| might be the only thing keeping you together. As soon as
| the work of the laptop class is automated by next
| generation agentic LLM's, you will probably understand.
| filoleg wrote:
| > As soon as the work of the laptop class is automated by
| next generation agentic LLM's, you will probably
| understand
|
| Coming any second now, right behind robotaxis, with the
| only difference being that robotaxis will probably
| actually happen within the lifetimes of the current
| "laptop class".
| jmvoodoo wrote:
| We aren't talking about cake though. We are talking about
| inexpensive highly processed foods made predominantly
| from ingredients that are subsidized specifically because
| of their caloric density. I.e. corn.
|
| High caloric density is what you want if you need to be
| able to feed your country in war, so we subsidize these
| foods.
|
| No one wants to eat just plain corn though, so companies
| process it into other foods that are then sold cheaply
| because they are receiving these large subsidies.
|
| People end up consuming large quantities of these foods
| because they are cheap, and our brain reward centers a
| pre-wired to love lots of cheap easy calories.
|
| Knowing all of this, it makes perfect sense to tax the
| living crap out of highly processed foods that are made
| from subsidized ingredients. You're just taking back the
| subsidy you put there in the first place, and shaping
| consumer behavior for the greater good (which is a common
| use case for taxation).
| AnthonyMouse wrote:
| > Knowing all of this, it makes perfect sense to tax the
| living crap out of highly processed foods that are made
| from subsidized ingredients.
|
| The consequence of this would be that the subsidized food
| gets exported to a country that doesn't tax it, at which
| point you're subsidizing some other country's food.
|
| The US is also a large net exporter of food, implying
| there is more than enough domestic production for wartime
| needs. Also, the US hasn't been in that kind of a war in
| almost a hundred years and MAD makes it unlikely that it
| ever would be again. The obvious conclusion is to
| eliminate the subsidies.
| pydry wrote:
| >The consequence of this would be that the subsidized
| food gets exported to a country that doesn't tax it, at
| which point you're subsidizing some other country's food.
|
| If theyre smart they won't take this shit either.
|
| Nice of you to let Americans sacrifice their health on
| $othercountry's behalf though.
| AnthonyMouse wrote:
| > If theyre smart they won't take this shit either.
|
| What do you suppose the chances are of 100% of other
| countries imposing a similar tax on this type of food?
|
| > Nice of you to let Americans sacrifice their health on
| $othercountry's behalf though.
|
| Stop subsidizing it and you don't have to tax the subsidy
| back out.
| pydry wrote:
| >What do you suppose the chances are of 100% of other
| countries imposing a similar tax
|
| Quite high. Agricultural dumping is typically frowned
| upon even more than regular dumping. Half of the reason
| for the WTO's existence was to get countries to stop
| being so trigger happy about doing this.
| AnthonyMouse wrote:
| You think the chances are "quite high" of _all_ other
| countries doing this? There are several countries that
| inherently have to import food because they don 't have
| enough arable land to feed their population.
| morelisp wrote:
| If you take this view, any tax on _current_ state is like a
| "cancer tax" - you're just doubly punishing the person.
|
| Sugar tax, coal tax, corn syrup tax, worked-your-
| employees-90h/week tax? Sure.
| moomoo3000 wrote:
| Public transit and walkable streets are also incentivized.
| People naturally end up walking more outside of US.
| Anon1096 wrote:
| Perhaps unexpectedly, people dying are usually _cheaper_ for a
| healthcare system than healthy people. This has been studied a
| lot with smokers, basically people in old age cost far more
| than young people and thus a true cost-minimizing system would
| not be how you expect. Of course, we aren't trying to minimize
| cost so the premise is flawed.
| sershe wrote:
| Do you have a reference for this? This was a weak hunch for
| me before but I always assumed I was wrong based on e.g.
| insurance rates. If insurance prices it higher, it must be
| more expensive to cover?
| Sharlin wrote:
| Smokers specifically are very much a net cost to society,
| because smoking kills slowly and in a very expensive manner.
|
| In any case, anything that makes people die young, or more
| generally reduces people's capacity to work (like many
| diseases of affluence) is incredibly expensive to society
| once you factor in indirect and opportunity costs.
| DoughnutHole wrote:
| This is very dependent on the illness.
|
| From a cost perspective it's best that people die suddenly.
| If I live a fairly healthy life into my 80s and die of a
| heart attack, I might not necessarily have cost my insurer
| that much, as opposed to if I suffer from a chronic illness
| for 10, 20, 30 years.
|
| Cancer is now usually not a sudden death sentence - treatment
| is good enough now that most cancers caught early can be
| treated and patients often go through multiple remissions
| before it or a complication from treatment finally gets them.
|
| Insurers very much do not want their customers getting
| cancer, because it is invariable an extraordinarily expensive
| condition to treat and treatment can go on for years.
| haldujai wrote:
| > Cancer is now usually not a sudden death sentence -
| treatment is good enough now that most cancers caught early
| can be treated and patients often go through multiple
| remissions before it or a complication from treatment
| finally gets them.
|
| Small clarification - early detection is most often
| curative and cheap.
|
| The really expensive part is that several advanced stage
| cancers (even IV with widely disseminated metastatic
| disease) now survive for many years on treatments costing
| low to mid 6 figures/year.
|
| It actually provides a pretty good incentive for insurers
| to cover screening and early detection beyond what is
| mandated by law.
| CrazyStat wrote:
| > Small clarification - early detection is most often
| curative and cheap.
|
| > It actually provides a pretty good incentive for
| insurers to cover screening and early detection beyond
| what is mandated by law.
|
| The evidence in favor of mass screening programs in the
| hope of early detection is actually weak to non-existent
| [1].
|
| > In total, 2 111 958 individuals enrolled in randomized
| clinical trials comparing screening with no screening
| using 6 different tests were eligible. Median follow-up
| was 10 years for computed tomography, prostate-specific
| antigen testing, and colonoscopy; 13 years for
| mammography; and 15 years for sigmoidoscopy and FOBT. The
| only screening test with a significant lifetime gain was
| sigmoidoscopy (110 days; 95% CI, 0-274 days). There was
| no significant difference following mammography (0 days:
| 95% CI, -190 to 237 days), prostate cancer screening (37
| days; 95% CI, -37 to 73 days), colonoscopy (37 days; 95%
| CI, -146 to 146 days), FOBT screening every year or every
| other year (0 days; 95% CI, -70.7 to 70.7 days), and lung
| cancer screening (107 days; 95% CI, -286 days to 430
| days).
|
| There are large institutions, both nonprofit and
| commercial, which stand to gain by convincing people that
| mass screening is useful and important. The available
| scientific evidence does not support their position.
|
| [1] https://jamanetwork.com/journals/jamainternalmedicine
| /fullar...
| haldujai wrote:
| You're looking at the wrong metric and misinterpreting
| the stats, not only is overall survival not a good metric
| for cancer screening none of the studies are sufficiently
| powered for OS.
|
| What you want to do is look at stage at presentation,
| treatment costs by stage, and screening costs. These were
| done for nearly every recommended screening program.
|
| The available evidence behind currently recommended
| screening programs unequivocally shows improved cancer-
| specific survival and earlier stage at diagnosis.
| CrazyStat wrote:
| I'm going to strongly push back on both (1) the notion
| that overall survival is the wrong metric and (2) that
| I'm misinterpreting something, given that I didn't really
| offer any interpretation at all. I just cited a paper.
|
| > What you want to do is
|
| No, what I want to do is assess whether broad screening
| programs actually make people live longer. Overall
| survival is the correct metric. Evidence in favor of the
| claim is lacking.
|
| > none of the studies are sufficiently powered for OS.
|
| "Sufficiently powered" is relative to what size of effect
| you want to detect--which you haven't specified, so I'm
| not sure how you can make the assertion that none of the
| studies are sufficiently powered.
|
| > The available evidence behind currently recommended
| screening programs unequivocally shows improved cancer-
| specific survival and earlier stage at diagnosis.
|
| These outcomes ignore negative effects of screening on
| people who don't have cancer, which is why I'm not
| interested in them. And yes, there are negative effects,
| and no, they are not negligible.
| haldujai wrote:
| > No, what I want to do is assess whether broad screening
| programs actually make people live longer. Overall
| survival is the correct metric. Evidence in favor of the
| claim is lacking.
|
| Correct according to whom? If you want to choose only one
| metric quality adjusted life years is likely the best
| one.
|
| While OS may be your goal that's not the primary endpoint
| of screening programs.
|
| Some examples of why OS is limited: breast lumpectomy vs
| mastectomy and systemic therapy or polypectomy vs
| neoadjuvant therapy and colonic resection are both
| associated with very high morbidity that is very
| important to patients. The vast majority of patients care
| about quality of life.
|
| > "Sufficiently powered" is relative to what size of
| effect you want to detect--which you haven't specified,
| so I'm not sure how you can make the assertion that none
| of the studies are sufficiently powered.
|
| We do not expect any one screening program to have a
| large change on overall survival because there are many
| ways to die, very few studies are powered to detect the
| small differences expected. The reference below does some
| modeling and discusses cancer-specific vs all-cause
| mortality for your perusal.
|
| https://onlinelibrary.wiley.com/doi/full/10.1002/cam4.247
| 6
|
| > These outcomes ignore negative effects of screening on
| people who don't have cancer, which is why I'm not
| interested in them.
|
| See morbidity discussion around delayed diagnosis above.
|
| > And yes, there are negative effects, and no, they are
| not negligible.
|
| As you're choosing to limit the discussion to overall
| survival, do you have any data to support the claim that
| screening has more than a negligible negative effect?
|
| There is a better argument to be made for other harms of
| screening like cost and stress but if we want to discuss
| these negative effects of screening we also have to step
| back from overall survival and discuss morbidity
| benefits.
|
| ETA:
|
| > 2) that I'm misinterpreting something, given that I
| didn't really offer any interpretation at all.
|
| This is your interpretation, and is an incorrect one:
|
| > The evidence in favor of mass screening programs in the
| hope of early detection is actually weak to non-existent
| [1].
|
| The evidence you cite says nothing about early detection
| and treatment paradigms.
| lazide wrote:
| Eh, depends. COPD, or like the article is about, Silicosis,
| is a long slow drawn out illness.
| lazide wrote:
| How do you explain the massive push to ban/stop Smoking?
|
| The US is pretty much the only country to successfully reduce
| it, near as I can tell (perhaps Canada has had success too?).
| steve_adams_86 wrote:
| Canada worked to discourage and regulate smoking more
| aggressively around 20-30 years ago, and in 20 years we've
| gone from around 1 in 4 people smoking to more like 1 in 10.
| It steadily trends down.
|
| https://uwaterloo.ca/tobacco-use-canada/adult-tobacco-
| use/sm...
| mitthrowaway2 wrote:
| I'm curious about how you got that impression. In Canada,
| smoking is down from 26% in 2001[1] to 15% in 2019[2].
| (Cannabis consumption is probably trending upward though). I
| have no reason to believe that this decline is particular to
| the US and Canada. Japan has been trending down from 33% in
| 2000 to 20% in 2020[3]. I expect this will have accelerated
| since the government made a strong anti-smoking push during
| the Tokyo Olympics. In fact, this seems to be a trend across
| the entire developed world, see this chart[4] showing that
| cigarette sales per adult per day peaked by the 1980s in
| every developed country surveyed, and all have been trending
| downward for decades. The US shows up as exceptional mainly
| in how extremely high its cigarette consumption habits were
| in the '60s and '70s.
|
| [1] https://www150.statcan.gc.ca/n1/pub/82-624-x/2012001/arti
| cle...
|
| [2] https://www150.statcan.gc.ca/n1/pub/82-625-x/2020001/arti
| cle...
|
| [3] https://www.macrotrends.net/countries/JPN/japan/smoking-
| rate...
|
| [4] https://ourworldindata.org/grapher/sales-of-cigarettes-
| per-a...
| lazide wrote:
| Ah, it was just a much larger shift in the US, especially
| demographically. It went from 44% of adults (stats not
| gathered on younger folks, but anecdotally it was 'cool'
| and a lot of highschool age kids smoked) to 13.8% for
| adults (anecdotally many quite old) and only 8.8% for
| younger folks.
|
| Traveling outside the US to Europe or Asia
| (eastern/southern Europe or China in particular) it's very
| visible, where in the US outside of a few locations it's
| almost invisible now and notably uncommon.
|
| Especially for educated or higher income folks, too.
| was_a_dev wrote:
| The majority of Western countries have implemented and
| successfully reduced smoking rates.
| Shaanie wrote:
| What's with Americans and their strange view that the US is
| somehow managing to do something nobody else has? Just as an
| example I checked my country:
| https://www.researchgate.net/figure/Prevalence-of-daily-
| smok...
|
| I'm pretty sure the figures will look somewhat similar in
| most western countries.
| lazide wrote:
| What is it with non-Americans and their strange view that
| the US as a whole does anything?
| dang wrote:
| Please don't take HN threads on generic nationalistic flamewar
| tangents. I'm sure you didn't intend it, but that's what this
| leads to, in the statistical case.
|
| https://news.ycombinator.com/newsguidelines.html
|
| Edit: we've had to ask you not to do this on HN more than once
| before. Please avoid it in the future.
|
| https://news.ycombinator.com/item?id=34492512 (Jan 2023)
|
| https://news.ycombinator.com/item?id=34073107 (Dec 2022)
| mabbo wrote:
| Sorry Dang. I hadn't realized it was coming off that way, but
| I'll be my best to check myself in the future.
|
| I can see how what I said would be construed that way.
| DoreenMichele wrote:
| Last I checked, Canada doesn't share a border with Mexico and
| some portion of these Latino "day workers" are illegal
| immigrants. Day workers are often paid under the table and when
| I have read other stories about them, they tend to include
| medical horror stories like "So, this guy cut 3 of his fingers
| off and they didn't even take him to the ER. They just returned
| him to the place where they had picked him up."
|
| This is not exactly the best use case for arguing about Canada
| versus US healthcare policies.
| Tao3300 wrote:
| More policy preaching from ultra-white northern countries
| that don't let anyone in. It's such a tired trope...
| kamilner wrote:
| Canada doesn't let anyone in? Over a fifth of their
| population was born outside of Canada.
|
| Edit: Actually over a quarter.
| swagempire wrote:
| Canada is pretty heavy on immigration I hear-- its how they
| partially make up for a declining birthrate.
| pgeorgi wrote:
| > its how they partially make up for a declining
| birthrate.
|
| To the detriment of their origin countries who suffer
| from losing their best and brightest. How "Northern
| countries exploit the South again" is a (rather quiet)
| talking point that I believe will become louder in the
| future.
| chiefalchemist wrote:
| It's not only Canada that uses immigration - legal or
| turning a blind eye to illegal - to make up for falling
| birthrate.
|
| Look at Germany. Look at France. Look at what's happen to
| Japan because such an option isn't as viable.
|
| It's simply not politically feasable to say, "Without
| immigrants, our economy is f'ed."
| arcticbull wrote:
| American too, birth rate is 1.6, well below a replacement
| rate of 2.1
| pgeorgi wrote:
| > It's simply not politically feasable to say, "Without
| immigrants, our economy is f'ed."
|
| And yet, that's what politicians in Germany are saying:
| "Denn Deutschland braucht sie dringend: Durch die seit
| Jahrzehnten sinkende Geburtenrate gibt es auch weniger
| Arbeitskrafte. Diese Lucke konnte lange uber Zuwanderung
| aus dem EU-Ausland gefullt werden. Doch inzwischen reicht
| das nicht mehr aus."
| (https://www.spdfraktion.de/themen/neustart-
| migrationspolitik, the social-democrat representatives in
| Parliament)
|
| "Because Germany needs them urgently: Due to the
| declining birth rate for decades, there are also fewer
| workers. For a long time, this gap could be filled by
| immigration from other EU countries. But this is no
| longer enough."
| sologoub wrote:
| 26.4% of Canada's population are first generation
| immigrants (foreign born):
| https://www12.statcan.gc.ca/census-recensement/2021/as-
| sa/fo...
| guraf wrote:
| Canada will have imported over 1M immigrants in 2023 (for
| their population of only 40M!). Newsflash: most aren't
| white.
| mitthrowaway2 wrote:
| Canada doesn't have a border with Mexico, but it does have
| its share of undocumented and under-protected workers.
|
| > While there are no accurate figures representing the number
| or composition of undocumented migrant population in Canada,
| estimates range between 20,000 and 500,000 persons
|
| > Research suggests most undocumented individuals live in
| large urban centres and typically work in seasonal and
| informal sectors, such as construction, agriculture,
| caregiving and housekeeping.
|
| > Undocumented migrants are a vulnerable group due to their
| lack of immigration status, as was seen during the COVID-19
| pandemic. They have limited access to health care, social
| services or employment protections.
|
| Source: https://www.canada.ca/en/immigration-refugees-
| citizenship/co...
|
| Until this year, asylum-seekers could transit through the
| United States into Canada under the Safe Third Country
| Agreement, by crossing the border at an irregular crossing
| like Roxham Road.
|
| Sources: https://www.cbc.ca/news/politics/deal-roxham-road-
| migrants-b...
|
| https://www.cbc.ca/news/canada/canada-asylum-seeker-
| increase...
|
| https://web.archive.org/web/20230601135133/https://www.nytim.
| ..
| DoreenMichele wrote:
| A quick search suggests there are 10.5 _million_ in the US.
|
| https://www.pewresearch.org/short-reads/2021/04/13/key-
| facts...
| mitthrowaway2 wrote:
| On a per-capita basis that's not hugely different, but
| one of the reasons may be that Canada provides a
| _somewhat_ easier path, relative to the United States, to
| becoming a legal immigrant rather than remaining
| undocumented.
| [deleted]
| lazide wrote:
| Really? I've had relatives try to immigrate to Canada
| (from the US), and it was quite a horror story. Any
| specifics?
| nemo wrote:
| Relative to Canada the United States is even more
| difficult to legally immigrate to, consider that the US
| system has been constantly adding ever increasing hurdles
| to legal immigration for ages.
| spanktheuser wrote:
| A quick search suggests there are 335 million Americans
| but only 37 million Canadians.
|
| https://www.indexmundi.com/factbook/compare/canada.united
| -st...
| prepend wrote:
| So Canada has 1/10 the population of the US and 1/20 the
| population of undocumented immigrants.
|
| So seems like Canada has many fewer immigrants of this
| type than the US.
| LegitShady wrote:
| Canadas temporary foreign worker program means you don't
| need to illegally hire day workers, you just keep the wages
| low enough that nobody will take the job and then tell the
| government you need to bring in foreign workers - not for
| professional or technical work, not for picking in the
| fields, but for working at McDonald's and tim Hortons.
|
| They also allow international students at diploma mills to
| work 40 hrs a week, above the table.
|
| It's a sham.
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