4 ms·

We spend more on pension and benefits than we do on wars. The United States government is a benefits manager with a standing army.

by tptacek 2mo ago

toomuchtodo 2mo ago
The evidence shows we could spend less and deliver more within the scope of healthcare delivery (this piece). We actively choose not to. The Pentagon hasn't passed an audit eight years in a row, I hear little that "we cannot afford to keep funding the military at these levels and with such inefficiency." https://usafacts.org/government-spending/ https://usafacts.org/government-spending/ https://usafacts.org/articles/how-much-of-the-federal-budget-is-discretionary-spending/ https://usafacts.org/articles/how-much-of-the-federal-budget... https://www.militarytimes.com/news/pentagon-congress/2025/12/19/pentagon-fails-financial-audit-for-8th-year-in-a-row/ https://www.militarytimes.com/news/pentagon-congress/2025/12...
- tptacek 2mo ago
  I don't want to sound like I'm fundamentally arguing with you, because if I could swap our system with Germany's I'd do so in a heartbeat. But (a) the "money that should be going into health care and education is going to military" argument is highly rebuttable, so I'd be careful hanging my hat on it, and (b) everybody, literally everybody (except the AMA) agrees we're spending too much on health care --- the problem is that money goes to practitioners, so it's very tricky to talk about clawing it back.
  - toomuchtodo 2mo ago
    I appreciate you keeping me honest on this topic.
    - tptacek 2mo ago
      Back atcha!
  - bonsai_spool 2mo ago
    > except the AMA What an idle comment - where is the AMA on record saying that we should spend more on healthcare? Here's all the work they do to describe our increasing costs: https://www.ama-assn.org/about/ama-research/policy-research-perspectives-national-healthcare-expenditures https://www.ama-assn.org/about/ama-research/policy-research-... Also, when people invoke the bogeyman of 'AMA' they treat it like the lobbies that tech companies belong to. The AMA is not enriching physicians or hospitals (which have their own lobby!) but generally espouses consensus perspectives among doctors while making money from administering things like a residency program application system. It's frustrating for someone like you to make this statement which feels quite divorced from any fact when you would not do the same about a security topic.
    - tptacek 2mo ago
      The AMA orchestrated the capping of residency slots through CMS/Medicare, which is the primary structural impediment to increased supply. Doctors in the US make integer multiples of what they do in Europe in part as a result of this. I have to say: you can go either way on the AMA, I guess, but it's a weird hill to die on, isn't it? They're a trade group, not a public health organization. They exist for the benefit of their members.
      - bonsai_spool 2mo ago
        I really would love to see the sources you have on this. As someone who has been in medicine for decades now, I have never hears this. This may be the result of a game of telephone but I'll comment as I can: > The AMA orchestrated the capping of residency slots through CMS/Medicare, This has very little to do with the AMA, though it is true that in 1997 the AMA was predicting an oversupply of physicians. CMS funding is the role of Congress and the AMA has supported increases in residency seats since the prediction of oversupply was found incorrect. If there's a problem with an advisory group suggesting that the US not overspend, then I think we'll not agree on much. I take their 1997 position as one in good faith; the graduate training component of medicine is very resource-intensive (and honestly dangerous!) so it should not be expanded without good reason. > Doctors in the US make integer multiples of what they do in Europe in part as a result of this. Doctors in the US make mulitples of what they do in Europe because we do not have a single-payer. You even say this earlier in the thread! > They're a trade group, not a public health organization. They exist for the benefit of their members. I assure you, no physician feels their needs are reflected by the AMA. It's an odd duck that probably made sense in the era of PCPs owning their own firms. The AMA has several structural roles in medical training (they administer application programs, primarily) so they're not going away any time soon, no matter what I may wish.

We spend more on pension and benefits than we do on wars. The United States government is a benefits manager with a standing army.

by tptacek 2mo ago

We spend more on pension and benefits than we do on wars. The United States government is a benefits manager with a standing army.

toomuchtodo 2mo ago

The evidence shows we could spend less and deliver more within the scope of healthcare delivery (this piece). We actively choose not to. The Pentagon hasn't passed an audit eight years in a row, I hear little that "we cannot afford to keep funding the military at these levels and with such inefficiency." https://usafacts.org/government-spending/ https://usafacts.org/government-spending/ https://usafacts.org/articles/how-much-of-the-federal-budget-is-discretionary-spending/ https://usafacts.org/articles/how-much-of-the-federal-budget... https://www.militarytimes.com/news/pentagon-congress/2025/12/19/pentagon-fails-financial-audit-for-8th-year-in-a-row/ https://www.militarytimes.com/news/pentagon-congress/2025/12...

tptacek 2mo ago
I don't want to sound like I'm fundamentally arguing with you, because if I could swap our system with Germany's I'd do so in a heartbeat. But (a) the "money that should be going into health care and education is going to military" argument is highly rebuttable, so I'd be careful hanging my hat on it, and (b) everybody, literally everybody (except the AMA) agrees we're spending too much on health care --- the problem is that money goes to practitioners, so it's very tricky to talk about clawing it back.
- toomuchtodo 2mo ago
  I appreciate you keeping me honest on this topic.
  - tptacek 2mo ago
    Back atcha!
- bonsai_spool 2mo ago
  > except the AMA What an idle comment - where is the AMA on record saying that we should spend more on healthcare? Here's all the work they do to describe our increasing costs: https://www.ama-assn.org/about/ama-research/policy-research-perspectives-national-healthcare-expenditures https://www.ama-assn.org/about/ama-research/policy-research-... Also, when people invoke the bogeyman of 'AMA' they treat it like the lobbies that tech companies belong to. The AMA is not enriching physicians or hospitals (which have their own lobby!) but generally espouses consensus perspectives among doctors while making money from administering things like a residency program application system. It's frustrating for someone like you to make this statement which feels quite divorced from any fact when you would not do the same about a security topic.
  - tptacek 2mo ago
    The AMA orchestrated the capping of residency slots through CMS/Medicare, which is the primary structural impediment to increased supply. Doctors in the US make integer multiples of what they do in Europe in part as a result of this. I have to say: you can go either way on the AMA, I guess, but it's a weird hill to die on, isn't it? They're a trade group, not a public health organization. They exist for the benefit of their members.
    - bonsai_spool 2mo ago
      I really would love to see the sources you have on this. As someone who has been in medicine for decades now, I have never hears this. This may be the result of a game of telephone but I'll comment as I can: > The AMA orchestrated the capping of residency slots through CMS/Medicare, This has very little to do with the AMA, though it is true that in 1997 the AMA was predicting an oversupply of physicians. CMS funding is the role of Congress and the AMA has supported increases in residency seats since the prediction of oversupply was found incorrect. If there's a problem with an advisory group suggesting that the US not overspend, then I think we'll not agree on much. I take their 1997 position as one in good faith; the graduate training component of medicine is very resource-intensive (and honestly dangerous!) so it should not be expanded without good reason. > Doctors in the US make integer multiples of what they do in Europe in part as a result of this. Doctors in the US make mulitples of what they do in Europe because we do not have a single-payer. You even say this earlier in the thread! > They're a trade group, not a public health organization. They exist for the benefit of their members. I assure you, no physician feels their needs are reflected by the AMA. It's an odd duck that probably made sense in the era of PCPs owning their own firms. The AMA has several structural roles in medical training (they administer application programs, primarily) so they're not going away any time soon, no matter what I may wish.