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> Different climates, industries, demographics and educational achievement change what diseases/health issues are present and how they are dealt with in the com

by 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.

roenxi 6y ago
> Sure, but the US is 82% urban https://en.wikipedia.org/wiki/Urbanization_in_the_United_States https://en.wikipedia.org/wiki/Urbanization_in_the_United_Sta... Alaska is substantially larger than any of the European countries you listed, and is not very urban. > I'm merely questioning your claim that "it won't scale". Given how badly the US has mucked it up? With that level of technology sophistication, social dynamism and money? Pretty solid evidence that it can't be done. It got stuck in the morass that is politics at the US Federal level. > Why is this relevant? That's like saying "the flags are very different". European countries are coordinating healthcare at the equivalent level of a US state and it is working. The US has made moves to coordinate at the Federal level and it is not. The separate legal systems indicates that these are highly independent policy-wise. > I still don't understand an iota of what you mean when it comes to healthcare and education. Healthcare is similar to housing. Sickness is location-specific and population-specific. For education the arguments take a slightly different flavour; but boil down to different industries have different educational needs and a one-size-fits-all educational system will either systematically under- or over- educate students in different cities with different industry needs/opportunities.
- gspr 6y ago
  > Alaska is substantially larger than any of the European countries you listed, and is not very urban. Sure, but hospital requirements don't scale with area. If the US had a horrible healthcare system in Alaska, and a great one in urban areas, maybe we wouldn't have this debate. > Given how badly the US has mucked it up? Is the mucking up due to size though? That is the crux of the matter, and I can see no evidence that that is the case. > Pretty solid evidence that it can't be done. This sounds like insanity to me. It's literally one datapoint! Isn't that a bit like saying "China hasn't gone to the moon, so that's pretty solid evidence that the preference of rice over potatoes as main starchy staple makes moon landings impossible". > Healthcare is similar to housing. Sickness is location-specific and population-specific. For education the arguments take a slightly different flavour; but boil down to different industries have different educational needs and a one-size-fits-all educational system will either systematically under- or over- educate students in different cities with different industry needs/opportunities. There's nothing of substance in what you're saying here. You made a very bold claim, and all your evidence for it seems to be "oh it could be that, it could be this, maybe that".
  - kongolongo 6y ago
    > Sure, but hospital requirements don't scale with area. They absolutely do. How can you say the requirements of getting emergency response to a sparsely populated area is the same as a much smaller and more densely populated area? Getting a appropriate response times to cover the larger and more sparsely populated area is definitely going to be more costly and difficult. >If the US had a horrible healthcare system in Alaska, and a great one in urban areas, maybe we wouldn't have this debate. Actually yes healthcare in rural areas is significantly worse. Urban is not great, but that is not relevant to the point, also they are not disjoint systems they share significant funding. Saying urban US doesn't have great healthcare doesn't disprove the point that rural areas have higher healthcare costs and worse outcomes. https://hpi.georgetown.edu/rural/#:~:text=The%20rural%20population%20is%20consistently,population%20with%20respect%20to%20health.&text=Rural%20residents%20are%20also%20more,tests%20for%20various%20chronic%20conditions https://hpi.georgetown.edu/rural/#:~:text=The%20rural%20popu....
jandrewrogers 6y ago
You are underestimating the extent that geographic diversity materially impacts the design of government policy around social services, irrespective of population scale. Social policy is based on a set of assumptions about local needs and local conditions. The larger the geographic area, the less valid any particular set of assumptions are going to be. Two geographically rural regions in the US can have very different medical care requirements. It isn't the "rural" that makes them different but "geographically distant", the latter being correlated with widely varying ethnicities, cultures, environment, and demographics. Almost any uniform Federal policy would be completely broken for some part of the US due to its geographic extent and diversity. This is a recurring issue for policy that has nothing to do with social services. For example, the fundamental legal axioms around water management are different between the eastern and western US because it would be a policy disaster for that to be uniform. See also the disaster of trying to apply uniform highway policy in the US, which have since partly devolved back to local control. Social services are similar, including the implementation of medical care and schools. We already have cost problems in some regions of the US where required medical facilities are virtually never used because incidence varies widely across widely separated parts the US, it doesn't average together, a large part of which is explained by genetics, culture, and environment. Every aspect of schools vary wildly from region to region, virtually nothing about it is uniform, because States recognize that maximizing school participation -- a social good -- requires respecting local conditions, culture, and constraints. I grew up across several geographically diverse parts of the US and experienced the extreme range of local adaptation first hand. There were some questionable local policies here and there, but in the vast majority of cases those diverse social service policies were trying to optimize local outcomes. If there was a uniform and in-depth Federal policy for all of these things, the amount of flexibility and leeway required to not produce objectively worse local outcomes for many people would asymptotically approximate having no uniform Federal policy at all. All of the European countries you list have a geographic extent that fits within a single policy jurisdiction for both healthcare and education in the US. In the larger US jursidictions, they devolve considerable control of these to more local authorities, recognizing the limitations of uniform policies in large geographic jursidictions.

by gspr 6y ago

roenxi 6y ago

> Sure, but the US is 82% urban https://en.wikipedia.org/wiki/Urbanization_in_the_United_States https://en.wikipedia.org/wiki/Urbanization_in_the_United_Sta... Alaska is substantially larger than any of the European countries you listed, and is not very urban. > I'm merely questioning your claim that "it won't scale". Given how badly the US has mucked it up? With that level of technology sophistication, social dynamism and money? Pretty solid evidence that it can't be done. It got stuck in the morass that is politics at the US Federal level. > Why is this relevant? That's like saying "the flags are very different". European countries are coordinating healthcare at the equivalent level of a US state and it is working. The US has made moves to coordinate at the Federal level and it is not. The separate legal systems indicates that these are highly independent policy-wise. > I still don't understand an iota of what you mean when it comes to healthcare and education. Healthcare is similar to housing. Sickness is location-specific and population-specific. For education the arguments take a slightly different flavour; but boil down to different industries have different educational needs and a one-size-fits-all educational system will either systematically under- or over- educate students in different cities with different industry needs/opportunities.

gspr 6y ago
> Alaska is substantially larger than any of the European countries you listed, and is not very urban. Sure, but hospital requirements don't scale with area. If the US had a horrible healthcare system in Alaska, and a great one in urban areas, maybe we wouldn't have this debate. > Given how badly the US has mucked it up? Is the mucking up due to size though? That is the crux of the matter, and I can see no evidence that that is the case. > Pretty solid evidence that it can't be done. This sounds like insanity to me. It's literally one datapoint! Isn't that a bit like saying "China hasn't gone to the moon, so that's pretty solid evidence that the preference of rice over potatoes as main starchy staple makes moon landings impossible". > Healthcare is similar to housing. Sickness is location-specific and population-specific. For education the arguments take a slightly different flavour; but boil down to different industries have different educational needs and a one-size-fits-all educational system will either systematically under- or over- educate students in different cities with different industry needs/opportunities. There's nothing of substance in what you're saying here. You made a very bold claim, and all your evidence for it seems to be "oh it could be that, it could be this, maybe that".
- kongolongo 6y ago
  > Sure, but hospital requirements don't scale with area. They absolutely do. How can you say the requirements of getting emergency response to a sparsely populated area is the same as a much smaller and more densely populated area? Getting a appropriate response times to cover the larger and more sparsely populated area is definitely going to be more costly and difficult. >If the US had a horrible healthcare system in Alaska, and a great one in urban areas, maybe we wouldn't have this debate. Actually yes healthcare in rural areas is significantly worse. Urban is not great, but that is not relevant to the point, also they are not disjoint systems they share significant funding. Saying urban US doesn't have great healthcare doesn't disprove the point that rural areas have higher healthcare costs and worse outcomes. https://hpi.georgetown.edu/rural/#:~:text=The%20rural%20population%20is%20consistently,population%20with%20respect%20to%20health.&text=Rural%20residents%20are%20also%20more,tests%20for%20various%20chronic%20conditions https://hpi.georgetown.edu/rural/#:~:text=The%20rural%20popu....

jandrewrogers 6y ago

You are underestimating the extent that geographic diversity materially impacts the design of government policy around social services, irrespective of population scale. Social policy is based on a set of assumptions about local needs and local conditions. The larger the geographic area, the less valid any particular set of assumptions are going to be. Two geographically rural regions in the US can have very different medical care requirements. It isn't the "rural" that makes them different but "geographically distant", the latter being correlated with widely varying ethnicities, cultures, environment, and demographics. Almost any uniform Federal policy would be completely broken for some part of the US due to its geographic extent and diversity. This is a recurring issue for policy that has nothing to do with social services. For example, the fundamental legal axioms around water management are different between the eastern and western US because it would be a policy disaster for that to be uniform. See also the disaster of trying to apply uniform highway policy in the US, which have since partly devolved back to local control. Social services are similar, including the implementation of medical care and schools. We already have cost problems in some regions of the US where required medical facilities are virtually never used because incidence varies widely across widely separated parts the US, it doesn't average together, a large part of which is explained by genetics, culture, and environment. Every aspect of schools vary wildly from region to region, virtually nothing about it is uniform, because States recognize that maximizing school participation -- a social good -- requires respecting local conditions, culture, and constraints. I grew up across several geographically diverse parts of the US and experienced the extreme range of local adaptation first hand. There were some questionable local policies here and there, but in the vast majority of cases those diverse social service policies were trying to optimize local outcomes. If there was a uniform and in-depth Federal policy for all of these things, the amount of flexibility and leeway required to not produce objectively worse local outcomes for many people would asymptotically approximate having no uniform Federal policy at all. All of the European countries you list have a geographic extent that fits within a single policy jurisdiction for both healthcare and education in the US. In the larger US jursidictions, they devolve considerable control of these to more local authorities, recognizing the limitations of uniform policies in large geographic jursidictions.