Was he crazy or was he made to look that way as an excuse to dismiss his views? Sitting here in the 2020s knowing what we know now about "how it all works" it sure does cast a lot of doubt upon the past.
He was a super-rich guy, who had had too many people telling him he was a genius for way too long (reminds you of anybody?), and so was way too sure of himself. A bunch of his ideas were crazy, which doesn't mean others weren't trying to dismiss his views.
Which ones?
btw young idealistic me voted for Perot in 1992
His book “United We Stand” with modern context is quite amazing considering it came out in the early 90s.
I remember the debates around the time, though, and what most people said was that shipping manufacturing jobs out of the united stated would actually create prosperity here so that the manufacturing types could "move up" into less menial work. They're saying the same thing now, and although it _does_ seem that that did happen in the 90's when all the manufacturing jobs went offshore, it doesn't seem to be happening now.
With all of the medical group consolidation, all of the wait time woes our Canadian friends always complained about are the reality here now as well. So I’m paying more than anywhere else on the world and have to wait 6 months for a PCP appointment. We have the worst of both worlds.
An example of a country with "good healthcare" and such a system would be Germany. Extra insurance does exist there as well nowadays from what I understand but health insurance isn't tied entirely to employment and the extras are things like a 20 EUR per month to cover the co-pay on large and expensive procedures. While private insurance exists there too, I want to compare to the often touted "free healthcare" i.e. public system. There are still different providers even under the one public system.
So from a quick search, Germany has insurance rates from ~14-16% of gross salary, half of which the employee pays from their gross salary. But most insurances have an extra percentage they charge on top. I found one as an example that charges 17.29% total, which if you're self-employed, you have to cover yourself (to be comparable to your marketplace bronze plan being entirely self-paid).
Now the question becomes: Are you paying more or less as a percentage of your salary and by how much?
(and side question for your parent I guess: how does that compare to the $10k the employer pays, which would be 8.645% in this example)
Now the downside … because health care is free, everyone uses it and the wait times are longer. My grandfather recently required an MRI (non life threatening). The wait time in Ontario was 3 months. He drove to the USA, paid out of pocket, and had it done within in week …
Imo, singapore solves this well, by ensuring that some cost is borne by the patient at point of use, but it's never anything excessive. No one goes bankrupt from emergency hospital visits.
https://www.kff.org/health-costs/key-facts-about-hospitals/?...
I am not sure where your question about a percentage of your salary is valid on the face of it. Do you count the employer portion of your medical coverage as part of your salary? Do you count the tax exemption? How do you figure the taxes taken out to support Medicare/Medicaid/Veterans Health (all of which are required to support the system as it exists)? And how do you figure that for single payer systems?
So a much more direct way of comparing is to look at total costs per person, and then figure out how outcomes compare. When you do that the U.S. comes to about double the cost, and generally worse outcomes. Conservative politicians will scream about how long it takes to get procedures, but the research shows that elective procedures take about the same time (and no-one waits for emergency procedures in comparable systems).
https://www.pgpf.org/article/how-does-the-us-healthcare-syst...
I asked from an employee and cost perspective. So whether or not to count the employer portion depends on whether we're comparing one or the other. If you buy on the marketplace in the US, compare with the full cost in the example I gave for Germany. If you get insurance through your work the US/CA, compare with the employee only portion (as the employer pays part of the insurance there as well).
Theoretically it's even more complicated as at least in Germany private insurance also exists and is cheaper if you're a healthy single youth and more expensive if you're an older family ;)
But again, like you say, it is totally valid to also compare outcomes / wait times per dollar spent of course.
False. From what I know, only prescription drugs, dental, and vision are not covered. And since Americans frequently drive to Canada to buy prescription drugs, we can assume that's not as big a burden as in the US. But hospital stays, surgeries, lab testing, imaging, doctor visits, vaccines are all fully covered.
Private insurance also can cover a higher percentage, i.e. provincial plans do not always cover 100% of everything. Also, Health Care Spending accounts are in many cases part of private insurances and can be used to cover things that provincial plans do not cover at all (unapproved drugs et. al.)
Like what?
The first info about what's not covered for example is concerning diabetes. There's a limit to the number of test strips for example. I'm no diabetic, so I don't know if these numbers are "enough" or not but there is an actual limit. It also then states:
Syringes, lancets, glucometers and other diabetic supplies are not covered by the ODB program.
A single person aged 65 years or older with a yearly income above $25,000 after deductions pays:
the first $100 of total prescription costs each program year (August 1 to July 31 the following year)
this is called the deductible and is paid down when you fill your prescriptions
after paying the deductible, up to $6.11 for each prescription, filled or refilled
this amount is called the co-payment
I'll stop here but I'm sure this is both similar in other provinces and/or other limits may apply in specific cases.
Just to be clear: I'm not saying the OHIP / other Canadian insurance programs aren't great overall in comparison to the US. But neither they nor I suppose Germany's "full coverage" actually are in all real world cases.
The last time I had reason to look at full market-rate price for a family of four for a good PPO (Seattle market, circa five years ago, large tech company), it was around 3300 USD per month, or over $39k/yr. That was for cobra coverage, so a combination of what I would have normally paid and what the employer would've (about one third us and two thirds them when I was employed by that corp). I can only imagine it's gotten more expensive since then; we left the country three years ago.
My employees are about $500 per month in a major metropolitan area, and a family of 4 can run up to $2000 a month for the most expensive plans (I cover individuals and their spouses in full for standard plans, and could cover one dependent for basic plans).
I looked at marketplace plans in WA because I was curious, and it looks like it's about the same as where I am but nowhere near what you were quoted 5 years ago.
Individuals do not cost $10k per year under any normal circumstances, and if you're paying almost $2k a month for a family bronze plan, you either have a lot of kids, you have some unusual needs, or you are getting ripped off. Even more so if you're waiting for a PCP appointment, because that is unusual as well.
The costs need to be fixed, first. Moving to the government/taxes paying for it doesn't fix that.
It kinda does, bigger players have more bargaining power. There is no bigger player than the government in a universal healthcare system.
Furthermore, a significant cost in healthcare is all of the bureaucracy around billing. Much of that goes away with single payer.
Obviously, paying someone 300K a year to sit on a 1 hour peer to peer explaining why they think they should do a surgery is just bad business. But, we do it, and I think a lot.
If there were single payer, what would their role be in the healthcare delivery process?
Apparently they made 2.3 billion in profits on 113 billion in revenue in Q3 of 2025. How much of that friction would evaporate if they weren't in the healthcare delivery infrastructure.
Someone once said "the best part is no part" ?
The USPS is obligated to deliver letters at the same cost to everyone in the country, and they do a pretty okay job at it -- I've certainly had horrid events from UPS and FedEx, and those guys get to just pass the crap delivery tasks off to USPS if they don't like it.
Lots of old people in the USofA seem to like their government run medical insurance, same with people in the VA system.
The Doge crew spent months looking for fraud waste and abuse and I don't see any big law enforcement results from all the fraud they found, and I don't see anyone crowing over all the waste they curtailed.
It's possible that the world's more complex than you imagine, and that sometimes people just do their jobs (IE the bureaucrats) and hard problems get solved.
Now, tell me again, what part of the health care system is UnitedHealth? What critical problem do they solve?
This turns out to be a decent analogy to healthcare: insurance companies do not provide the coverage, universality and simplicity that a single payer system would; instead, you'll get something like insurance coverage networks providing spotty and inconsistent care.
Either approach has upsides and downsides, but single payer, universal coverage for basic and emergency healthcare seems like a no-brainer.
That's 2.3 billion in ONE QUARTER of 2025, on a revenue of 115 billion. In a quarter. There are four quarters in a year.
$5 trillion is how much is spent in all of healthcare in the USA for the whole year.
UnitedHealth's revenue was $500 billion (and net profits is 10 billion) for the year. For one insurance company. There are 6 that each have more than $80 billion per year in revenue. This isn't to mention the billing departments for each hospital, the claims processing providers smaller doctors need to enlist, the endless hours interacting with insurance companies, etc.
And tell me, please, what specific healthcare outcomes are driven by insurance companies?
Basically all healthcare spending in the US goes through insurance companies, Im not sure why you have a problem with that. Under m4a medicare would spend trillions a year, would you be complaining about that too? Large profits would be a problem, but that doesnt exist. Our healthcare system is rotten top to bottom, insurance is part of that but imo it gets way too much blame for existing in the system the government has created.
I said "medicare sets fee schedules" and you respondeed "nobody takes medicaid"
Presumably you know the difference between them?
https://www.qunomedical.com/en/research/healthcare-salary-in...
But even absent any movement there you have a lot of savings to be had away from that: 1. The U.S. medical administration costs have ballooned, in large part because of the highly adversarial billing system between insurers and practitioners. Medicare/Medicaid is much less (but not completely) unpredictable. Doctors complain bitterly about the prices at times, but the system is much more efficient. 2. U.S. insurance companies are woefully inefficient. To the point that companies complained bitterly when the ACA required them to pay out 80% of premiums as medical payments. Before that there were companies making more than 20% profits. The most efficient insurance companies today use about 12% of their revenues for non-medical care. In comparison Medicaid uses about 3.9%.
There are lots of other parts you could address as well: 1. Fraud drawn to the huge payouts for medical bills. If people's accidents were just covered as a normal part of life those payouts, and most of that fraud just goes away. 2. Malpractice insurance. This is like the first, but would mostly be solved by a combination of single payer and a working medical review system (seriously, what we have now is the definition of regulatory capture).
Which the industry views as a historical accident, and now that they basically own all the hospitals and other companies, you can expect them to fix it.
I would expect neutering Doctor labor power will happen soon. This admin will get a small donation or two, and the republicans will insist that letting doctors have high wages is the sole cause of our expensive healthcare. They've never really cared about the truth, seeing as they have often claimed "Medical tort" is the cause of healthcare costs, even though places like Texas, which have limits of Medical tort payout don't have cheaper healthcare.
The US spends something like $4.9 trillion dollars on medical care, and employs around 1 million physicians, 4.5 million nurses, or 9.8 million health care workers in total [1].
If this was paid out in wages the average health care worker would be make almost $500k/year. Compare that to the wage of the average doctor at $335k/year [2] or average nurse at under $100k/year. There is a lot of money in medical care that is not going to wages.
[1]https://www.census.gov/library/stories/2021/04/who-are-our-h...
In Europe (here: Germany example), which is frequently seen here as the ideal example of healthcare spending:
Employees and employers typically split around 14.6% of gross salary for public health insurance. [1]
[1] https://feather-insurance.com/blog/germany-healthcare-statis...
Depends on if you make 35k or 200k/year
And that 10k$/year can be considered middle class / heck I can even argue just slightly above middle class in India
And you can actually enjoy food and a lot of things really cheap as well
Usually the only problem becomes if something is inherently expensive (think college or land) which is where PPP does hurt but in everyday life, I think India's decent to live in.
Now I want to ask you but even if someone spends around ~$10k+ a year, even then I have heard people describe american healthcare subpar. Like why? Is it just corruption at healthcare level and lobbying efforts?
Is there truly nothing that the average american can't do about to make things better for the healthcare situation. To me its feeling like america's moving even backwards right now from cutting medicaid putting even more strain on the amount and still even on the average person themselves as well.
So why aren't they pushing for abolishing employer-based health insurance? They had no problems getting rid of pensions but for some reason nobody really lobbies for employers to get out of the health care business. The same for 401k. Why do companies have to manage those instead of just contributing some money and let the employees find the right package on the open market?
It's really weird.
This part is true.
>Then, because our society has become fundamentally incapable of saying "You are an adult. You have nobody to blame but yourself, and now you will face the consequences," this will become someone else's problem to pay for it.
Except that's an incredibly stupid short-term way of thinking. Because regardless, we end up paying for people's mistakes. As we should, because that's the whole point of society - we need to take care of the failures, the degenerates, the pieces of shit, etc because they play an important role in society - they too are humans and some of them weren't gambling away their savings out of a sense of fun, they did so to be able to continue to live in a day and age where costs continue to skyrocket, job growth is negative, and the economy is being hollowed out. We have many tools and mechanisms to help the winners in society. We need that for the opposite party, too. In winner-take-all capitalistm, the losers will always outnumber the winners. And you need to make life palatable for the losers, in hopes that their luck may one day change. Because if you don't take care of people who continue to lose and have nothing going for them, they will grow in numbers and eventually eat you.
And besides, we've bailed out enough bad actors in important sectors of the economy that main street deserves to be taken care of too.
Radical individuality is an illusion. Yes, it would be nice if everyone could be solely responsible for paying for their healthcare or retirement. But is it possible? If you can't answer if it's possible or not before you do something, you probably shouldn't be doing it.
Because "Deal with our illegal, immoral, or stupid work requests or literally lose your healthcare" is such a massive bargaining chip for them.
They would rather spend more money and have more docile and controllable workers, but not spend that money on paying workers more to be docile and controllable.
It's not about the money.
Honorable mention to Senator Bernie Moreno of Ohio for introducing legislation to tax outsource payment flows.
The HIRE Act: 25% tax on outsourcing - https://news.ycombinator.com/item?id=45161419 - September 2025
Ohio senator introduces 25% tax on companies that outsource jobs overseas - https://news.ycombinator.com/item?id=45146528 - September 2025
(US centric perspective)
I think its because I suppose we can either talk about small businesses who can be very cost cutting because their overall profits are very thin (you really can't blame them that much I think)
And the medium to large corporations either take Venture funding and want to cost cut to show more growth or maximizing share holder profit
https://en.wikipedia.org/wiki/Dodge_v._Ford_Motor_Co.
(taking an short summary from ddg AI)
The case you're referring to is Dodge v. Ford Motor Co., decided in 1919, where the Michigan Supreme Court ruled that a corporation must operate primarily for the profit of its shareholders, rather than for the benefit of employees or customers. This case is often cited as a foundational example of "shareholder primacy" in corporate law.
This is the root cause of the issue.
Do you know that there is a solution to it
They are called social enterprises and there are legal frameworks to do that. You might've seen some labels given by independent parties to show that as well
So they exist, but nobody creates them, why?
Because, its insanely hard to raise funding in them compared to the average structure. I looked up into it and the system of funding is just created such way where it rewards any and every cost cutting
I think that just like non profits get good value from doing good. A middle way where a company's purpose becomes some aspect of social good and not entirely profits. This might help but we need govts supporting them (similar to perhaps even non profits)
I have a hypothesis that if you provide easy access to lower interest loans with less collateral overall (perhaps even none?, provide micro-grants perhaps) at a federal level/banking level might be the best way to really start up some new innovation whose idea is social mission
Most people have an idea of enough, I think that academically inclined people who create companies would really appreciate this and this could even include the creation of things like google etc. which really just turned evil from dont be evil because of the wiki link/case that happened imo
Taxation as you say in the 25% tax won't really work that well imo as we saw recently in the tax scandal recently in America where billions were lost.
Although so much of US especially its politics is so much lobbied etc. that I find the idea of this change just stopping because it could prove a real threat to the completely capitalist corporations which will fire 1000's of people in an instant
Also whenever you position something as tax, the capitalist forces would find ways to evade it anyway, here let me give some ideas on top of my head
What would happen if people paid outsourcing companies via stablecoin crypto, how would you tax that?
What if things like this can count as gig work and laws related to that?
What if an outsourcer creates their own mini company and such creates an invoice, I am not sure but this would be considered a service so how would that work, is there a service tax if so how much %?
Suppose somebody got a consultancy company to work on a project and then just created the project end to end and deployed it and just tweaked it enough where its a mini saas designed just for that company, the company/consultancy can argue its a saas, so how would the taxation work for saas. Are we gonna reach a point where even things like saas could be highly taxed?
The easiest way seems to me crypto for (bootstrappable outsourcing?) but depending upon the size of the outsourcing, they can employ multiple methods as I gave.
How would the govt approach the multiple loopholes as such?
The whole issue stems from a pure capitalist system where it sometimes rewards to do malicious things so long term, countries need to find ways of supporting social entreprises/funding them.
I've been hearing this since the early 90's, and I'm still not seeing any evidence that it's true.
Exec compensation above a reasonable salary needs to to tied somehow to longer term outcomes.
The Weathertech CEO (or maybe I'm misremembering, in any case it was a big private company CEO) has a good talk about this IIRC.
I guess we could think of that as just "part of the reality," but I think its a little silly not to at least mention it.
Even good conditions and everything in country like India paying them around 10-30k$ is seriously really really good (source: I live there) and its english speaking and well integrated etc.
I saw another comment which mentioned that just merely healthcare in america can cost around 10k$/year
So Labour should be empowered in a good way but this idea still won't help america simply because of power purchasing parity.
Not to forget that America is going through some really tough economic crisis right now which it needs to figure out on. The deficit is still high and everything and companies are favoured completely capitalistic and so combined with all of these factors, we really come to the situation where it is.
I appreciate your optimism but I have my doubts. Especially when one reads the tense atmosphere of America right now
Think of it as two huge reservoirs of water, one of which is at a higher altitude. If you connect them with a pipe, they will inevitably tend to equalize - this is what is happening with globalization. It's good for the developing world but bad for the developed. The labor class not only needs to demand better working conditions, but also standards of living, environment regulations, housing, etc. etc. until equilibrium is reached. The owner class will be exploiting the difference until that happens.
The biggest issue is that even if one provides better working conditions, but also standards of living, environment regulations, housing, etc. etc
Even then, there would still be an imbalance and equilibrium would still not be reached simply because of power purchasing parity and other factors.
Plus another issue is corruption. There are rules and laws already in place but corruption takes their way
Also another thing but corruption can actually also take regulations and hijack them and actually penalize things simply for reducing competition etc.
Corruptions also the reason why we have enough food to feed the world but corruptions in the way and I am not sure if there is a way to solve it
y'know I have this pet theory that corruption is everywhere but the incentives of corruption/ways changes.
In the UK, the prices of rent are so damn high, this is a developed country.
In America, corruption takes place in the form of lobbying and the coupling of politics and finance and also the immense parity of money between the average person and the CEO salary's ratio being one of the highest and the shrewd incentives being one causing these issues in the first places being written almost in law, CEO's of major companies will fire 10_000's of people or more in a blink of an eye.
China, although secret, In my opinion has corruption inside the country as well from a more political standpoint as well
In India, there are some regulations and systems meant for good but people skirt through them via corruption.
So I don't know but to me corruption feels natural in the sense that altruism can't be the only gene and biology would dictate maliciousness to be present
This does make me sad thinking about it but I think that the nash equilibrium is unfair. This is how the system works, this is a cycle and Countries Like India/China once were super rich then became poor then are getting on their path again
At the end of the day, the person speaking about this Jensuan huang is corrupt as well selling AI hype in the first place, spiking actual prices of actual goods people buy thus contributing in inflation but also that some people accuse them of even writing this statement as a way to people please
When I had thought about it previously, I think um the best things we can do is probably reduce the incentives of corruption and then the nature of good ideas would take prevalance.
It's also just not a developing vs developed countries thing anymore as I said. We see in the news cycle how much blatantly corrupt America's current administration is becoming.
At the end of the day, facing reality is hard but that's the only way we can really put real change in the world.
if you have some thoughts about how to counter corruption in your idea/ actually creating incentives to be good and not corrupt or even malicious compliance in your idea and I am listening and I'd love to discuss more about it.
I wish there was less corruption but I am starting to think that incentives are set this way to help corruption and those themselves might've been/were brought by corruption themselves as one wrote on HN once that corruption brings more corruption , so how can one stop this vicious cycle? Because if that happens, I am telling you that America has enough money but the corrupt forces distribute them in a concentrated manner, even solving that problem to me feels like something which can help empower the labour globally
perhaps the rich can be taxed for what they deserve and that money can then be spent in developing countries labour class in your idea? This to me feels the most okay way to help but the problem is, nobody's taxing the rich/its hard because of all the loopholes/malicious legal compliance in many places.
Or it's a great way to spur innovation in automation, which has other beneficial downstream effects. This is what people always seem to forget to consider, and I don't know why.
This is is a fallacious argument. Most or even all of those places couldn't have hoped to out-compete the domestic companies without the traitorous companies shipping complete factories to them. The reason the Soviets didn't outcompete us wasn't down to just incentive structures (though that was part of it), quite alot of their failure was down to being locked out of the market on machine tools.
https://en.wikipedia.org/wiki/Dodge_v._Ford_Motor_Co.
Basically, A company is bound by legal precendence to focus on capitalistic gains. It would be better if we argue the existence of other structures/their prevalence but I don't think that we can blame the entire companies but the darn structures that they are in
A CEO makes 100x (yes its not becoming hyperbole, sad reality) than workers. He is given power and he is given incentives to cut money wherever he can. He sees off sourcing and does this.
But I am not seeing America go towards a path like this, on the contrary, we are seeing America try to actively talk about workers in here and then talk about businesses without doing anything about all the issues in the first place.
There is a fundamental conflict of interests and America's promising both sides. It honestly feels political to me now because the news cycle for America is moving so damn fast (which is really really bad) that nobody comes to question these things in the first place or most aren't because they aren't literally having the time to do such with all the news cycle imo
I don't really know what America can do at this point.
> This is is a fallacious argument. Most or even all of those places couldn't have hoped to out-compete the domestic companies without the traitorous companies shipping complete factories to them. The reason the Soviets didn't outcompete us wasn't down to just incentive structures (though that was part of it), quite alot of their failure was down to being locked out of the market on machine tools.
Do you have any sources for this, I found it quite fascinating that machine tools can play such a big impact.
If it is, is it a sort of chicken and egg problem where machine tools require factories themselves which again require machine tools. If so, why couldn't Soviet Union just import some from other countries to bootstrap the production of tools which could then bootstrap all factories?
And, the cheapest labor is slave labor like Dubai and the US (via prison labor in current use by multiple major corporations) use already. If there's no floor of standards, that creates perverse incentives and ridiculous instability.
Why does it seem like it is getting pushed down relative to other posts that have less upvotes and with longer times?
Here are some posts that are currently higher ranked.
https://news.ycombinator.com/item?id=46445412 currently 8 hours and 82 points
https://news.ycombinator.com/item?id=46465493 currently 4 hours and 29 points
https://news.ycombinator.com/item?id=46497589 currently 5 hours and 82 points
It does not make sense unless some force is pushing the Jensen post down, or the other posts up?
But, I don’t think anyone is naive enough to propose such a thing seriously. It is impossible to believe that some administration wouldn’t use it for political favors.
Why? It's selfish, but since the US and EU sent jobs out to India and China. India and China, have created protections that make getting those jobs back nearly impossible short of stopping payments. At the same time, these countries have huge trading imbalances (see FR complaining that their CN trade imbalance is untenable) and have become the defacto for cheap labor.
I’m hoping that free markets tend to produce winners more often than protectionist ones. I don’t really want stagnant US companies to just stick around because they cozied up to the government.
Also, last I saw, he wasn’t prevented from speaking at any point in those past 2 decades and I don’t remember any mention from him about these issues despite the fact that there’s been bipartisan concerns about manufacturing in China for at least a decade.
It’s almost like he’s trying to position his company’s profit growing enterprises as a part of helping the poorest Americans to justify the U.S. taxpayer paying for a lot of it, or at least assuming all downside risk…
20yr ago you could at least plausibly lie to yourself and say that things were ok. The seeds were sown back in the late 60s early 70s at least. Fair amount of gas was put on the fire in the 80s.
American leaders lost hope in Americas ability to build the future. They decided this was as good as it's going to get and squoze the people at every level with unproductive IT, bureaucracy, consumerism. This country doesn't have a workforce capable of building the future anymore, it's dropouts and druggies the lot of them.
https://www.youtube.com/watch?v=VRr60nmDyu4
We have shipped millions of jobs overseas, and ... a strange situation, we have a process in Washington where after you serve for a while, you can cash in, become a foreign lobbyist.
We have got to stop sending jobs overseas.
You're paying 12, 13, 14 an hour for factory workers and you can move your factory South of the Border, pay a dollar an hour for your labor, have no health care. That's the most expensive single element making a car. Have no environmental controls, no pollution controls and no retirement and you don't care about anything but making money.
There will be a giant sucking sound going south.