5 ms·

This makes it sort of obvious how large the US welfare state is. Medicaid: 10% "Safety Net": 7.1% Social Security: 22.6% Medicare: 14.2% 53.9% of the feder

by arjie 7mo ago

This makes it sort of obvious how large the US welfare state is. Medicaid: 10% "Safety Net": 7.1% Social Security: 22.6% Medicare: 14.2% 53.9% of the federal budget is spent on welfare. That seems roughly in line with most Western nations.

deleted 7mo ago
[deleted]
airstrike 7mo ago
In line on price, but not on value. If anything this speaks to the cost of welfare in America. The corollary is that many suggestions to reduce welfare spending would lead to even less actual welfare being delivered, without addressing systemic cost problems.
phillipcarter 7mo ago
Unfortunately, much of that gets dispersed into an unfathomably complex web of private and profit-seeking interests, with much less actually going to individual beneficiaries.
- trollbridge 7mo ago
  Social Security almost entirely flows to beneficiaries, as do programs like SNAP, where overhead is around 6-7% (admittedly, fraud might be a good bit higher than that); likewise Medicare is one of the most efficient systems at getting money directly to medical providers (although fraud might be a problem there too, estimates range from 10%-25%).
  - munk-a 7mo ago
    Yup, Medicaid and SNAP are extremely efficient. Social Security is almost completely disbursement charges but those disbursements aren't means tested so even quite wealthy individuals receive them. Additionally you mentioned that Medicare gets money to medical providers but I suspect that was meant to mean medical insurance providers - rather than health care providers (like doctors) since the system is partially direct payments but mostly runs through intermediary privatized companies and, of extreme note here, is that Medicare is famously barred from cost negotiations so while our Canadian healthcare system can talk to a pharma manufacturer and tell them "The price for this drug is unreasonable, we won't cover it unless it's cost competitive to biosimilars" Medicare just needs to roll over and accept whatever made up numbers it's given. The benefits that are intended to go exclusively to the impoverished though, those are extremely means-tested and often have work requirements or other hoops to jump through.
    - RhysU 7mo ago
      > Social Security is almost completely disbursement charges but those disbursements aren't means tested so even quite wealthy individuals receive them. Only to those who paid into the system and far less than they personally could have earned on investing the same dollars.
      - renewiltord 7mo ago
        Yeah, one of the problems I have with taxes is that if I pay $100 into taxes I don’t get $100 of value back. Everyone should get at least as much as they put in back. Also, some other people should get more back. But we shouldn’t spend more than we make as a government.
        munk-a 7mo ago
        Assuming the presence of a sovereign wealth fund which does work somewhat logically for programs like social security - that would make sense. The government should sensibly invest money they're holding onto... however, it's unrealistic to ever expect the government to tolerate a level of risk and thus a rate of return above what you're personally comfortable with so it's unrealistic to assume that the government will be as efficient with money as you'd personally be if they'd never taken that money. Additionally, a lot of these programs will pay out beyond what you've personally put in - programs like Medicaid are nearly entirely social subsidies to ease poverty and financial distress, so I'm not certain where you'd find the money to pay for them if not looking at either other people's taxes or debt. As a taxpayer I expect the money I give to the government to be evident in some social projects but I don't personally expect that for each dollar I pay that I'd see a dollar in benefit to me personally. I have a belief that I indirectly benefit from the expenditure of charitable safety net programs even if I never expect to collect from them directly - the improvement in the lives of those around me is to my personal benefit by making society more just and egalitarian as well as reducing the incentive for crime which is a difficult to measure but observable direct benefit to myself. The fact that so much of our budget goes to debt servicing is probably my personal biggest objection as it is effectively just a wealth extraction from our earn national budget to some select individuals.
- jimbokun 7mo ago
  I don’t think that’s true. US government services generally have very low overhead.
  - phillipcarter 7mo ago
    It's quite true. Take Medicaid grants to states for example, which then goes out to 50 different systems of disbursement to private entities. Enrollees on plans are often done so through private insurers, many hospitals are run as for-profit including being owned by PE groups, etc.
  - airstrike 7mo ago
    And the intermediaries? And admin?
- ch4s3 7mo ago
  A lot just gets sucked up by 3rd parties of all stripes. Only ~20% of hospitals are for profit institutions for example.
  - airstrike 7mo ago
    Non-profit doesn't mean money-hating, though
    - ch4s3 7mo ago
      No but it directly contradicts OP's claim of "profit-seeking interests".
      - airstrike 7mo ago
        Individuals in such hospitals can still very much seek profit.
        ch4s3 7mo ago
        Care to explain what you mean specifically?
        airstrike 7mo ago
        Hospital Administrative Expenditures Exceed Direct Patient Care by Nearly 2x https://www.trillianthealth.com/market-research/studies/hospital-administrative-expenditures-exceed-direct-patient-care-by-nearly-2x https://www.trillianthealth.com/market-research/studies/hosp... This one is ironic because they're touting the inflating admin headcount as a good thing: https://www.athenahealth.com/resources/blog/expert-forum-rise-and-rise-healthcare-administrator https://www.athenahealth.com/resources/blog/expert-forum-ris...
  - tgrowazay 7mo ago
    My daughter’s classmate’s father is a head of a non-profit hospital. They have a 6k sqft house with a basketball court, pool and a pool house in the prime location in West Los Angeles. They had to join two lots to build to their liking.
- deleted 7mo ago
  [deleted]
- BurningFrog 7mo ago
  Not sure if this is comforting or distressing, but it's the same in all welfare states.
trollbridge 7mo ago
One of the most generous welfare states with one of the best safety nets. I' not really aware of any place better. Maybe one of the small countries like Lichtenstein.
altruios 7mo ago
What would you rather have the government spend it's money on if not on the wellbeing/welfare of its citizens?
Alupis 7mo ago
Yet, people still meme how unsupportive the US is to its people. The reality is the US operates the world's largest social services apparatus, including the world's largest public healthcare system.
- silentsea90 7mo ago
  Both can be true. US spends a ton but people feel the pain because the money is spent poorly
- jimbokun 7mo ago
  The problem is that our public health care system could cover the entire country at no additional cost…if our health care spending per capita was inline with other nations with better health outcomes.
- deleted 7mo ago
  [deleted]
deleted 7mo ago
[deleted]
hyperhello 7mo ago
The people paid for that welfare for themselves. Everything that helps people is a scare word. They’re too entitled to welfare!
K0nserv 7mo ago
The US spends the most per capita[0] on healthcare in the world, all to receive a healthcare system that still requires lots of citizens to carry private insurance. I've never dug deep into why, but it sure is noteworthy. 0: https://www.statista.com/statistics/283221/per-capita-health-expenditure-by-country/ https://www.statista.com/statistics/283221/per-capita-health...
- ch4s3 7mo ago
  The private insurance expenditure is part of that per capita number. US healthcare isn't "A system", its a number of interrelated systems that have lots of expensive hand-offs. We also spend a ton on lifestyles diseases because no one walks and culturally we eat like shit on average.
  - phillipcarter 7mo ago
    > We also spend a ton on lifestyles diseases because no one walks and culturally we eat like shit on average. And there's a pretty straight line between that and government subsidies for sugar and processed foods in general, not to mention car-based infrastructure, although the latter doesn't stop other countries from not having crippling obesity rates.
    - TimorousBestie 7mo ago
      And acknowledging the very obvious instances of regulatory capture that directly harm quality of life is political suicide for anyone with even the smallest amount of access to power. It’s hard getting normies to admit that if soft drinks weren’t so heavily subsidized by the government at every step of manufacture and distribution, there would be less overall obesity.
    - ch4s3 7mo ago
      > And there's a pretty straight line between that and government subsidies for sugar and processed foods in general No there isn't. Sugar subsidy accounts for 1.7 cents per 12-ounce can of soda. Soda in the US is generally inelastic, and research has shown that a 10% increase in price results in lessss than a 5% decrease in consumption. Americans just like sugar and sitting, culturally.
mikepurvis 7mo ago
Given that reality, I wonder why it is that spending in this category seems to be so much less effective in the US relative to other nations? Why is the US #22 in general quality of life [1], and the bottom of many rankings of health system performance [2]? Speaking as a Canadian, I wonder if at least part of it is the attitude that investments in these areas are "welfare" and not simply a part of the portfolio of essential services that are delivered by the state to citizens? [1]: https://www.usnews.com/news/best-countries/rankings/quality-of-life https://www.usnews.com/news/best-countries/rankings/quality-... [2]: https://www.commonwealthfund.org/publications/fund-reports/2024/sep/mirror-mirror-2024 https://www.commonwealthfund.org/publications/fund-reports/2...
- fhdkweig 7mo ago
  It may just be my cynicism talking, but it seems that it comes down to the power of lobbyists. In the US, the healthcare companies control the government. Elsewhere, the government controls the healthcare companies.
  - mikepurvis 7mo ago
    The media narrative is a factor too. Like I have extended family, friends, and work colleagues in the US, many of whom are wealthy and well-traveled and even a lot of them will still loudly assert obviously disprovable untruths like "well at least we don't die in waiting rooms like in Canada" or "at least we don't have death panels deciding who gets to have life-saving treatment" or worst of all "ehh I mean I have good insurance, and outcomes are much better here for top-5%ers, so I don't really care about the rest of the system." All while decades of TV hospital dramas depict a well-oiled medical system delivering effective and efficient care to people with nary a whisper about how it's getting paid for. It's got to be desperately frustrating trying to fight this kind of thinking when you've got whole communities who have never even thought to question it. My main hope at this point is with bottom-up type efforts. Let Mamdani show people that an effective city government can fill potholes and operate a few at-cost supermarkets. Let that be the start of citizens expecting more than chainsaw-waving and twitter meltdowns for their tax dollars.
silentsea90 7mo ago
Playing devil's advocate - the measure of success of welfare isn't in the budget spent on it but public outcomes. That said, it is true more taxes or expenditure aren't the panacea that the left might think it is.
cidd 7mo ago
If clinics and hospitals do not bill 1k dollars each visit, 100k+ for a simple surgery, and pharmacy does not sell medicine 10x the price, US gov't do not need that much allocation for healthcare.
- mekdoonggi 7mo ago
  They only bill that much because they need the average amount of money collected for a procedure to pencil. They get that cash price amount from a tiny amount of people, 70% of that price from private insurers, 30-60% from Medicare, less from Medicaid. Even then, they have to basically litigate the bills through private insurance appeals. If they had one payer which had a single reimbursement rate, they wouldn't have to do these shenanigans.
ForHackernews 7mo ago
A big chunk of the "defense" budget is also healthcare and benefits for veterans.
yohannparis 7mo ago
That is the sad part, your money is wasted. You guys pay roughly as much in welfare, but get a tenth of it back.
einpoklum 7mo ago
The distribution itself does not tell you much; you have to normalize by the share of GDP (or some other measure of production/activity) that the federal budget constitutes. Also, as other commenters mention, the specifics of how money is disbursed or spent, matters. If, say, pharmaceutical companies are allowed to massively over-charge, than the same level of care would mean a higher level of spending than in other world states.
pennomi 7mo ago
Except the US doesn’t have universal healthcare, and other nations do.
- srslyTrying2hlp 7mo ago
  [dead]
atoav 7mo ago
Yes, if it was actually spent on welfare and not lost as friction in a system of cronies.
ekjhgkejhgk 7mo ago
My (admitedly superficial) understanding is that in the USA because the welfare state is mostly private, it optimizes for profit. So just because you put a lot into it doesn't mean you get much out. I have no first hand experience of this, but the other day I stumbled upon an article explaining private equity buying up the "ambulance business" and costs balooning, so that tracks.
insane_dreamer 7mo ago
That depends on your definition of "welfare". For most Americans that means the government providing support for those who can't afford it (taking from the taxes of others). Social Security isn't really welfare -- it's more like a nationwide retirement plan, whereby I'm getting X back in future dollars for Y paid in now. Medicare isn't really welfare either -- it's medical insurance that I am paying for in advance. (Now you can argue that a percentage of SS and Medicare is welfare because there is a floor on how much you receive regardless of what you put in, though you have to have paid in for at least 10 years to be eligible to receive anything.) So that really just leaves Medicaid and Safety Net as true welfare: 17.1%.

by arjie 7mo ago

deleted 7mo ago

[deleted]

airstrike 7mo ago

In line on price, but not on value. If anything this speaks to the cost of welfare in America. The corollary is that many suggestions to reduce welfare spending would lead to even less actual welfare being delivered, without addressing systemic cost problems.

phillipcarter 7mo ago

Unfortunately, much of that gets dispersed into an unfathomably complex web of private and profit-seeking interests, with much less actually going to individual beneficiaries.

trollbridge 7mo ago
Social Security almost entirely flows to beneficiaries, as do programs like SNAP, where overhead is around 6-7% (admittedly, fraud might be a good bit higher than that); likewise Medicare is one of the most efficient systems at getting money directly to medical providers (although fraud might be a problem there too, estimates range from 10%-25%).
- munk-a 7mo ago
  Yup, Medicaid and SNAP are extremely efficient. Social Security is almost completely disbursement charges but those disbursements aren't means tested so even quite wealthy individuals receive them. Additionally you mentioned that Medicare gets money to medical providers but I suspect that was meant to mean medical insurance providers - rather than health care providers (like doctors) since the system is partially direct payments but mostly runs through intermediary privatized companies and, of extreme note here, is that Medicare is famously barred from cost negotiations so while our Canadian healthcare system can talk to a pharma manufacturer and tell them "The price for this drug is unreasonable, we won't cover it unless it's cost competitive to biosimilars" Medicare just needs to roll over and accept whatever made up numbers it's given. The benefits that are intended to go exclusively to the impoverished though, those are extremely means-tested and often have work requirements or other hoops to jump through.
  - RhysU 7mo ago
    > Social Security is almost completely disbursement charges but those disbursements aren't means tested so even quite wealthy individuals receive them. Only to those who paid into the system and far less than they personally could have earned on investing the same dollars.
    - renewiltord 7mo ago
      Yeah, one of the problems I have with taxes is that if I pay $100 into taxes I don’t get $100 of value back. Everyone should get at least as much as they put in back. Also, some other people should get more back. But we shouldn’t spend more than we make as a government.
      - munk-a 7mo ago
        Assuming the presence of a sovereign wealth fund which does work somewhat logically for programs like social security - that would make sense. The government should sensibly invest money they're holding onto... however, it's unrealistic to ever expect the government to tolerate a level of risk and thus a rate of return above what you're personally comfortable with so it's unrealistic to assume that the government will be as efficient with money as you'd personally be if they'd never taken that money. Additionally, a lot of these programs will pay out beyond what you've personally put in - programs like Medicaid are nearly entirely social subsidies to ease poverty and financial distress, so I'm not certain where you'd find the money to pay for them if not looking at either other people's taxes or debt. As a taxpayer I expect the money I give to the government to be evident in some social projects but I don't personally expect that for each dollar I pay that I'd see a dollar in benefit to me personally. I have a belief that I indirectly benefit from the expenditure of charitable safety net programs even if I never expect to collect from them directly - the improvement in the lives of those around me is to my personal benefit by making society more just and egalitarian as well as reducing the incentive for crime which is a difficult to measure but observable direct benefit to myself. The fact that so much of our budget goes to debt servicing is probably my personal biggest objection as it is effectively just a wealth extraction from our earn national budget to some select individuals.
jimbokun 7mo ago
I don’t think that’s true. US government services generally have very low overhead.
- phillipcarter 7mo ago
  It's quite true. Take Medicaid grants to states for example, which then goes out to 50 different systems of disbursement to private entities. Enrollees on plans are often done so through private insurers, many hospitals are run as for-profit including being owned by PE groups, etc.
- airstrike 7mo ago
  And the intermediaries? And admin?
ch4s3 7mo ago
A lot just gets sucked up by 3rd parties of all stripes. Only ~20% of hospitals are for profit institutions for example.
- airstrike 7mo ago
  Non-profit doesn't mean money-hating, though
  - ch4s3 7mo ago
    No but it directly contradicts OP's claim of "profit-seeking interests".
    - airstrike 7mo ago
      Individuals in such hospitals can still very much seek profit.
      - ch4s3 7mo ago
        Care to explain what you mean specifically?
        airstrike 7mo ago
        Hospital Administrative Expenditures Exceed Direct Patient Care by Nearly 2x https://www.trillianthealth.com/market-research/studies/hospital-administrative-expenditures-exceed-direct-patient-care-by-nearly-2x https://www.trillianthealth.com/market-research/studies/hosp... This one is ironic because they're touting the inflating admin headcount as a good thing: https://www.athenahealth.com/resources/blog/expert-forum-rise-and-rise-healthcare-administrator https://www.athenahealth.com/resources/blog/expert-forum-ris...
- tgrowazay 7mo ago
  My daughter’s classmate’s father is a head of a non-profit hospital. They have a 6k sqft house with a basketball court, pool and a pool house in the prime location in West Los Angeles. They had to join two lots to build to their liking.
deleted 7mo ago
[deleted]
BurningFrog 7mo ago
Not sure if this is comforting or distressing, but it's the same in all welfare states.

trollbridge 7mo ago

One of the most generous welfare states with one of the best safety nets. I' not really aware of any place better. Maybe one of the small countries like Lichtenstein.

altruios 7mo ago

What would you rather have the government spend it's money on if not on the wellbeing/welfare of its citizens?

Alupis 7mo ago

Yet, people still meme how unsupportive the US is to its people. The reality is the US operates the world's largest social services apparatus, including the world's largest public healthcare system.

silentsea90 7mo ago
Both can be true. US spends a ton but people feel the pain because the money is spent poorly
jimbokun 7mo ago
The problem is that our public health care system could cover the entire country at no additional cost…if our health care spending per capita was inline with other nations with better health outcomes.
deleted 7mo ago
[deleted]

deleted 7mo ago

[deleted]

hyperhello 7mo ago

The people paid for that welfare for themselves. Everything that helps people is a scare word. They’re too entitled to welfare!

K0nserv 7mo ago

The US spends the most per capita[0] on healthcare in the world, all to receive a healthcare system that still requires lots of citizens to carry private insurance. I've never dug deep into why, but it sure is noteworthy. 0: https://www.statista.com/statistics/283221/per-capita-health-expenditure-by-country/ https://www.statista.com/statistics/283221/per-capita-health...

ch4s3 7mo ago
The private insurance expenditure is part of that per capita number. US healthcare isn't "A system", its a number of interrelated systems that have lots of expensive hand-offs. We also spend a ton on lifestyles diseases because no one walks and culturally we eat like shit on average.
- phillipcarter 7mo ago
  > We also spend a ton on lifestyles diseases because no one walks and culturally we eat like shit on average. And there's a pretty straight line between that and government subsidies for sugar and processed foods in general, not to mention car-based infrastructure, although the latter doesn't stop other countries from not having crippling obesity rates.
  - TimorousBestie 7mo ago
    And acknowledging the very obvious instances of regulatory capture that directly harm quality of life is political suicide for anyone with even the smallest amount of access to power. It’s hard getting normies to admit that if soft drinks weren’t so heavily subsidized by the government at every step of manufacture and distribution, there would be less overall obesity.
  - ch4s3 7mo ago
    > And there's a pretty straight line between that and government subsidies for sugar and processed foods in general No there isn't. Sugar subsidy accounts for 1.7 cents per 12-ounce can of soda. Soda in the US is generally inelastic, and research has shown that a 10% increase in price results in lessss than a 5% decrease in consumption. Americans just like sugar and sitting, culturally.

mikepurvis 7mo ago

Given that reality, I wonder why it is that spending in this category seems to be so much less effective in the US relative to other nations? Why is the US #22 in general quality of life [1], and the bottom of many rankings of health system performance [2]? Speaking as a Canadian, I wonder if at least part of it is the attitude that investments in these areas are "welfare" and not simply a part of the portfolio of essential services that are delivered by the state to citizens? [1]: https://www.usnews.com/news/best-countries/rankings/quality-of-life https://www.usnews.com/news/best-countries/rankings/quality-... [2]: https://www.commonwealthfund.org/publications/fund-reports/2024/sep/mirror-mirror-2024 https://www.commonwealthfund.org/publications/fund-reports/2...

fhdkweig 7mo ago
It may just be my cynicism talking, but it seems that it comes down to the power of lobbyists. In the US, the healthcare companies control the government. Elsewhere, the government controls the healthcare companies.
- mikepurvis 7mo ago
  The media narrative is a factor too. Like I have extended family, friends, and work colleagues in the US, many of whom are wealthy and well-traveled and even a lot of them will still loudly assert obviously disprovable untruths like "well at least we don't die in waiting rooms like in Canada" or "at least we don't have death panels deciding who gets to have life-saving treatment" or worst of all "ehh I mean I have good insurance, and outcomes are much better here for top-5%ers, so I don't really care about the rest of the system." All while decades of TV hospital dramas depict a well-oiled medical system delivering effective and efficient care to people with nary a whisper about how it's getting paid for. It's got to be desperately frustrating trying to fight this kind of thinking when you've got whole communities who have never even thought to question it. My main hope at this point is with bottom-up type efforts. Let Mamdani show people that an effective city government can fill potholes and operate a few at-cost supermarkets. Let that be the start of citizens expecting more than chainsaw-waving and twitter meltdowns for their tax dollars.

silentsea90 7mo ago

Playing devil's advocate - the measure of success of welfare isn't in the budget spent on it but public outcomes. That said, it is true more taxes or expenditure aren't the panacea that the left might think it is.

cidd 7mo ago

If clinics and hospitals do not bill 1k dollars each visit, 100k+ for a simple surgery, and pharmacy does not sell medicine 10x the price, US gov't do not need that much allocation for healthcare.

mekdoonggi 7mo ago
They only bill that much because they need the average amount of money collected for a procedure to pencil. They get that cash price amount from a tiny amount of people, 70% of that price from private insurers, 30-60% from Medicare, less from Medicaid. Even then, they have to basically litigate the bills through private insurance appeals. If they had one payer which had a single reimbursement rate, they wouldn't have to do these shenanigans.

ForHackernews 7mo ago

A big chunk of the "defense" budget is also healthcare and benefits for veterans.

yohannparis 7mo ago

That is the sad part, your money is wasted. You guys pay roughly as much in welfare, but get a tenth of it back.

einpoklum 7mo ago

The distribution itself does not tell you much; you have to normalize by the share of GDP (or some other measure of production/activity) that the federal budget constitutes. Also, as other commenters mention, the specifics of how money is disbursed or spent, matters. If, say, pharmaceutical companies are allowed to massively over-charge, than the same level of care would mean a higher level of spending than in other world states.

pennomi 7mo ago

Except the US doesn’t have universal healthcare, and other nations do.

srslyTrying2hlp 7mo ago
[dead]

atoav 7mo ago

Yes, if it was actually spent on welfare and not lost as friction in a system of cronies.

ekjhgkejhgk 7mo ago

My (admitedly superficial) understanding is that in the USA because the welfare state is mostly private, it optimizes for profit. So just because you put a lot into it doesn't mean you get much out. I have no first hand experience of this, but the other day I stumbled upon an article explaining private equity buying up the "ambulance business" and costs balooning, so that tracks.

insane_dreamer 7mo ago

That depends on your definition of "welfare". For most Americans that means the government providing support for those who can't afford it (taking from the taxes of others). Social Security isn't really welfare -- it's more like a nationwide retirement plan, whereby I'm getting X back in future dollars for Y paid in now. Medicare isn't really welfare either -- it's medical insurance that I am paying for in advance. (Now you can argue that a percentage of SS and Medicare is welfare because there is a floor on how much you receive regardless of what you put in, though you have to have paid in for at least 10 years to be eligible to receive anything.) So that really just leaves Medicaid and Safety Net as true welfare: 17.1%.