« The Weeds

Childbirth, retirement, and terror in between

2015-11-20

This week, Ezra, Sarah, and Matt discuss the flaws in the DC elite's favorite idea: raising the retirement age, consider how to respond to terrorist attacks (with a bonus digression about 19th century anarchist assassins), and debate a striking new data set that shows the baffling variation in how frequently different hospitals perform c-sections rather than traditional childbirths. This episode is brought to you by Squarespace. Start building your website today at Squarespace.com. Enter offer code WEEDS at checkout to get 10% off. Squarespace—Build it Beautiful.

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This is an unofficial transcript meant for reference. Accuracy is not guaranteed.
This episode of the weeds has brought you buy square space, start building away said today it square space, dot, com and your offer weeds at check out to get ten percent off Square space builder beautiful. my task ahead of the just its daily show about news and culture and whatever flits across my consciousness. It's good! It's funny! You like it. So recently we had a series of conversations with Fordham University Criminologists: John Faff. The issue was mass incarceration and how reforms just not daddy's at some point we're gonna have to asking how we gonna tree violent offenders, and no one is really talk about that at all subscribe to the just that I too die com, slash panoply or wherever you get your podcast. The following podcast contains explicit language
Reviewed gouged seventeen sixty still see in front of my couch hello, welcome to another episode of the weeds boxes: policy, podcast, mechanically network Matthew, Iglesias with me as usual. My colleagues are clear and has recline back as it is back. We had some complaints about the sound levels on unless weeks up so so we're going to try to speak directly interim profound, and we also fire Dylan. You know there will be no more problems like self critique such got into, and we ve got a great show for you today, where we're gonna space things up a little bit by substituting a data set of the weak instead of a white paper of the we anarchy here. It says that in a week when we like to get wild, especially as far as the days grow shorter, it's important to keep the shows Trusting you know, but first I think we are
to talk about an important sort of long term policy question that some people have written into ask us about, and it's a question of. When should people be we're tired jerk, though before I say that I got to listen to the weeds as a lesson to us, we can, I learned a lot about universal basic income. So thank you, your favorite fact. I don't do that, don't riddle. Put me on the top of man is always badly inaudible due to poor level of us. Get anywhere is like the conceptual question that was raised of there being a kind of the mirror image problem in the way the two parties to think about a universal basic income that what you have on the on the right is an effort to bring down the government away have on the left is an effort to make a much marks answer than advocates an interesting example of a policy that people constantly claim two sided support for, but what the two sides believe there supporting is very, very different when you get into the details, because it details
I mean it's weird- to talk about eliminating Medicare entirely as a detail, but that is one of it. He tells us that would be. There would be at work here but just as I listen to it, if people have not, they should in this era, Clifford will test you on whether you had I well good comprehension. Memories of it said I'm here for its own, it's all going beyond the exam. So I wonder about a policy that I think of his kind of at the centre of, insofar as Washington. you know the way people talk about it as a singular entity has an ideology is sort of smack in the centre of it, which is raising the retirement age. If you look at the Publican racer president, this here, you see a very large number of candidates who have already proposed raising return teenage JEB Bush. Chris Christie, I believe, Rand Paul number them, although I don't want to get him be wrong and memory here. But if you kind of go back into recent budget deals and the or at least proposed budget deals like Simpson Bowles, you also see it come up a lot. It's
These things that in Washington and in budget conversations is spoken of his in no brainer and people present the fact that we haven't done it more recently. It's worth noting that the retirement age is currently be raised a little bit every year because of the eighty six deal, I think it is. who have to some time any adsl terminated Reagan, Tipp, O Neill they'll be word. We riddles small share of what this is the thing that people talk about us not doing it as an example of everything being broken and caution and Alan Simpson, who is the coach of the Simpson Balls Commissioner, senator said if you can't raise retirement the sixty eight by the your twenty fifty without the eight hour p losing their marbles than the country just won't, make it His numbers were off because I think we're raising the terminator on that anyway, but nevertheless his point there is taken, except that I think, raising
Tom and age is a really bad policy. I think that it is a really cruel. Policies speaks to some kind of deep class biases in Washington political. Conversely, and- and I want as a framing nosey, I'm acting not against cutting social security. I'm not sure we don't spend too much. and on it. I really think that spending on it is poorly distributed, but I think rays Retirement age is a policy that are supposed to a simple targeted cut has become very popular because it's him sort of bad lazy thinking. You often hear people say, for instance, that we need to raise retirement age because life expectancy has gone up so much sense of security was in. But since you know roughly seventy, which is close to the last time we raised it, life expire,
It's a gains have been distributed by income level. You seen, I think, a six year life expectancy gain for the top half the income distribution and a one point. Three year life expectancy gave her the bottom have the income distribution present, this a very sharp class, skew medicine life expectancy, but in what does it mean to people? working into deep sixties. So what so Ellen Simpson, whose a sort of a delightful character after a fairly extensive career in elected office, went and took a job at the the Harvard instituted politics which he was wanting went when I was an undergraduate there, so I got to know a little bit there and he was an old guy that time and he had a good Senate pension, and you can always, as an ex senator, get it check from here. There or do a little lobbying a little consulting right you want to, but he had a real passion for this project of engaging and people in the political system and after that he stepped down. But hidden did this Simpson bowl
commission- and I dont know if they paid him or not, but you won't work. He wasn't doing it because he was out of money and needed needed to get some food right. He. He really was interested in this idea of barnstorming the country to try to get this entitlement cutting project, that's great. If you around and went on the one hand there their jobs at the difficult, in the sense that you have to get up in the morning and to some extent fly around, but it's not physically taxing work and its it's very engaging to him right he's he's a privileged person was the opportunity to work on projects that he thinks are really Morton and meaningful. But when you talk about raising the retirement age, you tell me, for a lot of people year as a line cook another year as a cashier Walmart another year as a long distance truck driver and this
wrong with having jobs like that, but they don't inspire the same kind of feeling and commitment in people, and you really talking about too sharply different universe of work, and when you look at the people making the decisions about this, this is probably pretty obvious, but they fall into Ellen Simpsons Category, not the lime cook category. These are people who are less later as they decide to run for office again, I think it's hard work showing up to campaigning you too long. Our its long hours later but like their most of them, are not doing it because they need to draw seller they're doing it because legislating as an interesting citing and they get ready again. Average age of senators is like a hundred comically rising people. I dont know what you'd see seems like an our job to me honestly about the people who have an hour is obviously the artists and their experience. Working these people who are going to decide to nor are we going to raise the retirement age is very different from a lot of people. There
We have a great and their numbers around this, so that what they call the normal retirement age for social security, sixty five or roughly the merits of the thing it's up up a little bit because because of the way we're raising retirement age even now, but you can get maximum benefits, bartering. Seventy and you can begin taking so security was held early by Bert, Harriet, sixty two young at a smaller check, and if you look at when people really retire, the average age of retirement acquaint gallop is sixty two that to me, as a very powerful revealed preference their retiring as early as they can for most people they want to get out perforce. They don't enjoy their job. They want to spend a couple years in and if you're on in the poor have the income distribution, the actual tables suggest that is gonna be fewer years than if you are richer and that they want to spend some years and in retirement. and it's this is. I think, the reason that the discussion of retirement age and particular discussion of it obvious common senseless rubs me.
Wrong way and in a way a lot of policy discussions. I just kind of disapprove. Don't you You look around Washington, not just in the house in the Senate, but you look at think tanks. You look at journalism, people don't retire at sixty two or sixty five, I'm a long way from a tournament. So it's hard to say what my preference would be at that point, but you and I what we were doing this kind of writing when nobody was paying us to do in college right. We started out as as bloggers we we are very lucky to have the work that pays us be work that we love to do in and that's a tremendous privilege, but for people who kind of live to work as opposed to work to live. I think it is very easy to approach a cot like this and think it is painless and its one reason I much more comfortable with a cut that fundamentally to cut aimed at retirement
does. Is it is a cut that targets people who hate their jobs, because you don't hate your job because not going to hurt you very much, but I will just be more comfortable with a straightforward cut. You just said people in the top half the income distribution are going to make this much less from social security going forward or another policy that you could do that actually ends up closing more of a social security shortfall about about twice as much as raising retirement age to seventy is to lift the cap on peril tax income. So people make more then- and I might get this number Lebaron commemorating its run a hundred fifteen, but it might have gone up a little bit in recent years, but people make a right
the hundred fifteen dont pay payroll taxes above that threshold. If you lifted the cap, it be very big increase on the kind of people who are having this tax discussion and be very big increase on members of the Senate and be a big increase on people who are high up a think tank to be a big increase on journalists who are doing well and yet there's a lot less enthusiasm for it, and I think this is a place for this quietly. You see class preferences really affecting what washing and thinks is an obvious idea. Verses. What it thinks is a sort of a class warfare idea, but I think that its worth trying to be a little clear about saying that I think liberals And always understand about one of the reasons why cutting social security in general is such a passion point, but for certain people, which is I I went to an event, earlier this year over the summer- and I heard Elizabeth Warren giving a talk in. It was a very big picture. Talk.
And she was trying to lay out. You know a sort of progressive liberal pro be government agenda for economic growth. And you know you can sort of imagine how it goes right, she's done many infrastructure to strong message occasions at Helstone, where basic research and its a good speech, you can look it up She talks about regulation to her idea is ok. Government has an affirmative role to play, boosting the economy and in making America the great society that that it is not the amazing It is not something you know, like liberals, really believe in, and it's something that more moderate, more centrist people part of what makes them more moderate people is it. They appreciate that liberals are onto something with this, that this conservative cut everything approach is wrong, but
not true that spending money on helping old people not work, boosts the economy, and that's really one of the main things of the federal government spends money on. If you look at social security, you'll get Medicare and you'll get a portion of Medicaid that is going to senior citizens. It's a huge so one of the non military side of the budget and not only does and boost the economy. Readied actively impairs the economy, the economy, meeting GDP like GDP would be higher if all those people would get off the golf course and go work at Walmart right, and that's the reason why establishment thinking where which is very influenced by, The views of the business community very influenced by the desire of politicians to generate economic growth is always so innocent targeting these programmes, because if you could take money out of paying people do not work and put it into investments in here
capital investments in infrastructure things like that. You would have a real sort of boon to the growth rate and to make the case against that kind of move. You have to make the case against economic growth, which I think is not impossible to do, but it isn't something that liberals it a comfortable doing? I think that there is another liberal idea on this that has pushed the conversation prettier and social security in a direction of weird fixes. It can be sold as technical, the retirement age, but all something else we could talk about change. phoebe I amount is. There is a very pervasive liberal idea that the reason social, security and Medicare our strong programmes is it. They are universal and then is really important to keep this kind of abstract concept of you.
Sovereignty as represented in the precise current distribution. More or less of benefits in order to keep the programmes from losing their support among the upper middle class among the rich that the ideas develop- is hugely broad coalition in a way that progress for the poor really happened and as such, if you begin to cut those problems, you begin to do means testing on them. If you did it, get it caught at the upper income seniors. You would be and even if that cut would normally be something liberals would support. You begin eroding this kind of very, very broad and very powerful coalition that protects these programmes. I am looked at this from a different angles and hunted alot reporting on it, and I just don't think it's true. I cannot find the evidence of all these other programmes that are large but much more targeted, the poor that are so. We
they are constantly being cut into pieces. I mean, if you listen to republican rhetoric, which I think are on this sexual desire to be correct and telling when they talk about medicate and food stamps, what they see is a suitor on ending year on year, expansion of the welfare state and they see that be. As it has been an unending here on your expansion of the welfare state. These two programmes have, under both Republicans and Democrats, been expanded significantly and so actually think that that one thing that keeps his discussion from just being a normal discussion about what we need to cut spending or raise taxes. How do we do it Should we do it on? Is the idea that if you allow there to be something that is framed as a cut that cuts piano upper, come people you all shatter. This idea that Social Courtesy, Universal Programme, then you'll shatter its political coalition, but just think this kind of spending is alot tougher to cut in anymore politics and honestly over extended periods of time,
you to expand the lot of other people do it. You know, medicate has gotten a lot bigger in recent years: fruits Umsuka lot bigger social security, disability insurance, which is a little bit of midway programme here, has also for reason. Some people like, and some people don't gotta a lot bigger. I'm not sure the universality argument goes as far as people want out. I would push back and not allow that particularly focus on Medicaid right, think it actually, I would argue, actually is easier at this point to make changes that cut Medicaid or we just accepted less of a standard of Our four medicate patients than we do for Medicare through, for example, Medicaid, typically pays less than Medicare and adjust standard fact, and that means that meditations dont get as much access to doktor. There are fewer doctors who take met paid than take Medicare. Another great example. This contrast, I think, as of this year in that way. It's bizarre podcast, but if you look at the Medicare Doc facts, which is this cliff, though every we use it every year where there wasn't enough made on Medicaid Congress find the money they will always find.
Neither would always be able to keep payment steady. You saw the exact opposite happened with medicate, where there was a kind of payment bump fur their care doctors as part of Asia, and they were also facing uclaf. There also looking at this cut to primary care, Medicaid doctors and all the interests around. Medicaid really tried this to make this a dock fix. They tried to say you can't. but these reimbursement patients are going to lose out and they lost Congress. Let those payments fall. So I I would give a little more credence to those concerns that we have so many who do a wise middle ground here. I think that the issue is not so much programme cards, but its programme quality right that when you have public services that middle class people you lose, the government tries to make them work well read when they don't work. Well, it's a big freak out. If you remember back during the original sequester huge across the board, cuts to everything
poor moms could not get their kids into preschool. The political system did not give a flying fuck because he does not care in a really fundamental way. It does not care what happens the poor and did not order no right but airport, secure, you we're gonna do on and they fix them. Gotta, be because member Congress and donors like if they fly on airplanes a lot right, so they really care. So I think that if you can make financial cuts to Medicare that still have upper income, senior citizens using the metal program. You know you can have more cost sharing things like that, but is one, is there still a benefit to them to, in some sense being in the medical care you preserve what's most important about it, which is that if suddenly doctors want touch Medicare, the alarm bells go off, but would you dont want is for programmes, important programmes and people's lives to reach the status of
city bus in Cleveland words and totally marginalized social service, for but who are not participating in mainstream society and nobody has any idea if it works. Well, I mean not just single: you live at the Cleveland Transit system, which I get him. A big fan of the weeds was as it did not expect have. Had I write I have. I have written the boss. I try to make a point when I go places of checking out their local bus systems and you know how to say, like God, bless the bus drivers in Tulsa who a really nice to me and are trying to do a good job. But but you see that if you have these cities right now, like New York, but cities where quoting quote, everybody has a car and drives gonna, go out everywhere. Actually, there's like poor people, writing a buzz and its turns into garbage, and it would be a problem if health care for senior citizens reach that kind of stuff. I agree, and I very much agree political programme quality
I, was slightly different red on the Medicaid start, which I think is an upward trajectory, even as it's been a much cheaper programme for a long time for covering many more people through, it Obama care digging, increase reimbursements in certain ethnic specialities and parts of the programme and I think that the overall trend of these is towards expansion, even if they start much more limit of medicate at its outset was a really limited programme and its become a pretty big entitlement. But but you, you bother, definitely write about quality dimension of this. That that's why I mean it's not a binary thing, and this is why again, I think that the discussion over so securities odd right now, social security is a much worse deal for rich seniors and policy. does it mean right now the programmes already a substantially progressive and is no comment. Right- and it is this minor interest money, but that its really well done in that way.
there is an issue right. Food stamps once you're on them are often pretty efficiently administered, but their places- and this is a lot to do also, I think, with whether you make a programme state, federal or just federal their states. It make it incredibly difficult the sound of her food stamps. Breakfast places that make it pretty easy, but under George W Bush, the actual distribution of those benefits was. I believe this is right made electronic, which was a huge improvement. George W Bush tried to take the stigma out of the program. By renaming and snap, he tried to make it more like a debit cards. He weren't going with his very stigmatizing looking little voucher. He have. She did. I think some really good work there, but I think that we are so far from a place where you would threw doing just more straightforward cuts, be changing anything significant about the political equilibrium underlying social security, but I think we end up
racing pretty bad policies in order to stay away from this kind of political fear that that a lot of liberals have he knows I mentioned chained CPI or earlier in which is a way of changing the inflation, the cost of living increases when so, Kennedy and similarly, the retirement age, people like people justified as a technical fix, your just we live longer, so the retirement age should go up a little bit and I just think it would be better to just be a little bit more straightforward and honest about what people want to do. If you want to do a cot to say what the cut is, and we can argue about what they cut as you onto a tax increase, stood a tax increase, say what it is, an argument that tax increase. But there is an effort, I think, to make pretty complex s, o terek changes where the reason they being proposed is because they are complex is because they sell ethnic in a certain kind of way, but that often ends up meaning that, in order to hit that mark, you end up having to have a much stranger distribute
the pain than you would normally want. I think in a normal world people not say let's target our social security cuts, it people very miserable jobs, but they do that because it allows mucus. their political argument that all this isn't really cut? This is just keeping up with life extension trends which abroad a word about this change, sepia idea, although there's probably more weeds there than we can, we can fully get into, and I even tenos we need to. I, I need to come prepared with a good mathematically, correct example, but the basic idea is that social security. When you first claim benefits, you get a cheque which the size and the check is determined by how much taxes you pay and by how old you were when you started taking benefits and a couple other thing: zero illegal to Europe, yeah. Well out of that, your marital status. It is a pretty complicated formula, but gives you an initial check and then what happens every year that chickens adjusted upwards in line with the consumer price index, which is the
german of inflation. That comes out most frequently, and that is most well known. But. The most well known because, as the oldest one, that the government publishes an in subsequent years they developed more technically sophisticated methods, including which was called chaining, which is to try to account for the fact that, when the relative prices of things change what people by also changes ride. So if the price of cheap terrible cheese goes up a lot and the present fancy cheese only goes up a little normal people are gonna shift and start using more fancy cheese and a little bit less cheap cheese, as as part of the response to that right, and so the can general sepia doesn't account for that kind of consumer behaviour should be used, was called the chain sepia I or the one the FED uses, which is a different.
Index. You basically reach the conclusion that inflation is a little bit lower. So popular idea is what we switch inflation measurements. Then inflation turns out to be lower, so we sent checks that are smaller, and these two issues about this one is that the technical, economic, of chaining verses, not training, and the other. This is to address point is that this like a lot of work and its very complicated, and running through the math is weird and what it all comes down to. Is they want people's checks to be zero point? Five percent smaller in their year to year, increases right and insight much easier to explain, but the pros and cons of that right that the cons other people will have less money. The process of the gun, have more money and its across the board right. So if it is actually very soon
to debate right where's, debating that technical merits of the inflation indexing thing is, is really weird, but that is a future, not a bug of that. That's what I don't like that is. That is why they do, and then you end up with these weird situations. We have all these complex formulas bumping into each other like what we had with Medicare this year, where you have a price. You have cost increases security that doesn't happen, and then Medicare has hitherto that in some way and and Medicare benefits are all of a sudden costing like a hundred. percent more, and you end up with these very bizarre regions that would not have happened. If you too said: ok, we're gonna, cut social security or point o five, four I didn't know that until recently way they didn't do cost of living adjustments for social security. The Czechs we're just fixed in nominal terms, and then Congress would, on the fly say we're bumping Ben how has it been tangier? Won't like no issues like the minimum. We owe you know where would have. This weird saw to thread
and so in the seventies, inflation was getting really high and they decided we need a more automatic system, but the idea at the time was that what actually restore, even so- carries mending that are used to that there were just kind of always be this political push. The way there is now with the minimum wage for Democrats really like the minimum wage issue oh yeah, we got it. We got to help the seniors out, and so they they switch to this inflation indexed thing and now the conventional view is that the inflation index thing hers too generous, and they want engine around, but I think the favourite might sort of favorite site least favorite hide the ball. Move on this is that everyone so security plan right. You can make the most hard core stone, cold budget cutting public in Washington and they are telling you that if you are fifty five years old that ten years from now, you can start getting social security and you can keep getting it for one in five thirty forty years and that across this fifty year time span, you are not going to see any cuts under their play.
right and that's it that's a view they take towards any other kind of programme right if they want to cut food stamps a convergent tomorrow and it sets clever, yes, because I think it's important, but its attitude of virtually all of the republican budget plans right now that do things like Medicare premium support right now, verging on the republican budgets touch so security at all like if you look at the Rhine, Butscha plenty used to rhyme is a big Could he privatized are perfect, jab social security play. I Christie such as badly, but now that their external come out them all of em say that none of this affects anyone over fifty five right. It I'll begins for people who are fifty four, younger rights. It is not just that it doesn't really a crack. Howard hang on earth. It's like next year. Cry like
of Amr CARE as like repeal of on agreeing with another go, you have a monarch every decade, because people still eyes for a long time. I think I've been written about as if their saying, ok, there's a ten year grace period and then it for rising, but no they're saying it never phases in Russia. This Hugh, like a generation or two generations of people speaks to us, is weird as extra political coalition issue. I think a very interesting tension in their public and party right now is it. It is simultaneously the party of government cutting right and old people, and old people, rely very heavily on her head of government programmes, and so republics have come up with his kind of maneuver, where they say their senior voters. Ok, none of these changes will affect the EU, which is those young people you don't really high and that we don't really. We don't really need right itself. I remember when there was a lot of when oh Mamma care past. Actually there was
a lot of smart wonky conservatives are upset about how the Cadillac tax was being delayed until twenty eighteen and they argued and were seeing some. This now they argued well, it's delayed until twenty eighteen in this bill is passing in Budapest on twenty Ten and twenty per head answer ass, ours, eyesight twenty ten That's gonna be plenty of time to repeal the Cadillac tax and you're seeing right now, as we come closer to the catalogue, tax happening, the correct text being attacks on very expensive employer provided insurance plants that there is a lot, effort repealed, I don't think it will be repealed, but definitely could DARPA chives down that he ever radiology. We can circle back, but I guess I either way. That was a good argument that Republicans it then put this much longer lead time into their key entitlement reforms, and you don't see that much anger about it. It's just the sort of a political compromise had people on the rioters, except that they have
to make any needs it. It's an odd kind of portable compromise, because the idea is that, ok, if you can't achieve full liver Toby, I read you have to: u have to settle for selling last, so what you should set, four is an enormous cut delayed into the indefinite future, rather than just like us, all right, I didn't like up much more politically convenient to no compromise. Where right you could circle back into it. You can get rid of the unpopular things as they become. You know not a decade away, but you don't one or two years I mean I think it's actually hard to know ready mean what is being proposed is so outside the realm of actual experience. The right to pass a law in twenty seventy and there would radically change the nature of Medicare, but not until twenty twenty eight and only for a tiny, tiny, action of Medicare recipients, I have no idea what would happen in twenty twenty eight. If that actually came about
So I can think of anything remotely along those lines. Right you'd have this programme, for its first several years. Right, almost nobody was in right because everyone is to younger to old. Wouldn't, like would people sign up it all just seems a little. It's it's hazy exert its driven by you know. A lot of these conversations right people are really this is very high prestige in Washington to talk about the long term by picture and you can draw these great charts and, like the CBS, does them lots of people? Do them and isn't it you try to bring them back to reality, social security is first pass in nineteen, thirty, five anything but the seventy five year. Time projected from then and your skipping worldwide to the cold war. People travelled to the moon, the cold war ends,
antibiotic speaking with things right suddenly there's like workable medical treatments. It's very challenging to bring some of those lines on the chart down to re, there's an amazing c r s table. I love that are put in showed a rational research service. As its though I may do a bunch of research for Congress, as their name implies, but it shows each year the projection for when the Medicare Trust Fund would go bankrupt, as obviously never gone bankrupt. But there's always these projections. They very completely wildly like it's always times two years away, is among the fifteen years away, because, where small changes in rural areas, because they have no end no unexpected, like an Medicare, you know new Hepatitis C drive comes on the market on a sudden, there's a massive cost or costs low down a little bit interested. I think it's very interesting because it shows that all these actions that we rely on year after year are missing so it is obviously an obviously they wish you good fortune ass to the future direction of medical technology. You will not be
working at the congressional deregulation projections right like you, could make like billions on Wall Street with that right. But we could also is a country just do some smart maneuvers around that an insult our budget problems in a much more and much from their way. I think we should move on from but before I do, I need to facts like myself requests. Ok, it said earlier. I, in response to it, when I read announced Simpson, quote that we already moving so skirting toward sixty eight, the current maximum. It's going to reach a sixty seven sixty eight would be an increase above that real time backtracking awesome. Let's talk about a sponsor and then we'll come back with some exciting newsy topics it is out of the weeds, is sponsored by square space. You guys, if you listen to the show before or probably any pod cast you. You know, square space at ease of the people that help you build a professionally designed website. You don't need, any real web skills that there's no coating require although they also do if you know a little code, you they have the option to let you go in there and and customize things, which would
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Square space, build it beautiful. So this week, while we are walking out about retirement ages and an entitlement programmes, normal people are talking, bout does rather spectacular series of terrorist attacks that were carried out in Paris involving a large and were people seemingly coordination across several different country. and you know it. It poses the question in some ways, particularly because this did not happen in the United States. France is an interesting middle ground, a lot of times. Things happen in the developing world and nobody in America cares things happen in the United States and its equal America as to do something. France is a country that,
people have been two people follow news about it. A lot, but is also not did the USA, so we get to sort of observe a foreign country processing this, and you know we heard that the President of France vowed in his speech to wage merciless war against the people who perpetrated this, and- and I saw that the french newspapers- and this came up allow do be recognisable to Americans I'm said: set colossal again this time, it's war right. So it's a big deal. They want to have a big response and in the question sitting here is the go. What book in France are actually do war? Why is that will improve this right, so their increasing the pace of bombings of the ICES Capital and Russia, but other people? already bomb that city as it turns out, and they sort of you know you go when you start bombing someplace you look down, whoa whoa whoa would be good to bomb and any hit that staff and then While what else have we got? One of us
We got it right. There was a story in the New York Times. It's it's hard to report out of the centre vices territory, but the time Lebanon corresponded whose name is escaping me. It s a fantastic job of getting in touch with people living in Lebanon, who have relatives who live inside ices territory and searches were counting a little bit second hand what they're telling her. But it it's the best. We can tell em they're saying that the French are basically bombing nothing that their bombing stuff that has been bombed before and that arises is long since vacuum, waited that they're. Just sort of you know, thereby So there was on the list, but that the American AIR Force a Navy is full of more who, just like forgotten, to take out this terrorist headquarters that somewhere the ices all have moved there things either into areas where there's sheltered by the civilian population and western governments are reluctant to bomb or its hidden somewhere, and we don't know where it is, but there's not great stuff left to do. But so you have this, this emotion,
desire to do more and to really do more in war terms about this, you would have to either start inflicting more civilian casualties or you have to start putting more people on the ground and western governments so far have been very reluctant to do either of those things. Basically, because it's there it's a bad idea and will make the situation worse. Can I can. I too, Abstract is out a little, but I think that there is a big You hear that is present beyond the the ISIS attack in Paris, which british and Irish is a security expert in an unwanted things. It he really focuses on is a relative risks of different kinds of things and and and part of the way he should it came to prominences. By making this argument in very vivid terms that terrorism is something that scares her.
deeply, but is not if you look at what ends up killing Americans people first relations generally, it's just not one of the really significant risks we faced, others tell risk issue around nuclear weapons and so forth, and we can. We can talk about that a little separately, but his great line that he's homeless
said terrorism is a crime against the mind, and that is not to take anything away from the unbelievably horrible slaughter of actual people, the destruction of families. I mean the wounded. It's obviously cruelly also a crime against the people who are directly affected, but I dont think it should take anything away from what happened in Paris and and its horror to say that in seven days, more people die from gunboats in America, died in the Paris attacks and we do not have the reaction to that that we have to the Paris attacks, or is it that the way those attacks are carried out create a feeling, even in a country that was not affected directly in terms of being there of just tremendous deep vulnerability at group like ISIS, but also group prefer
like Al Qaeda, do not have the capacity to beat America on a battlefield; they can't do anything, but our aircraft carriers- you don't have an air force, they are not going to invade us. It is not a war like that. What they are trying to do on some level is scare us into achieving their goals for them. Whether that goal is getting us to stop mean ISIS and the Middle EAST. Whether that goal is as it was to some degree for frock ADA to get us embroider old in endless wars in the Middle EAST, it would destroy so to the american Empire by draining it of resources, whether that goal is simply to make us afraid and one of the big things it's come out that its begun to be. As a direct response to the bombing and the attack in Paris, a backlash against refugees and ices hates these refugees end wants them turned away, wants them to be treated like garbage in Europe, because then they can actually recruit from among this population, and I think the thing that
It's really hard to deal with it and met your and of our good piece about this and about the way the Obama administration thinks about it. But I think the thing that is very difficult about terrorism is that it pushes you towards emotional responses, are counter productive at the point of the tactic is that it puts you in a place where the thing that you want to do is to some degree also the thing the terrorist wants you to do and that's why terrorism is really dangerous. It's not just the virus. and since this kind of psychological warfare of it- and I am not sure where we're gonna end up on the other side of the Paris attacks, but if ices is able to launch for five of these in different countries, I think they pry will be religious watching the reaction, I think you'll be very hard for
Do you ask send a ten other and other nations that are affected to save this is unbelievably horrible, but it's we cannot get pulled into a land war in the Middle EAST over it, because it is that this is going to end up killing more people. There is a real, an inability to wisely fulfill the emotional needs it. This kind of attack creates an feels like very like a large scale version of like something we are all familiar with. Like picking a fight, we kind of proud someone poke someone to they respond. Almost like the largest scale version of. Yeah we're trying to kind of code, someone in back to the thing if we are really was interested masterpieces generally this weekend boxes idea that grey light. So great site this violent black hawk veto has really enjoy greater effort. but what I really don't think it's very hard to see the speech. That Obama goes its Kynaston, though, as I was saying that basically says you have these terrible things have happened, but you know we're not we're not going tourists.
Because of reasons excellency, and we don't think it's the right thing. We don't think you'll be productive, soon, left with these option, is that the about menstruation doesn't seem to appear to think are good options. Are productive options are option that will make american safer in any way but also this sort of situation seems to demand some kind of action. put and in a very tough endemic. It's by MRS Lulling, I mean, I know the day that they worry about alive, because you can have a situation right in the late nineteenth Ninetys, there were actually things the Clinton administration wanted to do against Al Qaeda that they could not do that. They thought were politically, not feasible that he was not gonna work to put a lot of weapons and manpower into helping the northern alliance defeat. The Taliban and Richard Clark was working on these plans. You know he had them, and I dont know if Al Gore tells himself
in his heart, said like he would have rolled it out if he had won the election. But the fact is that machinery was not going anywhere cause. People didn't think it was a real issue, even though the experts thought it was real issues like the public and the political system. You know really sort it didn't, and the FBI had. This wish list of civil liberties, crushing ideas that they had drawn up in the wake of Oklahoma City and that Congress Republicans who, at the time were into privacy, had stop them from doing and to the nine eleven happens? Am there was stuff that people in the government had about? You waited, and rightly or wrongly, they thought it was a good idea, good counter terrorism policy, and so they did. The Obama administration finds itself operating in a climate where everybody thinks terrorism, particularly islamic extremists. Terrorism is a big problem and in fact they think it's not as bigger problem as many of the other actors in the political system right there on the more David end of the spectrum,
they are already doing all of the things that they think it's a good idea to do right and if something terrible happened right, if dozens hundreds, even thousands of people were killed by terrorists tomorrow, it doesn't change the fact that the Obama administration has already bombing all the stuff that they think it makes sense to bomb that they are already doing. The farm see that they think is the correct one. But you see right, of course, France alone do not respond to this terrorist attack. By saying you know what this is accomplished, problem, the West has already been working on it for a number of years. We really think that doing more staff would be useless or possibly even counterproductive, so we're just gonna kind. I keep on keep on keep an eye on right. You you had to say,
thing and its particularly challenging for the Obama administration, because they know that there are lots of people who want them to do other kinds of stuff right. I mean there's agencies, then why more funding? There's John Mccain and one gram and in the Senate we wanted to invade a thousand countries. Any really fear stuff, like MIKE Huckabee, said right after Paris attack that this shows that we need to cancel the deal with a ram I know that makes no logical sense. Things have nothing to do with each other, but as we saw when the USA Navy had not heavy IRAN not having a nuclear weapon is the kind of thing for this but it may need not even a beggar ain't there. My own language is fighting ISIS right. It's it's nonsense, but You saw after nine eleven right, so we invaded Iraq according to two Richard Clark done Rumsfeld at one point said that what is no good targets to bomb and Afghanistan but they had this like long standing desire to invade Iraq, so it became a good reason to do it. This
RO. I ran into an axis of evil in a speech, so IRAN, which had been saying oh hey, We ve been actually trying to fight these Taliban guys for awhile. Why don't we collaborate? Oleson was like a holy shit rusty right because that's what that's? What happens? comes a reason to just sort of take off the shelf. any old thing that anybody wants to doing Anders evidence right now, like northerners, things are working, but that ices is possibly losing in a way I found Zack Beecham's peace. Also on great website boxer where he is going to brooking, I think brooking, Wilma Chemical plants, which will put an show now it's great book on yeah and he did a fascinating interview over the weekend after the Paris attacks. Basically, his accounts theory of why these tax were happening right now. Is that essentially ices is losing ground or losing space they less territory than they used to and that they are kind of lashing out in this way to get more attention.
To kind of almost pleasant to you know some of the things that are happening, uniting us fixed as yours point. Rather psychology of terrorism. really hard to reconcile what happens in Paris with the idea that that ISIS is losing feel very separate base, its feels very more powerful, but there's actually evidence of the opposite. It's also partially, Ices is a very unusual kind of actor. Ices is both a quasi state actor and now their becoming a sort of they weave OZ connected them correctly is initially began as a branch of them. Without Kate up, but they didn't initially really have the same goals. L kid I'll Cato was, you know they had a sort of long term Apocalypse Caliphate scenario, but in the near term they were launching attacks on western part at something that was really why we cared about them. Ices has been very focused on being a caliphate in the Middle EAST right now and an end in itself. It is a state they are holding territory
are running oral money. They are administered in their version of justice. I'm now our lag. They have a flag. They did not want to be an of war with the West Indies, not initially what they wanted was to be left alone to create the caliphate, and then they started being bombed by the West and now is Mccann says they ve about twenty to twenty five percent of their territory, and so now they are developing a hybrid roles in international terrorist organization as well. Although one of the more defined base him up, Patients who are saying that AL kid also had a recently defined based operations at different times in Afghanistan and in Somalia at another point. But but it wasn't, they weren't the government in the way they did ISIS his government. I also think that it's important to distinguish between two things that we often conflate when we talk about terrorism and its not that they are both terrorism, but they are. There are very different in their effects. I'll caters attack in a nine eleven was really spectacular. Attack using very unusual weapons right they crashed planes into things were
the closest you can get if you dont habit of of launching a missile at America. The thing we worried about after nine eleven the wasn't guns it wasn't even suicide bomber. Where did we get more speckly were worried and not just spectacular but dead that we worried about biological agents. Word about chemical agents who word about nuclear weapons word about weapons of mass destruction. That was the key word right, the whole time. That's why we in theory one you, Iraq, that we were worried. What happened right now from We can tell anatomy. We can tell the future a hundred percent,
There has been a lot of work and out enough it's enough, but a lot of work on the part of America to try to fortify against nuclear weapons against chemical weapons against biological weapons. That is something that oh bomb has a very deep abiding interest, going back to his time and Senate with with Richard Luger on nuclear, non proliferation on boost fissile materials and there's a lot to be afraid of their. But but that is something where a lot of different act as: U S included, feel that they have cut the possibility. Quite substantially, there's more confidence when you talk to people about these issues now than there was ten years ago, what ISIS did in Paris a spectacular as it was, was very crude. It was suicide bombers and it was guns, and when you talk to me,
I'm administration. They do not think that they can with a hundred percent certainty or even something close to that, ensure that no one is ever gonna get into America either an American who has been turned by ices and already lives here or somebody. Ices somehow managed to bring it on about papers. Did it they're not sure they can keep anyone from ever getting it. America taken advantage of our incredibly easy gun buying system and going into a mall and shooting a bunch of people. that happens now. It happens in theatres. Now we know right that we cannot stop people from God. We have decided not to do really anything to stop it, like even small things and so they're kind of caught in this in this very strangeness, where they are terrified that this can happen. They know that on some level they can do what they can to prevent it, but they can't get anywhere near perfect certainty that they can prevent it, but
The cost is something that, on the one hand, America's already decided is willing to pay on some level. We are willing to pay the cost of continuous Gunderson ordered and not have more of a crackdown on weaponry. On the other hand, if a terrorist does it, the reaction is gonna, be very, very, very different in this kind, free and might lead to, and it could be under future president too, and might lead to America getting involved in conflicts that are really long term driver. Bad for us, but I do think there you see I do. There is actually a house Republican explicitly said that one of the reasons we can't let syrian refugees in it is. That is far too easy to get guidance of the United States. So I really do think that you're starting to see- and this is when we talk about guns ever episodes ago I mean I talked about Its- is just connection to people's cultural values right and so to people The liberal, cosmopolitan mindset read it goes without saying that the United States needs to be welcoming to refugees, but it does not go without saying that the United States needs to be a place where super ease,
to get long guns with big magazines and you can shoot lots of people with them, but there's another point of view right, that's just the opposite: incitement to preserve our status as a land of liberty, with easy access guns. We really have stringent population control in terms of who is actually present in the United States, because there is consensus white that we do not have as the laws are currently up. We just don't have a system in place to prevent, at of hundreds of millions of people living in the United States and hundreds of millions of guns in the United States. Someone is gonna, get a gun, he's gonna get some ISIS propaganda material and it's gonna shoot some people. We have enough people with guns, shooting a bunch of people that it just seems inevitable, That one of them will hook or some other terrorist organisations, notably with something veto, and we even had a couple things that should have walked up close to this right, but we
Never had this explicit connection to some kind of an international terrorist organization, but we have the shootings constantly, I'm not constantly, but its multiple times a year right. It's not like a outlandish hypothetical at all right and you can make connections through the internet. People who are citizens of european countries can travel to the United States without visas. So it's almost in that ability, it seems to me- and this really difficult question of what are we going to do when I am this seems to me in, and I dont know what I don't know, what the common I'm about to make. The observation about to make would even imply, but it does seem to me that, insofar as terrorism is meant to be but you are kind of psychological warfare- is meant to elicit certain kinds of reactions did the time to deal with. That is not after a terrorist attack
I am, and we can talk about this in future- opposite maybe, but I am for the most part, a I'm very sceptical presidential messaging is way to get basically anything done ever, but I do think that. This is something we above indecision worries about something that the next president, depending on their temperament. Well, we'll have to worry about, and at some point I think it needs to be part of a discussion with Congress and into somebody with the american people that this is world we live in in in, and we need to recognise that these enemies of ours, thankfully our week this is not the Soviet Union and that the thing they can do is is paraphile us Erik Erikson is a as a conservator
that and he lives in Georgia. I believe in any summers. Radio show that he's afraid to go to the star wars, opening because it's a potential terrorist target and another he got caught a made fun of for this. Given the deep, also often wants to launch a lot of wars and and so forth, but I am sympathetic to the idea that this is how it feels to everyone I mean it makes sense to. Maybe ISIS would decide that the way to really scare me answers to watch attacks in a bunch of mid sized american cities on a moment when people are just going in and have a good time logic star wars, but we're gonna hafta, you know in a long course of this country to some degree figured away to fortify ourselves against both the actual attacks, but also that the kind of tat that would follow. Them are also actually say that the best reaction and I must become a key Shania internet to be like the John Oliver Cleverness
but actually that John Oliver had a really. I was an hp. O comedian had a really good reaction, it s where he basically had this segment, where he cursed it ISIS for a while, and then he just said, you're going to fight a war with France over culture fucking love you're, not gonna, you're, not gonna win at anything. You are trying to do and he is They are not gonna win at anything there trying to do in, and we work in me to somehow come to a place where, hopefully, where we can mourn the victims of these kinds of attacks. As we should, I mean nothing. We're Seigneur should be should take away from the tremendous tragedy in Paris where we can fortify ourselves against him and in ways that a reasonable, but that we can also admit, as we admitted in with cars as we submitted with Gun DAS, as we had hid where people eating fatty foods are getting heart disease that just living in the modern world
they brings risks that we are not willing to do everything we can to eliminate. If that's how we feel that is a decision we want to make on the front end, then we have to be prepared. On the back end to say: watch us It is horrible. We are going to do everything we can prevent it. We're gonna respond ways of a smart, but we are. We are not going to change everything with believed up until this point, so you know sitting. That gives me a little hope when I'm looking for inspiration that it did actually is possible psychologically to maintain. This is in the late nineteenth and early Twentyth century that mrs a twenty year span of time from eighty ninety four until port or one breaks out, took twenty years later, when anarchists work killing people Willy nilly, they killed the present France. They killed the Prime Minister of Spain. They killed the empress of Austria, they shot and killed the king of ITALY. They shot and killed the press.
To the United States, tried to kill their that the king of Belgium. They did kill the king of Spain that they killed the king of Portugal. There was a bomb thrown in union square. There were come while sporadic shootings here, the chief of police of Buenos Aires was shot a nail bomb, went off in the french parliament, the Russian minister was shot. The head of the russian secretly. Don't lie fallow. Just on this. The prime minister of Spain, for a second prime minister of Spain, was killed the king of Greece. Then there was a bomb went off in John Rockefellers Hausa, but he wasn't around, but they killed like five guys there and kind of stuff was happening. It's unthinkable these days honestly. That attacks on that scale would go off like these people have security personnel read that nobody would ve. We dream that you could kill asks simply multiple european heads of state is mind boggling, The idea that the anarchists theory of this it was called propaganda, the deed and- and the idea was that,
they were gonna shoot these people and it was gonna suppose the sort of hollow rotten core of this somewhat democratic political systems at the time and the crackdown was can be so veer. The mask would slip and workers would see and it would be a revolution and whose didn't happen, security those were taken. This is why nowadays there is security around heads of governments. You can't just walk up in stab them. The way you he thieves, do it with it with these different people in a sort of profit. Sense like nothing was done right. They just got bodyguards for these people and you can kill someone who doesn't know bodyguards any just a faded writer a little bit mysteriously. What we're one happened, I mean realities changed, but they didn't do that. to be fair world, where one is an example of a political murder leading to signal You can't just, although not an anarchist strike, not in activities in their budgets to say there wasn't a war on anarchism ray was an underclass
Ending did this was actually was the strategy. They were trying to do enough crazy shit that the governments of the world would do something crazy in response and hold. someone come crashing down, and so the governments of the world they just they they didn't. They enjoy their victorian world order, and so they decided they were gonna, stick with it. we're gonna, make changes around the edges to make it harder to stop people and we actually hand France a success story right there. The security guards at the stadium prevented a bomber from getting in there, and so he blew the bottom up on the street right any it's difficult to call something like that security success story, because so many people did die, but so many fewer people died than if they had had that in place, and that's the kind of thing that you can do right. You can make it so that they can't kill the president and throw the government did into disarray, that they can't blow up a stadium and killed thousands of people that they take it a nuclear bomb and destroy a city, but it does mean that you have
you have to start to take those as windows on some level that are really determined. Killers are gonna, be able to find some ways to kill some people and does not that much. You can really do about it, but you can try to keep your society intact and that's. It seems to me you know what they did in those in those pre war one years and something that we have, I think largely gotten away from the west that idea of building some resiliency so that we know that we are going to survive through this and that the problem may endure for protection. For quite a while, but that, ultimately, our political systems will at last that problems to good boy, whom I think we should move to our data set of the weak right running a totally wild. Instead of doing a white paper of the week do in data set of the weak and big? Yes, it's ground for the weeds. The data set today,
comes from amino, which has helped start up in San Francisco, and they shared with me. Some really interesting data is collected on sea sections. This is a company they collect dear divide insurance claims. So they have data on over four million birth have happened in the United States and what does he see section? Sarah C section is basically a surgical delivery. Ever baby, it's a pretty routine surgery. The risks are well however, the risks, are much lower of having a traditional national, but the risk of dying during delivery, while rare and other any case is four times higher for a c section than for others, birth. But we have this really big rise in sea sections. Over the past two decades, doctors and patients like see sections because they make birth more predictable. You can literally schedule sees exe at two o clock on Tuesday and you don't have your baby and particular time just
broke their there's some kind of births where you do need to see that our definition of media healthy, so I'm a twin. My mom has these action because we're multiple babies, you recommended to have a section but firm, uncomplex dad low risk births of single babies. Typically imagined delivery is the preferred routes, but you ve had this is to huge Greece and sees actions over the past twenty years. Coming down over three years, as doctors have been working against. This anyways. You, with this dear said from amino, shows as justice huge variation in c section rates by zip code, one of them guess examples of variation I found in their data. That is, if you look at these two New York City, Sub We want a new jersey, one in New York. One of them has a seventy percent seas. Generate one of them has a nine percent c section rate the nation average, depending on whose data used hovers between high twenty percent. John, the low thirty per sentence.
And it is this huge variation that really suggests that doctors are practising medicine very differently in different places that they are doing. Things did the whether you have a c section. It depends bet on it. You know your highness pregnancy, how old you are some other characteristics, but also depends on you know: does your doktor to schedule things one of my coworkers that When I was working story mentioned to me, a story about you know her first, delivery and issues do on the day of the Super bowl and the doktor want to watch the Superbowl ok, you out of this baby the day before or after the Superbowl, a kind of like it's easier to schedule births, but there's all send there's evidence tapping, there's evidence, tat. In some places more than others, and there is evidence that that increases the risk of giving Earth and the United States, and in this speaks to something I think that we do not like to think about in the medical system, but I think the mental model people have of how the doktor operates is that they come in prison,
some kind of September undecided Are there? Can have a child or they their backers her whenever it might be ended to go into the back and sort of like opens up this book, and when you open up the book is light coming out of the pages, and it just says if the hard to do this or if there's a child for China to be born in these, are the conditions do that and what we know is a bit culture change is really dramatically city to city in America and that really changes how doctors practice medicine that is kind of hewing to elude think of as an accepted best practice model cases. There aren't best practices. In some cases the best practices are not based on any good evidence in some cases are actually outdated by the time doctors are using them, but you have very, very very different cultures and different cities and indifferent hospitals and in different areas. Two very different kinds of medicine being practice so into the sea. Section example you give if you're a doctor and a hospital where it is normal to schedule, see sections. You won't think about that at all
and if you're a doctor and a hospital where there's been a push in recent years to get rid of sea sections her or to make them is as small percentage of as you can possibly have. Thou feel very different, and I dont think people like kind of facing up to how much a medicine is not evidence based how much of it is doctors, choosing between a range of options, some of them good and and honestly, some of the bad and for reasons based sometimes on evidence, sometimes on culture, sometimes inconvenience, sometimes on payment incentives, sometimes on structures. Sometimes on things were not thinking about her. that the kind of medicine you get can just do very tremendously, depending on which hospital be embraced? By one thing I learned about this example. I cited in New York in New Jersey. No until I wrote the article, I got an email from a local reporter there about how much culture has paid off there. She I didn't realize as there's a huge hasidic jewish population in New York, supper That has a very low c section rage
the women there are planning to have lots and lots of babies, so they don't want to have a c section which could require c section each time, a super that may have a baby, so this hospital she she me too. So, yes, but they did- I say yes, but, except by time people business podcast already be on the internet but you know I don't know, if I can, I can mansplain childbirth you for a minute. You are the only one here who has a child's. I will give you suggest thirty and that women who, I have spoken to you, who have had multiple children almost universally say that the subsequent ones were easier, so another person who have had see sections of a bad neutered entered on Turkey additional right today that the later labors are faster and easier than than the earlier ones. So, one of the issues with the hasidic women and in the large families is that they are more c section. Averse with that. First,
It because they are planning to have many and they don't want to have many abdominal surgeries, but the other is that the child births in that population may be much more skewed toward second third, fourth, kids, then you would have an average population, and so when I talk to their doctors or whether, when my wife, pestered thee actors administrators at simply about their a hospital here and in addition, there are sort of on the high side of the range of sea sexes. They attributed to the demographics of the population that they have, which is a little bit older than the national average until a bit more first births, that than the nest Average, so I do think that the variation from zip code to zip code is very telling, but he tells us about the patient characteristics as well as about the healthcare providers, and
is interesting, though searchable on day, I did a fantastic article on the rise of c section births. A number of years ago, it's collected in one of his books and we'll figure out which one to put in the show notes, but one of the points he made in there is that one reason c sections are popular: is it they're actually they're? Not a risk with surgery, but they are simple one and in births can present in many many different ways in and natural birthing and making sure you're able to have a safe natural birth actually requires a higher level of skill. Then teaching people to do c sections which can be done pretty mechanically, and so you can't have places where you have just really great childbirth teams, but those are often hospitals that are a little bit bigger a little bit more. You know sometimes little bit more urban, you no excetera, excetera and and sort of an effort on this, whereas is it you have places where very low level. Complications complications that for birth that could be dealt with, but are being looked at by
be a team of may be a doctor who has too many patients were present now anyway, or maybe doesn't have that much training. Isn't that comfortable there, not that near major medical center and so C sections in those cases can be can become a kind of a fallback maneuver. The begins happening often because it allows him to just be scheduled for, the bull and easily replica ball with relatively limited Emily. Typically, when you haven't obstetrician on chef trade, it would not be unusual, for the doktor could be supervising multiple labour simultaneously. and so you can have a situation where, if you have Two or more mothers experiencing moderately complicated chow burn. You get a situation where the conjunction of becomes a harder situation to hand where's. As you say, they actually can just sort of space out. You don't even need a surgeon to do secession. That's attrition sue them. My son was born. We see sex
after a very lengthy and ultimately, not not going anywhere labour and might be the actual surgery is lightning compared to yeah. I heard what am I going to trial required when I grow. Those working on the story be a friend of an obstetrician about noticing and up check in these actions at the end of the day that, once you get to four or five p m, what kind of doctors are like? looking to get home their kind of looking to get at the office and you kind of seed and pick up a little bit in the way after noon, but also gap and oceans are looking to not use. It was no use shift change yet another hand over to set a new people. They may be gotten comfortable. They ve working with a nurse and a doctor, for hours on this feel that they formed ever ginger put them, and now everyone saying you can
to keep on with theirs but like where get mad at you had one of the hard things out driving down the c section rate is when you have a c section. Your much like they'd have unfair. Second birth in this amino data was ninety one percent of women who have a c section for the first Bertha C, section four subs while births, just because you do not Surgery is a little harder to have a traditional delivery. So that's you know. I think one of things that's going on here in these high rates is that its showing people who come back and their near, certainly that nine out of ten times are going to have another site section and that's one thing that makes it, although the difficult too in these rates- and you will have to start with women who have not any babies and have this kind of culture change, it's going the same time. I viewed of treating people differently on your older patients are coming back for a second birth or third child. What is the case against quote include too many sections, and what is the problem
that is attempting to be introduced. Army no began infer health insurance company who prefer to have mom, do the work on compensating, rather than April is the prime definition of uncompensated labour rang it's it's really. It's really difficult area and they don't reimburse you at all, whereas, like in the in the surgery room, there's a whole bunch of people standing ready as NEO gave a twofold one is costs obviously sees actions. Libraries are much more spent more expensive than traditional national deliveries. The other is risk, that whenever you of a surgery there's you don't risk associated with that, there's more risk. There's more recovery. Time, like I said, so we started earlier that the risk of death is low. In any case, the living a baby is having a baby. You know and uncomplicated pregnancy is a very safe thing to do in the United States are now but the maternal death. When I looking up the statistics, Romam DE was at the American College of Obstetricians and gynecologists therefore
as many maternal deaths with these actions and there are with traditional deliveries. So the cases either. The case again see section is basically a car smaller, there's more risk to the to the woman is so if you can An additional delivery is preferred at this. Time. You know, I think it's fair to acknowledge that you're going to have these. If you like, riskin, like forty hours, labour, maybe that increased risk is something you're willing to accept, I I mean I remember when I had my my wisdom teeth out and their asking me. You know: do you Let's do a local anesthetic or she you do a general anesthetic and I was definitely general anesthetic and they were like ok but I mean before we give you a general anesthetic. We have to tell you you, you might die whereas you're like really not gonna, die from us. Taking the teeth. General anaesthetic, it's pretty safe world. To do it, but some simple die- and I thought about it- and I was like I'm taking
And so what are the issues in in childbirth? Is that when they give you an epidural anaesthetic that is consistent with its safe for the baby that greatly increases the chance that you wind up having a c section in the end because it's harder, you can't move what what, when you have epidural end and the way that they get Miss positioned babies to try to like come back around is through the not super scientific way of that kind of lying down I'm around, have you walk and have you like I'm yoga balls and cope that that that the baby will turn. And they know that giving up are and having you lay in bed makes it harder to get the turn, which makes it harder to do the vaginal delivery and more likely that the you ultimately
have the c section. So on one level you are facing that same wisdom tooth trade off I mean there's a couple stages of delay, but it's like something very painful is happening. They have an effective pain treatment, but it does increase the chances that you're gonna wind of being a surgery and the surgery, though quite safe as far surgeries go, is more dangerous than not having the surgery. And yet you don't. We do live people having that wisdom teeth out, get the general static, even though some number of lives. I guess we do let women have a c section on our cases against. I want to clarify one thing. I showed that earlier really the cases against scheduled cease actions these these actions, you schedule of our day. You come in but also dissimilar from your waste case, where you EDA were true. out. You know traditionally wherein there you're in there, but it's really. These scheduled see sections that there's no case
for theirs loses, there's not a strong case for those and we know their happening. There is this amazing graph, India Amino Data that you could find on vocs that, missus ray wayside. We now I'm set itself guide like this. I know babies born I'm pretty smart. Alright, there's no see sections on Christmas. When you like, look at c section rates, you see it like starting to drop Christmas Eve. The lowest day foresees actions of any day of the year as Christmas Day, because no one as scheduled, that's yeah, I mean like, unless someone really want to Christmas birthday in part, because they schedule induced laborers around that right, which is a separate, part of that as well. I think like doubly because using the c section rate dropped so on those days, and you see on weekends weekdays. Where weakens, there's a lot less sees actions and week days that people practising medicine differently, depending on the day of the week, who we have nothing
That said the good advice we have more episodes. I hope you can go back and our episode Archive on Itunes. We should also give us. Yes, always always we were viewing us an island and ideally listening. If you reach this point, if I can't you for letting me he's been another episode of the weeds boxes, policy, Pakistan Panoply Network, like to thank our sponsors, this week's airspace, our producer it's Valdez, and we will not be having an episode next week because the Thanksgiving holiday, but we will be back after that with them or wiedzy wonky awesomest. Thank you for listening, happy Thanksgiving,
Transcript generated on 2021-09-15.