6 ms·

Other countries are able to provide these same things with even more government support. Somehow, they end up costing even less. How does your theory explain th

Other countries are able to provide these same things with even more government support. Somehow, they end up costing even less. How does your theory explain that fact?

pxeboot 6y ago
At least with housing, London, Sydney, Vancouver and other major cities are even more expensive than the US when adjusted for earnings.
roenxi 6y ago
Which other countries are we talking here? I'll guess Europe. The United States covers ~1/3 of a continent and has ~1/3 of a million people who make up probably the most diverse ever polity on the planet. They can't adopt approaches that don't scale really well. Compare that to, say, Sweden. Small physically, small population wise, although they are a lot more diverse than they used to be. Nevertheless, they can reasonably adopt policies that do not scale and target a group of people with very similar experiences. For the US to provide Schools/Hospitals/Houses services comparable to the European countries it would be done at the State level. At the Federal level it is to some degree unprecedented to provide services at the level of quality and at the scale.
- gspr 6y ago
  Another one! I keep hearing this over and over again. Can you PLEASE explain how these things won't scale from a few million people to a few hundred million people? Of course there are some things that only work in very tiny places, like the prince of Liechtenstein inviting all citizens to a garden party at his place – and some things that only work in very big places, like a manned lunar program. But why wouldn't things like hospitals and schools scale well for the range "a few million" (Sweden in your example) to "a few hundred million" (the US in your example)? Sorry that I'm getting all worked up here, but I feel like a crazy person for being presented with this argument over and over and not grasping even a fraction of it! Nobody says "oh, those things from Sweden won't scale to Germany (10x)", but for some reason this conversation keeps getting shut down with "oh, those things from Germany can't possibly scale to the US (4x)". Above I'm only talking about population, because surely you don't actually mean that "small physically" has a positive effect on hospitals, schools and housing? If we were discussing transportation infrastructure, sure, but…
  - roenxi 6y ago
    > But why wouldn't things like hospitals and schools scale well for the range "a few million" (Sweden in your example) to "a few hundred million" (the US in your example). Different climates, industries, demographics and educational achievement change what diseases/health issues are present and how they are dealt with in the community. That sort of thing varies wildly in a population of 10s-100s of millions spread over a large geographic area. A sparse rural population has different healthcare needs than an urban one, for example. Coordinating that sort of thing across a continent isn't that helpful. State level administration makes more sense than trying to coordinate a policy across a continent. What is cross-continent coordination supposed to win anyone anyway? It just makes the politics harder to manage. > Nobody says "oh, those things from Sweden won't scale to Germany (10x)", but for some reason this conversation keeps getting shut down with "oh, those things from Germany can't possibly scale to the US (4x)". I'm happy to say that; there will be things Sweden is doing that are completely different to what Germany does because of scaling. Plus the fact that they have different laws and legal systems. Although I suspect neither of us speaks Swedish or German, so it would be hard to settle that one decisively. > because surely you don't actually mean that "small physically" has a positive effect on hospitals, schools and housing? I mean exactly that. Australia faces similar issues where West Australia has a decidedly different culture to the east coast states and it doesn't make sense to try and coordinate housing policy between them. We don't coordinate hospitals either for that matter, although there may have been some push towards a nationalised education standard.
    - gspr 6y ago
      > Different climates, industries, demographics and educational achievement change what diseases/health issues are present and how they are dealt with in the community. I'm sorry, I'm not buying this without some source that shows that Americans need more healthcare than Swedes due to those factors. > A sparse rural population has different healthcare needs than an urban one, for example. Sure, but the US is 82% urban, Sweden is 88%, Germany 77%, France 81%, Norway 83%, Denmark 88%, Finland 85%, Switzerland 74% – I can go on [1]. All very much in a comparable range. [1] https://www.cia.gov/library/publications/the-world-factbook/fields/349.html https://www.cia.gov/library/publications/the-world-factbook/... > State level administration makes more sense than trying to coordinate a policy across a continent. Fine. Many public hospitals in Germany and Switzerland – two countries with federal systems – are run at the equivalent of the state level. > What is cross-continent coordination supposed to win anyone anyway? It just makes the politics harder to manage. I'm not claiming that the US would have some gain in these areas for being huge! I'm merely questioning your claim that "it won't scale". > I'm happy to say that; there will be things Sweden is doing that are completely different to what Germany does because of scaling. This is incredibly vague. Of course there are "things done differently". That's not an argument for why the US can't do a version of the same. > Plus the fact that they have different laws and legal systems. Why is this relevant? That's like saying "the flags are very different". > Although I suspect neither of us speaks Swedish or German, so it would be hard to settle that one decisively. I can understand Swedish just fine, and rudimentary German. Even if I couldn't, the legal, healthcare and educational systems in both countries are well-described in English language sources. > Australia faces similar issues where West Australia has a decidedly different culture to the east coast states and it doesn't make sense to try and coordinate housing policy between them. I'll perhaps grant that the housing situation may be extremely different from place to place, and coordination can be hard, but I still don't understand an iota of what you mean when it comes to healthcare and education.
- bryanrasmussen 6y ago
  I've never been able to follow the argument that social welfare policies won't work for a diverse society, in which, as far as I've been able to figure out diversity means lots of different racial groups? How will diversity of population keep approaches from scaling well? How similar in experience must a population be for a policy to work for them, for example a policy of universal health care. I would have thought that the experience of being mortal would suffice, but evidently not.
  - luckylion 6y ago
    I believe it's less about ethnicity and more about culture. Policies work differently for e.g. the citizens of Tokio and those of New York City. If you have largely homogeneous groups, you're having a much easier time to create policies than if you have very heterogeneous groups. The US is very culturally diverse, so "one size fits all" is likely much more difficult. > I would have thought that the experience of being mortal would suffice, but evidently not. If that's so, why do we see different approaches to social policy in different cultures? Surely, they are all mortal?
    - bryanrasmussen 6y ago
      the question was not why are there different policies in different cultures, the question was why would universal health care not work because of diversity of the population. I suppose that universal health care will work for diverse populations because once that is introduced to the population the benefit should be clear, and that really the only thing that should be required for universal health care to work for diverse populations is that they be human - hence my reference to mortality. I believed this chain of thought would be clear, unfortunately I was mistaken.
      - luckylion 6y ago
        "Everybody wants to live" is one side. I'm certain there's no issue there. "Everybody wants to pay for the system the same way" is another. I assure you, there are issues here. Do you see how it might be a thing that different cultures approach differently?
- dpweb 6y ago
  The idea of govt just taxing all and funding the services has already been proven out in the US. Medicare. I don't think the issue is that these things won't scale. BUT, Medicare comes with price controls. Free tuition, free healthcare for all has been proposed. Not free of course, it's simply taxed to the general public. Politically in the US, it doesn't sell. Not knocking it, a good argument can be made for these systems, and its a debate that needs to occur. "Socialism" (which it isn't really) evokes a visceral negative reaction in the US among many. Being stoked by the media (aka those who have an opposing financial interest) of course.
  - take_a_breath 6y ago
    Medicare is the most popular policy in America.
- take_a_breath 6y ago
  == For the US to provide Schools/Hospitals/Houses services comparable to the European countries it would be done at the State level.== The tax structure of the US makes it very hard for states to provide this as so much of our tax dollars go to the Fed. Then, as a blue state resident, a bunch of those Federal taxes go to poorer states. We could do a lot with the ~$4 billion annually we pay in taxes that go to other states. == At the Federal level it is to some degree unprecedented to provide services at the level of quality and at the scale.== Medicare? US military? Us postal services? And on and on.
  - chrisco255 6y ago
    When I look at the California high speed bullet train project, that has been over a decade in progress and has cost over $75 billion and still nowhere near completion... I see the real problem with just throwing money blindly at every problem.
    - take_a_breath 6y ago
      Has anyone made that proposal?
jryle70 6y ago
Other Western countries have unquestionably more efficient and better coverage healthcare system, but you need to define what you mean by "more government support". The US made up 33% of revenue of pharmaceutical companies in 2017, 50% more than 15 Western Europe countries combined. [0] One may argue that pharma companies use US revenue to subside their cost elsewhere. The US spent $4.7T on healthcare in 2018, of those 40% were paid by Medicare and Medicaid. In general more than 70% are from federal and state governments, employers and other non-household sources, the rest is out of personal pocket. So no, there's been enormous government support healthcare spending in the US. The issue is efficiency. [0] - https://www.statista.com/statistics/784420/share-of-worldwide-pharma-revenue-by-country https://www.statista.com/statistics/784420/share-of-worldwid... [1] - https://www.cms.gov/Research-Statistics-Data-and-Systems/Statistics-Trends-and-Reports/NationalHealthExpendData/NHE-Fact-Sheet https://www.cms.gov/Research-Statistics-Data-and-Systems/Sta...
- take_a_breath 6y ago
  Nobody said there wasn’t enormous support for healthcare in the US, so I’m not sure what you’re arguing. It seems like a strawman. Without more information on the population, healthcare systems and income level of the 15 Western European countries, your data point doesn’t really prove anything. Also notable that you focused exclusively on healthcare in lieu of mentioning education or housing.
  - chrisco255 6y ago
    U.S. also spends an extraordinary amount on schooling: $12,201 per year per student in 2017 (K-12 education) [1]. College education spending is also very high, as public colleges and universities are highly subsidized (typically an in-state student only pays about 1/3 to 1/4 of total costs, which is why out-of-state is more expensive) [2]. Keep in mind, low income students are eligible for Pell grants. There's a lot of federal and state funding of research, etc. I would wager U.S. is among the highest in per capita spending for education. [1] https://www.census.gov/newsroom/press-releases/2019/school-spending.html https://www.census.gov/newsroom/press-releases/2019/school-s...). [2] https://www.usnews.com/education/best-colleges/paying-for-college/articles/paying-for-college-infographic https://www.usnews.com/education/best-colleges/paying-for-co...
gilbetron 6y ago
Not the OP, but different types of government support results in different outcomes. In the US, the US will give students whatever size loan they need for education. This creates the incentive for Education institutions to charge more and more, because there is no one to say "no". In other countries, the government provides the money directly to the Edu institution, and therefore acts as the single buyer of education, in a way. And so there isn't that inflationary incentive. I think this could have a downside, as well, which is less need to compete for student's attentions. Although even that is nuanced, as making fluffier, happier student life isn't necessarily good either!
Press2forEN 6y ago
Do the countries you're referring to have the geographic size, population size, diversity, polarization, and the military responsibilities that the US has?
- gspr 6y ago
  I've long been puzzled by this argument! Can you please elaborate? > geographic size That might matter for things like transportation infrastructure, but surely being graphically large doesn't make healthcare, schooling or housing harder? At worst, it's surely irrelevant, and at best it might even be an advantage for some of those? > population size I ask another commenter about this here: https://news.ycombinator.com/item?id=23518452 https://news.ycombinator.com/item?id=23518452 > diversity How does this matter? > military responsibilities Arguably, the US is spending far more on the military than her responsibilities necessitate.
  - kongolongo 6y ago
    Population distribution in conjunction with geography is what makes it difficult. Even though most of the US population lives in cities, it is necessary to serve the health needs of sparsely populated areas as well. The cost to serve those areas is significantly higher and the distribution of those areas around the U.S. geographically is much different challenge than in Europe. In general, the EU is much more densely populated than the U.S. [1]. Shortages of specialists and emergency services are common examples of challenges with serving rural U.S. areas. The diversity of the population matters because, for example, different cultural practices result in many different health impacts that result in a more diverse set of healthcare challenges aside from the technical ones. Even something as seemingly simple as patients being able to effectively communicate their health issues and healthcare providers being able to understand these needs is a challenge due to cultural barriers. We can make specific comparisons, but in general EU countries populations are more homogeneous than the U.S. [2]. There is significant challenge to be able to train and maintain a healthcare work force that can understand needs of a diverse population. I'm not sure how spending on military affects healthcare directly either, but the VA program is definitely a factor in how the US spends on healthcare. [1] https://en.wikipedia.org/wiki/Population_density#/media/File:World_population_density_1994_-_with_equator.png https://en.wikipedia.org/wiki/Population_density#/media/File... [2] https://www.washingtonpost.com/news/worldviews/wp/2013/05/16/a-revealing-map-of-the-worlds-most-and-least-ethnically-diverse-countries/ https://www.washingtonpost.com/news/worldviews/wp/2013/05/16...
Ericson2314 6y ago
It's the difference between a government doing a thing, and a government subsidizing a thing.

Other countries are able to provide these same things with even more government support. Somehow, they end up costing even less. How does your theory explain that fact?

pxeboot 6y ago

At least with housing, London, Sydney, Vancouver and other major cities are even more expensive than the US when adjusted for earnings.

roenxi 6y ago

Which other countries are we talking here? I'll guess Europe. The United States covers ~1/3 of a continent and has ~1/3 of a million people who make up probably the most diverse ever polity on the planet. They can't adopt approaches that don't scale really well. Compare that to, say, Sweden. Small physically, small population wise, although they are a lot more diverse than they used to be. Nevertheless, they can reasonably adopt policies that do not scale and target a group of people with very similar experiences. For the US to provide Schools/Hospitals/Houses services comparable to the European countries it would be done at the State level. At the Federal level it is to some degree unprecedented to provide services at the level of quality and at the scale.

gspr 6y ago
Another one! I keep hearing this over and over again. Can you PLEASE explain how these things won't scale from a few million people to a few hundred million people? Of course there are some things that only work in very tiny places, like the prince of Liechtenstein inviting all citizens to a garden party at his place – and some things that only work in very big places, like a manned lunar program. But why wouldn't things like hospitals and schools scale well for the range "a few million" (Sweden in your example) to "a few hundred million" (the US in your example)? Sorry that I'm getting all worked up here, but I feel like a crazy person for being presented with this argument over and over and not grasping even a fraction of it! Nobody says "oh, those things from Sweden won't scale to Germany (10x)", but for some reason this conversation keeps getting shut down with "oh, those things from Germany can't possibly scale to the US (4x)". Above I'm only talking about population, because surely you don't actually mean that "small physically" has a positive effect on hospitals, schools and housing? If we were discussing transportation infrastructure, sure, but…
- roenxi 6y ago
  > But why wouldn't things like hospitals and schools scale well for the range "a few million" (Sweden in your example) to "a few hundred million" (the US in your example). Different climates, industries, demographics and educational achievement change what diseases/health issues are present and how they are dealt with in the community. That sort of thing varies wildly in a population of 10s-100s of millions spread over a large geographic area. A sparse rural population has different healthcare needs than an urban one, for example. Coordinating that sort of thing across a continent isn't that helpful. State level administration makes more sense than trying to coordinate a policy across a continent. What is cross-continent coordination supposed to win anyone anyway? It just makes the politics harder to manage. > Nobody says "oh, those things from Sweden won't scale to Germany (10x)", but for some reason this conversation keeps getting shut down with "oh, those things from Germany can't possibly scale to the US (4x)". I'm happy to say that; there will be things Sweden is doing that are completely different to what Germany does because of scaling. Plus the fact that they have different laws and legal systems. Although I suspect neither of us speaks Swedish or German, so it would be hard to settle that one decisively. > because surely you don't actually mean that "small physically" has a positive effect on hospitals, schools and housing? I mean exactly that. Australia faces similar issues where West Australia has a decidedly different culture to the east coast states and it doesn't make sense to try and coordinate housing policy between them. We don't coordinate hospitals either for that matter, although there may have been some push towards a nationalised education standard.
  - gspr 6y ago
    > Different climates, industries, demographics and educational achievement change what diseases/health issues are present and how they are dealt with in the community. I'm sorry, I'm not buying this without some source that shows that Americans need more healthcare than Swedes due to those factors. > A sparse rural population has different healthcare needs than an urban one, for example. Sure, but the US is 82% urban, Sweden is 88%, Germany 77%, France 81%, Norway 83%, Denmark 88%, Finland 85%, Switzerland 74% – I can go on [1]. All very much in a comparable range. [1] https://www.cia.gov/library/publications/the-world-factbook/fields/349.html https://www.cia.gov/library/publications/the-world-factbook/... > State level administration makes more sense than trying to coordinate a policy across a continent. Fine. Many public hospitals in Germany and Switzerland – two countries with federal systems – are run at the equivalent of the state level. > What is cross-continent coordination supposed to win anyone anyway? It just makes the politics harder to manage. I'm not claiming that the US would have some gain in these areas for being huge! I'm merely questioning your claim that "it won't scale". > I'm happy to say that; there will be things Sweden is doing that are completely different to what Germany does because of scaling. This is incredibly vague. Of course there are "things done differently". That's not an argument for why the US can't do a version of the same. > Plus the fact that they have different laws and legal systems. Why is this relevant? That's like saying "the flags are very different". > Although I suspect neither of us speaks Swedish or German, so it would be hard to settle that one decisively. I can understand Swedish just fine, and rudimentary German. Even if I couldn't, the legal, healthcare and educational systems in both countries are well-described in English language sources. > Australia faces similar issues where West Australia has a decidedly different culture to the east coast states and it doesn't make sense to try and coordinate housing policy between them. I'll perhaps grant that the housing situation may be extremely different from place to place, and coordination can be hard, but I still don't understand an iota of what you mean when it comes to healthcare and education.
bryanrasmussen 6y ago
I've never been able to follow the argument that social welfare policies won't work for a diverse society, in which, as far as I've been able to figure out diversity means lots of different racial groups? How will diversity of population keep approaches from scaling well? How similar in experience must a population be for a policy to work for them, for example a policy of universal health care. I would have thought that the experience of being mortal would suffice, but evidently not.
- luckylion 6y ago
  I believe it's less about ethnicity and more about culture. Policies work differently for e.g. the citizens of Tokio and those of New York City. If you have largely homogeneous groups, you're having a much easier time to create policies than if you have very heterogeneous groups. The US is very culturally diverse, so "one size fits all" is likely much more difficult. > I would have thought that the experience of being mortal would suffice, but evidently not. If that's so, why do we see different approaches to social policy in different cultures? Surely, they are all mortal?
  - bryanrasmussen 6y ago
    the question was not why are there different policies in different cultures, the question was why would universal health care not work because of diversity of the population. I suppose that universal health care will work for diverse populations because once that is introduced to the population the benefit should be clear, and that really the only thing that should be required for universal health care to work for diverse populations is that they be human - hence my reference to mortality. I believed this chain of thought would be clear, unfortunately I was mistaken.
    - luckylion 6y ago
      "Everybody wants to live" is one side. I'm certain there's no issue there. "Everybody wants to pay for the system the same way" is another. I assure you, there are issues here. Do you see how it might be a thing that different cultures approach differently?
dpweb 6y ago
The idea of govt just taxing all and funding the services has already been proven out in the US. Medicare. I don't think the issue is that these things won't scale. BUT, Medicare comes with price controls. Free tuition, free healthcare for all has been proposed. Not free of course, it's simply taxed to the general public. Politically in the US, it doesn't sell. Not knocking it, a good argument can be made for these systems, and its a debate that needs to occur. "Socialism" (which it isn't really) evokes a visceral negative reaction in the US among many. Being stoked by the media (aka those who have an opposing financial interest) of course.
- take_a_breath 6y ago
  Medicare is the most popular policy in America.
take_a_breath 6y ago
== For the US to provide Schools/Hospitals/Houses services comparable to the European countries it would be done at the State level.== The tax structure of the US makes it very hard for states to provide this as so much of our tax dollars go to the Fed. Then, as a blue state resident, a bunch of those Federal taxes go to poorer states. We could do a lot with the ~$4 billion annually we pay in taxes that go to other states. == At the Federal level it is to some degree unprecedented to provide services at the level of quality and at the scale.== Medicare? US military? Us postal services? And on and on.
- chrisco255 6y ago
  When I look at the California high speed bullet train project, that has been over a decade in progress and has cost over $75 billion and still nowhere near completion... I see the real problem with just throwing money blindly at every problem.
  - take_a_breath 6y ago
    Has anyone made that proposal?

jryle70 6y ago

Other Western countries have unquestionably more efficient and better coverage healthcare system, but you need to define what you mean by "more government support". The US made up 33% of revenue of pharmaceutical companies in 2017, 50% more than 15 Western Europe countries combined. [0] One may argue that pharma companies use US revenue to subside their cost elsewhere. The US spent $4.7T on healthcare in 2018, of those 40% were paid by Medicare and Medicaid. In general more than 70% are from federal and state governments, employers and other non-household sources, the rest is out of personal pocket. So no, there's been enormous government support healthcare spending in the US. The issue is efficiency. [0] - https://www.statista.com/statistics/784420/share-of-worldwide-pharma-revenue-by-country https://www.statista.com/statistics/784420/share-of-worldwid... [1] - https://www.cms.gov/Research-Statistics-Data-and-Systems/Statistics-Trends-and-Reports/NationalHealthExpendData/NHE-Fact-Sheet https://www.cms.gov/Research-Statistics-Data-and-Systems/Sta...

take_a_breath 6y ago
Nobody said there wasn’t enormous support for healthcare in the US, so I’m not sure what you’re arguing. It seems like a strawman. Without more information on the population, healthcare systems and income level of the 15 Western European countries, your data point doesn’t really prove anything. Also notable that you focused exclusively on healthcare in lieu of mentioning education or housing.
- chrisco255 6y ago
  U.S. also spends an extraordinary amount on schooling: $12,201 per year per student in 2017 (K-12 education) [1]. College education spending is also very high, as public colleges and universities are highly subsidized (typically an in-state student only pays about 1/3 to 1/4 of total costs, which is why out-of-state is more expensive) [2]. Keep in mind, low income students are eligible for Pell grants. There's a lot of federal and state funding of research, etc. I would wager U.S. is among the highest in per capita spending for education. [1] https://www.census.gov/newsroom/press-releases/2019/school-spending.html https://www.census.gov/newsroom/press-releases/2019/school-s...). [2] https://www.usnews.com/education/best-colleges/paying-for-college/articles/paying-for-college-infographic https://www.usnews.com/education/best-colleges/paying-for-co...

gilbetron 6y ago

Not the OP, but different types of government support results in different outcomes. In the US, the US will give students whatever size loan they need for education. This creates the incentive for Education institutions to charge more and more, because there is no one to say "no". In other countries, the government provides the money directly to the Edu institution, and therefore acts as the single buyer of education, in a way. And so there isn't that inflationary incentive. I think this could have a downside, as well, which is less need to compete for student's attentions. Although even that is nuanced, as making fluffier, happier student life isn't necessarily good either!

Press2forEN 6y ago

Do the countries you're referring to have the geographic size, population size, diversity, polarization, and the military responsibilities that the US has?

gspr 6y ago
I've long been puzzled by this argument! Can you please elaborate? > geographic size That might matter for things like transportation infrastructure, but surely being graphically large doesn't make healthcare, schooling or housing harder? At worst, it's surely irrelevant, and at best it might even be an advantage for some of those? > population size I ask another commenter about this here: https://news.ycombinator.com/item?id=23518452 https://news.ycombinator.com/item?id=23518452 > diversity How does this matter? > military responsibilities Arguably, the US is spending far more on the military than her responsibilities necessitate.
- kongolongo 6y ago
  Population distribution in conjunction with geography is what makes it difficult. Even though most of the US population lives in cities, it is necessary to serve the health needs of sparsely populated areas as well. The cost to serve those areas is significantly higher and the distribution of those areas around the U.S. geographically is much different challenge than in Europe. In general, the EU is much more densely populated than the U.S. [1]. Shortages of specialists and emergency services are common examples of challenges with serving rural U.S. areas. The diversity of the population matters because, for example, different cultural practices result in many different health impacts that result in a more diverse set of healthcare challenges aside from the technical ones. Even something as seemingly simple as patients being able to effectively communicate their health issues and healthcare providers being able to understand these needs is a challenge due to cultural barriers. We can make specific comparisons, but in general EU countries populations are more homogeneous than the U.S. [2]. There is significant challenge to be able to train and maintain a healthcare work force that can understand needs of a diverse population. I'm not sure how spending on military affects healthcare directly either, but the VA program is definitely a factor in how the US spends on healthcare. [1] https://en.wikipedia.org/wiki/Population_density#/media/File:World_population_density_1994_-_with_equator.png https://en.wikipedia.org/wiki/Population_density#/media/File... [2] https://www.washingtonpost.com/news/worldviews/wp/2013/05/16/a-revealing-map-of-the-worlds-most-and-least-ethnically-diverse-countries/ https://www.washingtonpost.com/news/worldviews/wp/2013/05/16...

Ericson2314 6y ago

It's the difference between a government doing a thing, and a government subsidizing a thing.