As a Czech (a country with highly developed public transport), I quite often get into public transport-related discussions on Reddit, Hacker News etc.
I can confirm that the only people who ever tried to morally lecture me about the presence of screaming, threatening or stinking people on public transport are the American leftists. For them, this is a racist (because the homeless can't be white?), bigoted prejudice against the "less fortunate" and "less privileged", who are entitled to do anything they want and your only moral reaction ought to be "shut up".
This is just a bizarre ideology based on worship of anti-social behavior. Because if the system is bad, people disrupting it must be good, right?
The fact that tolerance of such behavior destroys a fairly expensive commons that is disproportionally used by lower-income people just does not register to them.
In the rest of the world, even lower-income countries manage to keep their public transport nice and safe. You could eat from the floor in the metro stations in Kyiv (GDP per capita about one tenth that of the worst US state), even today, after four years of active war.
Yeah, just bizarre, but it seems to be downstream from that dysfunction-worshipping worldview.
Tolerate is the keyword here and the source of the problem. I am married to a Czech and spend significant time there each summer. There are “rough sleepers” there as in every country but they are largely invisible in the Moravian cities I am most familiar with. They are hiding out behind the Billa grocery drinking their beers and avoiding people. I think they feel shame and certainly do not want to bring shame on their families. We have created cities that homeless or near homeless have migrated too. The other aspect of tolerance in the USA is we have created a whole industry to support this life in the form of feeding at various places in town, free cell phones, bicycles etc.
We have also legislated or gentrified out of existence thinks like SRO housing and tenements with shared baths and eating facilities and the old notion of a same sex boarding house is relegated to old movies.
That’s a little hobby horse of mine, SROs and boarding houses. We need to bring them back. When they were demolished or legislated out of existence, their inhabitants didn’t just go buy nice houses in the ‘burbs. SRO’s may be ugly, but they give poor people shelter and a place to defecate indoors and if they want to shoot up, at least the needles won’t be lying around on the sidewalk.
Boarding houses and YMCA’s and so on were largely temporary housing for younger singles (or sailors or laborers) who were looking to get established. I’m not in favor of bringing back all the curfews and chaperones and so on but it might be nice to have a kind of boarding house or communal dorm-adjacent place where young people just starting out could stay cheaply and get to know the city.
As I commented elsewhere on this post, I wonder if the insane level of police brutality in the US (to the point that even white Americans are at considerably higher risk from it than non-white immigrants in Europe) plays a role in US progressive tolerance of crime and disorder.
I think your link is more or less right—progressives generally do believe this is true. And there is a whole set of beliefs downstream of that that eventually lead them to tolerate or venerate crime to a degree that is completely incomprehensible to normies.
But it also seems to be the case that those very same progressives are absolutely not open to evidence that we have merely sane levels of police brutality. So the progressive tolerance of crime isn’t going anywhere any time soon.
I'm talking about "police brutality" as measured objectively, in terms of how likely a law-abiding person of a given nationality and ethnicity is to be killed by a cop.
And in those terms the United States is far worse than any European country (or Israel, contrary to BLM claims). Widespread proliferation of firearms is likely one reason, but another is inadequate training: while officers in the NYPD (which has one of the lowest incidences of brutality in the US) attend academy for 6 months, German police officers attend for 3 years.
While police shootings is easier to measure, I do not think that is a good proxy for police brutality.
In the vast majority of police shootings, the "victim" was armed. (~85%)
America's level of police shootings is largely justified by the fact that we have so many anti-social, violent people, combined with the prevalence and accessibility of firearms.
Where are you getting your data on how many "law-abiding" people are killed by cops?
It's also dumb to make this comparison by interracial killings. Maybe police kill "persons of a given ethnicity" because other nations are homogenous? It would take a much longer time for a Japanese cop to find a non Japanese than an American cop to find someone of a different race.
I brought up race primarily to emphasize how horrific the US rate of police shootings is in general: while both US and European police are more likely to kill non-whites than whites, US police are more likely to kill whites than European police are to kill non-whites.
This doesn't make any sense. People don't want to be murdered. Having more police, even the brutal kind, is safer then having less police with more murder.
Another hypothesis I've had about "defund the police" is that many black Americans live in inner-city neighborhoods that would be extremely valuable were their location values not suppressed by crime, and thus see the criminals almost as protectors against displacement by gentrification.
There is a pervasive and largely correct belief that "the system has failed" these people and that, therefore, harsh enforcement against or exclusion of them only compounds the injustice. Obviously, the efficient solution is to address the original system failure rather than tolerate the negative results of the failure, but this approach starts to run afoul of other rights-based beliefs shared by both left and right - personal autonomy, "freedom", personal responsibility - many of which are enshrined in laws and legal doctrines that are difficult or impossible to overcome (the entire western United States until recently suffered under circuit court decisions declaring that it was a violation of the Eighth Amendment's prohibition on "cruel and unusual punishment" to remove homeless people from public spaces unless shelter beds were available and offered). We also have a long history in this country of using vaguely-worded "anti-vagrancy" statutes and ordinances to lock up "undesirables", who are disproportionately racial minorities, whether or not they are behaving inappropriately in public spaces. So there is a lot to overcome, but the left makes it harder by focusing almost exclusively on the potential negative outcomes for specific marginalized people rather than balancing these against the larger benefits to the community at large. It's this inability to balance the trade-offs that makes the leftish discourse on this subject unserious.
And, Noah has coined the term “anarchyfare” to describe the phenomenon of letting public spaces be a free-for-all in the name of giving poor people more rights, access and freedom, *in lieu of* actual services, which cost money. And that’s the rub, money, which there never seems to be enough of even in blue states that spend freely (which does raise the point of where it goes and to whom). Actually sheltering people, humane supportive housing for the severely mentally ill, etc. seems to be such pie in the sky fantasy as to be unthinkable, but, I think across the spectrum, there is a feeling that 1) something has to be done and 2) ideally in a humane fashion, so, for the left at any rate, we get anarchyfare, which at least is cheap and allows for “freedom.”
If people are committing crimes -- harming or endangering others -- they need to be locked up, taken off the street.
People have agency, and are responsible for exercising it.
If money's a problem, fire all the social workers -- busybodies who think it's their business (or ours) to remake other people's lives (i.e., to give them "the help they need," whether or not it's "help" that they want).
To understand American leftists, consider the following analogy:
A naïve mother has two sons who have been arrested for criminal activity. But when the police bring them back to her house, she doesn’t punish them. Instead, she gets mad at the police; she insists that her sons are actually “good boys at heart” and that the only reason they’re misbehaving is because “life has been unfair to them”; that “people like you [law enforcement] have been too hard on them,” and that if she were to just “give them more love/affection and ‘reason with them better,’ they would stop misbehaving.”
THIS is what drives the American left - misdirected maternalism.
I’ve only briefly visited touristy areas of Czechia, but I saw plenty of homeless. They beg in a body position I’d never seen elsewhere.
I don’t know why people beg that way, but my gut reaction was that it was dehumanizing and completely unacceptable to my libbed out Seattle sensibilities.
I know my reaction was informed by my biases and ethnocentric.
It is not my place to judge, but that’s how I felt.
These "face down" guys are highly concentrated along the most tourist-y routes in Prague and they are known to pull significant money daily, way above the local median wage. Precisely because a lot of soft-hearted foreigners give it to them. The best spots are highly coveted and subject to occasional fights.
The actual poor-poor tend to live in distant regions, hours from Prague.
I think there are two needs: the ability m commit people into a mental health facility who are persistently delusional and antisocial and more housing to prevent people from falling into living on the street, which makes everything worse. Right now, there are deeply mentally ill people who are not served by cycling between jail and the streets and who may end up killed or killing without help. I see them and my heart breaks for them, and I believe in giving food or other help given they are on the street. But as an individual, i don't know hoe to get them the right help, which is a place where they can receive support and deep care. In some cases, families deeply want to commit their relatives to protect them, but they can't. Of course, there should be opportunities for these ill people to move to a more flexible setting if they are getting better.
This is spot on. Many people seem to assume that homelessness is either some sort of lifestyle choice or the result of the homeless being deficient in important virtues such as the work ethic or self-respect. But you're absolutely right: it's not a choice, it's forced on people as a result of bad luck and poverty or mental illness which should not be confused with lacking character or virtue.
I have two thoughts about that for what little it’s worth:
1. People commonly say begging people make a lot of money. Begging is always clustered around where tourists are (high traffic areas). It could be true I guess, but I find claims of “begging as a choice” to be a bit difficult to believe. I’m not saying you are implying that. I’ve also never seen any evidence either way so this is vibes-based on my part.
2. It’s pretty obvious to me that some high percentage of social media Americans talk about how great the transit, parks, stores and sometimes even hospitals/clinics are during their European/Japanese vacations compared to where they live at home. While there’s some truth to these takes, it’s also bit much sometimes. I feel like it could be similar to someone visiting someplace like Bend Oregon in July and concluding “this is what America is like.”
I lived within walking distance from the Prague city center for five years, walked around a lot, knew the local cops, emergency workers, shopkeepers, talked to them in the lazy hours. I am quite "in picture".
"Fleecing tourists" is unfortunately a major industry, an octopus with twenty tentacles. Every year, several million people with their wallets open will crowd to the same place and this concentration of purchasing power will be exploited from all directions, half of those illegal and controlled by the mob. Even someone's soft heart will become someone else's business opportunity.
You'll have fake masked musicians who only pretend to play the electronic piano. You'll have horse-drawn carriages with tired, sick horses in extreme heat or cold. You'll have "cabarets" charging obscene money for a bottle of mediocre wine. You'll have taxi drivers overcharging their clients tenfold. You'll have friendly ladies who become handsy with drunken young men, relieving them of their wallets. You'll have ladies spiking drinks and stealing from the men they put to sleep (one accidentally killed her victim and got 15 years in prison). You'll have fake antique items dealers and fake drug dealers. You'll have cartel-like organizations selling hotdogs, where if anyone tries to undercut prices, their stand will mysteriously burn down. You'll have peddlers of unsafe home-brewn liquors (this got cracked down a bit after two idiot bozos made a deadly methanol-rich mix that eventually killed 50 people). You'll have predatory exchange shops. You'll have beggars organized and controlled by enforcers. Let's not even delve into the erotic world... It is a vast underbelly of Prague built over the billion USD/EUR that the tourists spend in the city center yearly, often in various stages of inebriation and reduced judgment.
There is a huge difference between a beggar at a distant railway/metro station and between a beggar right next to the Astronomical Clock. No one can just take such a lucrative spot randomly. These spots are every bit as lucrative as everything else there, and very tightly controlled by organizations that may be charitably called "guilds", but with a lot of muscle.
Similar things happen in the US — plenty of auto intersections funneling commuters with soft hearts and extra change get recurring attendees.
There has to be a minimum bar of life stability for anyone with the means to get to one of these intersections on a regular basis.
I suppose it's more humane than in places like India where the rap is that amputees draw more sympathy — and therefore more revenue — leading to some, well, unfortunate choices. My spouse witnessed some stuff in Jaipur decades ago that leaves their head spinning to this day.
Thank you for saying what almost nobody else will: the American status quo for crime and disorder in urban spaces is, and has long been, disgraceful. All our urbanist dreams are for naught as long as our crime and disorder problem persists. Until we fix it, we will remain a car oriented suburban/exurban county.
However, as for your "urbanist dreams"? I'm fine with living in a car-oriented suburban/exurban country. Enough talk about taking people out of the driver's seat, stacking them in apartments where one man's ceiling is another man's floor -- and trying to pass that off as "abundance."
A(n electric) car in every garage! Now, THAT's abundance!
YOU might be OK in suburbia, but what about the 1/2 of us who want to live in a walkable urban node connected to other nodes via public transportation?
You want to live in an urbanist theme park (i.e., a "node")? That's fine with me; you can even ban cars entirely from your "node," so that everyone can do the poodle-walk down your cutesie cobblestone streets.
Just make sure that (as in the "old towns" of European cities like Zaragoza or Montpellier) there's parking nearby or underground.
But you'll have a hard time convincing me that half of all Americans want to live that way. We became a car-oriented, suburban/exurban country for a reason -- and (especially in the age of "ethnoburbs" like Milpitas or Houston's Chinatown), that has a lot more to do with private space than it does with race.
Just remember that while you "transit" between "nodes," I can go anywhere I want, whenever I want, improvising my own route -- as far and as fast as a car can take me. And yes, I'm willing to plan around traffic (and take "transit" as a last resort, if need be).
And remember, too, that the best mom-and-pop eateries are at those strip malls so reviled by urbanists. Need a lift?
There are lots of reasons why "we became a car-oriented, suburban/exurban country" Post WW2 US suburbanization was driven by car/tire/concrete/engineering interests, federal home financing policies/local zoning regulation and the literal destruction of public transit and urban cores to make room for parking and freeways. This autopia vision of "the future" was legitimated by the likes of Robert Moses. All the normies were given huge incentives to move out of the cities, and many of those incentives/subsidies continue to this day. Take them away and you would see a very diffent landuse/transportation system
Plus the FHA ensured that 'normies' didn't include African Americans by making it a condition of developers receiving subsidies to build housing in the suburbs that the houses could not be sold or resold to people of colour.
REPEAT: "We became a car-oriented, suburban/exurban country for a reason -- and (especially in the age of 'ethnoburbs' like Milpitas, CA, or Houston's Chinatown), that has a lot more to do with private space than it does with race."
In other words, what was happening in the 1950s is no longer true of suburbia today.
"People of color"? It's not just Asians. As Senator Ruben Gallego (D-AZ) puts it: "Every Latino man wants a big-ass truck, which, nothing wrong with that.... They want to really live the American dream.”
But then again, for those who believe that individualism is merely a symptom of "white supremacy culture," I'm wasting my breath.
Perhaps "an autopia vision of 'the future' was legitimated by the likes of Robert Moses" -- but then again, "road diets" and "complete streets" -- turning every thoroughfare into an obstacle course or a stop-and-go, single-file crawl -- have been legitimated by the likes of today's self-righteous urbanists, whose motto is "Get people out of their cars."
The difference now is that the vast majority of those very people (who were never asked) still prefer to drive.
The saying on the neoliberal subreddit (probably stolen from Twitter) is…
You will learn to code, live in a pod and eat bugs. Like it or not.
The issue I see, at least where I live, is new suburbs are increasingly far away from where the jobs are. People are idling in soul crushing traffic for hours each week. And no, young people can’t always remote into jobs at the hospital, courthouse, etc.
I like my suburb, which I think is pretty ok because we have the cheap prices and ample parking, but also a train station that connects to downtown and the airport. It’s not particularly fast, but it’s reliable and $3 ($1 for seniors and free for under 18).
Wow, I'd love to know where you live; it sounds like The Impossible Dream! Meanwhile, my sister lives in Great Neck, NY, near the train station -- and (along with the train fare) it's anything but cheap. ;-)
While I can deal with dodging traffic here and there (even if it adds up to "hours each week"), "living in a pod and eating bugs" (along with living amid crowds in general) is a situation that I'd find TRULY soul-crushing -- though it's what urbanists (looking down from above) call "vibrant"!
Actually far better than lock them up is prevent the crime from happening in the first place. That occurs with large numbers of police and high certainty of getting caught.
Even urbanist basics like bicycling - 45% of bike theft victims give up cycling rather than replace the bike. Meanwhile, advocacy NGOs focus only on fortifications for bike lockup, which remove most of the point-to-point utility of a bicycle, because they don’t dare say theft should be be dealt with.
I think the US’s insanely high crime rate also explains our much-maligned incarceration rates. They are high because other violent countries can’t afford the incarceration rates they need and other rich countries have so much less crime to punish.
And yeah, I will continue to treat people who behave erratically in public as a threat because they are high risk.
Incarceration levels are-or at least were--hugely fueled by nonviolent drug crimes, that account(ed) for *nearly half* of our entire national (state + fed) prison population. Thank you Rockefeller drug laws, and our War On Drugs.
*Nonviolent* crime rates are not much higher in the US compared to the EU. And our much, much higher homicide rates are linked to our 2nd Amendment fetish, as firearms are used in roughly 80% of US murders.
These are both GOP-created problems. Or at least GOP-perpetuated problems.
>Incarceration levels are-or at least were--hugely fueled by nonviolent drug crimes, that account(ed) for *nearly half* of our entire national (state + fed) prison population
The link says 37000/1090000 state prison inmates are in for drug possession. That is 3 pct. The other parts of the pie don't break drugs out by category, though federal convictions are unlikely to be for simple possession. The county jail numbers might include people awaiting trial, plus people serving time for misdemeanors.
And I suppise some people serving drug sentences might have committed violent crimes but pled to the associated drug crimes in exchange for dropping the violent charges.
I'm going to speculate that that statistic (nearly half) only actually applied to federal prisons, where drugs still account for 40%, and used to be higher.
Yes, that slippery use of statistics was a criticism of The New Jim Crow.
And, as I mentioned, simple possession is not a federal crime, except, eg, in a national park. So those people are dealers, perhaps major dealers, FWIW.
Using federal numbers is a bit disingenuous. Only certain specific crimes are generally prosecuted federally (generally drug crimes and immigration crimes). Roughly 90% of prisoners are state prisoners. So it's unsurprising that Federal prisons hold a disproportionate number of drug crimes. And people in federal prison are unlikely to be there for things like 'possession'. It would most likely be drug crimes that crossed state are national borders.
It used to be 45% or so for Federal/State/County during the aughts and '90's. Before CA and other states began to decriminalize weed. Because States now rarely prosecute weed possession/distribution, the State share of the pie has fallen dramatically.
Currently it's ~20% nationally; with ~50% of Federal prisoners.
US incarceration rates are so high compared to other developed countries, not because US crime rates are far higher (https://worldpopulationreview.com/country-rankings/crime-rate-by-country) or because there are a greater number of crimes for which people are sent to prison, but because people are sent to prison for far longer.
The murder rate is far higher in the US than in other developed countries (about 5 times higher)(https://en.wikipedia.org/wiki/List_of_countries_by_intentional_homicide_rate). But if other countries had on average one firearm per head of the population as the US does, doubtless their murder rates would be comparable to those of the US.
So you don't have a crime problem per se. You have a gun problem and a, probably not unrelated, fear problem. But good luck with fixing the gun problem.
No, doubtful. Because we can compare to the other countries with high gun possession rates, it's clear that US gun-related crimes are due to both culture and possession, not possession alone.
Yes, Canada and Switzerland are the examples usually cited. But the US has more than 3 times the number of guns per capita in circulation that Canada does and 4 times the number of guns that Switzerland does. That's more than enough to account for the difference in the murder rates.
These figures for household penetration suggest a far wider gap between the US and Canada or Switzerland (US any firearm 42%, handguns 22%, Switzerland 29% and 10%, Canada 16% and 3%). The gun culture is reflected in so many people having them and why they have so many. That's one of the reasons it would be so hard to get the number down - the political blow-back would be enormous. Another is that taking 400 million of anything out of circulation (guns, rubber ducks, whatever) would be a colossal undertaking. But the number of guns in circulation must feed into the culture too. Once guns are this common most people will assume that anyone they come into contact with could have one and it's better to err on the safe side and assume everyone has. I'm sure this must be a factor in the number of civilian shootings by police officers in the US. It feels like an insoluble problem - the more guns in circulation, the more afraid people are and feel they need to own one themselves and therefore the more politically difficult it is to reduce the number in circulation.
It would be easier to get *bullets* out of circulation in the US than guns - according to something I once read, the US has something like a 100-year supply of guns but a 4-year supply of bullets.
Yes, there are several different sources, and sometimes sources are hard to compare between countries.
I agree that there are dynamic effects at work that seem like a doom spiral. But never despair. If you've lived long enough to see enormous change for the worse on gun culture, you know it has been better and can be again, even if reversing the direction of the spiral is very hard.
What is a "per-capita rate of gun ownership"? Rate of gun ownership I get; it's the proportion of the population that owns guns. But where does per-capita fit in this?
The per capita rate is an average figure calculated by dividing the total number of guns in circulation in the country by the number of people in the population - i.e. the number of guns on average per head of the population. The US has nearly 400 million guns in circulation and a population of about 330 million so the average number of guns per capita i.e. per head of the population ('capita' means 'head' in Latin) is 400m / 330m = 1.2.
So in the US you have 1.2 guns each. The per capita figure for the UK is 0.05. So in the UK we have on average 1/20th of a gun each! As a result each of us is constantly squabbling with 19 other people about whose turn it is with the gun - though this rarely turns violent because there are so few guns.
The % figures are rates of penetration of gun ownership in the population or in the households which the population live in. These % penetration figures are established by interviewing a representative sample of the population (or of households) and asking them whether they own a gun or not. The % of people or households saying they own a gun is the penetration rate of gun ownership. The figure is a bit more intuitive than the per capita figure but costs more to estimate.
Possibly. You'd have to check the footnotes. The problem with a lot of cross-country comparisons is that countries differ in the way they collect the data and in how they define the thing being measured - as RT says above.
Many of the transit crimes listed in Noah’s post - peeing on the train, passenger stabbed to death on a bus, woman pushed to her death on a subway platform, person lit on fire on BART have nothing to do with guns.
Exactly. And the US doesn't have a particular problem with those sorts of crime. No worse than the rest of the developed world. What's more, most types of crime have declined significantly since the mid-1990s in the US, as they have everywhere else.
Yes, the US has a unique combination of 1) a high crime rate; 2) a state with sufficient capacity to do something about it; and 3) elected officials who a responsive to major concerns of their voters.
In London the underground has its own special police and crime is taken much more seriously if it takes place there. I believe this is possibly because every part of the social hierarchy takes the tube. Janitors, homeless, billionaires, politicians. There is real motivation from high office and wealth to make this a safe somewhat comfortable place. I do find the low standards for public order from American socialists to be a bit odd. It seems like a bigotry of low expectations.
When Rahm Emmanuel was mayor of Chicago, he took the brown line downtown most days. The trains were never cleaner or ran better than the years he was in office.
Joe Biden used to take the Amtrak all the time (because of fear of drunk drivers, another crime) but he probably rode with a coach load of secret service agents, or whoever guarded him while in Congress. I guess crime on trains is mostly on the local trains not express service, but then again, the only time I was ever assaulted was on the Shinkansen in Sendai.
Yes, it's like using buses. I don't know any Americans who take buses. But UK population density is so high (the same population as France but in a quarter of the land area), our roads forced to have so few lanes due to lack of space, and our city-centre layouts so old (especially London), that we don't have much choice but to use public transport. Having your nose stuck in a complete stranger's armpit for 30 minutes on the Northern Line is great for social cohesion - albeit with a deep undertow of loathing for the human condition!
Anecdote: I had tried to report egregiously, visibly inappropriate behavior by a fellow who was crowding an already narrow SFBART escalator, the station attendant said security was unresponsive.
I lived in downtown Chicago and for much longer Manhattan and my main comment is we have a big untreated mental health problem in the US. I'm not sure why policies are called compassionate when they lead to drug deaths and scared citizens. Releasing career criminals over and over to repeat their crimes doesn't seem to show much care for citizens either. Quality of life matters. And to the tweeter, I haven't been traumatized by all the interactions and interventions I've been involved in on the subway. I'm not a small person and I am well trained. My wife on the other hand stopped using it because she is vulnerable. That's not right.
The old institutions “asylums” for the mentally ill were horrible places, and people were not just there because they were mentally ill (sometimes just inconvenient!). They needed to be reformed/replaced. Unfortunately there was no replacement - the Lanterman-Petris-Short act - which was bipartisan, NOT Republican, and NOT Reagan - put severe restrictions on involuntary confinement, in the name of civil rights. What happened was that Reagan *did* defund what was supposed to replace confinement, that is community care, so it basically became “family or the streets.” And since most families are estranged or unequipped or terrified, it became the streets.
There really needs to be some kind of complete supportive housing for the population of adults who cannot care for themselves. Unfortunately, to do this humanely means lots of money, and paying lots of caregivers and social workers (AI can’t do these jobs!), and that seems more out of reach than ever these days when there isn’t even money to shelter the homeless who are merely employed at low-wage jobs or down on their luck.
So, we get “anarchyfare” (thanks, Noah!) which 1) does nothing, zero, zilch, nada, and jack to help the homeless/mentally ill, and 2) ruins the commons for everyone else.
The US is a wealthy country with some characteristics of a Latin American state, namely higher rates of violence, especially gun violence, which confuses those who think we're a European outpost in North America, which we're definitely NOT. But urban disorder in America is definitely a symptom of progressive governance, a hallmark of which is first world levels of taxation with third world levels of services, especially here in California.
More seriously, no. It's been wryly but correctly observed before that the Quebecois are not French living in America, but americans who speak French. (America here does not refer to the US, but the hemisphere).
Well, Canada came in third place after USA and Turkey in the chart of per capita murder in the article, so maybe not really. Or is Turkey an Asian outpost in Europe?
Noah Smith is being such a hack on healthcare in this post.
"But this is tempered by the fact that Americans spend a lower percent of their health care costs out-of-pocket compared to people in most other rich countries:"
This is true Americans spend about 11% of the cost of their healthcare out out of pocket while Canada spends 15%.
But Noah Smith leaves out the top line number because it is absolutely devastating to his case.
According to the OECD, per capita healthcare expenditure in the US in 2024 was 14,885$.
In Canada in 2024, the same number was 7,301$.
Now, Noah Smith, ECONOMIST, didn't want to do this math, because it shows that US healthcare is actually bad.
So 11% of 14,885 = 1,637$ out of pocket in the US.
In Canada, 15% of 7,301$ = 1,095 $ out of pocket.
American out of pocket proportion looks low only because the top line number is so high.
Americans are spending 60% more out of pocket than a lot of the rest of the world.
(I purposely chose Canada because it was at the top of the provided chart, but it is even worse looking at the others. France is 7,354$ per capita but only 9% of that is out of pocket so 662$)
Your logic is wrong sorry. Math is hard. Americans spend more on healthcare because it is a luxury good and the richer people get the more they want to spend on it.
Noah's point is that Americans are "radically richer too".
500 bucks of difference at the household level doesn't seem that much when you compare it to median household incomes, where the US is usually more than 500 bucks ahead.[1]
Of course things add up, all those riches goes to paying for the inefficiencies (as evidenced by the worse outcomes in crime, education, healthcare).
The problem is that a generally high price level with significant inequality leads to a lot of people having a hard time. (Even if they are insured.) For example I can easily imagine that this household spending difference is suppressed, because many people with problems cannot afford to pay more. So they have a worse quality of life despite having "insurance".
That's a fine point to make and he could have done so.
I think Noah Smith knows that.
We can adjust it to GDP per capita and it is still bad.
The US GDP per capita according to the world bank from 2022-2024 was 85,000 USD. France's, according to the same source, was 46,000 USD.
With that kind of ratio, you'd expect US medical costs to be 85,000/46,000 = 1.85x more.
But they are actually more than 2 times as much when comparing total spending per capita and almost 2.5 times as much when comparing out of pocket spending.
Noah Smith is a huge booster of Japan and Taiwan, but he never talks about their health systems because doing so would force him to point out how bad the US one is by comparison.
In general I don't want to carry too much water for him, because I also think a bit more rigor and attention to detail would be, um, a good idea. [1] :)
Also, it's not like he needs random people to defend him in his own comment section. But I think he covered the problems of the US healthcare system. [2][3] (Though maybe he's running out of topics to write about and should consider doing a healthcare systems comparison!)
... that said, Japan has a mandatory 30% cost sharing, right? And the prices are set by the government. Which is roughly what Noah says[2], that bargaining/negotiating at the nation level is important, and that's why national healthcare is a good idea.
[1] Sometimes his conclusions are ... simply crude, like in the Europeans don't want AC. Even if the title is incendiary to be clickbait-y ... the whole thing seems ridiculous, and I used to live in a city where it's Arizona-light in the summer. -- https://www.noahpinion.blog/p/europes-crusade-against-air-conditioning
[2] https://www.noahpinion.blog/p/insurance-companies-arent-the-main search for "good idea" (And one more conclusion which ... is so blunt it's almost certain to be dumb "The only reason Americans’ bills are higher is that U.S. health care provision costs so much more in the first place.")
In number 3, he writes "But it’s worth noting that pretty much every other rich country in the world regulates health care more than we do, including price controls. And all of them subsidize health care very heavily via universal health insurance systems. And all of them have MUCH CHEAPER HEALTHCARE than the U.S., while providing similar quality. So in the clearest-cut case of cost disease socialism, the proven cheaper alternative seems to be…actual socialism."
So apparently something happened between 2023 and 2026 that made him think that US healthcare wasn't actually all that expensive (as he argues in this post)
I have no idea what that could be, but it seems like a huge about face.
He actually did make that point. He specifically said that even if you subtract the extra health care costs paid by americans they are still left with more more money:
"And if you took health spending entirely out of the equation, Americans would still be richer than people in almost any other country".
Meaning even taking health care spending out of their incomes, Americans are wealthier than most European countries.
One reason why Brexit (and the anti-immigration mood that made it happen) has been a disaster for the NHS: it is very dependent on immigrant staff as British-born doctors and nurses tend to chase higher salaries in the US or Australia.
And how much of Canadian pharmaceuticals and medical equipment was developed or built in the US? Did Canada make a COVID vaccine? Part of the American healthcare spending that isn’t out of pocket is for research like Project Warp Speed.
45 out of ever 100 healthcare dollars spent worldwide are spent in the US, a country with 4.2% of the world's population.
This is a horrible deal for the average American.
Every so often something like Project WarpSpeed happens where it is public money, but most of the time, the cutting edge research is being funded by charging Americans 3-5 times more for the same medication.
So if you have MS and get Ocrevus in the US, your costs will be between 62,000 and 119,000 USD per year... every year... for the rest of your life. The vials of the drug cost 30,000 USD.
Getting that same drug in France is 8,000 Euros per vial so it is a lot cheaper.
There is no reason for the price difference beyond that the US will pay it while France has a Health Technology Assessment Agency (as do almost all other wealthy countries) which looks at the cost and medical efficacy of a drug and decides how much the public system will pay for it.
Up until the Biden administration, the US government was forbidden by law from doing this and, even then, that restriction was only barely relaxed.
The good people of America are there to fund the world's biomedical research, whether we want to or not.
As a European living in a city, its unfortunately getting worse here too. And we have similar taboos: in my own experience there is a relation with illegal / asylum migration from outside Europe but there is a taboo on saying this out loud for the obvious reasons.
I guess the sad part is, and maybe that is the reason why in the US it is apparantly worse, that to a certain extend you get used to it and start to accept it as a fact of life.
The tolerance for crime (it’s honestly not too much of a stretch to say the reverence for crime or the celebration of crime) is the single biggest thing that has me personally estranged from the Democratic Party.
There is absolutely nothing liberal about criminal justice nihilism or about abandoning public spaces and public services to the most antisocial elements of society.
But this has become an acid test for whether or not someone is a “progressive” in good standing.
This is bad. And the people who encourage this are bad.
Is there a leader of the Democratic Party - a President or nominee for President, a speaker of the house or Senate majority/minority leader, an important Governor who demonstrates a “reverence” for crime? Or are you thinking of selfie shouting online people?
From 1975 to 2025 NYC and SF went on a run of wealth creation and success not seen since like 13th century Venice. They are the successful parts of America. NYC really used to look like the French Connection and now it really looks like Sex and the City. The problem is the unsuccessful parts of the country where crime and ugliness and lousy ideas about the good life are entrenched. Drive from Raleigh to Charlotte and behold the endless stripmall dollar stores and pawn shops… T
Calling alcoholism / substance addiction and obesity "diseases of wealth and irresponsibility" is both way too reductionistic and also plain wrong, unless you twist the meaning of "irresponsibility" to a breaking point when used as an explanation on population data level. Look into European countries, for instance, and you see that neither of these things even correlates with wealth, and again I am not sure it makes sense to label entire populations as "more irresponsible".
Irresponsibility applies to both, wealth applies to obesity. Obesity comes down to taking in more calories than you use each day, and nobody responsible looks at their life and says "I should do meth about this."
That is exactly the type of reductive moralising that is unhelpful in addressing the underlying issues and also ethically questionable allocation of "moral opprobrium". We did not collectively achieve a significant victory over e.g., the cigarette industry by viewing smoking as a deficiency of character. Rather, legislation was imposed to limit the channels (social and physical) for the addiction to set in, and over time those limitations also caused a corresponding change in social norms related to smoking.
Of course addicts act irresponsibly, but that does not mean that "irresponsibility" (whatever that means in Noah's parlance) is the CAUSE of differences in addiction rates on a population level.
Do you think how responsible someone is/isn't is a factor in likelihood of becoming an addict? I would say the addicts I've known are highly correlated to irresponsibility in other areas too, even prior to addiction.
Or do you think culture doesn't impact responsibility, so "how responsible a population is" doesn't vary at all from place to place and it's entirely a factor of societal wealth or something?
We absolutely helped achieve victory over smoking by invoking shame. Over time, smoking went from "cool" to gross and weak; we shunned smokers to huddle outside.
“legislation was imposed” - do you think it was imposed out of nowhere?
It was imposed by politicians who saw the public health disaster unfolding: smokers who imposed massive costs upon themselves and those around them, but didn’t care because they were chasing their fix. You could say these smokers had a deficiency of character.
Just so you know, every single thing you said here is very wrong. You'll never realize it, until the very end, but hopefully there's an instant you do.
I think it's funny because at an individual level, if someone told me they are scared to ride bart or muni, I would roll my eyes unless they specifically mean something like "as a young woman by myself from sf to fruitvale at 2am on a weekday." But that isn't me saying disorder on bart or muni is basically fine! I also don't think yelling "you should exercise more!" is a good public policy, but it might be reasonable advice for a friend looking to lose weight, just like an eyeroll is a reasonable response to a friend who won't come out because uber is too expensive and bart is too scary.
The common perception that “the U.S. has much more crime than other rich countries” is only clearly true for homicide. Perhaps this is because of guns rather than progressives.
And also for public transit peeing. And public transit stabbings. And things that matter-ings, no?
Even if it's true that quantifiable disorder is low and falling there seems to be a drastic rise in calls for action against that.
(Likely it's the social media hype-cycle that started with the immigrants bad, no-go zones, open drug markets, "Skid Rows" of various cities, and then porch pirates and car break ins were in the zeitgeist, and phone grabbers, and as now it's commuter safety. And usually there are actions taken, so attention is not necessarily bad. The bad part is when this attention leads to bad outcomes, ie. when it's already part of a political campaign, emotions and propaganda memes are flying high, and at that point cost-benefit analysis and critical thinking usually disembarks immediately.)
Even if all guns disappeared tomorrow and guns homicides dropped to 0, the US would still have a homicide rate that's notably higher than most other developed countries. We'd drop from 6.8 to 1.4 homicides per 100,000 people. An enormous improvement, but still over 2x the median. And that's the best case scenario, where all of these killers, when denied their access to guns, decide not to kill instead of using other means. That's not a realistic outcome. All that being said, I do agree (as does Noah), that Progressives aren't somehow causing American criminality.
But the US also has over double the road fatality, and it’s going up again now instead of down like most developed countries.
And if you chart it vs the homicide rate by state, you could use the road fatality rate correlation to explain about half of homicide rate variation. That suggests to me that the whole society is more aggressive, and there are just various symptoms where it shows up.
Interesting point. That might be a factor contributing to non-gun homicides being higher than the average for rich countries as pointed out in FreneticFauna’s comment.
I really liked this post and think Noah should run for president or at least mayor.
But, Noah focused mostly on urban crime which is problematic, but my understanding is rural crime rates are actually higher than most urban crime rates, especially in the south. Clearly the progressive left isn't in charge of Mississippi. What's the solution here?
Only a fifth of the US population is rural, and a _national_ murder rate is per 100K population nationally. So rural rates have much less statistical influence on a national rate than urban and suburban rates do.
As for rural rates, since there are differences in rates of crime being reported the best source for this question is the National Crime Victimization Study. (A very-large recurring survey of Americans which collects data on serious-crime victimizations without regard to whether the crimes were formally reported.) The most-recent NCVS data puts the overall rate of being a crime victim the lowest in rural areas, the highest in urban, and in the middle in suburban. The urban rate is a bit more than double the rural rate.
Those are national averages, there can of course be variation regionally or locally. This also could be getting shifted by the current unprecedented national drop in crime rates, which thus far is reducing urban rates more than rural or suburban ones. (NCVS annual-survey results are reported out on a 2 or 3 year lag.)
Rural and urban murder rates are not the same; while large cities often have higher homicide counts, recent data indicates that rural counties frequently experience higher per-capita total firearm mortality rates, driven significantly by gun suicides. Data indicates that between 2011 and 2020, rural counties had up to a 37% higher overall firearm death rate. - National Institutes of Health (.gov)
Key details regarding U.S. murder and gun death rates:
Total Firearm Deaths: Recent studies show rural areas can have higher firearm death rates than urban areas, with a 2024 analysis showing rural gun mortality was 45% higher than in large metro areas.
Gun Homicides vs. Suicides: While large metro counties have higher gun homicide rates (5.1 per 100,000) compared to rural counties (3.5 per 100,000 in 2024), the high rate of rural gun suicides (12.5 per 100,000) drives the higher overall firearm mortality in rural areas.
Trends: From 2018 to 2021, firearm homicide rates spiked in both, but rural counties have struggled more with recovery in these rates.
Moreover Paul, as an urban resident with no handgun in my home (and therefore a miniscule risk of death or injury by handgun), my personal experience of "urban disorder" is almost all via the presence of congregations of indigent and unstable street people who occupy and often live in public spaces.
Noah's post was titled "Why does America feel worse than other countries? Crime.".
My point is that most (emotive) perceptions of crime arise from crime that occurs in public spaces. Most murders, either rural or urban, involve handguns and occur inside the home and are rarely reported on much. So your homicide rate comparison rural/urban misses the point.
While grisly murders that are perped in public spaces are always too many, the incidence is actually very low (especially if one excludes the crazies who perp mass shootings - there's that availability of gun thing again). Your odds of being murdered by a random stranger anywhere in the US is extremely low. Maybe higher than other nations, but still very low.
But because urban areas have much more public space than suburban or rural areas, one will naturally experience more disorder and menace from indigent, disturbed people who make up the bulk of what we term "homeless", populating public space. Their presence would not be tolerated in most suburban or rural localities.
As far as I can tell, it's this urban disorder of the "homeless", that drives feelings America has worse crime than other nations. The murder rate in the US is a result of our perverse cult of permissive gun availability.
Your assigning to me of words and arguments which I did not offer -- a.k.a. straw-manning -- is irritating and in my view disqualifying.
Even if it wasn't, your responding to a clarification of a narrow statistical fact with sweeping impressionistic assumptions would be off-putting even without the condescending tone.
In short life's too short....happily Substack does have a "mute user" function so, bye.
I think progressives should be open minded to making the movement more palatable to more people, rather than being so defensive! We need to be able to win over the “average American” and using academic jargon to rationalize public urination is just a loser position.
Yes obviously the gun situation is absurd and is a huge contributor to high rates of violent crime.
Yet the tolerance of vandalism, anti social behavior, general disorder, is not ok. There must be a balance of compassion for the harms of racist / classist policies with individual accountability.
I was on the train in Boston at rush hour the other day, and a man was rolling blunts on the train and just dumping the tobacco innards on the floor. Just throwing his trash directly on the ground. No one did anything.
I feel like there is a weird dynamic with who is empowered and incentivized to enforce rules and the law. Shop lifting for example…. Like, can shop keepers do anything about this? I can’t get toothpaste without calling the cashier to unlock it. Seriously we need to solve this.
I wonder about this often and agree that there seems to be a uniquely American flavor to both the disorder and crime and progressives’ framing of these in terms of race and privilege. I think you’ve correctly ruled out several potential proximate causes of urban disorder in this piece, but I’m left wondering what is different in America that has gotten us to this point. It seems that both homelessness and the displays of antisocial behavior you describe have their roots in untreated mental illness, and I’m curious how deinstitutionalizing care for severe mental illness in the US (without actually replacing that broken system with a functioning outpatient alternative) correlates to crime rates, homelessness, and incarceration rates and how this compares to other countries. Perhaps this explains some of the difference, at least in these severe forms of antisocial behavior and crime you point to.
I do think there is a broader, harder to define apathy at play here as well that leads to many smaller tragedies of the commons (or even just surly attitudes at the checkout counter) that doesn’t go away even if you solve for severe mental illness playing out in public spaces. I don’t know how we solve for that, but it’s another difference I notice in cities outside the US - people just seem to care more.
Sometimes I wonder how this looks from abroad. Given how much crime and disorder shows up in our media, it’s surprising we’re still perceived as the world’s leading power. I’m sure it’s just seen as wild. That gap between capacity and visible dysfunction feels uniquely American too.
We're perceived as the world's leading power bc we are the world's leading power. We are the wealthiest and most militarily powerful country in the world. That's power!
As a Czech (a country with highly developed public transport), I quite often get into public transport-related discussions on Reddit, Hacker News etc.
I can confirm that the only people who ever tried to morally lecture me about the presence of screaming, threatening or stinking people on public transport are the American leftists. For them, this is a racist (because the homeless can't be white?), bigoted prejudice against the "less fortunate" and "less privileged", who are entitled to do anything they want and your only moral reaction ought to be "shut up".
This is just a bizarre ideology based on worship of anti-social behavior. Because if the system is bad, people disrupting it must be good, right?
The fact that tolerance of such behavior destroys a fairly expensive commons that is disproportionally used by lower-income people just does not register to them.
In the rest of the world, even lower-income countries manage to keep their public transport nice and safe. You could eat from the floor in the metro stations in Kyiv (GDP per capita about one tenth that of the worst US state), even today, after four years of active war.
Yeah, just bizarre, but it seems to be downstream from that dysfunction-worshipping worldview.
Tolerate is the keyword here and the source of the problem. I am married to a Czech and spend significant time there each summer. There are “rough sleepers” there as in every country but they are largely invisible in the Moravian cities I am most familiar with. They are hiding out behind the Billa grocery drinking their beers and avoiding people. I think they feel shame and certainly do not want to bring shame on their families. We have created cities that homeless or near homeless have migrated too. The other aspect of tolerance in the USA is we have created a whole industry to support this life in the form of feeding at various places in town, free cell phones, bicycles etc.
We have also legislated or gentrified out of existence thinks like SRO housing and tenements with shared baths and eating facilities and the old notion of a same sex boarding house is relegated to old movies.
That’s a little hobby horse of mine, SROs and boarding houses. We need to bring them back. When they were demolished or legislated out of existence, their inhabitants didn’t just go buy nice houses in the ‘burbs. SRO’s may be ugly, but they give poor people shelter and a place to defecate indoors and if they want to shoot up, at least the needles won’t be lying around on the sidewalk.
Boarding houses and YMCA’s and so on were largely temporary housing for younger singles (or sailors or laborers) who were looking to get established. I’m not in favor of bringing back all the curfews and chaperones and so on but it might be nice to have a kind of boarding house or communal dorm-adjacent place where young people just starting out could stay cheaply and get to know the city.
"I’m not in favor of bringing back all the curfews and chaperones and so on..."
But don't we need some form of that? Or else it gets subsumed and erased by the crime discussed here?
San Francisco has multitudes of SROs
At what price, though? This is San Fransisco we're talking about...
As I commented elsewhere on this post, I wonder if the insane level of police brutality in the US (to the point that even white Americans are at considerably higher risk from it than non-white immigrants in Europe) plays a role in US progressive tolerance of crime and disorder.
“insane level of police brutality”
I think your link is more or less right—progressives generally do believe this is true. And there is a whole set of beliefs downstream of that that eventually lead them to tolerate or venerate crime to a degree that is completely incomprehensible to normies.
But it also seems to be the case that those very same progressives are absolutely not open to evidence that we have merely sane levels of police brutality. So the progressive tolerance of crime isn’t going anywhere any time soon.
I'm talking about "police brutality" as measured objectively, in terms of how likely a law-abiding person of a given nationality and ethnicity is to be killed by a cop.
And in those terms the United States is far worse than any European country (or Israel, contrary to BLM claims). Widespread proliferation of firearms is likely one reason, but another is inadequate training: while officers in the NYPD (which has one of the lowest incidences of brutality in the US) attend academy for 6 months, German police officers attend for 3 years.
While police shootings is easier to measure, I do not think that is a good proxy for police brutality.
In the vast majority of police shootings, the "victim" was armed. (~85%)
America's level of police shootings is largely justified by the fact that we have so many anti-social, violent people, combined with the prevalence and accessibility of firearms.
Where are you getting your data on how many "law-abiding" people are killed by cops?
It's also dumb to make this comparison by interracial killings. Maybe police kill "persons of a given ethnicity" because other nations are homogenous? It would take a much longer time for a Japanese cop to find a non Japanese than an American cop to find someone of a different race.
I brought up race primarily to emphasize how horrific the US rate of police shootings is in general: while both US and European police are more likely to kill non-whites than whites, US police are more likely to kill whites than European police are to kill non-whites.
This doesn't make any sense. People don't want to be murdered. Having more police, even the brutal kind, is safer then having less police with more murder.
Another hypothesis I've had about "defund the police" is that many black Americans live in inner-city neighborhoods that would be extremely valuable were their location values not suppressed by crime, and thus see the criminals almost as protectors against displacement by gentrification.
There is a pervasive and largely correct belief that "the system has failed" these people and that, therefore, harsh enforcement against or exclusion of them only compounds the injustice. Obviously, the efficient solution is to address the original system failure rather than tolerate the negative results of the failure, but this approach starts to run afoul of other rights-based beliefs shared by both left and right - personal autonomy, "freedom", personal responsibility - many of which are enshrined in laws and legal doctrines that are difficult or impossible to overcome (the entire western United States until recently suffered under circuit court decisions declaring that it was a violation of the Eighth Amendment's prohibition on "cruel and unusual punishment" to remove homeless people from public spaces unless shelter beds were available and offered). We also have a long history in this country of using vaguely-worded "anti-vagrancy" statutes and ordinances to lock up "undesirables", who are disproportionately racial minorities, whether or not they are behaving inappropriately in public spaces. So there is a lot to overcome, but the left makes it harder by focusing almost exclusively on the potential negative outcomes for specific marginalized people rather than balancing these against the larger benefits to the community at large. It's this inability to balance the trade-offs that makes the leftish discourse on this subject unserious.
And, Noah has coined the term “anarchyfare” to describe the phenomenon of letting public spaces be a free-for-all in the name of giving poor people more rights, access and freedom, *in lieu of* actual services, which cost money. And that’s the rub, money, which there never seems to be enough of even in blue states that spend freely (which does raise the point of where it goes and to whom). Actually sheltering people, humane supportive housing for the severely mentally ill, etc. seems to be such pie in the sky fantasy as to be unthinkable, but, I think across the spectrum, there is a feeling that 1) something has to be done and 2) ideally in a humane fashion, so, for the left at any rate, we get anarchyfare, which at least is cheap and allows for “freedom.”
Noah Smith has talked about a lot of non-profits basically being ineffective grifts...
If people are committing crimes -- harming or endangering others -- they need to be locked up, taken off the street.
People have agency, and are responsible for exercising it.
If money's a problem, fire all the social workers -- busybodies who think it's their business (or ours) to remake other people's lives (i.e., to give them "the help they need," whether or not it's "help" that they want).
"Services," my ass!
To understand American leftists, consider the following analogy:
A naïve mother has two sons who have been arrested for criminal activity. But when the police bring them back to her house, she doesn’t punish them. Instead, she gets mad at the police; she insists that her sons are actually “good boys at heart” and that the only reason they’re misbehaving is because “life has been unfair to them”; that “people like you [law enforcement] have been too hard on them,” and that if she were to just “give them more love/affection and ‘reason with them better,’ they would stop misbehaving.”
THIS is what drives the American left - misdirected maternalism.
I’ve only briefly visited touristy areas of Czechia, but I saw plenty of homeless. They beg in a body position I’d never seen elsewhere.
I don’t know why people beg that way, but my gut reaction was that it was dehumanizing and completely unacceptable to my libbed out Seattle sensibilities.
I know my reaction was informed by my biases and ethnocentric.
It is not my place to judge, but that’s how I felt.
These "face down" guys are highly concentrated along the most tourist-y routes in Prague and they are known to pull significant money daily, way above the local median wage. Precisely because a lot of soft-hearted foreigners give it to them. The best spots are highly coveted and subject to occasional fights.
The actual poor-poor tend to live in distant regions, hours from Prague.
I think there are two needs: the ability m commit people into a mental health facility who are persistently delusional and antisocial and more housing to prevent people from falling into living on the street, which makes everything worse. Right now, there are deeply mentally ill people who are not served by cycling between jail and the streets and who may end up killed or killing without help. I see them and my heart breaks for them, and I believe in giving food or other help given they are on the street. But as an individual, i don't know hoe to get them the right help, which is a place where they can receive support and deep care. In some cases, families deeply want to commit their relatives to protect them, but they can't. Of course, there should be opportunities for these ill people to move to a more flexible setting if they are getting better.
This is spot on. Many people seem to assume that homelessness is either some sort of lifestyle choice or the result of the homeless being deficient in important virtues such as the work ethic or self-respect. But you're absolutely right: it's not a choice, it's forced on people as a result of bad luck and poverty or mental illness which should not be confused with lacking character or virtue.
I have two thoughts about that for what little it’s worth:
1. People commonly say begging people make a lot of money. Begging is always clustered around where tourists are (high traffic areas). It could be true I guess, but I find claims of “begging as a choice” to be a bit difficult to believe. I’m not saying you are implying that. I’ve also never seen any evidence either way so this is vibes-based on my part.
2. It’s pretty obvious to me that some high percentage of social media Americans talk about how great the transit, parks, stores and sometimes even hospitals/clinics are during their European/Japanese vacations compared to where they live at home. While there’s some truth to these takes, it’s also bit much sometimes. I feel like it could be similar to someone visiting someplace like Bend Oregon in July and concluding “this is what America is like.”
I lived within walking distance from the Prague city center for five years, walked around a lot, knew the local cops, emergency workers, shopkeepers, talked to them in the lazy hours. I am quite "in picture".
"Fleecing tourists" is unfortunately a major industry, an octopus with twenty tentacles. Every year, several million people with their wallets open will crowd to the same place and this concentration of purchasing power will be exploited from all directions, half of those illegal and controlled by the mob. Even someone's soft heart will become someone else's business opportunity.
You'll have fake masked musicians who only pretend to play the electronic piano. You'll have horse-drawn carriages with tired, sick horses in extreme heat or cold. You'll have "cabarets" charging obscene money for a bottle of mediocre wine. You'll have taxi drivers overcharging their clients tenfold. You'll have friendly ladies who become handsy with drunken young men, relieving them of their wallets. You'll have ladies spiking drinks and stealing from the men they put to sleep (one accidentally killed her victim and got 15 years in prison). You'll have fake antique items dealers and fake drug dealers. You'll have cartel-like organizations selling hotdogs, where if anyone tries to undercut prices, their stand will mysteriously burn down. You'll have peddlers of unsafe home-brewn liquors (this got cracked down a bit after two idiot bozos made a deadly methanol-rich mix that eventually killed 50 people). You'll have predatory exchange shops. You'll have beggars organized and controlled by enforcers. Let's not even delve into the erotic world... It is a vast underbelly of Prague built over the billion USD/EUR that the tourists spend in the city center yearly, often in various stages of inebriation and reduced judgment.
There is a huge difference between a beggar at a distant railway/metro station and between a beggar right next to the Astronomical Clock. No one can just take such a lucrative spot randomly. These spots are every bit as lucrative as everything else there, and very tightly controlled by organizations that may be charitably called "guilds", but with a lot of muscle.
Similar things happen in the US — plenty of auto intersections funneling commuters with soft hearts and extra change get recurring attendees.
There has to be a minimum bar of life stability for anyone with the means to get to one of these intersections on a regular basis.
I suppose it's more humane than in places like India where the rap is that amputees draw more sympathy — and therefore more revenue — leading to some, well, unfortunate choices. My spouse witnessed some stuff in Jaipur decades ago that leaves their head spinning to this day.
Thank you for saying what almost nobody else will: the American status quo for crime and disorder in urban spaces is, and has long been, disgraceful. All our urbanist dreams are for naught as long as our crime and disorder problem persists. Until we fix it, we will remain a car oriented suburban/exurban county.
Noah's right about crime. Lock 'em up!
However, as for your "urbanist dreams"? I'm fine with living in a car-oriented suburban/exurban country. Enough talk about taking people out of the driver's seat, stacking them in apartments where one man's ceiling is another man's floor -- and trying to pass that off as "abundance."
A(n electric) car in every garage! Now, THAT's abundance!
YOU might be OK in suburbia, but what about the 1/2 of us who want to live in a walkable urban node connected to other nodes via public transportation?
You want to live in an urbanist theme park (i.e., a "node")? That's fine with me; you can even ban cars entirely from your "node," so that everyone can do the poodle-walk down your cutesie cobblestone streets.
Just make sure that (as in the "old towns" of European cities like Zaragoza or Montpellier) there's parking nearby or underground.
But you'll have a hard time convincing me that half of all Americans want to live that way. We became a car-oriented, suburban/exurban country for a reason -- and (especially in the age of "ethnoburbs" like Milpitas or Houston's Chinatown), that has a lot more to do with private space than it does with race.
Just remember that while you "transit" between "nodes," I can go anywhere I want, whenever I want, improvising my own route -- as far and as fast as a car can take me. And yes, I'm willing to plan around traffic (and take "transit" as a last resort, if need be).
And remember, too, that the best mom-and-pop eateries are at those strip malls so reviled by urbanists. Need a lift?
There are lots of reasons why "we became a car-oriented, suburban/exurban country" Post WW2 US suburbanization was driven by car/tire/concrete/engineering interests, federal home financing policies/local zoning regulation and the literal destruction of public transit and urban cores to make room for parking and freeways. This autopia vision of "the future" was legitimated by the likes of Robert Moses. All the normies were given huge incentives to move out of the cities, and many of those incentives/subsidies continue to this day. Take them away and you would see a very diffent landuse/transportation system
Plus the FHA ensured that 'normies' didn't include African Americans by making it a condition of developers receiving subsidies to build housing in the suburbs that the houses could not be sold or resold to people of colour.
REPEAT: "We became a car-oriented, suburban/exurban country for a reason -- and (especially in the age of 'ethnoburbs' like Milpitas, CA, or Houston's Chinatown), that has a lot more to do with private space than it does with race."
In other words, what was happening in the 1950s is no longer true of suburbia today.
"People of color"? It's not just Asians. As Senator Ruben Gallego (D-AZ) puts it: "Every Latino man wants a big-ass truck, which, nothing wrong with that.... They want to really live the American dream.”
But then again, for those who believe that individualism is merely a symptom of "white supremacy culture," I'm wasting my breath.
Actually, until about 1920, the majority of the country lived in rural areas, not urban.
You had more people moving in to the suburbs (from rural areas) post WWII than moving out to them from cities.
They typically did not have an attachment to or fondness for dense cities.
Who foisted what on whom?
Perhaps "an autopia vision of 'the future' was legitimated by the likes of Robert Moses" -- but then again, "road diets" and "complete streets" -- turning every thoroughfare into an obstacle course or a stop-and-go, single-file crawl -- have been legitimated by the likes of today's self-righteous urbanists, whose motto is "Get people out of their cars."
The difference now is that the vast majority of those very people (who were never asked) still prefer to drive.
The saying on the neoliberal subreddit (probably stolen from Twitter) is…
You will learn to code, live in a pod and eat bugs. Like it or not.
The issue I see, at least where I live, is new suburbs are increasingly far away from where the jobs are. People are idling in soul crushing traffic for hours each week. And no, young people can’t always remote into jobs at the hospital, courthouse, etc.
I like my suburb, which I think is pretty ok because we have the cheap prices and ample parking, but also a train station that connects to downtown and the airport. It’s not particularly fast, but it’s reliable and $3 ($1 for seniors and free for under 18).
Wow, I'd love to know where you live; it sounds like The Impossible Dream! Meanwhile, my sister lives in Great Neck, NY, near the train station -- and (along with the train fare) it's anything but cheap. ;-)
While I can deal with dodging traffic here and there (even if it adds up to "hours each week"), "living in a pod and eating bugs" (along with living amid crowds in general) is a situation that I'd find TRULY soul-crushing -- though it's what urbanists (looking down from above) call "vibrant"!
Actually far better than lock them up is prevent the crime from happening in the first place. That occurs with large numbers of police and high certainty of getting caught.
long prison terms don't have much of an effect.
Even urbanist basics like bicycling - 45% of bike theft victims give up cycling rather than replace the bike. Meanwhile, advocacy NGOs focus only on fortifications for bike lockup, which remove most of the point-to-point utility of a bicycle, because they don’t dare say theft should be be dealt with.
I think the US’s insanely high crime rate also explains our much-maligned incarceration rates. They are high because other violent countries can’t afford the incarceration rates they need and other rich countries have so much less crime to punish.
And yeah, I will continue to treat people who behave erratically in public as a threat because they are high risk.
Incarceration levels are-or at least were--hugely fueled by nonviolent drug crimes, that account(ed) for *nearly half* of our entire national (state + fed) prison population. Thank you Rockefeller drug laws, and our War On Drugs.
*Nonviolent* crime rates are not much higher in the US compared to the EU. And our much, much higher homicide rates are linked to our 2nd Amendment fetish, as firearms are used in roughly 80% of US murders.
These are both GOP-created problems. Or at least GOP-perpetuated problems.
>Incarceration levels are-or at least were--hugely fueled by nonviolent drug crimes, that account(ed) for *nearly half* of our entire national (state + fed) prison population
This does not seem to be true. https://www.prisonpolicy.org/reports/pie2025.html
I suppose it is possible that the numbers were vastly different at some time in the past, but I 'd like to see actual evidence of that.
My info may be out of date.
Out of curiosity: what's the current % of our prison population in for nonviolent drug offenses?
I doubt that it was ever true.
The link says 37000/1090000 state prison inmates are in for drug possession. That is 3 pct. The other parts of the pie don't break drugs out by category, though federal convictions are unlikely to be for simple possession. The county jail numbers might include people awaiting trial, plus people serving time for misdemeanors.
And I suppise some people serving drug sentences might have committed violent crimes but pled to the associated drug crimes in exchange for dropping the violent charges.
Anyhow total drug offenses = 18 pct.
I'm going to speculate that that statistic (nearly half) only actually applied to federal prisons, where drugs still account for 40%, and used to be higher.
Yes, that slippery use of statistics was a criticism of The New Jim Crow.
And, as I mentioned, simple possession is not a federal crime, except, eg, in a national park. So those people are dealers, perhaps major dealers, FWIW.
Using federal numbers is a bit disingenuous. Only certain specific crimes are generally prosecuted federally (generally drug crimes and immigration crimes). Roughly 90% of prisoners are state prisoners. So it's unsurprising that Federal prisons hold a disproportionate number of drug crimes. And people in federal prison are unlikely to be there for things like 'possession'. It would most likely be drug crimes that crossed state are national borders.
It used to be 45% or so for Federal/State/County during the aughts and '90's. Before CA and other states began to decriminalize weed. Because States now rarely prosecute weed possession/distribution, the State share of the pie has fallen dramatically.
Currently it's ~20% nationally; with ~50% of Federal prisoners.
That doesn't seem right. See "State prison population by offense type, 1980-1999" here:
https://www.justice.gov/archive/mps/strategic2001-2006/entiredoc.htm
These were fake statistics released over and over during the anti-prison reform era a few years ago.
US incarceration rates are so high compared to other developed countries, not because US crime rates are far higher (https://worldpopulationreview.com/country-rankings/crime-rate-by-country) or because there are a greater number of crimes for which people are sent to prison, but because people are sent to prison for far longer.
The murder rate is far higher in the US than in other developed countries (about 5 times higher)(https://en.wikipedia.org/wiki/List_of_countries_by_intentional_homicide_rate). But if other countries had on average one firearm per head of the population as the US does, doubtless their murder rates would be comparable to those of the US.
So you don't have a crime problem per se. You have a gun problem and a, probably not unrelated, fear problem. But good luck with fixing the gun problem.
"doubtless"
No, doubtful. Because we can compare to the other countries with high gun possession rates, it's clear that US gun-related crimes are due to both culture and possession, not possession alone.
Yes, Canada and Switzerland are the examples usually cited. But the US has more than 3 times the number of guns per capita in circulation that Canada does and 4 times the number of guns that Switzerland does. That's more than enough to account for the difference in the murder rates.
The US household rate of gun ownership is 32% vs 26% in Canada. So about one-fifth higher, but the murder rate is 3 times higher.
Canada is by far the closest match culturally to the US extant, but the most commonly observed distinction is the culture around guns.
Gun availability matters, but differences in gun culture matter more.
This becomes more obvious in studies that examine changes in gun culture over time in countries with lots of guns.
This is bad news, because culture is very difficult to purposefully change.
https://en.wikipedia.org/wiki/Percent_of_households_with_guns_by_country
These figures for household penetration suggest a far wider gap between the US and Canada or Switzerland (US any firearm 42%, handguns 22%, Switzerland 29% and 10%, Canada 16% and 3%). The gun culture is reflected in so many people having them and why they have so many. That's one of the reasons it would be so hard to get the number down - the political blow-back would be enormous. Another is that taking 400 million of anything out of circulation (guns, rubber ducks, whatever) would be a colossal undertaking. But the number of guns in circulation must feed into the culture too. Once guns are this common most people will assume that anyone they come into contact with could have one and it's better to err on the safe side and assume everyone has. I'm sure this must be a factor in the number of civilian shootings by police officers in the US. It feels like an insoluble problem - the more guns in circulation, the more afraid people are and feel they need to own one themselves and therefore the more politically difficult it is to reduce the number in circulation.
It would be easier to get *bullets* out of circulation in the US than guns - according to something I once read, the US has something like a 100-year supply of guns but a 4-year supply of bullets.
Yes, there are several different sources, and sometimes sources are hard to compare between countries.
I agree that there are dynamic effects at work that seem like a doom spiral. But never despair. If you've lived long enough to see enormous change for the worse on gun culture, you know it has been better and can be again, even if reversing the direction of the spiral is very hard.
What is a "per-capita rate of gun ownership"? Rate of gun ownership I get; it's the proportion of the population that owns guns. But where does per-capita fit in this?
The per capita rate is an average figure calculated by dividing the total number of guns in circulation in the country by the number of people in the population - i.e. the number of guns on average per head of the population. The US has nearly 400 million guns in circulation and a population of about 330 million so the average number of guns per capita i.e. per head of the population ('capita' means 'head' in Latin) is 400m / 330m = 1.2.
So in the US you have 1.2 guns each. The per capita figure for the UK is 0.05. So in the UK we have on average 1/20th of a gun each! As a result each of us is constantly squabbling with 19 other people about whose turn it is with the gun - though this rarely turns violent because there are so few guns.
The % figures are rates of penetration of gun ownership in the population or in the households which the population live in. These % penetration figures are established by interviewing a representative sample of the population (or of households) and asking them whether they own a gun or not. The % of people or households saying they own a gun is the penetration rate of gun ownership. The figure is a bit more intuitive than the per capita figure but costs more to estimate.
There are two rates used in gun ownership stats: per-capita rate and household rate.
Due to my own lack of reviewing my post, the rates of 32% and 26% I quoted were actually household rates, not per-capita rates, so I will fix that.
Doesn't the Swiss rate include all of their Army Reservists, who by law are required to keep their service weapons at home?
Possibly. You'd have to check the footnotes. The problem with a lot of cross-country comparisons is that countries differ in the way they collect the data and in how they define the thing being measured - as RT says above.
Many of the transit crimes listed in Noah’s post - peeing on the train, passenger stabbed to death on a bus, woman pushed to her death on a subway platform, person lit on fire on BART have nothing to do with guns.
Exactly. And the US doesn't have a particular problem with those sorts of crime. No worse than the rest of the developed world. What's more, most types of crime have declined significantly since the mid-1990s in the US, as they have everywhere else.
I want to say prison sentences in the US are also unusually long.
Yes, the US has a unique combination of 1) a high crime rate; 2) a state with sufficient capacity to do something about it; and 3) elected officials who a responsive to major concerns of their voters.
In London the underground has its own special police and crime is taken much more seriously if it takes place there. I believe this is possibly because every part of the social hierarchy takes the tube. Janitors, homeless, billionaires, politicians. There is real motivation from high office and wealth to make this a safe somewhat comfortable place. I do find the low standards for public order from American socialists to be a bit odd. It seems like a bigotry of low expectations.
When Rahm Emmanuel was mayor of Chicago, he took the brown line downtown most days. The trains were never cleaner or ran better than the years he was in office.
Actually the British Transport Police polices trains all over the UK, not just the London Underground.
Joe Biden used to take the Amtrak all the time (because of fear of drunk drivers, another crime) but he probably rode with a coach load of secret service agents, or whoever guarded him while in Congress. I guess crime on trains is mostly on the local trains not express service, but then again, the only time I was ever assaulted was on the Shinkansen in Sendai.
He did not have security with him when he was commuting as a senator
Yes, it's like using buses. I don't know any Americans who take buses. But UK population density is so high (the same population as France but in a quarter of the land area), our roads forced to have so few lanes due to lack of space, and our city-centre layouts so old (especially London), that we don't have much choice but to use public transport. Having your nose stuck in a complete stranger's armpit for 30 minutes on the Northern Line is great for social cohesion - albeit with a deep undertow of loathing for the human condition!
Anecdote: I had tried to report egregiously, visibly inappropriate behavior by a fellow who was crowding an already narrow SFBART escalator, the station attendant said security was unresponsive.
(this was Oakland, shortly postpandemic)
Great post. I'm glad to be a subscriber.
I lived in downtown Chicago and for much longer Manhattan and my main comment is we have a big untreated mental health problem in the US. I'm not sure why policies are called compassionate when they lead to drug deaths and scared citizens. Releasing career criminals over and over to repeat their crimes doesn't seem to show much care for citizens either. Quality of life matters. And to the tweeter, I haven't been traumatized by all the interactions and interventions I've been involved in on the subway. I'm not a small person and I am well trained. My wife on the other hand stopped using it because she is vulnerable. That's not right.
The old institutions “asylums” for the mentally ill were horrible places, and people were not just there because they were mentally ill (sometimes just inconvenient!). They needed to be reformed/replaced. Unfortunately there was no replacement - the Lanterman-Petris-Short act - which was bipartisan, NOT Republican, and NOT Reagan - put severe restrictions on involuntary confinement, in the name of civil rights. What happened was that Reagan *did* defund what was supposed to replace confinement, that is community care, so it basically became “family or the streets.” And since most families are estranged or unequipped or terrified, it became the streets.
There really needs to be some kind of complete supportive housing for the population of adults who cannot care for themselves. Unfortunately, to do this humanely means lots of money, and paying lots of caregivers and social workers (AI can’t do these jobs!), and that seems more out of reach than ever these days when there isn’t even money to shelter the homeless who are merely employed at low-wage jobs or down on their luck.
So, we get “anarchyfare” (thanks, Noah!) which 1) does nothing, zero, zilch, nada, and jack to help the homeless/mentally ill, and 2) ruins the commons for everyone else.
The US is a wealthy country with some characteristics of a Latin American state, namely higher rates of violence, especially gun violence, which confuses those who think we're a European outpost in North America, which we're definitely NOT. But urban disorder in America is definitely a symptom of progressive governance, a hallmark of which is first world levels of taxation with third world levels of services, especially here in California.
Would Canada be more of a "European outpost in North America"?
European and Punjabi outpost, maybe.
More seriously, no. It's been wryly but correctly observed before that the Quebecois are not French living in America, but americans who speak French. (America here does not refer to the US, but the hemisphere).
If you look at any given statistic about social problems, Canada sits between the EU and america.
Well, Canada came in third place after USA and Turkey in the chart of per capita murder in the article, so maybe not really. Or is Turkey an Asian outpost in Europe?
Turkey definitely IS a Middle Eastern outpost in Europe.
More like a bridge between Europe and the Middle East, given that only a very small part of its territory is in Europe.
Republican state governments can blame Democratic mayors and county executives, but cities/counties must follow state law.
I’d argue if this were an exclusively Team Blue governance problem, Republican state legislators could override them and fix the problems.
Plus we’ve had Republican legislative and high court control at the federal level more often than not since 1995.
I’m not saying progressives don’t have blame to share, but not 100%.
Law enforcement is mostly a local responsibility, state and federal involvement is necessarily limited by the constitution.
There’s no carve out for local government in the Constitution as far as I know.
Texas has all of these problems too.
Noah Smith is being such a hack on healthcare in this post.
"But this is tempered by the fact that Americans spend a lower percent of their health care costs out-of-pocket compared to people in most other rich countries:"
This is true Americans spend about 11% of the cost of their healthcare out out of pocket while Canada spends 15%.
But Noah Smith leaves out the top line number because it is absolutely devastating to his case.
According to the OECD, per capita healthcare expenditure in the US in 2024 was 14,885$.
In Canada in 2024, the same number was 7,301$.
Now, Noah Smith, ECONOMIST, didn't want to do this math, because it shows that US healthcare is actually bad.
So 11% of 14,885 = 1,637$ out of pocket in the US.
In Canada, 15% of 7,301$ = 1,095 $ out of pocket.
American out of pocket proportion looks low only because the top line number is so high.
Americans are spending 60% more out of pocket than a lot of the rest of the world.
(I purposely chose Canada because it was at the top of the provided chart, but it is even worse looking at the others. France is 7,354$ per capita but only 9% of that is out of pocket so 662$)
Your logic is wrong sorry. Math is hard. Americans spend more on healthcare because it is a luxury good and the richer people get the more they want to spend on it.
What is wrong about the logic here? Americans spend a lower percentage (out of pocket) of a higher number.
Are you arguing that the American health spending per capita is NOT radically higher than our peer countries?
Noah's point is that Americans are "radically richer too".
500 bucks of difference at the household level doesn't seem that much when you compare it to median household incomes, where the US is usually more than 500 bucks ahead.[1]
Of course things add up, all those riches goes to paying for the inefficiencies (as evidenced by the worse outcomes in crime, education, healthcare).
The problem is that a generally high price level with significant inequality leads to a lot of people having a hard time. (Even if they are insured.) For example I can easily imagine that this household spending difference is suppressed, because many people with problems cannot afford to pay more. So they have a worse quality of life despite having "insurance".
[1] Though of course this is also complicated. ( https://www.csls.ca/reports/csls2019-01.pdf )
That's a fine point to make and he could have done so.
I think Noah Smith knows that.
We can adjust it to GDP per capita and it is still bad.
The US GDP per capita according to the world bank from 2022-2024 was 85,000 USD. France's, according to the same source, was 46,000 USD.
With that kind of ratio, you'd expect US medical costs to be 85,000/46,000 = 1.85x more.
But they are actually more than 2 times as much when comparing total spending per capita and almost 2.5 times as much when comparing out of pocket spending.
Noah Smith is a huge booster of Japan and Taiwan, but he never talks about their health systems because doing so would force him to point out how bad the US one is by comparison.
In general I don't want to carry too much water for him, because I also think a bit more rigor and attention to detail would be, um, a good idea. [1] :)
Also, it's not like he needs random people to defend him in his own comment section. But I think he covered the problems of the US healthcare system. [2][3] (Though maybe he's running out of topics to write about and should consider doing a healthcare systems comparison!)
... that said, Japan has a mandatory 30% cost sharing, right? And the prices are set by the government. Which is roughly what Noah says[2], that bargaining/negotiating at the nation level is important, and that's why national healthcare is a good idea.
[1] Sometimes his conclusions are ... simply crude, like in the Europeans don't want AC. Even if the title is incendiary to be clickbait-y ... the whole thing seems ridiculous, and I used to live in a city where it's Arizona-light in the summer. -- https://www.noahpinion.blog/p/europes-crusade-against-air-conditioning
[2] https://www.noahpinion.blog/p/insurance-companies-arent-the-main search for "good idea" (And one more conclusion which ... is so blunt it's almost certain to be dumb "The only reason Americans’ bills are higher is that U.S. health care provision costs so much more in the first place.")
[3] https://www.noahpinion.blog/p/why-do-education-health-care-and
In number 3, he writes "But it’s worth noting that pretty much every other rich country in the world regulates health care more than we do, including price controls. And all of them subsidize health care very heavily via universal health insurance systems. And all of them have MUCH CHEAPER HEALTHCARE than the U.S., while providing similar quality. So in the clearest-cut case of cost disease socialism, the proven cheaper alternative seems to be…actual socialism."
So apparently something happened between 2023 and 2026 that made him think that US healthcare wasn't actually all that expensive (as he argues in this post)
I have no idea what that could be, but it seems like a huge about face.
He actually did make that point. He specifically said that even if you subtract the extra health care costs paid by americans they are still left with more more money:
"And if you took health spending entirely out of the equation, Americans would still be richer than people in almost any other country".
Meaning even taking health care spending out of their incomes, Americans are wealthier than most European countries.
I’m not sure that’s the main cause. Picking one example, knee replacement surgery:
"Blue Cross Blue Shield estimated in 2019 that the average cost of an inpatient knee replacement procedure was $30,249" USD
Going by a CJRR annual report, in Canada the total cost to the system is about $18,000 CAD.
The US spends a lot more because people demand choice AND we pay providers a lot more.
For example, your average doctor in the UK makes about $170k a year, the average doctor in the US makes $260k a year.
Other countries keep their costs down through price controls and rationing.
One reason why Brexit (and the anti-immigration mood that made it happen) has been a disaster for the NHS: it is very dependent on immigrant staff as British-born doctors and nurses tend to chase higher salaries in the US or Australia.
And how much of Canadian pharmaceuticals and medical equipment was developed or built in the US? Did Canada make a COVID vaccine? Part of the American healthcare spending that isn’t out of pocket is for research like Project Warp Speed.
45 out of ever 100 healthcare dollars spent worldwide are spent in the US, a country with 4.2% of the world's population.
This is a horrible deal for the average American.
Every so often something like Project WarpSpeed happens where it is public money, but most of the time, the cutting edge research is being funded by charging Americans 3-5 times more for the same medication.
So if you have MS and get Ocrevus in the US, your costs will be between 62,000 and 119,000 USD per year... every year... for the rest of your life. The vials of the drug cost 30,000 USD.
Getting that same drug in France is 8,000 Euros per vial so it is a lot cheaper.
There is no reason for the price difference beyond that the US will pay it while France has a Health Technology Assessment Agency (as do almost all other wealthy countries) which looks at the cost and medical efficacy of a drug and decides how much the public system will pay for it.
Up until the Biden administration, the US government was forbidden by law from doing this and, even then, that restriction was only barely relaxed.
The good people of America are there to fund the world's biomedical research, whether we want to or not.
US prices include recouping all the R&D, where whatever they can get out of France above manufacturing cost is gravy.
Healthcare isn't expensive because of drug costs though. It is the highly paid professionals and over usage of medical care and procedures.
As a European living in a city, its unfortunately getting worse here too. And we have similar taboos: in my own experience there is a relation with illegal / asylum migration from outside Europe but there is a taboo on saying this out loud for the obvious reasons.
I guess the sad part is, and maybe that is the reason why in the US it is apparantly worse, that to a certain extend you get used to it and start to accept it as a fact of life.
The tolerance for crime (it’s honestly not too much of a stretch to say the reverence for crime or the celebration of crime) is the single biggest thing that has me personally estranged from the Democratic Party.
There is absolutely nothing liberal about criminal justice nihilism or about abandoning public spaces and public services to the most antisocial elements of society.
But this has become an acid test for whether or not someone is a “progressive” in good standing.
This is bad. And the people who encourage this are bad.
Is there a leader of the Democratic Party - a President or nominee for President, a speaker of the house or Senate majority/minority leader, an important Governor who demonstrates a “reverence” for crime? Or are you thinking of selfie shouting online people?
From 1975 to 2025 NYC and SF went on a run of wealth creation and success not seen since like 13th century Venice. They are the successful parts of America. NYC really used to look like the French Connection and now it really looks like Sex and the City. The problem is the unsuccessful parts of the country where crime and ugliness and lousy ideas about the good life are entrenched. Drive from Raleigh to Charlotte and behold the endless stripmall dollar stores and pawn shops… T
Calling alcoholism / substance addiction and obesity "diseases of wealth and irresponsibility" is both way too reductionistic and also plain wrong, unless you twist the meaning of "irresponsibility" to a breaking point when used as an explanation on population data level. Look into European countries, for instance, and you see that neither of these things even correlates with wealth, and again I am not sure it makes sense to label entire populations as "more irresponsible".
Irresponsibility applies to both, wealth applies to obesity. Obesity comes down to taking in more calories than you use each day, and nobody responsible looks at their life and says "I should do meth about this."
That is exactly the type of reductive moralising that is unhelpful in addressing the underlying issues and also ethically questionable allocation of "moral opprobrium". We did not collectively achieve a significant victory over e.g., the cigarette industry by viewing smoking as a deficiency of character. Rather, legislation was imposed to limit the channels (social and physical) for the addiction to set in, and over time those limitations also caused a corresponding change in social norms related to smoking.
I interact directly with addicts daily. I assure you, irresponsible is the nicest term I could use to describe them.
Of course addicts act irresponsibly, but that does not mean that "irresponsibility" (whatever that means in Noah's parlance) is the CAUSE of differences in addiction rates on a population level.
Do you think how responsible someone is/isn't is a factor in likelihood of becoming an addict? I would say the addicts I've known are highly correlated to irresponsibility in other areas too, even prior to addiction.
Or do you think culture doesn't impact responsibility, so "how responsible a population is" doesn't vary at all from place to place and it's entirely a factor of societal wealth or something?
We absolutely helped achieve victory over smoking by invoking shame. Over time, smoking went from "cool" to gross and weak; we shunned smokers to huddle outside.
“legislation was imposed” - do you think it was imposed out of nowhere?
It was imposed by politicians who saw the public health disaster unfolding: smokers who imposed massive costs upon themselves and those around them, but didn’t care because they were chasing their fix. You could say these smokers had a deficiency of character.
Just so you know, every single thing you said here is very wrong. You'll never realize it, until the very end, but hopefully there's an instant you do.
I never understood the "US just has unhealthier lifestyles" argument about healthcare costs. Europe drinks and smokes much more than the US.
I think it's funny because at an individual level, if someone told me they are scared to ride bart or muni, I would roll my eyes unless they specifically mean something like "as a young woman by myself from sf to fruitvale at 2am on a weekday." But that isn't me saying disorder on bart or muni is basically fine! I also don't think yelling "you should exercise more!" is a good public policy, but it might be reasonable advice for a friend looking to lose weight, just like an eyeroll is a reasonable response to a friend who won't come out because uber is too expensive and bart is too scary.
The common perception that “the U.S. has much more crime than other rich countries” is only clearly true for homicide. Perhaps this is because of guns rather than progressives.
And also for public transit peeing. And public transit stabbings. And things that matter-ings, no?
Even if it's true that quantifiable disorder is low and falling there seems to be a drastic rise in calls for action against that.
(Likely it's the social media hype-cycle that started with the immigrants bad, no-go zones, open drug markets, "Skid Rows" of various cities, and then porch pirates and car break ins were in the zeitgeist, and phone grabbers, and as now it's commuter safety. And usually there are actions taken, so attention is not necessarily bad. The bad part is when this attention leads to bad outcomes, ie. when it's already part of a political campaign, emotions and propaganda memes are flying high, and at that point cost-benefit analysis and critical thinking usually disembarks immediately.)
Even if all guns disappeared tomorrow and guns homicides dropped to 0, the US would still have a homicide rate that's notably higher than most other developed countries. We'd drop from 6.8 to 1.4 homicides per 100,000 people. An enormous improvement, but still over 2x the median. And that's the best case scenario, where all of these killers, when denied their access to guns, decide not to kill instead of using other means. That's not a realistic outcome. All that being said, I do agree (as does Noah), that Progressives aren't somehow causing American criminality.
https://www.cdc.gov/nchs/fastats/homicide.htm
But the US also has over double the road fatality, and it’s going up again now instead of down like most developed countries.
And if you chart it vs the homicide rate by state, you could use the road fatality rate correlation to explain about half of homicide rate variation. That suggests to me that the whole society is more aggressive, and there are just various symptoms where it shows up.
Interesting point. That might be a factor contributing to non-gun homicides being higher than the average for rich countries as pointed out in FreneticFauna’s comment.
I really liked this post and think Noah should run for president or at least mayor.
But, Noah focused mostly on urban crime which is problematic, but my understanding is rural crime rates are actually higher than most urban crime rates, especially in the south. Clearly the progressive left isn't in charge of Mississippi. What's the solution here?
Yes, I think our murder rate and urban disorder are two different critters.
Only a fifth of the US population is rural, and a _national_ murder rate is per 100K population nationally. So rural rates have much less statistical influence on a national rate than urban and suburban rates do.
As for rural rates, since there are differences in rates of crime being reported the best source for this question is the National Crime Victimization Study. (A very-large recurring survey of Americans which collects data on serious-crime victimizations without regard to whether the crimes were formally reported.) The most-recent NCVS data puts the overall rate of being a crime victim the lowest in rural areas, the highest in urban, and in the middle in suburban. The urban rate is a bit more than double the rural rate.
Those are national averages, there can of course be variation regionally or locally. This also could be getting shifted by the current unprecedented national drop in crime rates, which thus far is reducing urban rates more than rural or suburban ones. (NCVS annual-survey results are reported out on a 2 or 3 year lag.)
Rural and urban murder rates are not the same; while large cities often have higher homicide counts, recent data indicates that rural counties frequently experience higher per-capita total firearm mortality rates, driven significantly by gun suicides. Data indicates that between 2011 and 2020, rural counties had up to a 37% higher overall firearm death rate. - National Institutes of Health (.gov)
Key details regarding U.S. murder and gun death rates:
Total Firearm Deaths: Recent studies show rural areas can have higher firearm death rates than urban areas, with a 2024 analysis showing rural gun mortality was 45% higher than in large metro areas.
Gun Homicides vs. Suicides: While large metro counties have higher gun homicide rates (5.1 per 100,000) compared to rural counties (3.5 per 100,000 in 2024), the high rate of rural gun suicides (12.5 per 100,000) drives the higher overall firearm mortality in rural areas.
Trends: From 2018 to 2021, firearm homicide rates spiked in both, but rural counties have struggled more with recovery in these rates.
Moreover Paul, as an urban resident with no handgun in my home (and therefore a miniscule risk of death or injury by handgun), my personal experience of "urban disorder" is almost all via the presence of congregations of indigent and unstable street people who occupy and often live in public spaces.
While suicide is a tragedy, it's different from the "crime" that is the subject of Noah's post and of my comment.
With that noted, your comment does not appear to have any logical connection to mine.
Paul,
Noah's post was titled "Why does America feel worse than other countries? Crime.".
My point is that most (emotive) perceptions of crime arise from crime that occurs in public spaces. Most murders, either rural or urban, involve handguns and occur inside the home and are rarely reported on much. So your homicide rate comparison rural/urban misses the point.
While grisly murders that are perped in public spaces are always too many, the incidence is actually very low (especially if one excludes the crazies who perp mass shootings - there's that availability of gun thing again). Your odds of being murdered by a random stranger anywhere in the US is extremely low. Maybe higher than other nations, but still very low.
But because urban areas have much more public space than suburban or rural areas, one will naturally experience more disorder and menace from indigent, disturbed people who make up the bulk of what we term "homeless", populating public space. Their presence would not be tolerated in most suburban or rural localities.
As far as I can tell, it's this urban disorder of the "homeless", that drives feelings America has worse crime than other nations. The murder rate in the US is a result of our perverse cult of permissive gun availability.
Hope this helps.
Best
John,
It does not.
Your assigning to me of words and arguments which I did not offer -- a.k.a. straw-manning -- is irritating and in my view disqualifying.
Even if it wasn't, your responding to a clarification of a narrow statistical fact with sweeping impressionistic assumptions would be off-putting even without the condescending tone.
In short life's too short....happily Substack does have a "mute user" function so, bye.
I think progressives should be open minded to making the movement more palatable to more people, rather than being so defensive! We need to be able to win over the “average American” and using academic jargon to rationalize public urination is just a loser position.
Yes obviously the gun situation is absurd and is a huge contributor to high rates of violent crime.
Yet the tolerance of vandalism, anti social behavior, general disorder, is not ok. There must be a balance of compassion for the harms of racist / classist policies with individual accountability.
I was on the train in Boston at rush hour the other day, and a man was rolling blunts on the train and just dumping the tobacco innards on the floor. Just throwing his trash directly on the ground. No one did anything.
I feel like there is a weird dynamic with who is empowered and incentivized to enforce rules and the law. Shop lifting for example…. Like, can shop keepers do anything about this? I can’t get toothpaste without calling the cashier to unlock it. Seriously we need to solve this.
I wonder about this often and agree that there seems to be a uniquely American flavor to both the disorder and crime and progressives’ framing of these in terms of race and privilege. I think you’ve correctly ruled out several potential proximate causes of urban disorder in this piece, but I’m left wondering what is different in America that has gotten us to this point. It seems that both homelessness and the displays of antisocial behavior you describe have their roots in untreated mental illness, and I’m curious how deinstitutionalizing care for severe mental illness in the US (without actually replacing that broken system with a functioning outpatient alternative) correlates to crime rates, homelessness, and incarceration rates and how this compares to other countries. Perhaps this explains some of the difference, at least in these severe forms of antisocial behavior and crime you point to.
I do think there is a broader, harder to define apathy at play here as well that leads to many smaller tragedies of the commons (or even just surly attitudes at the checkout counter) that doesn’t go away even if you solve for severe mental illness playing out in public spaces. I don’t know how we solve for that, but it’s another difference I notice in cities outside the US - people just seem to care more.
Sometimes I wonder how this looks from abroad. Given how much crime and disorder shows up in our media, it’s surprising we’re still perceived as the world’s leading power. I’m sure it’s just seen as wild. That gap between capacity and visible dysfunction feels uniquely American too.
We're perceived as the world's leading power bc we are the world's leading power. We are the wealthiest and most militarily powerful country in the world. That's power!
It's a little like the Black Bush sketch
" it’s surprising we’re still perceived as the world’s leading power"
Ironically, perhaps it even contributes to that - giving the idea that USA is a country of badass people?