[ryandrake]

I think the USA going to soon learn the ugly truth about your item 4: that massive swaths of the population have not saved adequately. I mean, I make pretty ok money and save the max every year, but there is no way on earth my pathetic 401k is going to last even 10 years after I stop working. Now consider the average American who has fuck-all in their retirement account. Despite their disadvantages, pensions at least let people who didn’t save retire in (perhaps difficult) dignity. When my account says $1 and I have no other living breadwinners in my family, my only remaining retirement option is to spend that last dollar on a bullet.

[shantly]

I'm pretty sure that and our 2-3x inflation annual increases in our already-insanely-high healthcare spending are going to lead to civil unrest in the next 30-40 years. On the shorter side for the healthcare spending (no way we can keep up the current rate of increases even 20 more years without an actual, honest-to-god revolt) and somewhat later for the failing retirement system (such as it is). I'm a lot more worried about those than climate change, which we are for-sure not going to address anyway if those aren't dealt with.

[learc83]

>(no way we can keep up the current rate of increases even 20 more years without an actual, honest-to-god revolt

Why would you assume the rate of increase would keep increasing at the same rate?

[shantly]

Rate at which the spending is increasing, that is, not rate at which the rate of increase is increasing.

[learc83]

That's what I meant. Why would you assume it would keep increasing at the same rate. Nothing maintains a steady growth rate long term.

[shantly]

If long term's just another 20 years, at the outside, that'll be enough. Short of lots more people getting sick and dying or living with chronic illness, untreated (so, not generating medical bills, and see also: civil unrest), I don't see what's going to slow it down in that time frame. I think effective legislation, which could theoretically do it, isn't likely for at least another 10 years or so if we're lucky. If it takes longer than that, well, I just hope the rioters blame the correct things/people for their problems. And hopefully the retirement crisis hasn't reached first-page-story status by that time yet, either, or it'll really be a mess. I suspect that one will hold off a bit longer, though. Pretty sure mid- to late-Gen-X folks will be the ones who make that one pick up the pace, especially if inheritance amounts have been trending significantly down for those same folks due to EOL healthcare bills for their parents.

So yeah, I agree it won't maintain a steady growth rate in the long term. I just don't think it'll stop before it causes some pretty big problems.

[EDIT] incidentally I'm not aware of high-profile projections of this stuff that have HC costs doing anything but continuing up way faster than inflation through at least 2030, provided the regulatory environment remains fairly similar. Even Warren's plan isn't projected to do much about that—need price controls in one form or another (like AFAIK every other OECD state uses) and a fix for our doctor supply problem, at least, probably, to do much about the rising costs.

[learc83]

Look at healthcare as a percentage of gdp over the last 50 years. Costs have been rising at a much slower rate over the last 10 years, and have dropped over the last 3. There's no reason to think the rate will stay constant over 20 years.

If anything naive extrapolating shows falling costs as a percentage of GDP, and sustainable rising real costs.

The only way we get crazy numbers is extrapolating using the average from 2000-2020, but there's no reason to do that.

https://www.statista.com/statistics/184968/us-health-expendi...

[ClumsyPilot]

Why would you criticise his extrapolation without offering a well-justified alternative?

[learc83]

Because naive extrapolation based on current growth rate is almost always a bad idea.

[ClumsyPilot]

I understand that, but if you are going to criticise him (?), you should suggest whatever it is you deem appropriate. Then it's going to be constructive.

If you are not going to make the effort, why should he take your criticism seriously?

[learc83]

There's nothing appropriate to suggest. Predicting the rate at which health insurance costs are going to rise over the next 20 years is impossible.

I can however tell you that naive extrapolation is definitely the wrong way to do it.

Look at the 2nd derivative it's all over the place, so assuming that it will magically stay constant is wrong. The 2nd derivative of healthcare as a percentage of GDP is actually negative over the last few years.

[xkde]

Not arguing about the US being about to learn this the hard way. But when we get to that point, neither a pension nor a 401k will be able to save anyone.