The private sector can’t do everything – we need government, regulations, and taxes. But why are government agencies so encumbered by bureaucratic inefficiency? Here are some possible reasons:
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Politics and Economics
… It all depends on what else is happening in a country, especially related to other indicators of well-being. For example, if high inequality is coupled with high poverty and low social mobility, then we have three problems. If high inequality is coupled with low poverty and high social mobility, it’s not clear to me that we have a problem.
As if the example of other countries’ healthcare systems weren’t enough for ideas on how to fix the US system, the Urban Institute recently released a report comparing six multi-payer health reforms with two single-payer reform options, including Medicare for All. Care of the Commonwealth Fund, here is a nice summary of the eight possible reforms…
According to the researchers, these emotional reactions are understandable in the context of human evolution. Human emotions evolved to help our ancestors survive and reproduce during a time when conditions were brutal. Emotional reactions served to reinforce behaviors necessary for individual and group survival: warm fuzzies for individuals who demonstrated a willingness to put in the effort, reciprocate, and cooperate; and anger for individuals deemed lazy, selfish or uncooperative.
The most common hate crime bias motivations are, in order: anti-African American, anti-sexual orientation, anti-Jewish, anti-white, anti-Latino, and anti-Islamic. Per the following table, the bias mix shifted in 2018…
Cross-cultural studies have found that most people agree with the following: 1) Distribute resources equally, when need and merit are equal and the rules allow it; 2) Give more to the needy at some threshold of neediness, regardless of merit; 3) If there are agreed upon rules, and resources are allocated unequally based on these rules, that’s okay; and, 4) Merit is partly based on considerations of effort, both quantity and quality.
Why is it taking longer for today’s under-40 set (aka millennials) to accumulate significant wealth? Mostly because they’re delaying marriage and home ownership, which is partly a result of financial constraints and partly a matter of social change. Compared to previous generations of young adults, millennials are staying in college longer, have higher levels of student debt, and face tighter mortgage lending standards. They also tend to live in cities with nonoptimal housing markets.
Wasteful spending on health care is not a trivial problem. It represents resources that could be redirected to, say, higher wages, R & D budgets, affordable housing, or climate change adaptation. Yet it is a problem the political class has pretty much downplayed or ignored, probably because serious spending reform would anger a lot of voters, especially the healthcare workers who lose their jobs or get their pay cut as a result of reform. Luckily, the media and some politicians are finally beginning to grapple with the issue
The challenge of housing the chronically homeless is how to do it without breaking the bank, distorting the local housing market, or incentivizing dependency.
I put this snapshot together, because the original report goes on and on, making it hard to see the forest through the trees. Part of solving a problem is organizing your information into relevant facts. One of the problems I’d like to solve is how to fix chronic homelessness without creating serious problems elsewhere. This is a beginning of that project.
Responsive government is like a doctor treating a patient: sometimes 'wait and see' is the way to go and sometimes active intervention. Either way, the best doctors know how long to give the current approach a chance and when to cut one's losses and try something else. Above all else, the best doctors are not burdened by ego, former convictions, or the tyranny of past investment. They let go.
Free speech is essential for moving closer to the truth of things. That’s enough for me, but I’ll add that free speech is also good for problem-solving, good governance, and democracy. Apparently, that’s not enough for some people. It’s not so much that these folks have fully articulated arguments for limiting the right to speech. It’s more that they have ways of thinking that minimize its value and justify restricting speech. Here are a few examples: …
Opportunity quickens desire and power creates opportunities. And so the dream of absolute power continues to beckon.
To simplify the authors’ argument:
“There are a few standard explanations for unequal outcomes. But those explanations do not explain all the variance in outcomes. Therefore, unobservable facts reflecting systemic barriers explain the rest and they are the ultimate cause of injustice. Elimination of these barriers will require fundamental change in the nature of our society.”
Categorizing and calculating healthcare waste is an excellent first step to fixing the problem of waste. The next step is figuring out who’s responsible, and why.
In 2017, US health care spending reached $3.5 trillion, or $10,739 per person, in 2017 - 17.9% of the US gross domestic product (GDP). Per the JAMA study, as much as $935 billion of that spending was wasted.
The program was funded by the city of Chester and had previously been managed by a local non-profit - rather poorly it would seem, given its dismal job placement and dropout rates. My employer - Associates for Research in Behavior - took over the city’s contract with the promise of improving outcomes by applying the principles of motivation to the business of training adult students. The main principles were: …
Bottom line: this is doable. Rental income covers the developer’s costs and profit and the ongoing building management and rental subsidy cost per resident is just $1103 a month. A few years ago, the average cost of supportive housing in San Francisco was $17,353 a year per person. Given Bay Area inflation rates, let’s say it’s $24,000 now, or $2000 a month. The above scheme is a lot cheaper. Now if only local politics would align with my vision.
Straight off the street, no money, get a totally subsidized 8x10 SRO, with bathrooms down the hall. Those with at least $600 for monthly rent could get a studio. Couples with at least $600 for rent each would qualify for bigger studios or a small one-bedroom apartment. All in the same building, as an incentive for individuals to aspire for something better, something that is within reach, and with help available (e.g. completing benefit paperwork, arranging monthly rent transfers).
There is no reason conservatives can’t embrace goals like universal healthcare, affordable housing, elimination of poverty, or increased social mobility. With the above safeguards in place, they may go forth and advance bold policy initiatives without violating their core principles.