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Medicare, social security and the interest on the debt are the 3 top federal spending categories

Social welfare is the top local spending category in many local/state governments

Yea, and medical costs - including those paid for by medicare, often for people who aged into the program with worse health, which in turn is partially attributable to a tendency to avoid preventative care earlier in life due to higher costs - in the US are drastically more expensive than elsewhere, primarily because of this exact pump: Providers, insurance, equipment manufacturers, and various middleman orgs have arisen to deal with a system that is riddled with cost-inflating private-public partnerships and regulatory band-aids to mitigate small parts of the mess that end up having second-order effects that mostly also raise costs.

I believe some functions are simply best performed by non-profit-motivated government agencies. However, I would usually prefer an actual unregulated or black market over the corrupt frankenstein of private-public partnerships

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