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Comment by himeexcelanta | Hacker News Reader

I’ll probably get downvoted for this, but a strong argument can be made that the European welfare state has only been made possible due to massive US defense subsidies and economic stimulus during the post WWII/Cold War. This doesn’t mean that the US has a good excuse for relatively poor domestic social services vis a vi many European states, but let’s also be real about what allows Germany, France, etc to provide “free” healthcare and other social subsidies.

In the particular case of Germany, defense spending is only 1.2% (this stat is easily found via google). I’d rather have Pax Americana (which arguably is in decline) over the past 70 years providing stability in Europe, helping to lift hundreds of millions of East Asians out of agrarian subsistence, etc than slightly cheaper healthcare. Although, tell that fact to someone who receives huge, opaque medical bills for simple procedures in the US and they probably wouldn’t take too kindly to that line of reasoning...

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What's the strong argument?

Germany spends 11.14% of GDP on healthcare or 442B. The US by contrast spends 17.07% of GDP on healthcare or 3498B. Therefore the US spends more and still lacks a comparable system.

Additionally the amount Germany saves by under-spending on defensive wouldn't offset the cost of the wealthfare state for example if Germany spent 3% (the US spends 3.5% on defense) of its GDP on defense instead of the current 1.2% they go from spending 47B to 119B. That extra 72B is less than 17% of their total healthcare costs, which again, are much lower than the US'.

This whole argument is a US Conservative talking point that has little to no basis in fact. When you look at the underlying data, it simply doesn't hold up, the cost of medical care and defense are orders of magnitude different and the US's system is so inefficient, even with the savings after decreasing defense spending from 3.5% of GDP to 1.2% (extra 472B/year) it wouldn't function well.

Just that. And at least in Germany health care isn't even paid for by the government. Rather the government defines minimum things to be covered and sets limits for non-private health insurance premiums in % of gross salary.

You say 17% like that is a small amount. That could easily break their welfare system if they had to extract that shortfall via more taxes or contract their healthcare system.

Also the military is not the only way the European healthcare system is subsidized by the US. Americans finance the drug research that pushes the world forward. If the US adopted European healthcare regulations the incentives for drug research would plummet, and healthcare innovation would slow to a crawl

They spend 11 and the us spends 17%. Do you think German health care somehow gets more expensive if they spend more on their military?

By the way, compare EU military spending to the US, not that of one country.

> The combined military expenditure of the member states amounts to just over is €192.5 billion. This represents 1.55% of European Union GDP and is second only to the €503 billion military expenditure of the United States. The US figure represents 4.66% of United States GDP.

https://en.wikipedia.org/wiki/Common_Security_and_Defence_Po...

Unless the EU wants to have military places all over the world like the US and equally extraordinary military expenses, for whatever strange reason, far outspending anyone located near Europe, that sounds like plenty enough money for the military. Of course, it seems to me the US uses much of that money for what elsewhere might be called "socialism" and "central economic planning" because doing so directly would never fly with the American public. So it's labeled "defense" and then it's fine.

> Americans finance the drug research that pushes the world forward.

I see claims like that a lot because for some reason some (few but vocal) Americans seem to take personal offense at any suggestion something might not be "the best", I have yet to see even a bad source for it, never mind a good one.

I can tell you German health care is shit too in so many ways that I'd be hard pressed to recommend it as a model to any nation, but according to the actual data it seems it's still better than the US system. Disclosure: I'm German but lived and worked in the US for a decade.

I also think cost alone is not a good path of argument. Costs on an economy level are circular - they are somebody else's income. Also, much of health care is "optional", whatever level people want. The more important point is what does that money flow achieve. According to the analysis I am aware of it achieves less, in the US, on average.

And US military spending since WWII wasn't and isn't high out of the goodness of American's hearts either. The US spend that much because it was beneficial at least from the point of view of those who got to make those spending decisions, and I'm sure they didn't have "foreigners" interests in mind but their own.

Drug companies also spend more on marketing than R&D, and given that marketing drugs is largely banned in other nations, the bulk of it is also spent in the US.

Further, that R&D is often more production development of drugs or drug families first identified in public research efforts. The pipeline for which has been drying up in recent years because of gov't austerity - and in response the billions per drug brought to market number has been going up for the commercial drug company efforts.

Last time I checked the Swizz, Germans and Brits were major players in drug and medical R and D.

Most of the important deep tech happens in university done by post grads, not by for-profit companies.

Drug development in the US is expensive due to the dysfunctionality that exists within the FDA.

> Last time I checked the Swizz, Germans and Brits were major players in drug and medical R and D.

Where do you think those European drug companies get the bulk of their revenues from to do that R&D in the first place?

They make their money off the U.S market!

> Drug development in the US is expensive due to the dysfunctionality that exists within the FDA.

No, drug development is expensive because it's expensive. The EMA & co. are not substantially different in their requirements and expense than the FDA is. Regardless, even still, half of the R&D conducted in the entire world is funded directly by the US.

Yes and those Swizz Germans and Brits are making the majority of their money from the US

I’m not arguing that the US healthcare system is more efficient (it definitely isn’t). I’m arguing the political and economic conditions present in post-91, EU-integrated, unified Germany were only made possible in part by constant military and political deterrence provided in part by US defense spending. US military power also increased the politician and diplomatic leverage of the West during the Cold War (the most obvious example being NATO).

Sure, but the "if it wasn't for our military you'd all be speaking Russian/German" angle is about as relevant to arguments that European countries are better than the US at promoting public health as "if it wasn't for our colonialism you'd all be speaking Native American" is to arguments that Silicon Valley is better than Europe at promoting VC-led innovation and growth. US military spending is not the reason the US politicians and political culture has chosen to prioritise tax cuts and healthcare middleman profits over citizens dying of preventable diseases over the last half century

The US could have been a Great Power and built a better public healthcare system.

That’s quite BS knowing France has a much better healthcare system compared to the US and also can nuke any country to death. Defense spending and healthcare are clearly unrelated.

I read somewhere France still has colonies somewhere in Africa.

Might want to factor in what the US defense gets out of that continued military presence, especially as a relay for operations in the Middle East.

US military spending makes us considerably less safe.

> US military spending makes us considerably less safe.

I see you're based in the UK. In that case, you might want to contact Parliament and let them know, because the UK is currently engaged in most of the same war efforts in the middle east that the US is.

Per capita amounts are more relevant here:

442B in Germany is 5K per capita. 3498B in the US is 11K per capita.

So the spending difference is even more in US's favour.

I somewhat agree with your point, but defense spending in the U.S. is only 3.1% of GDP. It's likely that we could have both Pax Americana and universal health care if the public/private divide were allocated differently. Medicare spending is roughly on par with defense and covers the most expensive patients; the government already pays for 64% of healthcare spending. Bump spending up to about $1T (5% of GDP) and you've got universal health care.

If you look at what Germans actually give up in exchange for the social safety net, it's the ability to get fabulously wealthy. If you're say a high-achieving software engineer or surgeon, it's possible to make roughly 10x more in the U.S. than in Germany - and that's saying nothing about startup founders or CEOs. Hence, people who fit into those categories tend to emigrate.

Your personal value system will determine whether you value the ability to get fabulously wealthy over the ability to know that you'll always have health care and education for your kids. There's a pretty strong selection bias within countries though: many people in America moved there (or their ancestors did) because of the ability to get fabulously wealthy, while the people left behind in the Old World tended to stay because they valued stability. That's perhaps why proposals for a strong social safety net haven't gotten much traction, particularly in the post-80s boom.

> let’s also be real about what allows Germany, France, etc to provide “free” healthcare

Germany doesn't provide free healthcare, it has a compulsory insurance purchase system. Both Germany and France spend less on both a per capita and per GDP basis on health than the US does, so they need no subsidy; in fact, their more efficient healthcare systems are a vastly larger subsidy to the rest of their welfare system than US’s defense spending is. (Moving defense spending from their current levels up to US levels would cost them 1-2% of GDP, moving healthcare spending from current levels up to US levels would cost 8-9% of GDP.)

The reason the US can't afford the rest of a European-style welfare system isn't the (huge, but still not a big deal in this instance) amount the US spends on defense, but the mind-bogglingly enormous amount the US wastes on the most wasteful and inefficient healthcare system in the world, which would be fairly in line, in per GDP costs, with many universal healthcare systems if you considered only the public expenditures, and not the (slightly larger) private share of health spending.

There's also the issue that there is not a "US health system". There are 50 slightly different health systems. Health insurance is still a state-level thing with different state-level requirements. We can't create a German-style compulsory insurance system until something is done about that.

Of course, nothing except political will is stopping individual states from doing so.

> We can't create a German-style compulsory insurance system until something is done about that.

Germany also has, IIRC, a mix of federal (including the basic mandate and baseline standards) and state-level rules for health insurance.

Oh, maybe there is something of a model in Germany then.

I think the US defense subsidy is underrated, as is generational wealth in Europe accumulated over hundreds of years by plundering, enslaving, and colonizing the rest of the world.

Europeans don't want to hear that though, they like to imagine they're just simply more civilized than barbaric Americans.

The US defense budget is more than that of the rest of the top 10 combined. There are many things that could be said about it, but underrated is a bit of a stretch, to say the least. You could cut it by two thirds and the so-called pax americana people like to mention wouldn't be threatened in the least.

>hundreds of years by plundering, enslaving, and colonizing the rest of the world.

This has got to be the most egregous case of pot calling the kettle black I've read in a while.

> The US defense budget is more than that of the rest of the top 10 combined.

Not quite. It's slightly less than the next 8.[1] Also, that number appears to include the $79B spent by the Department of Veterans Affairs[2], which is exclusively used to support post-service personnel.

There's a lot of shit we can and should cut, but let's not distort the facts.

[1] https://sipri.org/sites/default/files/2019-04/fs_1904_milex_...

[2] https://en.wikipedia.org/wiki/2018_United_States_federal_bud...

>This has got to be the most egregous case of pot calling the kettle black I've read in a while.

I know Britain extracted lots of wealth from India tho, the European continent became quite rich through colonisation efforts and once they had enough stimulus to fuel their economies, they became industrial powerhouses.

Not all country have such dynamics, Europeans really need think it through. Why Europe is rich and India is not? Why US can't offer free healthcare when Europe can.

India is rich though? There are also plenty of non-European countries offering free healthcare?

>This has got to be the most egregous case of pot calling the kettle black I've read in a while.

Both countries have terrible histories in these respects, but I think a fair case can be made for Europe having a longer period of this sort of method of wealth accumulation(/theft?) opposed to the US. The US shouldn't be cast as some sort of bystander in that same context--just a younger protege.

> but I think a fair case can be made for Europe having a longer period of this sort of method of wealth accumulation

The US territory itself was conquered using exactly those European advantages you speak of. US history is not separate, it's a spin-off from the European one. The US history without Europe ended with the settlers and their expansion, and they brought "Europe" with them. You can't claim a US history that is separate and didn't benefit from European history, given what actually happened there and by whom it was done.

>You can't claim a US history that is separate and didn't benefit from European history, given what actually happened there and by whom it was done.

I agree and wouldn't claim such, but you also cannot claim all the wealth was inherited through past practices from European colonialism. Much wealth was obtained under policy and practice by a sovereign US government and population. Once the US declared independence and became an independent nation, anything thereafter was conducted on its own accord under its own independent governmental system, free of the history of Europe with respect to responsibilities of practices. I wouldn't claim people instantaneously dropped their past inherited cultural beliefs or acquired wealth that kickstarted the process, but from them on, responsibility falls on the US.

Several wars, atrocities and theft of land from native Americans during continued expansion (trail of tears comes to mind), african american slavery used for production, exploitation of various other immigrant populations for wealth production--those practices fall squarely on the shoulders of the US and, in many cases, led to increased wealth and land in US. It is an offshoot of European history but when it comes to pointing fingers, the separation can certainly be made.

Such practices could have been abandoned by the US but continued onward, largely due to the tightly interwoven history you mentioned. Again, neither group can claim a rosey history but I would argue Europe had a headstart (if nothing else, just due to the arrow of time...).

European countries wouldn't be as wealthy in a world which hadn't seen colonialism, but they would exist...

The word underrated in the context means that it is not given sufficient credit for enabling European countries to spend more of their wealth on social services, not that it is less large than in it is.

> This has got to be the most egregous case of pot calling the kettle black I've read in a while.

The point remains that the kettle is black, regardless of who calls it so.

The apple doesn't fall far from the tree.

It is exactly those plunderers, enslavers, and colonizers that, well, colonized the new world and built their economies on top of slavery which eventually became independent countries.

Let’s try to consider the arguments in isolation without resorting to ad hominem.

Germany spends a bit over 10% of its GDP on healthcare. Even the US are only spending 3.2% of their GDP on defense. So even if Germany or some other European country did decide to raise their military spending and (for some reason) decided to pull the money for that out of their healthcare budget, it'd only make a relatively minor dent. It'd be painful, but it's certainly no either-or thing.

30%+ of all medical spending in the U.S. is wasted, so one doesn't really have anything to do with the other.

And then on top of that doctors in America kill somewhere between a quarter and a half million people per year[1].

[1] https://www.cnbc.com/2018/02/22/medical-errors-third-leading...

Do you have a source for that?

http://www.nationalacademies.org/hmd/Reports/2012/Best-Care-...

The US government spends more than many other OECD governments on health care. Not enough Americans know this basic fact.

Your argument is based on a faulty premise: Germany actually spends just a small bit more on government health care. Meanwhile the US spends vastly more on health in total when you add private spending.

https://www.healthsystemtracker.org/chart-collection/health-...

Some of the reasons for exorbitant health costs are not due to budget. The legislature actively attempts to obscure market conditions by allowing insurance companies to not publish prices. Remember that the US spends more as a percentage of GDP on health care than any other country.

Totally agreed + upvoted.

Having military bases in Europe (if that's what you're referring to) is mutually beneficial to the the U.S and Europe but I wouldn't call it a subsidy. It's done primarily to preserve America's global sphere of influence.

The economic stimulus ended in the 50's, the cold war 30yrs ago.

You can have free healthcare as well as Pax Americana. If anything I believe that free healthcare (and a better education system) would keep Pax Americana around a lot longer.

Agreed with your last point.

The US didn’t fund European security due to its kind nature. Rather, it was due to realpolitik concerns that there would rise another violent, genocidal European hegemon bent on world domination which would invariably threaten US security.

> I’ll probably get downvoted for this, but a strong argument can be made that the European welfare state has only been made possible due to massive US defense subsidies and economic stimulus during the post WWII/Cold War. This doesn’t mean that the US has a good excuse for relatively poor domestic social services vis a vi many European states, but let’s also be real about what allows Germany, France, etc to provide “free” healthcare and other social subsidies.

> In the particular case of Germany, defense spending is only 1.2% (this stat is easily found via google). I’d rather have Pax Americana (which arguably is in decline) over the past 70 years providing stability in Europe, helping to lift hundreds of millions of East Asians out of agrarian subsistence, etc than slightly cheaper healthcare. Although, tell that fact to someone who receives huge, opaque medical bills for simple procedures in the US and they probably wouldn’t take too kindly to that line of reasoning...

I may be misunderstanding your point, but are you attributing European stability to American military power?

I don't think you misunderstood. That commenter was definitely making that argument. Do you have thoughts on that?

I found it amusing to hear the American military occupation of Germany described as a subsidy.

It worked out better than the Russian military occupation of Germany.

I don’t think it’s much of a stretch to say that the only thing keeping Russian tanks out of Berlin is the US military/nuclear umbrella.

It is much of a stretch. Of a total lunacy variety.

I think this is a bit of a stretch now, but it was absolutely true - for West Berlin, at least - from 1945 through 1989.

This is pretty much wrong, Germany's welfare state in particular goes back to _1883_ (https://en.wikipedia.org/wiki/Healthcare_in_Germany#History).

There may be some truth to this, but I also think we choose to spend exorbitantly on military of our own accord. It is not the EU lobby that has kept us from massively reducing our military spending. Charitably, it is our own fear and uncertainty about what would happen if we massively reduced our military footprint. More cynically, the military is a big money maker for defense contractors and am entrenched jobs program. I think there is truth to both things: I certainly fear what would happen if we decided to stop investing in overwhelming force, but I'm also frustrated by the entrenched interests that seem to make it politically impossible to reconsider our posture. But I don't think it has much to do with propping up the European welfare state.

Agreed on your first point.

Although I think massive US defense spending during the Cold War was the primary factor in deterring the Soviets from tank rushing the Fulda Gap (and Soviet domination of Europe in general). I think it’s pretty clear that the Soviets were aggressively opportunistic in expanding their political and military influence (Hungary in 1956, etc)

Using military spending as a percentage of GDP is a huge oversimplification, and ignores many other huge factors.

For one thing, those countries tend to have higher taxes, especially on higher incomes.

More importantly, they spend Much less than the US per-capita on healthcare despite better overall outcomes [1], which is the real indictment of the US healthcare system, and the reason, as you point out, that the US has little excuse for it's healthcare conundrum.

1. https://www.healthsystemtracker.org/chart-collection/health-...

Interesting angle, but the US war machine has also trampled on the rights and freedoms of thousands. Look no further than Operation Menu in Cambodia, or the countless regime changes we funded in South America.

Surely we could have our cake and eat it too, in this case? Bear the brunt of defense spending but also not waste time on needless wars and coups, and put that towards a welfare state?

The thing is we don't really know what the world would look like today without post WW2 USA hegemony. Before that, the world was far more violent under what was essentially European hegemony than it is today. Instead of plundering at will, arbitrarily breaking countries up, and colonizing - the USA has taken an approach of world police. And yes, lots of mess ups and greed fueled wars. But the USA has carried the brunt of this policing and the world is safer than it has ever been in the post industrialized period. for the record, Europeans generally thought of themselves as more civilized and sophisticated than the people they were colonizing and the crude Americans. This is not a new perception Europeans have of themselves and is perhaps part of general European identity.

So, we don't know how many of these wars and coups have been "needless" to maintain the peace we have. Perhaps many of them have led to less peaceful times globally, but we can't go back and A/B test this hypothesis. But we shouldn't just assume the world would be peaceful or even more peaceful without continued USA intervention into the affairs of others. Perhaps it would, but history does not suggest so.

> But the USA has carried the brunt of this policing and the world is safer than it has ever been in the post industrialized period.

Maybe since 1989 or so. But if we're talking post-WW2, the Cuban missile crisis nearly erupted into global nuclear war. There were also a number of other near-misses up until the collapse of the USSR. That doesn't seem very safe to me.

I'm not even at odds with the idea that the US playing world police has done good for the world. I'm merely pointing out that when you allow anyone to be world police, you can't do that without some form of accountability. You simply cannot trust people to do good things and hope they won't abuse their power, because with no accountability, they will.

And that's what's happening right now. We have detention camps on the border because there's no accountability for power abuse, we have an entirely unnecessary campaign of bombing that murders children in Yemen because nobody will put their foot down and hold Saudi Arabia accountable. China has detention centers (disguised as "vocational schools") because nobody will hold them accountable. Pharmaceutical companies can jack up the price of insulin 700% over 20 years (FTR, inflation over the 1996-2016 time period was 53%) because there is no accountability.

We'll always need someone to watch the watchers, basically. Because if we don't, they'll abuse their power and trample on the rights of others. And I know the original post was about healthcare, but this still holds true. All of these things are happening at the cost of the standard of living of the average person, because those in power are not accountable to those they represent.

Well I think the exercise of power inherently will result in killing people, manipulation, lies, and general suffering inflicted on some group of unfortunate people.

Not sure it’s as easy as taking a dollar from funding Western Hemisphere coups and putting it towards health care. I think it’s also important to try to appreciate the security concerns of politicians and policy makers during the Cold War when attempting to prevent Soviet/Russian influence from creeping into the hemisphere (Monroe Doctrine).

It's hard to tell if a war is going to be "needless" until it's over.

Was Vietnam a needless war?

How about the Korean war? Was that needless too?

The Korean War is universally and intentionally ignored in such discussions, because to bring it up as an example of a needless war when eg discussing Vietnam is to proclaim the South Koreans should be living like the North Koreans right now. That is, it's to say that they should be enslaved under Communism and living at the very bottom of third-world style conditions. So nobody will dare to say that, they'll just ignore the Korea outcome and focus on Vietnam as the example instead.

The US spends an enormous amount on healthcare, we just get less for every dollar...

You could have your Pax Americana, equivalent healthcare, and more money in your pocket!

A first class surgeon earns in Spain around lets say 3000-5000 Euro/month (minus taxes).

The same first class surgeon in USA doing exactly the same job would earn... dunno, 25000 dollars? Probably more.

"I’ll probably get downvoted for this, but a strong argument can be made that the European welfare state has only been made possible due to massive US defense subsidies and economic stimulus during the post WWII/Cold War. "

As a German that's actually something I agree about with Trump. Europe lets the Americans often do the dirty work for them (an example would be Yugoslavia in the 90s where nothing happened until the Americans started doing something). Europe should be paying more for its own defense.

But that shouldn't be an excuse for a lot of dysfunctional policies in the US. The health care system is expensive and bad. Mass incarceration is very expensive and disenfranchises large population groups. A lot of low income workers are being exploited without recourse.

I also question if the US really needs to spend as much on military as it does.

I have the same sentiment but that was more or less part of the US strategy for maintaining peace in the world during the Cold War. As someone once said the purpose of NATO is to "keep in the US in, the Russians out, and the Germans down". It's a bit unfair to the Germans to blame both wars on them but the strategy of extending American protection over the Western European powers means they won't have to be too heavily armed as long as there is guarantee that the US can come rescue them in case of an invasion. I think the system stayed in place after the war and without a threat of invasion, why wouldn't the Germans and other Western allies dial down the defense budget even more?

" I think the system stayed in place after the war and without a threat of invasion, why wouldn't the Germans and other Western allies dial down the defense budget even more?"

I think it's time for Europe to grow up and stand on their own feet.

I don't necessarily disagree with this, but I can understand why Germany would be reluctant to significantly expand its military, and I can understand even better why the entire rest of Europe (especially, but not only, Russia) would prefer to have Germany protected by American nukes and not German nukes.

What about Canada? The United States has traded with us to great profit for both parties, but you could hardly call that a subsidy.

I think this is actually a great point. To expand on it a bit further, imagine that the US ceased to exist tomorrow. Europe would have to massively increase its own defense spending, or else risk that China or Russia would decide to walk right in.

That massive increase would have to come at the cost of social services, or else further increase their already considerable debt-to-gdp ratio.

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