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There are three gigantic sources of waste in the US: healthcare, military spending and education. All of them are 1) run by large organizations with growing bur

There are three gigantic sources of waste in the US: healthcare, military spending and education. All of them are 1) run by large organizations with growing bureaucracies, 2) considered so important that any expense is justified, 3) heavily subsidized or financed with loans or insurance, so growing costs are always met 4) in a position where the bureaucracy decides how much should be spent, not the end consumer. In other words, the school decides its students need $300 text books, or to raise rates $1k to fund new buildings and programs. Same with hospitals: the last hospital I was at had a grand piano and robots roaming the hallway. Politicians don't want to be seen cutting defense spending, so the military bureaucracy decides how much to spend, and when there's money left at the end of the year they always find a way to spend it. I'm not sure how we should fix it, but I'd imagine we either have to increase pressure on these institutions to save money by drying up their endless source of revenue, or take the purchasing decisions out of their hands and back into the hands of consumers.

kem 10y ago
Although I can appreciate the comparison in terms of amount of money in each, I don't know there is tremendous waste in all three, or that the source of expense is the same in all three. What they do have in common is being seen as indispensible or essential services. I agree they also all have tremendous bureaucracies. For example, I think one primary source of costs in healthcare (strangely almost completely unaddressed in the current healthcare law debates) is lack of competition. Licensing laws and government regulation over procedures and whatnot stifles effective choices in healthcare. There are many other problems too, like lack of transparency over pricing, and an inversion of the normal economic decision-making process (for example, instead of the buyer having fixed costs and benefits to choose between, they are often at best only given the option of accepting or refusing the service). Education is a bit different, IMHO. There, you have businesses using degrees as checklist criteria and pushing off real training onto schools; schools have become administratively topheavy. Rather than being faculty-driven, they're increasingly administratively-driven (it's not uncommon to have several deans of a given college, for example). States, which have historically funded universities in the public interest, are cutting that funding and pushing costs onto students. I guess my point is that I don't really see the solutions being the same, nor do I see simply cutting funding and "starving the beast" as the right solution. Education is already underfunded, and what tends to happen is that administrators cut other positions over their own, or over relinquishing decision-making authority to democratic processes. Too much discussion has focused on who pays for healthcare, and in what way, or how much. It's important but not really helpful in the long-term, because the real problems are in transparency and overregulation. It's ridiculous, for example, to assume that citizens can take responsibility for their own healthcare if the government explicitly prevents people doing just that: by preventing them from making their own healthcare decisions, preventing competition, and raising regulatory hurdles to new services (e.g., in the form of drug regulation, overly strict laws about who can provide what service, and what hospitals and manufacturers must do). So we end up with a system where you can't refill a harmless medication you've used for years without getting approval of an overpaid provider, but can get a harmful opiate from that same provider when another service (from a different type of provider) would be more helpful. The amount of money being spent in these areas is not really the problem; it's a symptom. Just cutting spending on them will not really address the problems, and may make them worse.

kem 10y ago

Although I can appreciate the comparison in terms of amount of money in each, I don't know there is tremendous waste in all three, or that the source of expense is the same in all three. What they do have in common is being seen as indispensible or essential services. I agree they also all have tremendous bureaucracies. For example, I think one primary source of costs in healthcare (strangely almost completely unaddressed in the current healthcare law debates) is lack of competition. Licensing laws and government regulation over procedures and whatnot stifles effective choices in healthcare. There are many other problems too, like lack of transparency over pricing, and an inversion of the normal economic decision-making process (for example, instead of the buyer having fixed costs and benefits to choose between, they are often at best only given the option of accepting or refusing the service). Education is a bit different, IMHO. There, you have businesses using degrees as checklist criteria and pushing off real training onto schools; schools have become administratively topheavy. Rather than being faculty-driven, they're increasingly administratively-driven (it's not uncommon to have several deans of a given college, for example). States, which have historically funded universities in the public interest, are cutting that funding and pushing costs onto students. I guess my point is that I don't really see the solutions being the same, nor do I see simply cutting funding and "starving the beast" as the right solution. Education is already underfunded, and what tends to happen is that administrators cut other positions over their own, or over relinquishing decision-making authority to democratic processes. Too much discussion has focused on who pays for healthcare, and in what way, or how much. It's important but not really helpful in the long-term, because the real problems are in transparency and overregulation. It's ridiculous, for example, to assume that citizens can take responsibility for their own healthcare if the government explicitly prevents people doing just that: by preventing them from making their own healthcare decisions, preventing competition, and raising regulatory hurdles to new services (e.g., in the form of drug regulation, overly strict laws about who can provide what service, and what hospitals and manufacturers must do). So we end up with a system where you can't refill a harmless medication you've used for years without getting approval of an overpaid provider, but can get a harmful opiate from that same provider when another service (from a different type of provider) would be more helpful. The amount of money being spent in these areas is not really the problem; it's a symptom. Just cutting spending on them will not really address the problems, and may make them worse.