Hacker News Reader

It's a confusopoly!

They're most obvious with "basic" products like energy and comms - in theory what is delivered is mostly undifferentiated kWh or GB but through the magic of "confusing plans", marketers have succeeded in making comparisons very difficult for regular people.

(You can do it, but you need OCD, a year of billing data and a spreadsheet - which greatly exceeds the cognitive effort most people will invest in choosing a mobile or energy provider).

The US healthcare sector seems to be the largest, most intricate and most successful (in terms of gdp extraction) confusopoly in history.

Huh? I look on a comparison website for price per kWh.

...because the healthcare corporations get congress to sell out citizens. $3.5 BILLION flow through lobbyists every year (all industries). Healthcare being a huge part of that. Congress sells out US citizens & corporations fuel it

That's a pretty good deal considering US federal spending alone amounts to 7.3 trillion dollars.

Lobbying American reps has the highest ROI of any investment in human history.

Ted Cruz would probably cosign a bill to 'throw all puppies off a mountain' for an all inclusive trip to Tulum

This is an underrated joke.

To be fair, energy isn't just kWh. A Joule delivered during times of peak demand costs more to produce (or has a larger opportunity cost) than a Joule during a lull.

Also a marginal Joule that you can demand at will is different from one that you committed to months in advance.

Similarly for data.

Of course, in practice most plans don't reflect this 'essential' complexity, but are full of accidental complexity to confuse people.

Off-topic but "confusopoly" maybe Scott Adams true contribution to human understanding. IIRR he wrote a comic management book and dropped in a throwaway line and invented the term.

> Healthcare is such a base layer of the economy

Academically this sounds enlightening, but it only takes one cursory walk around a supermarket in the US to see this is unequivocally false. Healthcare is an externality, not a base of anything. From the average customer to the product in the aisle to the marketing - everything is 100% not a direct cost benefit function in terms of healthcare.

And add on top the oft-repeated that “health insurance is healthcare.” That’s how you obfuscate a whole of things.

I'm not sure what that proves, given that you went to a grocery store instead of a pharmacy.

I'm guessing parent was saying that most medical spending is payback for terrible US American eating habits?

I hope his view isn’t so myopic/“boot straps” but I guess it’s possible.

Thanks for the benefit of doubt, 'hoo!

After you criticized the comment as only “sounding enlightening” I was eager to hear your thoughts.

Unfortunately I think your comment is even less enlightening.

I mean, not all healthcare problems are caused by lifestyle. So clearly healthcare is a base layer - there is no situation where it wouldn’t exist.

I'll concede that the comment was vague and relied too heavily on a shared intuition. Though I will admit, the reward became well played dry comedy throughout your sibling comments.

So I'll break down my reasoning a bit. It requires a full blog post to get out, so please forgive the abridged version.

Healthcare is a catch all for all the other problems of society. The top costly conditions in the US are (in order of this barely sourced article): Mental Disorders, Heart Conditions, Trauma-Related Injuries, Diabetes, Cancer, COPD and Asthma.

Every single one of these is plainly racking up unneeded costs by the daily actions of all of us. My quip on the supermarket was a remark on the total view of health (from mental to reproductive care to basic carcinogens to ...).

How many people are mindlessly scrolling on Instagram while performing another task, how many people smell of cigarettes, the marketing of 'sinful goods' (depending on the state), the near impossibility to avoid added sugar in every packaged foodstuff, the number of 'alcohol noses' you can see down a 50ft isle, the parenting of children, the smell of fossil fuel exhaust from the parking lot, the gait of the elderly, injured, or soon-to-be, the accommodations (or lack thereof) for those in wheelchairs and with living assistance, and still the primary food at checkout - And to include everyone in the conversation: think of the anyone working two jobs and has 0 time to prepare fresh food for themselves or anyone else, the eventual cost is in the habitual behaviors made in the constraints of under-compensated labor.... I could keep going and I've left out other observations contributing to other conditions but I think you understand.

The thing I'm trying to say is that there are interventions all over the place - however, the up-front costs (ignoring all else) of a 'double blind randomized trial' for every single one of them to earn the proper authority to define its relative utility to cost is unrealistic at the moment (also most governments do not allow for risk based price of care) - an economic externality.

Couple this externality behavior with a market of near perfect inelasticity for good health (and before someone comments, yes, suicide / assisted euthanasia may not be inelastic in price on this metric) - and you can't say "Healthcare is such a base layer of the economy" - an alternative analysis is "Healthcare is an externality that is priced in a government controlled market"

[Edit] I completely left out the externality of the high reward litigation industry on malpractice and all of the above conditions as evidence of harm - adding pressure on compensation to the highest paid professionals.

The workers who are not allowed to sit their entire shifts, a uniquely American cruelty

It is offset at all by all the workers who are forced to sit their entire shifts? It's probably better on our bodies to stand than to sit for 6 hours at a time, but it starts in schools and ends at desk work. Standing desks are nice, and can help, but not everyone has access to them.

One of the nice things about working from home is that it allows people to escape that kind of environment to a point, but it just enables other types of obsessive micromanagement like "Why hasn't your mouse moved for 15 minutes!" or keeping cameras pointed at you all day long.

What we really need is less micromanaging and an expectation that not everyone is going to be at their desk every minute of the day, but that's a very hard sell in some environments.

Why job punishes a sitting worker for standing momentarily within a shift? And what do you mean by one cruelty offsetting another?

> It's probably better on our bodies to stand than to sit for 6 hours at a time, but it starts in schools and ends at desk work.

It definitely isn't, standing puts enormous strains on our bodies. Walking for 6h is much easier and better, but sitting out lying down are much better than just standing.

They're also talking about a population of workers - this includes elderly people with bad hips, bunions, handicapped people who aren't always given proper accommodations, etc.

Yes, most governments do not allow pricing according to ricks; but, whether insurance will take that risk group and insure them does in fact act as pricing according to risk. An example is diabetes. As if you are not with an elite insurance carrier via elite high income job you have actually not having insurance and dying from diabetes due not being able to afford insulin shots.

Walk around the supermarket that you drive to, hopefully not being maimed or maiming someone else on the way. A ludicrous expenditure of energy to avoid physical activity so that you can buy products to help alleviate the symptoms of the energy expenditure and laziness. Can’t walk, or bike, or take the non-existent public transit. That’s for sure.

I don't think driving is merely to avoid physical expenditure. Driving is a result of rural and suburban living as well as poor urban planning. Lots more people would walk or bike if it was reasonably feasible.

I suspect it's a bit of a chicken/egg problem (based on my opservations from visiting the US). Even in suburban areas there seems to be roads everywhere, often very hard to cross without a car.

Where I live in Europe, the expectation is that the kids will walk or take the bike to school. 95% of the paths they need to travel is covered by walkways (usually separated from the roads, and in many cases with dedicated bike lanes). Everywhere the kids need to cross, there are crosswalks, and every morning before school a team of parents is organized to safeguard these crosswalks.

Meanwhile, driving is slowed down significantly by the efforts above. The roads are underfunded and lines tend to form around the school (some parents still do drive their kids, up to about half when the weather is really bad). But with parents blocking the crosswalk every time a kid is near, bottlenecks do form. Basically, if you're in a car, you're treated as a 2nd rate citizen. :)

Oh, and I suppose one benefit of all this walking is that hospital bills go down. Mostly because of the exercise, but also to some extent due reduction in air polution (which is helped further by most of the remaining cars being electric, most of which, ironically, are of a certain American brand).

Where i live in the suburbs we don't even have sidewalks ffs. I live about 3 blocks from my kids' school, yet they are driven or take the bus to school because kids are not allowed to bike or walk to elementary or middle school, unfortunately.

wow, didn't realize so much of EU can afford electric vehicles. They are more expensive over here in the U.S. - especially compared to a decent used car. Is this a function of the cost of fuel being much higher over there? Or are there subsidies for purchasing electric or something else?

> wow, didn't realize so much of EU can afford electric vehicles. They are more expensive over here in the U.S. - especially compared to a decent used car.

I don't live in the EU, though. You need to move a bit further north and west.

And it's not that electric cars are cheaper here than in the US, rather other cars are taxed at +100% or so (more for "luxery" cars), while electric cars have had low to zero taxes.

Also, fuel has an extra tax of about $1/liter ($3.8/gallon) on top of the normal price (and 25% VAT even on that), meaning even before the current boom, fuel was typically priced around $1.5-$/l (around $5-$7/gallon), and has been approaching $2.5-$3/l (up to about $10/gallon) recently.

Another difference compared to the US is that we have about 25% fewer cars per capita here, despite having about 20% higher nominal GDP per capita than the US (purchasing power of households are lower than in the US, due to taxes and tariffs ). Partly because of car-hostile taxes (except for electric cars) and partly because other means of transportation are subsidized. More of the money is put into buses, trains and sidewalks and less into cars, roads and parking lots.

> our patient population is very different from other countries > our expectations are very different from other countries > our scale is dramatically different than other countries > the way are population is taxed is very different than other countries

do you have evidence to support these claims? what makes the US patient population or their expectations or the US taxation system unique in the world?

Not the OP, but Americans as a whole are very unhealthy (with 42% of the population being obese and over two-thirds being overweight) and culturally have very high expectations of what medicine can do for them, as opposed to making difficult changes to their lifestyle.

A part of the latter is based on the actual superiority of the quality of medical care in this country -- due to the high levels of wealth produced by this (mostly market-oriented) economy and advanced medical technology, doctors can in fact perform miracles here that they cannot elsewhere.

A part of the latter is based on the actual superiority of the quality of medical care in this country...

How is it superior? Sure, some countries fare worse. But folks aren't getting the healthcare they need because of cost, and the results aren't exactly the best in the world. I'm not convinced that "culturally" folks have high expectations either, and sure, you might want to change your lifestyle to lose weight - but at the same time, you might just need medical oversight to do so. Not to mention that a bunch of things medicine helps are not things that lifestyle just fixes.

Yes, folks are being priced out of healthcare, but the healthcare that is being provided is of superior quality than can be found in other countries -- even first world countries with socialized healthcare. I mean it in that narrow sense, that the service that is being delivered is of higher quality.

It sounds like your point is that wider delivery of healthcare would be superior overall. That's fine, but I contend that the best way to achieve that is by increasing the supply of healthcare providers, instead of applying a price ceiling, which leads to shortages (as seen elsewhere on this thread[0]) and quality deterioration.

[0]: https://news.ycombinator.com/item?id=32745467

> e invest many times per capita what other countries put into basic medical research

This is a big thing. I'm in the UK, where healthcare is very socialised, but I very much appreciate the fact that the US invests in making and productionising the next generation of healthcare, which we can then buy in bulk at a discount.

I understand you're the relative expert here, but even so I must disagree with your general thrust.

I've been hospitalized in four different countries. The least sane was America. The sanest was a private hospital in England, but the public hospital in England was fine too. My home country of Canada is sane, reliable, and reliably slow and mediocre bordering on subpar. Cyprus lacked toilet seats, but at least the food was fantastic.

America's healthcare system is bananas. Even trying to come up with a metaphor here is difficult. It's $5k a day stays with Wonderbread, tuna, and bad not-actually-mayo-mayo for lunch. It's well groomed, well respected, monied indentured second and third opinion servants. It's Moloch's own mediation on Moloch[0] sold on the discount rack of the bookstore pharmacy downstairs.

You can think Americans are different. They are not. They move to Canada all the time and we service their bum knees just fine.

You can think Americans do all the medical research in the world. They don't. Plenty comes out of Europe, China, and elsewhere.

You can think your tax code is unique. Ok this one I kinda agree with. It's almost as bananas as your medical system. But it doesn't change the fact that Americans put up with absolute bananaspants insanity for a healthcare system when they're perfectly capable of funding their libraries and roads.

China beats you on scale. And so on.

The basic fact is that Americans have what is essentially a psychopathic medical system at the best of times. One can negotiate with a psychopath, but Kafka returns your offer with a can of stale soup and doesn't even laugh.

[0] https://slatestarcodex.com/2014/07/30/meditations-on-moloch/

You're coping. Americans are responsible for about half of the world's medical research.

That's factually untrue. China and Japan alone match the USA, and when adjusting for percent of GDP the USA isn't even in the top five countries.

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

Why would you adjust this value instead of using absolute terms?

If you mean PPP, then the reason is simple. How much a janitor is paid to clean a research lab's washroom doesn't materially affect the quality of the research produced. There are other measures that look at things like papers cited or page rank like algorithms, and on those USA does even worse if I recall correctly.

At the end of the day, though, this is a distraction from the core argument. A valid defence of US healthcare policy is not "but we're good at research." Imagine if China was trying to defend their overbudget and under-effective military by talking up how much they've done for global aeronautical research.

Grandma lost her house because she got kidney stones, but, butterfingers, at least we research stuff! Oh and often times our pharma kills more people than it saves and true justice is never metered out ala opioid epidemic.

Keep shouting #1, #1, #1 until you believe it.