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My biggest fear of a bill like this is even should we have the most progressive anti corruption government implement this law originally, whats to prevent this

My biggest fear of a bill like this is even should we have the most progressive anti corruption government implement this law originally, whats to prevent this from becoming incredibly wasteful just like our military is. I.e. we spend a trillion dollars over decades trying to develop some drug that turns out to take us nowhere, while enriching pfizer shareholders this time instead of lockheed martin ones. I absolutely support medicare for all, even though as a healthy young software engineer this will raise the cost of my healthcare a ton, I'm just nervous that this will result in the largest negative iron triangle in the history of our country.

mlthoughts2018 8y ago
That is the line of thinking explored in Robin Hanson’s article, “Cut Medicine in Half.” https://www.cato-unbound.org/2007/09/10/robin-hanson/cut-medicine-half https://www.cato-unbound.org/2007/09/10/robin-hanson/cut-med... Combined with research on how wealth, family status, social status, access to sex partners, etc. etc. correlate with health outcomes even after controlling for access to doctors, hospital care, etc., it raises a lot of questions. It seems most of the money we spend on medicine as a society is just a form of signalling. We “care” if we give X dollars worth of medical service, regardless of whether that led to a positive outcome or if the outcome could have been obtained more effectively through less “showy” ways or unglamorous things that don’t involve medical procedures or treatment. It goes along with the idea of “betting is a tax on bullshit.” If we paid medical entities based on successful outcomes, including at the population level, then it might incentivize creative, cost-effective solutions instead of providers shoveling more ineffective treatment and demanding high pay just based on administering it.
nickysielicki 8y ago
This is why the scope of government matters. I do not understand why people have this idea that it's the job of the government to do things like speculate on the economy via quantitative easing, or save money overall on healthcare costs. The federal government ought to have a few simple jobs --- the ones laid out in the constitution, and everything else can be left up to the people and to the states. I would rather live in a country where healthcare maybe costs more than it otherwise could, and where the economy maybe recovers slower than it otherwise would have, than to live in a country where the government takes lots of our money trying to fulfill promises that it cannot keep. Medicare is projected to be insolvent in 2026, and Social Security is projected to be insolvent 8 years later. We're due for an economic downswing in the next few years (if not the next few months). Our economy will not keep up with the developing world powers; NATO is increasingly irrelevant and the petrodollar is threatened. What are we going to tell the people who depend on these dying programs? "I know that you worked your whole life in a factory, and I know that you are too old to work, and I know that you paid into this system your entire career, and I know you aren't getting enough to get by. But we had the best intentions in mind!" America is rich because we won WWII, not because of American Exceptionalism. The comfortable life that American culture was built on (while the rest of the world needed half a century to recover) is going away quickly. The social programs that we already have in place have less than 6,000 days remaining before they fall apart, and in these last hours, we're seriously talking about adding on? No thanks. I'm okay with living in a poor country. I'd prefer for my government to not fail as a result, though.
- maxxxxx 8y ago
  Medicare and social security won't be insolvent. They can go on for a long time by doing some adjustments that account for life expectancy and other factors. Unfortunately the people in DC are more interested in fighting each other than running the country in a responsible manner.
- jayd16 8y ago
  This is a really sheltered point of view. I I get the sense that you imagine living in a poor country to be eating instant ramen and not dying in a gutter.
maxxxxx 8y ago
Maybe US citizens should demand better government instead of wasting time on the never-ending partisan warfare. There are plenty of countries with regulated healthcare markets that work very well for their citizens and are cheaper than the US system.
- dragonwriter 8y ago
  > Maybe US citizens should demand better government instead of wasting time on the never-ending partisan warfare. Never ending partisan warfare is what you get when people demand better government but disagree deeply on what is necessary for better government.
  - maxxxxx 8y ago
    I don't believe that people disagree along the lines drawn by parties. Most political fights are artificial constructs to keep the people busy while the the people in DC and their donors stay in power.
    - dragonwriter 8y ago
      > I don't believe that people disagree along the lines drawn by parties. There is plenty of evidence that they do, and also that (by comparing to other democracies and over time) this is directly a product of the party system—an electoral systen supporting small number of signficant parties results in a small number of significant viewpoints, mostly divided on the same lines that divide the parties. > Most political fights are artificial constructs to keep the people busy while the the people in DC and their donors stay in power. Even to the extent that is arguably true, that a fight is an artificial construct or a distraction does not mean that the people at whom it is directed don't deeply buy into and incorporate into their identity the side of the fight they have been propagandized into. In fact, it wouldn't work if they didn't.
      - maxxxxx 8y ago
        "Even to the extent that is arguably true, that a fight is an artificial construct or a distraction does not mean that the people at whom it is directed don't deeply buy into and incorporate into their identity the side of the fight they have been propagandized into. " Most people don't bother understanding an issue or building a real opinion but just follow the part line Just watch the deficit discussion. When Obama was in power, a lot of people thought deficits are bad. Immediately after Trump came in the same people started worrying about deficits. The propaganda put out by the parties is finely tuned and very effective but that doesn't mean that the effects are lasting.

mlthoughts2018 8y ago

That is the line of thinking explored in Robin Hanson’s article, “Cut Medicine in Half.” https://www.cato-unbound.org/2007/09/10/robin-hanson/cut-medicine-half https://www.cato-unbound.org/2007/09/10/robin-hanson/cut-med... Combined with research on how wealth, family status, social status, access to sex partners, etc. etc. correlate with health outcomes even after controlling for access to doctors, hospital care, etc., it raises a lot of questions. It seems most of the money we spend on medicine as a society is just a form of signalling. We “care” if we give X dollars worth of medical service, regardless of whether that led to a positive outcome or if the outcome could have been obtained more effectively through less “showy” ways or unglamorous things that don’t involve medical procedures or treatment. It goes along with the idea of “betting is a tax on bullshit.” If we paid medical entities based on successful outcomes, including at the population level, then it might incentivize creative, cost-effective solutions instead of providers shoveling more ineffective treatment and demanding high pay just based on administering it.

nickysielicki 8y ago

This is why the scope of government matters. I do not understand why people have this idea that it's the job of the government to do things like speculate on the economy via quantitative easing, or save money overall on healthcare costs. The federal government ought to have a few simple jobs --- the ones laid out in the constitution, and everything else can be left up to the people and to the states. I would rather live in a country where healthcare maybe costs more than it otherwise could, and where the economy maybe recovers slower than it otherwise would have, than to live in a country where the government takes lots of our money trying to fulfill promises that it cannot keep. Medicare is projected to be insolvent in 2026, and Social Security is projected to be insolvent 8 years later. We're due for an economic downswing in the next few years (if not the next few months). Our economy will not keep up with the developing world powers; NATO is increasingly irrelevant and the petrodollar is threatened. What are we going to tell the people who depend on these dying programs? "I know that you worked your whole life in a factory, and I know that you are too old to work, and I know that you paid into this system your entire career, and I know you aren't getting enough to get by. But we had the best intentions in mind!" America is rich because we won WWII, not because of American Exceptionalism. The comfortable life that American culture was built on (while the rest of the world needed half a century to recover) is going away quickly. The social programs that we already have in place have less than 6,000 days remaining before they fall apart, and in these last hours, we're seriously talking about adding on? No thanks. I'm okay with living in a poor country. I'd prefer for my government to not fail as a result, though.

maxxxxx 8y ago
Medicare and social security won't be insolvent. They can go on for a long time by doing some adjustments that account for life expectancy and other factors. Unfortunately the people in DC are more interested in fighting each other than running the country in a responsible manner.
jayd16 8y ago
This is a really sheltered point of view. I I get the sense that you imagine living in a poor country to be eating instant ramen and not dying in a gutter.

maxxxxx 8y ago

Maybe US citizens should demand better government instead of wasting time on the never-ending partisan warfare. There are plenty of countries with regulated healthcare markets that work very well for their citizens and are cheaper than the US system.

dragonwriter 8y ago
> Maybe US citizens should demand better government instead of wasting time on the never-ending partisan warfare. Never ending partisan warfare is what you get when people demand better government but disagree deeply on what is necessary for better government.
- maxxxxx 8y ago
  I don't believe that people disagree along the lines drawn by parties. Most political fights are artificial constructs to keep the people busy while the the people in DC and their donors stay in power.
  - dragonwriter 8y ago
    > I don't believe that people disagree along the lines drawn by parties. There is plenty of evidence that they do, and also that (by comparing to other democracies and over time) this is directly a product of the party system—an electoral systen supporting small number of signficant parties results in a small number of significant viewpoints, mostly divided on the same lines that divide the parties. > Most political fights are artificial constructs to keep the people busy while the the people in DC and their donors stay in power. Even to the extent that is arguably true, that a fight is an artificial construct or a distraction does not mean that the people at whom it is directed don't deeply buy into and incorporate into their identity the side of the fight they have been propagandized into. In fact, it wouldn't work if they didn't.
    - maxxxxx 8y ago
      "Even to the extent that is arguably true, that a fight is an artificial construct or a distraction does not mean that the people at whom it is directed don't deeply buy into and incorporate into their identity the side of the fight they have been propagandized into. " Most people don't bother understanding an issue or building a real opinion but just follow the part line Just watch the deficit discussion. When Obama was in power, a lot of people thought deficits are bad. Immediately after Trump came in the same people started worrying about deficits. The propaganda put out by the parties is finely tuned and very effective but that doesn't mean that the effects are lasting.