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But US is pretty much a third world country when it comes to social safety net


I think people from actual third world countries would love to be in the US where the government gives you stimulus cheques, instead of back home.

Trust me, the unemployed life in third world countries, and even in second world countries, is far more brutal than the unemployed life in the US, especially for unemployed big-tech workers who can find a new job anytime.


  > unemployed life in third world countries, and even in second world countries, is far more brutal than the unemployed life in the US
maybe so, but we should look at the trend not just one sample group at one point in time... for a long time it can be argued that the u.s is riding along as fast as it can to catch up to "the 3rd world" in that regard....


The US safety net, in terms of spending, is as expansive or more expansive than the rest of the world. For example, the U.S. spends $748 billion on Medicaid, health care for the poor, which is matched by state governments. Obamacare subsidies are another $160 billion a year. The fact is the terrible U.S. government administration of these programs and the regulatory capture of the health care system by doctors, pharma, and hospitals are the core issues, but liberals whistle past these real issues and wonder why we don't have European comforts and outcomes per dollar.


Just to be clear, you’re not implying that, just because the US spends more on healthcare than other countries, that means it’s any good right?

Coz like… it’s not hard to spend trillions of dollars when you charge $5000 for a tablet you can buy in Australia for like… $20.


I don't think that was the point that they are trying to make.

A lot of people hold the belief Healthcare in the US is bad because it callously refuses to spend money on people. This is not the case.

When you remember that those funds were largely deducted from someone's paycheck, it has a real impact on those workers and it's important not to dismiss all the hard work that did go into supplying those funds.

That's not to say that there are major structural issues with how Healthcare is regulated in the US, primarily related to how those funds are spent


I don’t know how “spending more money for less benefits” is better than “callously refusing to spend any money”? If your country has good intentions or bad it makes very little difference when u’re dying from treatable cancer because u can’t afford the care. Or when u have to go back to work immediately after giving birth. Honestly, my mother lives in Russia, which is by no means an example of a country with a good social net, she was mortified when I told her about US labor laws. It’s true u net more cash in the US, but u also have only urself to rely on if anything bad happens, and people are really bad at financial planning for any and all unfortunate circumstances


There are significant differences when it comes to expectations on a fix. If the problem is just refusal to spend, the policy problem is easily improved with easy to write legislation: 'medicare will now cover everyone over 55'. The US healthcare system is far more difficult to improve than that, as just asking the government to cover more bills at the prices companies and the public pay would be hard to sustain. Changes to make costs more in line with European countries would have extreme opposition from some people: Every dollar of waste is someone else's income, and in general those are also American voters. This doesn't make American healthcare any better, but it means that it takes extreme efforts to make it better, even a little bit. So it's at least not a matter of malice.

As for labor laws, the US does far better than it seems. Easy to fire also means easy to hire too, as the risk taken by the employer is also far lower. And the stronger the protections, the higher the slack, showing in unemployment. Very few European countries have the unemployment rates of the US, and the ones that do get there via a lot of temporary work, which has about as many protections as US work. And even with those protections, you still see Spain and Greece at well over 10% unemployment, while the US is under 4.


I think there are some "simple" fixes that would go a long way to improving the healthcare system.

The easiest is basing Medicare spending on patient benefit in terms off quality adjusted life years.

I think it is a common misunderstanding that European countries maintain lower costs via price caps. In actuality, most don't limit the sale price, but control how much they are willing to pay for a drug, device, or procedure. This means that a product has to be substantially better to command a substantially higher price. More treatment with slightly worse products means much more benefit overall. Similarly, it puts some downward pressure on the price of new products because they have to compete with cheaper but less effective ones.


Using spain and greece for comparison sure seems like cherrypicking your data.

Also it has been proven many times by many people that if US were to transition to single payer insurance system, it would actually decrease the spending. No one claims it is easy, but there is absolutely no reason for the US insurance system to exist under single payer, that would be just setting piles of cash on fire.


I would quibble with the word proven here. There are compelling arguments with good data. single-payer could be better or worse depending on actual implementation and coverage.

It's also worth noting that many countries with single pair still have a supplemental insurance market for premium coverage not included.


>I don’t know how “spending more money for less benefits” is better than “callously refusing to spend any money”?

I don't know if it is better, but it is certainly a different problem, which matters if anyone is interested in understanding or fixing it.

I think it is important to understand the problem specifically there are a lot of patients dying of treatable cancer who would benefit from a health care system that functions better.


Sure it is necessary to understand the problem to fix it, I am not denying that. Sure, “refusing to pay” vs “paying a lot and accomplishing fuck all” are different problems. But the context of this discussion is “can US healthcare system be objectively called third-world-like” which it can. Whether it is bad because of X or Y reasons is not relevant and comments like the one I responded to, come off as trying to diminish how dire the situation really is.


Didn't seem like they were trying to diminish anything. The specifically called out how terrible the administration of the health programs are.


Big numbers are just big numbers, per capita and outcomes is where it's at.

Having said that, the US healthcare system is very efficient at extracting profit.


An interesting rebuttal to the usual complaints about the US healthcare system (no idea how factual it actually is, but it passes my basic sniff tests, but it is a subject I am unfamiliar with):

https://randomcriticalanalysis.com/why-conventional-wisdom-o...

That said: tying insurance to employment is evil. I’m a New Zealander and our healthcare system certainly has its problems too.


We don’t have European comforts because we pay for our own national defense. We also pay for Europe’s defense.

We should work out a deal where we continue to provide their security, and they provide our healthcare. Even Stevens.


American healthcare is not underfunded due to defence spending. American healthcare is very well funded. It's just horribly inefficient and perverse.


The USA pays for a lot of offense too. The USA also pays a lot for healthcare in general so lack of funds isn’t the issue.


It never seizes to amaze me the simplicity with which the Americans view the world :)


There's literally a war in Europe right now because Europeans underfunded defense. Luckily, America will save you again :)


> but liberals whistle past these real issues and wonder why we don't have European comforts and outcomes per dollar.

The US should grow up and stop it with these bicameral partisan pissing matches.

Both the US centre right and alt-right parties are equally responsible for putting US citizens taxes directly in the grubby hands of middlemen who fail to deliver outcomes.


The biggest problem with us Healthcare spending is how the money is allocated and spent. A lunch pin in the high cost is that the government has no concern for the cost to benefit of treatments and largely props up the price of the market. This is a bipartisan problem. If the government set reimbursement for treatments based on patient benefit, it would go a long way to reducing the cost in the US.




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