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>What services are costing more now outside of healthcare?

Infrastructure. Our (USA) costs are COMPLETETLY OUTRAGIOUS compared to the global standard. We're talking multiples.

Things like the gateway project in NJ/NYC cost 4x what they should for a crappier outcome.

This - I've looked at a number of projects. There's some kind of tipping point with public / govt infra projects at which point they just go crazy in terms of cost, it's like the make work / interia / rent extractors just tip out the get things done folks at some point.

NY / SF, even germany for a bit with Berlin's airport. I look at what they did in the past (huge railroad bridges in 100 days) and even now with private money (Tesla in germany is going up fast and sports stadiums go up like weeds despite their scale) the contrasts are remarkable.

Space Launch System is $20B with not a single flight. SpaceX comes along, get's no $1B/year base, get's paid a fraction of the "big players" - and has done 80+ F9 launches.

Also - success academies in NY seems to have some pretty amazing results relative to local schools. I realize some confounding factors, but if I was a parent in NY - that would be the choice if I lived in an area they served.

>Space Launch System is $20B with not a single flight. SpaceX comes along, get's no $1B/year base, get's paid a fraction of the "big players" - and has done 80+ F9 launches.

You might be conflating Falcon 9 and Falcon Heavy. Falcon Heavy is a more applicable comparison to SLS. Falcon Heavy had one launch in '19 and two in '20.

When it comes to infrastructure, I think there are a few confounding factors. 1) Our level of risk is lower. We no longer find it an acceptable risk to lose workers at the rates that were acceptable 100 years ago and 2) the systems are inherently more complex. Even so, we tend to oversimplify them when planning [1]

[1] https://freakonomics.com/podcast/project-management/

Higher education also.

Indeed. Someone recently linked to an article that does a pretty good job of going over the massive infrastructure costs[1]. The U.S. also has relatively well funded education[2]. I think many of the comments here reflect one of the reasons we're in the situation we are in - the inability to consider that we might be able to do things better, even when there are plenty of examples from other countries to look at. To quote from the first article:

> The answer, I believe, has to do with American incuriosity. Incuriosity is not merely ignorance. Ignorance is a universal trait, people just differ in what they are ignorant about. But Americans are unique in not caring to learn from other countries even when those countries do things better.

I think there's a lot of truth in that; look at how almost all the discussions about healthcare ignore the successful systems in other countries. It goes beyond that, though. We shouldn't have to look at other countries to consider the possibility that we could be doing things better. But whenever it's suggested that we could make things better, there seems to be a lot of hostility to the idea and push back against it.

[1] https://pedestrianobservations.com/2019/03/03/why-american-c... [2] https://data.oecd.org/eduresource/education-spending.htm

"But the other countries are smaller, so of course they're spending less in aggregate!"

Is the one thing that seems to be enough to shut every discussion down for a certain political group.

Caring for a smaller, homogenous, less geographically distributed population is definitely different from a larger, heterogenous distributed population - and that's a valid criticism of attempting to wholesale copy other countries. I just wish that the criticism was used as a launching point for questions like "How can we overcome those challenges?" or "What parts of the system would potentially transfer well?" instead of the rhetorical blunt instrument it seems to have become.

The US does great on educating the kids it cares about. The many kids that are written off (poor and/or non-white usually) drag down the average. If we spent on family stability instead of prisons, we'd turn things around quickly, but that might benefit the "wrong" people.

> non-white usually

This just isn't correct. Many majority non-white school districts are very well funded -- cities like Chicago or Washington or LA. It's simply not an issue of lack of funds.

Correct. We fund the "wrong" things when it comes to education.

Simply pumping more money into poorly performing school districts isn't a solution, but we continue to do so. Some of that money might be better spent on social services to help ensure stable households and early education for the kids in those areas. Or higher minimum wages to help ensure the parents don't need to work 12 hours/day to make ends meet. Etc.

And neither side of the political aisle can come to a consensus on what to change, so here we are. Le Sigh.

School choice would help to solve this by putting pressure on school systems to improve or lose students (and dollars) to better schools.

Except schools largely aren’t failing because the school itself is terrible, they’re failing because the students have massive disadvantages.

Vouchers might allow a few exceptional students to leave but strands the average students. And those exceptional students still need to find transport to the school across town. It also assumes a better school actually exists.

Society would be better off ensuring equal opportunity at all ages, stable households, good healthcare (including food) instead of blowing up the system to the advantage of a small number of people.

I listened to a recent podcast that went into excruciating detail about how NY basically shunted white students into "gifted" programs and stacked black and Puerto Rican students in overcrowded schools that had to rotate classes at lunch. Kids basically got half a days education.

This is not an isolated incident, just forgotten. Well funded districts are often not spending on every child.

This is an extremely depressing statistic, but my mother has been a teacher for 10+ years.

Apparently they forecast future prison populations by...3rd grade standardized test scores :(

It isn't ignorance or lack of curiosity. It's called American Exceptionalism: in that America (the USA) is exceptional and the rules of other countries don't apply to it. This can be used for both good reasons (perseverance when others failed) and bad ones (the "that will never work here" argument).

This is just a trite excuse and no where near the truth. We can do better we can learn from others and have done it before. A lot of it has to do with generational disadvantages for poorer parts of society as well as lack of opportunity and mobility.

I don't think it's incuriosity or ignorance.

From my observations of Canada, the reason is that it "creates jobs". It it's the classic "not-invented-here" syndrome. Noone wants to borrow the solutions of another country, or even a province or city within Canada!

Always finding some rationale to do it their own way, or do more local (inferior) studies to tick a box. Then hire a bunch of inexperienced engineers to build something that they have never done, and get x10 expensive, and 10x worse results.

All under a flag that it will create local jobs.

Imagine that's how tech would work? We want to be build a complex micro-service system, that we have never built, and we are only going to hire talent from within the distance of 10 km, to "create jobs". How would that work out?

main problem: if you are planning to open up a healthcare center in the united states you must prove that you will not compete with any others. thank government regulation

I've never heard this reasoning before, are you saying the reason competitive healthcare services/pricing doesn't exist is because competing healthcare providers within a region are disallowed?

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

It has been law in many states starting in the 1960's. The original intention was to prevent too much competition which could skew incentives.

Yup. We basically built a worst-of-all-options* system in the US. It's not free market. And it's not fully socialized.

* From the perspective of an average consumer. It's a brilliant system if you're in a position to profit off it. And it has resulted in the best health care in the world (for those who can afford it).

I've heard of that requirement before (of course the artifical limiting of the numbers of doctors able to start practicing every year is somewhat a similar type of practice,) but I'd be curious to see what the original rationale for the Certificate of Need program was.

Is '[too much] competition' not supposedly the bedrock of our Wonderful System of Market Capitalism?

But that isn’t an American problem.

Infrastructure buildout in AZ is done in an incredibly efficient and cost effective manner.

Dallas is similar.

Utah’s buildout for the Winter Olympics was amazing and inexpensive.

Cali/NY/MA? Not so much.

I haven’t seen that claim before. Do you have cites?

I looked up Utah’s Olympics build. It cost $2.1 billion, and was 24% over budget. I don’t really know whether that’s efficient or not?

24% is a -low- number for overbudget. Talk to any civil engineer or look at city records, particularly in heavily regulated cities and famous NIMBY cities.

Exactly. Things that affect everyone fairly equally are now just more expensive. Healthcare. Infrastructure. Housing. Higher education.

It's great that our universities are capable of turning out transformative technologies like CRISPR, but it's arguably slowing down, and it's happening at a time when our basic assumptions about what education opportunities should be available to our children. And make no mistake, they're narrowing.

Space travel may retrospectively look in a thousand years like an absolute necessity. But that will be from a perspective of inequality here on earth having exploded. And fewer people will be involved than our collectivity would like.

Costs go up when the process gets complicated, especially when the complications are increasingly tangential to the activity. YIMBYism, environmental impact, indigenous land rights, historical considerations (preserving sites with historical value) all play a part in increasing costs in the west in building physical things.

That is not an argument AGAINST these things. It may be a valid trade-off that we all accept. Or it may be a power grab by some department or group. It is tough to know generally speaking.

That is true in all areas where costs are rising wildly - medicine, education, cost of building real estate in pre-COVID bay area, cost of infrastructure. Whether you think the trade-offs are justified will depend on your mood affiliation as much as anything else.

What services are costing more outside of healthcare.

Housing and Higher education are obvious standouts. Relative to other countries networking and cellphone service are absurdly overpriced, but so is tax prep, highway construction, and other government adjacent industries.

What is your definition of "government adjacent industries"?

Companies/industries that exist because of government outsourcing work to them. Defense contacting being the obvious example, but there are a wide range like education outsourcing text books and testing services. As a rule of thumb if the industry suffers when efficiency increases, things get worse.

> What services are costing more outside of healthcare

This is a known effect in economics: https://en.wikipedia.org/wiki/Baumol%27s_cost_disease

"... the rise of salaries in jobs that have experienced no or low increase of labor productivity, in response to rising salaries in other jobs that have experienced higher labor productivity growth"

That doesn’t explain why collage tuition increases so much faster than the cost of a classical music performance which is part of the original 1960’s study. Baumol's cost disease is in effect a labor price floor, but says nothing about a sectors overall efficiency.

Because of the 1992 Higher Education Amendments to the 1965 Higher Education Act and the 1993 Student Loan Reform Act, colleges have no incentive to compete on price: anyone who can't pay for tuition out-of-pocket can get government money to do so.

FAFSA is basically a perfect price discrimination system for colleges: why wouldn't they attempt to extract the maximum amount possible from each student?

An additional factor to consider is that higher education has increased the number of roles in their org-chart where Baumol's original proposition applies: the number of administrators in higher education just keeps rising. I'm not super familiar with the economics of orchestras, but I would be very surprised if the San Francisco Symphony is staffed with 4x the number of administrators that it was in 1978, even though the number of chairs in the orchestra remains the same.

That’s one theory, but it doesn’t explain why private high school tuition has also spiked. Vermont’s average is up at $31,532 per year. In reality there are a host of social, economic, and political forces in play.

Most private high schools are using a roll-your-own-FAFSA version of price discrimination. Additionally, private high schools have quite a different distribution of attendees (by parental income) than colleges do.

That’s definitely part of it, but Virginia averages half as much at 15,574 and that’s still high nationally. https://howmuch.net/articles/average-private-school-tuition-...

Essentially the most expensive schools are priced as feeders into the elite collages of the North East. Exclusivity is a benefit when students are competing with each other students for placement into top schools. Other parts of the country have a much stronger focus on institutions with a religious rather than purely academic focus.

Which gets back to my original point. You get inefficiency when that’s what’s rewarded. It’s not that schools can’t operate cheaply, rather people actively want a different model.

That's part of it. Two other factors I've seen are ridiculous build out per capita (student population) and also states lower % they contribute to schools more every year almost.

> ... why collage tuition increases ...

Also covered in economics! https://en.wikipedia.org/wiki/Signalling_%28economics%29

Being able to get into and complete several years of college signals to a potential employer that you are a better candidate. The more prestigious the institution, more difficult to get in etc, the better for the candidates that manage to. That increases demand, but the (roughly) fixed supply at a college results in increased prices and other things that reinforce the college (eg better sports and more successful sports teams).

To clarify some of the confusion- my point is not that the world is great. My point is that if I free myself from intellectual rigor and data/evidence based claims, and allow myself to focus on emotion, vague statements, and anecdote, I can paint whatever picture I want. lots of good examples in replies about how dome of the wishy washy statements don't really hold up - thats the point - I only mentioned spacex while leaving out the money pit that is SLS for example.

Ultimately the irony here is that the article itself is a pretty good example of self interest - its a bunch of the type of arguments they go after academics for making, and then uses it to try and sell their book.

> if I free myself from intellectual rigor and data/evidence based claims, and allow myself to focus on emotion, vague statements, and anecdote, I can paint whatever picture I want

Well said. This needs to be carved in granite somewhere

> The problem right now is a lack of investment into fixing bridges- not that the money we're pouring in is wasted.

I can't really agree with this. If you look closely, ridiculous budgets for infrastructure disappearing into black holes are rampant in the US. A great example is the southern California High Speed Rail project. As other commenters have also stated, US infrastructure development costs are out of proportion with the rest of the developing world and seem to be absurdly expensive simply because they can be [1].

[1] https://www.brookings.edu/wp-content/uploads/2019/07/2019-07...

That’s a terrible example since that’s a moonshot project. Moonshot projects are always a money pit, you’re trying to figure something out no one else is doing.

Is it really a moonshot? What's the innovation in building a high speed rail connecting two major cities ~400 miles apart? I guess no one has done this in California before.

Was it a moon shot when China or any other country with comparably sized high speed rail systems did it?

A quick google shows China's existing high speed rail system at 23,600 mi, in comparison to the total of 800 miles planned for CA.

I don't disagree that it was a moon shot, but it was not a moon shot for reasons of technical difficulty or novelty, but for the reason that it is now so systemically difficult to competently implement any large scale infrastructure in America, and California particularly. I won't comment on what the reasons for that might be.

My interpretation is that this kind of decay in capability is that the author is driving at.

China can throw an entire ethnic group in concentration camps and starve them to death on video. Their subjects and the world shrug.

Do you really want to use them as an argument for "Just make rail 4Head?"

it's only a moonshot in grifting terms.

How the hell is a high-speed rail that's not even as fast or as long as ones already in existence in many other countries around the world a moonshot?

I can't agree. Tons of other countries do it. Hire good people from there. It was a travesty how terribly run that whole ordeal was. It should be taught as an example of how -not- to do a railway.

>> Most things are getting commoditized/cheaper.

How about the price of food. Only Ramen and maybe fresh produce have stayed low. Also any kind of internet connectivity, housing.

Well things that you cared about are mostly for rich, already well off. Rich will see what they cared about.

On the other side it's worse, health care, education loan, minimum wage not a living wage, affordable housing homeless etc. Things are are important for not everyone not just a few at top.

What services are costing more now outside of healthcare?

All services when the buyer is the government.

most things are going very well. a few things that matter a lot to ordinary people are not (healthcare, education, housing in some locales).

some of the dysfunction is just baffling. the rent for the apartment I live in increases faster than my salary. this is in a city where the population has been decreasing YoY for at least a decade and in a neighborhood where I can see two large apartment complexes under construction out my window. how is this possible?

> You can cherrypick examples to fit whatever narrative you want.

So, what makes your examples better than the author's?

I think the point is that there's so much variability that drawing a conclusion based on anecdotes is bound to be ignoring a lot of reality.

They aren't- that's the point. My examples are equally bad since they're also incomplete. I'm not really arguing the opposite as much as I'm trying to illustrate why nuance and data are important. Some things are getting better, some are getting worse, but it helps the author sell their book if they can get you to ignore one aspect of it. You might even say that there's a lot of self interest in the way the argument is made

American cars is one thing, they are tons better when compared with cars from the 90s and previous. It's easy to get 200k-300k out of a car now with standard maintenance and upkeep.

> Have I noticed all these things? You can cherrypick examples to fit whatever narrative you want.

And you can also be deliberately avoidant of the things you don't want to think about. Yes, the space programs are doing okay, but the city streets are decaying and filled with crime. Yes, we know about the Higgs Boson, but we also have no savings, and an opioid epidemic.

> If every decision is made to maximize self interest - what about the near eradication of polio and Guinea worm disease by the gates and Carter foundations?

Good things can come from self-interested acts, nobody denies that, but you're thinking about this from within the paradigm of liberalism and so you're missing the critique, like someone who can't see the forest for the trees. In fact, that adage has never been more apt, because the issue with liberalism and with self-interest in general is that it boils down to a cult of the individual.

Within the decaying liberal system, the individual is above all else. Only the experiences of individuals matter. "Communities" don't exist, except as categories; and the categories themselves only exist as ways of aggregating individuals for marketing purposes. We are all atomized, all recluses even when we are being social.

> In the past few years we got CRISPR, an explosion in AI, the Higgs boson, gravitational waves, etc etc etc. All from academics.

Each of those academics is motivated by many factors, some of them selfless, some of them pure curiosity, but ultimately in the case of every successful participant there is the selfish interest in being the person to publish the paper, getting that credit, getting a bit of career advancement, maybe even a bit of fame. Individuals.

The result here is that the academics who do get some notoriety are those who are working on sexy projects, like the ones you named. CRISPR, very cool; funded with a lot of tax money; never likely to do a goddamned thing for 99.999% of the population who fronted the money for it, nor for their children, but hey, maybe 100 years from now we live in some gene-edited hellscape. Yay.

The point of my post is that I'm also cherrypicking. The point im trying to convey is that if I decide to unmoor myself from nuance and rigor in incorporating data etc, I can make the world sound as good or as bad as I want.

> but the city streets are decaying and filled with crime.

Although there's been an uptick in recent years, violent crime is way down compared to the 70's. As for nonviolent crime, I'd like to see numbers.

Pure antisocial crime is way down. Rape, murder, serious assault. Minor economic crimes less so.

When I worked south of market I'd see drunk art school students walking down seedy alleys at 2am. Past drug dealers, homeless men, and crazy people. Nothing ever happened to them. But leave a pack on the passenger seat of your car at two in the afternoon.

At least in the Bay Area I've noticed that a lot of property both private and public have been fixed up over the last 30 years. Used to drive through Oakland in the 90's and most of the houses were run down and now they aren't.

>> Have I noticed all these things? You can cherrypick examples to fit whatever narrative you want.

The problem with the position that "everything is fine" is that it doesn't resonate at all with the observable reality experienced by 99% of people (outside of HN). Maybe it's hard for you to believe but for most people, the premise of the article could not be more obvious. It's like trying to convince homeless people who are sleeping outside the gates of a mansion that they are actually wealthy because they own a sleeping bag...

My position isn't that everything is fine. My position is that everything is nuanced, and that its easy to use anecdotes and emotion to convey an unnuanced worldview to sell a book