Not commenting on the specific numbers, but maybe it shouldn’t be surprising that a year of college costs less than food, housing, healthcare, security, and programs combined?
1) that a society that mostly believes that a system of private businesses competing in a free market is the be all and end all of optimal resource allocation end up having the most expensive health care, higher education and apparently, prison system in the world; that this fact does not trigger more thought and discussion;
2) that despite incarcerating people being more expensive than sending them to Harvard, you still favor punishment over prevention and rehabilitation, having the highest incarceration ratio in the world.
You've created a compelling argument against government intervention, actually.
2. I agree with the second point. The US government officially does, too. Prison should be about rehabilitation and not retribution. It's just that the government doesn't act like it agrees.
Whenever I bring up this point I see downvotes. What I would love instead is a counter example of a country whose largest economic sectors do not capture the government and then have a huge hand in dictating policy in those sectors.
Our government intervention in the education market with student loans is just an awful system that encourages prices to continue to rise.
Uhh, Roche? (which also owns Genentech)
Novartis?
You can lead the world in pharma and have it captured by special interests. Infact I would say its almost inevitable.
Now that's not to say that your point about it being bad isn't legitimate.
Rank Company 2016 USD billions
1 Johnson & Johnson NYSE: JNJ 71.89
2 Roche SIX: ROG 50.11
3 Pfizer NYSE: PFE 52.82
4 Novartis NYSE: NVS 48.52
Number 2 and Number 4 are swiss companies.
(E.g. changing the equality laws for men and women, rapidly industrializing an agrarian Russia, leading China to top global economy from a century plus slump, letting Cuba have a top notch and cost effective hospital system, and so on)
The NHS is a good example too, but it requires one to look under the hood and see how many functions have been outsourced to private companies over the last ~20 years.
Specifically:
- Cuba's hospitals are not top notch, to say the least.
- Russia did the rapid industrializing but it already was on this way before the revolution and would be much better off should the socialist revolution never occurred.
- The equality laws for men and women are not due to socialism.
- China enjoyed the economic rise because they freed the marked not because they tied it, it's the opposite of socialism.
Cuba's doctors are excellent. And their healthcare is a marvel compared to their Latin American "free market" equivalents. And let's not even compare cost/benefit ratio to the US one (I obviously don't care if a millionaire can get better high end machines in a US hospital -- for the price of a Central Park overlooking condo or two). They key healthcare indicators are telling:
https://www.georgetownjournalofinternationalaffairs.org/onli...
>- Russia did the rapid industrializing but it already was on this way before the revolution and would be much better off should the socialist revolution never occurred.
If the "socialist revolution never occurred" the push to industrialization would be many times slower, and in all probability Russia would have been defeated and thus a German territory after WWII -- along with all of Eastern Europe if not more. So there's that.
>- The equality laws for men and women are not due to socialism.
"Beginning in October 1918, the Soviet Union liberalized divorce and abortion laws, decriminalized homosexuality, permitted cohabitation, and ushered in a host of reforms that theoretically made women more equal to men." -- Stalin took some of those back, but it took a lot of time for the US to even reach that level (assuming they even have).
>- China enjoyed the economic rise because they freed the marked not because they tied it, it's the opposite of socialism.
China remains a single-party state, with mass government intervention in the economy, and centrally planned activities. Besides, combining an open market with a socialist state is as old as Lenin's NEP.
If there is a real free market where consumers have a real choice, it can be argued that the system works, even if it's a race to the bottom. Even you indirectly admitted that most markets aren't free.
There are numerous cases where "socialism" (as laissez-faire Americans like to define it) achieves its goals better and cheaper, like healthcare and pretty much all natural monopolies such as infrastructure. Need any hard evidence with A/B tests? Look at the results of the privatization of European national railways.
I don't know enough about (Western) European railways but I have data about American and Russian railways. Russian railways are controlled by a single government entity and they are a corrupted disaster. Americans tried to nationalize their railways in 1800s and all it led to was higher costs and worse quality.
My observation is that everywhere where markets are let free people get better results. It's true that most markets aren't free but it's not because of the markets themselves but rather because of the government staying on the way.
I've also been meaning to read more on how the pharmaceutic industry works in the states, if the high prices on drugs are fair or not. Because even though prices may be high, it doesn't necessarily follow that the companies setting those prices are gouging people/being greedy, as many people claim.
The rate they pay is fixed by the state but all the assets — the insurance companies, the hospitals, the insurance policies — are in private hands.
In Germany none of that stuff is state owned, either.
This is one of the strangest things about the healthcare debate in the United States: we frequently contrast our system with “public” systems that are actually well regulated private systems.
https://de.wikipedia.org/wiki/Gesetzliche_Krankenversicherun...
and is 100% state-controlled.
That’s not the same thing as being state owned. Everyone has to be in one but there isn’t only one. Some are connected to regions and some to major industrial consortiums, like Audi.
It’s a small distinction, perhaps — but falsity proves anything. If it’s not state owned, it’s not, and we might as well not obscure debate about the US healthcare system with untruth.
Why doesn't lack of free market trigger a demand for reform of the sectors but only hand-waving excuses/acceptance?
When credit card companies in Europe started to price gouge with high fees the EU responded by putting a cap on fees. Why does the US government not respond by putting a cap on prices for hospital treatments?
In Denmark when the doctor sends you to the drug store with a prescription for e.g. pain medication, the drug store is required by law to tell you about cheaper alternatives (with the same active ingredient) even if they do not stock the cheap alternative. We simply do not accept being locked into a corner by medical companies. https://min.medicin.dk/Generelt/Nyheder/50
It's not like our prison costs more because our cultural values require us to treat the prisoners substantially better than countries Canada.
Because of lobbying
> Why does the US government not respond by putting a cap on prices for hospital treatments?
Because that's _socialism_, and it means the Communists have won
Because prices aren't arbitrary numbers slapped on to products and services that can be managed by diktat. It's like trying to control the temperature by limiting how high thermostats can go.
All 50 US states have generic substitution laws, and 89% of all prescriptions are of generics.
Definitely, the American system is a dumpster fire.
Denmark's isn't terrific, either, though. I remember having to call in a favor of my girlfriend's uncle (a doctor) to get a simple doctor appointment that wasn't 4 months out.
Certainly the government does have the people more in mind when making laws - that's not the case in the US. Our government cannot be trusted to have our interests at heart, unfortunately. Pushing for more regulation usually means helping the businesses and not the citizens.
Private health care is cheap and great throughout Europe. You can get an appointment quickly, have doctors that spend time with you, and spend a lot less than you would in the US. The private doctors here in Europe also tend to be better at their job - they've self selected.
The best medical care I've experienced, though, was in south east asia. Most of those countries have a pretty free market. You can even see ads in Bangkok for the price of a baby delivery - front and center on billboards even! Truly a capitalistic health care system.
I've described my own experience with SEA care here:
https://news.ycombinator.com/item?id=15904413
The point is that health care is broken around the world but certain places need different solutions to make it less broken.
America already spends enough public money to afford public health care for everyone but we don't end up with any quality of care for that money.
America is unable to follow Europe on this one even though most european systems would be better.
There is demand for reform but there's almost an equal demand for status quo.
Cutting financial fees is one thing. Healthcare is a capital AND labor intensive industry. Cutting fees carelessly could cause massive layoffs, disrupted services and a lot of trickle down effects. The system has evolved to this point and while it's certainly due for disruption, it's not as simple as capping prices.
big difference
I don't think anyone is really saying that except for the most extreme neoliberals.
A, the "no true Scotsman".
The main thing (except insistence on dogma) free market adherents have with leftists (and their similar: "Stalinism/Maoism/Pol-Potism/Tsaucescuism/Titoism/DDR-ism/etc wasn't real socialism" defense).
"there is no free market but they are oligopols"
There used to be 12 private prison companies in 2000 but it appears there are only 3 now.
The start of the journey was privatization of prisons. This is where that path has currently led. It is what it is, ergo free market didn't work?
But we choose a free market or whatever because we believe it will produce the best outcome. If it doesn't work as envisioned then we can either tweak it until it does work, or throw it out and start again, the worst option is to leave it alone, especially as we know it works elsewhere.
There seems to be a view that free market v socialism is a binary choice. Its a continuum, and both pure socialism and pure free market are equally bad. No country follows either path 100%.
This is also why insulin is expensive (the discoverers and patent holders made their patents freely available long ago). It's regulations which keep insulin, and other drugs, protected from competition and therefore can be expensive... Really, there are endless stories about this.
The gov vs private debate is kind of academic when the reality is a lot of the problem comes down to collusion and cheating from both of them.
Usually competition is the way to insure fair prices.
The collusion then might be to not allow competition. In the case of pharmacy, for example, I would guess there are many regulations that make it very expensive or infeasible to start a competing firm.
There are, in my opinion, certain aspects of government, which never should be outsourced for private gain. A prison company being one of the most extreme examples.
If other companies can satisfy the needs of the state, why not prisons? You wouldn't mandate that governments should build their own cars, for example?
In my opinion (and we can certainly debate this point) this should never be outsourced to third party entities. A rent-a-cop in a mall should not have the power to arrest customers (or even search their belongings) without calling the cops.
Outsourcing such functions have the inherent risk that the privat company cuts costs and corners and moreover hires unqualified and cheap staff, which makes a bad situation even worse.
Incarceration of a human being should never, ever be a license to aply additional torture in any way, shape or form. Private law enforcment with minimal oversight is a direct route to such excesses, which should not be tolerated by a civilized society.
You wouldn't mandate that governments should build their own cars, for example?
That's a rather silly analogy, don't you think? Consumer products usually don't violently intrude into the freedom and bodily integrity of other people.
[1] https://en.wikipedia.org/wiki/Monopoly_on_violence
edit : added link
This is a strange assumption. As a free market proponent and almost a libertarian, I don't base my argument on "optimal resource allocation", neither care that much for it; I assume that most economically right-wing people don't pursue this as a main goal either, and rather see it as a nice side effect.
When it comes to privatizing stuff that really should be handled by a welfare state the “optimal resource allocation” argument comes up frequently though.
And it completely misses the point of supporting a welfare state.
It’s of course not about being optimal with resources, it’s about providing the best standard of life to as many individuals as possible.
Do this and the number of incarcerated will most likely drop.
It’s all a big game of balance, the way I see things.
Which is also a nice thing to have but definitely not the main objective for people on "my" political side. Main argument for privatising stuff is not being optimal or not: it's the principle of making the government, which is the only entity with monopoly on violence, as weak and as small as possible.
Think about it as a microkernel (I must admit that I don't know enough about kernel development, so this analogy is very crude). Even if moving different services from the kernel to user-space would hurt perfomance, it's still a good security practice: this lost efficiency is worth, even if the advantages are "abstract" and not clear from the get-go.
That would seem to address small govt concerns whilst avoiding the problems of the free market.
Violence is a consequence of many factors, and in a decent democracy having it monopolized with the governement we have elected is probably a good thing.
The great thing is that we have history as a reference and I think we should use it.
I’m not aiming for the extremes here, but rather life and living standard in the world and perhaps west specifically, post WW2.
The numbers are there, we can see the trajectories.
The numbers seem to say, pretty clearly — having a great standard of life seems to gain everyone (except for perhaps the ultra wealthy).
Think about this, and give me you view:
Why is the worlds most happy nations also the ones taxed the highest, and as such have the biggest government influences?
I'll pick different entities competing with one another over a monolith.
> Violence is a consequence of many factors, and in a decent democracy having it monopolized with the governement we have elected is probably a good thing.
Never said it wasn't. But the entity that monopolizes it should be as small as possible.
> Why is the worlds most happy nations also the ones taxed the highest, and as such have the biggest government influences?
Same reason you would probably find the biggest tumors in people with the healthiest lifestyles: they would kill others at much earlier stages.
From what I have experienced so far through life it looks like this supposedly healthy competition leads to variants of VW & co behaviour down the line.
I see very few exceptions from my northern europe socialist bubble.
When it comes to:
- School - Health - Police - fire & rescue services - etc, whatever you would consider part of welfare
I want the best, not a choice.
”Sir, you’re having a heart attack. Would you like the best treatment, or can we offer you this more competetive offering at a discount?”.
It’s just, to me, a really odd way of viewing a society.
The more we’ve privatized and NPM’ed all the things, the more it costs, and quality on the whole have suffered.
It’s great for politicians that can push blame I guess...
Also, a well thought out democracy is what gives options through voting. If all options are sub-par or too expensive, what’s the point?
We should send all criminals to Harvard. We’ll save money, and they’ll become productive members of society.
After the fact, it’s a bit late.
Perhaps there are mechanics in place that goes a bit deeper?
Are humans born stictly social or anti-social, and will anything accentuate these effects in the life of an individual?
Research is quite clear on this matter I believe, but of course there will always be exceptions.
The question is which cycle to you, as a society, want to feed? That is the one that will grow. Reference to the "Nordic" experience shows what a long-term shift in focus looks like.
They don't send "criminals to Harvard", but they have prisons close (if not more) habitable as a Harvard dorm, very humane treatment of prisoners, extensive educational programs, and so on.
And they have less costs, less crime, and a healthier society doing so.
So snark from a country with the largest prison population (by percentage) in the world, huge associated costs, rampant crime rates, and is so backwards as to still have the death penalty (in the 21st century!), is unwarranted.
It’s a bit of a chicken and egg problem we’ve got. We could just not prosecute many non-violent crimes, like our District Attorney chose to do in San Francisco. But that didn’t pan out well and we now have the highest non-violent crime rate of any major US city.
Nature or nurture? If nurture, then it's at least highly plausible that their prison systems have something to do with it. Recidivism is also much lower.
(I'm sure there's a joke about Harvard educated bankers in there somewhere.)
In regards to health care, US public spending on health care is similar to that of other western countries, although it does spend more on private. Make of that what you will but saying that the US doesn't spend on public healthcare is just incorrect.
> While the U.S. has similar public spending, its private sector spending is triple that of comparable countries [0]
Same is true about public eduction
> In 2014, the United States spent $12,300 per full-time-equivalent (FTE) student on elementary and secondary education, which was 29 percent higher than the OECD average of $9,600. At the postsecondary level, the United States spent $29,700 per FTE student, which was 81 percent higher than the OECD average of $16,400. [1]
Private prisons house a small portion of California inmates:
> The California State Prison System is administered by the California Department of Corrections and Rehabilitation Division of Adult Institutions, which had 136,000 inmates as of 2014. The state of California also relies on private and leased prisons. The number of California prisoners in private out of state facilities is around 8,763 and 4,170 are housed in leased facilities within the state. [2]
[0] https://www.healthsystemtracker.org/chart/u-s-similar-public...
So you're for decreasing the amount of public spending on health care in the US?
As an example, the price of Clopidogrel (Plavix), developped in France is sold 5x more expensive in the US than in France. Do patients in the US experience better outcomes by paying more? No, it's the same drug.
"Providing more" for healthcare, means better overall health, fewer avoidable deaths and longer life expectancy.
So anything sold oversees is pure profit (minus marketing / lobbying).
It is NOT supported, at least not by the citizens of the United States.
It is supported by the corporations, lobbyists, and outright purchased politicians of the United States.
The simple answer to most of these questions about "why doesn't the United States..." is because we no longer have a functioning democracy.
See Citizens United, electoral college, gerrymandering, 2 Senators for states with populations smaller than an average city, social media engineering by foreign actors, Mitch McConnell blatantly ignoring the Constitution with no repercussions...
U.S. 655 Switzerland 81 Japan 41
I'm thinking that a defining quality of Americans is their propension to spending. Saving money is just not something they seem to think about- it's not what you save that is important, but the total amount of money circulating in the economy. There are little incentives to make things less expensive, there are more incentives to consume as much as possible, both for privates and for businesses. It's wasteful, but contributes to make the economy stronger (even if the resulting society is more unequal and harder for those who earn less).
You have to think the scale though. US is not the same as e.g Sweden and can't be the same. The amount of benefits you get in Scandi countries or Europe in general against the US are massive. At the same time you have to think that the US is a country of 330m people compared to an average EU country of 10-20m people.
In the UK whilst there is free healthcare etc and its a country of 66m, the healthcare has been getting worse and worse. The appointment queues go up to years for a simple thing in London. (I had a meniscus tear and they appointed me to see an orthopaedic in a year after I was diagnosed. Just to see him. While its understandable that emergency issues are getting bumped up the ladder, mine which was a non-emergency felt like a bummer when I heard the orthopaedic wont see me for a whole year just to see at which stage I am at. That includes doing some scans to see my stage which the GP won't know unless he is some kind of magician. Yes again he can check if the leg is hammered around the knee to bump up how of an emergency it is.)
Generally speaking I think the main issue is that the US is such a large country that can't work the same as EU countries. That goes for everything, from benefits, to working schedules to prison systems etc.
Agreed. In addition to that, private health insurance is extremely cheap in London compared to the USA, and you can see a GP or specialist the same day if you have this.
That doesn't mean it's not extremely unfair to those that can't afford private health insurance, as treatment should be needs based, not finance based, but it's also difficult to campaign against when you're a beneficiary of a broken system.
This is largely a consequence of chronic underfunding, a deliberate political choice by the Conservative party.
It's also worth noting that despite the tremendous waste, at the very high end the US has no equal in healthcare or universities. That might not matter to the average customer though.
These things are generally not considered to be operating in a free market. All are highly regulated and receive massive government funding or subsidies.
Comparing college with prison is patently ridiculeous. Why would someone expect that keeping someone incarcerated be cheap?
The point is that they are different possible futures for a given individual. The matter of which of these two possibilities comes to fruition depends on policy and on that individual's conduct. To the degree that it's determined by policy, it makes sense to restrict incarceration such that it is used at most in the limited situations in which there is societal benefit.
Drug prohibition, for example, does not achieve this, but as a policy is responsible for a huge portion of the costs of incarceration.
Universities: 18 year olds moving out of home for the first time.
Prison Population: Many from unfortunate circumstances and have been fending for themselves long before 18.
It's like saying a refrigerator is more expensive than a microwave. It doesn't mean anything because they do different things.
"food", "housing", "healthcare" and "security".