The problem with the US system is that it doesn't know what it's trying to be.
If you did a socialist system then everything is "free" but possibly slow and expensive on the back end when the government isn't efficient.
If you did a libertarian system then everything is cheap but it's caveat emptor because nobody is stopping you from buying morphine for $10 from Amazon.
The US system isn't either one. It pretends to be a market sometimes but then has a bunch of rules to thwart competition. Doctors are required by law to do residency but the government limits the number of residency slots in response to lobbying from the AMA so there aren't enough doctors. "Certificate of need" laws explicitly prohibit new competitors for various services. Insurance is tied to employment to make it hard for individuals to shop around. Laws encourage, require or have the government provide "prescription drug coverage" to make patients price insensitive so drug companies can charge a huge premium for patenting a minor improvement or simple combination of existing drugs and have the patient will something which is marginally if at all better even if it's dramatically more expensive because they don't see the cost when the insurance/government is required to pay for it.
It's a big pile of corruption, because all that money is going to places. But then if you try to fix it, half the population insists on doing the first one and the other half is only willing to do the second one, and the industry capitalizes on this to prevent either one.
Maybe instead we should do both rather than neither. Have the government provide a threshold level of services, like emergency rooms and free clinics and anything more than that the local government wants to fund, and then have a minimally regulated private system that anyone can use if the government system doesn't satisfy them.
I think you're trying to apply ideology where it doesn't belong. Nobody on earth would advocate for such extensive spending to facilitate agreement on financing. It's extremely, extremely inefficient. (But it does produce jobs, which makes politicians super horny.)
The market also won't assist us, as we can't exactly compete future treatment costs against unknown illnesses.
Merely providing emergency rooms and "free clinics" will ensure that people only use these services.
A public option eliminating profit margin seems to at least be sane, and ideally would starve private funding from existence. Any remaining options would highlight deficiencies in the existing system.
A schumpeterian system, if you must slap an ideology on it.
> Merely providing emergency rooms and "free clinics" will ensure that people only use these services.
Emergency rooms operate by triage. If you're having a heart attack, you're going in right now. If your shoulder has been bothering you for six months, you might have to come back multiple days in a row and spend the whole day waiting before there is a slow enough day that you can be seen. There is then an obvious incentive to go pay a private physician to be seen immediately instead. Free clinics are similar: There are no appointments, it's first come first served, and then most people prefer to pay $100 to schedule an appointment rather than wasting an entire day waiting in a queue, but you still have that option for people with no money.
Emergency rooms are also a natural monopoly because in an actual emergency the primary consideration is which one is closest, which doesn't make for a competitive market. So it makes sense to have the government do that. Whereas non-emergency care (which is the large majority of medical expenses) would allow people to compare prices or make cost trade offs against distance or convenience etc., if we would actually expose people to pricing. For example by requiring price transparency and then having insurance pay the second-lowest price for that service within 100 miles of your location, but then letting you choose where you actually want to go and make up any difference yourself, or choose the lowest cost option instead of the second lowest and then put the difference in your HSA.
> A public option eliminating profit margin seems to at least be sane, and ideally would starve private funding from existence.
It's not clear how a government option that doesn't have taxpayer subsidies would do this any better than a private non-profit. There are many existing non-profit healthcare providers and they don't have meaningfully lower costs than for-profit ones.
The general problem is that "non-profits" and government-operated services still have money flowing through them and "profit" can be extracted in all manner of ways other than paying dividends to shareholders. The officers can just pay themselves high salaries, or whoever is in charge of the budget can take bribes/kickbacks to shovel money in the direction of the contractors or unions paying them off.
Meanwhile the nature of "profit" in a competitive market is largely misunderstood because of accounting differences. If a non-profit wants to buy an MRI machine, they have to take out a loan, and then pay back the loan with interest which they account for as an expense. A for-profit company might get the money to buy it by selling shares to investors, and then paying dividends to the shareholders instead of paying interest on a loan, which goes on the books as "profit" instead of interest expense. But you couldn't just replace them with a non-profit and then lower prices by the amount of "profit" they were making because then they also wouldn't have had private investment and you're back to needing the loan and paying the same money as interest to the bank.
The thing that requires providers to be efficient is competition, because then the ones wasting money or taking bribes have to cover the amount wasted/embezzled by charging more to customers and then the customers don't choose them because they have higher prices. But that's the thing the existing regulatory system goes out of its way to thwart.
> I guess it is much better than the situation before that, where you paid $5000+ and they also gave you an opioid addiction.
Having a condition that actually warrants strong opioids and not being able to get them at any price is definitely not an improvement.
The problem is fundamentally that we want to pretend doctors can always distinguish two people describing the same symptoms when one person actually has them and the other is trying to get drugs. The often can't, so you can either make it hard for people to get pain medications even if they need them, or you can make it easy for people to get them even if they don't. And between these the second one is unambiguously better, because the first one is the government screwing innocent people and the second one is guilty people screwing themselves.
> And between these the second one is unambiguously better, because the first one is the government screwing innocent people and the second one is guilty people screwing themselves.
Could not agree more. Depriving people with legitimate pain of opioids is IMHO legitimate torture. It's a bit of a variance on the trolley problem in that the doctor/government isn't causing the pain, but their inaction is prolonging it.
Brother (or sister), you were simply not trying hard enough. I live in a very clean, safe, expensively-policed county, and even I know where to buy fentanyl for much lower cost than a hospital. I would happily turn to that than take 20(!!!) advils in s single day.
Let's review the policy options in light of your suggestion:
1) We make it hard to lawfully acquire pain medications. You pay $$$ to see a doctor and you pay it even if they refuse you. If they do, you then have to pay $$ to get them from Stringer Bell, or start there to begin with if you didn't have $$$, and hope they're not cut with drain cleaner or unevenly mixed so that some days you get 100% corn starch and other days you get a fentanyl overdose.
2) We make it easy. Anyone can get them from Walmart. The people who need them pay the same $ they do for a bottle of Advil/Tylenol instead of paying $$ to murderers or $$$ to waste scarce medical resources that could have saved someone else's life. The bottle from Walmart always has a consistent amount of the drug in it and neither the dental patients nor the addicts get a surprise fentanyl overdose.
If a significant percentage of cars start to become EVs then spaces where people regularly park overnight will get chargers because it will allow whoever is operating them to make a bit of money selling electricity. You don't have to be making a huge profit margin to make it worth your while to have people passively buying ~200kWh/month of electricity from you.
The same applies to workplaces, especially if solar causes electricity to cost less during daylight hours, and then it becomes convenient to get an EV if there is a charger where you park at night or where you park during the day.
that would depend on the infrastucture cost to install such charging and to maintain it? This is kerbside slow charging presumably overnight. Note that spaces in these residental areas are typically not even marked spaces; the worst outcome might be losing more footpath space to charging infra for road users.
Non-fast chargers aren't very big. They can be installed in lampposts, or in lampost-diameter boxes sunk into the pavement (with the socket sticking out at the top)
> For example, HVDC. Interconnect and buy power from somebody with more sun.
Who is Japan interconnecting with, or any other country that doesn't trust its neighbors? What is Canada supposed to do when it's ~6000 km from the equator and might not want to rely on the US for electricity regardless?
> Or just overbuild solar by a lot. It's cheap, so chances are having too much of it still works out economically.
Solar is cheap per kWh but those kWh come disproportionately in the sunnier months of the year at any non-equatorial latitude. To build enough for January you'd then have oversupply and a price of zero for the nine months out of the year when you have the most output, requiring you to make back the entire cost in the three months when solar output is lowest. Then you're only getting paid anything for e.g. 12.5% of the kWh you generate (the 25% of the months that have 50% of the average output) which means you need the price during those months to be 8x the average price you need to break even, but then you're not cheaper than existing alternatives. And that's before you even deal with nights or cloudy winter days.
It obviously makes sense to use solar to reduce the need for natural gas plants during hot summer days with a lot of air conditioning demand, or for charging electric cars that can hold off a couple days if it's cloudy. It equally obviously doesn't make sense to try to generate 100% of electricity from the same intermittent source whose output is regionally correlated by season and weather systems.
> What is Canada supposed to do when it's ~6000 km from the equator and might not want to rely on the US for electricity regardless?
Most Canadians live quite far south. Toronto is on the same latitude as France’s Mediterranean coast and they of course have plentiful hydropower. Solar is surprisingly useful even in more northerly places like the UK or Denmark since it is anti-correlated with wind power.
"South" in Canada is still north. Calgary (third largest city) is almost 6000 km from the equator. Toronto is the major city furthest south and it's still almost 5000 km.
> Toronto is on the same latitude as France’s Mediterranean coast
Europe is also quite far north. The Mediterranean has warmer temperatures because of ocean currents carrying warm water from the south, not because of its latitude. Toronto is at the same latitude as Wisconsin.
> and they of course have plentiful hydropower.
They get a little over half from that. You still need something to do the other half.
> Who is Japan interconnecting with, or any other country that doesn't trust its neighbors? What is Canada supposed to do when it's ~6000 km from the equator and might not want to rely on the US for electricity regardless?
With space. By space-based solar power instead of HVDC.
That's not really how it works. ITER has a budget measured in billions over multiple years, the global energy industry is trillions every year. The amount needed to do the research is such a small proportion that if there is even a tiny possibility that it could long-term provide a significant proportion of world energy, it's well worth doing the research. The scientific knowledge gain is just icing on the cake.
> That's a lot of time for the world to get worse while waiting for fusion to happen, and we might as well just throw renewables at the problem now instead of waiting.
> Democrats are secretly communists who want to communist genocide you
Isn't this just how politics looks now? The Republicans say that, the Democrats say the Republicans are secretly nazis who want to nazi genocide you, both parties contain millions of people so both can point to some extremists on the other side saying something shocking and then they both go back to trying to get 51% of the votes so they can be the ones picking your pocket this year.
edit: It's beautiful how the two immediate replies to this post are, respectively, "it's not both sides because only the Democrats are actually Marxists" and "it's not both sides because only the Republicans are actually Fascists".
When things are this lopsided, both-sidesing is indistinguishable from sweeping for the bad one.
Want to prove me wrong? Show me the last time Kamala Harris engaged in guillotine rhetoric (which is the left-coded equivalent). Point me to what you think the Democratic equivalent of the ICE killings are. Show me dead protestors and stifling of legal proceedings to hold them accountable. Show me Democratic fraud on the scale of the $40B swap line to Argentina, pumping and dumping the American economy by announcing on-again-off-again war, creating a board of peace / putting yourself in charge / giving it $10B, and shitcoin rugpulls.
> both-sidesing is indistinguishable from sweeping for the bad one.
That implies there is a good one. The lesser of two evils is still evil, and even how to measure lesser is extremely subjective.
> Show me the last time Kamala Harris engaged in guillotine rhetoric
Harris campaigned on saying as little as possible. Several Democrats have called for Trump's assassination. Some (like Stacey Plaskett) quite directly, others (including Harris) have implied or joked about it. Someone worked the nutters into a sufficient frenzy to attempt it with Trump and to murder Charlie Kirk.
> Point me to what you think the Democratic equivalent of the ICE killings are.
Around 3 million people die in the US per year, on the order of 6000 of those are in prisons, ICE was on the order of 30.
The media focuses on that because Trump campaigns on immigration, not because it's a significant proportion of the people the government kills. Significantly more people die when Democrats get paid off by the AMA to limit the number of medical residency slots, or impede housing construction even in states their party fully controls resulting in homelessness and poverty-inducing high rents.
> Show me dead protestors
Are you referring to the unarmed woman killed by the capitol police in 2021?
> stifling of legal proceedings to hold them accountable
Biden pardoned a lot of people in his own party.
The government failing to hold itself accountable is the default. Most of the time they don't even initiate proceedings against themselves when they're committing a crime, and hide behind qualified immunity etc. if someone wants to sue them.
> Show me Democratic fraud on the scale of the $40B swap line to Argentina, pumping and dumping the American economy by announcing on-again-off-again war, creating a board of peace / putting yourself in charge / giving it $10B, and shitcoin rugpulls.
The Inflation Reduction Act was a trillion dollars. The federal budget is multiple trillions every year and a double digit percentage of it is corruption every year, regardless of which party is in office.
In general it seems like you want to point to specific things that represent a fractional percentage of the overall problem and ignore the systemic bipartisan corruption and government unaccountability that has been the status quo for generations.
Oh, so you can't find equivalents from Harris and Walz! That's what I thought. You aren't an enlightened centrist, you're a partisan hack posing as one.
> residency slots, NIMBY
Who put forward the last bill addressing the residency slot issue? Which party has the bigger YIMBY faction?
> Ashli Babbitt
She was storming the capitol! The officer who shot her was investigated and cleared because the courts agree: cops are allowed to shoot if you are trying to breach the inner defensive perimeter of the US capitol. Where are the investigations for Rene Good and Alex Pretti?
> state investigators were denied access to the shooting scene by the federal government
Oh. This isn't even "we've investigated ourselves," it's just "we kill you, you die." That's new in US politics.
> IRA was a trillion dollars
Spending that you do not like is not fraud. That's not what the word means. I'd love to call the trillions spent on Iraq and Afghanistan and (soon) Iran fraud, but I can't, because that's not what the word means.
> you want to point to specific things that represent a fractional percentage
The reason why you can't come up with equivalents for the Trump fraud is because they don't exist, so you have to pretend that congressional appropriations that you don't like are somehow equivalent. But they aren't. They made Jimmy Carter sell his peanut farm, but Trump can just pocket billions and Republicans say "both sides." No, it's not both sides, it's not normal outside of shithole countries, and despite Trump's best efforts to turn the US into a shithole country we can still decide to enforce our laws and turn back the clock on that.
I can't help but feel you're leaving out some key details here...
was she perhaps trespassing after walking through broken barriers, past security guards that told people to leave, and through broken windows? was she also warned to stop multiple times while climbing through a broken window to circumvent a barricaded door at the time of being shot?
If those things happened to be true, it would seem that you're attempting to deceive us as readers to make a point in poor faith. Probably no need to do that, right?
The Democrats have a very similar platform to the Republicans (especially around ICE and Israel, both of which Harris vowed to continue supporting). Trump is uniquely incompetent though, which if you believe in accelerationism may or may not be a good thing. For instance Democrats have long yearned to go to war with Iran, now Trump did it, but he did it in such an incompetent and rushed manner that it's led to US bases throughout the Middle East being destroyed and abandoned. That's a good thing that came out of a bad situation.
I'm not trying to be combative, just honest. Here is Harris saying Iran is our greatest adversary (sorry for the Zionist source). Chuck Schumer and Hillary Clinton have also been very vocal about wanting to attack Iran. Clinton actually recently praised Trump!
Oh, Harris called Iran an adversary! Wow! I'm glad we didn't elect her or the party that negotiated the last deal with Iran! The party that tore up the Iran deal and kept joking about bombing them into the stone age and started 2 out of 2 of the last middle eastern forever wars is the much better bet.
What? They bombed Iran and started forever war 3 of 3? Who could have seen this coming?!
No, Harris failing to push back hard enough on Gaza is not in the same galaxy of culpability or catastrophe as Trump starting a war with Iran on Israel's behalf. And endorsing their actions in Gaza, lest we forget.
And let's not forget who is actually in office and started the war, and how it's currently going. We can wring our hands about what democrats might have done but we have active proof of what republicans are currently doing and it isn't pretty. There's a vast gulf between "hawkish" and "actively bombing." I'd be willing to give pretty much anyone else a shot at it right now.
I simply do not vote for Zionists of either party. They can keep swapping seats and lose every time. If you support Israel, you cannot have my vote. I'll just sit out the election if I have to (and did last time).
Oh, that's why you can't acknowledge the simple fact that Kamala was better on Gaza, because if you do you acknowledge your own culpability in making the genocide worse.
More people in Gaza were murdered under Biden/Harris than Trump. I’ll never understand neo-liberal extreme parasocial behavior. These people are not your friends, they are the scum of the earth. Treat them as such.
What Biden did in Gaza (and Trump continued) is way worse than what has happened in Iran. It's a vile crime against humanity to attack Iran and kill civilians but Gaza is a straight up US fueled genocide.
All five actual Marxist-Leninists in the US appreciate your attention. Now let's list the actual fascists. Symmetry is beautiful but sometimes it's just not there.
Exactly: the tear-down-the-system left barely exists outside twitch and college campuses, while the far right has the presidency and majority control of the Republican party. These are not the same.
> edit: It's beautiful how the two immediate replies to this post are, respectively, "it's not both sides because only the Democrats are actually Marxists" and "it's not both sides because only the Republicans are actually Fascists".
I don't think we should pat ourselves on the back too hard for milquetoast takes devoid of any specifics.
(also I think you misread the responses to your post)
> All five actual Marxist-Leninists in the US appreciate your attention. Now let's list the actual fascists. Symmetry is beautiful but sometimes it's just not there.
"There are five actual Marxist-Leninists you need to be paying attention to in the US but we can't even name one relevant actual fascist, so the symmetry isn't there."
That was my initial reading, and it's because I've encountered numerous people who sincerely believe that. Using sarcasm in posts subject to Poe's Law is a good way to be ambiguous.
Lets start: you. Followed by Stephen Miller. Trump, per the assessment of his own former chief of staff. Josh Hawley. Leonard Leo. All the "Dark Enlightenment." Your initial reading is tendentious and of little value. Are you seriously going to challenge the notion that American politics has a spectrum from center right to fascists-would-blush ideological crackpots like the dark enlightenment?
This is honestly a meaningless cliche. There is a bottled water company called Liquid Death, is that a reason to expect their product to be more hazardous than competitors? A lot of free software has traditionally used self-deprecating names, should we expect them to be bad as a result? How about when something is called Truth Social?
My rule is, "if you have to say, it isn't". If the tofu were really yummy and tasty, you wouldn't need to say so on the package. (Some years ago, when Americans' idea of uses for tofu was mostly as a salad topping, Texas had a tofu brand that said "yummy and tasty!" on the package.)
"Truth Social"? Probably a cesspool of lies. "Liquid Death"? Well, I would have expected it to be full of alcohol, capacsin, and/or cinnamon, not bottled water...
If they gradually increase production capacity then prices stay high for 10+ years (or for as long as it takes for demand to crash) because a gradual increase in production takes that long for them to add enough capacity for current demand.
If they add enough capacity to meet current demand quickly then if demand crashes they still have billions of dollars in loans used to build capacity for demand that no longer exists and then they go bankrupt.
The biggest problem is predicting future demand, because it often declines quickly rather than gradually.
do we have evidence of RAM manufacturers going bankrupt? do we have evidence that the increased capacities after the mentioned past shortages went unused or were operated at a loss?
> Memory makers did get themselves into this situation by selling all wafers for empty promises and alienating everyone but OpenAI tbh.
Wasn't the problem here that OpenAI was negotiating with Samsung and SK Hynix at the same time without the other one knowing about it? People only realized the implications when they announced both deals at once.
> We live in a neoliberal world where corporate monopolies / oligopolies aren’t even remotely regulated. If you try to do even the gentlest regulation of companies people scream about communism and totalitarianism. Unless the regulation serves the monopolies by making it harder to enter the market.
The thing that enables this is pretty obvious. The population is divided into two camps, the first of which holds the heuristic that regulations are "communism and totalitarianism" and this camp is used to prevent e.g. antitrust rules/enforcement. The second camp holds the heuristic that companies need to be aggressively "regulated" and this camp is used to create/sustain rules making it harder to enter the market.
The problem is that ordinary people don't have the resources to dive into the details of any given proposal but the companies do. So what we need is a simple heuristic for ordinary people to distinguish them: Make the majority of "regulations" apply only to companies with more than 20% market share. No one is allowed to dump industrial waste in the river but only dominant companies have bureaucratic reporting requirements etc. Allow private lawsuits against dominant companies for certain offenses but only government-initiated prosecutions against smaller ones, the latter preventing incumbents from miring new challengers in litigation and requiring proof beyond a reasonable doubt.
This even makes logical sense, because most of the rules are attempts to mitigate an uncompetitive market, so applying them to new entrants or markets with >5 competitors is more likely to be deleterious, i.e. drive further consolidation. Whereas if the market is already consolidated then the thicket of rules constrains the incumbents from abusing their dominance in the uncompetitive market while encouraging new entrants who are below the threshold.
Arguably a more efficient approach might just be to have a tax that adds on to corporate tax incrementally for every % of market share a company has above say 7-8%. Then dominant companies are incentivised to re-invest in improving their efficiencies rather than just buying/squeezing out competitors. A more evenly spread market would then, as a result, be against regulations that make smaller market participants less competitive, as they'd all be in relatively less table positions.
> Arguably a more efficient approach might just be to have a tax that adds on to corporate tax incrementally for every % of market share a company has above say 7-8%.
How is this more efficient? You'd still be applying all of the inefficient regulatory rules intended to mitigate a lack of competition to the smaller companies trying to sustain a competitive market, and those rules are much more deleterious for smaller entities than higher tax rates.
If you have $100M in fixed regulatory overhead for a larger company with $10B in profit, it's only equivalent to a 1% tax. The same $100M for a smaller company with $50M in profit is a 200% tax. There is no tax rate you can impose on the larger company to make up for it because the overhead destroys the smaller company regardless of what you do to the larger one.
First, on the surface, this sounds like a terrible idea. Almost all ideas that I see on HN about economics fail with even the tiniest amount of common sense.
As a counterpoint: Look at very high value goods, like jet engines and MRI machines. I went for an MRI the other day and wondered to myself (then asked an LLM) what the international MRI market looks like. They are vanishingly small number of manufacturers and are usually dominated by a few international players. How are you going to apply this tax to non-domiciled (international) companies? Also, companies like General Electric, Mitsubishi Heavy, and Seimens are enormous and incredibly diverse. This idea falls apart quickly.
If you did a socialist system then everything is "free" but possibly slow and expensive on the back end when the government isn't efficient.
If you did a libertarian system then everything is cheap but it's caveat emptor because nobody is stopping you from buying morphine for $10 from Amazon.
The US system isn't either one. It pretends to be a market sometimes but then has a bunch of rules to thwart competition. Doctors are required by law to do residency but the government limits the number of residency slots in response to lobbying from the AMA so there aren't enough doctors. "Certificate of need" laws explicitly prohibit new competitors for various services. Insurance is tied to employment to make it hard for individuals to shop around. Laws encourage, require or have the government provide "prescription drug coverage" to make patients price insensitive so drug companies can charge a huge premium for patenting a minor improvement or simple combination of existing drugs and have the patient will something which is marginally if at all better even if it's dramatically more expensive because they don't see the cost when the insurance/government is required to pay for it.
It's a big pile of corruption, because all that money is going to places. But then if you try to fix it, half the population insists on doing the first one and the other half is only willing to do the second one, and the industry capitalizes on this to prevent either one.
Maybe instead we should do both rather than neither. Have the government provide a threshold level of services, like emergency rooms and free clinics and anything more than that the local government wants to fund, and then have a minimally regulated private system that anyone can use if the government system doesn't satisfy them.
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