
The Decline and Fall of the American Empire - thegrasshopper
https://www.bloomberg.com/view/articles/2018-07-30/the-decline-and-fall-of-the-american-empire
======
evrydayhustling
The most important factor in this analysis doesn't get called out by name:
healthcare costs. When Cowen mentions entitlement growth forcing spending
reduction and tax increases, healthcare is both the most certain and the
biggest culprit by a wide margin.

If you were going to do one thing to extend American prosperity, it would be
disruptive structural improvements to our healthcare system. That's structural
reform, not new biotech (except as allows you to disintermediate care). The
fact that our total expenditure is so high relative to other countries with
similar quality of care is evidence that the economic models, not the
technology available, are to blame.

~~~
internet_user
Attack exorbitant salaries of physicians, and watch them suddenly forget how
to treat your medical problems. And probably refuse to treat your family too,
just to teach you a lesson.

How long are you willing to go without medical care just to make a political
change? Not sure that geriatric politicians will be skipping their monthly
appointments.

~~~
Bartweiss
This entire line of argument distracts from the real issues and makes progress
harder to achieve. Physician salaries are one of the worst possible places to
start addressing this issue.

US doctors apparently earn about 2x the average for other comparable nations.
That's not a small number, but doctor's salaries _in toto_ are only about 8%
of US healthcare spending. A 50% reduction would bring our salary spending in
line with everyone else, but only save $100 billion out of a $3,300 billion
cost.

Meanwhile, outright waste in medical supply spending costs $765 billion per
year. That's drugs discarded at expiration dates which are known to be too
restrictive, spending on combination drugs which are identical to the sum of
cheaper components, and supplies thrown away by hospitals for non-sanitary
reasons (e.g. vendor change, or drugs allotted for a patient but never issued
or opened). Changing some parts of this would involve challenging the profits
of drug companies, but in many cases not even that would be required. A
handful of regulatory changes could save enough to offset the entire cost of
paying doctors.

The situation with unnecessary or ineffective medical treatments is
comparable. Some of the most common surgeries performed are known not to work,
suspected not to work, or known to be more risky than inaction for standard
patients, but they're still carried out at enormous expense. Adjustments to
medical publication standards, physician statistical training, and and
malpractice risk profiles could massively reduce the number of unnecessary and
even net-harmful surgical procedures performed every year, cutting costs while
directly _improving_ care.

Framing medical expenses as a conflict between consumer expenses and doctor's
salaries is false and harmful. It literally can't solve the problem, but it's
excellent at derailing the work that could.

[https://www.propublica.org/article/the-myth-of-drug-
expirati...](https://www.propublica.org/article/the-myth-of-drug-expiration-
dates)

[https://www.propublica.org/article/what-hospitals-
waste](https://www.propublica.org/article/what-hospitals-waste)

[https://www.theatlantic.com/health/archive/2017/02/when-
evid...](https://www.theatlantic.com/health/archive/2017/02/when-evidence-
says-no-but-doctors-say-yes/517368/)

~~~
internet_user
I know this is an unpopular view, but who are you to decide what level of risk
should a patient accept? Literally every step, including inaction has risks.
Can patients decide independently what should be done with their own body, or
are they presumed to be too dumb and must obey your decisions?

Should patients be consigned to disability immediately without even attempting
some procedure, simply because the chance of success is too small in your
arbitrary definition?

You have never been seriously sick.

~~~
Bartweiss
> _You have never been seriously sick._

For a comment arguing that I'm being dismissive of sick people, this is a
genuinely insulting and exceedingly false assumption to make. Yes I have, yes
I _am_ , and those experiences absolutely support my point.

> _Who are you to decide what level of risk should a patient accept?_ ... _Are
> they presumed to be too dumb and must obey your decisions?_ ... _Should
> patients be consigned to disability immediately without even attempting some
> procedure, simply because the chance of success is too small in your
> arbitrary definition?_

I did not say any of this at any point. I did not say anything remotely
resembling "people should be consigned to disability because some procedures
rarely work". None of what I am proposing is about denying patients treatments
they make informed requests for.

Please actually read that Atlantic article. It is not _in any way_ about
denying medical care to a sick patient who wants it because "doctors know
best". It is exactly the opposite - a patient was being railroaded into major
heart surgery that made sense as a malpractice precaution but not as patient
care. He did his own research, obtained multiple opinions, and independently
decided to what should be done with his body.

That is what I want more of. In a discussion of cost-cutting I focused on the
straightforward case of expensive treatments being pushed on patients without
giving them full information, but over-treatment and under-treatment both
happen. If it would make you happier, I can list some of the ways I think we
can get better care at lower costs by providing _more_ treatments and
emphasizing patient wishes over current medical consensus.

I'm painfully aware that the 'patients are clueless' attitude you're attacking
exists. I mean that literally, as a result of that attitude I'm in pain right
now. But you read an entire worldview into one sentence, in the face of
examples that specifically disagree with it. The thing you're objecting to is
terrible and deserves opposition, but you're picking a fight with someone who
already agrees about that.

------
hodgesrm
> The very worst fears about climate change won’t come true. But a nagging
> succession of storms, plus required adjustments along the coasts to
> accommodate a rise in sea level, will eat up about 0.5 percent worth of
> economic growth.

For a 'clean tale of hypothetical decline' this really seems to undersell the
climate problem. As of the weekend along the Norther American West coast there
was almost continuous forest fire smoke from southern BC to near the middle of
the Central Valley. It's not implausible we will see a sizable percentage of
the Western US forests destroyed by fire in the next couple of decades. For
anyone who has observed the ecosystems over the past few decades the changes
are starting to become quite alarming.

So the climate problem is pretty big. At least at the national level the US is
basically ceding responsibility for developing technologies to address it to
other nations. This looks like a big future opportunity loss in addition to
the actual costs imposed by climate changes.

------
dalbasal
I like the author, and his out there style has produced some gems. This
article though, it feels like he started, but didn't really get anywhere.

What is (for the purpose of this article) "American Empire" anyway?

If it's relative economic & military power, than the writing is on the wall.
China is matching and surpassing the US now.

Is it "Empire of the Mind" where the US leads the world in terms of political
ideas, holds the torch of civilization and such? That's a whole different
discussion.

Is this an article about upcoming disasters of a political-economic kind?

~~~
t1lthesky
The authors viewpoint would be that the “American Empire” is the large amount
of political, military, and economic influence that America wields
internationally. You can infer from the article that he believes this empire
is what keeps regional powers in check. This is a good thing because a lot of
those nations (China, Russia, Turkey, Saudi Arabia just from the article) are
much more autocratic and illiberal compared to the USA. Additionally, even if
you believe that’s not true of these societies, growing regional ambitions in
the absence of the “American Empire” leads to destabilization and more
conflict.

------
modells
Each fall of civilization is a tale of N cities... there’s rarely “the one
magic” factor.

US has:

\- situations leadership cannot (ie no immediate benefit for them) or will not
(ie blind tradition) correct the rules of the current system in a way
founders, whom understood human-nature, could adjust to make it work better..
instead the ship is falling apart:

\- essentially unlimited private campaign financing.. resulting in corruption
metastasizing into all three branches, from POTUS down to sheriff and district
attorneys, which leads elected officials to dismiss the public good to mostly
consider the rich’es and their good.

\- disengagement through manufactured consent, learned helplessness, divide-
we-fell polarized animosity and non-participation.. yes, and celebrity chefs.

\- mass-media oligopoly.

\- insane student debt bubble, just the latest bubble.

\- largely morally- and ethically-unmoored, unregulated market chicanery
leveraging complexity, obscurity and trade volume speculating to alter the
worth of real capital.

\- large, diffuse official workforce participating in inverted totalitarian
wage-slavery and living in their vehicles. more co-ops employee ownership,
shorter work weeks, higher pay relativr to the cost of living and workers on
boards-of-directors are needed.

\- “excess” labor due to automation and outsourcing. those “better jobs
elsewhere” rarely materialized, hence opioid crisis.

\- opiod crisis.

\- undocumented workforce which subsidizes costs of many essential goods for
the lower-income classes with their cheap labor.

\- complex geopolitical situation in an ever-flattening, connected and
population-stabilizing work (sans Africa).

Maybe in a million years Bezos will be the first quintillionaire Morlock and
feast on the marrow of the Eloi while paying for everyone’s UBI since there’s
no jobs left except Scruffy, the Janitor.

------
jnurmine
The article sounded like the silly Stratfor ramblings by Friedman, but in a
kind of reversed way, where USA ends up suffering. In the Stratfor fiction,
USA grows and flourishes, while varyingly imaginative scenarios emerge all
over the globe, harming others. This article was kind of the opposite.

Certainly the pax americana is at the end of its road, because of e.g. the
costs of upkeeping the military, but will USA somehow implode and shrink to
irrelevance and vanish completely? No, I don't think so.

China is emerging as the next big power. However, I am not so sure it will
stay as a cohesive whole during this development as it reaches its peak. I
believe technological advancements and ever-increasing interaction with other,
continuously developing and changing cultures are incompatible with an
increasingly tighter grip of the population (via e.g. the social credit
system). Free flow of ideas & communication and an ever tighter "police state"
in the physical world do not mix and will eventually collide, destructively.
From extreme to extreme, then balance.

Long story short, I think in the future the world will be a multipolar one and
this will be the "low energy state" of the global system. All of the current
top players will eventually take a hit of some kind, and become different from
what they are today, but not disappear nor sink into a Mad Max style world
full of oblivion and despair.

------
rdl
What seems least plausible about this to me is that a long period of decline
like that (basically what happened to France and the UK) wouldn't result in
something like a civil war or other split in the US.

~~~
Hasknewbie
Based on observed uprising or civil wars [1], to have one of those you need
(1) stark mass poverty that borders on famine, i.e. people _really_ scrapping
by, and (2) Youth! It's much much easier for a younger population to revolt.

And, no offense, but relative to the rest of the world Americans are kind of
old and kind of fat.

So: probably not.

[1] Sources:

[https://www.forbes.com/sites/jerrybowyer/2013/07/18/youth-
in...](https://www.forbes.com/sites/jerrybowyer/2013/07/18/youth-in-revolt-
the-demographics-behind-middle-eastern-uprisings/amp/)

[https://www.fragilestates.org/2012/11/25/causes-of-
revolutio...](https://www.fragilestates.org/2012/11/25/causes-of-revolution-
the-role-of-youth-and-other-social-factors/)

------
TomMckenny
Is it adapting rapidly enough to changes in technical/human/natural
environment or not?

Just ask this question of any society, past or present, and tell reliably
whether it's in rapid decline or not: democracy, empire or otherwise.

Accumulating enemies, losing friends, having trouble with rainfall amounts,
not adjusting to internal human needs and wishes, insisting on obsolete
techniques? Then you have a problem whether Mayan, Roman, Soviet or other.

------
justsomedude43
For the sake of humanity I really wish it would be true, but somehow I doubt
it. Not for another 50 years or so.

~~~
dmm
"Do you think you'll like the next empire better?", dmm asked with a small nod
west over the pacific.

~~~
justsomedude43
I don't know but at least there's hope that it will be different or perhaps,
get ready this is a bit radical, there won't be any empire.

------
hokumguru
It seems that American journalists and coastal elites do nothing more lately
than (ironically) talk about how much they hate their country. What happened
to patriotism? Why is it so 'cool' nowadays to hate the USA?

~~~
Hasknewbie
Can you tell us where in the linked article the author shows "how much they
hate their country"?

Please provide actual examples.

------
aeriklawson
This is purely speculation with no sources.

These articles are a dime a dozen in the age of Trump and most of them are
shortsighted and factless.

------
ransom1538
[deleted]

~~~
endorphone
Unprecedented? It isn't unprecedented at all. It is entirely pedestrian. Add
that it was substantially caused by a) a massive burst of government spending,
b) foreign buyers front-loading delivery to beat out pending trade wars. It is
going to get ugly from here.

The American economy is pretty much at 100% right now, as any chart could tell
you has been the result of almost 10 years of growth since the financial
crisis. Which is why it is shocking and startling that it is coupled with
extraordinary deficits approaching a trillion dollars. This is the time when
the government is supposed to be eliminating deficits, not blowing them up.

The US debt is simply grotesquely unsustainable, and when even the anti-
deficit right has ceded the fight...bad times are ahead.

So yes, the US economy is a "terror" movie of sorts. It is so profoundly
irrational that it has some serious jump scares coming up.

As an aside - Trump is boasting about a steel maker making record profits.
Ignore that it cost $12B in taxpayer money to farmers in a single year, and
will cost billions more, and that it dramatically increased the prices for US
consumers and threatened a wide swath of manufacturers...at least US Steel is
making money, right?

------
Areading314
Can we stop calling the world's largest democracy an empire? Belligerent
nation sure but it's so click baity and inaccurate

~~~
eznoonze
USA is not the world's largest democracy. That title goes to India.

~~~
Areading314
By economy, not headcount

~~~
eznoonze
Then it should say "world's largest economy", not "world's largest democracy".

------
_cs2017_
Stupid click bait. Expected to read about the fall of civilization in America,
kinda like a fusion of Mad Max + Walking Dead. Instead read about high taxes
and elderly people causing congestion on the roads.

That's what happens when economists write, they make the coolest topic boring
af.

~~~
fixermark
The reality of decline is going to be quite boring.

Boring,and a world worse than today in many ways, if we don't get out ahead of
the failure modes.

------
40acres
If you ask me, the fall of America from the lone 'superpower' to a 'great
power' is all but assured as long as the structural racial inequality in this
county persists.

Let's take a look at education for an example: USA ranks pretty low on global
education rankings despite the fact that we have some of the best schools in
the world across all levels, its hard to think why that may be the case but
when you consider the inequality in school systems due to property tax law and
de facto segregation it makes a lot more sense.

Look at the criminal justice system: we have over 1 million prime aged men who
are basically frozen out of achieving economic prosperity and contributing to
this countries success because of bad policing and disproportionate
enforcement of law.

Look at healthcare, there is a huge gap (although closing) of life expectancy
between races.

India and China are not utopias by any means, but they have 1B+ people: these
countries are growing larger and larger in influence and will create a middle
class that contains hundreds of millions of people. The US is getting more and
more in-equal and at a certain point we will reach an inflection point where
we are too damn lopsided for our own good. People want to talk about lower
productivity and lower wages, when you have 1.5 missing men from the workforce
what do you expect?[0]

0:
[https://www.nytimes.com/interactive/2015/04/20/upshot/missin...](https://www.nytimes.com/interactive/2015/04/20/upshot/missing-
black-men.html)

~~~
rb808
Can you name a time in America's history when there wasn't segregation and
inequality?

~~~
40acres
There has never been a time where America wasn't segregated or in equal. I
think throughout America's history we've had a long runway: the fact that the
continent was open to use w/o a well organized Mexican or Indian state to stop
expansion, the isolation from WW1 & WW2, the fast amount of land in this
country and natural resources, the decline of Europe and relative weakness of
China, etc. We've been able to take advantage of these conditions for 200+
years. The rest of the world is catching up though, we will need to really
unlock the potential of people who in the past have been marginalized to
continue our run as a superpower.

