5 ms·

+1 The whole system is setup to maximise the "care" whenever possible. IMHO it would be better with a universal healthcare that asked itself some tough questio

+1 The whole system is setup to maximise the "care" whenever possible. IMHO it would be better with a universal healthcare that asked itself some tough questions. Start from a pile of money and calculate maximum impact backwards from there. But maybe that's impossible for the US. (It's satanic and/or communist or something.)

rayiner 1y ago
I like universal healthcare in principle, but I don't think the funding mechanism is the problem. We see the same cost inflation in the U.S. in sectors that everyone agrees should be publicly funded, like community colleges or transit. U.S. public spending on tertiary education is about 0.95% of GDP, which is higher than the U.K. (0.5%), Ireland (0.57%), Italy (0.62%), Australia (0.68%), and not that much lower than Germany (1.1%): https://www.oecd.org/en/data/indicators/public-spending-on-education.html https://www.oecd.org/en/data/indicators/public-spending-on-e.... Most of those countries have what Americans would call "free college," but we spend just as much as a percentage of GDP--and more in absolute terms--without college being free. Our colleges simply spend way more money than European colleges. I grew up in Virginia, where George Mason University (GMU) is the second tier public school (behind UVA, William & Mary, and JMU). It's got a budget of $1.4 billion for about 40,000 students. Compare that to Heidelberg University, which I understand is a renowned university in Germany. Excluding the medical school (which GMU doesn't have), the budget is about 629 million euros, or about $725 million, for about 30,000 students. GMU, which is not a world-famous university, spends almost twice as much money for only 1/3 more students.
- actionfromafar 1y ago
  It's not the funding mechanism exactly, that matters I think. But that there's no single entity which looks at the whole pot of money and allocates according to best health for the population.
  - danielmarkbruce 1y ago
    The idea that some entity will make a good decision is almost certainly wrong.
    - actionfromafar 1y ago
      The idea that such a system will at least be less horrible has legs though. Gestures in the general direction of Europe
  - rayiner 1y ago
    Even single payer systems don’t have that. Conversely, the U.S. has huge cost inflation in education and transit as well, and those are centralized.
danielmarkbruce 1y ago
It's communist is the problem. Whose pile of money? If old Warren Buffett wants to spend a billion to extend his life by a year, who am I to stop him?
- actionfromafar 1y ago
  It's not like someone would forbid Warren Buffet from doing so. The government already set up a system that is all but in name compulsory. So, let's take a pile of the same size as the current system uses, but let it go through a single arbiter, with combined purchase power.
  - danielmarkbruce 1y ago
    In some sense we have that - what is covered by medicare and the insurance companies is covered for the relevant people in those schemes.
  - rayiner 1y ago
    We have a system like that for student loans—where the federal government itself originates and owns 90% of student debt—and it has led to massive cost inflation. What makes you think we’d implement a healthcare system better?
    - actionfromafar 1y ago
      Yeah, maybe it's a lost cause. America is kinda special.
    - rangestransform 1y ago
      The federal government hasn't even lifted a finger to control undergrad education costs. In British Columbia, Canada where I'm from, the government sets limits on student loan coverage (seems to be CA$520/week right now) and universities don't get anything more from student loans. When my student loan disbursement occured, the form explicitly had $5000 of "unmet need" that I would need to scrounge up somehow. If a universal healthcare system really wanted to, it could keep costs under control in a similar manner by telling hospitals to accept X amount for Y procedure or get bent. That the government doesn't swing its big dick on colleges in the US is entirely the fault of the government and a populace that always votes for "candy for dinner" vs. "eating vegetables".

rayiner 1y ago

I like universal healthcare in principle, but I don't think the funding mechanism is the problem. We see the same cost inflation in the U.S. in sectors that everyone agrees should be publicly funded, like community colleges or transit. U.S. public spending on tertiary education is about 0.95% of GDP, which is higher than the U.K. (0.5%), Ireland (0.57%), Italy (0.62%), Australia (0.68%), and not that much lower than Germany (1.1%): https://www.oecd.org/en/data/indicators/public-spending-on-education.html https://www.oecd.org/en/data/indicators/public-spending-on-e.... Most of those countries have what Americans would call "free college," but we spend just as much as a percentage of GDP--and more in absolute terms--without college being free. Our colleges simply spend way more money than European colleges. I grew up in Virginia, where George Mason University (GMU) is the second tier public school (behind UVA, William & Mary, and JMU). It's got a budget of $1.4 billion for about 40,000 students. Compare that to Heidelberg University, which I understand is a renowned university in Germany. Excluding the medical school (which GMU doesn't have), the budget is about 629 million euros, or about $725 million, for about 30,000 students. GMU, which is not a world-famous university, spends almost twice as much money for only 1/3 more students.

actionfromafar 1y ago
It's not the funding mechanism exactly, that matters I think. But that there's no single entity which looks at the whole pot of money and allocates according to best health for the population.
- danielmarkbruce 1y ago
  The idea that some entity will make a good decision is almost certainly wrong.
  - actionfromafar 1y ago
    The idea that such a system will at least be less horrible has legs though. Gestures in the general direction of Europe
- rayiner 1y ago
  Even single payer systems don’t have that. Conversely, the U.S. has huge cost inflation in education and transit as well, and those are centralized.

danielmarkbruce 1y ago

It's communist is the problem. Whose pile of money? If old Warren Buffett wants to spend a billion to extend his life by a year, who am I to stop him?

actionfromafar 1y ago
It's not like someone would forbid Warren Buffet from doing so. The government already set up a system that is all but in name compulsory. So, let's take a pile of the same size as the current system uses, but let it go through a single arbiter, with combined purchase power.
- danielmarkbruce 1y ago
  In some sense we have that - what is covered by medicare and the insurance companies is covered for the relevant people in those schemes.
- rayiner 1y ago
  We have a system like that for student loans—where the federal government itself originates and owns 90% of student debt—and it has led to massive cost inflation. What makes you think we’d implement a healthcare system better?
  - actionfromafar 1y ago
    Yeah, maybe it's a lost cause. America is kinda special.
  - rangestransform 1y ago
    The federal government hasn't even lifted a finger to control undergrad education costs. In British Columbia, Canada where I'm from, the government sets limits on student loan coverage (seems to be CA$520/week right now) and universities don't get anything more from student loans. When my student loan disbursement occured, the form explicitly had $5000 of "unmet need" that I would need to scrounge up somehow. If a universal healthcare system really wanted to, it could keep costs under control in a similar manner by telling hospitals to accept X amount for Y procedure or get bent. That the government doesn't swing its big dick on colleges in the US is entirely the fault of the government and a populace that always votes for "candy for dinner" vs. "eating vegetables".