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Comment by cscurmudgeon | Hacker News Reader

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… this is just whataboutism.

I can disagree with Republican cronyism and the endless "let some private contractor do it poorly" when the Federal government could just do it directly, and poorly, but with less indirection.

… I can also disagree with blue state's NIMBYism, "I got mine and screw you" attitudes towards housing, and work to promote things like better zoning laws, fairer tax legislation, better public transit, etc. at the same time.

(Note: the parent edited the above comment to add the CNN article. At the time I replied, it was only the NYT link.)

It is not whataboutism. It is pointing out outcomes in the other approaches may not be as good sounding as they are.

You know how NIMBYism is done in California?

It is usually along the lines of "We can't let developers profit!!" and "They are going to build luxury homes and not affordable homes!!".

So you think rejecting federal money to expand medicaid is good?

Where did I say that? I was responding to the ill-informed rant about state-govt websites and corruption while hilariously ignoring the article stems from corruption and issues in the original healthcare.gov website.

(https://en.wikipedia.org/wiki/HealthCare.gov#Concerns_about_...)

Do you think not addressing root cause for high medical costs is good?

https://harvardmagazine.com/2020/05/feature-forum-costliest-...

if you weren't addressing my point (medicaid expansion) then why are you responding with random articles?

I, in fact, think things like negotiating drug prices is good, sadly it was outlawed by republican policy: Medicaid Part D (One of the most expensive policies ever) -- the Biden "Inflation Reduction Act" addresses this Bush-era money-grab for drug companies.

I will still give Bush immense credit for passing Part D, even if it blew a hole in the federal budget - there is no way politically it would be possible today, and it was almost not possible then.

It will be interesting to see what happens as that funding is starting to be phased out. https://www.kff.org/medicaid/issue-brief/fiscal-implications...

Meanwhile, finding lower cost ways of providing health care still seems elusive in the face of provider and pharma legal efforts.

Providing lower-cost ways of providing health care is directly contrary to the interests of anyone with political or economic power in our country: the hospitals and pharmaceutical companies that directly benefit from high prices, the politicians who receive bribes in exchange for passing laws that keeps prices high (or just failing to pass laws that would lower prices), and the typical employer who can use the increasing importance of health insurance and the threat of medical bankruptcy as leverage against his employees when negotiating work conditions and pay.

Our health care system is, like basically any other institution of note in the US, first and foremost a means to effect the transfer of wealth to our economic and political elites from the rest of us. We need to first come to recognize that our system is currently working as intended before we can think clearly on what to do about it and take effective action.

"Our system is currently working as intended" implies that someone designed the system to work the way it does. What you're really arguing is that no actor is incentivized to improve things, and multiple actors are incentivized to preserve the status quo.

I'd argue that strident condemnations (ala your "our system is currently working as intended") is actually one of the features of the US political system that tends to create/preserve a subpar status quo: https://twitter.com/JohnArnoldFndtn/status/11063022464493690...

I don't believe that the US has a monopoly on greedy businesspeople or politicians, relative to other countries. But I do find myself wondering if the toxicity of our politics tends to filter out candidates with a good faith desire to serve the public. People who enjoy conflict tend to be jerks.

EDIT -- Here is some specific evidence that US elites are not uniquely rapacious:

A solid majority of Giving Pledge signatories hail from the US: https://gpcatalysis.blob.core.windows.net/gphostedcontent-pr... From the bottom of https://givingpledge.org/

While the US only has 735 of the world's 2640 billionaires: https://en.wikipedia.org/wiki/List_of_countries_by_number_of...

> "Our system is currently working as intended" implies that someone designed the system to work the way it does

I disagree

It is intended to be profit maximizing.

That it is

You linked me to a website for a US organization that apparently encourages the extremely wealthy to create more tax shelters for themselves, and followed that up by pointing out that the US accounts for 28% of the world's billionaires while making up 4% of its population.

I'm not sure what point you were trying to make. I don't think we have a monopoly on greedy businesspeople or politicians either, but I do think that as the epicenter of global capitalism, we dominate the market. You can't hope to solve problems if you won't allow yourself to accurately define them.

>You linked me to a website for a US organization that apparently encourages the extremely wealthy to create more tax shelters for themselves

It's true that the tax code encourages philanthropy. That's not the same thing as philanthropy being purely a tax shelter.

I hope you don't actually believe that providing health care is exorbitantly expensive. Providing health care is absolutely not exorbitantly expensive. It just isn't. Paying the prices that our hospitals, insurance companies, and drug companies charge is exorbitantly expensive.

How would you propose to resolve that? Should we cut physician pay in half to match their European peers?

https://www.medscape.com/viewarticle/997263

I propose cutting administrative costs by 90%. A bunch of paper pushers in meetings all day making too much money driving up the cost of everything they touch.

That's a good area to start, although 90% might be optimistic.

See this paper: Pozen, Alexis and David M. Cutler. 2010. Medical spending differences in the United States and Canada: The role of prices, procedures, and administrative expenses. Inquiry 47(2): 124-134.

https://dash.harvard.edu/bitstream/handle/1/5343032/Medical%...

Look at Table 1 and Table 2, page 19/20; the difference in cost due to salaries/income is $490 per capita, the difference in cost due to administrative overhead is $616 per capita.

That is not a realistic proposal. What specific costs can be eliminated?

Just layoff hospital staff until it hurts. Easy.

> Just layoff hospital staff until it hurts.

This is so obviously the wrong answer it is painful that anyone would write it down even in an internet forum.

https://dd17w042cevyt.cloudfront.net/pdf/vision/healthcare-d... shows that while it is easy to blame administrative costs for healthcare, most money goes to "patient benefits"

This sounds great, but really what it is doing is transferring money to pharam company profits: https://www.zippia.com/advice/us-pharmaceutical-statistics/

> Easy.

It really isn't.

Which staff?

Anyone who can't explain what they do in a single sentence.

Throw it all away and go single-payer like the rest of the world. This isn’t some unknown mystery to be discovered. It’s been implemented and proven over and over again.

Payer profit margins only account for a small fraction of total spending. Single payer won't solve the problem.

That doesn't save much money. You have to attack the costs. The rest of the world is not on single payer, you know?

Again, the "costs" are not the problem. The prices are. Please stop perpetuating the cost myth.

First fix the difference in drug pricing between the US and other countries.

> Prescription drug prices in the United States are significantly higher than in other nations, with prices in the United States averaging 2.56 times those seen in 32 other nations. ... The gap between prices in the United States and other countries is even larger for brand-named drugs, with U.S. prices averaging 3.44 times those in comparison nations. ... “Brand-name drugs are the primary driver of the higher prescription drug prices in the United States

https://www.rand.org/news/press/2021/01/28.html

So you're asking for price fixing? Who should set the prices?

The simple answer here is to just allow us to buy it in other countries to get around the price discrimination.

I think breaking the hold of the AMA on things like residency slots that has caused physician shortages. Increasing supply should eventually have an effect on wages.

We could also move to 5 or 6 year degrees for doctors, like Ireland, instead of 4+4 schemes.

We can do more targeted immigration for doctors.

We can continue to expand the activities that can be done by non-doctors.

We can massively reduce the number of things that require a prescription.

Can you read? That's literally what I said. (with the exception of insurance, which is just a reflection of the prices charged by providers and drug companies)

I think it depends on the definition of “exorbitantly”. US healthcare costs are absolutely extreme but even European countries with universal healthcare still struggle with healthcare expenditure.

> The report shows that global spending on health continually rose between 2000 and 2018 and reached US$ 8.3 trillion or 10% of global GDP

https://www.who.int/publications-detail-redirect/97892400177...

I'm trying to decide why we need to clutch our pearls because health care is 10% of global GDP? Is health care somehow an illegitimate expenditure?

I think people just scoff at the price tag of a lot of medical expenses, though the bill you see your insurance provider get is pretty fake IMO.

> It is not whataboutism.

When someone points out Republican's cronyism leads to bad outcomes in healthcare, and you respond with an opinion piece whose thesis is roughly "Blue states have bad policies that lead to unaffordable housing" … like that's basically textbook whataboutism:

> the technique or practice of responding to an accusation or difficult question by making a counteraccusation or raising a different issue.

Literally "what about housing" is raising a different issue here, one that's not related to healthcare, nor the Republican anti-pattern being discussed in this subthread…

You're further implying that Democrats are hunky-dory with the housing policy in states like CA, when they're not. Some are, some aren't, and AFAICT it wasn't exactly a partisan thing. As I alluded to, a lot of the YIMBY-iers there advocated for things like better mass transit — which isn't exactly a very Republican position.

> You know how NIMBYism is done in California?

> It is usually along the lines of "We can't let developers profit!!" and "They are going to build luxury homes!!".

I'm a former resident of Silicon Valley. I'm well aware how it's done. That doesn't make this not whataboutism, and it doesn't mean that there aren't democrats in those states who are fiercely against that line of argument.

> When someone points out Republican's cronyism leads to bad outcomes in healthcare

Why would you expect a party's cronyism to be restricted to one industry? If you're implying that Republican's shouldn't be in charge of healthcare because it will result in cronyism, pointing out the cronyism is far from a partisan issue is not whataboutism.

The latter isn't cronyism. There isn't some anti-developer who is lining politicians' pockets with money created by not developing. In fact, what we're seeing is Democratic state politicians in these blue states making laws that limit NIMBYism like SB 35, against the wishes of local governments voted in by local NIMBYs.

Fixing zoning and prop 13 would go a long way in fixing these things over the next few decades. https://edsource.org/2022/californias-prop-13s-unjust-legacy... has some details there, but there is some progress on the zoning front like https://www.sfexaminer.com/news/housing/new-sf-housing-legis... and https://www.planetizen.com/news/2022/06/117643-san-francisco... .

https://www.latimes.com/california/story/2020-11-10/proposit... was unfortunate in my opinion.

I dont believe the dichotomy that its a choice between government and public.

Both parties are fundamentally wrong on a whole host of issues - the democrats are wrong on how markets work, and republicans treat poverty like it's a moral failing.

I dont know how to fix this situation, I need to see how the realignment we're in works out.

> … this is just whataboutism.

"Whataboutism" is just pointing out you're applying a double standard. A rhetorical tool used since time immemorial.

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