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Healthcare - rather than just assuming that the most maximalist possible universal healthcare strategy is the best solution, actually consider how different hea
by presentation 25d ago
Healthcare - rather than just assuming that the most maximalist possible universal healthcare strategy is the best solution, actually consider how different healthcare strategies balance the cost of long-term solvency, cost control, speed and quality of service, and so on. For example, I am partial to the Japanese system, which unlike the Canadian system (which has crazy wait times), people pay 30% of costs so they still have skin in the game while the national healthcare system mandates fee schedules for common procedures to control costs. No blocking access to specialists behind primary care doctors, no banning private insurers. You get fast healthcare with a more sustainable fiscal basis, and less frivolous use of limited healthcare capacity than e.g. a system where there are no copays. The problem there though is that they have not enough supply of doctors (read: US should think about significantly increasing the supply of medical education and reducing the cost of medical training) and too much incentive for churning people through the system extremely quickly (read: US should have pricing not just be flat fee so that you aren't incentivized purely for speed).
The progressive wing seem irrationally tied to whatever Bernie Sanders claims is the best healthcare arrangement, and think that insurers are the source of all problems, when they actually are terrible from a business standpoint, they barely make money, and the cost of healthcare isn't from them but rather from other fundamental issues that have little to do with them. The result of this is that they land on a policy that half of America doesn’t want, and are too stubborn to budge on it, which means the United States will never get a rational healthcare system.
Housing & transportation - get rid of restrictions that reduce the ability of developers to actually build housing, from zoning restrictions to environmental legislation that is weaponized by NIMBYs to block development, to union labor requirements that send costs of building transit and housing through the roof, to affordable housing requirements that make projects not pencil out. Commercialize and densify areas in and around train stations as much as possible, specifically with for-profit developments, not trying to turn prime real estate into low-income enclaves because they hate gentrification more than they like progress (failing to think critically about what would likely happen if a poor and dangerous place became less poor and dangerous, or the people within such a place made some money to have the option of living elsewhere...).
I am partial again to the Japanese model where the available zones are set nationally, the rules for whether or not you get a permit is basically a checklist, if you check all the boxes you can build what you want, it doesn't discriminate on who's doing it, and for transit in particular, the train companies are literally private real estate companies that develop stations to the maximal extent possible because they make money from it. If you've visited Japan, did you think Shibuya felt awful because it was largely developed by Tokyu Corporation? Or that neighborhoods lack character and energy because the architecture is designed by a small handful of mass-manufactured modular home developer companies?
Progressives seem to think that supply and demand doesn't apply to their beloved cities, corporate landlords are the source of all evil when it comes to housing problems, and that private transit companies are not even a possible option because capitalists are greedy (when in reality they're more motivated than any of these activists are to actually do things that affect change on communities). My lived experience tells me that what I consider to be the greatest housing and transit successes in the world often come from large private developers who are incentivized well, because I've been places and observed how they function.
Also, we should be switching to land value taxes to incentivize efficient use of land, by making vacant lots expensive to hold, while also raising huge amounts of money, because the logic is simple enough for a 3 year old to understand - we have a lot of land and it is expensive. I haven't heard a single progressive even mention the idea despite being a great way to tax the wealthy while providing a strong incentive for better outcomes in cities, because they haven't thought about the root causes of why their cities feel like dumpsters long enough to care, and instead want to protect the historic laundromat and parking lot. Instead they harp on about wealth taxes that will mostly be evaded, and in the end net out tiny amounts of money that don't affect the economy as a whole and have no effect on the quality of their communities besides driving out economically ambitious and successful people.
I can keep going. I'm not a Republican, I'd much rather have the moderate Dems who actually think about the causes of issues to win primaries rather than populists who just try to get everyone pissed off (and probably are lying to their constituents anyway once they moderate as soon as the primaries end because they realize how unpopular and irrational their ideas are), but that isn't where the country is going these days. People are more interested in ideological purity tests than they are about substantive argument, in this sense the leftists aren’t any different than the MAGA people. Instead people like you already decided that people like me have no substantive opinions - very in line with the political zeitgeist these days where everyone's angry all the time and can't have rational conversations or learn from anyone else's experiences in the world. So, idk, enjoy your life.