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Comment by abvdasker | Hacker News Reader

I see astronomical figures like $2T and I wonder how anyone can seriously entertain the argument that the US cannot afford free health care for all of its citizens.

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One-off pallets of cash stories aside, most of these "re-building programs" are contracts that go out to US corporations (e.g., Bechtel, Halliburton, etc.) -- and are essentially corporate giveaways or corporate welfare.

Of course we can afford free health care for our citizens in the US -- but our leadership favors corporate welfare over citizen welfare and that is unfortunate. Corporate welfare is also welfare, it just doesnt get evenly distributed across US citizenry. You need to drive around McLean Virginia and see the houses to see the types of places where the money ends up.

On a side note -- many of the giant figures are not cash that we literally give from US coffers, but loans to these countries that come right back to companies in the US. The loans have a side "benefit" in that the loans allow us to dictate affairs overseas via loan covenants we can relax for this or that. If the loan cannot be repaid, only then it comes from US coffers (but the money never really went overseas, it just got re-distributed in the US.)

So basically, corruption. Related: Confessions of an economic hitman

> Of course we can afford free health care for our citizens in the US -- but our leadership favors corporate welfare over citizen welfare and that is unfortunate.

I think that's dramatically underselling the American voter's role in all of this. Many, many Americans balk at the prospect of raising taxes to pay for universal healthcare. But those same people shrug indifferently to the enormous costs to sustain the US military and the tremendous costs of campaigns such as Afghanistan.

So yes there is a whole segment of American politicians who are working hard to carve out tax cuts for billionaires while having not a care for the millions without healthcare. But I find that a lot of people are actively opposed to the government 'taking over healthcare' or they're scared of the price tag for universal healthcare. They're part of the reason we don't have it.

>I think that's dramatically underselling the American voter's role in all of this. Many, many Americans balk at the prospect of raising taxes to pay for universal healthcare. But those same people shrug indifferently to the enormous costs to sustain the US military and the tremendous costs of campaigns such as Afghanistan.

I think that's dramatically understating these American voters' role in this and their reaction to anything that can be dubbed "socialism". They happily vote for candidates who push for enormous "corporate welfare" to defense contractors, and scream bloody murder if anyone suggests using any public money at all to pay for someone else's healthcare.

American voters are getting exactly what they're voting for.

>They're part of the reason we don't have it.

They are the reason we don't have it.

As I frequently like to remind people, every nation gets the government it deserves.

You and the GP can both be right because, arguably, the voters have been given the "choice" of 2 platforms from the 2 dominant parties that share a common pro war-industrial-complex agenda.

I'm not sure that's really case. I find that few people think much more deeply about policy issues than the headlines and zingers from pundits like Shawn Hannity or Rachel Maddow.

We have a serious information problem, or lack thereof.

If people were truly informed on some of the issues, I can't imagine soany issues would be so divisive.

I think setting up some kind of reporting requirents to divorce opinion and pundits from actual journalistic news would be a start.

A perfect example is the turmoil inside the fox news network right now. If you watch the actual newscasters/journalists you will believe the obvious truth that Trump was ordering funds withheld to get negative press for the Democrats and Bidens from Ukraine. (Whether that rises to impeachment level is up for debate and tangential to my point).

If you watch only the fox news pundits (which are most of the primetime lineup) you will believe that it's all totally made up and even that the impeachment process itself is somehow unconstitutional and some sort of coop. Which is just completely divorced from reality.

This same thing plays out everyday on countless issues on both sides and is being controlled by a small handful of powerful people that are manipulating viewers for their own gain.

How often do voters get a real choice rather than two slightly different sides of the same coin?

I seem to remember multiple presidential primaries in the US where progressive candidates get side-lined within the party as either un-electable (long before actually competing at polling stations) or get kicked out due to technicalities meant to steer watered-down right-centrists into the general election.

I'm not talking about some right-wing conspiracy, I'm talking about basic mechanics of the electoral process that are unfair at the party level, in media, etc.

As one example, I might cite how current candidate Andrew Yang barely gets time to speak at debates while others polling at the same level get 2x or 3x as many minutes to speak.

Another example might be the way Bernie Sanders was all but eliminated by backstage machinations in the Democratic party in 2015/2016. How are voters supposed to vote for true progressive candidates who want to change the system in a major way if they cant even compete on an even playing field

>How often do voters get a real choice rather than two slightly different sides of the same coin?

The fact that voters don't have much choice is their own fault. It's their job to reform the system if they don't like it.

>I seem to remember multiple presidential primaries in the US where progressive candidates get side-lined within the party as either un-electable

Again, this is the voters' fault. If they don't like it, they should do more to change it.

>How are voters supposed to vote for true progressive candidates who want to change the system in a major way if they cant even compete on an even playing field

If the citizens of a country don't like the way the elections are run, it's their job to change it, by whatever means are necessary. That is what it means when I say that every nation has the government it deserves. This applies to every nation (except maybe occupied ones), no matter what kind of government it has. The citizens are the ones who ultimately have the power, so if their government sucks, it's their own fault.

I think for a lot of conservatives, more than the cost, is the philosophical question of whether the Fed Govt should be involved in social welfare programs like healthcare. The original role of the Fed Govt was foreign policy and the economy in a republic of strong states. The country is pretty well split between conservatives and progressives and a one size solution for all 50 states is always going to piss off 50% of the country. Why not look to your state for Healthcare? When a Democrat was in the Whitehouse, Texas talked about secession and now that a Republican is in the whitehouse California was talking the same thing. The thing is why does CA evern care about the whitehouse. It's the 5th largest economy in the world. If it wants healthcare for it's people then go right ahead and leave the rest of us out of it. Massachusetts offered healthcare to it's citizens under Romney before Obamacare and people who were opposed to that in MA were free to cross the border into NH, a libertarian state.

I think for some conservatives it's about the philosophical question of the Fed Gov't should actually be doing. But IIRC most are supportive of Medicare/Medicaid so they're not totally against government run healthcare.

I find that Libertarian leaning people definitely look at the universal healthcare as something that shouldn't be a public good.

Each state could make its own laws and to that point I think some will make some movement on that front if universal healthcare efforts falter.

Ha! States have been eroding local ability to make local efforts (our state minimum wage forbids counties/municipalities from choosing any other); feds have been eroding States rights to choose. All this under a party that pretends to support local small government. Of course they panic when that local small government tries something that they don't like, so they squash it.

Except for in Afghanistan, then social welfare is great.

Trump is the second US president in a roll that won promissing he would reduce the military actions, with an opposition saying they would do the opposite.

I don't know much important it was, I also don't don't if he or Obama fulfiled the promise to any degree. But it was there.

> One-off pallets of cash stories aside, most of these "re-building programs" are contracts that go out to US corporations (e.g., Bechtel, Halliburton, etc.) -- and are essentially corporate giveaways or corporate welfare.

Not just McLean. Google "wealthiest counties in the US". It's no surprise they're in VA and MD, all suburbs of Washington DC.

As a point of reference 2T over 18 years is ~111B/year.

The plan Warren is suggesting which I think would closest fit the definition of "free health care for all" - though not perfectly [1] would be 59T over 10 years or 5.9T/year.

Note also that the way these programs are funded is very different [2]. Things in the "Mandatory" funding category like Social Security and Medicare aren't funded year to year, but are ongoing expenses that you have to change entitlement laws to make changes to, so they are incredibly hard to change.

The Department of Defense is funded out of the "Discretionary" category which can change from year to year and is based on a different process which is not subject to the same laws.

[1] https://www.vox.com/2019/11/1/20942587/elizabeth-warren-medi...

[2] https://www.newamerica.org/education-policy/topics/federal-e...

Wow, US gdp is “only” 20T, so at 6T almost a third of the economy would be healthcare. Checking your link it seems the warren campaign is aiming for 5T, which is still a quarter. Already a fifth of the US economy is healthcare and that is absurdly higher than every other country, which typically don’t go over 10% of gdp.

In the UK, the NHS — which some people admittedly consider to be chronically underfunded — was about 7% of GDP [1] in 2018. Norway's is about 10.5% [2] (2016), and increasing by about 2% a year.

[1] https://www.ifs.org.uk/uploads/R143.pdf#page=20

[2] https://www.ssb.no/nasjonalregnskap-og-konjunkturer/statisti...

That’s over twenty years. So $100B/year. There are 0.3B of us. So that’s $3000 per person per year. That’s about what my employer pays for a BCBS elite HD-HSA PPO for my group of relatively young, affluent, healthy tech workers in Boston.

It doesn’t come close to covering all of it.

There are 3M nurses and 1M doctors in the US. That $100B/yr could pay each $25k in salary, and cover no equipment.

Let’s say we want to pay nurses $150k and doctors $250k, good middle class salaries comparable to tech incomes. You need $700B per year.

That’s not impossible to find at https://www.usgovernmentspending.com/US_fed_spending_pie_cha..., and I think we should—but it’s not obvious how to do so or what to sacrifice.

You have to think beyond the accounting. Think of the opportunity cost.

Many people stay at their jobs because of healthcare. Period. Either they don't want to lose it, or don't want to lose some aspect of it. How many startups aren't started? How many dreams aren't filled? How much value isn't created?

$100B/year divided by 0.3B equals $333 per year.

That’s not enough for one full monthly premium payment on the ACA exchanges.

However, the average ACA subsidy per person on the marketplace varies tremendously by State, but is typically well above $333 per month.

https://www.kff.org/health-reform/state-indicator/average-mo...

I don't think nurses are going to be earning an average of $150k/yr under any system.

The 100B/year would be as well as current health spending, not instead of it.

What would the additional costs of universal health care be, and would 100B/year cover it? Currently about 27m Americans do not have health insurance. 100B would yield about $3,700 per person which is probably about enough to do it.

> Let’s say we want to pay nurses $150k and doctors $250k, good middle class salaries comparable to tech incomes.

Regardless of the rest of the logic, those are not middle class salaries. They aren't even middle class household (i.e. 2x earners) incomes in almost all of the country.

Tech salaries are a terrible benchmark for a lot or reasons, but those are well above average tech salaries also.

The US pays more per citizen for healthcare than any civilized country in the world, and gets poorer outcomes.

There is a LOT of room for lowering your costs and improving your outcomes when you’re ready to redesign it. But yeah, if you just try to duct tape over a crack here, and bolt a new feature on there, nothing seems to work.

I'll take the extra $3k over spending it on achieving nothing in the middle east.

We have a tremendous appetite for risk when it comes to intervention. And we're extremely caution and austere when it comes to "investing" in our own citizenry.

It's also amusing how we become extremely obsessed with who "deserves" government money, establishing kafkaesque means-testing protocols, but have little issue handing out billions of taxpayer money to non-citizens in foreign countries.

Like the sudden urgency to throw 700,000 off food stamps with work requirements.

You can literally only make additive changes to social programs if you don't want to make people mad. Any change perceived as subtraction will make people scream and you will be made out as a tyrant grinding the faces of the poor even if you are trying to simplify, consolidate, make more efficient, close loopholes, etc.; it doesn't matter. Just look at France.

We've successfully made numerous cuts to social programs with no negative consequence. Like, what was the political cost of 1990s welfare reform? Well, President Clinton was re-elected by a landslide and the Republicans who helped champion the bill won control of the House.

Military spending is less than a quarter of the budget. Medicare/caid is 55% more than the defense budget, to say nothing of social security or other domestic spending. These may not be the right allocations, but domestic spending is hardly "austere".

Not quite. The military budget itself is really just a base operating budget. Developments towards research, weapon systems, and even wars themselves can and are funded separately.

To be fair, the Republicans elected the one candidate that seemed the most opposed to handouts to foreign governments. There are a lot of Rs that don't like those either.

I think the serious argument is whether US can afford not to do something.

US didn't have to invade Afghanistan, but it did.

US doesn't have to provide free health care, and it probably won't.

$2T over 18 years is $111B/year or about 3% of US yearly healthcare budget. If the US could somehow magically switch to a Swiss style healthcare system, that amount would pay for about 4% of the US yearly healthcare budget.

2T is indeed a big number but its dwarfed by the cost of healthcare. Keep in mind that's over 18 years. We spend more than that every year in the US. Apparently Warren's plan calls for 20.5 trillion in spending over the next decade and that's with some optimistic assumptions on cost reduction.

None of this necessarily means we shouldn't do it. Healthcare is expensive, but certainly many countries do have more of the cost covered by the government, but you can't see a big number and assume that was paid and assume it would pay for healthcare

A quick Google search seems to indicate it would cost over $3.2T a _year_ to give free medical to everyone. This is from someone (Sanders) that wants to make this happen.

https://www.bloomberg.com/news/articles/2018-07-30/study-med...

https://www.factcheck.org/2018/08/the-cost-of-medicare-for-a...

at least i would assume that would stay in the country and circle around our economy. its kinda like we took this 2T and lit it on fire. doesn't seem to have helped anyone

That is a valid point one way, huge multinational corps got paid.. but so did all the soldiers and employees of those corps (that are American). And the medicare budget would also give a huge slice of cash to different massive corps...

So, the difference may not be much... But consider it's the cost of the entire war every single year, that's just insane at any level.

I think the only solution is to lower the actual costs. No where else in the world does it cost so much. Something is fishy...

The US already spends more than most countries with free healthcare systems. The healthcare problem in the US has little to do with money...

The US gov certainly can afford it but they'll pass the bill on to taxpayers all the same.

There is literally no other way to do it. The government gets its money through taxes.

Or we could spend less on the military. If they need to raise taxes to pay for it they can't afford it.

I think you're missing my point. The money still comes from taxes, which come from taxpayers, no matter what. Saying that the government can afford it is saying that we can afford it. The government doesn't have any money except ours.

I'm not saying it doesn't. The grandparent's point was that the gov could spend the some of the $T it spends on the military on healthcare. My point is the gov is much more likely to fund healthcare through new taxes than to spend less on the military.

Make universal health care profitable for Halliburton and then it will happen.

You don't support the troops

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