[greenhexagon]

Norway is projected to produce $122,421,000,000 worth of oil next year, against a population of only 5 million people.

That's about $24,400 in annual oil revenue per citizen. Their sovereign wealth fund (profits from oil re-invested into the global stock market and real estate) is about $270,000 per citizen. Take the risk-free rate of putting that in US Treasuries and it's an additional $13,500 per citizen per year.

Judged in the context of Petro-states with tiny populations there is still a lot to like about Norway. But it's important to realize that UAE, Qatar and Saudi Arabia are realistically their peers, not countries like the US.

Norway was a lower income country until they discovered an infinite money glitch in the North Sea. When looking at the country, it's critical to realize their oil wealth enables them to have the government programs and society they currently enjoy, rather than mistakenly thinking those programs are the source of their wealth.

[hilux]

And have UAE, Qatar, and Saudi Arabia achieved what Norway has? (Where did anyone say that social programs are the source of Norway's wealth?!)

No one is acknowledging the US data I posted. Even if the US is not as rich per capita as Norway is, can we learn something from Norway (about investment in education and healthcare) with the resources we do have?

BTW, US per-capita healthcare cost is much, much higher than Norway's, and US life expectancy is much lower.

[AnthonyMouse]

> BTW, US per-capita healthcare cost is much, much higher than Norway's, and US life expectancy is much lower.

But that's the issue -- it's not a matter of allocating the money. The US is already spending it.

The question is, how do you make it more cost efficient? "Just do what Norway does" doesn't solve anything for two reasons.

The first is that it doesn't tell you if that's the right answer, only that what Norway is doing is better than the status quo in the US. But the status quo in the US is uniquely dysfunctional, so that's not a high bar. You still don't know if it's better to do what Norway does or what Singapore does (same life expectancy as Norway, much different system) or some third thing which could hypothetically be better than either of them.

The second is that it doesn't solve the political issue in the US, which is that all of the people making money from the status quo don't want it to change. It doesn't matter if the proposal is a public healthcare system or a market system with actual price transparency or something else entirely, until you can overcome the political inertia of the incumbent system.

And these feed into each other. Because it's obvious that the existing US system is inefficient, but it's not obvious which of the potentially more efficient systems to replace it with, so the people with different ideas fight against each other instead of fighting with each other against the status quo.

[vidarh]

I think the rest of the developed world would cheer on if the US just copied any of the dozens of other models for universal healthcare that produce better outcomes cheaper than the current US system.

What we find shocking is that the US appears uniquely unable to fix these things among developed countries despite the vast wealth and resources. There's a level of political dysfunction that is really hard to watch, but also incredibly hard to ignore.

EDIT: To give one example that I personally find shocking: That Medicare has restrictions on the extent of its ability to negotiate drug prices. I get your point that this is in part due to entrenched interests as seen with the attacks on the recent attempt to fix this issue by using powers under the Inflation Reduction Act, but that even chipping away on things like that is proving as hard as it is, is bizarre seen from the outside and the new ability to negotiate prices is still ridiculously limited.

[hilux]

Check out the tsunami of white American kids refusing to get even the most basic vaccines (because Jesus) ... polio and other long-forgotten diseases are about to make a big comeback.

NY Times had a big story about this.

"Insane" doesn't do it justice. We need new words.

[vidarh]

> "Insane" doesn't do it justice. We need new words.

Norwegian has another US-inspired term for crazy: "Helt Texas" ("completely Texas") [1]

(Though to be fair, that is mostly used for a hyperbolic allusion to the Hollywood version of the wild west, and translating it as something being "wild west" would perhaps better carry the meaning, but I still find it funny)

[1] https://www.washingtonpost.com/news/morning-mix/wp/2015/10/2...

[DeathArrow]

>Check out the tsunami of white American kids refusing to get even the most basic vaccines (because Jesus)

There's no need to be racist.

[hilux]

MENTIONING race is not racist.

Being white, voting for Trump, and claiming a Christian-evangelical religious exemption is core to these vaccine objectors' identity.

If you're American and you don't know this, you should definitely read one of many article about this trend. Because it is about to kill many people.

[AnthonyMouse]

> I think the rest of the developed world would cheer on if the US just copied any of the dozens of other models for universal healthcare that produce better outcomes cheaper than the current US system.

"Just pick one" isn't actually a method of choosing when different people disagree on what should be done. People don't even agree that "universal healthcare" is the right target, rather than e.g. a market-based system with actual price transparency that would introduce competition for non-emergency care.

This is also ignoring many of the factors that make the US system so expensive. For example, the AMA has lobbied for regulations that require doctors to do a lot of things that could reasonably be done by nurses. This has been exacerbating an existing doctor shortage, so then doctors get paid more (raising healthcare costs) while impairing outcomes (there aren't enough doctors to provide a high standard of care). This is a regulatory problem created by a powerful lobby.

It's things like that which in the aggregate cause the US system to be what it is, but you can't fix them by copying some different part of the system from another country. You have to fix that problem in particular regardless of what else you do, but fixing it is the thing strongly opposed by the lobbyists.

> To give one example that I personally find shocking: That Medicare has restrictions on the extent of its ability to negotiate drug prices. I get your point that this is in part due to entrenched interests as seen with the attacks on the recent attempt to fix this issue by using powers under the Inflation Reduction Act, but that even chipping away on things like that is proving as hard as it is, is bizarre seen from the outside and the new ability to negotiate prices is still ridiculously limited.

You have to understand the context for things like this. Nobody is talking about negotiating the price of aspirin, which is a cheap commodity regardless of who you get it from.

The issue is drugs under patent.

The way the patent system is supposed to work is that if you invent something you can patent it and then charge the monopoly price for a limited time in order to recover your R&D. The monopoly price is based on the value of the invention. You can patent some dreck and try to charge a million dollars for it and nobody will buy it from you. But if you cure some fatal disease, the value of the cure is very high, which allows you to recover the cost of developing the cure, which could also be very high.

This is obviously not going to be efficient when the drug is being paid for by insurance or Medicare. If the drug company patents something which is only marginally better than the generic, anyone paying out of pocket would just choose the generic and save a lot of money. But if the doctor prescribes the patented one, the insurance is now expected to cover it and by law only the patent holder can make it, so they can charge high prices even though the person choosing which drug to take isn't the person paying the bill anymore.

This is dumb but it's not completely crazy. Sometimes drug companies get away with charging a lot because they patented "existing drug, but with Tylenol" and then convinced doctors to prescribe it. But it also means they can recover their costs for actual life-saving drug research. It's not serving its purpose efficiently but it's still doing something of importance.

So now you want Medicare to "negotiate" these prices. Basically what you're saying is that you want to reduce the intentionally-created subsidy for drug research, or shift more of its cost from Medicare to private insurance and the uninsured. Which is bad policy, but is favored by people who want Medicare's numbers to look better.

What you really want to do here is one of two things. Option one, give up on the model of patenting drugs and then having insurance cover the cost and instead just publicly subsidize drug research and immediately put the drugs into the public domain. Option two, make the patent system work as intended by exposing some of the cost to the patient, e.g. by having a 10% copay for prescription drugs. Patients would then avoid drugs which are extremely overpriced relative to their benefit and you wouldn't have Medicare paying high prices for "existing drug, but with Tylenol" anymore.

[vidarh]

> "Just pick one" isn't actually a method of choosing when different people disagree on what should be done. People don't even agree that "universal healthcare" is the right target, rather than e.g. a market-based system with actual price transparency that would introduce competition for non-emergency care. > > This is also ignoring many of the factors that make the US system so expensive. For example, the AMA has lobbied for regulations that require doctors to do a lot of things that could reasonably be done by nurses. This has been exacerbating an existing doctor shortage, so then doctors get paid more (raising healthcare costs) while impairing outcomes (there aren't enough doctors to provide a high standard of care). This is a regulatory problem created by a powerful lobby. > > It's things like that which in the aggregate cause the US system to be what it is, but you can't fix them by copying some different part of the system from another country. You have to fix that problem in particular regardless of what else you do, but fixing it is the thing strongly opposed by the lobbyists.

The point is that pretty much every other developed country and a lot of developing countries have managed to figure this out, the first over 130 years ago, and they've all had to figure out how to get agreement, overcome the objections to having it at all, overcome lobbyists, overcome medical associations wanting to keep tight control, and so on. Not one thing of this is new.

This US exceptionalism is a bigger part of the problem than each and every one of these objections. You're just not that special other than in believing you're that special and stubbornly refusing to learn from what has worked.

> You have to understand the context for things like this. Nobody is talking about negotiating the price of aspirin, which is a cheap commodity regardless of who you get it from. > > The issue is drugs under patent.

This is not news. Every other country also has to deal with it. However, unlike the US, they have chosen to deal with it by negotiating best possible prices, usually by putting together portfolios of different drugs to negotiate over, and then deal with any perceived need to subsidise R&D into drugs that pharma companies aren't doing enough to address. The US is near unique in effectively letting pharma companies write public healthcare policy by making it a game of how to extract the most money from taxpayers.

It is, however, amazing how quickly the American belief in the free market collapses when someone suggests that Medicare should just act as one more actor in a market where the are already hundreds of other buyers negotiating the best possible prices.

> So now you want Medicare to "negotiate" these prices. Basically what you're saying is that you want to reduce the intentionally-created subsidy for drug research, or shift more of its cost from Medicare to private insurance and the uninsured. Which is bad policy, but is favored by people who want Medicare's numbers to look better.

The outcome is that you're misrepresenting the cost of providing care per patient by making the per-patient cost appear ridiculous when a huge bulk of it is an R&D subsidy that the entire world benefits from, that you're choosing to carry even for the half of the top 10 pharma companies that aren't even American, and that does not need to increase if the number of patients increase. If you want to pay that subsidy that's awesome, but when you're lumping it into Medicare it becomes an argument for not extending cover to more people because it artificially inflates the per-patient marginal cost of providing care.

> What you really want to do here is one of two things. Option one, give up on the model of patenting drugs and then having insurance cover the cost and instead just publicly subsidize drug research and immediately put the drugs into the public domain. Option two, make the patent system work as intended by exposing some of the cost to the patient, e.g. by having a 10% copay for prescription drugs. Patients would then avoid drugs which are extremely overpriced relative to their benefit and you wouldn't have Medicare paying high prices for "existing drug, but with Tylenol" anymore.

Or you can do what pretty much the rest of the developed world does: Publicly subsidise R&D (which the US also does - NIH grants for FY2023 are around $50bn) and negotiate best possible prices, so that you avoid creating perverse incentives to chase drugs to optimise the expected ratio of R&D expenses relative to ability to maximise costs to patients.

This willingness to actively defend a system that demonstrably is providing you substandard outcomes at the highest cost in the world is also fairly unique to American conditions.

[AnthonyMouse]

> The point is that pretty much every other developed country and a lot of developing countries have managed to figure this out, the first over 130 years ago, and they've all had to figure out how to get agreement, overcome the objections to having it at all, overcome lobbyists, overcome medical associations wanting to keep tight control, and so on. Not one thing of this is new.

The difference is the structure of the US government. The original constitutional framework envisioned a weak federal government with limited powers, with this sort of thing instead being handled by the states.

The populist movement in the 20th century didn't like this, so they removed some of the most important safeguards ensuring that that remained the case -- but those safeguards were the only thing preventing the federal government from being captured by industry.

So now that's what's happened. It's a structural problem because we broke the constitutional safeguards originally present to prevent it. The problem is the change is sticky because to undo it you need the votes of the people whose undeserved power you're trying to take away. This has been a problem for much more than just healthcare, but nobody has managed to solve it yet.

> However, unlike the US, they have chosen to deal with it by negotiating best possible prices, usually by putting together portfolios of different drugs to negotiate over, and then deal with any perceived need to subsidise R&D into drugs that pharma companies aren't doing enough to address.

You have a patent monopolist selling to a bureaucracy which is the sole provider of coverage for a large number of patients. That isn't a negotiation. If the buyer isn't allowed to refuse to buy the drug then they have no leverage. If they are then the government is just setting the price and saying take it or leave it.

> It is, however, amazing how quickly the American belief in the free market collapses when someone suggests that Medicare should just act as one more actor in a market where the are already hundreds of other buyers negotiating the best possible prices.

A patented product isn't a free market, it's a government-granted monopoly. The entire point of the patent is to allow the seller to charge a monopoly rent for the duration of the patent term.

If you don't want to pay the monopoly rent then there shouldn't be drug patents to begin with -- but that doesn't get you out of funding the R&D in some other way instead. TANSTAAFL.

> The outcome is that you're misrepresenting the cost of providing care per patient by making the per-patient cost appear ridiculous when a huge bulk of it is an R&D subsidy that the entire world benefits from, that you're choosing to carry even for the half of the top 10 pharma companies that aren't even American

Yes, this is exactly the problem -- other countries "negotiate" (i.e. the government dictates prices) and thereby pay less than their share of the drug development costs. The US could do the same thing but then nobody would be paying for it and the world would have less drug R&D.

It doesn't matter where the drug companies are headquartered. They all use the money to develop drugs that patients everywhere then benefit from.

The ideal solution would be for other countries to pay their fair share of the R&D instead of the US having to pay disproportionately, but in the absence of any way to force them to do that, what should we do? The thing that causes more people to die because there is less funding for drug development?

> and that does not need to increase if the number of patients increase.

The more patients receive the drug the more valuable its development is and the more incentive you want to provide for that.

> If you want to pay that subsidy that's awesome, but when you're lumping it into Medicare it becomes an argument for not extending cover to more people because it artificially inflates the per-patient marginal cost of providing care.

The cost isn't artificial, it's amortizing the cost of the system being used to fund drug development over the patients who use those drugs.

Maybe that system could be more efficient, but just reducing its funding without changing its overall efficiency is only going to result in less drug development.

> Or you can do what pretty much the rest of the developed world does: Publicly subsidise R&D

That would be the first option that I listed?

But there are disadvantages to that. The patent system is imperfect but it has a different set of incentives than a grant system and consequently results in different kinds of research. It's plausible that we're better off with both than one to the exclusion of the other. In which case we shouldn't be so offended at not slashing the funding source for the one of them.

> This willingness to actively defend a system that demonstrably is providing you substandard outcomes at the highest cost in the world is also fairly unique to American conditions.

America subsidizes the rest of the world and then the rest of the world criticizes us for it. Are we really being lectured for not being selfish enough?

[DeathArrow]

>And have UAE, Qatar, and Saudi Arabia achieved what Norway has?

What does Norway have that UAE should desire?

[vages]

The most interesting thing is that Norway does not tax oil profits – it taxes the oils “inherent value”, giving the oil company the profits.

Norway has implemented land value taxation for using natural resources. It’s been that way since hydropower was established more than 100 years ago.

https://slimemoldtimemold.com/2022/05/17/norway-the-once-and...

[vidarh]

> enables them to have the government programs and society they currently enjoy, rather than mistakenly thinking those programs are the source of their wealth.

The person you replied to didn't seem to imply they were, but conversely asked why the US is performing as it is given its wealth compared to Norway.

Average salaries in the US are far higher than in Norway, and GDP per capita, so you would think the US could afford to do better on more metrics

I'll also note that many of the largest welfare reforms in Norway predate the oil wealth, with the largest chunk of the reforms towards the current welfare model being passed in 1966, a year before the first successful oil well in Norwegian sector.

Yet while some things are probably better in the US (average house sizes are larger, I think), as someone who grew up in Norway and has visited the US many times and enjoys being in the US as a visitor, and currently lives in the UK, the UK is as far towards "American conditions" I can stomach. Dysfunctional but at least still has somewhat functioning public services. Why can't the US even match UK public services? The US is certainly significantly richer than the UK.

"Amerikanske tilstander" - "American conditions" - is a term with decades of use in Norwegian politics to scare voters.

Even a lot of conservative voters have historically been worried about "American conditions" because it has a history of being seen as lacking - ironically given far higher levels of faith in the US - in Christian compassion, which has made it unpopular even far into the Norwegian right-wing (e.g. quite a few Norwegian welfare reforms were passed in the 1960s under a center-right government that included the four center-right and right-wing parties of the time)

[greenhexagon]

> "American conditions" - is a term with decades of use in Norwegian politics to scare voters.

Neat, I always enjoy learning about the various bits of propaganda and stereotypes that exist in different cultures and this was a new term for me.

I've many times had fairly entertaining conversations with Scandinavians about what life in the US is actually like compared to their expectations. They always seem a bit in disbelief at how safe, comfortable, easy and secure life is in reality. I've learned to reassure them that things would be different if I were an entry level worker at Walmart or McDonald's, and that that life might look more similar to their expectations.

[vidarh]

Having spent enough time in the US that the immigration officials used to flick through my passport in disbelief at the number of US stamps I had in there, I think the disbelief is entirely justified because our concern is not what life is like as someone in a good job, but what society is like somewhere with the huge disparities and huge gaps in social safety nets that are there in the US, and I've seen enough of the outcome of that first hand to know I have no desire to live in American conditions even if my job experience means I'd personally have a safe, comfortable, easy and secure life.

[DeathArrow]

>what society is like somewhere with the huge disparities and huge gaps in social safety nets that are there in the US

True, in US you have to work to earn a living.

[throwaway_1987]

Work does not guarantee a decent living. There are many who work full-time low paying jobs. Many even need a second job to just to "earn a living"

As a European, it is really strange to see this attitude of "survival of the fittest" here on HN

The average HN reader probably works in an office with a decent salary. Why should we deserve better health care than people doing hard physical labor and have to retire early because their bodies are broken. The society is depending on them to function, so we could at least offer them adequate health care. Someone working in a factory or delivering your Amazon packages also work hard. Much harder than what I do.

The lack of humanity in one of the most religious countries in the western world surprises me.

The same can be said about humane treatment of prisoners. Abuse and rape in prisons have become standard jokes in American comedy. I guess they deserve it when they dare to steal your car...

[DeathArrow]

You don't deserve goods or services. You pay for them, or others pay for them if you live in a welfare state and you don't work. Either way, the doctor needs the money to buy food.

[vidarh]

And this is why we don't want American conditions.

[doktrin]

> They always seem a bit in disbelief at how safe, comfortable, easy and secure life is in reality

The US is by no means unique in this regard. Outside of active conflict zones and failed/failing states, most countries in the world can provide comfort and at least the illusion of safety to those with resources and means.

[defrost]

It's certainly remarkable that countries exist with cheap affordable health care for all, unemployment safety nets, disability support, and no fear of school shootings at all.

[vidarh]

To late to edit, so let me add to this here: Out of curiosity, I decided to do a search in the Norwegian National Library (nb.no, a lot of material requires VPN if you're from a non-Norwegian IP, and of course most material is in Norwegian) for "Amerikanske tilstander" to see if I remember it correctly and if I could find where it started, and of 8640 hits in Norwegian newspapers, some observations and examples:

* The very first one coming up in a simple search was a letter in Dagbladet, then as now a major daily newspaper, August 27 1927, and funnily enough given the subject of this article, the first use of "amerikanske tilstander" there was in a letter to the editor where a Norwegian author warned that as "the power of capital was evolving" we were on our way to get American conditions. He goes on to complain about the spread of "inferior" lowbrow magazines and rant about popular literature.

* In the 1930's there were just a few dozen uses of the term - one paper has the headline "One Murder Per Day" with the subtitle "American conditions in Finland", in 1932 another writes about American conditions in Paris where apparently masked bandits were roaming the streets.

* An interesting one given the US mythology around Ford's impact on the 8 hour working day is an article in "Smaalenens Social Democrat", a left-leaning paper with "American Conditions." in big letters with the subtitle "The 'Fordian system' is hell for the workers" that goes on to describe conditions in Ford factories in excruciating detail, and what was "hell" to a left-leaning 1930's Nordic paper would not seem that out of place if you claimed it was Amazon or Tesla today... Workers rights and welfare became an increasing reason for invoking American conditions in later decades.

* Only one 1930's mention that I could find described an American condition that would be seen positively by many today (thought the writer meant it negatively): Better economic outcomes for women in divorce cases.

The big increase came in subsequent decades:

From 8 in the 1940s, to 60 in the '50s, 378 in the '60s, 766 in the 70's, 1722 in the '80s, 1923 in the '90s, 2038 in the '00s, before a drop to 1230 in the 10's.

[hilux]

That is incredibly interesting - thanks for the research!

The cultural differences have persisted for a long time. But over time, they are progressing to their more extreme conclusions (in the US).

[ffgjgf1]

> Norway was a lower income country

Lower than now? Sure. However it still was one of the richest countries in Europe going back at least to ~1900 (just the gap wasn’t that big as now)

[creer]

> not countries like the US

It can't seriously be argued that the US are not a rich country? In GDP, the US are in fact in the same class as Norway. And for Norway part of that goes to the fund, while the US government runs a deficit.

As for Norway specifically, their sovereign wealth fund is there specifically so that the country does NOT use this wealth quickly (or much at all for now).

At any rate, no, the US could absolutely do much better.

[doktrin]

> Norway was a lower income country until they discovered an infinite money glitch

What metric are you using to arrive at this conclusion? Norway had roughly the same PPP GDP per capita as its neighbors (Sweden, Denmark) for 150 years prior to the discovery of oil.