4 ms·

Privatized progressive tax? IMHO this is great - broadest shoulders shoulder most. However, it likely should be more organized? Maybe do more of this research

Privatized progressive tax? IMHO this is great - broadest shoulders shoulder most. However, it likely should be more organized? Maybe do more of this research in public institutions and make it freely available to commercialize.

nwienert 1y ago
It's been like this, Americans heavily subsidize the world in healthcare/research. Which becomes annoying when fairly rich Europeans ride these coattails (and defense) while being incessantly snobbish about their healthcare superiority, in large part paid for by us. Though a big part of the Trump win comes from this - yea some Americans are rich, but a lot of them are really poor and justly mad at how much more expensive things are that we produce.
- watwut 1y ago
  [flagged]
  - throwmeaway222 1y ago
    Obamacare was actually great in the first year. Every year since it basically went up 20%.
  - BadCookie 1y ago
    I grew up in a blue collar family. One thing that Dems tend to overlook, I think, is that most people do not want to receive charity. They want to be able to afford things on their own through their own hard work. It hurts their pride to receive anything that could be construed as "welfare." It makes them feel like they, and their country, are failing. So I'm not sure if the Medicaid/ACA approach to healthcare is a particularly good one from a purely psychological standpoint. (Some folks are scared to accept Medicaid because of estate recovery, too.) In my state, a full 1/3 of the population is on Medicaid ... which seems extremely high for a program originally intended for the poor. From a financial standpoint, it doesn't seem like either party has succeeded at significantly slowing the growth in healthcare costs overall. How much more can it grow without breaking? The Dems haven't proposed a solution either.
    - bobthepanda 1y ago
      The American healthcare system is expensive partially because it’s not really a market, you’re tied to the insurance your work offers you and there are all kinds of middlemen like the PBMs. There were two options that have been debated before: * Obamacare’s deleted “public option” which would’ve essentially provided the baseline standard coverage introduced by the ACA; this got deleted due to opposition from moderates and so private insurers offer these plans instead * Medicaid for All just proposes this entirely to remove layers of middlemen, but is even more opposed by moderates —— The problem really is the linkage of health insurance to work, but it’s political suicide to sunset this since the transition period will be incredibly painful
      - buu700 1y ago
        The American healthcare system is expensive partially because it’s not really a market, you’re tied to the insurance your work offers you and there are all kinds of middlemen like the PBMs. I've long argued that this is precisely the problem with the American healthcare system. It's the worst of both worlds. The issue is caused by the fact that we use "insurance" to describe something that is not insurance, but rather a middleman subscription. Could you imagine how broken any other market would be if saddled with the same system? Imagine if you had no idea what any given property actually cost to rent, but instead just paid into a "housing insurance" plan that took care of it for you and socialized the costs. Add on layers of administrative bureaucracy to determine which properties you qualify for based on your needs, and give it a few decades for prices to adjust to the market distortion. One day we'd find that all the properties are owned by multibillion-dollar housing conglomerates charging prices that are completely impossible for anyone poorer than Jeff Bezos to afford without "insurance". Eventually someone ends up shooting a housing insurance CEO in the street over grievances like Luigi's, e.g. maybe he's stuck sharing a single bedroom with his wife and four kids, or couldn't get approved for a property in the same city as his elderly parents. Meanwhile, the public has been gaslit into defending this Kafkaesque central planning as "free market" because it isn't technically run by the government, ignoring any role of the government in creating and actively propping up the system. I don't think single-payer is necessarily the optimal solution due to the known impacts on supply / wait times under such systems, but if we're embracing central planning of a sector of the economy regardless, I'd rather the benefits be fully socialized alongside the costs. Right now we're socializing the costs while privatizing many of the benefits — great for profiteers of that system, but not so much for the rest of us. Although single-payer could potentially be a much stronger option in the future if optimized by large-scale anonymized economic data collection and AI-driven pricing, so I'm not necessarily opposed to it in principle. What I'd also want to consider, however, is a wholesale sunsetting of mandatory "insurance" in its entirety. Make patients bear the costs of their care and incentivize them to shop around for the best prices. Force providers to optimize, innovate, and actually compete with each other to provide the lowest rates — negotiating with suppliers, reevaluating compensation structures, cutting administrative bloat, and embracing technologies like AI and telemedicine would all be viable angles for practices to explore. No one would get away with Gilead-style pricing in a free market, particularly if certain price transparency requirements were imposed. Then add a universal progressive cost-sharing system on top of that to ensure that the poorest aren't left out in the cold. As a practical matter, emergency care prices could be set by states or counties to balance local availability against ensuring that ER patients aren't saddled with excessive debt, continually adjusting for maximum public benefit. In this world, health-related insurance products would still be available for people who really wanted them, but they'd function as actual insurance, and be completely optional without being subject to ACA-style regulation.
- deleted 1y ago
  [deleted]
- lossolo 1y ago
  US carries a big share of the biomedical load, NIH runs ~$48–50B/yr and the US is the launch market for 2/3 of new‑drug sales, which makes it the main revenue engine, but calling Europe a freeloader skips a lot of facts. The EU’s Horizon Europe is €95.5B (2021–27) with €16B for ERC alone, national funders like the UK’s NIHR spend ~£1.4B/yr, and Europe’s pharma industry invests ~€50B/yr domestically. Europe is home to Roche, Novartis, AstraZeneca, Sanofi, GSK, Novo Nordisk, each spending billions annually on R&D (Roche CHF 13.2B, AZ $13.6B, Sanofi €7.4B etc.). Also a big chunk of US list‑price "overpayment" never reaches manufacturers—rebates/discounts were an estimated $335B in 2023—so it’s not all subsidizing innovation. Innovation is now multipolar: in 2024 more NAS originated from China (28) than from the U.S. (25) or Europe (18). So strong US funding matters, but Europe clearly pays and builds a lot too.
- kldg 1y ago
  Since a year or two before the individual mandate ended (it was worth the fee), I dropped health insurance and self-pay for self and family; I pay now in a year for actual service what I paid in a month in premiums, mostly to dentist, without feeling any restrictions on seeking healthcare. I don't often need referrals, can self-order procedures directly, and the amount insurance says they "negotiated" is pretty misleading, often comparable to what I pay in cash without insurance. Since ACA was implemented, prior to covid, life expectancy in the US stopped increasing; not to say ACA is directly responsible (without more data), but whatever its net benefits may be are clearly losing out to other signals. That said, our ... fascinating ... experiences ... in trying to get the government to fix our health systems is certainly no outsider's fault. Europeans and others can feel at ease continuing to mock us.
  - ChrisMarshallNY 1y ago
    Ooohh... Wait until you have a really nasty health emergency. I'm 63, and my wife is near my age. We take this stuff seriously. I have known many people that have been completely devastated by medical crises. Even with insurance, some types of illness can be catastrophic, financially. I also have known quite a number of folks that have done an amazing job of taking care of themselves, yet still had medical crises.
    - kldg 1y ago
      It's a lottery either way, I think. I can pay $20k/year for health insurance and limit to $20k/year in expenses (or w/e current annual limit is), or I can save the $20k/year and put it into an unencumbered investment account. The insurance company charges so much that I feel much better about getting out of insurance in my 20s so that I have a pretty decent pile now in my 30s, and going forward, the pile accumulates as my risks do. -but if I get a terminal, especially long-term illness, it's a wipeout either way; if I'm out $20k/year to the healthcare providers and $20k/year to the insurance company, and can't work -- draining $40k/year in health costs just isn't going to work out for very long, unless I can make it another decade or two. Edit: I should say, too, I give money directly to my daughter (that is, well before [ideally] I'm ill), specifically so I can declare bankruptcy with less family wealth loss if I should have to, and to help fend off Medicaid clawback.
0xDEAFBEAD 1y ago
>broadest shoulders shoulder most Part of the reason the US has a higher GDP is because we work longer hours and take less vacation. "You work harder, therefore you should shoulder more" hardly seems fair. Europe makes fun of us for our defense spending yet demands protection, makes fun of us for working long hours yet says we should shoulder more, makes fun of us for overspending on health care yet charges us 10X as much for the drugs they manufacture: https://www.healthline.com/health-news/heres-how-much-more-ozempic-costs-in-the-u-s-compared-to-other-countries https://www.healthline.com/health-news/heres-how-much-more-o... I just can't shake the feeling that Europeans see Americans as suckers.
- fnordian_slip 1y ago
  Just in case you are interested in a European perspective, and aren't just commenting to let off some steam because of perceived injustices: > we work longer hours and take less vacation. Yes, but people working longer hours doesn't necessarily translate to more output, especially when quality is taken into account. Anecdotally, from what I've heard from people working in international companies, the American work culture doesn't seem to be very efficient when looking at the end result. The studies of 32 hour work weeks seem to indicate similar findings, though like the anecdotes, should be taken with a grain of salt of course. But I truly believe that in most cases, a developer who works 10 hours a day will not produce more than one who works 6 hours a day, at least after a couple of days. >Europe makes fun of us for our defense spending yet demands protection You do realise that until very recently, America has gained an absurd amount of soft power through this defence spending, right? And was able to convert this soft power into a lot of GDP through indirect subsidies of its international companies? Just because the current administration has squandered this advantage, doesn't mean you did not get out more than you paid for the last couple of decades. >I just can't shake the feeling that Europeans see Americans as suckers. I agree with you on that point,but not for the reasons you might think. I see the "temporarily embarrassed millionaire" phenomenon, people constantly against their self-interest and the like, and and it's hard not to. I have relatives in the US, and I still feel sympathy for your people. But it's getting harder and harder to not see you as suckers when you look at the tariffs or the cuts to welfare, science and education, all while the rich get massive tax cuts. And all is being done in the name of "draining the swamp", by a billionaire who is incredibly well-connected with 90% of the corrupt elite he publicly opposes.

nwienert 1y ago

It's been like this, Americans heavily subsidize the world in healthcare/research. Which becomes annoying when fairly rich Europeans ride these coattails (and defense) while being incessantly snobbish about their healthcare superiority, in large part paid for by us. Though a big part of the Trump win comes from this - yea some Americans are rich, but a lot of them are really poor and justly mad at how much more expensive things are that we produce.

watwut 1y ago
[flagged]
- throwmeaway222 1y ago
  Obamacare was actually great in the first year. Every year since it basically went up 20%.
- BadCookie 1y ago
  I grew up in a blue collar family. One thing that Dems tend to overlook, I think, is that most people do not want to receive charity. They want to be able to afford things on their own through their own hard work. It hurts their pride to receive anything that could be construed as "welfare." It makes them feel like they, and their country, are failing. So I'm not sure if the Medicaid/ACA approach to healthcare is a particularly good one from a purely psychological standpoint. (Some folks are scared to accept Medicaid because of estate recovery, too.) In my state, a full 1/3 of the population is on Medicaid ... which seems extremely high for a program originally intended for the poor. From a financial standpoint, it doesn't seem like either party has succeeded at significantly slowing the growth in healthcare costs overall. How much more can it grow without breaking? The Dems haven't proposed a solution either.
  - bobthepanda 1y ago
    The American healthcare system is expensive partially because it’s not really a market, you’re tied to the insurance your work offers you and there are all kinds of middlemen like the PBMs. There were two options that have been debated before: * Obamacare’s deleted “public option” which would’ve essentially provided the baseline standard coverage introduced by the ACA; this got deleted due to opposition from moderates and so private insurers offer these plans instead * Medicaid for All just proposes this entirely to remove layers of middlemen, but is even more opposed by moderates —— The problem really is the linkage of health insurance to work, but it’s political suicide to sunset this since the transition period will be incredibly painful
    - buu700 1y ago
      The American healthcare system is expensive partially because it’s not really a market, you’re tied to the insurance your work offers you and there are all kinds of middlemen like the PBMs. I've long argued that this is precisely the problem with the American healthcare system. It's the worst of both worlds. The issue is caused by the fact that we use "insurance" to describe something that is not insurance, but rather a middleman subscription. Could you imagine how broken any other market would be if saddled with the same system? Imagine if you had no idea what any given property actually cost to rent, but instead just paid into a "housing insurance" plan that took care of it for you and socialized the costs. Add on layers of administrative bureaucracy to determine which properties you qualify for based on your needs, and give it a few decades for prices to adjust to the market distortion. One day we'd find that all the properties are owned by multibillion-dollar housing conglomerates charging prices that are completely impossible for anyone poorer than Jeff Bezos to afford without "insurance". Eventually someone ends up shooting a housing insurance CEO in the street over grievances like Luigi's, e.g. maybe he's stuck sharing a single bedroom with his wife and four kids, or couldn't get approved for a property in the same city as his elderly parents. Meanwhile, the public has been gaslit into defending this Kafkaesque central planning as "free market" because it isn't technically run by the government, ignoring any role of the government in creating and actively propping up the system. I don't think single-payer is necessarily the optimal solution due to the known impacts on supply / wait times under such systems, but if we're embracing central planning of a sector of the economy regardless, I'd rather the benefits be fully socialized alongside the costs. Right now we're socializing the costs while privatizing many of the benefits — great for profiteers of that system, but not so much for the rest of us. Although single-payer could potentially be a much stronger option in the future if optimized by large-scale anonymized economic data collection and AI-driven pricing, so I'm not necessarily opposed to it in principle. What I'd also want to consider, however, is a wholesale sunsetting of mandatory "insurance" in its entirety. Make patients bear the costs of their care and incentivize them to shop around for the best prices. Force providers to optimize, innovate, and actually compete with each other to provide the lowest rates — negotiating with suppliers, reevaluating compensation structures, cutting administrative bloat, and embracing technologies like AI and telemedicine would all be viable angles for practices to explore. No one would get away with Gilead-style pricing in a free market, particularly if certain price transparency requirements were imposed. Then add a universal progressive cost-sharing system on top of that to ensure that the poorest aren't left out in the cold. As a practical matter, emergency care prices could be set by states or counties to balance local availability against ensuring that ER patients aren't saddled with excessive debt, continually adjusting for maximum public benefit. In this world, health-related insurance products would still be available for people who really wanted them, but they'd function as actual insurance, and be completely optional without being subject to ACA-style regulation.
deleted 1y ago
[deleted]
lossolo 1y ago
US carries a big share of the biomedical load, NIH runs ~$48–50B/yr and the US is the launch market for 2/3 of new‑drug sales, which makes it the main revenue engine, but calling Europe a freeloader skips a lot of facts. The EU’s Horizon Europe is €95.5B (2021–27) with €16B for ERC alone, national funders like the UK’s NIHR spend ~£1.4B/yr, and Europe’s pharma industry invests ~€50B/yr domestically. Europe is home to Roche, Novartis, AstraZeneca, Sanofi, GSK, Novo Nordisk, each spending billions annually on R&D (Roche CHF 13.2B, AZ $13.6B, Sanofi €7.4B etc.). Also a big chunk of US list‑price "overpayment" never reaches manufacturers—rebates/discounts were an estimated $335B in 2023—so it’s not all subsidizing innovation. Innovation is now multipolar: in 2024 more NAS originated from China (28) than from the U.S. (25) or Europe (18). So strong US funding matters, but Europe clearly pays and builds a lot too.
kldg 1y ago
Since a year or two before the individual mandate ended (it was worth the fee), I dropped health insurance and self-pay for self and family; I pay now in a year for actual service what I paid in a month in premiums, mostly to dentist, without feeling any restrictions on seeking healthcare. I don't often need referrals, can self-order procedures directly, and the amount insurance says they "negotiated" is pretty misleading, often comparable to what I pay in cash without insurance. Since ACA was implemented, prior to covid, life expectancy in the US stopped increasing; not to say ACA is directly responsible (without more data), but whatever its net benefits may be are clearly losing out to other signals. That said, our ... fascinating ... experiences ... in trying to get the government to fix our health systems is certainly no outsider's fault. Europeans and others can feel at ease continuing to mock us.
- ChrisMarshallNY 1y ago
  Ooohh... Wait until you have a really nasty health emergency. I'm 63, and my wife is near my age. We take this stuff seriously. I have known many people that have been completely devastated by medical crises. Even with insurance, some types of illness can be catastrophic, financially. I also have known quite a number of folks that have done an amazing job of taking care of themselves, yet still had medical crises.
  - kldg 1y ago
    It's a lottery either way, I think. I can pay $20k/year for health insurance and limit to $20k/year in expenses (or w/e current annual limit is), or I can save the $20k/year and put it into an unencumbered investment account. The insurance company charges so much that I feel much better about getting out of insurance in my 20s so that I have a pretty decent pile now in my 30s, and going forward, the pile accumulates as my risks do. -but if I get a terminal, especially long-term illness, it's a wipeout either way; if I'm out $20k/year to the healthcare providers and $20k/year to the insurance company, and can't work -- draining $40k/year in health costs just isn't going to work out for very long, unless I can make it another decade or two. Edit: I should say, too, I give money directly to my daughter (that is, well before [ideally] I'm ill), specifically so I can declare bankruptcy with less family wealth loss if I should have to, and to help fend off Medicaid clawback.

0xDEAFBEAD 1y ago

>broadest shoulders shoulder most Part of the reason the US has a higher GDP is because we work longer hours and take less vacation. "You work harder, therefore you should shoulder more" hardly seems fair. Europe makes fun of us for our defense spending yet demands protection, makes fun of us for working long hours yet says we should shoulder more, makes fun of us for overspending on health care yet charges us 10X as much for the drugs they manufacture: https://www.healthline.com/health-news/heres-how-much-more-ozempic-costs-in-the-u-s-compared-to-other-countries https://www.healthline.com/health-news/heres-how-much-more-o... I just can't shake the feeling that Europeans see Americans as suckers.

fnordian_slip 1y ago
Just in case you are interested in a European perspective, and aren't just commenting to let off some steam because of perceived injustices: > we work longer hours and take less vacation. Yes, but people working longer hours doesn't necessarily translate to more output, especially when quality is taken into account. Anecdotally, from what I've heard from people working in international companies, the American work culture doesn't seem to be very efficient when looking at the end result. The studies of 32 hour work weeks seem to indicate similar findings, though like the anecdotes, should be taken with a grain of salt of course. But I truly believe that in most cases, a developer who works 10 hours a day will not produce more than one who works 6 hours a day, at least after a couple of days. >Europe makes fun of us for our defense spending yet demands protection You do realise that until very recently, America has gained an absurd amount of soft power through this defence spending, right? And was able to convert this soft power into a lot of GDP through indirect subsidies of its international companies? Just because the current administration has squandered this advantage, doesn't mean you did not get out more than you paid for the last couple of decades. >I just can't shake the feeling that Europeans see Americans as suckers. I agree with you on that point,but not for the reasons you might think. I see the "temporarily embarrassed millionaire" phenomenon, people constantly against their self-interest and the like, and and it's hard not to. I have relatives in the US, and I still feel sympathy for your people. But it's getting harder and harder to not see you as suckers when you look at the tariffs or the cuts to welfare, science and education, all while the rich get massive tax cuts. And all is being done in the name of "draining the swamp", by a billionaire who is incredibly well-connected with 90% of the corrupt elite he publicly opposes.