[whodidntante]

The first few areas are easy,since budgets are known and there are actual comparative measurements that have been done.

Health. We spend $5T a year on our "health", which is 2X the per capita amounts spent by western European countries, yet we have poorer outcomes. We have poorer outcomes not just among lower income classes, but also poorer outcomes when comparing upper class incomes between the US/Europe

Education. We spend 1.5X per capita compared to western European nations, and we have poorer outcomes

If we would simply match the budgets for these two areas with European budgets, and even accept the fact that they would have better systems in place, we would save $3T a year. This is a fairly direct measure of how much more efficient Europe is with their resources. They are either that much better/smarter than we are, or we have a corrupt system, or a combination of the two.

Public construction costs. It costs 50% to 200% or even more to build public projects in the US than in Europe. That is, if we can even complete our projects. One of many reports and analysis: https://www.constructiondive.com/news/us-rail-projects-take-...

Other areas are difficult to have direct comparisons, and it is difficult to compare results. The US solution to everything is to pour money into it. And it seems that any cut, any type of cut at all, portends doom.

Military. We spend $1T a year. We have something like 1200 military bases, over half are international. We have massive cost and time overruns all the time. Yes, we may have the best military in the world, but it certainly feels like the taxpayers are being taken advantage of. You may feel differently. I do not think we need 1200 based. I do think that the military industrial complex profits way beyond what is reasonable.

Science research. We spend about $1T in R&D, almost triple of Europe. We pay our researchers 2X-3X what researchers make in Europe. Yet it seems that any type of cut to science budgets is met with the proclamation that we will lose all of our researchers to Europe. Our major research centers need a 70% incidental budget on top of their grants otherwise they will go out of business. CEO's of major non profit medical research centers need to make millions and millions of dollars per year. There is something wrong here.

Space. We spend 2X what China spends, and 4X what Europe spends. One example is the costs of space telescopes: China spends 9 figures, Europe spends 10 figures, and we spend 11 figures. NASA's SLS rocket is a case study in how to literally brun up billions and billions of taxpayers money. We can, and need to do better.

Corruption is not always the simple graft of the CEO and board. Corruption also comes in the form of a system where too many people make too much profit to want to make the system better.

[Arainach]

Saying things are expensive is not saying they are corrupt or inefficient. What specific problems and examples of corruption do you believe should be fixed?

Similarly, overall spending patterns do not mean corruption or even excess. We get huge economic returns on science and space spending, for instance.

Look at the source you cited. Labor is expensive here and infrastructure projects often create public outrage that makes them take longer. That's a problem but it's not corruption and not something you fix by slashing spending.

[whodidntante]

I wanted to give you an example of what I see is not just corruption, but an example of how feedback loops of self interest combine to create systemic issues that threaten our entire society.

It is "known" in the research industry that getting government grants, especially NIH grants, is "gold" in that they provide large sums of money, and, importantly, that a large part of these grants have little accountability and are not used directly for the research. Peoples careers are rewarded for successful at getting these grants, and there are societal mechanisms in place to insure these grants continue to flow. A lot of organizations are so dependent on these type of grants that when an attempt was made to reduce the unaccountable and "incidental" nature part of those grants to what is standard in non-governmental charities, there was fear that entire important research organizations would be brought down.

This is an example:

- My congressman has a public campaign to support the political and legal fight to preserve the ability of research organizations to carve out nearly half, or 42% of government research grants so that they can be used for general organizational needs, and not directly for the research projects they are awarded to. Part of this political and legal fight is about making these carve outs more accountable, as they currently are not. For comparison, non profit grants from non federal sources provide for 0% to 13% carve outs. The new proposal is to reduce the carve outs to 13%, in line with these other organizations, and to have stricter accounting rules. The more common name for this is the 69% indirect costs added to federal grants, as compared to the standard 0% to 15% added by non governmental grants.

- The former CEO of one of these nonprofit research institutes (Dana Farber) was making $3M to $4M per year. This is not unusual for the CEO's of many of these larger non profits.

- This CEO is the mother of this particular congressman.

- This former CEO had 50+ of her research papers called into question due to claims of fraud. These papers were called into question by an outside researcher.

- Six of these papers were retracted due to fraud, several dozen others were "updated". These papers are used directly or indirectly to acquire government grants, and are also used to justify making this person CEO.

- One of this former CEO's co-authors on some of these papers was also the Director of Research Integrity for the institution, who also investigated the allegations (though not the ones he was a co author on).

https://www.thecrimson.com/article/2024/4/21/dana-farber-pap... https://arstechnica.com/science/2024/01/top-harvard-cancer-r...

[andrekandre]

  > Corruption is not always the simple graft of the CEO and board. Corruption also comes in the form of a system where too many people make too much profit to want to make the system better.

maybe i misinterpret, but are you saying but it seems your saying some profit from govt spending is ok, but too much crosses a threshold to corruption?

if thats the case, how do we set that threshold? whats the criteria?

(i don't disagree per se, just curious on the thinking around this)

[whodidntante]

What I should have said is that the system is corrupt, not that there is corruption in the system. There will always be profit to made in the system (there has to be for it to work), and there will always be corruption to some degree in the system, but having a system that is corrupt is a different type of thing.

I believe our health system itself is corrupt. There is no one person or group of people that are causing the problem, it is the way the entire system works that is the problem.

Looking at the amount of health spend as a percent of GDP, it has gone from 5% 60 years ago, to 12% 30 years ago, to 18% today. This is clearly a trend that is unsustainable. Compare this to the EU which is more like 10%-12% of GDP (not that they do not have problems)

This increase is bad enough, but we also have a system that is worse in all the ways that count - percent of population that is covered, outcomes at every class level, and the complexity of the system.

From a societal perspective, the health system is simply out of control - it continues to grow and profit in excess of what the economy can support while at the same time provides less and less value than what is clearly possible by looking at other countries.

The answer is not to simply cut spending and fire people in a random manner

The answer is also not to simply tax and spend more.

And, no, I do not know how to fix this.

[andrekandre]

  > I believe our health system itself is corrupt. There is no one person or group of people that are causing the problem, it is the way the entire system works that is the problem.

thanks for the clarification!

  > The answer is not to simply cut spending and fire people in a random manner
  > The answer is also not to simply tax and spend more.

yea, its a difficult problem, i'm guessing one issue is the cost of medicine and also insurance?

probably with such a system that is so messed up, it will take a multi-pronged approach (and a party to campaign on it) i'd guess...

[wpm]

It's funny, I'm told my whole adult life "We can't be like Europe! We're too different! We're too heterogenous/big/special/insert_excuse_here!"

And yet, we can point to a number on their balance sheet and say full stop "This is what we shall spend and nothing more, if it still sucks, skill issue."

WHY does America spend trillions more on healthcare than our peers? Is it because of welfare queens on Medicaid? Or is it the scumsuckers in the private health insurance industry, in a system that keeps most people in all but indentured servitude to their employer to even be able to afford the privilege of getting dropped by the insurance companies the second you get sick?

Is there waste? Sure.

Tell me how just going in like Ron Swanson and slashing the shit out of every budget while simultaneously blowing up the debt with tax cuts fixes any of that.

[whodidntante]

Slashing will not fix the problem. Nor will more taxing and spending fix it.

The problem is systemic. We have an out of control health system that is steadily growing as a percent of GDP while providing less and less value to less and less people.