Sounds like Dems are finally listening to Abigail Spanberger (D-VA) who said, in 2018, "We will get fucking torn apart” if this crazy leftism continues.
I'm reading still, the Kenneth J Arrow paper you provided of December 1963. Fundamentally, it seems like a good argument forba single payer, price negotiating, National Healthcare system. Ah! Medicare and then Medicare for all.
Secondly. My family had free Healthcare in 1963. Free maternity care. Free hospitalizion. Miniscule family physician costs. Why? Because most of American Healthcare was provided by Charity hospitals, non profits. City Hospital, County Hospital, Catholic, Presbyterian, Jewish, University Hospitals. All free.
A. Blow up and destroy the non value add Health insurance industry. Proves zero value.
B. Medicare For All
C. Everyone pays
D. All hospitals back to non profits or state, city and county governments.
E. Cap medical doctor salaries and clinics incomes.
F. Put Pharmaceuticals on a Defense Department FAR bid basis like Cost plus and Firm Fixed Price.
G. Social Security. Easy. Tax the untaxed economy. OASDI receipts as percent of GDP fell from about 8-9% to 4% apx. 5% of GDP is $1 Trillion of missing Social Security receipts. Why? W-2s have fallen as percent of GDP as non wage income in PE, IB, Capital gains, large untaxed wealth transfers of Estates, trusts, real estate are not, but all should be, FICA taxed
The Japanese healthcare system is very good, but not at all what DougAz describes as his vision.
A. There is private health insurance in Japan mostly for mental health and dental and as a supplement to cover copays, over 70% of people have it, and all expats and temporary immigrants.
B. There are two insurance systems, one paid by employers and the other for those who aren’t covered by employers who pay based on their income
C. Everyone US citizen pays income tax to cover Obamacare and Medicare (if they have investment income) even if they live their whole life in another country. Japanese citizens only pay income tax if they reside in Japan.
D. Most hospitals in Japan are private, many small clinics in rural areas have a single doctor and MRI, CAT scanners and other advanced equipment in a small building with a few rooms. One tiny clinic I went to for a stomach cancer screening had an X-ray machine which rotated your body vertically like a hamster wheel to image the stomach.
E. There are no wage caps on doctors in Japan, they have more doctors per capita than the US
F. Pharmaceutical companies are private in Japan and develop many new treatments. There are price controls that give less than 10% of the listed price, but there are exceptions for new medicines to encourage development.
I like the Japanese model, I would hate to live under the other one.
Your figure for the US and Japan are a little old, but Canada's figure is wildly off.
In 2024, Canada has 13 public MRI machines per million. I don't know how many more are private, but they will soon outnumber the public ones, and they mostly serve Americans.
MRIs in the US come with lower duty cycle and obscenely high overhead costs, so the price, unsurprisingly, is about 4-6x of that in Canada. My private MRI in Canada last year cost C$360, or under US$300.
If you live in the US and need to pay for an MRI, it's probably cheaper to drive or take a short flight to Canada.
New Zealand has a government funded health care system that gives free access to hospitals and partially subsidized medicines & doctor visits. People who wish to jump the queue for elective surgery due to long wait lists in public hospitals, can use private insurance or their own funds to access private hospitals. It's a good mix of private and public health services that helps limit the amount of government spend but still provides an 'acceptable' level of healthcare for those on low to medium incomes.
We should just get rid of FICA and fund entitlements out of general funds, raising marginal rates across the board ... while charging income tax rates for all the investment carve-outs mentioned above. Maybe compromise by making ROTH contributions limits much higher is something to incentives, broad, long-term investment.
It seems to me that a lot of health care cost is driven by anticompetitive behavior: limits on residencies, regional hospital monopolies, opaque pricing etc... That's a lever that's rarely mentioned
The AMA and AHA pay lobbyists to make sure it isn’t mentioned by politicians, but I don’t know why Noah and other members of the press don’t mention it.
It seems like China is really going to come in clutch and solve global warming by reducing the cost of solar panels 99%. Too bad about the totalitarianism and territorial aggression, but I really do appreciate the solar panels.
Of course the panels cost reductions don’t make energy 99% cheaper, most of the other costs (support structures, inverters, power lines, backup batteries, and land have gone up in cost. The biggest cost now for US solar installations is transformers, which require special steel and are in short supply worldwide.
Water supply/quality/security is such an important issue, and largely overlooked. It is also a massive financial opportunity.
People often forget that a major long time driver of productivity growth is simply a) the quantity of primary energy production and b) the efficiency of its conversion into useful work.
In that vein, nothing could impact real world abundance more significantly than radically more abundant energy converted into more abundant (and secure) water supply.
There are significant tradeoffs and potentially show-stopping issues involved with current desalination technologies, specifically marine life mortality, brine disposal, and the need for baseload rather than intermittent (renewable) power. All of these are resolvable with the right technical innovations.
Finally, to your point about the VC winter, and structural changes in the venture market now that the low hanging fruit of internet deployment is largely picked: If our venture funding system were more focused on hard tech and incubating capital intensive businesses, we could make a lot more progress on rollout of innovative tech serving the energy/water/food nexus. If the venture community ever goes back to its roots of funding capital intensive hardware innovation, it will come to realize that capital intensiveness is a feature, not a bug, of such opportunities, because funding high ROI long duration assets allows you to scale revenues and compound capital sustainably long term. A mindset shift is needed in Silicon Valley on this topic, but I do think its happening.
Re startup failures and VCs: it’s good to see VCs like Josh Wolfe acknowledge reality, rather than to resort to the all too common shtick that the future is so bright that they’ve gotta wear shades. Better to deal with the world as it exists and figure out how to move forward than to stick one’s overly optimistic head in the sand.
Matthews was wrong in the 2010’s to embrace deficits. Deficits in excess of Σ(expenditures with NPV>0) shift resources from investment to consumption. They slowed growth in the 2010’s and they slow growth today. I will grand Matthews this much; the damage was smaller when interest rates were lower. Additionally, in a period of low interest rates and especially during recession when the marginal costs of some expenditures is less than their market price (the laid off policeman) the Σ(expenditures with NPV>0) is much greater than today. I'd even guess that during much of Obama's Presidency Σ(expenditures with NPV>0) was greater than deficits.
But the criterion for deficits does not change, just the parameters that are used to calculate the NPV.
Oh, BTW, even deficits that DO exceed Σ(expenditures with NPV>0) just slow growth. THEY DO NOT CAUSE INFLATION. The Fed causes inflation, and disinflation, and recessions, and recoveries. Deficits for an independent Fed (something we cannot take for granted if Trump wins the presidency) that has a Flexible Average Inflation Target, just produce higher interest rates.
Just because I like giving you a hard time. It isn't clear that NPV>0 is the actual threshold. If you were well into the shifting of resources, shouldn't it be public $ NPV> marginal private NPV?
On the VC winter, I suggest you look at Richard Katz, The Contest for Japan's Economic Future: Entrepreneurs vs. Corporate Giants (2024). Of course he's writing about Japan, not the U.S., but quite a bit of it may have application here. But see, The Business Reinvention of Japan by Ulrike Schaede (2020), for a much more optimistic view of Japan AND a whole different set of implications for the U.S.
Desalinization is great. So would be charging the marginal water user the marginal cost of bringing the water to them. When water is used to grow wheat in Saudi Arabia, sugar cane in Egypt, rice in Pakistan, and alfalfa in Arizona it's hard to get excited about needing more water before using what we have sensibly.
Noah has comments on healthcare costs hurting the budget and country - but none of what is here begins to address WHY the US has such incredibly high health care costs. Just cutting the employer health insurance deductible will put some pressure on costs, but won't actually address any core issues - and I seriously doubt it generates enough pressure to create fundamental changes.. Even the Medicare limited drug negotiation won't fix fundamental issues.
There are books and papers written on all this - but an utterly fragmented (and often voracious) insurance system (ask any doctor on how much time is spent dealing with that mess), incentives to get treated in crisis rather than prevention, aggregation of hospital chains, various semi-oligopolies in key areas, etc...... I'm sure there are many others that folks in the domain could enumerate.
IMO, this problem won't get fixed indirectly by putting some price pressure on - the problem is far more fundamental - the cost of healthcare in the US are so far out of the norm of other developed countries that it will take something less incremental.
“Medicare and other government health programs can more aggressively negotiate prices, as they’ve begun to do recently with pharmaceuticals. But the government can also choose to spend less on health care, both by cutting benefits for these programs and also by reducing the tax exclusion for employer-provided health insurance. Doing that wouldn’t just save the government money directly — it would save it money indirectly as well, by causing health care costs to fall.”
All of this is fine, but it’s treating the symptoms and not the disease. The government could also choose to spend less on subsidizing Big Ag and Big Food, the source for rampant obesity, diabetes, cardiovascular disease. Corn syrup, sugar, and fat are the staples of Big Ag and Big Food. All the talk of raising crops to feed cattle being a problem, but not a peep about the toxic processed food that isn’t healthy in any respect. It’s cheap food for a reason, but it’s incredibly expensive over the long term. The billions spent on the bad effects of processed food and the reduction of productivity because of poor health outcomes is down right criminal. The government is in effect subsidizing the diabetes and obesity epidemic. Spend an hour in any public place: America looks like a feedlot.
As with so many of the big issues, the lack of political will makes it almost impossible to tackle health care costs. Make a suggestion or any effort to push a food reform bill through the coin-operated Congress and armies of lobbyists representing Big Ag and Big Food would swarm Congressional offices. Just one case in point: Senator Amy Klobuchar worked to make public school lunches healthier. One of the things she eliminated was frozen pizza. OMG! Here came the lobbyists. It turns out some 90% of frozen pizzas are processed in Minnesota. Klobuchar put pizza back in the public school menus faster than you could bake one of those cardboard discs loaded with fat, salt, and chemicals for which the names mean nothing to consumers. A cursory glance at Klobuchar’s campaign funding for her early runs for Congress tell the tale: Cargill = Congress. Not to pick on just Klobuchar. The Big Ag and Big Food PACs lard many Congressional campaigns. Senators and Representatives must sing for their meals.
People have been catastrophizing Germany’s nuclear phaseout for years but the country’s energy transition continues as planned, steadily increasing renewables and storage, maintaining reliability, on target to phase out coal by 2038 and yes, importing some gas for balancing and industrial purposes from their most important ally the US who keeps pumping gas out at record low prices. In other areas like defense I agree with Noah’s critiques, but the worship of nuclear power is misplaced. It is not a clean source of power and it is not low cost in either capital or operational terms.
Consider also the situation of Ukraine. After their Zaporizhzhia nuclear power plant got invaded and nearly induced into catastrophic meltdown by Russians, can you imagine any European nation wanting to keep similar military exposures in their territory? Even if other Ukrainian nuclear plants have not been hit directly, they have been compromised by Russian shells, drones and missiles knocking out substations and transmission infrastructure that are needed to get the power from the plant to where it’s consumed. Any large generation resource is vulnerable to this sort of attack, but with nuclear it is very easy to quickly take out a huge amount of capacity in one strike, whereas with more distributed resources like solar and wind it would take a lot more investment and coordination from an attacker to take out the same amount of capacity, and damages can be much more quickly restored.
Sure, fossil fuel power plants (gas & coal) have higher fuel costs than nuclear, but uranium isn't free. What really makes nuclear power plant operations expensive though is that they are some of the most complex systems imaginable. You have to pay lots of highly skilled technicians and engineers to monitor a bunch of very difficult to understand mechanical, electrical, chemical and logistical systems 24/7/365, with multiple overlapping safety emergency readiness capabilities.
And then there is maintenance, which if you consider it is obviously going to be huge for these huge infrastructure projects. This is especially going to be true of the power plants Germany is turning off, which are all at least 40 or 50 years old. It's no coincidence that utilities all over the place are asking for subsidies to keep their old nuclear plants running, such as in Illinois, Ohio and New Jersey.
In the electricity system, nuclear is actually the worst of both worlds: it has the high upfront fixed costs of renewables (actually much higher), and high variable ongoing costs comparable to those of fossil fuel plants. Nuclear is also very inflexible and hard to ramp up and down, and so its value to electrical grids becomes lower and lower every year as more and more variable renewable energy capacity is added to the grid and more flexibility is needed to ramp down to allow for renewable generation when it's available and to ramp up when it is not.
Nuclear energy is not a cheap alternative and can be just as expensive or more as the energy generated from imported LNG. Nuclear energy does not solve the problem of depending on Russia, which still provides a large chunk of the world's uranium. Electricity supply from nuclear reactors is not as dependable as some expect - nuclear can be as "intermittent" or weather dependent as hydropower, wind or solar: in 2022 France lost billions of dollars because the country's electric grid relies so heavily on nuclear reactors which were going offline for unplanned maintenance requirements as well as in many cases due to not enough water volume in the rivers needed to cool down the reactors. By contrast, the investment made by many European countries (most importantly Germany) in solar energy allowed them to avoid billions in additional gas costs when prices spiked due to the consequences of the invasion of Ukraine. Moreover, Germany has a 50-year long history of broad and deep civil society efforts centered around phasing out nuclear power which need to be understood to correctly contextualize their decision to phase out nuclear. I believe they are doing the right thing, because in the end nuclear energy is not competitive and leaves behind enormous decommissioning and waste disposal costs for future generations to deal with.
It's actually economically less and less advantageous to keep nuclear plants running every year, even before getting into their reliability issues (which cost France billions last year) or their catastrophic risk (such as the trillion dollar hit to Japan's economy from the Fukushima disaster). Germans are acting quite rationally by turning off their nukes.
I'm curious to find out more about the expected effects of desalination and some of the wilder ideas out there like reforestation of arid regions. Might be a good topic for a deep dive or guest post.
Water, water, everywhere, And all the boards did shrink; Water, water, everywhere, Nor any drop to drink.
At some point, I had to memorize the rhyme of the Ancient Mariner. We have global problems, and we have American issues. Working as a Paramedic during the pandemic, obesity was one of the significant co-morbidities that cost lives. If you were black, obese, suffered from diabetes, and you were a smoker, you were likely going to die early on.
McDonald's $1 meals may be responsible for early deaths. The human body craves grease, fat, and sugar. For some perverse sins Americans are afflicted with, obesity kills. Poor people eat cheap food. In America, fruits and vegetables are more expensive than Hamburger Helper or a Big Mac. One of the problems that poor black communities suffer from is a desert of grocery stores.
The phenomenon is easy to understand. In the 1960s, riots occurred in ghettos. The Piggly Wiggly burned down, and it wasn’t replaced. Smaller, family-run bodegas and convenience stores populated the communities. It was easier to buy cigarettes than raspberries.
Nothing has changed. McDonald's is cheaper than fresh food, including fruits and vegetables. The addiction to high salt and fat, the lack of fresh food, and the availability of inexpensive food make the US the fattest nation on the planet.
Germany is possibly the dumbest country in Europe. Cutting their defense spending along with cutting military help for Ukraine is inexplicable. Destroying perfectly working Nuclear plants is proof of this stupidity.
The reason for the US and Europe to support Ukraine's fight with Russia is insurance. We can help fight Russian aggression with Ukrainian soldiers, or we can fight Russia with US soldiers. The America First politicians who believe Russia poses no threat to the US or to NATO are idiots. These are people who have never read a European history book. They do not think Putin means it when he says he wants to see the Greater Russia of history restored to power.
Germany’s reduced military assistance will support Trump and Vance for their position on Ukraine. Germany seems to have a suicide pact with itself.
"Working as a Paramedic during the pandemic, obesity was one of the significant co-morbidities that cost lives. If you were black, obese, suffered from diabetes, and you were a smoker, you were likely going to die early on."
You didn't have to be black. being an obese diabetic smoking white or brown person was just as bad. One of my kids was also a paramedic during COVID. He was (and still is) a healthy late 20s early 30s, non-smoking, lean, bike rider. He had negligible to zero risk of anything serious out of COVID, but that job made him super paranoid. Would sanitize groceries, wore a mask well beyond the time that they may have been useful, if ever. Would not hug his mom until she was vaxxed. That sort of thing. I think he has mostly recovered, and he is no longer working as a paramedic, other than some professional sports team gigs.
It produced a lot PTSD. By the end it was manageable. Early on, you were pulling a lot of unconscious people out of their homes. We were not allowed to intubate. ED’s were only intubating in vacuum-controlled rooms in hazmat suits.
Horrid, in NJ in the middle of summer. We were also supposed to leave our masks on, even while driving in the ambulance. Let me tell you, 95 degrees and 100% humidity with a mask on, humping up a 3rd floor? I almost had to go to the hospital.
Instead of trying to decrease healthcare spending by government planning, the government should seed all public water supplies in areas that have high obesity, diabetes and cardiovascular disease with semaglutides to decrease future healthcare demand.
Sounds like Dems are finally listening to Abigail Spanberger (D-VA) who said, in 2018, "We will get fucking torn apart” if this crazy leftism continues.
I'm reading still, the Kenneth J Arrow paper you provided of December 1963. Fundamentally, it seems like a good argument forba single payer, price negotiating, National Healthcare system. Ah! Medicare and then Medicare for all.
Secondly. My family had free Healthcare in 1963. Free maternity care. Free hospitalizion. Miniscule family physician costs. Why? Because most of American Healthcare was provided by Charity hospitals, non profits. City Hospital, County Hospital, Catholic, Presbyterian, Jewish, University Hospitals. All free.
A. Blow up and destroy the non value add Health insurance industry. Proves zero value.
B. Medicare For All
C. Everyone pays
D. All hospitals back to non profits or state, city and county governments.
E. Cap medical doctor salaries and clinics incomes.
F. Put Pharmaceuticals on a Defense Department FAR bid basis like Cost plus and Firm Fixed Price.
G. Social Security. Easy. Tax the untaxed economy. OASDI receipts as percent of GDP fell from about 8-9% to 4% apx. 5% of GDP is $1 Trillion of missing Social Security receipts. Why? W-2s have fallen as percent of GDP as non wage income in PE, IB, Capital gains, large untaxed wealth transfers of Estates, trusts, real estate are not, but all should be, FICA taxed
Yep, it's basically the argument for a national health insurance system. I like Japan's and Korea's the best.
The Japanese healthcare system is very good, but not at all what DougAz describes as his vision.
A. There is private health insurance in Japan mostly for mental health and dental and as a supplement to cover copays, over 70% of people have it, and all expats and temporary immigrants.
B. There are two insurance systems, one paid by employers and the other for those who aren’t covered by employers who pay based on their income
C. Everyone US citizen pays income tax to cover Obamacare and Medicare (if they have investment income) even if they live their whole life in another country. Japanese citizens only pay income tax if they reside in Japan.
D. Most hospitals in Japan are private, many small clinics in rural areas have a single doctor and MRI, CAT scanners and other advanced equipment in a small building with a few rooms. One tiny clinic I went to for a stomach cancer screening had an X-ray machine which rotated your body vertically like a hamster wheel to image the stomach.
E. There are no wage caps on doctors in Japan, they have more doctors per capita than the US
F. Pharmaceutical companies are private in Japan and develop many new treatments. There are price controls that give less than 10% of the listed price, but there are exceptions for new medicines to encourage development.
I like the Japanese model, I would hate to live under the other one.
Yep, people who want everything to be done by the government should check out Japan and Korea instead!
Number of medical MRI machines per million people in selected countries.
Combined private and government healthcare:
Japan: 57
USA: 40.7
Vs Nationalized healthcare/ Medicare-for-all
United Kingdom: 6.1
Canada: 4.6
Your figure for the US and Japan are a little old, but Canada's figure is wildly off.
In 2024, Canada has 13 public MRI machines per million. I don't know how many more are private, but they will soon outnumber the public ones, and they mostly serve Americans.
MRIs in the US come with lower duty cycle and obscenely high overhead costs, so the price, unsurprisingly, is about 4-6x of that in Canada. My private MRI in Canada last year cost C$360, or under US$300.
If you live in the US and need to pay for an MRI, it's probably cheaper to drive or take a short flight to Canada.
Awesome. I've had medical care in both countries in the 1980 and 90s.
New Zealand has a government funded health care system that gives free access to hospitals and partially subsidized medicines & doctor visits. People who wish to jump the queue for elective surgery due to long wait lists in public hospitals, can use private insurance or their own funds to access private hospitals. It's a good mix of private and public health services that helps limit the amount of government spend but still provides an 'acceptable' level of healthcare for those on low to medium incomes.
Defense procurement is a disaster, so I don't think we should look to that model for pharma or anything else.
> Social Security. Easy. Tax the untaxed economy
We should just get rid of FICA and fund entitlements out of general funds, raising marginal rates across the board ... while charging income tax rates for all the investment carve-outs mentioned above. Maybe compromise by making ROTH contributions limits much higher is something to incentives, broad, long-term investment.
The consumption from those sources taxed with a VAT
It seems to me that a lot of health care cost is driven by anticompetitive behavior: limits on residencies, regional hospital monopolies, opaque pricing etc... That's a lever that's rarely mentioned
The AMA and AHA pay lobbyists to make sure it isn’t mentioned by politicians, but I don’t know why Noah and other members of the press don’t mention it.
It seems like China is really going to come in clutch and solve global warming by reducing the cost of solar panels 99%. Too bad about the totalitarianism and territorial aggression, but I really do appreciate the solar panels.
Of course the panels cost reductions don’t make energy 99% cheaper, most of the other costs (support structures, inverters, power lines, backup batteries, and land have gone up in cost. The biggest cost now for US solar installations is transformers, which require special steel and are in short supply worldwide.
Water supply/quality/security is such an important issue, and largely overlooked. It is also a massive financial opportunity.
People often forget that a major long time driver of productivity growth is simply a) the quantity of primary energy production and b) the efficiency of its conversion into useful work.
In that vein, nothing could impact real world abundance more significantly than radically more abundant energy converted into more abundant (and secure) water supply.
There are significant tradeoffs and potentially show-stopping issues involved with current desalination technologies, specifically marine life mortality, brine disposal, and the need for baseload rather than intermittent (renewable) power. All of these are resolvable with the right technical innovations.
Finally, to your point about the VC winter, and structural changes in the venture market now that the low hanging fruit of internet deployment is largely picked: If our venture funding system were more focused on hard tech and incubating capital intensive businesses, we could make a lot more progress on rollout of innovative tech serving the energy/water/food nexus. If the venture community ever goes back to its roots of funding capital intensive hardware innovation, it will come to realize that capital intensiveness is a feature, not a bug, of such opportunities, because funding high ROI long duration assets allows you to scale revenues and compound capital sustainably long term. A mindset shift is needed in Silicon Valley on this topic, but I do think its happening.
There is a slow, but increasing pivot in VC to "deep tech" which emphasizes hardware and physical systems.
Love No. 2 in your list here. I've gotten into arguments with many people who I swear are stubborn as goddamn mules.
"Nope, the vibes aren't shifting. Wokeness has been institutionalized. The Dems are the authoritarians now. Hee haw! Hee haw! Hee haw!"
It's like they're permanently stuck with 2020 on the brain and can't get out.
It'll take them 15 more years to realize the truth...by then America will be into other topics. 😊
Re startup failures and VCs: it’s good to see VCs like Josh Wolfe acknowledge reality, rather than to resort to the all too common shtick that the future is so bright that they’ve gotta wear shades. Better to deal with the world as it exists and figure out how to move forward than to stick one’s overly optimistic head in the sand.
Matthews was wrong in the 2010’s to embrace deficits. Deficits in excess of Σ(expenditures with NPV>0) shift resources from investment to consumption. They slowed growth in the 2010’s and they slow growth today. I will grand Matthews this much; the damage was smaller when interest rates were lower. Additionally, in a period of low interest rates and especially during recession when the marginal costs of some expenditures is less than their market price (the laid off policeman) the Σ(expenditures with NPV>0) is much greater than today. I'd even guess that during much of Obama's Presidency Σ(expenditures with NPV>0) was greater than deficits.
But the criterion for deficits does not change, just the parameters that are used to calculate the NPV.
Oh, BTW, even deficits that DO exceed Σ(expenditures with NPV>0) just slow growth. THEY DO NOT CAUSE INFLATION. The Fed causes inflation, and disinflation, and recessions, and recoveries. Deficits for an independent Fed (something we cannot take for granted if Trump wins the presidency) that has a Flexible Average Inflation Target, just produce higher interest rates.
Just because I like giving you a hard time. It isn't clear that NPV>0 is the actual threshold. If you were well into the shifting of resources, shouldn't it be public $ NPV> marginal private NPV?
On the VC winter, I suggest you look at Richard Katz, The Contest for Japan's Economic Future: Entrepreneurs vs. Corporate Giants (2024). Of course he's writing about Japan, not the U.S., but quite a bit of it may have application here. But see, The Business Reinvention of Japan by Ulrike Schaede (2020), for a much more optimistic view of Japan AND a whole different set of implications for the U.S.
Thanks, looks like a good read.
https://www.goodreads.com/book/show/149062220
Desalinization is great. So would be charging the marginal water user the marginal cost of bringing the water to them. When water is used to grow wheat in Saudi Arabia, sugar cane in Egypt, rice in Pakistan, and alfalfa in Arizona it's hard to get excited about needing more water before using what we have sensibly.
I'm just pro farmers paying market rate for water.
Noah has comments on healthcare costs hurting the budget and country - but none of what is here begins to address WHY the US has such incredibly high health care costs. Just cutting the employer health insurance deductible will put some pressure on costs, but won't actually address any core issues - and I seriously doubt it generates enough pressure to create fundamental changes.. Even the Medicare limited drug negotiation won't fix fundamental issues.
There are books and papers written on all this - but an utterly fragmented (and often voracious) insurance system (ask any doctor on how much time is spent dealing with that mess), incentives to get treated in crisis rather than prevention, aggregation of hospital chains, various semi-oligopolies in key areas, etc...... I'm sure there are many others that folks in the domain could enumerate.
IMO, this problem won't get fixed indirectly by putting some price pressure on - the problem is far more fundamental - the cost of healthcare in the US are so far out of the norm of other developed countries that it will take something less incremental.
Note that the ACA did slow down the growth rate - good - but not nearly enough to make a big change.
https://www.healthaffairs.org/doi/10.1377/hlthaff.2019.01478
“Medicare and other government health programs can more aggressively negotiate prices, as they’ve begun to do recently with pharmaceuticals. But the government can also choose to spend less on health care, both by cutting benefits for these programs and also by reducing the tax exclusion for employer-provided health insurance. Doing that wouldn’t just save the government money directly — it would save it money indirectly as well, by causing health care costs to fall.”
All of this is fine, but it’s treating the symptoms and not the disease. The government could also choose to spend less on subsidizing Big Ag and Big Food, the source for rampant obesity, diabetes, cardiovascular disease. Corn syrup, sugar, and fat are the staples of Big Ag and Big Food. All the talk of raising crops to feed cattle being a problem, but not a peep about the toxic processed food that isn’t healthy in any respect. It’s cheap food for a reason, but it’s incredibly expensive over the long term. The billions spent on the bad effects of processed food and the reduction of productivity because of poor health outcomes is down right criminal. The government is in effect subsidizing the diabetes and obesity epidemic. Spend an hour in any public place: America looks like a feedlot.
As with so many of the big issues, the lack of political will makes it almost impossible to tackle health care costs. Make a suggestion or any effort to push a food reform bill through the coin-operated Congress and armies of lobbyists representing Big Ag and Big Food would swarm Congressional offices. Just one case in point: Senator Amy Klobuchar worked to make public school lunches healthier. One of the things she eliminated was frozen pizza. OMG! Here came the lobbyists. It turns out some 90% of frozen pizzas are processed in Minnesota. Klobuchar put pizza back in the public school menus faster than you could bake one of those cardboard discs loaded with fat, salt, and chemicals for which the names mean nothing to consumers. A cursory glance at Klobuchar’s campaign funding for her early runs for Congress tell the tale: Cargill = Congress. Not to pick on just Klobuchar. The Big Ag and Big Food PACs lard many Congressional campaigns. Senators and Representatives must sing for their meals.
+100
Yes, this is the REAL root of the medical cost problem.
"Scientists probably get political because they perceive that they’ll be treated as experts on political issues — but they won’t."
Agree. Now let's do:
"Economists probably get political because they perceive that they’ll be treated as experts on political issues — but they won’t."
Unfortunately, economists probably *will*...
Not by me. (Nothing personal).
Interesting! I want to read a column on why you think so!
People have been catastrophizing Germany’s nuclear phaseout for years but the country’s energy transition continues as planned, steadily increasing renewables and storage, maintaining reliability, on target to phase out coal by 2038 and yes, importing some gas for balancing and industrial purposes from their most important ally the US who keeps pumping gas out at record low prices. In other areas like defense I agree with Noah’s critiques, but the worship of nuclear power is misplaced. It is not a clean source of power and it is not low cost in either capital or operational terms.
Your argument is a good one for future German energy. Building new nuclear is expensive and slow!
But it's a bad argument for existing nuclear. Operating nuclear plants, is cost-effective and carbon free!
Noah is correct that Germany shutting down existing nuclear is nuts.
Consider also the situation of Ukraine. After their Zaporizhzhia nuclear power plant got invaded and nearly induced into catastrophic meltdown by Russians, can you imagine any European nation wanting to keep similar military exposures in their territory? Even if other Ukrainian nuclear plants have not been hit directly, they have been compromised by Russian shells, drones and missiles knocking out substations and transmission infrastructure that are needed to get the power from the plant to where it’s consumed. Any large generation resource is vulnerable to this sort of attack, but with nuclear it is very easy to quickly take out a huge amount of capacity in one strike, whereas with more distributed resources like solar and wind it would take a lot more investment and coordination from an attacker to take out the same amount of capacity, and damages can be much more quickly restored.
nuclear power plants actually also have very high operating expenses.
The US EIA sums it up quite nicely here: https://www.eia.gov/electricity/annual/html/epa_08_04.html
Sure, fossil fuel power plants (gas & coal) have higher fuel costs than nuclear, but uranium isn't free. What really makes nuclear power plant operations expensive though is that they are some of the most complex systems imaginable. You have to pay lots of highly skilled technicians and engineers to monitor a bunch of very difficult to understand mechanical, electrical, chemical and logistical systems 24/7/365, with multiple overlapping safety emergency readiness capabilities.
And then there is maintenance, which if you consider it is obviously going to be huge for these huge infrastructure projects. This is especially going to be true of the power plants Germany is turning off, which are all at least 40 or 50 years old. It's no coincidence that utilities all over the place are asking for subsidies to keep their old nuclear plants running, such as in Illinois, Ohio and New Jersey.
In the electricity system, nuclear is actually the worst of both worlds: it has the high upfront fixed costs of renewables (actually much higher), and high variable ongoing costs comparable to those of fossil fuel plants. Nuclear is also very inflexible and hard to ramp up and down, and so its value to electrical grids becomes lower and lower every year as more and more variable renewable energy capacity is added to the grid and more flexibility is needed to ramp down to allow for renewable generation when it's available and to ramp up when it is not.
Nuclear energy is not a cheap alternative and can be just as expensive or more as the energy generated from imported LNG. Nuclear energy does not solve the problem of depending on Russia, which still provides a large chunk of the world's uranium. Electricity supply from nuclear reactors is not as dependable as some expect - nuclear can be as "intermittent" or weather dependent as hydropower, wind or solar: in 2022 France lost billions of dollars because the country's electric grid relies so heavily on nuclear reactors which were going offline for unplanned maintenance requirements as well as in many cases due to not enough water volume in the rivers needed to cool down the reactors. By contrast, the investment made by many European countries (most importantly Germany) in solar energy allowed them to avoid billions in additional gas costs when prices spiked due to the consequences of the invasion of Ukraine. Moreover, Germany has a 50-year long history of broad and deep civil society efforts centered around phasing out nuclear power which need to be understood to correctly contextualize their decision to phase out nuclear. I believe they are doing the right thing, because in the end nuclear energy is not competitive and leaves behind enormous decommissioning and waste disposal costs for future generations to deal with.
It's actually economically less and less advantageous to keep nuclear plants running every year, even before getting into their reliability issues (which cost France billions last year) or their catastrophic risk (such as the trillion dollar hit to Japan's economy from the Fukushima disaster). Germans are acting quite rationally by turning off their nukes.
I'm curious to find out more about the expected effects of desalination and some of the wilder ideas out there like reforestation of arid regions. Might be a good topic for a deep dive or guest post.
Maybe get Casey Handmer himself, but I’m sure he’s very busy with his startups. Or you can read all of his posts at his blogs that Noah linked to.
Water, water, everywhere, And all the boards did shrink; Water, water, everywhere, Nor any drop to drink.
At some point, I had to memorize the rhyme of the Ancient Mariner. We have global problems, and we have American issues. Working as a Paramedic during the pandemic, obesity was one of the significant co-morbidities that cost lives. If you were black, obese, suffered from diabetes, and you were a smoker, you were likely going to die early on.
McDonald's $1 meals may be responsible for early deaths. The human body craves grease, fat, and sugar. For some perverse sins Americans are afflicted with, obesity kills. Poor people eat cheap food. In America, fruits and vegetables are more expensive than Hamburger Helper or a Big Mac. One of the problems that poor black communities suffer from is a desert of grocery stores.
The phenomenon is easy to understand. In the 1960s, riots occurred in ghettos. The Piggly Wiggly burned down, and it wasn’t replaced. Smaller, family-run bodegas and convenience stores populated the communities. It was easier to buy cigarettes than raspberries.
Nothing has changed. McDonald's is cheaper than fresh food, including fruits and vegetables. The addiction to high salt and fat, the lack of fresh food, and the availability of inexpensive food make the US the fattest nation on the planet.
Germany is possibly the dumbest country in Europe. Cutting their defense spending along with cutting military help for Ukraine is inexplicable. Destroying perfectly working Nuclear plants is proof of this stupidity.
The reason for the US and Europe to support Ukraine's fight with Russia is insurance. We can help fight Russian aggression with Ukrainian soldiers, or we can fight Russia with US soldiers. The America First politicians who believe Russia poses no threat to the US or to NATO are idiots. These are people who have never read a European history book. They do not think Putin means it when he says he wants to see the Greater Russia of history restored to power.
Germany’s reduced military assistance will support Trump and Vance for their position on Ukraine. Germany seems to have a suicide pact with itself.
"Working as a Paramedic during the pandemic, obesity was one of the significant co-morbidities that cost lives. If you were black, obese, suffered from diabetes, and you were a smoker, you were likely going to die early on."
You didn't have to be black. being an obese diabetic smoking white or brown person was just as bad. One of my kids was also a paramedic during COVID. He was (and still is) a healthy late 20s early 30s, non-smoking, lean, bike rider. He had negligible to zero risk of anything serious out of COVID, but that job made him super paranoid. Would sanitize groceries, wore a mask well beyond the time that they may have been useful, if ever. Would not hug his mom until she was vaxxed. That sort of thing. I think he has mostly recovered, and he is no longer working as a paramedic, other than some professional sports team gigs.
It produced a lot PTSD. By the end it was manageable. Early on, you were pulling a lot of unconscious people out of their homes. We were not allowed to intubate. ED’s were only intubating in vacuum-controlled rooms in hazmat suits.
He wore a hazmat suit. Said they were miserable once the summer heat of 2020 set it.
Horrid, in NJ in the middle of summer. We were also supposed to leave our masks on, even while driving in the ambulance. Let me tell you, 95 degrees and 100% humidity with a mask on, humping up a 3rd floor? I almost had to go to the hospital.
Instead of trying to decrease healthcare spending by government planning, the government should seed all public water supplies in areas that have high obesity, diabetes and cardiovascular disease with semaglutides to decrease future healthcare demand.
LOL, why not.