Random Critical Analysis

I'm all for universal and single-payer healthcare, education reform, basic income (negative income tax is the best version of UBI), and so on. But still, QE might be here to stay. It's hard to stay, I know very-very little about these things. (Even compared to - let's say - healthcare costs [see https://randomcriticalanalysis.com/ ].)

Parent is probably using murder rates because murder is very unlikely to be unevenly enforced, with the implicit implication that these differences extend to other violent crimes (but the data there is muddied by differential enforcement). Here is the strongest presentation of this argument that I've seen: https://randomcriticalanalysis.com/2015/11/16/racial-differences-in-ho… I don't have a well-formed opinion here, but IMO it's worth considering many possible combinations of factors.

Are healthcare outcomes worse in the US than other first world countries? Life expectancy is endogenous to variables like diet and exercise. Looking at cancer survival rates, the US is best at some and mediocre at others but other countries are not "objectively better"[0]. Is health expenditure in the US higher than in other countries? Yes, but that is because the US is rich, really rich. If we plot US Real Household Income against healthcare consumption, the US is perfectly inline with global trends[1]. [0] https://www.cdc.gov/cancer/dcpc/research/articles/concord-2.htm [1] https://randomcriticalanalysis.com/2018/11/19/why-everything-you-know-…

I think this is an excellent analysis with sources: https://randomcriticalanalysis.com/2015/11/16/racial-differences-in-ho… His conclusion is that on a county-by-county level in the US, race is the strongest predictor of homicide rates, with rates of single-motherhood being next strongest. Poverty is a reasonable predictor, but weaker than these and several others. I read this closely a couple years ago, but only skimmed it now to remind myself of the conclusions. I'd be interested to hear peoples' thoughts on whether his statistical techniques are appropriately applied. I recall it was was convincing to me at the time.

I was only talking about the US. I am not familiar with European problems, my outside view is if Europe were more like the US perhaps it wouldn't be poor compared to the US, but I don't know for sure. In the US, you gave me a short term data and I just gave you a longer term view than gives a fuller picture, as you've tried to discount my taxes data before (even though that data included relevant tax reform years). Moreover I gave you BLS consumption data. Spending on housing went from 29 to 32% from 1960 to 2000, with no obvious changes in trend. While the median house is 1.5-2x big and quality and safety regulations became more strict. Oh and household sizes decreased iirc. Housing may be becoming less accessible since covid, sure. Any 1980ies welfare state etc changes don't have much to do with that. Then, Detroit in fact has a massive number of abandoned houses, so yes prices did effectively go to zero. Presumably if they could be sold to anyone they would be, but they are not worth owning https://detroitmi.gov/news/deputy-mayor-detroit-land-bank-authority-co… Thanks for providing me with this great argument for supply and demand, I will use it in future ;) "Market gud, democracy bad and I am very smart”, I see" Vibes, vibes. There's tons of data on this, from micro data to between city comparison. There's even more data on costs, delays and cancellations for larger projects due to reviews and lawsuits.…

While not directly related to your question, I think this will help answer many questions you may have about our spending. This is a good start comparing america's healthcare expenditure to other countries' expenditures: https://randomcriticalanalysis.com/why-conventional-wisdom-on-health-c… The short of it, on a national level: Health spending is determined by income Income predicts changes in health expenditure The rising health share explained by rising quantities per capita (not prices!) America spends much more because it consumes much more The claim that US health care prices are inexplicably high was never well-evidenced! Real health inputs (labor) increase rapidly with income levels High overall wage rates and profit margins cannot explain much. Physician take-home pay explains even less The composition of the American health workforce is consistent with trends observed elsewhere. and finally... Diminishing returns to spending and worse lifestyle factors explain America’s mediocre health outcomes These headline claims map to large sections of the linked content. I highly recommend chewing through it all.

The title doesn't make it at all obvious what or who this is about. It appears to be a followup to https://randomcriticalanalysis.com/why-conventional-wisdom-on-health-c… , recently posted at https://news.ycombinator.com/item?id=41870858 (and also several other times since the original publication, but this is the first time it got traction on HN). The thing that isn't clear to me in the author's model is why it should make sense to see this kind of power-law result (it obviously cannot extend indefinitely, since at some level of income, health care spending would be predicted to exceed 100% of income). This should be at least as much of a problem as the "poor countries are predicted to have negative health care expenditure" problem that the author points out with linear models. (If we're concerned with out-of-sample data in judging the soundness of a model, then presumably we should also be concerned with these sorts of hypotheticals. The author does seem to note the concern, but IMO dismisses it too readily.) A more intuitive model, IMO, would be a fixed percentage of income in excess of some threshold - but this is also problematic in that our "threshold" for covering basic needs is apparently highly variable (given how poor some countries are compared to the US).

I feel like I am repeating myself, both those situations are irrelevant to your original point. I agree we can try to make things more efficient, and society can improve how it redistributes wealth. You seem to be saying we should distribute any gains to artists. I am saying that we distribute those gains to working people, and let the artists do their thing in their free time. If we start getting to the point where there is not enough “work” to go around, then we can follow the scandi practice of reducing everyone’s working hours. Although admittedly that doesn’t address the problem that there is an unlimited need for highly skilled people (the drive behind the power law of income distribution and why the more highly paid professionals have no spare time). UBI is a lovely concept, but unfortunately in the very major examples I have already seen of UBI (retirement being the biggest example), I don’t see much return in scientific or creative output. PS: this is a fantastic read about the US health system: https://randomcriticalanalysis.com/why-conventional-wisdom-on-health-c…

> Really? That is news to me, as a dual US|EU (Croatian) citizen, who is culturally American--but currently living in Croatia. Yes, and just like that health policy analyst, I can attest to it. I've read more than enough plan documents, and work with health actuaries every day. > Also, just in case you want to blame this on "lifestyle factors" (which means that this is a public health matter, which the United States has severely underfunded--locally, state, and nationally for more than a few decades now), the third leading cause of death is believed to be preventable medical errors. (The source I provide has been verified by several follow-up studies.) Actually, there's a fantastic analysis that addresses this point head on, even analyzing the IHME data: https://randomcriticalanalysis.com/2017/05/16/the-explanatory-power-of… The vast majority of the variance in average life expectancy is attributable to lifestyle factors. As long as you stay away from drugs, you don't participate in a gang, or you take the bus (or any public transit), you're on roughly equal footing with the rest of the OECD. "The data suggests motor vehicle accidents, homicides, and drug overdose deaths can explain a large fraction of the US life expectancy gap as compared to several highly developed countries. Obviously this does not account for obesity, diabetes, (historical) smoking, and related lifestyle differences that are likely to…

The figure you're looking for is called 'Adjusted Household Disposable Income per capita PPP' - probably the best indicator of material standards of living there is. The word adjusted refers to the fact that in-kind transfers, like healthcare, social benefits or universal education are paid by the taxpayer. PPP, Purchasing Power Parity, evens out the impact of price differences. Several things stand out: - Citizens in larger countries have it better than one would expect. This reflects the economies of scale, and matches well with the informal anecdotes of people who have lived there - that despite GDP and productivity figures, somehow life's better there - Tax havens don't really benefit the citizens of their countries, outside of a narrow sliver of population. Material standard of living in Ireland is below that of Italy Here's a report from Eurostat: https://ec.europa.eu/eurostat/databrowser/view/sdg_10_20/default/table… Here's a more comprehensive set of data - builds up a very interesting argument, based on AHDI figures: https://randomcriticalanalysis.com/2018/11/19/why-everything-you-know-…

> Your findings are not mutually exclusive with other theories about the underlying causes of high U.S. healthcare expenditure, such as a chronic lack of price transparency. My findings strongly agitate against the notion that high US health spending is a product of idiosyncratic features of our system. Presumably most of these critics believe we'd spend much less if only our system looked more like other countries, but my evidence indicates we'd spend very similar amounts in the long run regardless. Further, we'd likely have similar outcomes and many other similar healthcare attributes (prices, intensity, health worker density, etc). Most of the things about US healthcare people believe to be important and unique (i.e., not explained by income) just aren't. > The more money is in the pot, the greater the incentives to pilfer it, and, in lieu of adequate controls, the more it will be pilfered I wouldn't argue there's no "pilfering" or that more money doesn't create more opportunity for this, but the high income elasticity likely has little to do with pilfering. Where are these ill-gotten gains going? I certainly don't think you'd have much success in showing this if you look at, say, the growth in physician incomes, pharma/biotech industry profits, and so on. The data are much more consistent with mundane explanations like rising technological sophistication, higher intensity, and so on (ultimately much of this being driven by some combination of patient/family…

>That isn't a thing. You can argue this specification minimizes the residuals at the high end if you want, No, but yes. >> So if you have data about healthcare prices not being out of order, that seems a lot more relevant > https://randomcriticalanalysis.com/2018/01/06/its-not-the-pr... > It is the consensus view amongst researchers that have published long-run analyses: >https://www.cms.gov/research-statistics-data-and-systems/statistics-tr… So I think it's interesting here that you make no mention of the explanation for HCE increases provided in the "consensus view" link. >In health care research, the impact of medical technology on health care cost increases has always been a great unknown. Yet 81 percent of the leading health economists agreed with the statement, “The primary reason for the increase in the health sector’s share of GDP over the past 30 years is technological change in medicine”.1Growing attention to the role of technological change in driving growth in health spending, and to the costs and benefits associated with new medical innovation reflects an acknowledgement of the long-term dilemma posed by historically unsustainable rates of growth in medical costs, combined with an increasing consensus that technological advance is a major factor in driving this growth. The current acceleration in health spending growth - following the quiescent period accompanying the spread of…

> This argument uses average income as proxy for what health care spending in the US should be. > That seems clearly wrong given that with US now having a GINI coefficient, high level of income inequality, median household income would be a better thing to measure health care spending, since every individual has to spend money on staying healthy. The author responds to that criticism in the following comment[1]: >> Two, I don’t understand why you’re using mean rather than median AIC throughout. > Several reasons. > 1) We don’t have good internationally comparable statistics for income or consumption at various points in the distribution... > 2) When I’ve looked into this I have not found measured differences in the distribution or the median to be particularly informative... > 3) This makes sense because there is approximately no relationship between individual income and health spending in the developed world, including the United States... As for your second argument: > The argument generally seems wrong too. The need for health care isn't elastic - if someone need care, they need care and people going without needed health care is a humanitarian crisis (a situation that the US is arguable in - see the people giving free dental in a stadium a few years back). I'm not sure I follow your argument. RCA is saying that, as a country, the U.S. spends more on healthcare because we consume more health care than other countries. The U.K. kept their prices low for a long…

I think you have to account for multiple factors like Americans are generally unhealthy people, the people have better access to the top of the line medical technology, people actually spend and consume more compared to the EU. This blog post explains a lot more. https://randomcriticalanalysis.com/why-conventional-wisdom-on-health-c…

If you ever want to "sanewash" healthcare spending in the US, this random guy stood up an entire website to argue that per-capita healthcare spending in the US is more or less in line with expectations based on per-capita income: https://randomcriticalanalysis.com/why-conventional-wisdom-on-health-c… TL;DR: As people/countries get richer, a larger share of their money goes towards consumption. It's not just that Americans pay more for the same procedures (sometimes they do, sometimes it's just sticker prices) but we consume more healthcare the more money we make. So it skews costs up disproportionally. That wealth also enables chronic health and lifestyle problems that are expensive in their own right. I'm not sure I'd buy the theory entirely, but it's very well argued and as a null hypothesis it makes a lot of sense.

"Our high spending is overwhelmingly a product of our high incomes and if other OECD countries had our exceptionally high material standard of living most of them would be spending very similarly, with similar utilization, similar intensity, similar prices, and otherwise not obviously better overall outcomes." https://randomcriticalanalysis.com/2018/11/19/why-everything-you-know-…

https://randomcriticalanalysis.com/2015/11/16/racial-differences-in-ho… It's not that simple.

It’s not pharma that’s driving rising medical costs, it’s hospitals: https://www.bloomberg.com/features/2025-cancer-drug-markups/ Another contributing factor is that Americans consume a LOT of healthcare, often well past the point of diminishing returns: “Why conventional wisdom on health care is wrong (a primer)” https://randomcriticalanalysis.com/why-conventional-wisdom-on-health-c… Finally, basic preventative health care — at least for children — could save more than it costs when we take into account the overall economic effects of poor health outcomes. We should consider making it an entitlement.

Any thoughts on arguments like https://randomcriticalanalysis.com/why-conventional-wisdom-on-health-c… that basically the US spends a lot on healthcare because the US is very rich?

I know of at least one source arguing that in fact, population health (mainly obesity and gun violence) explain upwards of 70% of the difference in healthcare spending between the US and other developed nations.[1] To me, this seems like the most likely explanation because I believe we have pretty similar diagnostics and treatments to other developed countries, and I don't feel like a British doctor would give me any treatment that an American doctor wouldn't, and vice versa. As for the other 30%, I think it's probably due to inefficiencies in the insurance-based payment system and our patents lasting too long making drugs more expensive. [1] https://randomcriticalanalysis.com/why-conventional-wisdom-on-health-c…

A quick reading of the summary shows a lot of debunking and just one item that explains the bad health of North Americans: Diminishing returns to spending and worse lifestyle factors explain America’s mediocre health outcomes https://randomcriticalanalysis.com/why-conventional-wisdom-on-health-c…

https://randomcriticalanalysis.com/2017/06/22/no-us-school-funding-is-… Being a progressive and seeing real-world data crush your entire world view time after time must be a strange feeling.

This argument is pretty hand-wavy. If it were as simple as adjusting for income-level, then there would be no controversy. However the fact remains that black Americans commit violent crime at a significantly higher rate than white Americans, even when adjusted for income. I am not making the "it's race/genetics" case, but there's more going on here than a simple correlation between crime and poverty. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2782848/ https://randomcriticalanalysis.com/2015/11/16/racial-differences-in-ho…

> we can change the reason for the statistical correlation: poverty. Even within the same income bracket, the black homicide rate is an order of magnitude larger than the white one (and after 1975, the homicide rate of the richest blacks is larger than of the poorest whites): https://randomcriticalanalysis.com/2015/11/16/racial-differences-in-ho… , table 6

It's not strictly speaking the color of anyone's skin, but the taboos around discussing criminals of a certain shade that bugs me. >Classism is the issue. Crime does correlate somewhat with income, but racial differences in rates of violent crime are poorly explained by income level. Page 93, Table 6: https://www.newyorkfed.org/medialibrary/media/research/epr/99v05n3/990… And here, see "Analysis of the Combined Data" and the conclusion section: https://randomcriticalanalysis.com/2015/11/16/racial-differences-in-ho… The author claims a large amount of the difference is explained by family structure. I'm inclined to agree, and I wish our leaders touched on this more often. You can't welfare or police your way out of a failed subculture where kids aren't raised to respect life and property, or themselves for that matter.

1. School funding is actually somewhat progressive: https://randomcriticalanalysis.com/2017/06/22/no-us-school-funding-is-… 2. People who are concerned about the allegedly regressive character of public school funding would do well to spell out their model of how spending affects basic math and writing performance. For almost all of history, every educated person studied under conditions that made the most impoverished reservation school in North Dakota look like Andover.

Yes, the evidence is quite strong: https://randomcriticalanalysis.com/2015/06/18/on-sat-act-iq-and-other-…

>In many states, the vast majority of school funding comes from property taxes. So schools in wealthy neighborhoods are better funded than schools in poor neighborhoods, and this guarantees homes in wealthy school districts maintain their value since everyone wants their kids in those schools. In the US, school funding is (on average) progressive because federal and state funding more than offsets any local inequalities. See https://randomcriticalanalysis.com/2017/06/22/no-us-school-funding-is-…

Here's a long data analysis making that argument: https://randomcriticalanalysis.com/why-conventional-wisdom-on-health-c…

I disagree, I don't think payer-side things are why healthcare is expensive, but payee-side things (hospitals, pharmacy benefit managers, docs, and the choices that flow from them) + obesity/T2D. I think this is pretty clear from where the money goes and why people in the US need so much healthcare in the first place, and that hamming about insurance is 95% a canard. If you think you can replicate the healthcare success of [pick your model country] without also replicating their obesity rates, doctors salaries, amount of testing and prescriptions, etc, you will find that who pays for it all is the least of your concerns. As Americans consider it, we probably have too much "healthcare", not too little. Others have spent far more time than me on this if you're interested: https://randomcriticalanalysis.com/2020/01/31/i-created-a-primer-on-fu…