Comment by rayiner | Hacker News Reader

Comment by rayiner | Hacker News Reader

How about we talk about the top 10% instead? These articles reduce to “look at how much money these people have!” Okay, but so what? How does that effect ordinary people?

The bigger problem to me seems like the growing income disparities between the upper middle class and everyone else. When my family in Oregon complains about housing prices shooting up, I don’t think it’s Jeff Bezos that’s to blame, except insofar as he’s paying tons of money to knowledge workers who buy up housing in places like Bend. The stuff middle class people care about—skyrocketing costs of education, housing, health care, etc., seem mostly to be supply and demand problems where the upper middle class is both helping limit supply and inflating prices through demand.

The really bizarre thing is that the top 10% doesn’t realize that it’s interests are highly aligned with the top 1% or top 0.01%. Globalism, intense focus on education, etc., make the top 0.01% richer but also accelerates the divergence between the top 10% and the bottom 90%.

You seriously think that hospitals charge $10 per aspirin because the upper middle classes are using more of it these days rather than because the upper upper classes are running a racket?

Hospital operating margins are in the single digits: https://www.healthcarefinancenews.com/news/hospital-margins-.... Almost all of that $10 aspirin goes to paying doctors, administrators, nurses, rent, etc. All of those are in short supply and demand continues to grow.

Why would you reflexively assume “the upper upper class” is involved? Billionaires tend to make things cheaper for consumers while gutting the upper class below them. Amazon wipes out owners of regional or local retail chains, but makes things cheaper for consumers. (That’s a big part of why the 0.01% is pulling away from the 1%. It’a billionaires eating the lunch of millionaires.)

Contrast areas like education, where there are no “upper upper class” making profits. Tuitions continue to skyrocket due to growing expenses—in salaries, physical plant, etc. It’s a racket, but it’s a racket run by the upper middle class.

Hospital operating margins are in the single digits, so what? That doesn't mean that less than 10% of the price of that aspirin goes to profit.

How much of that rent is profit? How much of the drugs being used goes to profit, and how much of the equipment and material of that drug goes to profit, and so on.

If you want to cite a meaningful margin number, use the entire vertical. You can't limit yourself to a single level in the value chain and say that the overall margins are low.

There are definitely upper upper classes making profits in education. "Physical plant" means money going to RE conglomerates. Beyond that the slew of education industry providers seems to make an EBITDA margin on average of more than 10% : https://csimarket.com/Industry/industry_Profitability_Ratios...

It's all one system. If you supplied aspirin at cost+10%, other prices would swing wildly to offset the change. Ultimately, the real expense in health care is health care professionals delivering health care services, and no matter what you think aspirin should cost, the hospital won't run at a deficit; some combination of line-items on your bill is going to add up to the cost of all the professionals delivering the work.

It's not good that "hospital aspirin" has a price disconnected with the economics of aspirin. But it's a sideshow issue. You can't make health care cost effective for consumers by fixing the aspirin problems.

>Hospital operating margins are in the single digits

Of course. And Star Wars made a loss: https://www.techdirt.com/articles/20110912/13500315912/holly...

>Why would you reflexively assume “the upper upper class” is involved?

Because at the same time that their wealth is climbing stratospherically, healthcare costs are also rising stratospherically and there has been significant market consolidation. Somebody's making bank.

>In crude terms, the health-care labyrinth comprises six layers, each involving the state, mutual organisations and private firms. People and employers pay insurance companies, which pay opaque aggregators known as pharmacy-benefit managers and preferred provider organisers. They in turn pay doctors, hospitals and pharmacies, which in turn pay wholesalers, who pay the manufacturers of equipment and drugs. Some conglomerates span several layers. For example on March 8th Cigna, an insurance firm, bid $67bn for Express Scripts, a benefit manager. A system of rebates means money flows in both directions so that the real price of products and services (net of rebates) is obscured.

https://archive.is/Qh8ev#selection-745.0-745.683

Did you think the hospital is the only party that could make a profit out of your suffering?

The difference between the middle class and upper middle class is infinitesimally small compared to the difference between the upper class and everyone else. Your argument is what's been commonly used lately to dupe people into thinking their doctor neighbor is the enemy rather than the guy who owns 2 islands and 4 yachts.

Want to know what affects housing prices a whole lot more than one person buying one house? An investor with dollar signs in his eyes buying up 20 of them.

An investor with dollar signs who buys 20 houses in order to rent them out doesn't affect housing costs all that much. It just shifts stock from owner occupied housing to renter occupied housing.

Agree 100%.

While the top 10% talk about the 0.001%, you’ve got 50% Americans whose ticket to a middle class lifestyle (good paying blue collar jobs) have disappeared, pulling up the ladder.

The top 10% argue about not being able to afford $1M houses or get their kids into Stanford, while the 50% worry about having a future at all.

And that’s one big reason why Trump was elected president. He at least acknowledged it.

> And that’s one big reason why Trump was elected president

He won because he's a billionaire who duped many Americans into thinking their doctor neighbor is the enemy rather than his own billionaire friends.

Sadly it seems like Biden is doing the same with his recent tax plan.

> And that’s one big reason why Trump was elected president

Its a popular explanation (because it is politically useful for bith Trump supporters and progrrssive Democrats, for different reasons) that isn’t, however, born out by the political demographic data.

Should I take your word for it?

There was a major shift in lower income support for Trump, even among non-whites. Sure, college educated males voted heavily for him, but they’ve always voted Republican.

Reply on news.ycombinator.com