The federal government alone spends $1.9 trillion annually on healthcare. That's enough to buy almost a million Tomahawk missiles every year. The total production will be around 9,000 missiles over 46 years, or less than 200 per year. We do not meaningfully choose between paying for healthcare domestically and blowing up foreigners. Even overthrowing Iraq's government and trying to make it a democracy only cost about $2.4 trillion over 10 years.
We don't, our healthcare outcomes are consistently worse.
If that's in contradiction to us buying more healthcare, then we must admit that some of that healthcare isn't productive, it's rent seeking. IMO, this is what I actually see in the US, so it all adds up.
There certainly is rent seeking, but you also have a wealthy market where people are free to pay for treatments that have low returns.
As an example, rich people getting lots of testing done increases spending, but it's driven by their wealth as much as it is by doctors enthusiastic to increase revenues. And if they are healthy, it isn't going to provide them much value.
Couple this with the attempts to centrally plan capacity and you get a cost spiral.
It’s not “rent seeking” necessarily. That’s just one kind of inefficiency. There’s also overly defensive medical practice. For example, my five year old boy had a run-in with a table and got a black eye. Our pediatrician physically inspected him, decided nothing was wrong, but sent him to get an X-ray and CAT scan anyway. It took just an hour and a half because the U.S. has expensive medical equipment just lying around.
In a sanely administered system, you wouldn’t send every five year old that ran into some furniture to get a CAT scan. You’d just accept the infinitesimal risk of some hidden injury that couldn’t be caught with physical contact examination but could be caught with a CAT scan.
In another example, my wife’s grandmother had a stroke at 87. They medevacced her out of her house in rural Oregon to Portland. Then the doctors wanted to do a bunch of expensive procedures until she passed away a few days later. She was a lovely lady, but no European country would’ve greenlit these procedures on an 87 year old woman who had a quarter of her long missing due to lung cancer in her 60s.
The more you drill down into health indicators to distinguish the effect of medical care from other factors, the less it seems like US outcomes are worse. US overall indicators, like life expectancy, are worse. But those factor in many things that have nothing to do with the health system, such as homicide, car accidents, demographic, obesity, etc.
For example, Americans eat a truly disgusting amount of food compared to europeans. I’m a relatively low resource consumption asian, and even I was always hungry when we visited Paris because the portion sizes were so small.
> Our pediatrician physically inspected him, decided nothing was wrong, but sent him to get an X-ray and CAT scan anyway. It took just an hour and a half because the U.S. has expensive medical equipment just lying around.
Because it has the X-ray equipment, they have make a return on investment on it, and that's why they end up doing useless tests. Those are even harmful by the way, as X-rays are ionizing reaction, and useless CT scans are actually responsible for a non-negligible fraction of cancer in the US.
The reason why european countries don't run more CT scans isn't that they lack equipment, it's because the risk/benefit isn't good for cases like your son.
> In another example, my wife’s grandmother had a stroke at 87. They medevacced her out of her house in rural Oregon to Portland. Then the doctors wanted to do a bunch of expensive procedures until she passed away a few days later. She was a lovely lady, but no European country would’ve greenlit these procedures on an 87 year old woman who had a quarter of her long missing due to lung cancer in her 60s.
This is wrong. If we're sharing anecdotes let me tell you about my 97yo grand dad who's been admitted thrice in ER this year in France, and received what would have amounted to almost $100k of medical bills in the US. (He's OK now, but at this age you never fully recover to your previous state, so every trip to the hospital is a step down).
> The more you drill down into health indicators to distinguish the effect of medical care from other factors, the less it seems like US outcomes are worse. US overall indicators, like life expectancy, are worse. But those factor in many things that have nothing to do with the health system, such as homicide, car accidents, demographic, obesity, etc.
This is true, it explains a good fraction of the life expectancy difference, but it's irrelevant to the fact that the US pays twice are much for similar healthcare.
> The reason why european countries don't run more CT scans isn't that they lack equipment, it's because the risk/benefit isn't good for cases like your
But because the risk/benefit isn’t as good, they don’t have as much of this expensive equipment. The U.S. has about 40 MRI machines per million people, versus 10 for Canada or Denmark or 20 for Spain.
Yes it is, because if you know they're different then you're literally moving the goalpost: We were talking about CT scans but the difference in CT scans both sides of the Atlantic has nothing to do with the availability of CT scan machines so you switch to another equipment in the middle of the discussion.
Also, your numbers are cherry-picked: Japan has more MRI machines per capita for instance, and Germany or even Greece aren't far behind the US.
> Yes it is, because if you know they're different then you're literally moving the goalpost: We were talking about CT scans but the difference in CT scans both sides of the Atlantic has nothing to do with the availability of CT scan machines so you switch to another equipment in the middle of the discussion.
I used Canada as a data point because it’s common to compare the U.S.’s healthcare system to Canada, because the countries are otherwise pretty similar. Japan and Greece have very different populations.
That’s the story anyway. They’ll be paid either as Cost Plus or on a Firm Fixed Price. Neither of which incentivize the supplier to give the USG a better deal.
Which in practice likely means that the C-suite and top people will be 4% richer, there will be 5% more unnecessary administrators, there will be 2% more line workers and the experience will be 1% better at the same or worse price point for all of us.
I'm not defending spending the $$ on bombing brown people, but it's hard to overstate how divorced spending is from outcomes in US healthcare. It's as bad or worse than colleges.
they spend 1.9T on healthcare because the largest F500 companies in the US are healthcare companies and they have utter regulatory and legislative control, and will never, ever drop prices.
European countries pay far less and have as good or better overall outcomes.
The U.S. didn't even get the oil! The Chinese got the oil. The whole thing was because George W. Bush's heart was bigger than his brain: he thought the U.S. could create a functioning democracy from the Iraqi population.
Iraq's current government is still siginficantly better than Saddam's regime, depsite being currupt and somewhat dysfunctional (and things have improved over the years in case you dig up an article from a decade ago about ISIS).
It's a parliamentary democracy with free elections and independent media. It's also chaotic, corrupt, and violent. It's much worse than Sweden or Switzerland but better than many other Arab countries.
As i mentioned in another post, if you measure success as creating a strong, prosperous, independent, viable democracy - then Iraq was an utter failure and so was Libya, Yemen, Somalia, Sudan, Jordan, Egypt and Iran. Which begs the question why does the US pursue the same failed policies over and over again. It turns out we were asking the wrong questions in 2005. If you measure success from the purview of the Yinon plan to establish Israeli hegemony over the entire middle-east then everything aforementioned - including all the death, terrorism, suffering, sectarian and religious strife, massacres and genocides, refugees crises, the rise of ISIS, the recent Al Qaeeda takeover of Syria - everything, was a resounding success.
The social cultural analysis people really left us hanging when it came to finding out what is it with middle eastern culture that makes it unable to build working states and socities. Anti imperialist and anti colonial babblepprotecting the status quo of a patriarchaical, imperialist and colonisl culture that just gets constantly defeated because its handicapped by itself. Like a doctor declaring your disease a lovely character trait instead of helping. The o so solidaric allies are the worst enemies you can get. Chances are when your ideology is bad at managing economies, it's even worser at managing societies .
Its a special kind of evil to deny billions of people hope and participation in the worlds society so one can get high on ones own ideological supply. Bush at least tried . In this he and whatever the Israelis do to prevent the region blowing itself up is the lesser evil.
> The social cultural analysis people really left us hanging when it came to finding out what is it with middle eastern culture that makes it unable to build working states and socities
Nobody said that. Iraq under Saddam and Syria under Assad were working states and societies. The trouble is with bottom up democracy, and that’s a shortcoming of virtually every non-european society. Singapore for example is wealthy, but is already having trouble after its benevolent quasi-authoritarian ruler died.
> Its a special kind of evil to deny billions of people hope and participation in the worlds society so one can get high on ones own ideological supply
To the contrary, it’s cruel to push democracy on societies that aren’t capable of sustaining them.
Bill Clinton signed the Iraq Liberation Act in '98. Bush took over and then launched a ridiculously false campaign about WMDs stockpiled in Iraq. We never found a single one. It's extraordinarily naive and ignorant of basic facts to think Bush invaded Iraq out of the kindness of his heart and to support a true democracy, especially given Bush signed the extremely undemocratic, unconstitutional Patriot Act domestically right after 911 (a bill Biden claims to have originally written... noticing a pattern?)
Let's back up even further. We were "liberating" Iraq from Saddam's government, right? After we tried teaching him a lesson in the Gulf War?
Except declassified circumstantial evidence suggests that Saddam rose to power after a collaborative period between US and Egyptian intelligence agencies including a failed assassination of Qasim, and that he maintained alleged continued contact with US agencies through the 60's. But at some point the US decided it did not like Hussein's objectives and turned on him just like we'd intervened in Qasim's Iraqi government.
This is literally just US military interventionism and you should not proscribe good intent when history shows us otherwise.
edit : I forgot to mention that as of 2024, the US still controlled all oil revenue transactions in Iraq.
- thecradle.co/articles-id/27007
>George W. Bush's heart was bigger than his brain: he thought the U.S. could create a functioning democracy from the Iraqi population.
George Bush probably knew what he was doing in Iraq because his VP, Dick Cheney could have told him way back in 1994[1] what would happen if we overthrew Saddam :
> "Once you got to Iraq and took it over, took down Saddam Hussein’s government, then what are you going to put in its place? That’s a very volatile part of the world, and if you take down the central government of Iraq, you could very easily end up seeing pieces of Iraq fly off: part of it, the Syrians would like to have to the west, part of it — eastern Iraq — the Iranians would like to claim, they fought over it for eight years. In the north you’ve got the Kurds, and if the Kurds spin loose and join with the Kurds in Turkey, then you threaten the territorial integrity of Turkey.
> It’s a quagmire if you go that far and try to take over Iraq.
> The other thing was casualties [...] was how many additional dead Americans is Saddam worth? Our judgment was, not very many, and I think we got it right."
"Spreading freedom and democracy" was just another propaganda spin like the "WMDs". The question still remains, why did America spend thousands of lives (tens of thousands, if one counts contracters, veteran suicides, chronic conditions, etc. ) and 2 trillion dollars and counting to overthrow Saddam. Why did they continue to make the same "mistake" in Syria, Libya, Yemen , Sudan, Somalia and Iran[2] causing millions of deaths, millions of refugees, spreading death and destruction across the entire region. By 2025 the picture has become a lot clearer as only theory continues to stand the test of time - that America invaded and intervened to overthrow and destabilize the entire region to clear a path for Israel to invade and expand into "Greater Israel"[3] and become the regional hegemon. How any of this actually serves America's strategic interest is an untenable case to make at which point one will have to consider the notion that when it comes to Israeli-American relations, the tail wags the dog.
One of the justifications for 9/11 was that US troops were in Saudi Arabia. US troops were put in Saudi Arabia after Iraq went into Kuwait. Part of the reason for going into Iraq was to be able to remove these troops.
