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The simplest way to improve efficiency would be to crack down on end of life care abuses. However the population that benefits, senior citizens, is one of the

The simplest way to improve efficiency would be to crack down on end of life care abuses. However the population that benefits, senior citizens, is one of the most entrenched and powerful political lobbying groups in the US. There is something bizarre about the American psyche that leads us to overspend on end of life care. It makes no sense. Countries like France and Canada don't allow it and get huge efficiency gains b/c of it. Americans are also uniquely litigious. We expect doctors to be perfect and demand extreme degrees of training and accountability. The minute the smallest mistake is make (the kind which most of us make dozens of times per day in our normal jobs) we expect the legal system to assist us with revenge and remuneration. This not only ads tremendous cost but drives up the quality of doctors to the point where there are barely enough people qualified to go through medical training. Top tier med schools typically over admit and have to weed out a few students each year. Still others burn out b/c they could not handle the rigor. It would make sense for us to significantly lower the bar on physician quality and for the government to stop providing reimbursement for much of the costly end of life care that is now routine... but those solutions will never fly. Most of the critiques about our system (and this one, disguised as a plea for efficiency) are complaints about what has happened prices after the market has responded to all the incentives, psychologies, laws, etc. This leads to the proposed solutions usually being variations on price controls. Americans want to be fat, we want to smoke, we want to have our "insurance" pay $200K for our last week of life hooked up to a dozen machines while our semi-estranged families arrange time off work to fly in and not feel too bad about themselves for being absent from our lives..., and we want to be able to file a lawsuit if a 1 in 100 mistake occurs. These are the privileges that we pay top dollar for.

joe_the_user 13y ago
Americans want to be fat You're making nonsense statements apparently dictated by your ideology. The average American is confronted by a variety of choices and often windups making choices which results in them being fat. Of course they are unhappy with the result and don't want to be fat in any non-cockeyed sense of 'want'. But of course such desires don't matter unless there is a concrete policy to prevent such things. With a little more sophistication, one might spin out the point that Americans democratically and collectively decided that having the option of cheap and dubious junk food is more important than remaining thin and fit. Sure but that argument hinges on American democracy not having been fully captured by various corporations which benefit from these short-sighted and unhealthy policies.
- grandalf 13y ago
  So you think there should be laws to prevent people from behaving in a shortsighted way? Some people's utility function is simply short-term oriented. I speak from experience -- I had the fried chicken (at a variety of different NYC gastro pubs) four times in the past month. Definitely short-sighted and foolish for my health and BMI. Similarly, doing a startup is not rational. Most fail and the expected returns are worse than if the money were invested in an index fund. Unless you advocate some kind of police state that enforces constraints on aspects of peoples' utility function that most of us happily enjoy choosing, I don't think you'll be able to achieve the kind of world you envision (corporations or not). Even if we try to "nudge" behavior using subtle approaches, as Thaler and Sunstein advocate, there are practical limits, and a system of laws to enforce "good nudges" gets absurd pretty quickly. I think my argument is supported by Michael Moore's conclusion in Bowling for Columbine. America is a unique and odd place. There is something about America that gives those who are down on their luck the hope to put that last quarter into a slot machine. It's the same thing that leads people to drop out of Harvard or Stanford to do a startup. America's healthcare debacle is just as much a function of our unique psyche, and it's inseparably linked to some of the greatest aspects of our culture... for example our faith in medical breakthroughs and the optimism that fosters, our desire to fight mortality and disease through science, and our odd secular crutch of granting doctors too much authority.

joe_the_user 13y ago

Americans want to be fat You're making nonsense statements apparently dictated by your ideology. The average American is confronted by a variety of choices and often windups making choices which results in them being fat. Of course they are unhappy with the result and don't want to be fat in any non-cockeyed sense of 'want'. But of course such desires don't matter unless there is a concrete policy to prevent such things. With a little more sophistication, one might spin out the point that Americans democratically and collectively decided that having the option of cheap and dubious junk food is more important than remaining thin and fit. Sure but that argument hinges on American democracy not having been fully captured by various corporations which benefit from these short-sighted and unhealthy policies.

grandalf 13y ago
So you think there should be laws to prevent people from behaving in a shortsighted way? Some people's utility function is simply short-term oriented. I speak from experience -- I had the fried chicken (at a variety of different NYC gastro pubs) four times in the past month. Definitely short-sighted and foolish for my health and BMI. Similarly, doing a startup is not rational. Most fail and the expected returns are worse than if the money were invested in an index fund. Unless you advocate some kind of police state that enforces constraints on aspects of peoples' utility function that most of us happily enjoy choosing, I don't think you'll be able to achieve the kind of world you envision (corporations or not). Even if we try to "nudge" behavior using subtle approaches, as Thaler and Sunstein advocate, there are practical limits, and a system of laws to enforce "good nudges" gets absurd pretty quickly. I think my argument is supported by Michael Moore's conclusion in Bowling for Columbine. America is a unique and odd place. There is something about America that gives those who are down on their luck the hope to put that last quarter into a slot machine. It's the same thing that leads people to drop out of Harvard or Stanford to do a startup. America's healthcare debacle is just as much a function of our unique psyche, and it's inseparably linked to some of the greatest aspects of our culture... for example our faith in medical breakthroughs and the optimism that fosters, our desire to fight mortality and disease through science, and our odd secular crutch of granting doctors too much authority.