This is a classic american problem - keep throwing money at something until it works.
This conundrum plagues their healthcare, their education, their military, their welfare spending and so on. For example, they spend more on their military than the next 15 highest spending countries combined, and don't get proportionally better results. They spend a lot more on education (per student) than most European countries, but suffer from worse education quality than some developing nations. There is a fundamental problem with how this money gets spent, instead of how much of it is available.
There is also the issue that they look at the top of the line to aknowledge an issue (or not).
Show how their healthcare system is not very good for the bucks for the average person, and you get answered that the very top specialist at the very top hospital for the very top money there gives you the best treatement ever.
Thanks but I will still take my average specialist at my local hospital for a low price that's included in my mensual who gives me top of the line.
Show the student debt problem or their school system issues, and you get answers about the top ivy leagues and the likes ...
I'm not sure where this comes from.
I'm not saying they're wrong and I'm right, but that I'm even having issue understanding the other's side point of view; I can't really see the benefit to society of that kind of model. To me this feels like going back to feudalism and nobility without the titles. Because I can't see the discussion from their point of view, I'm not able to argue and discuss propely either.
Try saying that America isn't #1 in public and see what happens. You will be shunned, ignored, or plain out told to leave the country. There is a fundamental ideological issue going on here that needs to be addressed to allow for open communication for the big personal issues that you brought up. It's time we all get a bit uncomfortable and perhaps give up things personally for the benefit of everyone.
Tuition costs skyrocketed because demand* skyrocketed. (Student debt)
Healthcare costs went haywire because demand* is insanely huge.
* - demand meaning the actual micro-economical concept, that is the curve/graph/function/relation describing the "preferences" of the customers. And since there is a lot of money in the system, the demand is big. A lot of people can and are willing (and of course forced) to spend a lot on health care. (And similarly on education. Since you want the a better future, at all costs, right? Right.)
> For example, they spend more on their military than the next 15 highest spending countries combined, and don't get proportionally better results.
Hmm what do you mean by results here? Like winning more wars? You can’t really compare two different wars. I don’t think it’d be crazy to say instead that the US can indeed project as much power as the next 15 spending countries, so results are proportional.
Don't forget that the usa sells arms at a loss to it's Ally's when you consider all the r&d aspects.
I'd also bet that you are underestimating some of the militarys classified weapons. Wouldn't even surprise me if we have nukes in space.
Finally look at it this way. There's 23 aircraft carriers in the world right now. The us has 11 of then. China's aircraft carriers are 2nd hand from Russia.
The us navy might not be 15x the size of the next 15 county's. However on a per equipment basis it's likely got a good advantage and we are likely some multiple bigger.
> Wouldn't even surprise me if we have nukes in space.
There's a treaty prohibiting that. Of course, it wouldn't surprise me if the US broke a treaty unilaterally, then was eventually discovered prompting an international arms race to space to the detriment of everyone.
You don't need nukes in space with the "Rods from God" kinetic bombardment technology. The easiest way of putting WMDs in space even without breaching any international treaties:
No, it's actually not enough politics. (Or you can say too much of course, because it's a totally nonsensical analogy.)
The problem is a very inefficient compromise. The US system is a worst of both worlds, because it has both private and public elements and those both work to jack up the prices.
If the public part (medicaid/medicare) negotiated the prices and healthcare providers weren't allowed to go above that, then things were peachy, but that's not the case.
America is a net importer of capital. Money is cheap. The world pays America to be wasteful and spend. All of these problems will be "solved" when that reverses.
How is that calculated? Do you happen to have sources/articles on this topic?
I'd think that the larger economy eats the smaller (that is US money goes and makes profit in the smaller ones), but maybe it's a lot more complex than that.
It has to do with the balance of payments. US entities do invest and make profits overseas. However, investments into the US (including loans to the US Treasury, for example) happen in larger amounts than investments from the US into other countries. Regardless of where profits are made or who made them, people prefer to put their money in the US.
Their margins are limited by law and the people paying (employers) are mostly price inelastic.
This puts them in a position where they're incentivized for costs to go up, because 15% of $2000 is more than 15% of $1000. In other industries, you'd see insurance companies push back because ultimately consumers will push back and either drop insurance or switch to another provider.
Switching insurance at an employer, though, is a colossal undertaking that is bound to frustrate employees, so often it isn't done. And until recently, individuals would be fined for not having insurance, so dropping insurance wasn't really an option.
If consumers were the ones paying for it, switching weren't a pain to do, and insurance companies weren't incentivized to maximize costs, that'd go a long way toward fixing this.
Not enough competition. Too high barriers for entry.
(The market is actually not one big, but 50+ smaller ones. Furthermore each of those have very high regulatory limitations for entry.
And since we're talking about a risk-premium business, it has inherent risks - so the easy actuarial areas are already well covered - like life insurance, but the various others are a lot harder to estimate ROI-wise better than the competition.
And since you can make a lot of money elsewhere, there's relatively not much money chasing new health care insurance.)
Plus the market is set up very inefficiently, as the HMOs (health maintenance organizations, the networks, the "insurers") can play the divide and conquer game. Play employees and employers and the government against each other, so there's no real incentive to compete on prices.
They try. They insist on paying doctors as little as possible. They challenge the necessity of procedures. Doctors fight back by choosing to classify procedures in more expensive ways. It's a tug of war. There are whole teams of people at hospitals whose job it is to make as much money as possible by arguing as much as possible with insurance companies over prices and necessary procedures.
The fundamental problem is the antagonistic nature of that system, as disconnected from the need of the patient. Doctors want to do more and charge more. Insurance wants to do less and pay less. Nobody is asking whether a procedure is worth what it costs the patient.
You can't improve system prices with distant and ignorant downward pressure, even if you're a huge buyer. You just don't have the information and intelligence. Medicare tries that, with the result that it sometimes pays for lots of unnecessary procedures and spends too much, and sometimes insists on prices that are too low and has doctors quit taking it. It doesn't have the information to get it right in either direction, and insurance has the same problem.
What is needed is price discrimination at the point of sale. In a very blunt sense, we have this in the patient's decision to go to urgent care rather than the ER. In a broader sense, though, when a doctor says (for example) they'd like to do a test just to be on the safe side, there should be a discussion about how much that test costs and what the consequences might be of not taking it. When someone says (for example) with respect to end of life care, "We can try this very expensive probably-futile procedure", costing the grandkids their inheritance is a not unreasonable piece of that conversation.
My experience is that doctors in insurance-dominated environments typically do not even know what their suggested interventions cost. But I once had a conversation with a doctor in a self-pay environment (urgent care) who said, "We did test A, $5, and it's negative. We have the option to do test B which is more accurate with respect to false negatives but $100, but I'm pretty sure you don't have it based on other signs." Reeeeally useful conversation if you're looking to save money and understand the consequences of a decision. More of that can bring the price of healthcare down by orders of magnitude. The insurance doctor did test B twice a month without even asking me about it, and probably had a team of specialists ready to argue for its necessity with insurance (there was no insurance, I was paying, and I would not have regarded it as worth the cost).
This conundrum plagues their healthcare, their education, their military, their welfare spending and so on. For example, they spend more on their military than the next 15 highest spending countries combined, and don't get proportionally better results. They spend a lot more on education (per student) than most European countries, but suffer from worse education quality than some developing nations. There is a fundamental problem with how this money gets spent, instead of how much of it is available.