It’s more the divorce between the receiver, the seller and the buyer. Sellers are not selling to the people using the wheelchairs, they’re selling to insurance companies and the government. Both types of entities have a proclivity for overpaying.
This is also true for most drugs. If we removed private insurance companies, Medicare and Medicaid in their totality from the equation, the market rate for drugs and medical equipment would drop into the abyss compared to where they’re at now.
You also need the unreasonable barriers to entry for the scam to work. Otherwise new entrants would still drive down the price. So the FDA is doing its part to keep prices high.
Consider the public schools. You have the customer (the students), the buyers (the taxpayers) and the service provider (the teachers), which are accountable to neither.
Define "accountable"? If a teacher does something awful to a student (e.g. sexually harass them), a taxpayer-funded entity (the school board, the police, or the courts depending on the severity and what happend) will reprimand the teacher.
With something less egregious like "giving a the students a bad education", we still have some level of accountability based on standardized testing and school funding. Standardized testing is far from perfect, and it can be an example of Goodhart's Law, but it's still accountability.
The schools' poor performance relative to private schools is a strong signal of lack of accountability.
Another signal is the firing of teachers for incompetence is practically non-existent.
A third signal is anytime someone from the school talks about solving issues, they always always always put it down to lack of funding, and the credulous journalists repeat that unquestioningly and the schools get their tax increase.
A fourth signal is repeatedly lowering the requirements for a diploma.
A fifth signal is getting rid of "high stakes testing".
> The schools' poor performance relative to private schools is a strong signal of lack of accountability.
How much of that can be attributed to selection bias though? Private schools are pretty pricey, meaning you generally have to come from a fairly rich family to go to one. Rich families can afford extra tutoring that a poor family might not be able to.
A better statistic might be to compare public schools to charter schools, and that's a much less clear cut distinction. I can point you to dozens of cases where charter schools are a joke, and a bunch of cases where they're great, it's not a clearly defined "better" just because there's a profit incentive.
> A third signal is anytime someone from the school talks about solving issues, they always always always put it down to lack of funding, and the credulous journalists repeat that unquestioningly and the schools get their tax increase.
Yeah, so that's just not true. If you go to a poorly funded public school, the calls for funding are immediately obvious. There are holes in the ceiling, often there's no chalk/markers to write on the board, the computers will be from the late 90's and half of them just don't boot up.
You could argue that this is due to simply poor allocation, and there's probably some truth to that, but implying that they're not poorly funded is flatly wrong. Have you even seen a high school in a poor neighborhood in the last forty years?
> Another signal is the firing of teachers for incompetence is practically non-existent.
Fair, but you've worked for private corporations haven't you? Surely you've seen employees that do literally nothing manage to hang around the company for years. I had a friend that jokingly told me when he retires he's going to get a job at Bank of America because he can just show up and do nothing at his desk while still taking home a paycheck. I don't know that that's an issue with "accountability" so much as it's an issue with "large organizations are bad at finding outliers".
> A fourth signal is repeatedly lowering the requirements for a diploma.
The GED has been around for since the 40's. I've never taken it since I did high school the normal way, but I know several people of different age demographics that claimed it's much easier than normal high school, so I don't think this is new.
> A fifth signal is getting rid of "high stakes testing".
I guess I just fundamentally disagree with this being a bad thing. Understanding a subject isn't a binary yes/no like a test implies. Testing can be a good way to gauge the level of understanding a student has on a subject, but "high stakes" implies that the student will be punished in some way unless they pass, and I guess I disagree with the utility of that. Again, it becomes a Goodhart's Law situation.
> A sixth is getting rid of the gifted tracks.
Has this actually happend? My younger sister graduated from high school four years ago, she had exclusively AP classes. I'm a good chunk older than her and graduated high school in 2009, but I skipped two grades in math. Where has this happened? A quick search had a few articles calling for the removal of gifted tracks but I didn't see any indication that it actually happened.
> How much of that can be attributed to selection bias though?
The Seattle Public Schools have recently seen a large outflow of parents because of their wretched performance. The performance difference has to be pretty bad for parents to be willing to pony up $20,000 for private tuition.
> so that's just not true
I read the paper. Every single article about the schools has the schools saying they need more revenue, for my entire life. The Seattle Public Schools get $24,000 per student, and they're claiming they need more revenue.
> private corporations
Sure, I have. They all regularly laid off the non-performers, except for the union members.
> GED
I wasn't talking about the GED. I'm talking about the public schools.
> high stakes testing
No, there is no punishment for failing the tests. But the public schools decry those tests because it shows what a bad job the schools do. They also claim that students can master a subject while being unable to answer questions about it. I'm not buying it. Would you get on an airplane with a pilot who flunked his certification tests? Would you take his word that he really was a good pilot? Washington State just lowered the requirements for becoming a lawyer - passing the Bar exam is no longer a requirement. Would you hire such a lawyer? Not me. Next time I need a lawyer, I'll ask if he passed the Bar. I'd move on if he hadn't.
lol. The teachers have very little say in anything. The service provider is the school board and the administrators, the teachers are just like an instrument they operate as they see fit.
There have been a lot of acquisitions and rollups in this space. We have regulations against this, but they are not enforced, and the VCs have the money to push through this layer anyways.
It's both.
The US lacks serious competition in _most_ of it's industries right now.
Weirdly, not really in the US. The regulations are all a little pointless because it's a "self-regulated" industry. Look at the cyber truck - stuck floor pedals and trunk closer that cuts off fingers, or trivial to clone car fobs.
This is also true for most drugs. If we removed private insurance companies, Medicare and Medicaid in their totality from the equation, the market rate for drugs and medical equipment would drop into the abyss compared to where they’re at now.