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Is it a coincidence that the industries with the most heavy government involvement - health care, education, and housing - are the most messed up with perverse

Is it a coincidence that the industries with the most heavy government involvement - health care, education, and housing - are the most messed up with perverse incentives? Whereas the software industry, with near zero government involvement, has had enormous improvements in function and has pushed the cost to literally zero.

joe_the_user 1y ago
Most other advanced nations have nationalized health care which works much better. The US health care system is broken because health care is a natural monopoly that US free-market ideology dictates be run with (fake) "free markets" with result being a variety of companies profiting by abusing the system.
- apwell23 1y ago
  other nations get benefits from 1. US subsidizing pharma startups and 2. less people with chronic diseases 3. offer lower quality of care at lower price point 4. import doctors vs solely rely on homegrown USA is very very good at complicated, cutting edge medical care but not efficient at delivering routine care.
  - bruce511 1y ago
    It's complicated, yes, but simplifying somewhat the "US" does not subsidize pharma startups. Yes, VCs do put money into pharma, but that's private money very much expecting an (overall) profitable return. (Ironically most of that profit comes from Americans who have little or no way to collectively bargain on pricing.) And yes, for bigger companies, there are tax breaks etc, but most of those are regular tax breaks that any company gets. I won't get into the chronic disease stats. Other than to say that good primary Healthcare tends to reduce the incidence of chronic diseases. Quality of care is hard to gauge on a national basis. It's a highly localized product, so experience can be different in very small geographic areas. Equally "quality of care" is s metric with many axies. Naturally for-profit medical advertises a lot, and they strongly push the "quality of care" message. So the general perception of that is "private is better". How much of that is true, how much is perception, is up for debate. My personal experience (which counts for nothing) having experienced both, is that the standard of medical care is the same. (Fewer tvs in public care though.) I'm not sure what importing doctors has to do with anything, or if it's even true. Personally I don't really care where a Dr is from.
    - lenkite 1y ago
      > It's complicated, yes, but simplifying somewhat the "US" does not subsidize pharma startups. This is utterly false. Agencies like NIH, BARDA, and NSF fund early-stage biomedical R&D by providing SBIR/STTR grants to biotech and pharma startups. They also fund basic research and clinical trials as well as translational studies. There is the Orphan Drug Tax Credit and R&D Tax Credit. Also, access to NIH labs, etc. There is a whole plethora of funding. Moderna’s mRNA platform was heavily backed by NIH and BARDA even before COVID.
    - apwell23 1y ago
      > (Ironically most of that profit comes from Americans who have little or no way to collectively bargain on pricing.) Thats what i meant by US subsidizing pharma for the whole world. I didn't mean the us govt. Would they continue to exist if every single country in the world is doing "collective bargaining"?
  - conception 1y ago
    “USA is very very good at complicated, cutting edge medical care” - i hear this but haven’t seen it in practice or in statistics. Everyone I know that has needed such things has had the same poor quality of care that primary care providers have - long waits, insurance issues and mediocre outcomes.
    - apwell23 1y ago
      > i hear this but haven’t seen it in practice or in statistics curious. what kind of statistics would that show up? When i was looking into clinical trials for prostate cancer. almost 80% of experimental cutting edge medicine was in usa. They even have spl k2 visa for International patients to participate.
      - conception 1y ago
        I suppose it’s semantics but i wouldn’t consider experimental research “medical care”.
        apwell23 1y ago
        even outside clinical trials. for prostate cancer, only doctors i found practicing newer therapies was in usa.
- refurb 1y ago
  > Most other advanced nations have nationalized health care which works much better. That's not true by the definition of "nationalization" (government ownership) Switzerland and Netherlands are entirely private insurance. Most European countries have a public system and private system. It's very common for people to purchase supplemental insurance on top of what the government provides.
  - Pooge 1y ago
    In the case of Switzerland, basic health insurance is provided by private companies but the price is mostly fixed by the Federal government. Prices do vary between companies but many people just use the official insurance comparison tool and choose the cheapest as the services are completely identical. I'm completely against that system and would prefer a national health insurance like Japan.
- WalterBright 1y ago
  If they're fake free markets then free market ideology doesn't apply. > health care is a natural monopoly It obviously isn't, because it wasn't a monopoly before the 1960s when the government got involved in it.
  - tim333 1y ago
    It's actually kind of refreshing to use free market lightly regulated medicine. I live in the UK where it's NHS government funded or related but travelling in Asia without insurance you can actually shop around and buy stuff - how much for a doc, how much for an xray etc. It's mostly quite cheap too. If you remove most of the regulatory barriers things work quite well. Obviously doctors and the like should pass exams for competence but I'm not sure you need to restrict it to only x people through y colleges in z country to restrict the supply. If the US said that to practice medicine and all you needed was a medical qualification from any respectable country it could drop costs like 10x I'd guess.
  - Yeul 1y ago
    You cannot free market healthcare because quite frankly there is no real profit in this industry. Yeah even your high net worth client that pays 50k in premiums every year wipes you out when they get some complicated form of cancer. Edit this actually came up in a videogame called Cyberpunk. A lot of people here on HN consider themselves code wizards indispensable to their employer. Google will replace your multiple sclerosis ass.
    - WalterBright 1y ago
      [flagged]
jancsika 1y ago
> Whereas the software industry, with near zero government involvement, has had enormous improvements in function and has pushed the cost to literally zero. What's most frustrating about this-- just take the poultry industry. To bring the cost to zero, all it would take is a single hacker to steal one government-regulated chicken and click "Copy" in its elusive little context menu[1]. Try telling that to a young person today. If you're like me you'll get the so-called "Gen Z Stare" in response. 1: Assume a 2d chicken.
- Dilettante_ 1y ago
  Sorry, but I'm completely lost on the chicken point. Would you mind expanding on that just a little more? Is the gov't keeping secret vat-grown super-chickens?
  - throw-the-towel 1y ago
    I think they're implying that software is completely unlike healthcare or chickens. One can be multiplied for free but the others cannot, no matter if regulated or not.
    - WalterBright 1y ago
      [flagged]
const_cast 1y ago
When it comes to healthcare, we didn't used to have so much regulation. And, well, it sucked. People died, black people got injected with radiation, and we experimented on humans. Ultimately, I don't want poor people to just... die. Because that's bad. So we need some sort of guarantees. Or, we don't: in which case, I hope you're content scraping bodies off the freeway for free. Someone has to do it if we're not paying for their healthcare and disposal costs. Hope you're not busy next weekend!
- WalterBright 1y ago
  > People died, black people got injected with radiation, and we experimented on humans. Those were experiments done by the government or funded by the government.
  - const_cast 1y ago
    I'm just not sure how you get around a private market inevitably letting people die. If someone can't afford healthcare, and in your vision we should refuse to provide it, then they die. That means, unfortunately, you are advocating for their death. Which is fine, maybe. Except that we still have to deal with that. If they can't afford to dispose of their own bodies, now what? No matter how you cut it, we either go back to the government or everything is awful. Me asking you if you want to scrape bodies off the freeway isnt rhetorical. It might seem that way, because it's so extreme, but that's the reality here. Someone, somewhere, has to pay for that. We already established that the person themselves cannot do it. Should it be you? Should it be me? Or should it be everyone? If you answer everyone, congratulations, you've reinvented taxes. The issue here is that these are already solved problems. Why do you think governments invented taxes hundreds of years ago? To steal from you? Look at the big picture.
    - WalterBright 1y ago
      Under a free market, medical care will be cheap. There's no particular reason why health care should be so expensive, but every time the government takes it over, that's the result. Look how cheap your cell phone is, despite the amazing engineering that went into it. Pretty much everyone has a cell phone, both rich and poor.

joe_the_user 1y ago

Most other advanced nations have nationalized health care which works much better. The US health care system is broken because health care is a natural monopoly that US free-market ideology dictates be run with (fake) "free markets" with result being a variety of companies profiting by abusing the system.

apwell23 1y ago
other nations get benefits from 1. US subsidizing pharma startups and 2. less people with chronic diseases 3. offer lower quality of care at lower price point 4. import doctors vs solely rely on homegrown USA is very very good at complicated, cutting edge medical care but not efficient at delivering routine care.
- bruce511 1y ago
  It's complicated, yes, but simplifying somewhat the "US" does not subsidize pharma startups. Yes, VCs do put money into pharma, but that's private money very much expecting an (overall) profitable return. (Ironically most of that profit comes from Americans who have little or no way to collectively bargain on pricing.) And yes, for bigger companies, there are tax breaks etc, but most of those are regular tax breaks that any company gets. I won't get into the chronic disease stats. Other than to say that good primary Healthcare tends to reduce the incidence of chronic diseases. Quality of care is hard to gauge on a national basis. It's a highly localized product, so experience can be different in very small geographic areas. Equally "quality of care" is s metric with many axies. Naturally for-profit medical advertises a lot, and they strongly push the "quality of care" message. So the general perception of that is "private is better". How much of that is true, how much is perception, is up for debate. My personal experience (which counts for nothing) having experienced both, is that the standard of medical care is the same. (Fewer tvs in public care though.) I'm not sure what importing doctors has to do with anything, or if it's even true. Personally I don't really care where a Dr is from.
  - lenkite 1y ago
    > It's complicated, yes, but simplifying somewhat the "US" does not subsidize pharma startups. This is utterly false. Agencies like NIH, BARDA, and NSF fund early-stage biomedical R&D by providing SBIR/STTR grants to biotech and pharma startups. They also fund basic research and clinical trials as well as translational studies. There is the Orphan Drug Tax Credit and R&D Tax Credit. Also, access to NIH labs, etc. There is a whole plethora of funding. Moderna’s mRNA platform was heavily backed by NIH and BARDA even before COVID.
  - apwell23 1y ago
    > (Ironically most of that profit comes from Americans who have little or no way to collectively bargain on pricing.) Thats what i meant by US subsidizing pharma for the whole world. I didn't mean the us govt. Would they continue to exist if every single country in the world is doing "collective bargaining"?
- conception 1y ago
  “USA is very very good at complicated, cutting edge medical care” - i hear this but haven’t seen it in practice or in statistics. Everyone I know that has needed such things has had the same poor quality of care that primary care providers have - long waits, insurance issues and mediocre outcomes.
  - apwell23 1y ago
    > i hear this but haven’t seen it in practice or in statistics curious. what kind of statistics would that show up? When i was looking into clinical trials for prostate cancer. almost 80% of experimental cutting edge medicine was in usa. They even have spl k2 visa for International patients to participate.
    - conception 1y ago
      I suppose it’s semantics but i wouldn’t consider experimental research “medical care”.
      - apwell23 1y ago
        even outside clinical trials. for prostate cancer, only doctors i found practicing newer therapies was in usa.
refurb 1y ago
> Most other advanced nations have nationalized health care which works much better. That's not true by the definition of "nationalization" (government ownership) Switzerland and Netherlands are entirely private insurance. Most European countries have a public system and private system. It's very common for people to purchase supplemental insurance on top of what the government provides.
- Pooge 1y ago
  In the case of Switzerland, basic health insurance is provided by private companies but the price is mostly fixed by the Federal government. Prices do vary between companies but many people just use the official insurance comparison tool and choose the cheapest as the services are completely identical. I'm completely against that system and would prefer a national health insurance like Japan.
WalterBright 1y ago
If they're fake free markets then free market ideology doesn't apply. > health care is a natural monopoly It obviously isn't, because it wasn't a monopoly before the 1960s when the government got involved in it.
- tim333 1y ago
  It's actually kind of refreshing to use free market lightly regulated medicine. I live in the UK where it's NHS government funded or related but travelling in Asia without insurance you can actually shop around and buy stuff - how much for a doc, how much for an xray etc. It's mostly quite cheap too. If you remove most of the regulatory barriers things work quite well. Obviously doctors and the like should pass exams for competence but I'm not sure you need to restrict it to only x people through y colleges in z country to restrict the supply. If the US said that to practice medicine and all you needed was a medical qualification from any respectable country it could drop costs like 10x I'd guess.
- Yeul 1y ago
  You cannot free market healthcare because quite frankly there is no real profit in this industry. Yeah even your high net worth client that pays 50k in premiums every year wipes you out when they get some complicated form of cancer. Edit this actually came up in a videogame called Cyberpunk. A lot of people here on HN consider themselves code wizards indispensable to their employer. Google will replace your multiple sclerosis ass.
  - WalterBright 1y ago
    [flagged]

jancsika 1y ago

> Whereas the software industry, with near zero government involvement, has had enormous improvements in function and has pushed the cost to literally zero. What's most frustrating about this-- just take the poultry industry. To bring the cost to zero, all it would take is a single hacker to steal one government-regulated chicken and click "Copy" in its elusive little context menu[1]. Try telling that to a young person today. If you're like me you'll get the so-called "Gen Z Stare" in response. 1: Assume a 2d chicken.

Dilettante_ 1y ago
Sorry, but I'm completely lost on the chicken point. Would you mind expanding on that just a little more? Is the gov't keeping secret vat-grown super-chickens?
- throw-the-towel 1y ago
  I think they're implying that software is completely unlike healthcare or chickens. One can be multiplied for free but the others cannot, no matter if regulated or not.
  - WalterBright 1y ago
    [flagged]

const_cast 1y ago

When it comes to healthcare, we didn't used to have so much regulation. And, well, it sucked. People died, black people got injected with radiation, and we experimented on humans. Ultimately, I don't want poor people to just... die. Because that's bad. So we need some sort of guarantees. Or, we don't: in which case, I hope you're content scraping bodies off the freeway for free. Someone has to do it if we're not paying for their healthcare and disposal costs. Hope you're not busy next weekend!

WalterBright 1y ago
> People died, black people got injected with radiation, and we experimented on humans. Those were experiments done by the government or funded by the government.
- const_cast 1y ago
  I'm just not sure how you get around a private market inevitably letting people die. If someone can't afford healthcare, and in your vision we should refuse to provide it, then they die. That means, unfortunately, you are advocating for their death. Which is fine, maybe. Except that we still have to deal with that. If they can't afford to dispose of their own bodies, now what? No matter how you cut it, we either go back to the government or everything is awful. Me asking you if you want to scrape bodies off the freeway isnt rhetorical. It might seem that way, because it's so extreme, but that's the reality here. Someone, somewhere, has to pay for that. We already established that the person themselves cannot do it. Should it be you? Should it be me? Or should it be everyone? If you answer everyone, congratulations, you've reinvented taxes. The issue here is that these are already solved problems. Why do you think governments invented taxes hundreds of years ago? To steal from you? Look at the big picture.
  - WalterBright 1y ago
    Under a free market, medical care will be cheap. There's no particular reason why health care should be so expensive, but every time the government takes it over, that's the result. Look how cheap your cell phone is, despite the amazing engineering that went into it. Pretty much everyone has a cell phone, both rich and poor.