Because they tax the middle class intensively.
In particular they have tax regimes built more around the Value Added Tax (which taxes consumption) and less around the income tax (which damages incentives to save and invest and which is easily bypassed by billionaires who simply borrow the money they spend without realizing income). If anything, the Nordic states with their lauded safety nets are more market- and capital-friendly than the US, and less economic-interventionist, and happy to say so.
It's not all roses. Competent government still matters; there are plenty of debt crises and pension crises and the like in certain nations without it. Overall, families are somewhat less well-off financially, and high youth unemployment remains a chronic problem.
Healthcare simply has too many hands in the pot. Government pays x amount but it costs hospitals 2x...so they charge 3x to insurance companies to make up the difference. It's insane, but making it "free" may not be what fixes it.
What safety net does the US not have? Over 60% of people paid no federal income tax last year and we have huge numbers of programs to help low income people.
What you are ignoring is that government is more involved in colleges in these other countries and they manage to keep it under control. Again, how is the US screwing up whereas everyone else has it working properly? You haven't actually addressed this.
>Healthcare simply has too many hands in the pot. Government pays x amount but it costs hospitals 2x...so they charge 3x to insurance companies to make up the difference. It's insane, but making it "free" may not be what fixes it.
Again....you are ignoring my point...It is working in other countries right now! If making it free does not fix it what will? The only other option is going further in the opposite direction of all the working systems...
>What safety net does the US not have? Over 60% of people paid no federal income tax last year and we have huge numbers of programs to help low income people.
Most programs have very strict criteria (thanks to corporatist Republicans and Democrats) such that you either have to fall into very bad poverty to even quality, wait a tremendous amount of time to get in, and then have to contend with so many criteria that forces you to either remain in a certain state of poverty or else you are kicked out of the program before you have gotten back on your feet. This is no real safety net like what other economies have. This is bolted on garbage to use as a talking point for people like you.
Governments in other countries are more involved in colleges...and they also restrict who gets in. We let pretty much everyone in that wants to go and will give them money to do so...that is a terrible way to run the system.
First of all the reason people are staying home thanks to pandemic unemployment is due to the fact that they were being paid so poorly before with no hope of career advancement that the meager 600$ a week was a leg up. Now that people have gotten a taste of what it feels like to not be constantly treading water, they are not going back to those low paying jobs. This is something the government should have gotten ahead of years ago in the sense of raising minimum wages and adding benefits but have constantly been blocked by anti-government forces. The minimum wage should be close to 23$ today yet we can't even have a discussion on 15$.
Luckily the people are starting to wake up. While government aid has ended in many states people are still not going back to work. There are numerous strikes that are beginning right now or are about to begin and I think this will continue for the foreseeable future. All of this is a response to people who think like you and have been at the reigns for decades.
>We let pretty much everyone in that wants to go and will give them money to do so...that is a terrible way to run the system.
You mean give them loans that are not dischargeable in bankruptcy very different from Europe. Furthermore you point on letting everyone in is 100% false. Are you an American? Its starting to sound like you are not. For example my alma mater which is a third tier technical school has only a ~50% admission rate. Many colleges are less than that. Also consider that only ~30% (going on 40% thanks to the pandemic) of Americans have a Bachelors degree or higher. This system is restricted by who can afford to go or who is willing to bear the burden of years of loans.
Just because people go to college doesn't mean they get degrees...but they certainly rack up the debt. Apply to enough colleges and you will get into one...I guarantee it. My alma mater, a state school had an 82% acceptance rate in 2020. Another local one...Portland State University had a 95% acceptance rate...95%!!!
With college in the US, the specific mechanism seems to be a combination of (a) colleges that have an incentive to raise tuition as high as people will pay, (b) people who consider a college degree important enough that they'll pay as much as they can afford, and (c) government action that greatly increases people's ability to pay, either via subsidies or by expanding the availability of student loan debt.
Compare this to the public K-12 school system, which doesn't have the same split between a seller and a cost-insensitive, subsidized buyer in its funding structure. (This is similar, I believe, to the way college is funded in a lot of other countries.) The cost per pupil in public K-12 school is also rising faster than inflation, but at a much slower rate than higher education. Same country, different funding structures, different results.
One of the biggest debates getting stonewalled right now, is whether or not the US Government should negotiate prices for Medicare.
Making this a "free healthcare" debate is just... missing the forest for the trees. There's a political party that's against even the US Government negotiating for better prices but otherwise keeping the same system.
As if negotiations are a bad thing or something. Look, I'm not liberal to believe in free healthcare, but... surely making the government pay less money for the same services is a good thing?
Since I have to pay for my medical procedures, the fact that the big government has "decided" that its okay to overpay on X means that I __also__ have to overpay on X. I, the small market participant, am relying upon the big guys to negotiate prices and set them more fairly for the rest of the market.
Nominally, this is the job of insurance companies, but no one trusts those guys. (I pay for insurance. The insurance companies negotiate more detailed prices with hospitals). And there's the issue that the government (or more precisely: Medicare / Medicaid) is a "bigger" market participant than any insurance company, so the government's lack of negotiation is probably raising prices on everybody artificially.
Is it? Are they actually paying less...or is the cost being dumped on to someone else? This is like saying people who get SNAP benefits are paying less and everyone wins...except someone has to pick up the cost. Many Medicare costs aren't negotiated and the hospitals are told what they will pay for certain procedures (and again hospitals change the price for others to make up the difference).
I think what they are talking about is prescription drug prices...which even Trump said needed to be done.
Cost compared to what? In a free market situation, everyone gets to negotiate for the price.
It seems insane to be a group advocating for the free market of ideas, only to decide that the free market / negotiation suddenly doesn't work in this case.
If the government negotiates too low, then the other side rejects the deal. If the government negotiates too high, the other side accepts the deal and the government wastes money (but probably less waste than no negotiation at all). You know, like sane people would. Standard free market philosophy.
Government doesn't want to lose services (Medicare / Medicaid promises a set of services), so that incentivizes the Government not to shoot too low on the price. That's the price discovery mechanism.
If the US has a culture of people making poor decisions for their own health, exploiting systems for their own benefit, and of government bureaucracies utterly failing to achieve the ends they're supposed to achieve with no accountability (and it does), no amount of tax revenue is going to suddenly provide everyone with world-class healthcare with no concern for their own money.
I'd love to never have to deal with my insurance company again, or take diagnostics or treatments without being able to find out how much I'll have to pay. I really would. I just have zero confidence that any of that would change no matter how much more of my money gets taken by the US government.
If corruption and incompetence was the path the whole time, how do you explain the US system becoming #1 in the world? Was it a fluke and that now that we have gotten 100 years of lucky wins the luck has run out and now we have the grim reality of the US system actually being trash?
You look at FDR and how close the US population supposedly almost came to eating the elites. Around that time we finally got breadcrumbs in the form of Medicare and Social Security. Now we are seeing moves to even get rid of those programs so we are left with nothing. You can't have a society where a certain percentage is playing by the rules while everyone else is picking whatever they can on the dying carcass.
The US was part of the industrial revolution, but suffered few domestic casualties (infrastructure) from either World War. The dollar becoming the world reserve currency for oil/capitalism cemented it.
(Where Russia, Continental Europe, and China were ravaged by WW2)
The US government spends as nearly much on healthcare as a national healthcare system costs in the UK as a percent of GDP. Medicare, Medicaid, and the VA are 1.5 trillion in spending. Or about 7% of GDP.
In normal years, NHS spending in the UK is 8% of GDP.
I am sure there are substantial coverage differences for a lot of procedures, but all the life threatening stuff for an entire population is handled for what the US spends on just the elderly and poor.
Not least of all the waste of all the parallel, sometimes overlapping and sometimes mutually exclusive public and private healthcare systems.
Over the past 30 years, steady changes to regulations in healthcare, education and infrastructure have created a system where we pay HUGE premiums for similar services compared to almost every other countries.
It is the result of unabated, in-the-open, perfectly-legal, endemic corruption.
This should be a universal and bipartisan issue that unites people, but it isn’t.
We’re too stupid to stop fighting each other. We always take the bait from the armies of talking heads telling us how to think and who to hate.
In the lovely words of Amy Mann, “It’s not going to stop until you wise up”
What do you think is the end state of this whole saga? It seems like either we reform or we eventually collapse. Maybe its possible a whole generation will continue to zombie walk through this trash system that we have?
Honestly, I don’t know.
But I don’t think reform and collapse are the only two outcomes.
A lot of countries hobble along and simply live with their corruption for long periods of time.
I tell you what my answer isn’t. It’s not some cliched breathy end-times prediction where I make vague comparisons to the fall of Rome while parroting the same reasons every other ding dong has been parroting long before I was born (decline in morality, government spending, rising inflation)
I don’t know what’s going to happen and the people who have consistently predicted the wrong outcome for the last 5 decades are just as clueless.
Let’s start from a place of humility and tell ourselves we don’t know.
Most of us are so profoundly ignorant on the subject we’d do a lot better asking BASIC questions that reveal our ignorance rather than bloviating inane predictions.
I have so many basic questions that I’d love to ask much smarter people. Questions like:
* Are there inflection points in history we should study where people brought about meaning reform without huge social volatility? * How can societies depolarize themselves? How has it happened throughout history? * What questions should I be asking? (This one should be asked every day)
There's a common (almost cliche) line of "bad times make strong men, strong men make good times, good times make weak men, weak men make bad times", which appears superficially true. Consider the Weimar Republic, or Imperial Russia from about 2 centuries ago. Both appeared to follow that pattern. The fall of Rome kinda fits that, too, if you squint.
The hallmarks of "bad times" appear to be increased law and regulation, increase in law/regulation complexity, non-dependable money supply (inflation was an issue in all three of the above scenarios), dilution of national identity, and so on. I'd argue that what underpins those changes is eroding morality. A perfectly moral people need no law, and their money supply is uncorrupted. As morality decreases, the necessity of law becomes apparent, and so the increase in law and regulation. As graft increases (which drove the need for law and regulation) the money supply becomes corrupted, fiat.
The collapse of empires (make no mistake, the United States is a cultural economic empire) is typically sudden, violent, and bloody. All three scenarios all featured a lot of death in a very short amount of time.
The end for the United States will likely be the same. Inflation will destroy what's left of the propped up economy. People will start to go hungry, their housing and livelihoods will be threatened. As soon as the bottom of Maslow's Hierarchy is in question, people start to rebel. You see some of that already with anti-vaccine riots. People believe their bodily autonomy is threatened. Definitely their livelihoods are threatened (this game of coercion -- get a vaccine, or you can't even work -- that Australia is playing and that the US seeks to implement -- is pushing people out of their comfort zones).
Are we in the end game? Dunno. We won't know until it is the end. Sudden, violent, bloody.
[edit] misplaced asterisks [/edit]
The thing I worry about is that the UK invested in its people after WW2 and formulated a robust safety net and for all their faults, if everything were to collapse they would likely have means to get back on their feet. They also have OK infrastructure and that is money already spent that can't be taken back.
Americans are in a situation where they have no real money (~40% live paycheck to paycheck), they have bad health thanks to the corn laden trash they have eaten their whole lives, no healthcare so a lot of preventative things have gone unaddressed and finally no real good infrastructure so that if everything were to collapse they would have nothing to fall back on as they rebuild. We spent all our precious resources on the wars and giving money to the rich.
On another note, who would even replace the US? After Evergrande I think a lot of people have realized that while China is full of talent and ambition they have serious structural problems that will prevent them from ever becoming #1 on the world stage.
There's millions of reasons why that isn't happening in the US. Billionaires are almost certainly not one of those reasons.
The US subsidizes so much for other countries. Without the US, these other countries wouldn't be able to have the same success.
Just look at the numbers:
https://en.wikipedia.org/wiki/List_of_countries_by_research_...
As an aside, I think the biggest irony is commenting this on HN. I know tons of SDEs that come from other countries because they get paid fractions of the salary they would get here.
> I know tons of SDEs that come from other countries because they get paid fractions of the salary they would get here.
This is not irony, and has nothing to do with billionaires. Most SDEs won't even be millionaires.
How?
>This is not irony
We're on a developer news site, talking about the US not having this or that, while also ignoring the fact that the US is very sought after by developers.
Also, it's not irony because it's not even a related subject. People are complaining about billionaires... 99.9999% SDEs are not coming to this country and becoming billionaires. Saying "we're ones to talk" or some kind of equivilant is an irrelevant attempt to lump any sort of wealth with being a billionaire... which is a fairly old-fashioned method to distract by creating lower-class infighting about what "wealthy" means.
For an SDE making a very healthy $200k a year... it would take five thousand years to reach $1 billion.
It's like arguing that the 2nd amendment should allow the private ownership of nuclear warheads. It's a strawman well outside the scale of the actual discussion.
>The US subsidizes so much for other countries. Without the US, these other countries wouldn't be able to have the same success.
This chart provides a false picture of R&D spending as European countries do in fact provide a lot of R&D to the global economy in ways that benefit regular people. How is the R&D broken down? I bet the US has a lot of R&D devoted to defense which I woudn't consider in the same category as other types of R&D spending. But regardless of this fact are you implying that since the US subsidizes so much for the other countries that Americans deserve to live in this second rate system where everyone is on their own?
>As an aside, I think the biggest irony is commenting this on HN. I know tons of SDEs that come from other countries because they get paid fractions of the salary they would get here.
I hear this trope trotted out so many times and in two tangental ways.
First point that is always made is we should be happy that US employees makes so much more salary. What you fail to understand is that Europeans are coming from an environment where they had good schooling, probably no debt from University and made it to adulthood without any health issues thanks to good healthcare and good healthy food policies.
All of this is a nonzero cost that allows Europeans to jump into the US system with a leg up from many of their American counterparts who may not have had those luxuries. Look at the typical middle class American household and you'll see all these hidden costs that reduce the chances of them achieving the success that the immigrants came into the country with.
Furthermore Europeans ALWAYS have an exit strategy to go back to a system that has all these fundamentals. The US employee may be paid better but they grew up and live in an environment where everybody else is sinking due to the lack of these fundamental systems. Just look at how San Francisco is turning out with its failures. Sure tech is booming but everyone else is sinking. Americans were born into this and for the most part are stuck in this system for life.
Secondly on a tangental point, Europeans love to talk about how Americans have access to a billion options for snacks and food. What they fail understand is that if you have grown up in this environment of corn laden garbage it is a prison that is difficult to escape. It is easy for Europeans to be in awe coming from an upbringing of whole nutritious foods. Its another thing to realize how much more expensive it is to eat healthy in the US vs Europe thanks to policies that were in place before even I was born (88).
Even if you consider defense RnD spending "useless" (its not), look at pharmaceutical spending.
https://www.oecd-ilibrary.org/docserver/health_glance-2015-7...
Why don't we nail down one of these countries you're describing, so we can directly compare the spending?
>but regardless of this fact are you implying that since the US subsidizes so much for the other countries that Americans deserve to live in this second rate system where everyone is on their own?
Where did I say that?
You asked why other countries can do X. One of the reasons is because they don't have to pay for Y. If other countries could not longer rely on the US or China, we would see a much different picture.
>First point that is always made is we should be happy that US employees makes so much more salary. What you fail to understand is that Europeans are coming from an environment where they had good schooling, probably no debt from University and made it to adulthood without any health issues thanks to good healthcare and good healthy food policies.
So why abandon that environment?
>Furthermore Europeans ALWAYS have an exit strategy to go back to a system that has all these fundamentals. The US employee may be paid better but they grew up and live in an environment where everybody else is sinking due to the lack of these fundamental systems.
Do you have evidence for this?
>Secondly on a tangental point, Europeans love to talk about how Americans have access to a billion options for snacks and food. What they fail understand is that if you have grown up in this environment of corn laden garbage it is a prison that is difficult to escape. It is easy for Europeans to be in awe coming from an upbringing of whole nutritious foods. Its another thing to realize how much more expensive it is to eat healthy in the US vs Europe thanks to policies that were in place before even I was born (88).
That's the first time I've heard of this.
Normally I hear "wow, you're going to pay 3x as more for the same job I was doing in Spain?"
Look, you asked why countries are different and I gave an answer. You're now debating whether or not that is "good". You're also leaving out countless negatives about these countries you're alluding to.
I’m Canadian and I am thankful for our benefits but our public services have been stretched for decades and I’m skeptical that our systems could handle 10x the population.
Or looking at it another way: with the assumption that a country of 30M people can have good infrastructure, and is not an outlier, and there can exists more than one of such country, what is different between 10 countries of 30M people each with good infrastructure and 1 country of 300M having bad?
Governments are big, so it's difficult to just point a finger at a specific cause of an issue, but it would seem to me the issue is not continuously building out infrastructure. That, and poorly written, but possibly well meaning, legislation that leads to regulations massively increasing administration costs on every and all areas of our infrastructure (healthcare, general construction, transport, housing).
Any national-scale policy will be poorly adapted for some major region of the US because it is simply too diverse geographically, culturally, historically, and economically.
It's one thing to be a Scandinavian country that has a homogenous culture and smaller population (and land mass)...and another to mix large amounts of different cultures across a giant nation of states and have everyone agree upon the same thing or be able to institute the same infrastructure.
I suspect the answer is somewhat different. Just look at their parliaments: they almost always have majority coalitions made up of multiple parties, and a diverse group of opposition parties.
What is exceptional about America is its calcification into a two party system, which I think is far more of an issue than the actual differences of opinion and culture in the American populace. In fact, polls regularly show that a majority of Americans generally agree on a number of issues, and broadly support a number of possible policies and programs. For instance, on abortion, a majority of Americans have long supported legalizing it some fashion up until recently. Through the 70's into the 90's, support even reached 60%. Only in the mid 90s did the discussion become wildly more combative and enter a stalemate.
Really, most of the extremely popular social safety net programs were created and institutionalized during the 40 years of continuous Democratic majority. What ended it, and brought about the modern Republican party and the current state of American politics, was the "Republican Revolution" in '94[0]. The 2 party system then ran into a brick wall as both parties froze into defensive turtling.
https://en.wikipedia.org/wiki/Diseconomies_of_scale
Inertia and institutional sclerosis are serious problems for organizations that are large, old, or both.
Certain things are fairly obviously good to regulate in healthcare, whether that is for privacy, or price transparency, or making sure emergencies don't get turned away, but administration costs of running our healthcare network seems to have blown far and away the cost of the actual healthcare providers (doctors, nurses, surgeons, etc). There is so much paperwork and administrative work in healthcare and it just seems like so much of it could be trimmed away.
Legislation seems to be written with the good intentions of protecting patients, but if the administration costs (monetarily or bureaucratically) of complying aren't taken into consideration, that too can indirectly affect patients.
I'm neither in the medical field nor do I know how US healthcare regulations compare to other countries, but it just feels like the amount of healthcare administration has grown at a far greater rate than the actual healthcare providers.
Citizens have much more power when it comes to the government versus private industry. I can't even vote with my wallet because my employer chooses my insurer.
Also, as another commented noted, it's not all roses in those other "modern economies" you mention: France, for example, with its subsidized healthcare system has a public debt equal to 117.8% of its GDP. The US's deficit amounts to 15.2% of GDP in contrast.