5 ms·

Except there are almost no programs where the government can actually deliver positive ROI, and the government never has any motivation to actually do this and

by zpeti 4y ago

Except there are almost no programs where the government can actually deliver positive ROI, and the government never has any motivation to actually do this and report on it. I think in almost all cases except where private markets can’t deliver (for example police, army, possibly roads), private markets will almost always use money (or resources) much better.

bolanyo 4y ago
I don't think this is true. If you look at the projects funded by the Roosevelt New Deal (where the stated purpose of the spending was to reboot the economy and create employment, rather than chasing a particular return), a lot of them returned many, many times the government's investment. For example, the Tri-Borough Bridge, the Hoover Dam, the paintings of Jackson Pollock.
wongarsu 4y ago
Infrastructure and education are two fields where it is often easy to demonstrate positive ROI. Of course not every project is good, but in general both drastically increase the productivity of their society. Food stamps and pension funds are a bit harder, since they mostly boil down to three arguments: ethics, crime and stability. People tend to turn to crime when they have no viable other means, so feeding them is a way to reduce crime, and crime would cost more. Also people who are desperate are more likely to revolt, which is either very costly to the government or entirely prevents them from doing other activities with positive ROI in the future. So they are cost centers, but arguably necessary. Postal service, telephone, internet and public transit would also fall in the infrastructure category. Societal benefit is often much larger than the willingness of the individual to pay for it, so it makes sense to have them either run or subsidized by the state. Universal healthcare can deliver positive ROI by being more effective than the private alternative. As a society we want citizens to be healthy, because healthy people are happy and productive, and don't infect other healthy people. I completely agree that governments should regularly run and publish ROI calculations, or maybe there should be an independent watchdog that does this. And a lot of money seems to be wasted because people on all levels of government have the wrong incentives. On the other hand, one of the major reasons why the idea of governments is so widespread is that they regularly do provide positive ROI overall.
throwaway2037 4y ago
In what countries is healthcare "better" when private markets deliver it? Here, the term "better" has multiple meanings: cost vs quality/outcomes. Example: Some people say that the US has the "world's greatest healthcare" (whatever that really means), but most people can agree that the US poor cost performance (high cost, poor outcomes). To editorialise for a moment, as I read about various public healthcare systems around the world, the diversity of systems is large, including outcomes. Almost none of them in highly developed countries are good and cheap. In these countries, healthcare is damn expensive, no matter how you do it. It's very difficult to spend less than 10% of GDP (that is huge for these countries) and have "good" healthcare. Another topic about which academics have debated for decades: Same question as above, except primary/secondary/tertiary education.
- lumb63 4y ago
  Let’s look at actual problems with the US healthcare system. I’ll propose ways that if the market for healthcare were actually free, it would be better. It is not actually free because in the US, employers typically provide healthcare, and if you do not have an employer who does, the plans are prohibitively expensive. Issue: People lose healthcare when they switch their jobs. Solution: Have people purchase their own healthcare rather than receive it through their employer. Issue: People don’t like their healthcare plan. Solution: Allow individuals to choose their own healthcare plans. They know what they need far better than their employer does. Issue: People cannot afford the healthcare plan they want. Solutions: Stop throttling the amount of doctors who can attend medical school so that there is a sufficient supply of doctors. Higher supply will lower prices and improve outcomes. Institute outcome-based pricing schemes, i.e. providers get paid when they fix your problem. This will fix insurance companies’ and providers’ misaligned incentives; right now, their goal is to charge you as much as they can for health care and provide you as little as they can. That maximizes their margins. If they were only paid when they solved issues, I’m sure they would prioritize that. IMO, the debate over “public” vs. “private” healthcare is a false dichotomy. The US does not have a private, free market healthcare system today, but proponents of public healthcare use the current state of it to argue against private systems, since it isn’t public. Proponents of private healthcare ignore anything that could improve the state of healthcare because they do not want to see it socialized and assume all suggestions will come in this form. The people in need of healthcare are left with poor healthcare as politicians fight imaginary healthcare dragons. There is also a secondary issue in the healthcare discussion: prevention. Why do we have to spend so much on healthcare? It’s not like the human body spontaneously breaks down at such a fast rate. The actions we take as individuals, and as a society, cause a lot of disease. If we are concerned about healthcare prices, it is disingenuous and negligent of us to not look at what is driving our healthcare costs.
deleted 4y ago
[deleted]
yamtaddle 4y ago
> Except there are almost no programs where the government can actually deliver positive ROI, and the government never has any motivation to actually do this and report on it. This is sharply contrary to figures I've seen on the outcomes of government spending. Got a citation?

by zpeti 4y ago

bolanyo 4y ago

I don't think this is true. If you look at the projects funded by the Roosevelt New Deal (where the stated purpose of the spending was to reboot the economy and create employment, rather than chasing a particular return), a lot of them returned many, many times the government's investment. For example, the Tri-Borough Bridge, the Hoover Dam, the paintings of Jackson Pollock.

wongarsu 4y ago

Infrastructure and education are two fields where it is often easy to demonstrate positive ROI. Of course not every project is good, but in general both drastically increase the productivity of their society. Food stamps and pension funds are a bit harder, since they mostly boil down to three arguments: ethics, crime and stability. People tend to turn to crime when they have no viable other means, so feeding them is a way to reduce crime, and crime would cost more. Also people who are desperate are more likely to revolt, which is either very costly to the government or entirely prevents them from doing other activities with positive ROI in the future. So they are cost centers, but arguably necessary. Postal service, telephone, internet and public transit would also fall in the infrastructure category. Societal benefit is often much larger than the willingness of the individual to pay for it, so it makes sense to have them either run or subsidized by the state. Universal healthcare can deliver positive ROI by being more effective than the private alternative. As a society we want citizens to be healthy, because healthy people are happy and productive, and don't infect other healthy people. I completely agree that governments should regularly run and publish ROI calculations, or maybe there should be an independent watchdog that does this. And a lot of money seems to be wasted because people on all levels of government have the wrong incentives. On the other hand, one of the major reasons why the idea of governments is so widespread is that they regularly do provide positive ROI overall.

throwaway2037 4y ago

In what countries is healthcare "better" when private markets deliver it? Here, the term "better" has multiple meanings: cost vs quality/outcomes. Example: Some people say that the US has the "world's greatest healthcare" (whatever that really means), but most people can agree that the US poor cost performance (high cost, poor outcomes). To editorialise for a moment, as I read about various public healthcare systems around the world, the diversity of systems is large, including outcomes. Almost none of them in highly developed countries are good and cheap. In these countries, healthcare is damn expensive, no matter how you do it. It's very difficult to spend less than 10% of GDP (that is huge for these countries) and have "good" healthcare. Another topic about which academics have debated for decades: Same question as above, except primary/secondary/tertiary education.

lumb63 4y ago
Let’s look at actual problems with the US healthcare system. I’ll propose ways that if the market for healthcare were actually free, it would be better. It is not actually free because in the US, employers typically provide healthcare, and if you do not have an employer who does, the plans are prohibitively expensive. Issue: People lose healthcare when they switch their jobs. Solution: Have people purchase their own healthcare rather than receive it through their employer. Issue: People don’t like their healthcare plan. Solution: Allow individuals to choose their own healthcare plans. They know what they need far better than their employer does. Issue: People cannot afford the healthcare plan they want. Solutions: Stop throttling the amount of doctors who can attend medical school so that there is a sufficient supply of doctors. Higher supply will lower prices and improve outcomes. Institute outcome-based pricing schemes, i.e. providers get paid when they fix your problem. This will fix insurance companies’ and providers’ misaligned incentives; right now, their goal is to charge you as much as they can for health care and provide you as little as they can. That maximizes their margins. If they were only paid when they solved issues, I’m sure they would prioritize that. IMO, the debate over “public” vs. “private” healthcare is a false dichotomy. The US does not have a private, free market healthcare system today, but proponents of public healthcare use the current state of it to argue against private systems, since it isn’t public. Proponents of private healthcare ignore anything that could improve the state of healthcare because they do not want to see it socialized and assume all suggestions will come in this form. The people in need of healthcare are left with poor healthcare as politicians fight imaginary healthcare dragons. There is also a secondary issue in the healthcare discussion: prevention. Why do we have to spend so much on healthcare? It’s not like the human body spontaneously breaks down at such a fast rate. The actions we take as individuals, and as a society, cause a lot of disease. If we are concerned about healthcare prices, it is disingenuous and negligent of us to not look at what is driving our healthcare costs.

deleted 4y ago

[deleted]

yamtaddle 4y ago

> Except there are almost no programs where the government can actually deliver positive ROI, and the government never has any motivation to actually do this and report on it. This is sharply contrary to figures I've seen on the outcomes of government spending. Got a citation?