Political Confessional Threadi

[Elok]

I'm a libertarian who's found that a lot of the things the government does are either things the government is bad at doing (e.g. managing healthcare) or things that shouldn't be done at all (e.g. hassling prostitutes and potheads). Make of that what you will. Also welcome back. My recollection is that we didn't get along but that was at least fifteen years ago.

[N35t0r]

I'm a libertarian who's found that a lot of the things the government does are either things the government is bad at doing (e.g. managing healthcare) or things that shouldn't be done at all (e.g. hassling prostitutes and potheads). Make of that what you will. Also welcome back. My recollection is that we didn't get along but that was at least fifteen years ago.

Does it count if one of the reasons why it's bad at doing it is that half of itself believes it is bad, and is willing to die to prove it?

[Dauphin]

The managing healthcare bit. Is that true? I think the US is the only developed country without a national health care program of sorts, and it seems to rank middling to worse than countries that do have one. I don't see evidence that the government manages health care for all particularly badly, when compared to the alternative offering from private enterprise. Private care may get better outcomes for those that can afford it, but ir only works for people who can afford it. Not the optimum outcome for a nation.

[Aeson]

We also spend twice as much per person to get those middling health outcomes. Our national debt is built from stupidly overpriced healthcare and stupid wars.

[Agathon]

I'm a libertarian who's found that a lot of the things the government does are either things the government is bad at doing (e.g. managing healthcare) or things that shouldn't be done at all (e.g. hassling prostitutes and potheads). Make of that what you will. Also welcome back. My recollection is that we didn't get along but that was at least fifteen years ago.

Came to see what people here have to say about Civ 7, since it has proven "controversial" and I wanted to see what informed players had to say about it. (Answer: not a whole lot. lol).

[Elok]

Came to see what people here have to say about Civ 7, since it has proven "controversial" and I wanted to see what informed players had to say about it. (Answer: not a whole lot. lol).

Yes. This site is now mostly about three drunks and their shenanigans. We have a Greek drunk who talks almost entirely to himself and deletes most of what he types, a Russian drunk who says offensive and provocative things and gets mocked for it, and an American drunk who says offensive and provocative things and gets mocked for it. A while back, it was revealed that longtime scourge Ben Kenobi got married and has a life now, but we can't get enough hits off that dunking-on-idiots pipe. Also sometimes Geronimo tries, God bless him, but he's only one man.

Anyway, it occurs to me that I didn't properly answer your question. I am open to the possibility that other governments work better than ours, since I have no experience elsewhere, but I'm inclined to skepticism and I mostly don't care. Ours kind of sucks, is all I know.

As to the claim that Europe has learned to do healthcare great by harnessing the power of the Big Rock Candy Mountain: this sort of claim gets made about a lot of other things, and on the rare occasion I bother to dig into it I find that it's something of a mirage, essentially an updated version of Tacitus telling us the Germans are totally more virtuous and awesome than the Romans (see also "these rando tribal cultures you never heard of have sophisticated conceptions of transgenderism." Investigation of these tribal cultures often finds the reality more complicated.). In particular, other Western systems seem to work by aggressively rationing access to healthcare in a way that most Americans would not like at all. Also historically they've been grossly underspending on defense, etc, etc.

Really, as somebody who's actually worked in US healthcare for close to a decade, all this is missing the point. Assuming for the sake of argument that Europe is healthcare nirvana, saying "we just need to be like Europe" is kind of like saying Afghanistan "just needs to become a liberal democracy." When an American patient, or their family, is told something they don't like by a doctor, their reaction is very frequently:

1. But the internet says ...
2. I will be contacting my lawyer.

Why exactly we overspend on healthcare is an immensely complicated question, but at the heart of it is that we have a system where money goes in, healthcare comes out, and virtually nobody sees or understands what the hell happens in the middle. However, the public firmly believes, against all logic, that they should receive services whose value vastly exceeds the amount they pay for them. "The Government" should pay for it, or "the Rich," or else "healthcare should be a human right." They have "health insurance," which is sometime insurance but is mostly a middleman which doubles as a whipping boy. We have inserted this vast network of bureaucracies full of people who need paying, and expect this to work out to a substantial net savings, and when it doesn't it's because insurance companies are greedy. This makes no sense whatever, but we believe it so passionately that we will cheer when an insurance executive gets assassinated in the streets.

Because it's unusual to be confronted with a price-tag for a specific service, we have a tragedy of the commons situation where everybody is incentivized to pour as little as possible into the pot while extracting maximum value, insisting that it's the system's job to pay for it. Often this is not even a conscious decision, just a tacit assumption. For example, I often deal with end-of-life situations at work. When asked how far they want to take this, many if not most families will say, "we want everything done." This is because only a cold-blooded monster would explicitly put a price tag on the use of finite resources to prolong an increasingly unpleasant and precarious existence. Insurance will pay for it. So there's no kind of market discipline, and "how far" is usually translated to "how much do you love Uncle Bob?" The correct answer, of course, is "thiiiiiiiiiiis much!" The actual process ... well, this post is long enough, but holy **** is it ugly. Love can be astoundingly cruel, let me tell you. Incidentally, it's also extremely expensive, and ends up in a game of chicken between the doctor and the family. The house always wins, in the end.

And then people tell me, "Oh, the Europeans have discovered that if you rearrange the opaque system to pay for everything this way, you get substantial savings!" and I'm like "er, maybe Euros just have different mental wiring? Wouldn't make a damn bit of difference here. They'd just have irrational expectations of a different bureaucracy."

[Dauphin]

I'm intrigued as to why you invented a lot of strawmen to attack in that response. (e.g. Europe wasn't mentioned - every continent has countries with universal healthcare, ad there was no suggestion that healthcare is perfect or even good just not worse than private).

I think you got triggered and went onto autopilot. You may want to look into that.....

[Aeson]

Australia spends half per person what we do on healthcare, and has better health outcomes. South Korea too.

Our system is very straightforward. We pay too much for insurance so the insurance corporations can make record profits. We pay too much for medicines so pharmaceutical corporations can make record profits. Neither party will enforce anti-trust laws against the corporations because they are funded by the corporations.

Then 600k households go bankrupt due to medical expenses every year, and we go further into debt as a nation.

[N35t0r]

Australia spends half per person what we do on healthcare, and has better health outcomes. South Korea too.

Our system is very straightforward. We pay too much for insurance so the insurance corporations can make record profits. We pay too much for medicines so pharmaceutical corporations can make record profits. Neither party will enforce anti-trust laws against the corporations because they are funded by the corporations.

Then 600k households go bankrupt due to medical expenses every year, and we go further into debt as a nation.

There's also the threat to keep working at that ****ty place you hate where they treat you like garage, because otherwise you'll lose your insurance.

[Aeson]

Yah, and the perverse incentive for businesses to not give full time to their workers to avoid having to provide insurance.

It's truly a masterpiece of awfulness.

[Elok]

https://content.naic.org/sites/default/files/2024-annual-health-industry-commentary.pdf

Last year insurance companies in the US had an average profit margin of 0.8%, down from 2.2% in 2023. Both values are roughly consistent with those found in grocery stores, which are infamous for tight margins. Per the industry report here--assuming I am reading it correctly--they actually make a loss on paying claims; they stay in business with investors' cash. I don't know how this works, and I'm probably reading it wrong. But no, it appears our insurance companies are not making massive profits, unless the whole industry is engaging in massive fraud and misreporting their earnings.

On pharmaceuticals, I'm getting 16.84% for Pfizer, 35.6% for Novo Nordisk, 25.91% Eli Lilly. Macrotrends seems to have a clunky search feature and it's annoying to look these up, so I'll stop there. These sound like very respectable profit margins. First American non-healthcare company I thought of was Microsoft, and quick googling says they have margins of 36.15%. For Amazon, it's 7.8%. Different industries so very much apples to oranges, but those three drug companies at least sound like they're staying in the black just fine. This is consistent with a situation where prices are opaque to the consumer and everyone has a general expectation that a third party will pay for everything--offset somewhat by the prodigious expense of getting any new drug past FDA approval. Pharmaceuticals are cheaper in many other countries because their governments mandate lower prices and American drug companies know that if they don't accept those costs the foreign governments will likely ignore their patents. Most of the cost of drugs is in R&D, so they can recoup their losses through gouging domestically. This is indeed very dysfunctional, but what it means is that our healthcare system is effectively subsidizing a portion of everyone else's. Kind of like the military situation.

I am not digging into the weeds of any particular foreign system as there are too many variables to suss through and I'm not getting paid for this.

[Aeson]

UnitedHealth made $14 billion net profit last year. Yah it was down from 2023 when they made $22 billion. A certain video game character might have had something to do with that. Still above 2019 (and every year prior).

[Aeson]

One thing to bear in mind about these net earnings is because they are largely funded by deficit spending, we pay interest on it forever. Also, as deficit spending drives inflation, we pay a compounding inflation tax on it forever.

The cost to us is much greater than what they make from it. (Though once you get into the incestuous nature of ownership of pretty much all corporations, it's almost all flowing to the same "they", regardless of what industry is making the profit. This includes profiting off debt and inflation.)

[giblets]

Don't worry, AI can now deny your claim at the speed of light

[Agathon]

I’m from New Zealand, Elok. I couldn’t tell you about European healthcare other than the NHS, which my uncle used to work for. Canadian single-payer healthcare works pretty well. Aeson already said what I was going to say. Other countries spend much less than the US on healthcare for better results. This isn’t because we are more virtuous or smarter than Americans—it’s because our political system allows the government to do things while keeping it responsive to public opinion. My country changed its voting system in my lifetime for this reason. We would change it again if needed. The constitutional straitjacket prevents the US Federal Government from making these kind of changes.

Good for Ben on getting married. As a fine lady said, “every old sock finds an old shoe.”