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Comment by simonh | Hacker News Reader

The health care issue in the USA isn't due to lack of funding, the US spends more on health care per person than any other country, double that of many European countries with single payer systems.

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

The costs of medicare, medicaid and CHIP to tax payers are about what most Europeans pay in tax for universal health care, but then they also need to pay for health insurance for themselves.

As for controlling Hormuz, the US military absolutely could control Hormuz. I'm confident it's quite capable of it. It's that the US public wouldn't support the immense cost in lives and treasure it would take to do it, and maintain that control. No other military could even try, but the the USA could. It's not a matter of lack of military capacity.

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> the US military absolutely could control Hormuz. I'm confident it's quite capable of it. It's that the US public wouldn't support the immense cost in lives and treasure it would take to do it, and maintain that control

I never understood these kinds of arguments and they always come from those defending US military might.

Either they can do it or they cannot, if "the US public wouldn't support the immense cost in lives and treasure it would take to do it" is true, which it appears to be, then the US Military cannot control Hormuz.

Right I think its only an interesting argument in separating existential vs non-existential threats to the country.

So it means we aren't fighting in Iran the way we would in defending a hypothetical invasion of the lower 48 states, great.

But does it mean we'd fight any differently in the South China Sea, a Russian incursion into Poland, etc. Unclear, and presidential whim based.

The American public has shown willingness over decades and decades to commit to long term wars of choice. Not infinitely patient, but patient.

Of course, other Presidents have been willing to put in some sort of effort to make to make a case. And usually have some of theory of victory or purpose. And generally avoid making weird random claims about invading NATO allies.

That willingness is predicated on being at war with much weaker powers / enduring FAR lower casualty rates than Vietnam / Korea / world wars.

The entire 25+ year GWOT era has resulted in 7k American military personnel dying.

Vietnam that number was closer to 60K in 8 years, when US population was also 33% lower.

Dramatically different impact on society.

Sending marines to take an island in Hormuz or a carrier under fire in the South China Sea might look a lot closer to Vietnam than GWOT in a hurry.

The distinction between political resolve and military might is relevant specifically to the "what has all this money gotten us?"

All the money in the military has gotten us, almost certainly, the ability to conquer virtually any plot of land anywhere on the planet at any time.

But that does not (thankfully) intrinsically generate the political resolve required to do so.

Democracy and markets are beautiful things. It's fantastic that it can constrain even a military as mighty as the US and a commander in chief as braindead as Trump.

I dont think it's fair to say it's from those defending US military might.

I've seen the same logical fallacy used everywhere; including people hyping Russia and China.

>As for controlling Hormuz, the US military absolutely could control Hormuz. I'm confident it's quite capable of it. It's that the US public wouldn't support the immense cost in lives and treasure it would take to do it, and maintain that control.

This is like saying "I could easily afford a Ferrari. It's just that I wouldn't be able to make the interest payments on the loan". Military conquest is more than just guns.

No, it's like saying "I can easily afford a ferrari but I won't be able to afford groceries for a year after that because I've emptied my savings account.

The military might be capable of a ground invasion and succeeding. It would be Pyrrhic. Even if Iran was a genuine nuclear threat (I am not convinced at this point that Iran would launch a nuke at anyone if they had it), is it worth 500k dead Americans?

There was never a path to victory that didn't involve ground troops. We aren't losing in Iran because of military incompetence, but policy incompetence. Previous administrations did not do this because the cost was well understood.

There has never existed a military who could win this conflict without ground invasion. This was understood when this administration started it.

>We aren't losing in Iran because of military incompetence, but policy incompetence.

My point is these two things are inseparable, and to conflate them is simply Call of Duty-esque military fantasy. It's a feel good war story that doesn't actually reflect the reality of actually winning a war.

If the US military does not have the ability to hold, occupy, and install allied regime change, then the US military cannot win a war with Iran. You cannot separate the short term wins from the long term objectives. No one looks at Imperial Japan and says "they easily bombed pearl harbor, but due to policy failures they couldn't keep control of the South West Pacific theatre.

The US winning WW2 wasn't just dropping the nukes and high fives. There was rebuilding the Japanese nation, aligned to the US, becoming a long term ally.

This is no different than Afghanistan. Future humans aren't going to look back and say "the US easily controlled Afghanistan for 12 years, and then just returned to the Taliban". The lessons learned will be the US failed to hold Afghanistan and the Taliban returned to power and it was a military failure.

No matter how you dress it up, I can't afford the ferrari.

This is very different from Afghanistan.

The USA and its allies could sustain the Afghanistan occupation indefinitely, but chose not to(prematurely, in my opinion).

In Afghanistan, the west chose to lose, but victory was possible. We were(we, I was there in 2010) winning hearts and minds of the younger generation but abandoned them. Another Donald victory.

Iran is an impossible situation.

The reason the US can’t take the strait is that the war is unpopular and the American people don’t want it to happen. The US military could absolutely 100% invade and take the street, but it would be extremely unpopular and very expensive.

> As for controlling Hormuz, the US military absolutely could control Hormuz

They don't though

Health insurance company margins are 3% to 5%. The book America’s Bitter Pill: Money, Politics, Back-Room Deals, and the Fight to Fix Our Broken Healthcare System (2015) by journalist Steven Brill blames mostly wasteful practices in hospitals, pharma and device manufacturers, government and corporate health administration costs.

Wrong.

Health insurance company margins are meaningless. All the large insurers are actually "pay-viders", meaning they own huge (and growing) chunks of the physicians (providers) they pay out.

Go read STAT's Colossus investigative series on the myriad ways UnitedHealth Group abuses this structure. All the other pay-viders do the same.

Pay-viders can "generate x% profit" for any value of x. They control all the relevant levers, which also by coincidence eliminates any incentive in the entire system to reduce costs.

They are required by law to only make a certain value of x, and so, surprise surprise, they all make x!

Not to dismiss your point, but the US healthcare system has one meta problem.

Complexity.

There are too many parties. There are too many bespoke party-party contract. There are too many new middle-parties being created, with their own contracts. There are too many systems. There's too much tech debt.

That's a reason improvements to the US healthcare system have generally been via HHS/CMS imposing standardization mandates ('or no Medicare payments').

But providers, facilities, and insurers (most operating on low margins) can't be collectively more meta-efficient without simplifying the system.

Single payer / Medicare for all is a critical start not because of coverage, but because of simplicity.

There are so many intractable problems with the current system simply by virtue that changing anything about them requires 100s of parties to update 10,000s of party-party contracts and interfaces.

That's the biggest source of waste in the current system: constant duplicative re-engineering.

Thanks for the recommendation.

I think the most correct and probably most discouraging answer is that American healthcare costs about what it should.

Drug prices in the US are >2x the price as compared to other developed countries [1].

[1] https://www.ncbi.nlm.nih.gov/books/NBK611301/

Yes I know. That sounds about what it should be. Maybe less actually.

Why should drugs in America cost >2x the price of drugs in other countries?

Invert the question. Why do other countries pay half as much? Because they can't afford to pay more.

You don't pay twice as much just because you can lol

Because that's what efficient pricing regimes do.

US health insurance margins are thinner than European private insurance. Their administrative cost however are 9-10%, when in Europe (or really, France and Germany, I haven't looked elsewhere) they are 5-8%. The difference is probably in negotiating costs and audits. But that means that in total, for every 100 dollar paid, US insuree pay 4-10 dollar in efficiency+dividend that a European doesn't.

Dumb argument though when UHG owns the hospitals, pharmacy and the insurance company. They can make the "profit" of any one of them be anything they want really.

Right, they don’t “profit” much because they pay themselves so much. The CEO of united healthcare total compensation is $60 million a year.

Where do you think that money comes from?

You could just delete united healthcare and save bucketloads of money. They don’t actually do anything anyone wants, other than extract money as a middleman.

> The costs of medicare, medicaid and CHIP to tax payers are about what most Europeans pay in tax for universal health care, but then they also need to pay for health insurance for themselves.

People always say this, but I suspect Americans are more unhealthy in general and actually need more healthcare per person.

We have a development pattern where people barely walk, but less walk or cycle to work.

> As for controlling Hormuz, the US military absolutely could control Hormuz

I don't see how they could manage that without a full-scale invasion and control of Iran. It's far too easy for Iran to launch drones/torpedoes from small watercraft or from nearby land. I expect they could control Hormuz for a while, but it would be very expensive and I'd expect the logistics to break down fairly quickly if the economics doesn't stop it first.

"I don't see how they could manage that without a full-scale invasion and control of Iran" - that's precisely what they're saying, and that the domestic populace wouldn't put up with it.

I suppose "could" here is a bit of a stretch. Like technically, yes, you could if you whipped up your country into enough of a frenzy to support it. Hell, Iraq happened (twice), so I suppose it has historical precedent. And yes, a full-scale invasion of a fully committed US military should absolutely be able to conquer and hold Iran. But I can't imagine any circumstance where that's possibly going to happen in today's reality (outside of an Iranian terrorist event on USA soil, for instance).

> a full-scale invasion of a fully committed US military should absolutely be able to conquer and hold Iran

I doubt that - Iran is very large and would require something like conscription in the US to get anywhere near the required amount of troops. The US doesn't have a great track record with conquering and occupying other countries.

>No other military could even try

Iran military is trying alright.

You got me there.

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