A lot of these are tied to lack of healthcare. We need a universal healthcare system in America, I'm tired of arguing with people who claim that we can't do what almost every (if not every) other western country has already done.
I’m a supporter of universal healthcare. But the fact that Germany or Denmark can do it doesn’t mean we can. Copenhagen is building a fully automated circle line subway beneath downtown for the same money it’s costing us to build a shorter light rail line through the DC suburbs. Moving a bit further afield, our schools are terrible despite our per-student spending being near the top of the OECD. We already spend as much public money on healthcare as most Western European countries do, without achieving universal coverage. Our non-military government spending per capita is slightly higher than Canada’s, and we get fewer services for it. Americans are uniquely bad at government compared to western countries.
Look at it from the other side. If European governments were as inefficient at providing public services as Americans are, would Europeans support mass transit and universal healthcare? If it was going to cost $6 billion to build a light rail line through the suburbs, mightn’t the Danes say: “fuck it we’ll build a freeway?”
Concrete example on the healthcare front. In Europe, universal healthcare is typically paid for with social insurance taxes primarily imposed on people making under $70,000. If you look at the proposals for Medicare for All that have been proposed by Democrats, you see two remarkable things:
1) Nobody proposes taxes to actually fund the expected cost;
2) Nobody proposed the level of middle class taxes (VAT and social insurance) typically imposed in European countries to find universal healthcare. Sanders’ proposal comes the closest, but is half the level of say France’s.
There is an important political observation here: there is little support for European-style healthcare in the US. What would happen if we had a straight up/down vote on Germany’s healthcare system? Or France’s? Or the UK’s? The support that exists in the US is for universal healthcare that is paid for by billionaires and corporations rather than the middle class. That’s a system that exists nowhere in Western Europe. It’s completely unprecedented.
The entire second half of the comment you're responding to addresses this. You don't have to agree, but you can't reasonably rebut the whole comment by pretending he didn't address it.
The second part of OP's comment deals with the funding sources for public healthcare. I'm responding to the allegation that our government couldn't provide it in a cost effective manner in the first place. Where in the second half is this addressed?
Having lived Chicago, Philadelphia, New York, Baltimore, and DC, where you have to search far and wide to find a republican, but where public services still suck (despite high taxes), I think the causation runs in the other direction. I think if you took a bunch of Danes and made them live in Baltimore for a few decades, they’d vote down any attempt at expanding government services too.
I don't think you can say that Democrats in big cities cause big city problems unless you can point to some big cities that are mostly Republican and do better. It's my impression that if you map political affiliation at a granular level, the US has a consistent pattern everywhere of blue neuron-like clusters everywhere people live, in a sea of much less populated red. I don't think that pattern varies substantially in any region of the country, and the rhetoric about states and other subdivisions being "red" or "blue" obscures the reality.
When A and B are correlated, it's not necessarily the case that A -> B or B -> A, it may be that C -> (A and B).
Note the assertion that I was responding to, which is the idea that government is ineffective because Republicans sabotage it. To refute that assertion, I pointed out that government services in heavily blue cities in heavily blue states are still bad. That doesn’t mean that Democrats cause those problems, only that those problems exist even where there are few republicans to “sabotage” government.
There are urban areas controlled by Republicans, and they don’t do public services any better—they just don’t do public services. E.g. Phoenix.
I just looked up information on Phoenix, and it seems that it more or less corresponds to the 7th and 9th congressional districts, which seem to have had Democratic congresspeople since they were created, and also voted for Democratic presidential candidates in every election.
What does being “pro business” or “against regulation” have to do with the quality of public services? These cities and states spend a ton of money on public services—they just do a bad job running them.
Besides, Western European countries manage to have good public services even though they:
1) Are more “pro business” in key respects, especially from the point of view of taxation. Western European countries generally have lower reliance on corporate taxation than the US, and much higher reliance on consumption taxes (VAT). They also rely much more heavily on payroll taxes paid for by middle class individuals than on corporate taxes.
2) Are more deregulatory in key respects. There is an E.U.-wide directive that requires rail to be deregulated and opened up to competition. If we had something similar here, instead of having government departments operate commuter rail service in say Virginia, the state would have to separate ownership of the tracks and allow for-profit companies to bid to actually operate the service. In DC, the WMATA Union is fighting tooth and nail to prevent one part of one line from being operated under contract to a private company. By contrast, the entire Stockholm subway is operated by private companies (one being MRT, the Hong Kong rail operator).
> Scholar Charles Glenn noted that “governments in most Western democracies provide partial or full funding for nongovernment schools chosen by parents; the United States (apart from a few scattered and small-scale programs) is the great exception, along with Greece.”2 Or as Diane Ravitch pointed out in a 2001 article, “The proportion of students in government-funded private schools is sizable in countries such as Australia (25 percent), Belgium (58 percent), Denmark (11 percent), France (16.8 percent), South Korea (21 percent), the Netherlands (76 percent), Spain (24 percent), and the United Kingdom (30 percent).”
“Businesses” are a total red herring. Those nice public services in Europe aren’t paid for by “businesses” they’re paid for by taxes on the middle class. The middle class agrees to pay those extra taxes, because the government has proven it can run the public services effectively. Democrats would love to raise taxes and expand public services. (See, e.g., the Democratic primary.) They just can’t convince voters that voters would get their money’s worth.
Likewise, the idea that public services in US cities is bad because Democrats aren’t far left enough is totally absurd when in Germany you can ride around on a partially-privatized passenger rail system and send your kid to a private school 85% subsidized by the government.
"There is an E.U.-wide directive that requires rail to be deregulated and opened up to competition. If we had something similar here, instead of having government departments operate commuter rail service in say Virginia"
My impression is that in the US, the existing system basically gives priority to freight, and that passenger rail is poor because of that.
I have been on an Amtrak train that had to wait and wait for a (private) freight train, and of course people blame Amtrak and the government for the delay which is a little unfair.
But in the big picture, I think it's not intuitively obvious that prioritizing freight in the US is the wrong decision for the country. I mean, you could argue it, but maybe freight is the best use of rail given the overall lack of density of the country.
That's not really fair. American cities have "high taxes" in the sense that they are higher than in non-cities, but that's really not that much money. New York City raises something like $55 billion / year, but that's only around 4% of its GMP. New Yorkers are still taxed overall rather low for very big city in a very rich country.
As for public services sucking...it's easy to point to obvious failings but hard to compare public service suckiness overall. Americans are generally unhappy with their public services but so are most Europeans.
dunno about the rest of the cities, but I tried to find some data on wealthy republicans in baltimore. only about 8% of all the people in baltimore are registered republicans. pew forum doesn't even break down republicans by income, presumably because there are so few. [0]
it's true that wealthy people dominate politics in pretty much every municipality in the US, but at least in baltimore the shot callers are likely all dems.
Sounds like you're inventing anti-Republican conspiracy theories to explain the failure of states and cities that have been totally dominated by the Democratic Party for 50 years.
In doing so you're preventing the Democratic Party from being held accountable, so that they may be pressured to fix the serious problems that exist with their ideology and political structure, which ensures that more people are drawn to the Republican party, simply as the less unpalatable one of the two.
The people who are going to agree with your tenuous explanations for the failure of Democratic-run cities were always going to vote Democrat anyway. It's those people who are on the fence who are not in your political bubble who you are going to push away by turning the Democratic party into one that does not accept criticism and does not operate in the realm of evidence and reality.
Cities can’t overcome national policy that is directed at broadly destroying social safety net programs, disenfranchising large percentages of the population, driving income and asset concentration, eliminating collective bargaining and facilitating automation and international supply chains all of which rob local communities of the resources and opportunities necessary to rebound.
A mayor has no chance of fixing the city when the tax base is decimated because of these national policies.
For example, consider the housing and mortgage policies over the last 50 years where redlining literally systematically destroyed the real estate and tax base of the very cities you cite as examples of the democratic parties failure to effectively manage city services. When no one can get a mortgage to buy property in a city, prices drop, which means the tax base erodes, which means social services are reduced, which means property values drop further; very nasty negative cycle. Then add a national highway bill that gives preference to suburbs and exurbs and you should clearly see that the cause is not local party mismanagement but broad national policies.
>>Cities can’t overcome national policy that is directed at broadly destroying social safety net programs,
1. Some of these cities spend huge amounts of money per capita on public services. You need to actually look at the statistics and not just make assumptions that fit your preconceived ideological narrative.
2. Social welfare spending as a percentage of GDP has massively grown since the 1950s, which totally contradicts this idea that the social safety net has been dismantled. Before 1967 there wasn't even a Medicare in the US.
3. The most dysfunctional major cities in the US have been strongholds of the Democratic Party for decades. If the problems in Democrat-run cities are attributable to federal policy then Republican-run City should be doing just as poorly but they're not.
For all these reasons, I repeat my charge you're inventing conspiracy theories to blame Republicans instead of accepting facts that condemn the Democratic Party
1. You need to cite statistics instead of just saying they exist and systematically disprove my argument. In fact I think cities spend a lot per capita exactly for the reason I describe. Federal policies that hollow out city centers and job opportunity means more people will need services and per capita spending will increase as those that can afford to relocate (and don’t need services leave). Those that stay by definition need more services; this distorts the per capita spending and decouples it from causation. You have to look at all government policy for accurate causation not just local government policy.
2. Yes, some government social safety net programs are new. But they weren’t designed to fix or replace local services or bring the cost of those services down. In fact since they were enacted elderly and child poverty is drastically lower. Generally very successful result as what they were intended to address. But other many programs like food stamps, Medicaid, housing benefits have been drastically cut. Those that haven’t have been tied to work requirements that end up pushing people out of the system. The US has among the lowest social mobility among peer nations because the safety net isn’t there when people need it. So my point stands.
3. I did not refer to any conspiracy theory.
- Republicans policies have been clear and public. Reagan vilified welfare queens and said government was the problem.
- The rhetoric about “starve the beast” is as out in the open as you could ever have.
- The recent tax bill that explicitly targeted democratic states is easy to find.
- The history of the damage from highways cutting through minority neighborhoods and destroying their business districts is as clear and documented as anything in social science as is the racist motive and attitude of the leadership that pushed the actual design.
- Redline mortgages to prevent lending in minority communities was explicitly in the contract and you can read examples. You can find actual maps that were used to approve or reject loan origination based on race.
- There is a Supreme Court case dealing with property covenants that made it impossible to sell property to non-white buyers. Many suburbs were +90% white until these provisions were ruled unconstitutional.
-Should I go on? You’re telling me Baltimore should be able to single handedly fight these trends?
By all means hold the Democratic Party accountable. But first be accurate and complete in was is causing the problem. I never even said these were republican policies. I merely said federal vs local.
However, In reality only the Republican Party is on record saying they want to literally destroy the government because it shouldn’t exist in its present form. Only the Republican Party is on record supporting policies that target “takers” and target people based on race.
I don’t have a preconceived ideological narrative. I have an informed, descriptive theory of political economy based on years of fact gathering, research, and predictive testing. I was a libertarian when I started, now I am here.
Sure, cities can’t make up for federal labor laws. But they should be able to run basic municipal services, like schools, transit, etc., that in other countries are overwhelmingly paid for by municipal and local governments.
Median household income in Baltimore is about double that of Spain or Italy. Median household of African American households in Baltimore, though much less than that of white households in the city, is still about as much as Spain or Italy. There is an ample tax base there to support good municipal services if the government was capable of doing so efficiently.
Economics usually work in ratios not absolute dollars. Comparing services in Spain and Baltimore can only go so far as the cost of those service have drastically different inputs and those inputs may comprise very different ratios making the unit economics worse in what otherwise appears to be a wealthier area.
(I should clarify—I’m not trying to diminish the magnitude of the problem that black households have half the income of white households in Baltimore. That’s a separate issue from whether Baltimore’s tax base is sufficient to support decent public services—somehow, Spain and Italy make due with less.)
Isn’t part of the lack of efficiency of the US system the eye-watering prices for treatment? There seem to be all kinds of incentives for overtreating (eg, using more expensive diagnostics equipment for a simple broken bone), drug costs are unhinged, etc. It’s not only about creating a universal system but also an efficient one, and I did hear Sanders on the Joe Rogan podcast the other day mention some of these things, so maybe not all politicians are so oblivious to this?
I 100% blame the decades long hollowing of the civil service by republican administrations.
That isn't purely partisanship. It's been a stated goal, publicly, of the republicans, their propaganda wings, think tanks, and most importantly, their noxious donor overlords.
"In Europe, universal healthcare is typically paid for with social insurance taxes primarily imposed on people making under $70,000"
I wonder what segment of the population in Europe provides the lion's share of tax revenue overall.
It made an impression on me that I once ran across IRS charts showing that the US relies heavily on taxpayers who are between roughly $200-500K in yearly income. So, not CEOs and billionaires, but not people making $70K either. These are the people who have to be, and are, taxed heavily to keep the system running, but not to the point where it kills the golden goose.
I don't know whether this is how Europe works, or whether they don't have nearly as many people in that income bracket.
I have a hard time believing that you can build a healthcare system in a country with income distribution like the US with the 200-500k bracket as the backbone.
Here in the EU (Spain, but also lived in Germany and the UK) we are quite heavily taxed and there’s always talk about having the rich pay more but we (the middle class) have also accepted that we get what we pay for. Our healtchare systems are far from perfect, but no one with cancer or a serious liver condition is left behind. Never ever seen one of these feel-good stories on this side of the Atlantic.
I think the root cause for all of this is Group Cohesion vs Individuality.
America and Americans are deeply optimized for the Individual, including giving them more flexibilities and freedoms, but also sparing them the burden of societal obligation.*
I think this choice is why America is responsible for so much innovation and why it's a fantasy for immigrants to come and achieve their dreams.
I would venture a guess that America is relatively the easiest place in the world to become a millionaire or a billionaire.
However it's also why it's a dystopian hellscape if you ever slip and stumble off the path. It's also the easiest place in the developed world to become homeless, destitute, or die from a preventable disease.
So what does it mean. Should this kind of society exist? Conservatives always optimize for people who opt into this by choice. Privileged entrepreneurs, working hard to make their mark, without the same obligations and burdens that exist in other flatter egalitarian societies.
But most humans, even in America, don't choose their circumstances. They are born into them.
Which means that for them, the American Dream is a delusion, a fantastical tease, as likely as winning the lottery.
So I would venture that the American system is a net negative for their citizens, and for world humanity at large (not that other intervening super powers like China are any better).
Student loan debt, lack of healthcare, private individuals actively working to undermine the government from effectively operating, government contractors using public funds to fuel their entrepreneurial growth, all of these are symptoms of a deeper societal sickness.
But only 30% of the country (at best) wants to see it fixed. Another 30 thinks everything is just fine. The last third actually wants to make things even worse, and is inspired by either Atlas Shrugged or The Old Testament or The Handmaid's Tale.
So what now? The cynic in me thinks that "the American dream" will become in the 21st century that "the British empire" became in the 20th. A historical relic of past relevance, while the country slowly decays.
* Except when religious-based policies Trump everything else (E.g. "Personal freedom to live your life, unless you're gay."
By EU standards, these are medium-low taxes still, by percentage. The difference is not in healthcare though, but in other social spending, esp. pensions. US healthcare is extremely expensive by percentage.
It's a policy failure, not money failure.
But a lot of countries dubbed as having "universal healthcare" don't actually have universal healthcare. A lot of them only cover some services and still require you to pay into the system to receive care.
It's not sunshine and rainbows in many European countries either. Maybe it is that way in the rich ones, but not all of them.
You are right, but it still makes sense to compare. I am from Bulgaria, the poorest country in the EU and I have been living in the US for a while with an ok salary for a scientist. I keep an average (for the country) health insurance in both countries. I feel more secure when I am in Bulgarian health jurisdiction price-wise and emergency-wise (simple things like knowing no one will try to trick me into paying for an ambulance ride, that there are no gotchas about which provider I need to see, that my insurance will never be prohibitively expensive to keep, etc).
As a Dane living in Bulgaria, and who lived for a while in America, I too agree that I feel more secure with the Bulgarian health care system than the US one
It might not be sunshine and rainbows, but when i read about Americans taking an Uber to the hospital because they can't or don't want to afford an ambulance i can only shake my head in disbelief.
I once ran into a woman with stage IV cancer and a nasal medication infusion pump who was on her way to a bankruptcy hearing to justify keeping her clothes and living arrangements while the hospitals, doctors and insurance companies vampiricly liquidated her life and all of her possessions. That's where America is right now. If you're sick, you'll likely go bankrupt (it's the leading cause) and you still won't necessarily be able to afford proper treatment.. and then if you die, your family will be most likely be destitute.
PS: "rugged individualism" based on "pulling oneself up by their bootstraps" was taken from a children's fairytale about an impossible task.
Sounds like you may not be from Europe. In Europe nothing is perfect but man, reading how the system works in the US is very depressing compared to how it works here.
I am from Europe. I'm speaking from experience here - I've had years with no access to healthcare. It just meant that I didn't go to a doctor when I was sick and I just ignored my chronic conditions (asthma with no inhaler during allergy season is not fun).
Usually European healthcare is a patchwork that looks confusing but at the end everybody gets the healthcare and you don't go broke even if you have to pay something. For example, you may have to pay up to some sum per year or percentage of your income. If you have income you don't have to pay.
I'm saying that this is not true. Estonia requires you to contribute (pay for it through taxes), or be registered as a student, retired or be a recipient of unemployment benefits to have healthcare. If you're unemployed, but don't receive unemployment benefits (eg you don't qualify) then you don't get healthcare.
Poland is the same. In such case, you explicitly need to self-insure with the state, and pay about $100 per month. I believe it was done to move people out of the grey economy - now, even if they don't pay taxes, they still need to pay the insurance (whilst if you pay taxes, most of the insurance premium is deduced from the taxes you pay, i.e. "free").
That sounds a bit different from the gov / non-private system we have in Germany. Sure, no doctor will make an appointment with you for anything not life-threatening unless you have a valid insurance chip card. But you do have emergency services available and coverage is continuous.
A family member didn't pay for a while. He had to pay up for the entire duration eventually, even if he had switched providers. So I'd expect that insurance would have gotten the bill in case emergency aid would have become necessary. That's very different from the US, where you would have to pay the bill yourself (from my understanding).
> So I'd expect that insurance would have gotten the bill in case emergency aid would have become necessary.
In Poland, if you don't pay, then in theory the hospital bill comes to you (as otherwise, there would be no penalty for not paying). In reality, 99.9% is insured one way or another and it's really hard to find someone who actually did not pay the insurance and needed serious/expensive medical help to see what actually happened in his/her case - I've never heard of anyone like that. Also, our consitution says that "the authorities provide equal access to publicly funded medical care, regardless of one's financial situation". Which IMO makes the whole system unconstitutional, but no one bothered to challenge it yet.
There is an enormous amount of rhetoric about how terrible the US system is, but the differences seem very nuanced every time the details are discussed.
In the US, hospitals are required to provide emergency treatment. When I was uninsured and needed emergency treatment about 14 years ago (before the ACA/Obamacare), the hospital made an attempt to help me apply for public assistance (Medicaid), because they assumed I would not be able to pay. I ultimately paid the bill in full, out of a (perhaps misguided) sense that I should because I could, but I was told at some point that they normally wrote off half of any bill not covered by insurance.
The not-very-nuanced difference is the frequency with which people find themselves without affordable access to healthcare, and the scale of magnitude of the price tag when they have to pay anything.
It seems like you are making an effort to describe the situation in a manner that connotes authority and facts, but it would be more constructive if you used terms with clear definitions and provided the numbers that you are describing.
It's a form of mandate, so yeah, probably. But no idea why they didn't try that in the first place. Probably didn't had enough to make it worthwhile. You can negotiate a payment plan and I'm sure there are gov support programs, but I'm not familiar with those and that stuff is for sure quite complicated, just like every other system that tries to be fair.
I don’t know the healthcare situation in all European countries, and it’s inevitable that some countries will have less coverage than others.
But when one uses a country with a population of a bit more than 1 million as an example of how it’s not all sunshine in a continent of over 300 million, then I’m not really impressed with the argument.
I'm not arguing against universal healthcare. I'm saying that the claim that Europe has this is untrue. Europe (as a whole) is not an example of it. Maybe some individual country in it is.
I generally support universal healthcare in America despite the massive downsides of having the government administer it.
But I think the debate about values and principles is way more complicated than you are acknowledging. A lot of it boils down to terminal subjective value systems.
Do you value “freedom from” financial ruin more highly than “freedom to” spend your money however you see fit (e.g. low taxes)?
There’s no easy high level argument for why someone should normatively prefer “freedom from” over “freedom to” ways of thinking.
You won’t get anywhere just decrying the “freedom to” crowd and dismissing their sincerely held values and beliefs.
I dislike discussing this in terms of freedom, because I feel that it misses the severity of the situation. After all, how free one is when they're dead due to lack of healthcare? The CDC estimates that 45,000 Americans die each year due to lack of healthcare [0](from 2012).
People are not going to the doctor when they have something treatable and preventable, because they're not covered. They'll go to the ER when whatever they have progresses far enough, and the associated monetary costs and risks to that persons life will be of course be higher because they let the problem persist.
I also take issue with the idea that this would cost more than the current system does. We spend almost twice as much per capita than other industrialized nations with universal healthcare do.[1] There are cost savings involved when you get rid of the middlemen and redundancy that comes along with our current for profit system.
The number I keep seeing in the media is that, for example, Sanders healthcare plan would cost 32 trillion dollars over a ten year period. Yet we're currently paying 34 trillion dollars.[2]
But nothing you say is connected to whether someone should value this higher than freedoms that would be reduced. You’re making tacit normative assumptions and then refusing to engage with people who sincerely know the same facts you know and don’t attach the same meaning to them.
What? I'm not sure I understand what you're saying exactly, so please correct me if I'm making misinterpreting you here.
There are going to be people who are worse off with universal health care due to higher taxes, there is no doubt about that. The question is how much worse off will they be versus how much benefit will the average person gain as a result? How many losers will we have and how many winners, and by how much will the losers be hurt / the winners gain?
Like I've already mentioned, the costs that I've seen in the media are 32 trillion for universal healthcare, versus the 34 trillion we're paying now. So already the universal health care system is saving money and thus increasing "freedoms."
There will of course be people who have a higher burden than they used to, though. The idea is that this burden would be put on the wealthiest among us, who have, by the way, seen their share of wealth grow over the past 30 years while the wealth of the bottom 90 percent has fallen. Today, the top 1 percent of households own more wealth than the bottom 90 percent combined.[0]
Given such facts, I for one am comfortable with the idea that we sacrifice some of the "freedom" of these individuals in order to increase the "freedoms" of everyone else. By the way, even under such a tax system, the freest among us will still remain the most free.
This is all ignoring the fact that the current status quo is needlessly killing tens of thousands of people per year, which you neglected to address in favor of talking about some abstract decrease in freedom for people due to a decrease in income for people who are already extremely well off / the most free.
Yes, you are misunderstanding me. Some people might attach a subjective value to the freedom to do what they please with their money. To them, this might be a higher idealized state of being than a state of being where people are less free with money but more free from worry about whether the next medical crisis will ruin them.
This is not about any analysis of taxes or numbers of people who will die from lack of care: it’s a normative value. Sort of like saying “murder is wrong” ... okay, but why?
Some people just sincerely believe that it’s better, from a moralistic standpoint, that your personal property and money are unrestricted. To them that is a high ideal state of humanity flourishing, because they look at the fact of the number of people who die from lack of care and they think, our freedom is well worth that unfortunate cost, and the world where we give up freedom (so they would say) to reduce the number of people who die from lack of care is a worse world (in their way of assigning value to states of being).
You’re coming at it from a point of view where you seem to think the facts you cite “speak for themselves.” But there’s no such thing because many people are well aware of the exact facts you mention and yet think that universal healthcare represents a reduction of personal property freedoms that is morally wrong to such a degree that it’s worse than enduring the social costs that come with an absence of universal care.
I get what you’re saying. But I don’t think such a philosophical approach will move the discussion forward. I don’t think many value one belief (freedom to spend) absolutely over the other (freedom from financial ruin). Most are willing to compromise and can be swayed by appealing to other things they might value, like saving lives.
That’s a more reasonable feeling, though I think the polls of popular opinion on taxes, healthcare and guns undermine your argument. I think it really does boil down to fierce defense of raw philosophical ideals for most people. People, at least in America, are not swayed by compromises on saving lives and lay down deep hooks into value systems based on ideals and then believe the defense of those ideals may rightfully entail loss of life and it can be acceptable.
I actually think the left’s dismissiveness of this way of life, spurning sincere engagement on moralistic ideals to try to use government to push compromises on people, is what fails to move the discussion forward, even though I personally subscribe to most of those pragmatic social welfare approaches.
It's this thing where US political dialog has basically become "Well _I_ would like this but what about all these other people the media say won't like this? Won't someone think of them?" which short circuits to "Oh I don't want this"
Lots of people who worry a hell of a lot about the federal deficit when talking about whether they would like to be able to afford going to the doctor. Nevermind that this discussion rarely covers the deficit when it comes time to give tax breaks to "job creators".
Also the Democratic party is comically bad at politics in the US. Like "oh but you might lose your private insurance" is a discussion people in the primary are having _when you would be replacing private insurance with free healthcare_. What sort of positioning is even being had here? So many people are stuck in the 90s
> Like "oh but you might lose your private insurance" is a discussion people in the primary are having _when you would be replacing private insurance with free healthcare_. What sort of positioning is even being had here?
A common fear is that wait times to see a doctor would be much higher with universal healthcare compared to a system with private insurance.
Horror stories about people in Canada and the EU waiting months for a procedure that would be available immediately to someone with private insurance if in the US.
I don’t mean to start a health care debate in this thread. My main point is that there are reasonable (logical, rational) fears that people have causing them to be against universal healthcare. Understanding those fears and addressing them upfront is one way to get past them.
"I don't want to wait in line, so make sure poor people can't go to doctors", which is the reason there are lines and wait times, is basically a cartoon villain argument and anyone making it should be treated as such.
The anxiety is not about the wait but rather the potential consequences of the delay, such as the potential death or prolonged suffering of a loved one.
Got it. "my sick dying relative > your sick dying relative". Total morally reasonable now, thanks for clearing that up.
Why are there going to be lines and waits with expanded healthcare coverage? Because people who need to see doctors will be seeing doctors. If your logic train is "Expanding coverage will create lines, therefor don't expand coverage" and not "Expanding coverage will create lines and therefor we will need to find solutions to new problems when we expand coverage" IDK how you're not just doing some gatekeeping to keep services high for yourself at the expense of others.
>Got it. "my sick dying relative > your sick dying relative". Total morally reasonable now, thanks for clearing that up.
Yes, either that or one's own health being potentially at fault and having to wait too long for treatment. I didn't mean to insinuate that it was a morally correct choice; only that I thought it was a perspective not being considered. Better healthcare for all is a good thing and is something many people support, but doing so at cost of a loved one's health makes the decision far more difficult.
I will die on this hill. If you oppose expanding healthcare because you feel that then too many people will have healthcare and that will cause problems for you, you're a terrible person. "What about the smaller number of people who have a great situation" is never a counterpoint to "what about the much greater number of people who have a terrible situation"
If your tribal leaders support something, you do. Tribe comes before religion, race, or any other consideration, though admittedly many of those are correlated. In the end, for around 90% of Americans, its about R vs D.
The reason is pretty simple to understand- Those who can afford health insurance dont want their standard of care reduced on a 'free for everyone' system. Looking at the existing bureaucratic issues the current 'free' health programs have ( VA, Medicare, Medicaid, etc.. ) seems to indicate their fears might be well placed. In the VA for instance, you can go months just to get a first visit.
Basically, people who have a job and get health insurance dont want to be lumped in with the commoners and get worse care/longer wait times/less options/etc... Its fucked up, but its not hard to understand the pushback. They dont want their health care experience to turn into a 6 hour trip to the DMV.
That doesn't explain why people who can't afford health insurance are opposed to universal, government-funded healthcare, which is what the comment above you was about.
Meanwhile, I (SRE at a hedge fund) and all my liberal coastal elite friends can absolutely afford private doctors in an emergency without having to think about cost up front, and we do support universal healthcare—and we know it would be a larger tax bill for us.
(BTW, in practical terms, putting liberal elites in well-paying, politically-connected industries on your healthcare system is a great way to make sure it doesn't turn into the VA. America cares deeply about our happiness. It doesn't care about our veterans and sort of wishes they hadn't survive, so we could just remember their sacrifice instead of actually facing up to what we did to them.)
for a lot of deep-seated structural reasons, the US tends to be pretty bad at implementing most citizen-facing services. it doesn't seem unreasonable to think that we would also do much worse at universal healthcare than the europeans. for the services that the US does actually offer, we tend to spend more money and produce worse outcomes.
> (BTW, in practical terms, putting liberal elites in well-paying, politically-connected industries on your healthcare system is a great way to make sure it doesn't turn into the VA. America cares deeply about our happiness. It doesn't care about our veterans and sort of wishes they hadn't survive, so we could just remember their sacrifice instead of actually facing up to what we did to them.)
this is a pretty common talking point, but I don't really see this happening with the systems that already exist that wealthy people have to use. I, an upper-middle class white person, still have to take at least a half day of PTO any time I need to go to the DMV. my dad, wealthier than me, still had to spend a whole day at city hall disputing a $40,000 water bill (the city doesn't even have a functioning water meter on his property because DPW paved over the access; it's been "estimated" for twenty years).
>and we know it would be a larger tax bill for us.
It would quite possibly be a net saving. The UK, for example, spends less public money on healthcare than the US. There's no necessary reason why you should end up paying more in taxes for universal coverage than you pay currently for insurance.
convert your USD salary to pounds and then do a UK tax calculator. compare the UK NHS tax to your yearly premiums and copays plus the employer contribution (should be on your W-2). when I did this, I found that I would pay about $2k more for the UK tax than my total healthcare costs in the US (including the portion paid by my employer). I'm sure lots of people on this forum make even more than I do.
there are definitely some good arguments for universal healthcare, but software devs should not delude themselves that they will do any better than break even in most cases.
edit: probably not true, I didn't investigate the UK tax system enough.
What is the UK NHS tax? There is no such tax, as far as I'm aware. You may be thinking of "National Insurance", but that is not specific to the NHS (and nor do all NHS funds come from National Insurance).
sorry to be obtuse, did I just call it the wrong name or is it completely different? I'm american and I just assumed that NHS is the government org that handles healthcare and a mandatory contribution is pretty similar to a tax.
See my comment above. Not all of National Insurance goes to the NHS, and not all NHS funds come from National Insurance. There exists no special tax whose revenue is earmarked for the NHS. Thus, there is no easy way to see how much of your pay you are contributing to the NHS. Similarly, someone in the US can’t easily see how much of their pay goes to the US military or to the National Science Foundation.
edit: On an individual level, a lot will depend on your income, and how expensive your US health insurance is. Here is an informative post:
That works out to about $560/month for someone with a salary of $100,000. If you take into account employer contributions, that's still less than a lot of Americans are paying. If you're on a lower income, you're likely to be paying significantly less in the UK for much better coverage.
And I almost forgot - copays! The amount you're paying in taxes in the UK really is paying for virtually the full cost of your treatment when you're sick.
>That doesn't explain why people who can't afford health insurance
It's because doctors et al don't want to work for less than $x/hr and there are people who don't produce enough to trade with doctors or prefer to spend their money on other things. There's no way to get a free lunch out of this.
Respectfully need to split a hair on the VA comment: once you're into the VA system, their access is incredible. If you can't get an appointment in less than 20 days, or if you need to drive more than 30 minutes, they'll pay for you to see a doc in your community. So you certainly do not need to wait months to get an appointment at the VA.
There are veterans who are still waiting to get paperwork processed to show a service connection for health issues -- they're still waiting to get into the VA system -- but that's a different bureaucracy. The wait time at most VAs once you're in the system is substantially less than through my employer-provided insurance.
I'll preface what I'm about to say by pointing out that I am all in favor of universal healthcare.
BUT.
I have a hard time thinking of getting a doctor's appointment in 20 days as "incredible access." If I need to see a doctor, I can get an appointment at the local clinic within a day or two. And my employer-provided health insurance is pretty crappy! If I tell the clinic I think it's important (like I'm in pain but it's not an emergency), they'll try to fit me in the same day if possible.
And that's not even considering the Urgent Care facilities 15 miles away..
> I have a hard time thinking of getting a doctor's appointment in 20 days as "incredible access."
According to kaitai, those "20 days" are the absolute upper boundary. As a German, I don't find that upper boundary particularly high. When I need to see a specialist about something that's not an emergency, a wait time of a few weeks is normal since there are only so many specialists per area.
But does it really reduce your standard in those systems? I know it's really hard to properly compare the costs of something like this between countries, but it would be interesting to know how much you need to spend on healthcare in the US to get similar benefits as in some European country purely with public healthcare. Since another benefit of public health care is that you can be reasonably sure people around you are healthy and not dragging themselves to work with god knows what since they can't afford treatment. Be it your colleague or the cashier at the store.
It's actually quite baffling how Americans generally seem much more generous, warm and helpful to their fellow human beings, but the idea of potentially paying for someone else's medical treatment seems absolutely outrageous to most.
> It's actually quite baffling how Americans generally seem much more generous, warm and helpful to their fellow human beings, but the idea of potentially paying for someone else's medical treatment seems absolutely outrageous to most.
this is just my personal take as an american. I think the disconnect has to do with locality/proximity. americans who have some surplus income (ie savings and not living paycheck-to-paycheck) are quite willing to help people they know with cash or free labor and will happily donate time or money to help people in their broader community. what americans hate is being forced by the government to help people far outside their circle. I think partially we are suspicious that the money doesn't get where it's supposed to go intact, but there's also an element of "fuck them, what do those people over there have to do with me?"
obviously this is suboptimal as entire communities can be disjoint and have serious imbalances in funds available. also it tends to leave a lot of efficiency from scale on the table. but perhaps this at least explains some of your bafflement.
This might be true but still sounds like the information given about public health systems is biased.
In Spain the public health system is still better than the private one and most of the long and most expensive treatments are done within the public circuit. You can wait months for "minor" issues and there is where a private insurance can help (actually I think is beneficial for the system that anyone being able to afford a complementary private insurance should pay for it)
Also, having experience in both systems I feel better when I am treated by someone with no economic interests.
It’s funny, I live in Japan where contrary to my experience in the states, I can go see a doctor any time - just walk in. No need for specialist referrals either. If doc says I need to see a specialist, I just walk in.
US politics, specifically from the right, lobbies pretty hard and uses fearmongering to the max. Lower standard of care? What’s that? Wait times? Sure, you may wait a bit longer that one day, but someone will see you. I remember when my wife needed to see a therapist for her depression, we had to wait 2 weeks to see someone “in network” in CA. This was with good insurance. Here, walk in, wait, see doc, walk out. My fellow Americans need to wake up to reality and try to understand that powerful interests are lobbying against you and using fear as primary means for arguing against “universal” healthcare. Let me be clear, I still pay a monthly premium and I still have co-payments, but one this is for sure - it’s practically impossible for me to go bankrupt due to a medical issue.
Because the US has so many successful corporations, its politics is controlled by corporate interests to an extent not seen in most other developed countries (where the political “right” tends to be the nativists and the propertied class). The “small government” concept in the US creates a political incentive for government to be ineffective and wasteful creating a self fulfilling process through which any politically visible part of the US government is terribly ineffective and the pieces that are behind the scenes are excellent. That’s why universal health care is likely to be a terrible boondoggle in the US.
There are always people a rung below you on the social ladder.
"Sure, I would love to get healthcare. But I don't want /them/ to get it. Especially if they are immigrants."
The tribal divide in American politics is another reason ("if they want it, it must be wrong), but since this level of hatred is quite recent, I think it cannot fully explain it.
Americans are so racist, they'd rather get bankrupted by illness and die, than have universal health care help black people.
At the same time, they allow ~1 million mostly non-whites to legally immigrate every year.
I think insurance/medical industry lobbying is a far more consistent explanation. In general, if a story starts by bringing up racism from 150 years ago, it's more concerned with building a narrative than with explaining the current state of affairs.
Rather refreshingly, the NYT admits this: "It aims to reframe the country’s history, understanding 1619 as our true founding, and placing the consequences of slavery and the contributions of black Americans at the very center of the story we tell ourselves about who we are."
It's fascinating that HN downvotes comments pointing to America's historic struggles with race (which did, beyond a doubt, exist and leave a fingerprint on the political reality of our current country) when people ask questions for which race is a potential answer. It's happened to me before too, IIRC also with a cited claim.
I mean, I totally understand avoiding the subject because it leads to flamewars, because some people respond very poorly to the suggestion that racism exists and has practical effects today. But then you're better off not having a discussion about the topic at all than a skewed, censored one where one plausible answer is just too politically incorrect to be debated.
-Yes, racism existed in the United States. Virulently so.
-Yes, racism still exists and, yes, it is a huge problem. We should work together to support all minorities.
-No, racism is not the primary or even a significant cause of every single bad thing that happens.
It's like the people in the story of the boy who cried wolf; hearing "racism" being trotted out by one-note progressives as a response to any question about the United States' woes (particularly when it's not even very plausible) is viewed as tiresome and unconstructive. And I say this as a minority who has experienced racism!
I don't think it's even about the money anymore, since nobody seems to take issue with massive deficit spending in the US.
A lot of Americans see it as a threat to their sense of individualism, and that is why they fight it. To them, any government program which makes our lives easier will cause people to be lazy and dependent. If we want universal healthcare, we need to address that message.
Nobody works harder than a Japanese worker. And Japan has government-administered “universal” healthcare. The idea that access to affordable healthcare makes people lazy requires mental gymnastics and total ignorance.
Help me understand, which ideologies are allowed to be discussed? The person I replied to didn't understand why people don't vote for certain policies. I tried to help them understand the position of people who don't agree with increasing aggression.
It's not a question of one ideology rather than another. They're all equally bad when it comes to generic internet discussion, and especially flamewar. Such discussions have all been had a million times, they're all predictable and therefore tedious and therefore off topic here. HN is for curiosity. There's zero curiosity in "taxation is theft" (or "property is theft") flamewars. Ditto for "state aggression" here, which is a generic ideological tangent even from a subthread that was already one in its own right.
I'm a US citizen who does not want the government to run healthcare. I'm also an immigrant from a country where it does. I've seen what my family in my country of origin has to deal with and...no thanks.
Not at all -- you work for (and I assume are insured through) a rich company that contracts with insurers who are incentivized to keep that company happy and maintain their contract. Most Americans don't.
Google is also self-insured, which means that Google is actually paying for healthcare, not the insurer -- the insurer just manages the networks & relationships with providers, and it's just pure profit for them. Google, meanwhile, wants healthy employees. No one has an incentive to deny claims, so ultimately you are seeing the best side of the system, in which almost every actor wants good outcomes.
Contrast this with Medicare or Medicaid, or private insurance on the individual level, where the incentive is to reduce "medical loss", the industry term for...actually paying for healthcare. Arguing with insurers over denied claims is par for the course -- so much so that some insurers just routinely deny things (and patient is on the hook) that their own plans say should be covered, with the hope that patients won't realize they can appeal.
Having experienced both ends of this -- as a former Googler myself and in the individual market pre-ACA ("Obamacare") -- I can tell you the difference between the wealthy corporate insurance plans and the individual market is night and day.
Sorry for the very belated response. I'm also from England, and I have a number of American colleagues who live and work in the UK and strongly prefer the NHS (with all its drawbacks) to the American system of healthcare. So I'm surprised to hear your opinion.
> This speaks more to your country of origin than it does to universal healthcare.
Ignoring the rudeness of your comment, who is to say that the implementation of universal healthcare in the US will not wind up as dysfunctional as the system in the parent poster's country?
The problem with endtime's argument is that it's a non-sequitur. It comes down to:
> There is a country where government-run healthcare is bad. Therefore a proposed government-run healthcare system is probably also bad.
This simply doesn't follow. I could make the same argument backwards by pointing to a country where government-run healthcare works well, and concluding that therefore universal healthcare in the US is going to be awesome.
endtime is demonstrating his/her sentiment, but does nothing to advance the discussion.
Every other western country does it by piggy backing on all the innovation happening in the US.
Next there's the costs. Universal healthcare isn't going to make it cheaper. It will get more expensive since it's hard to set up in such a way (read: free market force way) that certain people have ownership and can be held accountable. With a government solution everyone gets incentivized to avoid as much ownership as possible. When things go wrong is when the the blame game begins. Departments pointing their fingers at each other. Or pointing at the department that should've been. The easiest way to resolve conflicts is by simply accepting the money lost. It's just tax money anyway.
We “piggy back” on US innovation - just like many other fields - but (a) we pay for everything we buy from America and (b) we’re still able to offer extended healthcare despite having in many cases comparable - or the same! - technology.
Or are you suggesting that the American people must sacrifice their poor so that Europeans can “piggy back” on the gains?
what is a bigger problem is that the us is seen as a place where companies (the wealthy) can avoid the cost of public services like universal healthcare, public transportation, and government backed pension that all other modern countries have. the us workers need to earn more to make up for the lack of government services. but this is not the case for foreign workers whether they are legal or not. foreign workers will always be able to underbid their us counterpart as if they ever get sick and/or old they can go back home.
corporations are forcing the us working class to give them a discount on their labor costs. this is why so many companies have heir headquarters in the us. plus they have the added benefit of ip protection. the wealthy people of the world are literally raping the us working class.
the american worker must be paid more to make up for the lack of social services. but us minimum wage is very low compared to other first world countries.
clearly one solution is for the us working class to form a massive worker's union. but another possibly more realistic solution is to destroy the US's reputation as a haven for the protection of intellectual properties. If the US is less known for ip protection, the wealthy will stop fighting the working class from implementing social services. they will start moving their companies to the EU.
> what is a bigger problem is that the us is seen as a place where companies (the wealthy) can avoid the cost of public services like universal healthcare, public transportation, and government backed pension that all other modern countries have.
“Other modern countries” don’t pay for these services through taxes on “companies.” Of the big 5 EU countries (which together comprise 70% of the EU population), 4 countries rely less on corporate taxes than the US. The UK is the only exception, with corporate taxes making up 8.3% of revenue, versus 7.6% in the US: https://www.oecd.org/tax/tax-policy/revenue-statistics-highl... (page 3). By contrast France is 4.5%.
Nor do corporate taxes fund the Nordic welfare states. Corporate taxes make up between 4.9-6.2% of tax revenue (less than the US) in Denmark, Sweden, Finland, and Iceland. Norway is the only one that’s higher than the US, and that’s only because of the special 55% tax on oil company profits (the normal 23% Norwegian corporate tax is in line with the other Nordic countries, and lower than the US).
In Germany, 65% of tax revenue comes from social insurance and consumption taxes, which are paid for by the middle class. (Those who make more than about $70,000 per year are exempted from having to purchase the mandatory health insurance, and from the corresponding payroll taxes.) In the US it’s under 40%.
Put another way, Germany’s higher consumption taxes amount to 3.7% of GDP, and its higher social insurance taxes amount to 5% of GDP. That’s almost all of the difference in total tax burden between the US and Germany.
your response reads like a right wing conservative talking points. maybe technically correct but very misleading due to the lack of context.
> In Germany, 65% of tax revenue comes from social insurance and consumption taxes, which are paid for by the middle class.
that's wrong half of the social security contributions comes from the employer in germany. and is close to 50% greater than the contributions required in the US.
vat (what your talking points refers to as consumption tax) largely exempts everyday expenses that people need to pay in order to live. however, it does increase the cost of doing business greatly as all transactions are taxed.
look at just germany and the us from your documents.
US
24% for ss
0% for vat
total portion of tax revenue = 24%
Germany
37.6 for ss
18.5% for vat
total portion of tax revenue = 56.1%
my point is proven. it's cheaper to run a business in the US because there's a huge discount from not having to pay for public services. and companies are further reducing their cost by hiring foreigners who are willing to game the system by taking advantage of their own country's social policies and in exchange giving their US employers a discount on their salaries.
Who bears the burden of a tax is different than who pays for it legally. (The actual effect of a 20% total payroll tax shouldn’t change depending on how you allocate it between employer and employee.) That is because employers can simply decrease wages to cover the tax. Payroll taxes are primarily borne by employees: https://taxfoundation.org/what-are-payroll-taxes-and-who-pay....
Another important point is that these social insurance contributions are deliberately regressive. In the US, the Medicare payroll tax is paid on all income, and Social Security is paid on the first $130,000. There is a big push in the US to eliminate the Social Security cap. In Germany, by contrast the pension contribution is only paid on income below about $70,000, and workers making more than that are exempt from the public insurance system. (So someone making $10,000,000 per year pays almost nothing in social insurance taxes.)
Likewise, VAT is primarily borne by consumers, and consumer-facing small businesses. Even though the business pays it, some of the tax is passed onto consumers through highs prices. Who bears the VAT depends on relative elasticity of supply and demand. In highly competitive industries like restaurants, the owners and workers can bear most of the VAT. But large corporations m in high margin businesses have the pricing power to pass on most of the VAT to consumers. (E.g. an iPhone is 25% more in Germany than the US, more than enough to completely cover the VAT.) VAT is not paid on investment income, nor on banking services. So the wealthy, who invest most of their money rather than spending it on consumption, pay little (as a percentage of income) on VAT.
Combined with low corporate taxes, the end result is rather right-wing. American Republicans would prefer to have a low overall tax burden because it boosts the economy. But if we had to raise taxes to say 35% of GDP, they would much prefer to have the European system, where the middle class bears most of that burden, than scaling up the US system, which would cause businesses and the rich to bear most of the burden. Notably, the only serious proposals for a VAT in the US has come from conservatives like Ted Cruz, Herman Cain, Saxby Chambliss, etc.
It is the Europe + the Commonwealth + a few other countries. In my mind "geopolitical Western" usually means Europe + the Commonwealth, so I do not see it as much of a Northern thing.
Of course. If you define a term differently than the majority, you'll find to wonder why everyone uses that term incorrectly (from your PoV). "Western" with a capital W is different from "western" with a lower-case W. Insisting that people only use the latter definition is just pedantry.
Well, everybody defines it differently, that's kinda the crux when the term "Western world" does not have a strict international definition. Let alone the historical definitions. So hardly any majority definition, which is why governments across the globe, don't use it. Hence I wasn't being pedant about a definition of it, sorry for that confusion. Merely stating that its use is just a historical hangover that in many area's, people have moved on and those that have not, have disparity in how it is defined.
I like Bernie, but it's not simple. Canada has 60 shrinks per 100k ppl while the US has 4. Universal healthcare is not going to increase the number of shrinks over night.
Another thing with the "all other western nations" line is the population in the US.
There is really no western or "developed" nation with anywhere close to same number of people.
