America's economic outperformance

[Scandium]

Another aspect to consider is that the US is made up primarily of people whose ancestors were willing to take risks and were probably at the far end of the bell curve for individualism.

I prefer to think of it as "America was founded by people who thought 16th century Europe wasn't quite religiously extremist and fundamentalist enough".
It explains a lot.

[ysette9]

Another aspect to consider is that the US is made up primarily of people whose ancestors were willing to take risks and were probably at the far end of the bell curve for individualism.

I prefer to think of it as "America was founded by people who thought 16th century Europe wasn't quite religiously extremist and fundamentalist enough".
It explains a lot.

Good point

[dang1]

Another aspect to consider is that the US is made up primarily of people whose ancestors were willing to take risks and were probably at the far end of the bell curve for individualism.

I prefer to think of it as "America was founded by people who thought 16th century Europe wasn't quite religiously extremist and fundamentalist enough".
It explains a lot.

curious then as to the American tradition of the separation of church and state

[Scandium]

Another aspect to consider is that the US is made up primarily of people whose ancestors were willing to take risks and were probably at the far end of the bell curve for individualism.

I prefer to think of it as "America was founded by people who thought 16th century Europe wasn't quite religiously extremist and fundamentalist enough".
It explains a lot.

curious then as to the American tradition of the separation of church and state

yes, that would be a good idea

[seattlecyclone]

Another aspect to consider is that the US is made up primarily of people whose ancestors were willing to take risks and were probably at the far end of the bell curve for individualism.

I prefer to think of it as "America was founded by people who thought 16th century Europe wasn't quite religiously extremist and fundamentalist enough".
It explains a lot.

curious then as to the American tradition of the separation of church and state

Many Puritans left England because their views were not welcome in the established church. Same with the Quakers. Of course the Puritans then banned Quakers from their colony in Massachusetts and even executed people for defying that law. Makes sense they'd prefer to agree to disagree about religion if they were going to form a new government together.

[Michael in ABQ]

Another aspect to consider is that the US is made up primarily of people whose ancestors were willing to take risks and were probably at the far end of the bell curve for individualism.

I prefer to think of it as "America was founded by people who thought 16th century Europe wasn't quite religiously extremist and fundamentalist enough".
It explains a lot.

That applies to New England, but the vast majority of American immigrants came over much later in the 19th and 20th century. Religious freedom was certainly the driving force behind many settlers in New England - most famously the Pilgrims. But there were multiple different colonies that were founded at different times and by different groups that eventually came together to form America. Maryland was a Catholic colony (until protestants basically took it over); South Carolina was founded by plantation owners from Barbados and the west Indies who were there for profit - not religion. Pennsylvania was founded by William Penn (a Quaker) who wanted to establish religious freedom as opposed to what was essentially a theocracy in New England. Along the way integrating other colonies like those from France in Louisiana and those from Mexico in the southwest plus waves of immigrants from Scotland, Germany, Scandinavia, Italy, etc.

[simonsez]

Canada and Australia have significantly more very remote country than the USA.

As a percentage of populace living in regions with low urbanicity?

https://en.wikipedia.org/wiki/Urbanization_by_sovereign_state
Australia 86% urban
USA 83% urban
Canada 82% urban

They're basically the same (though now I am curious if the US had 3% more urbanization to be equal to Australia just how much health outcomes would improve).  So it boils down to rural healthcare in the US compared to other countries and yes, it's objectively worse in the US due to the disparate regional differences.  I don't much about Australian or Canadian healthcare but I'm guessing the standard of care for rural areas is significantly more consistent?

[deborah]

Another aspect to consider is that the US is made up primarily of people whose ancestors were willing to take risks and were probably at the far end of the bell curve for individualism.

I prefer to think of it as "America was founded by people who thought 16th century Europe wasn't quite religiously extremist and fundamentalist enough".
It explains a lot.

That applies to New England, but the vast majority of American immigrants came over much later in the 19th and 20th century. Religious freedom was certainly the driving force behind many settlers in New England - most famously the Pilgrims. But there were multiple different colonies that were founded at different times and by different groups that eventually came together to form America. Maryland was a Catholic colony (until protestants basically took it over); South Carolina was founded by plantation owners from Barbados and the west Indies who were there for profit - not religion. Pennsylvania was founded by William Penn (a Quaker) who wanted to establish religious freedom as opposed to what was essentially a theocracy in New England. Along the way integrating other colonies like those from France in Louisiana and those from Mexico in the southwest plus waves of immigrants from Scotland, Germany, Scandinavia, Italy, etc.

How does any of this differ from the way Canada New Zealand and Australia were settled? 

Note:Please don’t say that Australia was settled by convicts and the USA wasn’t. In fact, the USA had slightly more convict migrants per head than Australia did during the time of convict transportation in each location, and the number of years convicts were transported there was similar in both locations.

Some of my Australian ancestors were escaping religious persecution, including some, who like the quakers, arrived in shiploads at completely new locations for Europeans and started their settlements from scratch thousands of miles from other settlements. Others escaped famine and wars. Others came for gold. Like most Australians I don’t have convict ancestors, so they aren’t in the mix.

One could argue that the USA had a lot more slaves, who probably weren’t as willing to take risks or were at the far end of the bell curve as far as risk-taking is concerned.

Canada and Australia have significantly more very remote country than the USA.

As a percentage of populace living in regions with low urbanicity?

https://en.wikipedia.org/wiki/Urbanization_by_sovereign_state
Australia 86% urban
USA 83% urban
Canada 82% urban

They're basically the same (though now I am curious if the US had 3% more urbanization to be equal to Australia just how much health outcomes would improve).  So it boils down to rural healthcare in the US compared to other countries and yes, it's objectively worse in the US due to the disparate regional differences.  I don't much about Australian or Canadian healthcare but I'm guessing the standard of care for rural areas is significantly more consistent?

We have an enormous amount of remote and very remote land. The people who live there have much poorer outcomes, and it’s really difficult to get anything like consistent outcomes when you’re got things like the biggest farms in the world - one place is the size of Israel and has nine people living there. The following compares health outcomes in different types of regions. It’s pretty shocking, and I’d expect it’s a lot worse than the USA outcomes because you just don’t have anywhere near as much remote and very remote land.

https://www.aihw.gov.au/reports/rural-remote-australians/rural-and-remote-health#:~:text=Around%207%20million%20people%20–%20or,and%20communities%20(ABS%202022c).

[Michael in ABQ]

Another aspect to consider is that the US is made up primarily of people whose ancestors were willing to take risks and were probably at the far end of the bell curve for individualism.

I prefer to think of it as "America was founded by people who thought 16th century Europe wasn't quite religiously extremist and fundamentalist enough".
It explains a lot.

That applies to New England, but the vast majority of American immigrants came over much later in the 19th and 20th century. Religious freedom was certainly the driving force behind many settlers in New England - most famously the Pilgrims. But there were multiple different colonies that were founded at different times and by different groups that eventually came together to form America. Maryland was a Catholic colony (until protestants basically took it over); South Carolina was founded by plantation owners from Barbados and the west Indies who were there for profit - not religion. Pennsylvania was founded by William Penn (a Quaker) who wanted to establish religious freedom as opposed to what was essentially a theocracy in New England. Along the way integrating other colonies like those from France in Louisiana and those from Mexico in the southwest plus waves of immigrants from Scotland, Germany, Scandinavia, Italy, etc.

How does any of this differ from the way Canada New Zealand and Australia were settled? 

For one, they didn't fight a war with England to gain independence.

I'm not as familiar with the history of Canada, Australia, and New Zealand but it looks like de facto independence (as a dominion) don't occur until the early 20th century with full independence (including control over foreign affairs) occurring as late as the 1980s.

Because they were still British colonies, immigration from other countries was presumably limited - especially in the 1800s to early 1900s when America saw the largest amount of immigration from all over Europe - and to a lesser extent from Asia.

Note:Please don’t say that Australia was settled by convicts and the USA wasn’t. In fact, the USA had slightly more convict migrants per head than Australia did during the time of convict transportation in each location, and the number of years convicts were transported there was similar in both locations.

The figure I found for Australia was 165k total convicts transported vs. 50-120k for North America - with not all of those ending up in the US. Convicts transported to the US were generally indentured servants and were spread throughout the colonies not concentrated in specific penal colonies. It obviously ended in 1776 - which is right about when it began in Australia.

[deborah]

Yes, more convicts were sent to Australia, but we also had more non convicts come out in that timeframe, so we ended up with fewer convicts per head over that period. They were also mainly indentured here, and spread out. Only those seen as criminal were kept in prison camps - I suspect the same happened there. And Canada was seen as wilderness, as there were very few people there, they were constantly fighting wars with the French, so extremely few North American convicts went to Canada. So much so, that after the war of independence, Britain had nowhere to send convicts so they started to invade Australia. And, of course, the Canadians were fighting not to become part of the US, so sending convicts there wouldn’t have been a good idea.

Immigration from other countries wasn’t very limited, especially once the gold rushes happened in Australia. Most Australian colonies didn’t have convicts when they were founded. Some decided to get convicts because they were growing very slowly and they needed more people, especially as the French were seen as a threat. There were convict outposts that didn’t last more than a few years in some places, but they were gone before the colony was founded - for instance, there was one near Melbourne in 1812, but it only lasted a few years. It was long gone by the time the colony of Victoria was founded in 1838, and by 1849 Victoria was big enough to be gazetted as a separate colony. Then the gold rushes started in 1850, and Victoria quickly became the largest colony, with ships pouring in from all over the world, including from the USA, since the California gold rushes were slightly earlier. The Scottish highland clearances and the Irish potato famine brought a lot of British immigrants.

[elysianfields]

I know the usefulness of pointing to stuff behind a paywall is limited. But this article in the Economist is really relevant to many of the discussions here:

https://www.economist.com/briefing/2023/04/13/from-strength-to-strength

If you have subscription, well worth reading. If you live close to a library, maybe worth the visit. If you need something to read this week and have an extra $8 bucks, this issue definitely worth grabbing. It might even be worth the fiddling of trying their free month subscription.

There's a service running at archive.ph that will un-paywall articles, for this one it's https://archive.ph/2UOt7.

I think it makes a lot of good points, but makes the mistake of more money = better. Yes, the US spends more on education and healthcare and groceries than other members of the G7, but we don’t get more for it. In fact, we get less.

Yes, Americans make more money which they can in turn spend more than someone in France. But spending 50% more for groceries of lower quality… is that really a win? Similarly spending 50% more on a healthcare system that produces lower quality of life indicators in every respect is not a win, it is waste and inefficiency.

Regarding healthcare, doesn't the article say that while we in US usually think our education system is terrible, it's actually pretty good? E.g., fifteen of the world's top 20 universities are in the US. And while the educational system sure seems inefficient, we spend a lot more (37% more) than the average developed economy. Further, the only country in world with higher completed tertiary education degrees is Singapore. I read the article to say that actually, for good students, the US does an awfully good job.

Regarding healthcare, agree that US system is extremely expensive. It seems to me too like we spend way too much. But I wonder if it isn't inaccurate to say it produces lower quality of life indicators in every respect. I looked for some data to support or rebut that at our world in data website. Could not easily find any. PS I'm glad US healthcare system was able to quickly develop a COVID vaccination.

One could argue that many of the top universities in the U.S. perpetuate rich kids' launch into the upper socioeconomic echelons of society through legacy admissions and the cost of tuition.  Those also make those top universities attractive to wealthy parents in other countries, who also want to launch their kids into the top 1%, and at least provide some "export" income to those universities, and by extension, to the U.S.

I agree that our ROI on spending on universities and health care, despite the high quality of the former and the innovations of the latter, leaves much to be desired.

As an escapee from employment at a university, I noticed how many professors want to lead a Center for the Study/Research of This, That, and the Other, they obtain grants or donations, and the Center thus established expands the bureaucracy & administrative staffing load.

I'm all for study & research of this, that, and the other, but not necessarily at the expense of undergraduate tuition fees rising at twice the rate of inflation for the last 50 years.

[Fru-Gal]

I keep pointing this out but I'm also struck with parallels between asset allocation formulas that mostly hold risky equities and the US economy that makes people bear more economic risk. On average people do better working in a higher risk situation. But you do get more inequality of outcomes.

Astute! I agree based on comments many Euro immigrants have said to me. Often been told that the option to reinvent oneself is encouraged in the US and nonexistent/poorly tolerated in Europe.

[Radagast]

I'll start with the stock market ones because there is solid data at least for those. Showing US stocks doing better starting in 1990 amounts to cherry picking. That was the peak of the Japan bubble, when it was more than half the global stock market capitalization, and US was only around a quarter of the total. Since then the US rose to 60% of market cap, and Japan is down under 10%. This was largely driven by valuations rather than fundamentals: since then US valuations are up by a factor of 3, while Japanese valuations are down by a factor of three. No fundamental advantage is demonstrated by that one, it's just noise. The US has done better economically in that time period, but not by nearly as much as implied.

Similar for the stock market to GDP ratio. That's not a sign of anything except past high returns to stock owners. If anything it's the Buffet indicator and is showing stocks are too expensive and returns will be lower in the future. You don't need to divide market cap by GDP to measure economic outperformance, GDP alone works. Market cap again only adds noise. So those two at least are cherry picked and misleading.

To the broader picture, I agree that the US has more economic and personal freedom that most places. Often people use that freedom to abuse themselves and others instead of bettering themselves and others, but it does go both ways and the net effect is at least not particularly negative, and is generally positive I would say. The US is riskier though, and a meaningful number of people get bad outcomes. In effect it retains properties of an emerging market in many senses.

[Radagast]

Articles like this, https://confrontingpoverty.org/poverty-facts-and-myths/americas-poor-are-worse-off-than-elsewhere/ and threads like https://forum.mrmoneymustache.com/welcome-to-the-forum/health-insurers-are-inhumane/ demonstrate that the USA is an economy first and a society second.  Unlike most other first world countries.

I'm more than happy to invest in an economy.  But I'm especially happy that I live in a society.

Agree that US relative to other developed economies really emphasizes the economy. (That link I've shared a couple of times in responses to posts lets someone look at disposable income by decile by country... and you'd want to poor in Sweden or Germany rather than US.)

Whilst the bolded is definitely true, I'm at the other end of the income and wealth distribution and I'd never choose the US.

Being a high income earner and wealthy whilst living in a society, rather than an economy I get to experience the full benefits that society has to offer.  My utilisation of these benefits often well exceeds those at the 'safety net' end of the spectrum, simply because high income and wealth often equates to free time in my country.  Being wealthy in a well functioning society has many benefits.

I am safe.  My wife is safe.  My kids are safe.  Violent crime (and crime in general) is much, much lower here than in the US.  I live in a city of several million people.  There is not a single street in the entire city that I would avoid at any time of the day or night due to not feeling safe.  Schools are safe.  My kids have never had to undertake an 'active shooter drill' at school.  Parks are safe and clean and utilised. 

I have access to cheap, high quality, clean and safe public transport.  It's fast, efficient and well maintained with excellent patronage.  The US has one of the lower patronages of public transport anywhere in the first world.  In some cases it's not safe.  In some cases it's not clean.  Or of high quality.  In some cases it's expensive.  But it typically drives patronage away from being universal.  It puts people into cars, which creates traffic congestion and pollution.  Consequently, there is no city of a comparable size, anywhere in the USA, that has lower levels of air pollution than where I live.  Most are significantly higher.  I travel to the US semi-regularly and I can literally taste the difference when I breathe.

I have access to cheap, reliable and high quality healthcare.  Now and forever.  No mucking about with "in network/out of network".  If I'm sick, I will be helped.  Medications are cheap if/when they are needed - insulin is not a luxury item in my country.  The chances of anyone in my country being bankrupted by a medical bill is essentially nil.  Unlike CopperTop's father (https://forum.mrmoneymustache.com/welcome-to-the-forum/health-insurers-are-inhumane/, and many others in the US, I know that I will be treated with dignity and respect as I age.  I will also have access to affordable, high quality aged care should the need arise.

My kids have access to free, high quality, universal primary and secondary education and very heavily subsidised tertiary education.  The funding and therefore quality of their education doesn't depend on their post code.  The lack of systemic disadvantage exacerbated by education drives that lower crime rate and accelerates living standards at all parts of the wealth spectrum.  My kids will come out of Uni with no debt as education here is seen as an enabler for the entire nation, rather than a profit source.  In contrast, I have a good friend in Allentown, PA who is sending his daughter to university in the UK, because it's cheaper than sending her to university in New York.  That's not a measure of a properly functioning education system.  Pricing of education, pharmaceuticals, aged care and healthcare in the US drive GDP, but this can be to the detriment of living standards.

I live in a country that has much higher food quality standards than the US.  No high-fructose corn syrup anywhere to be seen on the supermarket shelves.  Plentiful supply of affordable fresh fruit and vegetables.  Cheese that tastes like cheese.  Milk that's really fresh milk.  Bread that's not loaded with sugars.  All of these differences are driven by the excessive commercialisation of the food supply chain in the US and a race to high margin, low quality products.  Great for GDP metrics.  Rubbish for consumers.

I also live in a country with a living minimum wage and fair protections for employees (guaranteed sick leave, minimum four weeks leave, mandated parental leave, etc).  Nor is there a political environment here that enables angertainment, culture war and magnifies social difference.  Violent protest is not normalised.  This again mitigates social disadvantage and the problems that come of it.  As above, those problems are not just impacting those experiencing social disadvantage.

I'm sure there are parts of the US that live well.  Give me the level of social cohesion we have here any day.

LOL all this and you're just from Australia, the second most US-like country in the world with the possible exception of Canada, and one of the very few whose lifestyle exceeds the US in per capital pollution? I thought you would be from somewhere fancy like Sweden or Switzerland. This is some really bad tiny details exaggeration syndrome.

[Radagast]

I think it makes a lot of good points, but makes the mistake of more money = better. Yes, the US spends more on education and healthcare and groceries than other members of the G7, but we don’t get more for it. In fact, we get less.

Yes, Americans make more money which they can in turn spend more than someone in France. But spending 50% more for groceries of lower quality… is that really a win? Similarly spending 50% more on a healthcare system that produces lower quality of life indicators in every respect is not a win, it is waste and inefficiency.

Regarding healthcare, doesn't the article say that while we in US usually think our education system is terrible, it's actually pretty good? E.g., fifteen of the world's top 20 universities are in the US. And while the educational system sure seems inefficient, we spend a lot more (37% more) than the average developed economy. Further, the only country in world with higher completed tertiary education degrees is Singapore. I read the article to say that actually, for good students, the US does an awfully good job.

Regarding healthcare, agree that US system is extremely expensive. It seems to me too like we spend way too much. But I wonder if it isn't inaccurate to say it produces lower quality of life indicators in every respect. I looked for some data to support or rebut that at our world in data website. Could not easily find any. PS I'm glad US healthcare system was able to quickly develop a COVID vaccination.

Personally I find it important to distinguish between absolute ranking and average. Yes, the US has the most top universities and the best innovative medical advances and specialists, but that doesn't reflect that average person's experience. On school, picking at random Cal State East Bay in California vs. Université de Rennes, France. Both are fine but not remarkable schools. Cal State East Bay is $6,995 a year for CA residents. Université de Rennes is 170 euros/yr for undergraduates. An average university student is going to be way better off in France than California for approximately the same degree.

On healthcare, we can look at some objective outcomes across countries.

• Maternal mortality - US  21 per 100,000 births (France 7.9)
• Fetal mortality - 6.3 per 1,000 births (France 4.4); highest of 27 developed countries (https://en.wikipedia.org/wiki/Infant_mortality) (
• Life Expectancy - US 77.28 years (rank 51) (France 82.18 rank 15)
• Various cancer outcomes are ranked by country and the US does well in a small number but in the majority it doesn't break the top 10 (https://en.wikipedia.org/wiki/List_of_countries_by_quality_of_healthcare)

WHO has ranked health care systems by country and lists the US as 37 on overall health system performance, though #1 on expenditure per capita (winning!). (https://en.wikipedia.org/wiki/World_Health_Organization_ranking_of_health_systems_in_2000)

The single biggest failing of US policy, by a big margin IMO, is healthcare. I've had minor experience or heard anecdotal experience with the healthcare systems in a few countries, and by far the US system is the worst in the world. It's as bad as any third world country. Which isn't to say health care is as bad is any third world country, it's the system that is as bad. Any half assed attempt by a moderately stable government, or even a government that didn't even bother, would be better. What we have is a near perfectly alignment of big government and big business to make the system at once as slow as the worst socialized system, as inequitable as the most inequitable country with no government involvement in health at all, and far more expensive than any. The sheer amount of money thrown in is the only reason it's even as good as it is. Any unregulated free market or pure socialist system would surely be better. Even worse, Obama wasted his one good policy chance on RomneyCare. Mandatory insurance adds pointless cost and complexity and incentivizes all the wrong behaviours. Surprise surprise, spending vast amounts of money on health insurance instead of health care doesn't work well. We'd be better off canceling essentially government health mandate (excuding basic safety regulation such as through the FDA), and just giving the money to people directly as a stipend in an HSA. That applies to all of it: medicare, medicaid, VA, mandatory insurance, everything.

[wageslave23]

I think it makes a lot of good points, but makes the mistake of more money = better. Yes, the US spends more on education and healthcare and groceries than other members of the G7, but we don’t get more for it. In fact, we get less.

Yes, Americans make more money which they can in turn spend more than someone in France. But spending 50% more for groceries of lower quality… is that really a win? Similarly spending 50% more on a healthcare system that produces lower quality of life indicators in every respect is not a win, it is waste and inefficiency.

Regarding healthcare, doesn't the article say that while we in US usually think our education system is terrible, it's actually pretty good? E.g., fifteen of the world's top 20 universities are in the US. And while the educational system sure seems inefficient, we spend a lot more (37% more) than the average developed economy. Further, the only country in world with higher completed tertiary education degrees is Singapore. I read the article to say that actually, for good students, the US does an awfully good job.

Regarding healthcare, agree that US system is extremely expensive. It seems to me too like we spend way too much. But I wonder if it isn't inaccurate to say it produces lower quality of life indicators in every respect. I looked for some data to support or rebut that at our world in data website. Could not easily find any. PS I'm glad US healthcare system was able to quickly develop a COVID vaccination.

Personally I find it important to distinguish between absolute ranking and average. Yes, the US has the most top universities and the best innovative medical advances and specialists, but that doesn't reflect that average person's experience. On school, picking at random Cal State East Bay in California vs. Université de Rennes, France. Both are fine but not remarkable schools. Cal State East Bay is $6,995 a year for CA residents. Université de Rennes is 170 euros/yr for undergraduates. An average university student is going to be way better off in France than California for approximately the same degree.

On healthcare, we can look at some objective outcomes across countries.

• Maternal mortality - US  21 per 100,000 births (France 7.9)
• Fetal mortality - 6.3 per 1,000 births (France 4.4); highest of 27 developed countries (https://en.wikipedia.org/wiki/Infant_mortality) (
• Life Expectancy - US 77.28 years (rank 51) (France 82.18 rank 15)
• Various cancer outcomes are ranked by country and the US does well in a small number but in the majority it doesn't break the top 10 (https://en.wikipedia.org/wiki/List_of_countries_by_quality_of_healthcare)

WHO has ranked health care systems by country and lists the US as 37 on overall health system performance, though #1 on expenditure per capita (winning!). (https://en.wikipedia.org/wiki/World_Health_Organization_ranking_of_health_systems_in_2000)

The single biggest failing of US policy, by a big margin IMO, is healthcare. I've had minor experience or heard anecdotal experience with the healthcare systems in a few countries, and by far the US system is the worst in the world. It's as bad as any third world country. Which isn't to say health care is as bad is any third world country, it's the system that is as bad. Any half assed attempt by a moderately stable government, or even a government that didn't even bother, would be better. What we have is a near perfectly alignment of big government and big business to make the system at once as slow as the worst socialized system, as inequitable as the most inequitable country with no government involvement in health at all, and far more expensive than any. The sheer amount of money thrown in is the only reason it's even as good as it is. Any unregulated free market or pure socialist system would surely be better. Even worse, Obama wasted his one good policy chance on RomneyCare. Mandatory insurance adds pointless cost and complexity and incentivizes all the wrong behaviours. Surprise surprise, spending vast amounts of money on health insurance instead of health care doesn't work well. We'd be better off canceling essentially government health mandate (excuding basic safety regulation such as through the FDA), and just giving the money to people directly as a stipend in an HSA. That applies to all of it: medicare, medicaid, VA, mandatory insurance, everything.

Other than it being expensive, just what is so bad about US healthcare? I can make an appt to see see a specialist within a couple of weeks, I can schedule an mri or xray within 24 hrs. I've heard of months long waiting lists in other countries.  I've also never heard of people traveling to other countries when they are looking for top of the line surgeons and other specialists. Some people travel in order to save money which goes back to cost, but correct me if I'm wrong, if money is no object and you need brainsurgery you are probably not leaving the US.  Plus our drug development is top notch. So I'm seeing a world leading healthcare system that is just too expensive.

[BicycleB]

Other than it being expensive, just what is so bad about US healthcare? I can make an appt to see see a specialist within a couple of weeks, I can schedule an mri or xray within 24 hrs. I've heard of months long waiting lists in other countries.  I've also never heard of people traveling to other countries when they are looking for top of the line surgeons and other specialists. Some people travel in order to save money which goes back to cost, but correct me if I'm wrong, if money is no object and you need brainsurgery you are probably not leaving the US.  Plus our drug development is top notch. So I'm seeing a world leading healthcare system that is just too expensive.

That's a very interesting proposition!

(reaches for popcorn)

[seattlecyclone]

We have a health care system that can provide good outcomes for those who are able to pay. Even for them though the cost of American health care is a huge drag on the economy. We're paying twice as much as most other developed countries for outcomes that are worse for the average person. Cost is a feature, and we're losing the race.

[Telecaster]

Other than it being expensive, just what is so bad about US healthcare? I can make an appt to see see a specialist within a couple of weeks, I can schedule an mri or xray within 24 hrs. I've heard of months long waiting lists in other countries.  I've also never heard of people traveling to other countries when they are looking for top of the line surgeons and other specialists. Some people travel in order to save money which goes back to cost, but correct me if I'm wrong, if money is no object and you need brainsurgery you are probably not leaving the US.  Plus our drug development is top notch. So I'm seeing a world leading healthcare system that is just too expensive.

There is a statistic called "mortality amenable to healthcare"  which is to say the number of people who died of something preventable.   United States is No. 1 in the developed world.  And by that I mean, more people die of preventable conditions in the US than any other developed country.   And by a lot. 


https://www.commonwealthfund.org/international-health-policy-center/system-stats/mortality-amenable-health-care

[ysette9]

We have a health care system that can provide good outcomes for those who are able to pay. Even for them though the cost of American health care is a huge drag on the economy. We're paying twice as much as most other developed countries for outcomes that are worse for the average person. Cost is a feature, and we're losing the race.

And that is just for the people who can pay. As @telecaster pointed out with the awesome post, that leaves plenty of people to suffer and die for lack of access to healthcare that exists but isn’t available to them. That is a moral issue.

[seattlecyclone]

Indeed! I was trying to say that even for the folks who can afford whatever care they need, the system is still not great because they're paying much more than elsewhere and barely getting any better care (if at all). And for those who can't pay...well the numbers don't lie. They tend to die a lot.

[Scandium]

Indeed! I was trying to say that even for the folks who can afford whatever care they need, the system is still not great because they're paying much more than elsewhere and barely getting any better care (if at all). And for those who can't pay...well the numbers don't lie. They tend to die a lot.

feature, not a bug.
A myriad of rent-seeking health"care" companies get to skim money at every level, and poor people die and/or go into crippling debt? win-win for many. (Although I guess they'd prefer they pay off the debt, then die)

[Philociraptor]

I can make an appt to see see a specialist within a couple of weeks, I can schedule an mri or xray within 24 hrs.

This sounds amazing! This does not exist in much of the US though.

The wife and I both have healthcare through our employers and are fairly internet-savvy middle millennials. Even so, it took both of us probably half an hour to work our way through our health insurance websites in order to find doctors we are eligible to use for primary care (most are not accepting new patients). Once we found the doctors, you have to call their offices individually, wait in long call trees, and then provide a myriad of information about yourself before they will even give you the opportunity to make an appointment. Finally, we both reached that step, and the earliest appointments were no less than 3 months out. We're inside of the DFW metroplex, right between both Dallas and Fort Worth, and the wife still has to drive 15 miles to reach the closest female gynecologist in her network.

We pay SO MUCH for healthcare in this country, but getting actual access to that care, even with "good health insurance", is prohibitively difficult. The system is giving all the money to the middle-men, and not enough to the doctors/nurses/support staff that actually provide the care. Our educational system disincentives people to get the credentialing to go into the medical field through ridiculously expensive schooling and student loans. We individualize the cost of education, socialize the bloated bureaucracy of care, and privatize the profit; this is not a healthy system.

[BicycleB]

I can make an appt to see see a specialist within a couple of weeks, I can schedule an mri or xray within 24 hrs.

This sounds amazing! This does not exist in much of the US though.

The wife and I both have healthcare through our employers and are fairly internet-savvy middle millennials. Even so, it took both of us probably half an hour to work our way through our health insurance websites in order to find doctors we are eligible to use for primary care (most are not accepting new patients). Once we found the doctors, you have to call their offices individually, wait in long call trees, and then provide a myriad of information about yourself before they will even give you the opportunity to make an appointment. Finally, we both reached that step, and the earliest appointments were no less than 3 months out. We're inside of the DFW metroplex, right between both Dallas and Fort Worth, and the wife still has to drive 15 miles to reach the closest female gynecologist in her network.

We pay SO MUCH for healthcare in this country, but getting actual access to that care, even with "good health insurance", is prohibitively difficult. The system is giving all the money to the middle-men, and not enough to the doctors/nurses/support staff that actually provide the care. Our educational system disincentives people to get the credentialing to go into the medical field through ridiculously expensive schooling and student loans. We individualize the cost of education, socialize the bloated bureaucracy of care, and privatize the profit; this is not a healthy system.

Superbly put, @Philociraptor

[Radagast]

Other than it being expensive, just what is so bad about US healthcare?

1. Expensive like a monopoly
2. Unequal like a free market
3. Slow and inefficient like a DMV. That's not an exaggeration. If I make doctor appointment, it takes three weeks on average, and once I show up to the predetermined time I spend 15 minutes filling out paperwork and 45 minutes waiting. That is exactly like the DMV within a few minutes either side.
4. Literally the worst of all possible systems, and that's not an exageration.


I can make an appt to see see a specialist within a couple of weeks, I can schedule an mri or xray within 24 hrs.
You think that's impressive? An X-ray takes like 5 minutes? Maybe 45 total on average if things were efficient? I only have experience with X-rays in China and the US, and in China the X-ray process takes 2 hours average with no paper work and for a fraction the cost. Even in rural areas. I'm impressed that you think that taking 22 hours longer than a rural communist system is impressive. I reckon if we had totally free market healthcare, X-rays would be as fast Jack-In-The-Box.

I've heard of months long waiting lists in other countries.
Me too, so I am not totally sold on those systems. Of course, they are a lot less expensive and on average result in better outcomes, so they are better 2/3.

I've also never heard of people traveling to other countries when they are looking for top of the line surgeons and other specialists.
I've heard of lots of people going to Thailand and Mexico to get better care at a fraction the cost with room and board included.

Some people travel in order to save money which goes back to cost, but correct me if I'm wrong, if money is no object and you need brainsurgery you are probably not leaving the US.
Even the average poster on this forum, who has more time and money than pretty much anyone, would not likely be able to afford that.

Plus our drug development is top notch.
Is there any evidence this benefits the mean or median citizen? It looks to me like if there is a benefit its to other nations citizens.

So I'm seeing a world leading healthcare system that is just too expensive.
And slow. And bureaucratic. And unequal. And results in disproportionately poor results to the average person.

[dang1]

25 years or so with Kaiser Permanente in California - through work; so far so good - knock on redwood, lol. Always hounding me if I don't do my labs, $150 incentive to do my annuals. What forms? It's all in the system, love check-in by text, lol, just have to listen for my name to be called by the doctor's medi-cal assistant.

My nearest medical center with ER is 5 mins drive, 5 others within 25 miles. Emergency room waits have not been too long - xrays, tests, labs included. I've heard some people who got mri's, among other diagnostics, in ER visits. Never had to wait long for specialists to the point of being annoying, either. My last referral from primary to rheumatologist, neurologist took all, a week and half. Others I know are generally good with Kaiser too - cancers, accidents, etc. One is going thru chemo, referred by KP to Stanford and UCSF. I always have my garmin inreach when in areas with no cell signal, figured there should be some guvment helicopter that can medevac.

US is big. Maybe it's just the healthcare landscape around here. I've come across undocumented- including from Mexico, happy with their full-coverage Medi-Cal

as for my local DMV: currently zero wait time; get in line, online
https://www.dmv.ca.gov/portal/field-office/el-cerrito/

[ysette9]

25 years or so with Kaiser Permanente in California - through work; so far so good - knock on redwood, lol. Always hounding me if I don't do my labs, $150 incentive to do my annuals. What forms? It's all in the system, love check-in by text, lol, just have to listen for my name to be called by the doctor's medi-cal assistant.

My nearest medical center with ER is 5 mins drive, 5 others within 25 miles. Emergency room waits have not been too long - xrays, tests, labs included. I've heard some people who got mri's, among other diagnostics, in ER visits. Never had to wait long for specialists to the point of being annoying, either. My last referral from primary to rheumatologist, neurologist took all, a week and half. Others I know are generally good with Kaiser too - cancers, accidents, etc. One is going thru chemo, referred by KP to Stanford and UCSF. I always have my garmin inreach when in areas with no cell signal, figured there should be some guvment helicopter that can medevac.

US is big. Maybe it's just the healthcare landscape around here. I've come across undocumented- including from Mexico, happy with their full-coverage Medi-Cal

as for my local DMV: currently zero wait time; get in line, online
https://www.dmv.ca.gov/portal/field-office/el-cerrito/

Kaiser I think is the big exception to all the US bullshit. I’ve had Kaiser since I was a kid, mostly in Northern California but now I’m WA as well. I am really pleased with how well care is coordinated, how easily we can get care when needed, and the specialty care i needed during pregnancy and then with preemies. We spent six months on regular US health insurance a couple of years back and it was a dumpster fire, even with excellent employer coverage. I wouldn’t wish that on anyone.

[ChpBstrd]

25 years or so with Kaiser Permanente in California - through work; so far so good - knock on redwood, lol. Always hounding me if I don't do my labs, $150 incentive to do my annuals. What forms? It's all in the system, love check-in by text, lol, just have to listen for my name to be called by the doctor's medi-cal assistant.

My nearest medical center with ER is 5 mins drive, 5 others within 25 miles. Emergency room waits have not been too long - xrays, tests, labs included. I've heard some people who got mri's, among other diagnostics, in ER visits. Never had to wait long for specialists to the point of being annoying, either. My last referral from primary to rheumatologist, neurologist took all, a week and half. Others I know are generally good with Kaiser too - cancers, accidents, etc. One is going thru chemo, referred by KP to Stanford and UCSF. I always have my garmin inreach when in areas with no cell signal, figured there should be some guvment helicopter that can medevac.

US is big. Maybe it's just the healthcare landscape around here. I've come across undocumented- including from Mexico, happy with their full-coverage Medi-Cal

as for my local DMV: currently zero wait time; get in line, online
https://www.dmv.ca.gov/portal/field-office/el-cerrito/

Guessing $30k per year? Check your employer's total compensation statement to confirm.

[dang1]

25 years or so with Kaiser Permanente in California - through work; so far so good - knock on redwood, lol. Always hounding me if I don't do my labs, $150 ..

Guessing $30k per year? Check your employer's total compensation statement to confirm.

wow, good guess- a bit south of that. sunk cost, lol! what the union negotiated

[wageslave23]

Other than it being expensive, just what is so bad about US healthcare?

1. Expensive like a monopoly
2. Unequal like a free market
3. Slow and inefficient like a DMV. That's not an exaggeration. If I make doctor appointment, it takes three weeks on average, and once I show up to the predetermined time I spend 15 minutes filling out paperwork and 45 minutes waiting. That is exactly like the DMV within a few minutes either side.
4. Literally the worst of all possible systems, and that's not an exageration.


I can make an appt to see see a specialist within a couple of weeks, I can schedule an mri or xray within 24 hrs.
You think that's impressive? An X-ray takes like 5 minutes? Maybe 45 total on average if things were efficient? I only have experience with X-rays in China and the US, and in China the X-ray process takes 2 hours average with no paper work and for a fraction the cost. Even in rural areas. I'm impressed that you think that taking 22 hours longer than a rural communist system is impressive. I reckon if we had totally free market healthcare, X-rays would be as fast Jack-In-The-Box.

I've heard of months long waiting lists in other countries.
Me too, so I am not totally sold on those systems. Of course, they are a lot less expensive and on average result in better outcomes, so they are better 2/3.

I've also never heard of people traveling to other countries when they are looking for top of the line surgeons and other specialists.
I've heard of lots of people going to Thailand and Mexico to get better care at a fraction the cost with room and board included.

Some people travel in order to save money which goes back to cost, but correct me if I'm wrong, if money is no object and you need brainsurgery you are probably not leaving the US.
Even the average poster on this forum, who has more time and money than pretty much anyone, would not likely be able to afford that.

Plus our drug development is top notch.
Is there any evidence this benefits the mean or median citizen? It looks to me like if there is a benefit its to other nations citizens.

So I'm seeing a world leading healthcare system that is just too expensive.
And slow. And bureaucratic. And unequal. And results in disproportionately poor results to the average person.

Are you really going to compare the care level of a third world/developing country like China, Mexico, etc to the US?  Good luck with that, if you're fine with those then I'm sure I have a cousin that can give you a quick and cheap MRI out of his basement. 

My dad had a brain aneurysm rupture about 10 years ago.  Still perfectly healthy today, cost him about $5k out of pocket - he's a construction worker. 

My grandfather had triple bypass surgery at the age of 55.  Had another heart attack several years later.  Along with diabetes and later cancer that was treated into remission.  Lived a happy, healthy life to age 82.  Minimal out of pocket.  Worked for the local government.

My other grandfather had two heartaches and two heart surgeries.  Minimal out of pocket.  Worked part time at a community college.

My next door neighbor had multiple heart surgeries and later a heart transplant.  Lived another 15 years after the heart transplant.  He was a salesman.

These are all middle class, average joe's.  They didn't take care of themselves like most people don't, so they dealt with a lot of preventable diseases.  But they had outstanding medical care and I wouldn't want to have to go through what they did in any other country.  Top doctors, top facilities, immediate care, low out of pocket costs.  So again, the only issue is if you don't have good health insurance.  If you have good health insurance then I wouldn't trade our healthcare for any in the world.

[Radagast]

Are you really going to compare the care level of a third world/developing country like China, Mexico, etc to the US?  Good luck with that, if you're fine with those then I'm sure I have a cousin that can give you a quick and cheap MRI out of his basement. 

I'm not saying China has good health care, I'm saying it has a good health care system. They only spend 10% as much as the US on per capita healthcare, so I have low expectations. Still, being able to walk in with an ear infection and walk out with antibiotics within 40 minutes is head and shoulders better than anything in the US. CVS alone would take that long or more to make a prescription, and it would take at least that long again to get a prescription in the first place.

It's like saying McDonalds has a good food system. I'm not saying they have good food, or that I'd prefer to eat there regularly, but man is their system great. Per capita, the US spends more than 1,000% more than China does on healthcare. Is it 1,000%+ better? No definitely not, by any stretch. I'd say its at most 500% better, and noticeably slower for pretty much anything.

My dad had a brain aneurysm rupture about 10 years ago.  Still perfectly healthy today, cost him about $5k out of pocket - he's a construction worker. 

My grandfather had triple bypass surgery at the age of 55.  Had another heart attack several years later.  Along with diabetes and later cancer that was treated into remission.  Lived a happy, healthy life to age 82.  Minimal out of pocket.  Worked for the local government.

My other grandfather had two heartaches and two heart surgeries.  Minimal out of pocket.  Worked part time at a community college.

My next door neighbor had multiple heart surgeries and later a heart transplant.  Lived another 15 years after the heart transplant.  He was a salesman.

These are all middle class, average joe's.  They didn't take care of themselves like most people don't, so they dealt with a lot of preventable diseases.  But they had outstanding medical care and I wouldn't want to have to go through what they did in any other country.  Top doctors, top facilities, immediate care, low out of pocket costs.  So again, the only issue is if you don't have good health insurance.  If you have good health insurance then I wouldn't trade our healthcare for any in the world.

Not that impressed. You realize any country that spends even 1/2 as much on healthcare will be able to operate at a similar level right? In fact I'd even say this shows something that is seriously wrong with the US system. Insurance deductibles incentivize people to not spend money on preventive healthcare. Then, once an emergency happens, to rack up as much healthcare as they can once they cross the deductible. In other words, for an individual it makes sense to spend $0 per year for 30 years, and then run up $200,000 on acute care while only paying the deductible. Just spend $5,000 for 30 years of care! For society, it would be better to spend $2,000 per year on ongoing preventative care and to avoid acute care, thus totaling $60,000 in 30 years. And that explains why the US receives the same level of healthcare as nations that spend 1/2 or 1/3 as much.

[wageslave23]

Are you really going to compare the care level of a third world/developing country like China, Mexico, etc to the US?  Good luck with that, if you're fine with those then I'm sure I have a cousin that can give you a quick and cheap MRI out of his basement. 

I'm not saying China has good health care, I'm saying it has a good health care system. They only spend 10% as much as the US on per capita healthcare, so I have low expectations. Still, being able to walk in with an ear infection and walk out with antibiotics within 40 minutes is head and shoulders better than anything in the US. CVS alone would take that long or more to make a prescription, and it would take at least that long again to get a prescription in the first place.

It's like saying McDonalds has a good food system. I'm not saying they have good food, or that I'd prefer to eat there regularly, but man is their system great. Per capita, the US spends more than 1,000% more than China does on healthcare. Is it 1,000%+ better? No definitely not, by any stretch. I'd say its at most 500% better, and noticeably slower for pretty much anything.

My dad had a brain aneurysm rupture about 10 years ago.  Still perfectly healthy today, cost him about $5k out of pocket - he's a construction worker. 

My grandfather had triple bypass surgery at the age of 55.  Had another heart attack several years later.  Along with diabetes and later cancer that was treated into remission.  Lived a happy, healthy life to age 82.  Minimal out of pocket.  Worked for the local government.

My other grandfather had two heartaches and two heart surgeries.  Minimal out of pocket.  Worked part time at a community college.

My next door neighbor had multiple heart surgeries and later a heart transplant.  Lived another 15 years after the heart transplant.  He was a salesman.

These are all middle class, average joe's.  They didn't take care of themselves like most people don't, so they dealt with a lot of preventable diseases.  But they had outstanding medical care and I wouldn't want to have to go through what they did in any other country.  Top doctors, top facilities, immediate care, low out of pocket costs.  So again, the only issue is if you don't have good health insurance.  If you have good health insurance then I wouldn't trade our healthcare for any in the world.

Not that impressed. You realize any country that spends even 1/2 as much on healthcare will be able to operate at a similar level right? In fact I'd even say this shows something that is seriously wrong with the US system. Insurance deductibles incentivize people to not spend money on preventive healthcare. Then, once an emergency happens, to rack up as much healthcare as they can once they cross the deductible. In other words, for an individual it makes sense to spend $0 per year for 30 years, and then run up $200,000 on acute care while only paying the deductible. Just spend $5,000 for 30 years of care! For society, it would be better to spend $2,000 per year on ongoing preventative care and to avoid acute care, thus totaling $60,000 in 30 years. And that explains why the US receives the same level of healthcare as nations that spend 1/2 or 1/3 as much.

You must not have really read my original post. I basically said that problem with US healthcare system is that it is too expensive.  The quality of care is world class. Whether that's worth it to you is personal preference.

You must not live in the US or haven't lived in the US since the ACA was implemented, all preventative care is free. It's the law. And I could literally walk into half a dozen immediate care facilities within 10 minutes of my house and see a Dr and get a prescription for antibiotics.  Probably take a total of an hour maybe two at worst. That's plenty fast for non emergencies. 

I'm not really sure what you are trying to get at, other than just wanting to hate on the US. It's expensive we all understand that. Yes you are going to have to fill out paperwork, we are not a 3rd world country. There are tradeoffs.  I would love to see the costs come down, but I wouldn't trade the level of care for any other country. 

[Radagast]

You must not have really read my original post. I basically said that problem with US healthcare system is that it is too expensive.  The quality of care is world class. Whether that's worth it to you is personal preference.

You must not live in the US or haven't lived in the US since the ACA was implemented, all preventative care is free. It's the law. And I could literally walk into half a dozen immediate care facilities within 10 minutes of my house and see a Dr and get a prescription for antibiotics.  Probably take a total of an hour maybe two at worst. That's plenty fast for non emergencies. 

I'm not really sure what you are trying to get at, other than just wanting to hate on the US. It's expensive we all understand that. Yes you are going to have to fill out paperwork, we are not a 3rd world country. There are tradeoffs.  I would love to see the costs come down, but I wouldn't trade the level of care for any other country.

You must not have read anything I wrote. The cost is half of it. The other part is that on average the US system gives worse results. Yes it's better for 1% of use cases, typically acute, emergency, or unusual needs. For the other 99% its similar or worse. Most Americans would receive better healthcare if they lived in any other nation with a per capita GDP 60% or more of the US. Not world class, and not in the top 10%. (Another part is that it is generally slow and inefficient, although it has that in common with many socialized health systems.) It seems to me that you have no experience with healthcare in other countries, and are thus unqualified to say you wouldn't trade.

Re antibiotics: Why are you trying so hard to justify paying 10 times more for a system that takes twice as long to produce the same result? OK cost of living and quality differences apply, but accounting for those its still 3 times more and twice as long for the same result. Not great, or even close.

[SwordGuy]

One could argue that the USA had a lot more slaves, who probably weren’t as willing to take risks or were at the far end of the bell curve as far as risk-taking is concerned.

Maybe you don't understand that a lot of the ones that talked back or resisted ended up being killed or severely beaten?

Maybe you don't understand that the slave states had an active slave-hunting militia that was prepared to put down slave rebellions?   And there's always a coward in any community that's willing to rat out those who attempt to plan a rebellion?  Check out the history of resistance fighters against the Germans during WWII for plenty of examples of that.

Not sure you understand that being kidnapped at weapon-point in a slave raid, or born into a society prepared to administer death or maiming to those slaves who fail to conform - all with the full weight and power of the government behind them - does not give a fair measure of the risks a free person unsubjected to grotesquely evil bigotry would take?

And maybe you don't understand that those who could get away did so, and stopped being slaves when they did?   No different from a brain-drain or gumption-drain in effect, even if caused by different circumstances.  It's not like they could easily send back word to the other slaves, "Having a wonderful time, wish you were here!" in order to encourage the others. 

Maybe you don't understand that those who tried to escape put their lives at risk and had little to no economic or social resources to pull off a voluntary re-location to a free state or Canada? 

Or why in the hell some slave would want to take risks to make their master more wealth when they won't be treated any better for doing so?   It's not like they could take those newly learned skills down the street to the next employer and get a better wage.  The US slavery system had gobs of built-in disincentives.

And all the above is assuming the statement I'm replying to wasn't some kind of veiled racist bullshit about lazy black people.

[wageslave23]

You must not have really read my original post. I basically said that problem with US healthcare system is that it is too expensive.  The quality of care is world class. Whether that's worth it to you is personal preference.

You must not live in the US or haven't lived in the US since the ACA was implemented, all preventative care is free. It's the law. And I could literally walk into half a dozen immediate care facilities within 10 minutes of my house and see a Dr and get a prescription for antibiotics.  Probably take a total of an hour maybe two at worst. That's plenty fast for non emergencies. 

I'm not really sure what you are trying to get at, other than just wanting to hate on the US. It's expensive we all understand that. Yes you are going to have to fill out paperwork, we are not a 3rd world country. There are tradeoffs.  I would love to see the costs come down, but I wouldn't trade the level of care for any other country.

You must not have read anything I wrote. The cost is half of it. The other part is that on average the US system gives worse results. Yes it's better for 1% of use cases, typically acute, emergency, or unusual needs. For the other 99% its similar or worse. Most Americans would receive better healthcare if they lived in any other nation with a per capita GDP 60% or more of the US. Not world class, and not in the top 10%. (Another part is that it is generally slow and inefficient, although it has that in common with many socialized health systems.) It seems to me that you have no experience with healthcare in other countries, and are thus unqualified to say you wouldn't trade.

Re antibiotics: Why are you trying so hard to justify paying 10 times more for a system that takes twice as long to produce the same result? OK cost of living and quality differences apply, but accounting for those its still 3 times more and twice as long for the same result. Not great, or even close.

Ok, I'll just respond one more time and then we'll just have to agree to disagree. My ONLY point (and I am not a US healthcare proponent at all in real life) is that IF you have good health insurance, then the doctors and facilities and drugs in the US are world class. I gave several examples of everyday people who recieved top level care.  I hear of no top level athletes traveling to another country or other rich people traveling to other countries because the level of care is better somewhere else. If LeBron James is diagnosed with a rare form of cancer, is he going to a specialist in the US or somewhere else? Don't bother responding about cost, because I never claimed the US wasn't too expensive.  And don't bother quoting averages because I never claimed it was equal.  I'm only talking about those with good health insurance.

[ysette9]

Sure, that is true.

It is also true that if you are an uber rich white cis hetero religious male then Saudi Arabia is a great country. That can be true while simultaneously it is true that for everyone else, the vast majority of the population, it has little to recommend it.

So really the question comes down to what is "better". Better for the very privileged few, or better on average for the majority?

[BicycleB]

One could argue that the USA had a lot more slaves, who probably weren’t as willing to take risks or were at the far end of the bell curve as far as risk-taking is concerned.

Maybe you don't understand that a lot of the ones that talked back or resisted ended up being killed or severely beaten?

Maybe you don't understand that the slave states had an active slave-hunting militia that was prepared to put down slave rebellions?   And there's always a coward in any community that's willing to rat out those who attempt to plan a rebellion?  Check out the history of resistance fighters against the Germans during WWII for plenty of examples of that.

Not sure you understand that being kidnapped at weapon-point in a slave raid, or born into a society prepared to administer death or maiming to those slaves who fail to conform - all with the full weight and power of the government behind them - does not give a fair measure of the risks a free person unsubjected to grotesquely evil bigotry would take?

And maybe you don't understand that those who could get away did so, and stopped being slaves when they did?   No different from a brain-drain or gumption-drain in effect, even if caused by different circumstances.  It's not like they could easily send back word to the other slaves, "Having a wonderful time, wish you were here!" in order to encourage the others. 

Maybe you don't understand that those who tried to escape put their lives at risk and had little to no economic or social resources to pull off a voluntary re-location to a free state or Canada? 

Or why in the hell some slave would want to take risks to make their master more wealth when they won't be treated any better for doing so?   It's not like they could take those newly learned skills down the street to the next employer and get a better wage.  The US slavery system had gobs of built-in disincentives.

And all the above is assuming the statement I'm replying to wasn't some kind of veiled racist bullshit about lazy black people.

I think her point was that blacks didn't have a choice. You and her might be on the same side.

I mean, her main point was something else. "Blacks didn't have a choice coming to the US / at that time British colonies" (that's my understanding of her comment) was an example of some other point, maybe "Australia and US have more similarities than some people think" or something like that. But her comment is consistent with yours. Anyway, just offering the possibility that her remarks might be misunderstood.

Maybe by me, too, of course! Sorry to interject.

[SwordGuy]

One could argue that the USA had a lot more slaves, who probably weren’t as willing to take risks or were at the far end of the bell curve as far as risk-taking is concerned.

Maybe you don't understand that a lot of the ones that talked back or resisted ended up being killed or severely beaten?

Maybe you don't understand that the slave states had an active slave-hunting militia that was prepared to put down slave rebellions?   And there's always a coward in any community that's willing to rat out those who attempt to plan a rebellion?  Check out the history of resistance fighters against the Germans during WWII for plenty of examples of that.

Not sure you understand that being kidnapped at weapon-point in a slave raid, or born into a society prepared to administer death or maiming to those slaves who fail to conform - all with the full weight and power of the government behind them - does not give a fair measure of the risks a free person unsubjected to grotesquely evil bigotry would take?

And maybe you don't understand that those who could get away did so, and stopped being slaves when they did?   No different from a brain-drain or gumption-drain in effect, even if caused by different circumstances.  It's not like they could easily send back word to the other slaves, "Having a wonderful time, wish you were here!" in order to encourage the others. 

Maybe you don't understand that those who tried to escape put their lives at risk and had little to no economic or social resources to pull off a voluntary re-location to a free state or Canada? 

Or why in the hell some slave would want to take risks to make their master more wealth when they won't be treated any better for doing so?   It's not like they could take those newly learned skills down the street to the next employer and get a better wage.  The US slavery system had gobs of built-in disincentives.

And all the above is assuming the statement I'm replying to wasn't some kind of veiled racist bullshit about lazy black people.

I think her point was that blacks didn't have a choice. You and her might be on the same side.

I mean, her main point was something else. "Blacks didn't have a choice coming to the US / at that time British colonies" (that's my understanding of her comment) was an example of some other point, maybe "Australia and US have more similarities than some people think" or something like that. But her comment is consistent with yours. Anyway, just offering the possibility that her remarks might be misunderstood.

Maybe by me, too, of course! Sorry to interject.

I would be thrilled to have been wrong!   I hope you are correct!

[sixwings]

An Ode To America...

I have some quibbles with the piece but, overall, it addresses the whys and hows and whens.

Not addressed:

1) Global warming and climate related disasters.* Major hurricanes reduce GDP temporarily (and, stupidly, increase GDP due to the cleanup) but increase the cost of business permanently. It might also sink Florida's economy in 20 years. Meanwhile, out west, Vegas and Phoenix and LA will take the brunt of the water cuts from the Colorado. That, though, might help with...

2) Migration. Will fewer people move because they're reluctant to lose their 30y locked mortgages, which the rest of the world doesn't have? If they do move, they'll have less purchasing power and consumers run a large part of the economy.


* While Europe has droughts and heat, it doesn't have hurricanes causing $100B of damage every few years.


Eta: It'd be interesting to see a similar piece about, say, Germany. "While Germany has lost PPP compared to America, it still maintains strong labor protections, universal health care, and 14 weeks of paid maternity leave."

TBF, Europe has the slow down of the atlantic currents to deal with which will be very very very bad for them.

[JupiterGreen]

Vast numbers end up chucked to the side: a combination of drugs, gun violence and dangerous driving has led to a shocking decline in average life expectancy in America. This suffering is concentrated among the country’s poorest, most marginalised communities. Money could mitigate most of these problems, and outperforming America has money aplenty. But this is not what it is spent on.

 Of course we have money, capitalism is our god and we have a long and rich history of prioritizing that over suffering (people, animals, the environment, other countries etc.).  I don't think this is the metric we should be using to conclude we are a successful country. So what if we have money. What are we spending it on? Certainly not things that make us happier and healthier as a nation. Not to mention our negative global impact.

There are two things that matter to an economy in the long term: the size of its workforce and the productivity thereof. A higher fertility rate and a more open immigration system have long given America a demographic advantage over most other wealthy countries, and that continues.

And this is why certain politicians are rolling back women's rights and reproductive freedom.

The Conference Board, a think-tank backed by American business, has found that between 1990 and 2022 American labour productivity (what workers produce in an hour) increased by 67%, compared with 55% in Europe and 51% in Japan. Add on to that the fact that Americans work a lot. An American worker puts in on average 1,800 hours per year (a 36-hour work week with four weeks of holiday), roughly 200 hours more than in Europe, though 500 less than in China.

And this makes us great? Hooray we are working ourselves to death /s

Bosses are more comfortable with firing employees (and more easily able to: America has much weaker employee-protection law than other large economies). Markets are readier to reward companies for evidence that they are well run. America’s managerial strength, their survey finds, explains as much as half of the productivity lead that it has over other developed countries.

What is that saying about correlation and causation? I believe the author is doing it here. I don't see weakening workers' rights being a good thing (except for the richest class).

There are good reasons to question the efficiency of some of this spending: test results in science and maths for 15-year-olds could be better. But good—often privileged—students thrive

and this

Even after taxes and transfers it has the most unequal income distribution in the g7.

and this

on average Americans born today can expect to live to 77, about five years shorter than their peers in other countries at similar levels of development

and this

For the poor, with less access to medical care and more violence around them, the deficit is particularly obvious.

These quotes from the article help illustrate how America is run on the backs of those in the lower socio economic tier so the rich can have access to innovation, things like better healthcare, and they can keep getting richer.

Here are some good things fom the article:

The increase in the number of small businesses (though I wish they got more granular on this point as I suspect the entry fee is quite steep)
 and this

America’s share of such patents globally increased from 19% in 2004 (the first year for which data is available) to 22% in 2021, more than any other country.

If it is true, it is a good thing that our CO2 output is lower than in the 90s

And something I authentically do not understand from the article is this:

The government has started to throw billions of dollars at bringing chipmakers to America—in effect trying to hoover up lower-value parts of the industry in the name of supply-chain security. And it is trying to do much the same for electric vehicles, wind turbines, hydrogen production and more, potentially spending $2trn, or nearly 10% of gdp, to reshape the economy. These are aggressive interventions that run counter to America’s post-1980s stance; they may end up costing it productivity as well as money.

How would this be bad for the US?

[BicycleB]

Presumably by reducing our efficiency. In other words we shipped that work elsewhere because the profit on them was low. Regaining those jobs locks in lower returns, lower-quality jobs.