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DOGE's only public ledger is riddled with mistakes

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381–390 of 1001 posts

Re: DOGE's only public ledger is riddled with mistakes

#381

Rule of law is what allows us to grow. Acemoglu won a nobel prize showing that institutions cause growth. Destroy institutions and you'll undershoot potential.

The "Fuck you, I got mine" mentality and short-termism has been festering for decades at many American institutions, such as for-profit companies. Openly selling the country short for personal benefit is just one small step after many hundreds of them to get where we are.

Re: DOGE's only public ledger is riddled with mistakes

#383
post #248

For those who want to have a substantive discussion on the federal budget and believe these cuts are justified, I have a few questions (putting aside questions of constitutionality for this thread): 1. There are claims that federal spending is out of control. How do you square that with the fact that spending as a percentage of GDP is only slightly elevated compared to the historical average going back to at least th…

> Why shouldn't the health insurance industry be the first item on the chopping block? I don't understand this question: how can the private companies in the industry be placed on the chopping block? By outlawing them?

In the context of government it would mean nationalizing them.

Re: DOGE's only public ledger is riddled with mistakes

#384
post #366
post #277

Earlier quoted context omitted.

Number 3 can’t be overstated. Healthcare costs for the exact same care are 2x-3x what they are in Europe. Global health insurance plans usually come in two flavors: 1. Global coverage 2. Global coverage excluding United States (for half the monthly premium of the first plan) The United States in an extreme outlier in terms of cost. This is separate from rationing care. This is separate from even population health (ex…

20 years ago I read a story about an obstetrician in the USA. His premiums at that time for professional negligence were $1m per year. He would have to keep paying those premiums for 18 years after his retirement. Same for every obstetrician. Professional fees then must be set to cover those insurance premiums. Has that changed for the better in the USA? Seems very unlikely to be the same in Europe. Obstetrics is obv…

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Re: DOGE's only public ledger is riddled with mistakes

#385
post #358

Earlier quoted context omitted.

I know of at least one source arguing that in fact, population health (mainly obesity and gun violence) explain upwards of 70% of the difference in healthcare spending between the US and other developed nations.[1] To me, this seems like the most likely explanation because I believe we have pretty similar diagnostics and treatments to other developed countries, and I don't feel like a British doctor would give me any…

The U.S. has orders of magnitude of admin costs due to middlemen at every stage in health care. This should be obvious to HN types.

Also should be noted that health insurers’ marketing costs are part of “administrative overhead.”

Re: DOGE's only public ledger is riddled with mistakes

#386
post #249

Except, these are not mistakes. This is every single Musk's company modus operandi. Completely made up or inflated numbers, unrealistic timelines etc. Customers or investors buying into it, but if you look under the hood, outside of government subsides and contract, there is pretty much 0 money made from ALL of his businesses. He's just using the same playbook now, except when people will realize that the 5000$ DOGE…

They won't be able to cut checks unless congress approves. They'll say they will cut checks, get sued and lose. They'll blame the judicial system and it will probably be a pretense to undermine that branch of government.

So far they have found pretty much no resistance. The few judges raising their voices are threatened with jail to make examples. Do not put too much faith in the strength of your institutions.

Re: DOGE's only public ledger is riddled with mistakes

#387
post #248

For those who want to have a substantive discussion on the federal budget and believe these cuts are justified, I have a few questions (putting aside questions of constitutionality for this thread): 1. There are claims that federal spending is out of control. How do you square that with the fact that spending as a percentage of GDP is only slightly elevated compared to the historical average going back to at least th…

This framing is a bit far from the actual motivating issue underlying the federal "budget" itself. I think a better question is whether having a federal workforce of 4 million people managed by an unaccountable bureaucracy is in the best interests of any country. If you frame it as simply whether to spend money on this or that or if you're getting comparable value to other countries, then it is inevitable for the sides to talk past one another.

I think it is more productive to understand the "federal budget is out of control" argument in its spirit and motivational effectiveness. The simple fact is that many people are unhappy about HOW the money is spent and would rather reserve the choices on how to spend that money to the households.

To respond to your specific callouts, the growth of federal programs in the post WWII era is a fundamental point of contention. Averages going back to the 1970s (pegged to GDP of all things) are somewhat beside the political point. The federal bureaucracy is enormous. The ancillary industries that service the federal budget is prone to grift, graft, and corruption. Anyone who has worked in or near Washington DC knows this.

I believe you are talking about Social Security, which is a bit different from "taking care of the elderly." It is more like a public pension. Historically, no country in the world would have spent 36% of its budget "taking care of the elderly" because families, churches, and charities served that function, when necessary. Your framing is already misleading but let's go on.

Combining "defense and veterans" is also misleading. I believe somewhere south of 5% goes to Veterans Affairs (if that much). If you think the US government should spend 15% of its budget on its war machine and the inevitable foreign wars that feed the military industrial complex, we can have that discussion. I don't think 15% of budget is an absurd amount to maintain a global empire, but I assure you it won't be cut all that much.

"Taking care of the poor and disabled" is also a misleading number. Much of that is towards the "welfare state" which is a very gameable and corrupt program. Even if you remove all the outright fraud, reasonable people wonder why a healthy, wealthy country should incentive people not to seek work or to have families out of wedlock and become perpetual wards of the state, as the programs (as currently constituted) promote. And if you think the corruption only helps the poor, you are ignoring the many services that benefit from a large pool of welfare recipients.

Health care costs in the US are too high, but there are many perverse incentives at work leading to those costs that would be tedious to go into here. You cannot begin to fix them without removing the main sources of cost. One is that the population is unhealthy, but also over-medicalized. If Medicare can't negotiate costs by law (remember that battle?) the it is hard to bring down prices. If you want to have a good morbid laugh, take a look at the pricing sheet from a hospital one day. You don't charge that kind of money unless you have someone by the short and curlies.

Corporations are the employers of the workforce. Many are also owned by you and me as common stockholders in our 401k and other savings. You say they are declining as a percentage, but that says nothing about what the optimal percentage is. Too high and you will choke off dynamism and job creation, and drive industry overseas. Who does that benefit?

But all this penny-counting is a distraction. The political motivation for shrinking the federal government is as American as apple pie. As the recent political realignment suggests, most people don't want to be governed by this a federal bureaucracy (or civl service, if you prefer) that has its own political interests at odds with the rest of the population. Centralized power is very susceptible to grift and corruption. It's useful to point out "waste" in terms of inefficiency, but more revealing to point out spending at odds with the values of the majority of the population. People may not want their tax dollars spent on projects they find diametrically opposed to what they value. They don't want to be "pay pigs" for a vast patronage network that extends well beyond any benefits that come back to them. It is at those moments that people start to think that the government isn't working for them. Is that so hard to understand?

Re: DOGE's only public ledger is riddled with mistakes

#388
post #248

For those who want to have a substantive discussion on the federal budget and believe these cuts are justified, I have a few questions (putting aside questions of constitutionality for this thread): 1. There are claims that federal spending is out of control. How do you square that with the fact that spending as a percentage of GDP is only slightly elevated compared to the historical average going back to at least th…

1. But debt as percent of GDP has been growing. Can't do that forever. https://fred.stlouisfed.org/series/GFDEGDQ188S 2/3. If the US pays more for health care and gets worse results why should we give them more money? I don't think health insurance companies should be abolished by royal decree. I think the government should offer an alternative and when that alternative is 4x as dollar efficient the health insurance…

1. Agreed.

2/3. Then perhaps the US should elect representatives who will expand Medicare to more people. (Or go back in time and get the public option added back to Obamacare.) Unfortunately, instead we have an increasing number of people using Medicare Advantage, essentially a private wrapper around a public insurance plan, which costs taxpayers 22% more per participant.

4. Are we looking at the same graph? The ratio is almost half of what it was in the '70s. The economy has grown substantially; corporate tax contributions, not so much.

I agree with your sentiment that we should talk about what spending achieves and not just the dollar amounts. Hopefully, now that a lot of things are being cut, more people will appreciate what the government has been quietly providing for us all this time. I just hope that the rebuilding won't be as slow and painful as I fear it will be.

Re: DOGE's only public ledger is riddled with mistakes

#389

Earlier quoted context omitted.

We all know what efficient healthcare systems should look like, there are a dozen countries with lower overall healthcare spend per capita than US with better outcomes. What specific skillset of RFK do you find as compelling evidence they they will be extract higher efficiency similar to these other nations?

I'm not sure I meant to take a mantle as RFK's personal champion, but my _hope_ comes from hearing his points on prevention and improving the quality of the food supply. The incentives of both the healthcare and food industries in the US seem to be misaligned with a healthy population, much moreso in the US than in other countries in the West.

Being antivax is not a very effective way to prevent diseases. RFK is a national disaster waiting to happen

Re: DOGE's only public ledger is riddled with mistakes

#390

Earlier quoted context omitted.

The social security administration estimates ~$60b a year in fraud on ~$400b budget! [1] [2]. People can have a rational discussion as to where and how fraud and abuse are rooted out, but I have trouble understanding how people don’t think it’s an issue? [1] https://blog.ssa.gov/medicare-fraud-prevention-week/ [2] https://www.usaspending.gov/explorer/budget_function

It is an issue and should be addressed. But it should be fixed, not burnt to the ground.

Indeed. In fact, one couldn't be blamed for thinking that perhaps all of this is about something else entirely.
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