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Re:Jump in cancer diagnoses at 65 implies patients wait for ... by robomartin on Thursday April 01, 2021 @07:55PM (#26667742)
> One example: public transit is a huge economic enabler for dense cities where driving isn’t practical. It’s fine for it to lose money considered on its own, because it drives overall growth.

As I said before, and I'll add a little bit: Please, grab a spreadsheet, start to develop the financial equation for anything you care to look into and think it through.

Public transportation probably has a much larger profit motive than any private enterprise. You have to look at the financial equation that drives the thing. They don't call it "profit", and yet it is exactly the same thing.

What form that it take?

Go research benefit and pensions. People in these government organizations get life-long pensions that they did not pay for. They also get life-long health coverage...they did not pay for. These pensions are unsustainable without the "profit" in the form of ever-increasing taxation, bonds and other methods.

It's money in excess of the cost of goods sold. Same thing. Different name.

I think you misunderstood my perspective on this. I am not proposing some crazy scenario where capitalism runs rampant doing as everyone might wish and make an even bigger mess out of healthcare. Not at all.

My point of view is very simple:

Government is bad at executing on just about everything.

Their role should be to engage in creating the legal and regulatory framework within which entrepreneurs have to function in order to deliver goods and services.

They should not be in the business of implementing any of it. They fuck it up more often than not. Look at the mess the Trump administration made out of the vaccine deployment as a recent and painful example. This isn't a Republican or Democrat thing, they all suck at getting things done correctly, effectively and efficiently.

They should have grand debates (in public) exploring how to engineer a legal and regulatory framework for healthcare that allows our entrepreneurs to deliver excellent products to everyone. No monopolies. No exclusions. Etc.

Of course, they also need to make sure their rule-making deals with all relevant elements of the financial equation.

Simple example: You cannot, positively cannot, lower the cost of healthcare in the US if a medical education costs hundreds of thousands of dollars, malpractice insurance tens of thousands, and a hospital has more lawyers than doctors. It's crazy. So, again, for example, get out of the student loan business and education costs will come down.

There's a lot of "structural" work that needs to be done before any insurance entity, public or private, can reduce costs. I've been saying this all along. This isn't magic. It's math. There's a financial equation for everything and you can't force lower end-user costs if the cost of goods sold is high.

It's the no-free-lunch principle. Probably the fundamental law of the universe, right up there with gravitation.

Re:Jump in cancer diagnoses at 65 implies patients wait for ... by caconym_ on Thursday April 01, 2021 @09:13PM (#26668202)
> Go research benefit and pensions. People in these government organizations get life-long pensions that they did not pay for. They also get life-long health coverage...they did not pay for. These pensions are unsustainable without the "profit" in the form of ever-increasing taxation, bonds and other methods.

Yes. Public money subsidizes public transit, and that money comes from taxes etcetera. I'm not sure how any of this is supposed to contradict what I said, which explicitly acknowledged that public transit examined in a context-free vacuum is often a money loser—do you think I imagined that the funding for it pops out of thin air? The point is that mass transit is necessary for cities to function beyond a certain density, so the economic dividends of a growing city must in part be credited to it.

You could probably make a reasonable argument that if workers kept more of the wealth they create then public transit could more easily operate in the black. Instead, the people least likely to use it keep most of the money the people most likely to use it might have spent on it. Holding our current (extreme) wealth inequality equal, the solution to this is to disproportionately tax the wealthy to fund it. They may make a fuss, but they (or at least we) should remember that they made their money on the back of a functioning society.

Most of the very large cities in the Western world do appear to have relied to some degree on public transit to attain that status, so if you want to argue that it was actually an economic drag they'd have been better off without, the onus is on you to put together the spreadsheet (or whatever) proving that.

(We also have a problem of it being extremely expensive to build public transit in our cities, much moreso than in e.g. European countries with heavily socialist policies. To me, that suggests that there's a lot more going on here than big government bad, big corporation good.)

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> Government is bad at executing on just about everything.

> Their role should be to engage in creating the legal and regulatory framework within which entrepreneurs have to function in order to deliver goods and services.

There's a problem here, which is that the latter is something they will have to execute on, and I bet neither of us believes our current government is up to it. So that begs the question: if we did have a government actually capable of executing well on hard problems, why should they not directly solve the public problems that private enterprise is not well suited for, i.e. the ones that do not produce tangible local profits in the short to medium term?

Our government put men on the fucking moon, and IG Farben made Zyklon B for the Nazi gas chambers and bought slaves from the SS to use in lethal medical experiments. The right answer isn't easy; it may not exist at all, in the sense of having a destination and a workable route thereto through the intermediate configuration space. It's certainly not going to be as simple as people on Twitter want to imagine it is. Unfortunately, your vision of government stepping back to let private enterprise (with a gentle guiding hand) create a utopia where all people are provided for in their every need seems just as hopelessly idealistic as anything else.

Re:Jump in cancer diagnoses at 65 implies patients wait for ... by robomartin on Thursday April 01, 2021 @11:02PM (#26668691)
> There's a problem here, which is that the latter is something they will have to execute on

That could be slicing it too thin. Either we trust them to work on legislation and regulatory matters or we don't. In which case we have an even larger problem. When I say "execute" I mean the act of creating, administering and running organizations. Yes, there are examples of what I will call corner cases where they do OK.

> Our government put men on the fucking moon

I'm going to pull the "that was a different era" card on that one (and a bunch of others).

One thing that seems to be painfully clear of our era is that we can't seem to get anything of note or scale done. Here in California they sold everyone on high speed rail. Ten billion dollars they said. LA to San Francisco or some such thing. Well, we are up to, I think, $100 billion and, as far as I know, we haven't even built ten miles. Even worse, what we built doesn't even qualify for "high speed" by any stretch of the imagination (and you can't even ride it because it isn't finished). If I remember correctly, the project started in 2008. Twelve years later and we spent ten times what it was supposed to cost and have absolutely nothing to show for it. At this rate we are going to end up spending a trillion dollars on this disaster.

That's what I mean by "government is bad at executing on just about everything". There are so many examples of this its a tragedy.

Here's another one that drives me insane. The postal treaty of 1879. This is the treaty that makes it so parcels from China travel across the US for free. Yes, taxpayers subsidize transit of Chinese shipments through the US. The intent, back then, was good: Help developing nations gain access to markets and grow. China is the second economy in the world. This treaty is beyond ridiculous. I, as a US-based manufacturer, cannot compete with Chinese counterparts along a number of vectors. And yet, if my cost structure was exactly the same and my COGS was exactly the same as theirs, I could not ship across the US for free...and they can.

How incompetent do politicians have to be not to understand something like this and rescind it 25 to 30 years ago, if not earlier? The only politician in memory who even spoke about this and wanted to rescind it was Trump. And, of course, because our politicians are far more interested in party warfare than actually delivering results for the nation, nobody supported him. And here we are, subsidizing China's businesses.

This is a failure of execution in the sense that, when a problem is identified you move to resolve it. Ignoring something like this handicaps every single US business and it is objectively wrong.

> The right answer isn't easy; it may not exist at all

I could not agree more. While I believe my analysis of the various scenarios we discussed has merit, I have completely failed at even imagining what a real executable solution could look like. The reason, I think, is that the system has so many moving parts, so many variables, and such history, that it is now nearly impossible to alter the course we are on. Well, until we crash into a bank and they have to dig us out of the mud. Sorry, didn't mean to be defeatist...I just haven't come across anyone who can conclusively demonstrate that we have path out of this mess.

> Unfortunately, your vision of government stepping back to let private enterprise (with a gentle guiding hand) create a utopia where all people are provided for in their every need seems just as hopelessly idealistic as anything else.

Likely so.

This is where we can start to get into a philosophical discussion, the start of which is a simple question that is likely almost impossible to answer completely:

Are human beings free; or are we meant to be controlled by a ruling class?

These are two extremes. At the "I am free, man" end of things you have a complete mess. All you have to do is look at what happens at a Walmart when people get desperate. And, of course, at the "submit to our rule" extreme you have pain and misery...because men are evil to each other and we do evil things to each other...that's why my grandparents had to face a genocide and the death of so many members of their family...just because they existed.

I don't believe we do well in a 100% free state. What I mean by that is that humanity has shown this framework doesn't deliver a better life for the community, much less a large nation. In fact, this has never reached the scale of an entire nation for a reason; it doesn't work.

We do have examples of the opposite extreme, and as I said, it ends badly. I think reading The Gulag Archipelago should be required reading (perhaps in abridged form) in order for our young adults to understand what some of these systems can turn into.

I can't tell you what the right balance between those extremes might be. The US seems to oscillate around a centroid that has, so far, delivered decent standards of living and a sense of future that does not exist in other parts of the world. And yet I shudder to think about what could happen here if and when unemployment doubles or triples due to the almost impossible-to-stop domination of business markets by China.

What then? How will we behave? How are our politics going to change?

I have my predictions --based on having lived in multiple cultures, including under military rule. I'll spare readers the gory details at this point. It's too depressing to write about.

Re:Jump in cancer diagnoses at 65 implies patients wait for ... by robomartin on Friday April 02, 2021 @01:25PM (#26673595)
Here's a painful and personal example of the dysfunction one can experience in our broken medical system.

My mother is dealing with stage four pancreatic cancer. She has done OK but, of course, there is no stage five for a reason.

She is currently in the hospital (I was with her yesterday; I typed my prior comment from the hospital) with some complications. Doing OK, we think.

Here's the bullshit: Her oncologist can't go see her at the hospital because he is not in the system. The best they can do is consult with him over the phone for his opinion and then make their own decisions. Yes, she is on the ACA.

The sheer lunacy of this scenario is hard to describe with words. Screaming is more in line with a proper description.

I am not going to blame government for this. I have no clue how this situation is so other than to understand that it is about money, about who gets paid for what. And yet, our government makes the laws and rules that govern such industries. They have fucked up healthcare beyond what any objective observer would, I suspect, think is a good system that serves patients as first class citizens in a healthcare system.

Even in third world countries your doctor can come see you at any hospital. Here, in the US. Not so.

If you were wondering why I am so down on what our politicians have done (or not done) over decades, it comes from far more than an academic thought exercise.

Re:Jump in cancer diagnoses at 65 implies patients wait for ... by caconym_ on Friday April 02, 2021 @06:56PM (#26676789)
Really sorry to hear about your mom. I wish her the best.

I'd been meaning to write a more substantial reply to your last comment, but I've been underwater at work and haven't had the time; maybe this weekend. But I do think we have a lot of common ground, and you certainly won't hear me defending our current healthcare system or many of our current politicians.

Re:Jump in cancer diagnoses at 65 implies patients wait for ... by robomartin on Sunday April 04, 2021 @05:15PM (#26692911)
No problem. Part of life. She is doing fine and out of the hospital for now. Thanks.

One of the issues I have with trying to have longer discussions on HN is that there are a lot of non-participants who have nothing better to do than to downvote rather than participate. I don't care about the little karma counter, could not care less. What I do care about is being able to have reasonably intelligent discussions where people might not necessarily agree without using karma violence to silence one or more participants by eventually having posts flagged, etc.

HN, for the most part, is a decent community and they have done a great job of maintaining order. As someone who has been participating on discussion communities since the days of USNET I am equipped to fully appreciate the effort that has gone into HN.

That said --and I know this is hard-- I wish they could figure out a way to eliminate what I perceive as sophomoric punitive down-voting that is generally devoid of any substance and has, from my perspective, no value at all.

The only way we learn anything is to engage in substantive conversations where we openly explore ideas we might necessarily agree with. Canceling those we might not align with serves nobody, does not lead to anyone learning and all sides of an argument lose.

Yes, I know this is a hard problem.

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My general view of what government can accomplish and how tends to be very negative because I have seen them muck-up just about everything they touch. People will demand more from a fast food restaurant than the politicians they elected. It's crazy.

For example: Why is it that politicians suffer absolutely no consequences for lying to us? None. In fact, as a matter of law, if you or I lie to the federal government we go to jail. They can lie to us on a daily basis without consequences. How is that possible. You lie to a police officer and, same thing, the consequences to you are severe. The opposite is not true.

This asymmetry is very, very wrong. And yet, as I mentioned, we demand more of a fast food eatery than the politicians we elect. How does that happen? Lack of education? Lack of information? Indifference?

Same with the freedom of the press. Do we really think the bill of rights created this protection to include lies, fabrication and manipulation? I know this isn't an easy problem to solve. Sure. Well, how many centuries do we need to sort it out?

Oh, wait, these are things that require politicians to do their jobs. Never mind.

Yeah, the idea of having these people have full control of healthcare terrifies me.