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> don't you have already in USA public schools,roads, parks, firemen, police Sure. That has nothing to do with Socialism. There's nothing wrong with paying r

> don't you have already in USA public schools,roads, parks, firemen, police Sure. That has nothing to do with Socialism. There's nothing wrong with paying reasonable taxes to build and support an infrastructure that is of benefit to all involved. The healthcare problem in the US is grotesquely misunderstood. It has NOTHING to do with insurance (private and otherwise) and everything to do with stuff politicians have done to us over the years. Look, I work in aerospace. If I don't analyze things down to the real root causes of failures things go boom or worse, people die. And so I tend to look at problems with this perspective. If you analyze the healthcare problem in the US to identify root causes the last thing you are going to have on your list (if at all) is insurance. It is as irrelevant as can be. What's on the list? I'll list three, in no particular order of importance: - Government involvement in student loans - Tort reform - Federal and State regulatory burden The US government is involved in guaranteeing student loans, which creates a situation where universities can charge insane amounts of money for their product. Even worse, universities make these loans accessible to kids without consideration to what it will mean for their lives and society in general. If a doctor graduates with a nice new degree and $300K or more in debt, he or she is not going to be able to work for what I will term a "reasonable wage". Starting life with that much debt pretty locks people in to having to charge large amounts of money for their time and services. No imagine an operating room where each person has student debt in the range of $300K and more. That surgery, I don't care what it is, is going to be very expensive. Add to that the debt every single person in that hospital has to face and you'll get the picture. At a first level of inspection, the involvement of government in student loans has created a situation where the cost of medical care has increased to ridiculous levels over time. The solution isn't to spend unobtainable amounts of money to offer free education. The solution is for government to get out of that business and allow the free market to force universities to compete. If a doctor graduates with $100K or less in debt they, in theory, medical care costs would drop by 66%. They would be able to have a similar standard of living and charge 2/3 less for their services at the same time. That is a HUGE improvement all by itself. Tort reform is another huge issue. This one affects the entire chain of participants in the healthcare industry. In the US you can sue anyone and everyone for anything that might happen in the course of receiving medical care. In fact, if, as an example, there's problem with care and a lawsuit is filed, they will sue everyone from the doctor to the hospital, equipment providers, suppliers, etc. They will go as far and wide as they can. This means everyone in the chain has to have very expensive insurance to protect themselves. I know doctors who pay tens of thousands of dollars per year for this kind of insurance. My wife is a doctor, so we get to experience these realities first hand. Once again, this imposes minimum costs that have to be covered by what you charge for your services. And the cost is high. Not just in terms of what you have to charge but what you have to do. It is very common for US doctors to run a bunch of unnecessary tests. One of the fears is that if you don't and, for whatever reasons, a lawsuit is filed, you could be exposed to career-ending liability because you did not run the patient through every possible test in the universe. These things increase the cost of healthcare by an unknowable factor. Let's just say it is not insignificant. If we fixed this problem healthcare costs would come down. Drug companies are exposed to multi-billion dollar liability. Again, someone has to pay for these costs, and that someone are the patients. Finally, regulatory burden. I wanted to develop a simple medical device to help people with what's known as "Single Side Deafness" SSD. This is a case where a person can only hear from one side and is deaf on the opposite side. From a technical perspective, giving them the ability to hear something from the deaf side is easy: microphone on one side, earpiece in the other ear, bring some of the sound across, done. Well, I very quickly discovered that the cost to get such a device through regulatory testing and approvals was very easily in the tens of millions of dollars, if not a hundred million+. This is why hearing aids cost thousands of dollars and other medical supplies and equipment can be so expensive. Drug makers spend billions of dollars on the regulatory burden. Once again, these costs have to be paid by someone, that that someone are the patients. Nobody is proposing we eliminate all regulation but, if we truly care about universally available healthcare we have to look for ways to make these costs a rounding error rather than something that has an entrepreneur like me say "forget it, I'd rather put my money in to making websites people click for money". That's just reality my friend. And so, if you read all of this, got here and stop to think a bit, you should come to the conclusion that insurance isn't on that list because it likely does not belong there, at least not as a major cost driver. It is almost irrelevant. Address the above three (and there are more, of course) and the cost of healthcare in the US (as well as private insurance) will absolutely plummet. The people pushing stuff like "Medicare for all" are pushing a fantasy not rooted in reality and one that has truly evil side effects (read my other answer on the subject). They push this fantasy because the lie is far easier to sell than speaking about the truth and the hard work we have to do in order to solve the problems I listed here as well as other issues. A politician's objective is to gain votes, not to solve problem. In order to do that they have to win a beauty contest, not an intellectually sound argument. They use every trick in the book they lie, they misrepresent and they propose crazy stuff that no informed voter would ever support. And they do this because they know that the vast majority of voters operate at a basal level and virtually none of them are going to engage in this kind of analysis or the thought require in order to understand if what they are saying aligns with any objective reality. I hope you got this far and actually stop to think. Don't attack the messenger, address the argument. What I said above is based on root cause analysis of the US healthcare system and it is as near to irrefutable as I can get given the resources available to me.

simion314 7y ago
1 why not get the top say 10000 smartest people that want to study medicine and offer them free education. If some rich person is not in the top he can pay. Why would you prefer to lose some smart but poor people. I understand that the system is super complex and if you clean it up you would probably don't need to pay more insurance or taxes though I seen there is a lot of FUD that an European like system would cost people more then already pay (I am not sure if you are in this camp) Do you think something like Canada, UK or other countries have are not american enough for USA?
- alacombe 7y ago
  > why not get the top say 10000 smartest people that want to study medicine and offer them free education You forget to take into account racial / cultural / religious / gender "equality" concern which prevent you to get a 100% merit based system.
- robomartin 7y ago
  These are fair questions and I don't have real answers, just opinion based on having a good deal of exposure to other cultures and systems. I believe one of the misconceptions in the US is that free university in other countries means anyone gets in. That is simply not the case. A very simple example I have of this is the daughter of one of our close friends who wants to study medicine in Spain. She has been preparing for a full year to take entrance exams in order to be accepted into the university. Her parents are paying for her preparation to pass these exams. Even if preparation was free, the acceptance rate will be based on how many seats are available and some weighing of results. This means that only a certain type of student (notice I did not say class) will have access to university education, even if it is free. I get the sense some Americans think that making university free means everyone has an equal probability of obtaining a PhD. This is a fantasy. Universities can only accept a certain number of students per year and they have to filter from the total candidate population in order to reduce it down to what they are able to handle. It is hard to argue against the potential value of free education except to point out that, at a first level, if unworthy students are accepted at the exclusion of good students we would be wasting money and valuable resources. If we are going to give someone the gift of a valuable education they have to demonstrate they are ready for it and that the probability of success is reasonable. This, in the US, would setup yet another inequality problem. It is easy to see that kids from more challenging environments are not going to do well if they have to pass tests in order to enter Harvard or MIT when it is free. Do you exclude really good students to accept those who are almost guaranteed to fail? Why is it OK to discriminate against kids who are excellent students? Why is it not OK to tell less capable students to spend a year or two at an (also free) preparatory college and then take the entrance exam again. In other words, don't degrade standards for some misplaced social ideology. If we want to graduate excellent doctors, let's do exactly that through a process that ensures it. And then there's the problem of how to pay for all of that. Universities and colleges in the US currently exist under a system where students are paying anywhere from, say, $20K to $60K per year --if not more-- for their education. That means that, as a business, as an organization, their financial model is entirely based on the various revenue generators available to them, one of which is tuition. This financial model cannot be supported if tuition disappears. There is no way we can pay for that structure through taxation, even if we take all the money from all the billionaires in the nations (which is another massive lie these politicians are telling). To this point, one of the other things Amercian voters without exposure to other parts of the worlds don't understand is that universities in other nations are not as rich as those in the US. Professors don't get paid nearly as much in free-education nations as they do in the US. I mean, in the US salaries in the hundreds of thousands of dollars per year --even millions-- are a very real occurrence. https://thebestschools.org/magazine/highest-paid-college-professors-america/ https://thebestschools.org/magazine/highest-paid-college-pro... Outliers? Sure, but the reality of the matter is that free-university professors, in the US or elsewhere, simply can't make as much. The equation very quickly becomes mathematically unsustainable. However, it does not end there, there's staff and an organization behind each professor and class and those have budgets too. Simple put, if less money comes in you have to either close down or spend less. As you noted, things are far more complex than they always seem on the surface. We can't have free education for all without addressing costs. There is no way we are going to pay a professor hundreds of thousands of dollars or even millions if taxpayers are paying the bill and everything is free. At some point things have to be fair and reasonable. Simple example, my son is at a university studying robotics. They have a two million dollar humanoid robot in one of the labs. They also have equipment and other robots costing many, many millions of dollars. These costs have to be paid somehow and by someone. My guess is that, today, that's a combination of tuition and donations. If we make tuition free, the need for cash can only be reduced by lowering professor salaries, reducing the size and breath of the organization and controlling the other costs (no million dollar humanoid). This is a reality at universities all over the world, they can't afford to be government-funded and have the same kinds of extravagant things we often see at universities in the US. Can it be done? Sure, of course. Be we should not lie about how we would do it, and this should include a conversation about how our universities would change, how salaries would change and how access to technology and resources would change. Yet another level of detail: What does "free" mean. In Europe and Latin America you might have free university but the cost of books and the cost of living somewhere and all of your personal costs are still yours. In the US, unlike in other parts of the world, kids leave their parents home and go to university all over the nation. In other countries is is very common for kids to go to local universities and stay home. Well, if our universities are free, who is going to pay for a kid from Las Vegas to travel to Boston and live there while attending free Harvard? That is still a significant amount of money. And that should not be a part of "free". All of this means that, even if we make university tuition free you are going to have to filter kids based on academic performance --creating a social inequality battle-- and you are not going to pay for them living at some far away city at all. Again, things are always far more complex than they might seem on first inspection. I don't know what the solutions might be. My gut feeling is that, in the US, the first step is to get government out of the business of financing university education. That will force universities to compete, control costs and become more efficient (financially speaking). If we do that, tuition will come down and might become very affordable. This could resolve the problem to a satisfactory level as a first experiment. Allow a natural reduction of cost through competition. Ten years later, come back and consider the idea of funding the more efficient versions of our universities to cover, say, half of the tuition. Another ten years and we cover it all and university is free. I would much prefer to see a gradual, logical and careful process towards better and cheaper education than some mathematically impossible attempt that is far more likely to cause a disaster than to fix anything.

simion314 7y ago

1 why not get the top say 10000 smartest people that want to study medicine and offer them free education. If some rich person is not in the top he can pay. Why would you prefer to lose some smart but poor people. I understand that the system is super complex and if you clean it up you would probably don't need to pay more insurance or taxes though I seen there is a lot of FUD that an European like system would cost people more then already pay (I am not sure if you are in this camp) Do you think something like Canada, UK or other countries have are not american enough for USA?

alacombe 7y ago
> why not get the top say 10000 smartest people that want to study medicine and offer them free education You forget to take into account racial / cultural / religious / gender "equality" concern which prevent you to get a 100% merit based system.
robomartin 7y ago
These are fair questions and I don't have real answers, just opinion based on having a good deal of exposure to other cultures and systems. I believe one of the misconceptions in the US is that free university in other countries means anyone gets in. That is simply not the case. A very simple example I have of this is the daughter of one of our close friends who wants to study medicine in Spain. She has been preparing for a full year to take entrance exams in order to be accepted into the university. Her parents are paying for her preparation to pass these exams. Even if preparation was free, the acceptance rate will be based on how many seats are available and some weighing of results. This means that only a certain type of student (notice I did not say class) will have access to university education, even if it is free. I get the sense some Americans think that making university free means everyone has an equal probability of obtaining a PhD. This is a fantasy. Universities can only accept a certain number of students per year and they have to filter from the total candidate population in order to reduce it down to what they are able to handle. It is hard to argue against the potential value of free education except to point out that, at a first level, if unworthy students are accepted at the exclusion of good students we would be wasting money and valuable resources. If we are going to give someone the gift of a valuable education they have to demonstrate they are ready for it and that the probability of success is reasonable. This, in the US, would setup yet another inequality problem. It is easy to see that kids from more challenging environments are not going to do well if they have to pass tests in order to enter Harvard or MIT when it is free. Do you exclude really good students to accept those who are almost guaranteed to fail? Why is it OK to discriminate against kids who are excellent students? Why is it not OK to tell less capable students to spend a year or two at an (also free) preparatory college and then take the entrance exam again. In other words, don't degrade standards for some misplaced social ideology. If we want to graduate excellent doctors, let's do exactly that through a process that ensures it. And then there's the problem of how to pay for all of that. Universities and colleges in the US currently exist under a system where students are paying anywhere from, say, $20K to $60K per year --if not more-- for their education. That means that, as a business, as an organization, their financial model is entirely based on the various revenue generators available to them, one of which is tuition. This financial model cannot be supported if tuition disappears. There is no way we can pay for that structure through taxation, even if we take all the money from all the billionaires in the nations (which is another massive lie these politicians are telling). To this point, one of the other things Amercian voters without exposure to other parts of the worlds don't understand is that universities in other nations are not as rich as those in the US. Professors don't get paid nearly as much in free-education nations as they do in the US. I mean, in the US salaries in the hundreds of thousands of dollars per year --even millions-- are a very real occurrence. https://thebestschools.org/magazine/highest-paid-college-professors-america/ https://thebestschools.org/magazine/highest-paid-college-pro... Outliers? Sure, but the reality of the matter is that free-university professors, in the US or elsewhere, simply can't make as much. The equation very quickly becomes mathematically unsustainable. However, it does not end there, there's staff and an organization behind each professor and class and those have budgets too. Simple put, if less money comes in you have to either close down or spend less. As you noted, things are far more complex than they always seem on the surface. We can't have free education for all without addressing costs. There is no way we are going to pay a professor hundreds of thousands of dollars or even millions if taxpayers are paying the bill and everything is free. At some point things have to be fair and reasonable. Simple example, my son is at a university studying robotics. They have a two million dollar humanoid robot in one of the labs. They also have equipment and other robots costing many, many millions of dollars. These costs have to be paid somehow and by someone. My guess is that, today, that's a combination of tuition and donations. If we make tuition free, the need for cash can only be reduced by lowering professor salaries, reducing the size and breath of the organization and controlling the other costs (no million dollar humanoid). This is a reality at universities all over the world, they can't afford to be government-funded and have the same kinds of extravagant things we often see at universities in the US. Can it be done? Sure, of course. Be we should not lie about how we would do it, and this should include a conversation about how our universities would change, how salaries would change and how access to technology and resources would change. Yet another level of detail: What does "free" mean. In Europe and Latin America you might have free university but the cost of books and the cost of living somewhere and all of your personal costs are still yours. In the US, unlike in other parts of the world, kids leave their parents home and go to university all over the nation. In other countries is is very common for kids to go to local universities and stay home. Well, if our universities are free, who is going to pay for a kid from Las Vegas to travel to Boston and live there while attending free Harvard? That is still a significant amount of money. And that should not be a part of "free". All of this means that, even if we make university tuition free you are going to have to filter kids based on academic performance --creating a social inequality battle-- and you are not going to pay for them living at some far away city at all. Again, things are always far more complex than they might seem on first inspection. I don't know what the solutions might be. My gut feeling is that, in the US, the first step is to get government out of the business of financing university education. That will force universities to compete, control costs and become more efficient (financially speaking). If we do that, tuition will come down and might become very affordable. This could resolve the problem to a satisfactory level as a first experiment. Allow a natural reduction of cost through competition. Ten years later, come back and consider the idea of funding the more efficient versions of our universities to cover, say, half of the tuition. Another ten years and we cover it all and university is free. I would much prefer to see a gradual, logical and careful process towards better and cheaper education than some mathematically impossible attempt that is far more likely to cause a disaster than to fix anything.