Society has this figured out, at least a decent solution that works until we find a perfect one. Only the US society seems to be unable to find a solution.
IIRC if you look at the cost of Medicaide, Medicare, VA, and other federal and state spending it's the same as most other countries per capita or as a percent of GDP. The US taxpayer pays about as much as Canadians to fund their public system, then pays the same amount again for private cover since it's not universal.
No I'm not making a typo. Medicare, Medicaide, and the US system is such a rip off that per capita Americans are paying similar tax dollars to their joke of a public system.
But no one wants to fix it. US doctors are overpaid. US nurses are over paid. Dug companies. Admin. Lawyers. Everyone who makes the system work, and everyone who makes the system a mess are paid a fortune for it.
- no-one's talking about immigration in general. They're talking about mass immigration. So any general "look how immigration can be good" is not addressing the issue.
- mass immigration means that housing becomes scarce, driving up prices. This again makes GDP look good, because stamp duty revenue goes up and so do estate agent fees. But all the many negative externalities, such as everyone is now buying houses 10 years later, and leaning on their parents, and their dwellings are all being subdivided because even a tiny place is now worth renting out or selling, are totally ignored. The housing costs drive every other cost up. Minimum wage / living wage needs to skyrocket just to combat this one thing, both because people need more money to pay for their own accommodation, and people need to afford goods and services that are all also being made more expensive because their salary costs need to increase for the same reason.
- mass immigration spikes up demand for power. Power is often a large capital investment, which means that the country borrows a load of money from Macquarie Group to build it, with lots of interest paid back over decades. Seems to generate GDP as people are being paid to build things; actually a net negative all told over the lifetime of the investment.
- the same as power but for water.
- the same as power but for roads. Traffic and congestion are now being actively managed by computerised systems because there are so many cars on the road.
- the same as power but for pollution. Another negative externality of driving up population for GDP reasons. Every person imported is more pollution generated in and by the local country.
It's important we have young people entering the workforce. But adding more people from external sources is not sustainable. When they all get old do we import more people? Or should we just be repurposing the millions of young people who are doing less important but less icky jobs to do the jobs that we're currently getting immigrants to do. "Who will pick the cotton?" is not a good question.
The housing shortage is driven by NIMBY and regulatory capture. You are right that perpetual growth is unsustainable but we are not remotely near the possible carrying capacity of our land and resources. We have had periods of much greater population growth that were accompanied by greater prosperity overall.
Immigrants are not the problem, they are the convenient scapegoat of the business interests that have systematically hollowed out the middle class over the last 50 years.
My entire region has been overrun by Mexican immigrants. There are more Mexicans here than Mexico. They are poor, and they bring their poverty with them, driving down wages and sales prices everywhere and turning the place into a slum. The locals (natives) aren't the beneficiaries of this arrangement. Only the governments and businesses.
17% of GDP is healthcare. So between 1:10 and 2:10 people in this country are making more than they otherwise would (note I did not say wealthier) because the system is screwed up and hoovers up more of everyone else's wealth than it ought to.
Slavery was 12% and (while obviously geographic concentration of industry plays a lot into it) it took a war for them to take a haircut.
Systemic inertia is unimaginably strong.
I easily see that changing the USA to be more socialist, especially in areas where game theory indicates its the best solution, will likely take a civil war.
That also aligns with Marx's writings, that the capitalists will not acquiesce without a fight, and a big fight at that.
The slavery and Civil War connection is a comparison of similar economic magnitudes.
The fact that that pie is not sliced evenly does not change the fact that is an integer multiple larger than it ought to be.
Certain specialities probably are overpaid (orthopedics), but others like pediatricians or general practitioners usually aren’t.
And nurses!? From the nurses I know they are underpaid for what they deal with.
The ones making loads of many are willing to travel around the country and uproot their life once or more every year. Not exactly a lifestyle without its drawbacks.
Yeah, most pink / blue collar workers in the US are badly underpaid, but IIRC ones in the health sector are some of the best off, relative to medium salaries.
Compare teachers and nurses. In most countries they make about the same AFAIK (and I'd say nurses do deserve more, telling a parent Billy did badly on a math test has got to be easier than explaining a bad medical test). But in the US it's about 75k vs 95k. There's a huge premium for working in health in the USA, EVEN in the underpaid blue collar end.
Doctors make out even better in the US, and the c suite in health can have salaries that are just insane.
McKinsey did a nice analysis of what is driving US healthcare costs. It compares category spending to OECD then compared price and volume.
Turns out the US pays a bit more for drugs (relative to total spend), a little more for inpatient care and a TON more for outpatient care but half of the increase is volume, not price.
As someone who works in healthcare globally, the difference in US care is stark. Americans get much early and more access to new technology than other countries.
If your lymphoma has returned and you have a 20% of living more than a few years the best care is CAR-T with cure rates close to 60%.
Check out CAR-T rates in the US versus Europe, it’s almost 3x. The US started using it in 2014 and Singapore just started paying for last year (11 years later). Even in Europe adopt only ramped up in the last 5 years.
So yes prices are higher, but a big part is more aggressive care with more expensive treatment.
“Canadian health care” is not a thing. Each province administers its own completely independent system. Someone on PEI is in a healthcare system that has as much to do with Alberta’s healthcare system as it does their neighbours in Maine. As a result, anyone referencing Canadian healthcare is talking about a dozen or so unrelated systems that do things very differently. The closest it comes is that there are interprovincial billing systems so you don’t have to do the paperwork to get covered for an urgent visit out of province, and not all provinces are signed on.
You can safely dismiss anyone that has reduced that complexity, or is completely ignorant of it. It’s a great way to tell when a foreigner is spouting talking points they picked up from an unreliable source and did not do even a minimal fact check on. “Canadian health care” as it is talked about in the US media is frequently fiction for propaganda purposes.
Canadians talk about problems within a province.
No idea if the rest of his statement is poorly sourced propaganda as the first sentence.
So yes there may be differences between provinces in terms of when they fund what restrictions are put on it, the overall trend across Canada is pretty consistent.
And as I said Canadians don’t get the same care as Americans so concluding the higher cost is entirely higher prices for the same thing is false.
You're talking about cutting edge technologies available to the tiniest sliver of people - I'm not even able to get access to much of them with my private FAANG insurance - and drawing a false comparison.
And it's not "the tiniest sliver of people", we're talking about disease like cancer. Check out the CAR-T rates in the US vs. Canada, the difference is stark. And CAR-T is standard of care in some types of lymphoma.
Hell, ask parents with autistic kids what kind of early intervention is available to them in Canada. I had a coworker who moved to the US so he'd have much better access for his kid at a time when it had a big impact.
Look at access to the cystic fibrosis therapy that effectively cures it (e.g. Orkambi). It was paid for by insurance (and Medicaid!) from the day it was launched and avaiable to everyone it could help. In Canada some provinces just started paying for it, but only kids, adults are shit outta luck.
And I don't know the details of your FAANG insurance, but my US insurance (typical corporate insurance) pays for all these new technologies.
Canada is great if you have a routine issue. If you need something specialized you're going to be treated with therapies that are a decade or more old. Hell, even the CBC wrote a whole story about 2 friends with breast cancer and the differences in treatment.
https://www.cbc.ca/news/canada/british-columbia/a-tale-of-2-...
"Then I found out that this other country — which I thought had a healthcare system that was so superior to the U.S. — doesn't test for the tumour marker that saved my life, and doesn't cover this drug that is responsible for pushing my cancer into remission after traditional chemotherapy failed to do that."
Life expectancy shows that while the US is the best place to have stage 4 cancer, it's probably not the best place overall. Most places do the 80/20 stuff better.
But yeah, you are right that the US does some stuff well. Just not efficiently.
Life expectancy doesn't measure quality of healthcare, there are far too many confounding variables like genetics, diet, accidental deaths, etc. No serious study of healthcare quality relies on it.
Look at 5-year cancer survival rates. The US is better (significantly better) in many of them than other countries. A big part of that is access to the latest technology.
https://www.thelancet.com/journals/lanonc/article/PIIS1470-2...
The US leans aggressive on tests and heroic end of life care. I doubt you really disagree (except maybe on whether you think it's the right call). That is where the money is, since the insurance company can be forced to pay. It's kind of good for the rest of the world though if the US wants to pay (in both money and other issues) to be early adoptors.
Read "When doctors die", the US is the total opposite - everything goes to the big ticket aggressive (and yes, modern and cutting edge) treatment where it's hitting diminishing returns. https://pmc.ncbi.nlm.nih.gov/articles/PMC6179868/
Sure!
Turns out the CDC changed the way it counts maternal deaths, while other countries didn't, so you're comparing different measures.
The old US measure was deaths that occurred during birth or shortly thereafter, now it's within six months and they added a check box only asking if the woman had been pregnant in the last year.
Not "this woman died because of poor maternal care", but rather "this woman who died had been pregnant in the last year".
This change immediately doubled the number. The data was wildly overestimating maternal deaths and in fact the CDC and many states are revising data collection to improve the number.
Median pay for a Nurse Practitioner is $132K/yr [0]. I think that's reasonable.
Average pay for physicians ranges from $220-450K depending on specialty. [1]
Personally, I think doctors should be paid more than software engineers, so I think those numbers are all reasonable, especially when you consider what it takes just to enter the field. Nurses require a Master's degree. Physicians need a Bachelor's degree PLUS another 4 years of med school AND THEN a residency program that lasts 3-9 years depending on specialty before they finally earn their medical license.
IMO, the idea that nurses and doctors are overpaid is quite simply ludicrous.
[0] https://www.bls.gov/ooh/healthcare/nurse-anesthetists-nurse-...
[1] https://www.bls.gov/ooh/healthcare/physicians-and-surgeons.h...
You'll find that salaries across the board are lower in other countries. Software developers in Europe make half of what they do in the USA. In exchange, they get far better benefits.
Also, physician salary only makes up about 8% of total healthcare costs [0]. Cutting salaries in half wouldn't significantly lower our healthcare costs.
[0] https://www.medicaleconomics.com/view/physician-pay-makes-up...
Unwilling. It's absolutely feasible to find a solution, as seen everywhere else in the world.
From the article:
> In Tulsa and Oklahoma City, meanwhile, the government buys staffed unit-hours from an ambulance operator, while households can prepay a few dollars a month on their utility bill and owe nothing if the ambulance ever comes.
My favorite example is universal school breakfast and lunch. Without fail, someone will argue that some kids don't deserve it. It doesn't matter that all of the data shows it is more economically efficient and the benefits to kids is overwhelming.
The Republicans seem to see it as immoral to potentially give a few people support they don't need even if that means that most of the people who need the support actually get it. And, instead, they believe that having an inconsistent array of private interests will somehow be more able to service an enormous population than having an organization (like government...) that is large enough to match that population's needs.
The Libertarians seem to either genuinely not care about the rest of the world or, more often than not, seem to be naive about how life can be for the less privileged.
It's the lie of the "rugged individualist" in America. Most "successful" people come from successful families. Social mobility, in the US, is part of that lie. Here, we celebrate the person who rises from poverty to become wealthy as a member of a sports team, or as an actor, or similar, while disregarding that these massive successes are outliers.
I'm so often disappointed in my own country.
Good news is that if you want the democratic party to become the party of labor, now is the absolutely best time to have a real impact in your community.
I will tar and feather the "right" constantly. The "left", here, is somewhat better. As you say, though, neoliberalism has infected both parties.
Personally, I'll take the DSA over both. However, the population is unlikely to accept Sam's. And both political parties would sooner collude than accept the DSA as a modern inheritor of American Liberalism.
No, they just put boundaries on what services they want handled by the government. Government programs are the least efficient and most wasteful way of getting a job done, and there are endless examples of this.
Churches were historically the places people went to for assistance, and churches held people accountable and would push them to fix their underlying issues. Government programs have none of this, you can keep making the same bad decisions and nobody will hold you accountable and the benefits will keep coming in.
https://news.gallup.com/poll/697676/drop-religiosity-among-l...
Women commit just as much sexual abuse as men, it's just not talked about by society.
Please provide a citation for this assertion. Here’s mine refuting it.
https://www.ussc.gov/sites/default/files/pdf/research-and-pu...
https://smart.ojp.gov/somapi/chapter-2-etiology-adult-sexual...
https://www.humanrights.unsw.edu.au/news/study-finds-one-10-...
I agree that what you need here is someone(s) with leverage and respect in your life to interfere with systemic bad behaviors if they exist, but that takes community, government merely gets leverage, and churches are often not a welcoming place to many people's eyes, rightly or wrongly, around the US.
As I get older, I'm increasingly of the opinion that the best you can do is unconditional support from the government (because it's the only kind you can rely on no humans in the chain acting in bad faith to condition), and well funded local support structures for people to subsist while fucking up their lives and also help them get out of that spiral if they want to.
Not because I believe in some fundamental good in man or something, but because I think that's the only way you can design this that isn't subject to people's bad faith manipulation, and I've personally seen too many cases go wildly differently for "objective" criteria where the main difference seemed to be whether the person reading it went into it assuming you were lying or not.
It just boggles my mind how the poor are supposed to be continually punished just for being poor and should always be denied, almost by rote, any sort of government aid because, you know, did you hear that story about that fentanyl addict who was found with THREE active EBT cards in his wallet?
Yeah for sure...how dare some dirty addict should be able to eat!
Many choose ignorance because it’s comfortable.
they happen to be in the Fortune 50, or top 10.
serious, go look at the F500 list and see how many of the largest, meanest companies in the US (and world) world also happen to be healthcare
if you wanna know why it's never gonna happen -- there is the list. they will spend more money than god on social media, bribes, and whatever else they need to keep the system the way it is
https://companiesmarketcap.com/
Mostly only pharmaceutical healthcare in the upper tiers of that, but these businesses still have market caps and net incomes literally one or two orders of magnitude separating them. Grouping top 10, 50, and 500 makes no sense.
https://usafacts.org/explainers/what-does-the-us-government-...
The war in Iran in MAY was reported at 29 billion dollars. It's probably been a bit more since then. Justifying stupid actions because you hate brown people isn't good for any of us.
What a strange non sequitur.
No people shouldn't be bankrupted for a short cab ride that's not needed. I'm not arguing that.
I know that John Oliver is a bit of a “lightning rod,” for many folks, but he (or his staff, really) does his homework. He did a segment on it, some time ago: https://youtube.com/watch?v=Ezv8sdTLxKo
I’d also be careful about his facts: they’re usually well-researched, but by the nature of the format he only ever presents those which fit his argument, and that’s just not good epistemology. I can think of a few times when the show made me feel safer about my beliefs than I should have been feeling.
So why not make fun of them? There's no downside.
...except the populist right backlash, triggered in part by their resentment at coastal "elites" (think yuppies, not people who fly to davos annually) sneering at them.
As an aside, I think the culture which produces this result is related to people in the US always thinking crime is increasing, regardless of actual crime trends.
You’re not supposed to shape your political views from entertainment.
I can’t imagine it’s gotten cheaper.
EDIT: their own website states "If the ambulance only comes and stabilizes you on the spot but you don’t need to be transported, there are no costs." https://ambulanceamsterdam.nl/information-in-english/
The anecdote illustrates the issue then he dives into the analysis.
I feel like you have missed the entire point of the article.
Yes, you want to make that choice rather than shirk it off. Anything else is a perverse incentive. Making poor medical choices that prioritize your own well-being over the financial solvency of those you care for, those around you, is a shitty thing to do. But, some people like to pretend that if they can just make sure those people are the 300 million Americans rather than a more immediate circle of family, that the problem goes away. It doesn't, it becomes worse.
Most decent people would rather croak than ruin their own family. But those same people, through one false rationalization or another, are more than happy to ruin the entire country. Even if doing so won't result in net benefit. If I'm going to live, it's because the cost of keeping me alive is less than the net benefit of my increased lifespan. That calculation has to be the same no matter how you want to "spread the cost among everyone" or it all falls to shit. And since you're incapable of making rational decisions when it's spread further than your own family, well... things are going to continue to go downhill.
Victim of a violent crime? You shouldn't have left your house.
Run over by someone else? You shouldn't have left your house.
Caught an infectious disease? You shouldn't have left your house.
Fell down the stairs? Why were you in your house!?! Don't you know how dangerous it is?!?
I’m sure plenty of those soldiers would rather pay some money for the evac instead of a lifelong ass tat.
x2..x5 multiplier is always applied to any ambulance bill as far as I'm aware. I worked in that industry.
I've seen as long as I've been alive, "Communism killed hundreds of millions!!!" breathless claims.
When Capitalism kills, oh wait, it never does! Its always "bad individual choices", and never a review of the terrible for-profit system that caused it to begin with.
> Making poor medical choices that prioritize your own well-being over the financial solvency of those you care for, those around you, is a shitty thing to do.
And there it is. The system is highly predatory as intentioned. But the system is just part of capitalism, so its OK. But 'YOUR CHOICES' are the one that's bad, aka blame redirection.
And guess what? More and more people are seeing behind this facade that capitalism is good. Socialism is better. We're tired of being extracted, used up, and thrown away. Its why I'm also part of DSA. I'm done with this individual blame for systemic shit.
> But those same people, through one false rationalization or another, are more than happy to ruin the entire country.
You may not have agued it yourself but your two sentence comment is rather lacking in alternate arguments, so I can only interpret you as supporting said parent comment and now engaging in a motte-and-bailey now that you realise you don't actually like what they said.
Sure, but increasing healthcare costs are due to a number of factors like new technology adoption, not just an aging population.
So while I would agree that no one is going bankrupt from overuse of ambulances, it all adds up.
I am not obligated to make your argument for you, and I am not inclined to calibrate your motte-and-bailey merely because you feel like interjecting your support for a position you would call a strawman when called out.
Are you just uncomfortable with debate? How do you debate the merits of the argument without defining the terms being used?
We’re talking about financial ruin of the government.
It seems even a group that purports to be rational critical thinkers don't want to be rational critical thinkers to the extent of looking into the root causes.
But no, I won't be a communist with you. And if you insist, things could get ugly. Fortunately for me, you're still in your hipster-college-champagne stage of communism, and you're both scared of violence and worried about the PR backlash of being found out to be a bloodthirsty savage.
In November when it becomes apparent that the Democrats won't win back seats, you'll all start to panic. But the real fun will come in 2028 or 2030, when Obamacare will be dismantled. I can hardly wait.
Only a complete moron would think the answer to this is no. If there's no personal cost to using an extremely expensive service, every one is going to use it regardless of whether it's actually necessary. It will quickly turn into a free taxi service for anyone who wants to go anywhere near a hospital.
The only way a free ambulance system could work is if there were harsh penalties for people who abuse the system. Unfortunately, the American Democrat party has shown countless times that they have no interest in preventing fraud. Prominent Democrats like Tim Walz and Gavin Newsome have spent more time in the last year pushing laws to protect fraudsters than prosecuting them.
Okay, so why don't we see this behaviour more in other countries?
In my jurisdiction, the incentives are actually weighted towards pushing people to ambulances, as there is a €100 fee for self-referral to ED which is waived if you're transported, but while there are time wasters and frequent flyers, the service is actually less abused than US ambulances under EMTALA.
And what does the Democratic party have to do with all that? Your whole comment just seems like a thinly veiled and insulting political rant. Going by your account name, this seems to be a pattern.
The (fairly obvious) answer to that no one should be in that situation. It's horrible. Society should find a better way to pay for ambulances. Most of the world has accepted that some system to spread the cost among everyone is better than putting people in that situation.