[genderwhy]

This is great news. Honestly, I hope to see more nationalization of widely used services (or whatever the equivalent word for nationalization is at state or municipal levels.)

Municipal broadband, power, roads, schools, post, housing, and healthcare? It's long overdue, and with an appropriate amount of funding has been shown to be effective at controlling costs and delivering moderately good quality in most cases.

A lot of things get so warped by profit motive. And there are places I want a profit motive, but insulin (and healthcare generally) isn't one.

[AnEro]

Honestly though some industry's products/services verifiably don't improve end user/customer experiences from maximizing profits. It's hard not to see it at this point

[SuoDuanDao]

It makes sense that to improve end user experience you need competition. Works great in restaurants. Anywhere with network effects (utilities) or legal barriers to entry (healthcare) doesn't tend to compete away poor results.

[cheaprentalyeti]

You say that as if healthcare isn't extremely regulated already and as if the regulation weren't a big factor in allowing these companies to monopolize the production of insulin. (Or, my favorite example back when I needed the stuff, colchisine.)

[cuteboy19]

Nationalization is different though. It's not possible for anyone to monopolize it

[kybernetyk]

>Municipal broadband, power, roads, schools, post, housing, and healthcare? It's long overdue,

Yeah, everything was great under the state owned telco monopolies. Let's get back to that!

[subtypefiddler]

In the case of municipal broadband it mostly comes from communities that suffer form poor/no investment from the big players and is the only recourse for decent internet. It usually is faster and cheaper than existing solutions. There's clearly market failure here and players abusing their local monopolies to refrain from investing / provide decent service. The state of telco in the US is pretty shocking, even in places like NY state.

[rayiner]

> Municipal broadband, power, roads, schools, post, housing, and healthcare? It's long overdue, and with an appropriate amount of funding has been shown to be effective at controlling costs and delivering moderately good quality in most cases.

Where? The US has among the highest percentage of kids going to government owned and operated schools. We have plenty of government housing as well (projects). Nearly all of our roads and transit systems are publicly owned and operated too.

Almost uniformly, those government operated systems aren’t very good—in America. And it doesn’t have to do with “funding.” If you compare with Europe, we spend more money per student, per transit rider, and per public housing resident, etc.

[arcticbull]

Its easy to point at what doesn't work well, there's tons and tons of things that work great that nobody talks about.

Municipal broadband: the best broadband in the entire United States is provided by the municipality of Chattanooga. [1]

Post: The USPS is the most trusted brand in the United States, above FedEx and UPS. [2]

Transit: The New York City Subway is the 3rd largest metro rail system on earth after London and Guangzhou. Ok fine, it's expensive to build - but it moved 1,300,000,000 people in 2021.

That's just three random ones.

[1] https://www.ama.org/marketing-news/usps-ranked-most-trusted-...

[2] https://qz.com/1996234/the-best-broadband-in-the-us-is-in-ch...

[rayiner]

> Transit: The New York City Subway is the 3rd largest metro rail system on earth after London and Guangzhou

It’s also the worst large metro system, by timeliness and reliability, in the world, despite being very well funded.

People in the rest of the country aren’t exactly unaware of New York. But its transit, housing, and public school systems are a poster child for how government-run services are terrible, even when well funded. There’s a reason why New York has suffered net domestic outmigration for many years.

Look, if Stockholm was in America the American public would have a very different idea of what government-run services could be like. But we don’t have Swedes running our government services, we have Americans. It is what it is.

[xyzzyz]

> It’s also the worst large metro system, by timeliness and reliability, in the world, despite being very well funded.

You forgot to mention cleanliness, comfort, and safety, where it also is just atrocious compared to other metro systems outside US.

Praising NYC subway for being really big sounds to me similar to Soviet Union boasting how many tons of steel it produced. It sure did, but its citizens would have preferred instead to get something other than 1000 additional tanks.

[arcticbull]

> But we don’t have Swedes running our government services, we have Americans. It is what it is.

Gotta love the fatalism that ensures it stays that way. This is really how America lost it's way - acceptance.

[vluft]

> Municipal broadband: the best broadband in the entire United States is provided by the municipality of Chattanooga.

You can even get 25G from EPB now, though the 10G is good enough for me, frankly. That being said, there's several locations in the US where 10G residential fiber is broadly available; frequently either municipal or co-op (e.g. Utopia Fiber in Utah), though I believe EPB was first in 2015.

[kmeisthax]

American schooling sucks because it's beholden to political objectives contrary to the interests of educating children. Look at the manufactured controversy over "intelligent design" a few decades back, or the current controversies over transgender bathroom access, or Florida's censorship of material in school libraries[0].

Municipal broadband and the post works well because the US is good at building infrastructure. But at the same time, our government is also beholden to interests that want to kill that infrastructure so they can sell costlier and worse equivalents. States passed a bunch of laws to ban local government from running ISPs and Congress has been putting stupid funding mandates on the USPS's pension schemes that make a profitable public venture unprofitable.

Transit is a bad example because America is famously addicted to cars and allergic to any transit system that isn't a road. The NYC Subway could not be built today under the current political climate. Hell, it wasn't even built by the city or state government; it was stolen from the people who built the system through overregulation. Nationally, we have Amtrak[1], which was created by bailing out failing freight companies. With some high-speed upgrades it could be great, but the system is still beholden to those same freight companies' infrastructure[2].

The underlying problem is that America does not want to build working government programs. It is run by people who deliberately take funding in order to burn it so they can complain about how much better "privately-run" monopolized systems are.

[0] There are probably examples that right-wingers would point out as well - maybe check Reason or CATO for them, because I forgot.

[1] US citizen: Japan has high-speed bullet trains! We should build a Shinkansen!

US: We have a Shinkansen at home.

Shinkansen at home:

[2] Which, BTW, is actually supposed to give Amtrak priority over the rails. Like it says it in the actual law. Nobody cares.

[tptacek]

None of this has anything to do with why school sucks. Schooling sucks because it's erratically funded.

Wealthy families arrange to live in suburbs designed explicitly to cordon their children off from there less wealthy peers, each time setting up a vicious cycle where homes in those school districts derive much of their value from school funding, creating an incentive for an ever-increasing levy for de-facto private schools.

Meanwhile, big city school districts are relatively well funded (teachers in the largest cities have surprisingly strong compensation) but poor management. Not everything that Republicans say about teacher unions is wrong, and there is an extent to which management of city public schools is set up to allow schools with high parental engagement (= greater parent wealth) to succeed while others fail.

Simultaneously, if you look at school districts in poorer exurbs or, worst of all, downstate/upstate rural districts, teachers really are making the wages that TV shows make jokes about, supplies are scarce and enrichment classes (in some places) nonexistent.

These are structural problems, not culture-war-of-the-moment problems.

I'm not high-horsing any of this; my kids went to school in Oak Park, IL; I believe every full-time teacher at OPRF makes a six figure salary. Oak Park is essentially a pair of extremely well funded school districts (K-8 and high school) with a fire and police department tacked onto the side.

[acdha]

I agree with what you wrote and would add that a lot of times we’re only talking about schools because that’s how we fund a lot of social services in the United States.

My wife is a public school teacher here in DC. You can always find examples of the popular culture war hobby-horses, but most of the time when a student isn’t doing well it comes down to money. It hurts hearing about a kid who’s trying but falling behind since they haven’t slept more than two consecutive nights in the same place since a parent lost a job, or the top kid in the class cancels their SAT test because they need to watch a younger sibling because their mother can’t afford to miss work. When it comes to stats, that shows up for the school even if the student can’t.

[miguelazo]

There are many causes of lackluster public education, and funding is definitely one of them. Another huge one is the ability of parents who have the time and resources to divert their children (likely already at a huge advantage) to private and charter schools, thereby skewing the public school below the median in a vicious circle. I’ve seen this exact dynamic play out in many of the cities I have lived. It’s also why newer suburbs (avoiding legacy costs and filled with upwardly mobile, resourced families) have excellent public schools.

[OkayPhysicist]

It's difficult to overstate just how huge selection bias can get in the education space. I went to a high school in the Bay Area, one of a handful in my city. (1) Houses in our attendance area were ~$500,000+x more expensive than ones right across the street in another attendance area, because our school was "better". Why was it better? Because the parents paying an extra half million dollars to get their kid into a better school were going to make sure their kid did better, come hell or high water. So there were lots and lots and lots of after-school tutoring centers, where students would get taught the highschool material in advance, so that they would already know it forward and back when they were tested on it. Which makes the school test well, and thus look better than the other schools in the area, raising housing prices. x += $100,000; GOTO (1).

The actual quality of the education was substandard, but there is something to be said for being embedded in an environment where academic failure was simply not considered an option.

[rayiner]

> There are many causes of lackluster public education, and funding is definitely one of them

Explain why some of the worst school systems are some of the best funded. https://foxbaltimore.com/news/project-baltimore/more-than-75...

https://foxbaltimore.com/news/project-baltimore/baltimore-ci...

[miguelazo]

The increase mentioned in your article was in the last 4 years? Seems a bit late for the testing outcomes in your original link. Pretty terrible example. Also, that area is a perfect example of where parents with the means move their kids (and their attention) to charter/private operations, exacerbating the problem.

[anonuser123456]

If you study the insulin pricing issue carefully, you will find that largely the problem is government, not the market.

The profit motive coupled with competition works very well to keep prices low.

You need only realize the following; European firms stand at the ready to supply insulin at well below US prices today, but are prevented from doing so by the FDA. And they can do so and still turn a profit.

[swayvil]

Can I, in the usa, order my insulin to be delivered from Europe? If not then it's a fabulous opportunity for an enterprising smuggler.

[anonuser123456]

Insulin has a cold chain requirement, so smuggling is not recommended.

[WalterBright]

> has been shown to be effective at controlling costs

That has never happened. What does happen is the cost is borne by the taxpayer rather than the user of the service.

The "warping" of the profit motive in the insulin case is entirely caused by government interference and regulation (by making it nearly impossible for competitors to spin up and make insulin).

[Spooky23]

Not really. The internet is an example of what happens when you suck margin out of high margin businesses like content creators. India is an example for pharmaceuticals.

If the state takes a commodity and sells it on a cost plus or cost basis, it’s going to kill investment in the spaces and collapse the margin.

At this point, we’re killing people and bankrupting states and employees with out of control costs. Making an example out of insulin would fix that and constrain some of the players in the market.

[WalterBright]

> Making an example out of insulin would fix that

No it won't. It will just shift the cost to the taxpayers.

[Spooky23]

Who do you think is paying now? States are spending billions on it through Medicaid cost share.

A state like California with a contract manufacturer would probably break even on the insulin and save billions for reduced complications. Poor people with diabetes are frequent fliers for ER admissions. The cost of one ER visit is probably close to annual insulin cost.

[WalterBright]

> Who do you think is paying now?

It'll cost even more when the government takes it over. There's a reason why central economic planning results in poverty.

Instead, reduce the regulation and laws and interference by the government so that competitors can sprout.

[komali2]

Why make the jump directly to central economic planning? I mean what it sounds like you're saying is communism is when the government buys things? So not a big fan of like, roads?

Are you arguing in favor for no government regulations whatsoever? Are you arguing for cartel state?

[giraffe_lady]

> the cost is borne by the taxpayer rather than the user of the service

If the service is "not dying preventably" that's fine.

[WalterBright]

There are far better ways of doing that. For example, government agriculture, because feeding people prevents them from dying, is still a bad idea, because every time the government took over agriculture, people died of starvation. Free markets produce a food surplus.

[komali2]

Where is there a free market for agriculture? The usa subsidizes farmers to control volume and prevent surplus overrun. Prices of food are thus artificially high.

[fallingfrog]

In this case the regulation is certainly being pushed by the pharma companies themselves as they wish to use regulation as a means of eliminating their competition so they can charge monopoly prices. So less regulation is not going to help, rather, the political influence of the corporations is the problem. Doing an end run around the whole mess by simply producing your own insulin will rapidly cause collapse in prices as those companies will suddenly have competition, even if from a state run agency. It's happened many times before.

[WalterBright]

> So less regulation is not going to help

Yes it will. The government is far, far more powerful than the corporations.

[WalterBright]

Remember this - the California insulin manufacturing program is going to turn out to be very expensive.

[cuteboy19]

There are many cases where the government can produce things at cost and bankrupt for profit companies. It's not always effective but the situation is quite dire at this point

[WalterBright]

> There are many cases where the government can produce things at cost

Yes, and the costs are always higher than that of a for profit company.

> the situation is quite dire at this point

Right. The solution is to remove the regulatory and legal barriers that add $190 in cost to a dose.