US cities pay too much for buses

The biggest problem with US health insurance is that it's not actually insurance. The purpose of insurance is to cover major claims. If a storm does $30,000 in damage to your house, you file an insurance claim. If it does $30 in damage, you go to the hardware store and pay $30. But we expect health "insurance" to cover the little stuff. Health insurance should be for if you get cancer or need major surgery, not for a generic drug that ought to cost $30.

Which in turn is what messes up what could otherwise be a competitive market. Instead of picking who you want to buy the drug from, most people have insurance, and the insurance company picks. And then most people get insurance from their employer so they also don't get to pick their insurance which makes the insurance company unresponsive because the patient can't easily switch.

And then it sounds like what happened is that the manufacturers make nearly all of their sales through insurance, who only care about regulatory compliance, and there aren't enough people paying out of pocket to get them to compete on actual quality.

But the other problems shouldn't be there if we could get people actually buying what ought to be cheap generics themselves instead of through insurance:

> Plus, even in a functioning and truly competitive market, trying to experiment with different formulations to figure out which "gets better results" is a dangerous game for individuals; it's not like buying different Kleenex and deciding which holds together better. You have to do a lot of risky trial and error and get frequent blood tests.

This wouldn't be something most people would have to do themselves. If there are five companies making the same drug then forums for people with the condition it treats would have people already taking each of them, and if some of them are actually not right then aggregate data should show that, and then everybody would find out without each person having to do their own trials.

And somebody needs to be doing that anyway or you're going to have a lot of people whose medication is wrong who don't realize that it's because they're not getting what they paid for while the one that works is available from someone else.

> When we clearly end up paying dozens of times more than other countries (even for unpatented medicine) people raise the R&D issue to justify the costs.

But then we're back to, the trouble is that it's both.

And then people propose to have the government set prices, which is only trading one problem for another. Whereas what we ought to do is address the things causing the markets that are supposed to be competitive to not.

This seems different. A healthcare consumer (in the US) is overpaying in large part because (1) they need the coverage (2) they lack the expertise to distinguish between offerings and (3) there simply aren't more affordable offerings.

Single payer healthcare systems feature significantly lower costs and better quality despite that the payer is not the consumer.

> Perhaps you don't understand how HN works.

You continue with unnecessary attempts at belittling, while thinking you're in the 'right'. Perhaps take your own advice regarding internet forum usage.

> When you give an opinion, other people can disagree.

Yes, I'm disagreeing politely. You're the one having trouble accepting it.

First of all, I don't think anyone's goal is "an area full of tall buildings"; that's certainly not what I mean by "density" (although it is _one kind_ of density). Secondly, even in urban areas full of tall buildings, there's frequently much less space between buildings than a CostCo parking lot.

> Moreover, it isn't actually a density limit anyway because you can make the buildings taller instead of wider, and you can build a parking garage under the building rather than beside it.

Building vertically is expensive, and in many places land is cheaper, so it's easier to meet the legal requirement by surrounding the building with pavement than it is to build a parking garage beneath the structure. This is why you rarely see a Walmart with an underground parking garage (and when you do, it's usually in a dense city with more lax parking regulations).

> Moreover, you can't put the cart before the horse. If people currently live in the suburbs and arrive in cars, you can't expect them to walk before you allow anyone to build them housing within walking distance.

I think you're confused about what is being advocated. No one is suggesting we make everyone walk to work. I don't think that's a realistic outcome, and probably not a desirable one for many people (who wants to work close to a factory, airport, etc)? More importantly, relaxing parking requirements on developers doesn't make the existing parking lots go away, so it doesn't really affect the current crop of commuters; it just means that future suburban commuters will lean more on public transit to get to work.