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US cities pay too much for buses

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Re: US cities pay too much for buses

#581

Post by frollogaston »

doctorpangloss wrote: post #397
estearum wrote: post #269

Earlier quoted context omitted.

Also the largest insurers increasingly own the doctors you’re seeing too. Also the pharmacy you get your drugs from. Also the entity that negotiates prices between pharma companies and your insurer. More healthcare consumption = better, across the board

Uh, no… they want to deny claims. The best situation for insurers is that you are healthy for a while, then abruptly die of something that cannot be treated.

They are accepting claims that are way more expensive than in any other country, so I don't think this is their game

Re: US cities pay too much for buses

#582

Post by int_19h »

lyu07282 wrote: post #444
avar wrote: post #341

Earlier quoted context omitted.

I'm aware of your and the GP's claim, I'm saying it doesn't survive contact with reality. If you look at e.g. the per-dose price of insulin it's as low or lower in countries with single-payer universal systems, where someone requiring insulin is never going to have any idea what it even costs, because it's just something that's provided for them should they need it. In that case it's usually some centralized state pu…

Why do you even argue against someone that doesn't think "insurance" should exist? Its a troll, not even most serious libertarian freaks are that idiotic. Our goal should be to make sure these freaks have no power. OF COURSE single-payer means lower prices, the government has a shit ton of power in negotiating prices if they want to. They don't want to because they are corrupt, freaks like the above are only there to…

The original argument wasn't against public healthcare per se, but against the US system in which it really is run as insurance, with multiple competing providers, who therefore don't have the power to negotiate down prices.

It's very easy to find examples of abuse in this system. For example, in modern "factory towns" around corporate campuses, somehow, routine dental maintenance costs exactly the maximum amount provided for this purpose by the employee health plan.

Re: US cities pay too much for buses

#583

Post by int_19h »

matthewdgreen wrote: post #573
AnthonyMouse wrote: post #572

Earlier quoted context omitted.

I was kind of curious if there was some specific failure with this outside of the general brokenness of US healthcare competition, but it's starting to sound like the classic one: 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…

Well, US health insurance is insurance. That’s one function. But it’s also managed healthcare. The management is being performed by a series of large corporations with somewhat broken incentives, with the government backstopping and certifying everything and filling in all the gaps. That’s why other countries achieve such better results with government-managed healthcare, because our system genuinely has very little…

> This is the planned system we designed in one of the most capitalist countries on earth: it got to the state of being a planned system because the truly competitive market systems kept failing.

We didn't really "design" it though, it emerged organically out of the various constraints, many of them historical.

For example, why is quality health insurance in US tied to employers? Because during WW2, when federal government froze salaries, companies started to use various benefits to attract employees instead, and one of the most lucrative benefits turned out to be health insurance. And, since companies were large customers negotiating on behalf of all their employees, they could get more out of insurers for the same amount of money. And so gradually it evolved into what things have been before ACA, and ACA is basically a crutch that preserves this historical nonsense.

FWIW I don't think that free market is the answer here, but that doesn't mean that it can't produce significantly better results than what we currently have (it's not hard because our existing system essentially combines the downsides of free market with the downsides of centralized healthcare - you don't get the choice and you get fleeced).

It should also be noted that there are many different ways in which less-than-free market can be implemented. Single payer is a fairly extreme take with no clear evidence that it works better than more market-friendly approaches as seen across Europe. The one model that I'm really curious about and that doesn't seem to exist anywhere, though, is one where the government simply provides healthcare at a certain level as a non-profit public service, thereby setting the baseline, but doesn't try to heavily regulate private healthcare, and doesn't require citizens to participate in the public plan. Germany has some similarities but I don't think it's quite there yet.

Re: US cities pay too much for buses

#584

Post by lyu07282 »

int_19h wrote: post #582
lyu07282 wrote: post #444

Earlier quoted context omitted.

Why do you even argue against someone that doesn't think "insurance" should exist? Its a troll, not even most serious libertarian freaks are that idiotic. Our goal should be to make sure these freaks have no power. OF COURSE single-payer means lower prices, the government has a shit ton of power in negotiating prices if they want to. They don't want to because they are corrupt, freaks like the above are only there to…

The original argument wasn't against public healthcare per se, but against the US system in which it really is run as insurance, with multiple competing providers, who therefore don't have the power to negotiate down prices. It's very easy to find examples of abuse in this system. For example, in modern "factory towns" around corporate campuses, somehow, routine dental maintenance costs exactly the maximum amount pro…

I was posting in reference to:

> If consumers actually directly paid the whole cost for health services, the prices charged would become far more regular.

Which is arguing against the very idea of insurance which distributes risk, its an absurd argument not even libertarians make. The problem for literarians/neoliberals is that we already have exactly the system they think should work great, it just doesn't, but they completely refuse to ever recognize that the reason it doesn't work is systemic and it will never be fixed by more literarianism/neoliberalism, we need to shove it. Whats needed is a single-payer, universal, zero(!!!)-private, public health care system.

Re: US cities pay too much for buses

#585

Post by frollogaston »

ninalanyon wrote: post #451
samdoesnothing wrote: post #249

Earlier quoted context omitted.

Yes there is.

You first have to agree on a definition of free in this context. When Adam Smith was writing the Wealth of Nations most of the transactions in the market were between entities with more or less comparable power. Local people bought stuff from local suppliers. This is very much not the case any more when it comes to transactions involving private individuals on one side and corporations on the other.

This is true but beside the point. I don't care either way what you count as a "free" market or whether such a thing exists, you can just say that health insurance is less free than almost any other market.

Re: US cities pay too much for buses

#586

Post by int_19h »

lyu07282 wrote: post #584
int_19h wrote: post #582

Earlier quoted context omitted.

The original argument wasn't against public healthcare per se, but against the US system in which it really is run as insurance, with multiple competing providers, who therefore don't have the power to negotiate down prices. It's very easy to find examples of abuse in this system. For example, in modern "factory towns" around corporate campuses, somehow, routine dental maintenance costs exactly the maximum amount pro…

I was posting in reference to: > If consumers actually directly paid the whole cost for health services, the prices charged would become far more regular. Which is arguing against the very idea of insurance which distributes risk, its an absurd argument not even libertarians make. The problem for literarians/neoliberals is that we already have exactly the system they think should work great, it just doesn't, but they…

Why insist on single payer? It's not even dominant in Europe, and it makes the whole thing a much harder sell politically, yet there are no clear evidence that single payer is superior to other public healthcare arrangements.

Re: US cities pay too much for buses

#587

Post by dayvid »

Aunche wrote: post #192
rootusrootus wrote: post #159

Earlier quoted context omitted.

Repeating the oft-cited but questionable assertion that car companies dismantled city rail systems makes me uncertain about how trustworthy the rest of their claims are. Though they did mention that the US is the most wealthy nation in the world -- did they later offer an opinion whether that would still be true had we approached public transit and health care subsidies the same way European countries did?

Modern MBA videos are like ChatGPT. They sound reasonable when he's talking about something you don't know, but you'll notice him getting basic facts wrong in topics that you're familiar with. For example, he diagnoses the growth of public storage as people from single family homes to apartments in big cities and having no place to store their things, citing that America's urbanization rate has increased. However, th…

This is the most detailed I've seen covering numbers on train stats, especially around revenue per employee and different business models ranging from fully private to government subsidized around the world. I've also seen a number of other Modern MBA videos ranging from ok to good and this is arguably his best video

Re: US cities pay too much for buses

#588

Post by jodrellblank »

cyberax wrote: post #543
zbentley wrote: post #495

Earlier quoted context omitted.

Slower? In top speed maybe, but not in time-to-destination (or, given congested streets, average speed). Trains “require” you to make a transfer? Depends on your city, I guess; many train systems are hub-and-spoke-like enough (and dense enough) that common commutes don’t require any transfers. Also, I’m curious whether bus-centric mass transit requires more or fewer transfers than train-centric or hybrid.

> Slower? In top speed maybe, but not in time-to-destination (or, given congested streets, average speed). Yep. Transit is ALWAYS slower on average compared to cars. It is faster only in a very narrow set of circumstances. Try an experiment: drop 10 random points inside a city, and plot routes between them for cars and transit (you can use Google Maps API). Transit will be on average 2-3 times slower, even in the rus…

The grass is greener where you water it. Try an experiment: don't give over the entire public space to cars, so there's no on-street parking, no surface parking lots, and the driving routes are narrow, and always give priority to people outside a car without them having to wait while pedestrian crossings give priority to cars, and then compare.

Re: US cities pay too much for buses

#589

Post by jodrellblank »

dzhiurgis wrote: post #391
jodrellblank wrote: post #326

Earlier quoted context omitted.

You could have trams and trains with level boarding which helps people who don't have disabilities too, costs less, takes less space in the city, makes less noise, needs less maintenance, and moves more people.

Ah yes 100x more expensive and 10x less practical. How did we get to posting blatant nonsense here.

Tokyo's a very impractical city. It would be much more practical if all 14,000,000 people owned cars and drove them everywhere all the time. And 100x cheaper!

How did you get to posting blatant nonsense here?

Re: US cities pay too much for buses

#590

Post by DudeOpotomus »

kjkjadksj wrote: post #536
DudeOpotomus wrote: post #530

In many municipalities, it would be cheaper to run on demand van service for people than run busses. Not only would it get people to and from their actual homes and work, vans are cheap and readily available. Paying more drivers is cheaper than buying and maintaining multi million dollar busses that are empty a lot of the time. In most of CA, most homes are far from bus lines. Making their use prohibitive for all but…

Metro micro doesn’t scale at all. It is still limited to pilot study areas. Cost per trip is absurd compared to traditional bussing. One of the stated goals of the next gen bus plan in LA was to get a bus stop in a 10 min walk of 85% of the workers in LA county and this was achieved. The real trouble with transit is people choose where they live based on car convenience rather than transit convenience. So they open a…

Hard to figure this one with busses costing millions to purchase and tens of thousands a year to maintain. Not too mention drivers, bus stops, paint, etc.

No way that using cheaply available vans and part time drivers would ever cost more over time.

In my city in SoCal, busses are mostly empty. They are rarely full, and only at special events.

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