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Comment by yardie | Hacker News Reader

In all my travels no one is more deluded about the middle class than in the US. Healthcare is cheaper in Europe therefore it must be worse, somehow. The government is completely dysfunctional and we are worse off for it. Rather than pay slightly more to fully fund a working city/state/federal government everyone would rather pay slightly less and have a government that can't work at all. Then, complain about the fact the government doesn't work at all. Yes, the DMV sucks, but guess what, that is the level of service voters decided they wanted and that is what the DMV can deliver based on it's funding; 1-2 hour wait times with 2 or 3 agents at the counter.

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Don't even get me started. I did a year and a half of university in Tokyo and I used and paid for the health care system there a few times. Cavities filled for 20 dollars at high end central Tokyo offices. Skin doctors for zero dollars and prescribed creams for 800 yen. I knew a brain surgeon there who told me that the max price you could pay for his services was equivalent to 700 dollars. He didn't even bother going to conferences in America, and this was 10 years ago.

Oh, and people love to talk about wait and access to doctors: not only did none of my experiences have a wait they didn't even have a schedule. I simply walked in to an office and was seen immediately, and the Tokyo metro area has 35 million people living in it.

I don't have anything to prove it but I swear countries like Japan and Germany are very good at this sort of thing because the people have a culture of strict obedience to authority be it the government or whatever. They love having and following well defined rules and are nonplussed (in the original sense of the word) when people break the rules.

People in USA have the opposite attitude towards authority and rules.

Go someplace in Europe that doesn't have this culture and it breaks down. Italy's healthcare is a circus. When I was in Italy not even that long ago a doctor came in to see me with a lit cigarette in his mouth.

The USA's ethos in based in the motto of doing it their own way. Sometimes that's good: when everybody is doing the same, it breaks from the status quo and can become a leader in an industry, or just generally break ground in scientific and civil progress. That has happened many times in the past.

The flipside is that there are many things are a consensus worldwide because they _are actually better_ but that the US still refuses to adopt, generally because it would mean following others' lead, or because there are special interests in keeping the current status quo.

To me nothing is more emblematic of this problem than the country's refusal to adopt the metric system: the alternative is objectively worse, but the country is pretty much the last developed country on earth to refuse to use it.

It's more short-term pain avoidance based.

The reason we aborted the conversion to the metric system is because a generation of idiots couldn't stand the pain of switching, and the longer we delay the more painful it will be.

I don't think your analogy holds unless you cherry pick a bit - neither the French nor the British are particularly known as rule followers in the sense you are suggesting. Both have good (even great, in Frances case) health care.

The line you are drawing probably has at least as much to do with economics as culture.

Oh I bet someone in Italy got visited by a doctor with a cigarette (30 minutes late, lunch) today.

And yes, the systems work in Germany and Japan because they're culturally and racially homogeneous (Japan).

The United States was founded by people who didn't like their home country and decided to leave, rather than bend the knee.

As such, we fight about everything. It's inefficient for some stuff.

Italy's health care is pretty good actually.

Lived there for 15 years, on and off. My son was born there. My father in law survived a bad heart attack there.

Yes, there are areas in the south where it's not so good, but any reasonably large country probably has some areas where things don't work as well.

People live long, healthy, happy productive lives there.

> Yes, there are areas in the south where it's not so good

I was in Naples at the time and was a little disturbed by how lax the doctors (well, really everyone) seemed. I guess I shouldn't judge Italy's government/healthcare based on my experience in Naples, I have heard that northern Italy is on the ball for the most part.

Naples is a world unto itself. Much has been written on the subject, but yeah, it's kind of a mess. In some ways it's sort of the distilled essence of some of the worst - and best - of Italy.

> Italy's healthcare is a circus

1 - Italy was the 4th European country to introduce a smoking ban in public places.

2 - https://www.bloomberg.com/news/articles/2018-09-19/u-s-near-...

"Spain’s health system efficiency ranked third behind Hong Kong and Singapore, followed by that of Italy, which moved up two spots from a year earlier. Italy ranked as the world’s healthiest country in a separate Bloomberg gauge."

> Italy was the 4th European country to introduce a smoking ban in public places.

Is the ban enforced? If not, it's just lip service. When I went there 3 years ago (Rome, Naples), people smoked in public EVERYWHERE, even on public transportation. Sometimes I would get on a bus and there would be some guy in the back blowing smoke out of a cracked window

> people smoked in public EVERYWHERE

There are people smoking in Italy as there are everywhere. They were probably smoking down the street and that's fine. But I have never seen anyone smoking in hospitals, restaurants, cafe, buses, etc .. it is illegal and people wouldn't tolerate that.

That being said, of course, there are always people that do not respect the laws as everywhere else in the world.

> He didn't even bother going to conferences in America

Might there be content in these professional conferences that would be relevant and beneficial for patient care? Is not going to professional development conferences a badge of honor or a mark of quality that I fail to grasp?

IMO you could find the same information at European, Canadian or Australian conferences, etc. I speculate it has to do with the idea that the focus in the US isn't on patient care and outcomes but rather on profits.

The thing about American healthcare is that the solution politicians offer is to spend more money on it when the cost is vastly higher than what it should be. Spending more money on it will only increase costs, but this is what we get. Other high income countries have semi-private health care and have much much lower costs than we do. A politician who can figure out why the COSTS are so high and make concrete proposals to do something about it will have my vote. I think there was an idea around that said that the maximum you can bill for anything is 150% of the medicare reimbursement. Sounds reasonable.

You didn't have a wait because that's the ER. Scheduling a complex plan of care would probably have a different story.

The alternative view is that most Americans have only ever known one type of government: an incompetent one. We spend more per capita on Medicare than most first world countries spend on their universal health care, but we only cover 15% of the population. We build roads, railroads, pipelines, and other basic infrastructure at 4-10x markup over the costs that other first world countries are paying. We spend more on education than other countries but get worse outcomes.

If you ask any underperforming manager why they are underperforming, they'll all say the same thing: not enough resources. Give me more staff, give me more budget. But they don't get it because they squander the budget they do have.

Other countries might be getting 30% more funding than the US gives their government, but the returns on that spending are 1000% more than what the US gets from their government. Fix that problem first and I think you'll be surprised at how willing people will be to fund their government appropriately.

I mean, the old adage that it's expensive to be poor applies to government spending too. If you're missing 30% of what you need in the moment, you're probably going to end up spending way more over time.

But we aren't doing that. For example, Medicare already has the budget for universal health care, if we are going by standards for cost effectiveness that are set by other first world countries. But we don't have universal health care, do we?

Imagine having a government that through intense reform gave us top tier primary education, universal health care, and 10x more infrastructure, and they did it without raising taxes. All of that is possible today.

Now imagine that that same government proposed a new program for FTTH in all major metro areas. Passing funding for such a program would be a breeze. The government could say "this will cost you $x less than you are currently paying" and people would actually believe them!

This is pretty much how I feel. I've traveled all over the world and seen everything from good to bad. I generally opposed increased taxation in the US, not because I am opposed to the policies it would benefit, but because I do not believe I get my money's worth from our government. Given the services I receive, I pay a massively higher tax burden than I would in most of Europe comparatively.

The quality and quantity of services are so much higher in Europe that the minimal additional cost isn't burdensome, but our services are so few and so poor in the US that any additional cost I couldn't abide and I think we should be pushing hard for the government to do more with less.

In the end, this is what Eisenhower warned us about. It's a consequence largely of the military-industrial complex, and then similar complexes between government and other industries. These situations with the intentional incompetence to drive cost overruns is effectively a fraud committed against the American taxpayer, and it is absurd to expect us to want to pay one red cent more into what is effectively a scam.

Absolutely on the money. The corruption/inefficiency in US government is staggering. I am not sure how it is in other countries, but a major problem in the United States is that government employee unions are allowed to lobby the government, strike, and run political advertisements for their own agenda, which is usually not in the public at large's best interest.

There are also significant libertarian ideals at play in the US. People don't want to pay the government to control their healthcare, why shouldn't they control that themselves? To say people are just "deluded" is oversimplifying IMO.

This was once sort of the truth for the US, when everyone in the world owed America immense amounts of money after WWII and the US was paying _heavily_ into education. That's ended. The US is now becoming stupid politically and, even worse for the populace, uncompetitive - that "American Innovation" is dead and it ain't coming back for at least thirty or forty years unless education gets a serious booster shot.

This whole "But I've got mine" ideology that's circulating as "the essential America" right now is not historically accurate and is the biggest foot-gun the country has ever had.

On a per pupil basis, the US is near the top in spending. The problem is that money does not make it into teacher salaries or even into the classrooms. Like many other parts of the US government, the money gets wasted away in administration.

This also is not a new thing. When I was in high school years ago, quite a few school buildings in the county were literally falling down trailers. With that going on, the school board decided to build a huge brand new building on some of the most expensive real estate downtown. There were some protests and the news did stories about it, but in the end the building was built. And, there are still schools with buildings that are nearly falling down.

US education spending is somewhat tied to property taxes[1], Boston in particular has had historically terrible problems with inner city schools being underfunded while the suburbs throw around LCDs and laptops like they're candy - again due to a sort of terrible "the capitalist can do no wrong" ideal in the US a lot of money ends up being wasted by administrators on stupid technology that does nothing to help students learn.

[1] In most places AFAIK, and certainly in all the places I've ever lived

I see it as the schools in rich neighborhoods get more attention. If HVAC broke down the school district would hear it. Because the parents are more attentive and reactive. If the same thing happened to a school in a poorer neighborhood the parents wouldn’t react. Would t take time from work to attend those district meetings and the politicians will allocate the monies for their biggest complainers. Rinse and repeat for a decade and you end with those schools being in really bad shape due to delayed and neglected maintenance.

I live downtown and have been petitioning the school district for our own school. Downtown has grown from 10K to 80k residents in a decade. The school board has submitted and withdrawn plans for downtown. Costs are a big factor in withdrawing. But each year they delay that construction on a downtown school is only going to get more expensive.

I wasn't clear in my original comment. The building built downtown was not a school, but a building for district administrators.

Once we tried to had a conversation about gun control, health care, and social security with an American ex-colleague.

He went from being this nice composed man, to be a GunNutz-take the government out of my health care jihadist in just seconds. It was bizarre, no one really argued with him anymore since he was so visibly upset. That is some serious indoctrination that's going down there, that is for sure.

When I lived in NY I felt the same way about the DMV. Here in Canyon County Idaho there are a good 10-15 agents and I've never waited more than a few minutes. Guess we take all the savings from our poor education system and put them into the DMV!

Off topic but what kind of jobs are there in Canyon County?

ehhhh... Simplot (major potato producer/processor). Then there is the Amalgamated Sugar Factory (turns sugar beets into sugar). Outside of that, plenty of service level work. More tech in neighboring Ada county with Micron, HP and a lot of other startups etc.

> The government is completely dysfunctional and we are worse off for it. Rather than pay slightly more to fully fund a working city/state/federal government everyone would rather pay slightly less and have a government that can't work at all.

Here's the rub. Everyone agrees the government is dysfunctional, but no one agrees on the fix. Your fix appears to be to give the dysfunctional government more money to be dysfunctional with. Others would prefer to give a dysfunctional government less money to waste.

Until we get past the give more/less money argument, we will never fix what's wrong with the US government. The problem is so much deeper than pay a little more or less.

"In all my travels no one is more deluded about the middle class than in the US. Healthcare is cheaper in Europe"

Cheaper != better. Especially when it comes to something as important as healthcare. It also depends on what you are prioritizing. Universal care is good for checkups and when you are young and healthy. But it falls apart when you need major surgery due to much longer wait times and decisions made by a committee. It also makes it almost impossible to get private care, unless you are wealthy.

"Yes, the DMV sucks, but guess what, that is the level of service voters decided they wanted and that is what the DMV can deliver based on it's funding"

I'm not sure where you are going to the DMV in the US, but it hasn't been called that in about a decade where I live.

It's also very well organized. I can get in line from my state's website and get a text message to come to the office, so I no longer have to sit for 2-3 hours. But, this does depend on the State.

I would also see the actual stats on the middle class in Europe. As taxes get higher, it squeezes out the middle class and you pretty much just have two classes: the very rich and the rest. California is starting to resemble this and most of Europe has been like this for awhile.

Not sure where you are getting that information from. This is not 2012 and all your talking points have been discredited during the ACA debates. There is no queue for major surgery there is a priority. The systems I’m familiar with are French, German, Japanese and UK. Guess what, most of the providers are private. Your doctors, pharmacies, clinics and surgeons all have a private practice. You pay the government and the government pays them. When our son was sick the doctor would drive over to check on him. She also proposed some elective procedures that we could have the state pay for or elect to pay ourselves to get it done immediately.

My DMV is called FLHSMV but everyone calls it the DMV. Because that’s what they are known as nationally. They have moved some services online (renewal, address change) but most services still require an office visit, like voter registration.

Income distribution in Western Europe is quite healthy. A lot less so on the eastern and southern sectors. The US middle class is definitely shrinking even with tax cuts. So, I hypothesize taxes have nothing or little to do with it.

A larger government is the characteristic of the poorer countries in the graph

It’s generally not a good habit of mind to consider someone with a different political view deluded. The issues you raise are subjective.

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