7 ms·

Lets ask this question in the other direction. How is it in most modern economies you are able to have good healthcare, a robust safety net, pretty decent infra

Lets ask this question in the other direction. How is it in most modern economies you are able to have good healthcare, a robust safety net, pretty decent infrastructure, the opportunity to further yourself via education without breaking the bank and still keep those economies trucking along while the US: the richest country on the planet can't seem to get this done? There is obviously some disconnect.

sdf131 5y ago
I think we’re ignoring scale here. Is there a country with similar population levels that provides all that? I’m Canadian and I am thankful for our benefits but our public services have been stretched for decades and I’m skeptical that our systems could handle 10x the population.
- xboxnolifes 5y ago
  Isn't the theory that 10x the population would mean 10x the tax revenue, and 10x the infrastructure? The same reason a lot of people like to look at per capita measurements over absolute figures? Or looking at it another way: with the assumption that a country of 30M people can have good infrastructure, and is not an outlier, and there can exists more than one of such country, what is different between 10 countries of 30M people each with good infrastructure and 1 country of 300M having bad? Governments are big, so it's difficult to just point a finger at a specific cause of an issue, but it would seem to me the issue is not continuously building out infrastructure. That, and poorly written, but possibly well meaning, legislation that leads to regulations massively increasing administration costs on every and all areas of our infrastructure (healthcare, general construction, transport, housing).
  - j_walter 5y ago
    The bigger you are the harder it is to do things properly or react fast enough to changing conditions. This is why most companies get huge and then end up failing...they can't change fast enough to stay competitive. It's one thing to be a Scandinavian country that has a homogenous culture and smaller population (and land mass)...and another to mix large amounts of different cultures across a giant nation of states and have everyone agree upon the same thing or be able to institute the same infrastructure.
    - m_ke 5y ago
      There's also a reason why Google, Amazon and Microsoft are the only companies that can compete in cloud computing, it's called economies of scale.
      - j_walter 5y ago
        Sure, but why was Tesla able to start up and take a big portion of the EV market over the last few years? The big companies were too slow in reacting to changing demand. It took years to get something that was equivalent to what they are offering...and yet they still don't have anything close despite far more industry knowledge on how to mass manufacture cars.
      - pjscott 5y ago
        There are economies of scale. There are also diseconomies of scale: https://en.wikipedia.org/wiki/Diseconomies_of_scale https://en.wikipedia.org/wiki/Diseconomies_of_scale Inertia and institutional sclerosis are serious problems for organizations that are large, old, or both.
    - mabub24 5y ago
      Scandinavian countries also have diverse and differing cultures depending on where you live. Just because everyone calls themselves "Swedish" doesn't mean they all agree. I suspect the answer is somewhat different. Just look at their parliaments: they almost always have majority coalitions made up of multiple parties, and a diverse group of opposition parties. What is exceptional about America is its calcification into a two party system, which I think is far more of an issue than the actual differences of opinion and culture in the American populace. In fact, polls regularly show that a majority of Americans generally agree on a number of issues, and broadly support a number of possible policies and programs. For instance, on abortion, a majority of Americans have long supported legalizing it some fashion up until recently. Through the 70's into the 90's, support even reached 60%. Only in the mid 90s did the discussion become wildly more combative and enter a stalemate. Really, most of the extremely popular social safety net programs were created and institutionalized during the 40 years of continuous Democratic majority. What ended it, and brought about the modern Republican party and the current state of American politics, was the "Republican Revolution" in '94[0]. The 2 party system then ran into a brick wall as both parties froze into defensive turtling. [0]: https://en.wikipedia.org/wiki/Republican_Revolution https://en.wikipedia.org/wiki/Republican_Revolution
  - jandrewrogers 5y ago
    In the specific case of the US, it is the scale of the populated geography more than the number of people. This has created problems even in boring and non-controversial policy areas. For example, prior attempts to regulate highway speed limits nationally, which has since been devolved back to local control. At the scale of individual States, it works much more like it does in other countries. Any national-scale policy will be poorly adapted for some major region of the US because it is simply too diverse geographically, culturally, historically, and economically.
- handrous 5y ago
  It's ignored because it hardly seems relevant. Is providing healthcare to ~80m people (France, Germany—numbers off the top of my head but I think that's close for both) or, what, 150m or so (Japan, again, IIRC) really that different from 350m? What part of the difference in scale makes it impossible for the country of 350m with a higher GDP-per-capita than those other examples? Some parts of our country are sparsely populated, yes, but it's not like passing that off to a mix of highly-funded public ventures and market forces (i.e. our current very, very expensive system) magically solves that problem, so how's that relevant to preventing us from having universal healthcare? Plus, Canada's got that problem nearly as bad as we do, no? I know most of the population's down near the border, but you've got the same issues with large areas that are still lightly populated, but you manage. So that can't be the reason.
j_walter 5y ago
Politicians. College has gotten to expensive because the government is involved and has made it a priority for everyone to get a college degree...when many of the people going to college have no business being there. Give out money to kids to go to college...demand goes up...prices go up...give out more money...and the cycle continues. Healthcare simply has too many hands in the pot. Government pays x amount but it costs hospitals 2x...so they charge 3x to insurance companies to make up the difference. It's insane, but making it "free" may not be what fixes it. What safety net does the US not have? Over 60% of people paid no federal income tax last year and we have huge numbers of programs to help low income people.
- dragontamer 5y ago
  > Healthcare simply has too many hands in the pot. Government pays x amount but it costs hospitals 2x...so they charge 3x to insurance companies to make up the difference. It's insane, but making it "free" may not be what fixes it. One of the biggest debates getting stonewalled right now, is whether or not the US Government should negotiate prices for Medicare. Making this a "free healthcare" debate is just... missing the forest for the trees. There's a political party that's against even the US Government negotiating for better prices but otherwise keeping the same system. As if negotiations are a bad thing or something. Look, I'm not liberal to believe in free healthcare, but... surely making the government pay less money for the same services is a good thing?
  - adolph 5y ago
    The government could tax the service at a higher rate, which is fiscally similar to negotiating lower rates except the feature that taxes also skim from the non-govt payor remittances.
    - dragontamer 5y ago
      That also has the effect of artificially raising the price for everyone outside of the government sphere of influence. Ex: me, because I'm not on Medicare / Medicaid yet. Since I have to pay for my medical procedures, the fact that the big government has "decided" that its okay to overpay on X means that I __also__ have to overpay on X. I, the small market participant, am relying upon the big guys to negotiate prices and set them more fairly for the rest of the market. Nominally, this is the job of insurance companies, but no one trusts those guys. (I pay for insurance. The insurance companies negotiate more detailed prices with hospitals). And there's the issue that the government (or more precisely: Medicare / Medicaid) is a "bigger" market participant than any insurance company, so the government's lack of negotiation is probably raising prices on everybody artificially.
fennecfoxen 5y ago
> Lets ask this question in the other direction. How is it in most modern economies you are able to have good healthcare, a robust safety net... Because they tax the middle class intensively. In particular they have tax regimes built more around the Value Added Tax (which taxes consumption) and less around the income tax (which damages incentives to save and invest and which is easily bypassed by billionaires who simply borrow the money they spend without realizing income). If anything, the Nordic states with their lauded safety nets are more market- and capital-friendly than the US, and less economic-interventionist, and happy to say so. It's not all roses. Competent government still matters; there are plenty of debt crises and pension crises and the like in certain nations without it. Overall, families are somewhat less well-off financially, and high youth unemployment remains a chronic problem.
MattGaiser 5y ago
Waste. The US government spends as nearly much on healthcare as a national healthcare system costs in the UK as a percent of GDP. Medicare, Medicaid, and the VA are 1.5 trillion in spending. Or about 7% of GDP. In normal years, NHS spending in the UK is 8% of GDP. I am sure there are substantial coverage differences for a lot of procedures, but all the life threatening stuff for an entire population is handled for what the US spends on just the elderly and poor.
- dragonwriter 5y ago
  > Waste. Not least of all the waste of all the parallel, sometimes overlapping and sometimes mutually exclusive public and private healthcare systems.
- j_walter 5y ago
  It's only waste if you aren't one of the people pocketing from the inefficiency.
- nazgulnarsil 5y ago
  Waste is a fake answer. The UK makes tradeoffs that the US polity is unwilling to engage with. This is a very expensive form of juvenile behavior.
- MattGaiser 5y ago
  And I suspect I could find the extra 1% of GDP in things like Tricare, employee health benefits for federal, state, and municipal workers, CHIP, etc.
- micromacrofoot 5y ago
  Now ask who is profiting from the waste.
robswc 5y ago
Are you trying to imply that these other countries have those things you listed because they have no billionaires? There's millions of reasons why that isn't happening in the US. Billionaires are almost certainly not one of those reasons. The US subsidizes so much for other countries. Without the US, these other countries wouldn't be able to have the same success. Just look at the numbers: https://en.wikipedia.org/wiki/List_of_countries_by_research_and_development_spending https://en.wikipedia.org/wiki/List_of_countries_by_research_... As an aside, I think the biggest irony is commenting this on HN. I know tons of SDEs that come from other countries because they get paid fractions of the salary they would get here.
- micromacrofoot 5y ago
  The concentration of the majority of wealth to a smaller number of people is definitely a factor, it's the hallmark of a corrupt system... > I know tons of SDEs that come from other countries because they get paid fractions of the salary they would get here. This is not irony, and has nothing to do with billionaires. Most SDEs won't even be millionaires.
  - robswc 5y ago
    >The concentration of the majority of wealth to a smaller number of people is definitely a factor, it's the hallmark of a corrupt system... How? >This is not irony We're on a developer news site, talking about the US not having this or that, while also ignoring the fact that the US is very sought after by developers.
    - micromacrofoot 5y ago
      on inequality and corruption: https://www.hks.harvard.edu/publications/inequality-and-corruption https://www.hks.harvard.edu/publications/inequality-and-corr...... Also, it's not irony because it's not even a related subject. People are complaining about billionaires... 99.9999% SDEs are not coming to this country and becoming billionaires. Saying "we're ones to talk" or some kind of equivilant is an irrelevant attempt to lump any sort of wealth with being a billionaire... which is a fairly old-fashioned method to distract by creating lower-class infighting about what "wealthy" means. For an SDE making a very healthy $200k a year... it would take five thousand years to reach $1 billion. It's like arguing that the 2nd amendment should allow the private ownership of nuclear warheads. It's a strawman well outside the scale of the actual discussion.
macksd 5y ago
The same reason the US can spend what it did on the war in Aghanistan and still end up with the Taliban taking control of Kabul as they're on their way out. Total incompetence, no decent end game, and human nature in people that they just won't be able to change. Just a bunch of people lining their own pockets along the way. If the US has a culture of people making poor decisions for their own health, exploiting systems for their own benefit, and of government bureaucracies utterly failing to achieve the ends they're supposed to achieve with no accountability (and it does), no amount of tax revenue is going to suddenly provide everyone with world-class healthcare with no concern for their own money. I'd love to never have to deal with my insurance company again, or take diagnostics or treatments without being able to find out how much I'll have to pay. I really would. I just have zero confidence that any of that would change no matter how much more of my money gets taken by the US government.
- nebula8804 5y ago
  The question then becomes, when did things start to become this way? Was this culture always a US way of thinking or was there a time when the government and people in charge did focus on the long term benefit of its citizens? If corruption and incompetence was the path the whole time, how do you explain the US system becoming #1 in the world? Was it a fluke and that now that we have gotten 100 years of lucky wins the luck has run out and now we have the grim reality of the US system actually being trash? You look at FDR and how close the US population supposedly almost came to eating the elites. Around that time we finally got breadcrumbs in the form of Medicare and Social Security. Now we are seeing moves to even get rid of those programs so we are left with nothing. You can't have a society where a certain percentage is playing by the rules while everyone else is picking whatever they can on the dying carcass.
  - smileysteve 5y ago
    > how do you explain the US system becoming #1 in the world? The US was part of the industrial revolution, but suffered few domestic casualties (infrastructure) from either World War. The dollar becoming the world reserve currency for oil/capitalism cemented it. (Where Russia, Continental Europe, and China were ravaged by WW2)
steego 5y ago
<raising hand> Ooo! Ooo! I know this one!!! I know this one!!! Over the past 30 years, steady changes to regulations in healthcare, education and infrastructure have created a system where we pay HUGE premiums for similar services compared to almost every other countries. It is the result of unabated, in-the-open, perfectly-legal, endemic corruption. This should be a universal and bipartisan issue that unites people, but it isn’t. We’re too stupid to stop fighting each other. We always take the bait from the armies of talking heads telling us how to think and who to hate. In the lovely words of Amy Mann, “It’s not going to stop until you wise up”
- nebula8804 5y ago
  While OP may continue to bumble around with his right wing talking points, let me continue this discussion with you since you get it. What do you think is the end state of this whole saga? It seems like either we reform or we eventually collapse. Maybe its possible a whole generation will continue to zombie walk through this trash system that we have?
  - all2 5y ago
    I will note that GP mentions "We the People" are fighting each other because the talking heads tell us to. I contend that this is on purpose. A casual glance through Rules for Radicals shows that social friction is a tool for social change. With that noted, let's talk end game. There's a common (almost cliche) line of "bad times make strong men, strong men make good times, good times make weak men, weak men make bad times", which appears superficially true. Consider the Weimar Republic, or Imperial Russia from about 2 centuries ago. Both appeared to follow that pattern. The fall of Rome kinda fits that, too, if you squint. The hallmarks of "bad times" appear to be increased law and regulation, increase in law/regulation complexity, non-dependable money supply (inflation was an issue in all three of the above scenarios), dilution of national identity, and so on. I'd argue that what underpins those changes is eroding morality. A perfectly moral people need no law, and their money supply is uncorrupted. As morality decreases, the necessity of law becomes apparent, and so the increase in law and regulation. As graft increases (which drove the need for law and regulation) the money supply becomes corrupted, fiat. The collapse of empires (make no mistake, the United States is a cultural economic empire) is typically sudden, violent, and bloody. All three scenarios all featured a lot of death in a very short amount of time. The end for the United States will likely be the same. Inflation will destroy what's left of the propped up economy. People will start to go hungry, their housing and livelihoods will be threatened. As soon as the bottom of Maslow's Hierarchy is in question, people start to rebel. You see some of that already with anti-vaccine riots. People believe their bodily autonomy is threatened. Definitely their livelihoods are threatened (this game of coercion -- get a vaccine, or you can't even work -- that Australia is playing and that the US seeks to implement -- is pushing people out of their comfort zones). Are we in the end game? Dunno. We won't know until it is the end. Sudden, violent, bloody. [edit] misplaced asterisks [/edit]
jandrewrogers 5y ago
At least in Europe, the middle-class pays much higher taxes than in the US, which funds much of that safety net. Contrary to popular belief, high-income earners in States like California already pay tax rates similar to Western Europe. Imposing European-style tax rates on the US middle-class is unpopular with both major political parties.
xboxnolifes 5y ago
Aside from all of the things that generally come up in this discussion (politicians, country size, melting pot, american dream, government bloat, etc), I think a pretty big contender is poorly written legislation on regulations. Certain things are fairly obviously good to regulate in healthcare, whether that is for privacy, or price transparency, or making sure emergencies don't get turned away, but administration costs of running our healthcare network seems to have blown far and away the cost of the actual healthcare providers (doctors, nurses, surgeons, etc). There is so much paperwork and administrative work in healthcare and it just seems like so much of it could be trimmed away. Legislation seems to be written with the good intentions of protecting patients, but if the administration costs (monetarily or bureaucratically) of complying aren't taken into consideration, that too can indirectly affect patients. I'm neither in the medical field nor do I know how US healthcare regulations compare to other countries, but it just feels like the amount of healthcare administration has grown at a far greater rate than the actual healthcare providers.
- micromacrofoot 5y ago
  Do you trust health insurance companies or hospital administrators to pass on the costs saved from reduced regulation to consumers? I absolutely do not.
  - j_walter 5y ago
    No more than I trust the government to work on passing on reduced costs in the form of lower taxes...
    - micromacrofoot 5y ago
      Fair, but I can't vote for/against private health insurance companies and they have many fewer transparency requirements. Citizens have much more power when it comes to the government versus private industry. I can't even vote with my wallet because my employer chooses my insurer.
  - xboxnolifes 5y ago
oliv__ 5y ago
One could argue that the US is the richest country because of the way things are set up here, not in spite of it. Also, as another commented noted, it's not all roses in those other "modern economies" you mention: France, for example, with its subsidized healthcare system has a public debt equal to 117.8% of its GDP. The US's deficit amounts to 15.2% of GDP in contrast.
newsclues 5y ago
War.

sdf131 5y ago

I think we’re ignoring scale here. Is there a country with similar population levels that provides all that? I’m Canadian and I am thankful for our benefits but our public services have been stretched for decades and I’m skeptical that our systems could handle 10x the population.

xboxnolifes 5y ago
Isn't the theory that 10x the population would mean 10x the tax revenue, and 10x the infrastructure? The same reason a lot of people like to look at per capita measurements over absolute figures? Or looking at it another way: with the assumption that a country of 30M people can have good infrastructure, and is not an outlier, and there can exists more than one of such country, what is different between 10 countries of 30M people each with good infrastructure and 1 country of 300M having bad? Governments are big, so it's difficult to just point a finger at a specific cause of an issue, but it would seem to me the issue is not continuously building out infrastructure. That, and poorly written, but possibly well meaning, legislation that leads to regulations massively increasing administration costs on every and all areas of our infrastructure (healthcare, general construction, transport, housing).
- j_walter 5y ago
  The bigger you are the harder it is to do things properly or react fast enough to changing conditions. This is why most companies get huge and then end up failing...they can't change fast enough to stay competitive. It's one thing to be a Scandinavian country that has a homogenous culture and smaller population (and land mass)...and another to mix large amounts of different cultures across a giant nation of states and have everyone agree upon the same thing or be able to institute the same infrastructure.
  - m_ke 5y ago
    There's also a reason why Google, Amazon and Microsoft are the only companies that can compete in cloud computing, it's called economies of scale.
    - j_walter 5y ago
      Sure, but why was Tesla able to start up and take a big portion of the EV market over the last few years? The big companies were too slow in reacting to changing demand. It took years to get something that was equivalent to what they are offering...and yet they still don't have anything close despite far more industry knowledge on how to mass manufacture cars.
    - pjscott 5y ago
      There are economies of scale. There are also diseconomies of scale: https://en.wikipedia.org/wiki/Diseconomies_of_scale https://en.wikipedia.org/wiki/Diseconomies_of_scale Inertia and institutional sclerosis are serious problems for organizations that are large, old, or both.
  - mabub24 5y ago
    Scandinavian countries also have diverse and differing cultures depending on where you live. Just because everyone calls themselves "Swedish" doesn't mean they all agree. I suspect the answer is somewhat different. Just look at their parliaments: they almost always have majority coalitions made up of multiple parties, and a diverse group of opposition parties. What is exceptional about America is its calcification into a two party system, which I think is far more of an issue than the actual differences of opinion and culture in the American populace. In fact, polls regularly show that a majority of Americans generally agree on a number of issues, and broadly support a number of possible policies and programs. For instance, on abortion, a majority of Americans have long supported legalizing it some fashion up until recently. Through the 70's into the 90's, support even reached 60%. Only in the mid 90s did the discussion become wildly more combative and enter a stalemate. Really, most of the extremely popular social safety net programs were created and institutionalized during the 40 years of continuous Democratic majority. What ended it, and brought about the modern Republican party and the current state of American politics, was the "Republican Revolution" in '94[0]. The 2 party system then ran into a brick wall as both parties froze into defensive turtling. [0]: https://en.wikipedia.org/wiki/Republican_Revolution https://en.wikipedia.org/wiki/Republican_Revolution
- jandrewrogers 5y ago
  In the specific case of the US, it is the scale of the populated geography more than the number of people. This has created problems even in boring and non-controversial policy areas. For example, prior attempts to regulate highway speed limits nationally, which has since been devolved back to local control. At the scale of individual States, it works much more like it does in other countries. Any national-scale policy will be poorly adapted for some major region of the US because it is simply too diverse geographically, culturally, historically, and economically.
handrous 5y ago
It's ignored because it hardly seems relevant. Is providing healthcare to ~80m people (France, Germany—numbers off the top of my head but I think that's close for both) or, what, 150m or so (Japan, again, IIRC) really that different from 350m? What part of the difference in scale makes it impossible for the country of 350m with a higher GDP-per-capita than those other examples? Some parts of our country are sparsely populated, yes, but it's not like passing that off to a mix of highly-funded public ventures and market forces (i.e. our current very, very expensive system) magically solves that problem, so how's that relevant to preventing us from having universal healthcare? Plus, Canada's got that problem nearly as bad as we do, no? I know most of the population's down near the border, but you've got the same issues with large areas that are still lightly populated, but you manage. So that can't be the reason.

j_walter 5y ago

Politicians. College has gotten to expensive because the government is involved and has made it a priority for everyone to get a college degree...when many of the people going to college have no business being there. Give out money to kids to go to college...demand goes up...prices go up...give out more money...and the cycle continues. Healthcare simply has too many hands in the pot. Government pays x amount but it costs hospitals 2x...so they charge 3x to insurance companies to make up the difference. It's insane, but making it "free" may not be what fixes it. What safety net does the US not have? Over 60% of people paid no federal income tax last year and we have huge numbers of programs to help low income people.

dragontamer 5y ago
> Healthcare simply has too many hands in the pot. Government pays x amount but it costs hospitals 2x...so they charge 3x to insurance companies to make up the difference. It's insane, but making it "free" may not be what fixes it. One of the biggest debates getting stonewalled right now, is whether or not the US Government should negotiate prices for Medicare. Making this a "free healthcare" debate is just... missing the forest for the trees. There's a political party that's against even the US Government negotiating for better prices but otherwise keeping the same system. As if negotiations are a bad thing or something. Look, I'm not liberal to believe in free healthcare, but... surely making the government pay less money for the same services is a good thing?
- adolph 5y ago
  The government could tax the service at a higher rate, which is fiscally similar to negotiating lower rates except the feature that taxes also skim from the non-govt payor remittances.
  - dragontamer 5y ago
    That also has the effect of artificially raising the price for everyone outside of the government sphere of influence. Ex: me, because I'm not on Medicare / Medicaid yet. Since I have to pay for my medical procedures, the fact that the big government has "decided" that its okay to overpay on X means that I __also__ have to overpay on X. I, the small market participant, am relying upon the big guys to negotiate prices and set them more fairly for the rest of the market. Nominally, this is the job of insurance companies, but no one trusts those guys. (I pay for insurance. The insurance companies negotiate more detailed prices with hospitals). And there's the issue that the government (or more precisely: Medicare / Medicaid) is a "bigger" market participant than any insurance company, so the government's lack of negotiation is probably raising prices on everybody artificially.

fennecfoxen 5y ago

> Lets ask this question in the other direction. How is it in most modern economies you are able to have good healthcare, a robust safety net... Because they tax the middle class intensively. In particular they have tax regimes built more around the Value Added Tax (which taxes consumption) and less around the income tax (which damages incentives to save and invest and which is easily bypassed by billionaires who simply borrow the money they spend without realizing income). If anything, the Nordic states with their lauded safety nets are more market- and capital-friendly than the US, and less economic-interventionist, and happy to say so. It's not all roses. Competent government still matters; there are plenty of debt crises and pension crises and the like in certain nations without it. Overall, families are somewhat less well-off financially, and high youth unemployment remains a chronic problem.

MattGaiser 5y ago

Waste. The US government spends as nearly much on healthcare as a national healthcare system costs in the UK as a percent of GDP. Medicare, Medicaid, and the VA are 1.5 trillion in spending. Or about 7% of GDP. In normal years, NHS spending in the UK is 8% of GDP. I am sure there are substantial coverage differences for a lot of procedures, but all the life threatening stuff for an entire population is handled for what the US spends on just the elderly and poor.

dragonwriter 5y ago
> Waste. Not least of all the waste of all the parallel, sometimes overlapping and sometimes mutually exclusive public and private healthcare systems.
j_walter 5y ago
It's only waste if you aren't one of the people pocketing from the inefficiency.
nazgulnarsil 5y ago
Waste is a fake answer. The UK makes tradeoffs that the US polity is unwilling to engage with. This is a very expensive form of juvenile behavior.
MattGaiser 5y ago
And I suspect I could find the extra 1% of GDP in things like Tricare, employee health benefits for federal, state, and municipal workers, CHIP, etc.
micromacrofoot 5y ago
Now ask who is profiting from the waste.

robswc 5y ago

Are you trying to imply that these other countries have those things you listed because they have no billionaires? There's millions of reasons why that isn't happening in the US. Billionaires are almost certainly not one of those reasons. The US subsidizes so much for other countries. Without the US, these other countries wouldn't be able to have the same success. Just look at the numbers: https://en.wikipedia.org/wiki/List_of_countries_by_research_and_development_spending https://en.wikipedia.org/wiki/List_of_countries_by_research_... As an aside, I think the biggest irony is commenting this on HN. I know tons of SDEs that come from other countries because they get paid fractions of the salary they would get here.

micromacrofoot 5y ago
The concentration of the majority of wealth to a smaller number of people is definitely a factor, it's the hallmark of a corrupt system... > I know tons of SDEs that come from other countries because they get paid fractions of the salary they would get here. This is not irony, and has nothing to do with billionaires. Most SDEs won't even be millionaires.
- robswc 5y ago
  >The concentration of the majority of wealth to a smaller number of people is definitely a factor, it's the hallmark of a corrupt system... How? >This is not irony We're on a developer news site, talking about the US not having this or that, while also ignoring the fact that the US is very sought after by developers.
  - micromacrofoot 5y ago
    on inequality and corruption: https://www.hks.harvard.edu/publications/inequality-and-corruption https://www.hks.harvard.edu/publications/inequality-and-corr...... Also, it's not irony because it's not even a related subject. People are complaining about billionaires... 99.9999% SDEs are not coming to this country and becoming billionaires. Saying "we're ones to talk" or some kind of equivilant is an irrelevant attempt to lump any sort of wealth with being a billionaire... which is a fairly old-fashioned method to distract by creating lower-class infighting about what "wealthy" means. For an SDE making a very healthy $200k a year... it would take five thousand years to reach $1 billion. It's like arguing that the 2nd amendment should allow the private ownership of nuclear warheads. It's a strawman well outside the scale of the actual discussion.

macksd 5y ago

The same reason the US can spend what it did on the war in Aghanistan and still end up with the Taliban taking control of Kabul as they're on their way out. Total incompetence, no decent end game, and human nature in people that they just won't be able to change. Just a bunch of people lining their own pockets along the way. If the US has a culture of people making poor decisions for their own health, exploiting systems for their own benefit, and of government bureaucracies utterly failing to achieve the ends they're supposed to achieve with no accountability (and it does), no amount of tax revenue is going to suddenly provide everyone with world-class healthcare with no concern for their own money. I'd love to never have to deal with my insurance company again, or take diagnostics or treatments without being able to find out how much I'll have to pay. I really would. I just have zero confidence that any of that would change no matter how much more of my money gets taken by the US government.

nebula8804 5y ago
The question then becomes, when did things start to become this way? Was this culture always a US way of thinking or was there a time when the government and people in charge did focus on the long term benefit of its citizens? If corruption and incompetence was the path the whole time, how do you explain the US system becoming #1 in the world? Was it a fluke and that now that we have gotten 100 years of lucky wins the luck has run out and now we have the grim reality of the US system actually being trash? You look at FDR and how close the US population supposedly almost came to eating the elites. Around that time we finally got breadcrumbs in the form of Medicare and Social Security. Now we are seeing moves to even get rid of those programs so we are left with nothing. You can't have a society where a certain percentage is playing by the rules while everyone else is picking whatever they can on the dying carcass.
- smileysteve 5y ago
  > how do you explain the US system becoming #1 in the world? The US was part of the industrial revolution, but suffered few domestic casualties (infrastructure) from either World War. The dollar becoming the world reserve currency for oil/capitalism cemented it. (Where Russia, Continental Europe, and China were ravaged by WW2)

steego 5y ago

<raising hand> Ooo! Ooo! I know this one!!! I know this one!!! Over the past 30 years, steady changes to regulations in healthcare, education and infrastructure have created a system where we pay HUGE premiums for similar services compared to almost every other countries. It is the result of unabated, in-the-open, perfectly-legal, endemic corruption. This should be a universal and bipartisan issue that unites people, but it isn’t. We’re too stupid to stop fighting each other. We always take the bait from the armies of talking heads telling us how to think and who to hate. In the lovely words of Amy Mann, “It’s not going to stop until you wise up”

nebula8804 5y ago
While OP may continue to bumble around with his right wing talking points, let me continue this discussion with you since you get it. What do you think is the end state of this whole saga? It seems like either we reform or we eventually collapse. Maybe its possible a whole generation will continue to zombie walk through this trash system that we have?
- all2 5y ago
  I will note that GP mentions "We the People" are fighting each other because the talking heads tell us to. I contend that this is on purpose. A casual glance through Rules for Radicals shows that social friction is a tool for social change. With that noted, let's talk end game. There's a common (almost cliche) line of "bad times make strong men, strong men make good times, good times make weak men, weak men make bad times", which appears superficially true. Consider the Weimar Republic, or Imperial Russia from about 2 centuries ago. Both appeared to follow that pattern. The fall of Rome kinda fits that, too, if you squint. The hallmarks of "bad times" appear to be increased law and regulation, increase in law/regulation complexity, non-dependable money supply (inflation was an issue in all three of the above scenarios), dilution of national identity, and so on. I'd argue that what underpins those changes is eroding morality. A perfectly moral people need no law, and their money supply is uncorrupted. As morality decreases, the necessity of law becomes apparent, and so the increase in law and regulation. As graft increases (which drove the need for law and regulation) the money supply becomes corrupted, fiat. The collapse of empires (make no mistake, the United States is a cultural economic empire) is typically sudden, violent, and bloody. All three scenarios all featured a lot of death in a very short amount of time. The end for the United States will likely be the same. Inflation will destroy what's left of the propped up economy. People will start to go hungry, their housing and livelihoods will be threatened. As soon as the bottom of Maslow's Hierarchy is in question, people start to rebel. You see some of that already with anti-vaccine riots. People believe their bodily autonomy is threatened. Definitely their livelihoods are threatened (this game of coercion -- get a vaccine, or you can't even work -- that Australia is playing and that the US seeks to implement -- is pushing people out of their comfort zones). Are we in the end game? Dunno. We won't know until it is the end. Sudden, violent, bloody. [edit] misplaced asterisks [/edit]

jandrewrogers 5y ago

At least in Europe, the middle-class pays much higher taxes than in the US, which funds much of that safety net. Contrary to popular belief, high-income earners in States like California already pay tax rates similar to Western Europe. Imposing European-style tax rates on the US middle-class is unpopular with both major political parties.

xboxnolifes 5y ago

Aside from all of the things that generally come up in this discussion (politicians, country size, melting pot, american dream, government bloat, etc), I think a pretty big contender is poorly written legislation on regulations. Certain things are fairly obviously good to regulate in healthcare, whether that is for privacy, or price transparency, or making sure emergencies don't get turned away, but administration costs of running our healthcare network seems to have blown far and away the cost of the actual healthcare providers (doctors, nurses, surgeons, etc). There is so much paperwork and administrative work in healthcare and it just seems like so much of it could be trimmed away. Legislation seems to be written with the good intentions of protecting patients, but if the administration costs (monetarily or bureaucratically) of complying aren't taken into consideration, that too can indirectly affect patients. I'm neither in the medical field nor do I know how US healthcare regulations compare to other countries, but it just feels like the amount of healthcare administration has grown at a far greater rate than the actual healthcare providers.

micromacrofoot 5y ago
Do you trust health insurance companies or hospital administrators to pass on the costs saved from reduced regulation to consumers? I absolutely do not.
- j_walter 5y ago
  No more than I trust the government to work on passing on reduced costs in the form of lower taxes...
  - micromacrofoot 5y ago
    Fair, but I can't vote for/against private health insurance companies and they have many fewer transparency requirements. Citizens have much more power when it comes to the government versus private industry. I can't even vote with my wallet because my employer chooses my insurer.
- xboxnolifes 5y ago

oliv__ 5y ago

One could argue that the US is the richest country because of the way things are set up here, not in spite of it. Also, as another commented noted, it's not all roses in those other "modern economies" you mention: France, for example, with its subsidized healthcare system has a public debt equal to 117.8% of its GDP. The US's deficit amounts to 15.2% of GDP in contrast.

newsclues 5y ago

War.