[curt]

The United States is the most charitable country in the world. On top of that I never said to deny coverage to those that can't afford it. There are other ways. How about the giving them an annual voucher for $X, whatever they don't spend gets rolled over into the next year. Just like a HSA.

[jmathai]

Not sure what charity really has to do with it. Americans aren't going to willingly give money to "help the poor" to the extent that medicare does.

I would imagine that the US is also among the greediest countries in the world.

Odd how it can work out that way with percentages.

[edit: grammar]

[caseysoftware]

Why would you assume or imagine when you have the single biggest source of information in the world at your fingertips?

From http://www.charitynavigator.org/index.cfm?bay=content.view&#... we learn that:

- Total giving to charitable organizations was $298.42 billion in 2011 (about 2% of GDP). This is an increase of 4% from 2010.

- Giving by individuals (which includes bequests and family foundations) is critically important as it represents nearly 9 out of every 10 dollars donated.

- 32% of all donations, or $95.88 billion, went to religious organizations (down 1.7%). Much of these contributions can be attributed to people giving to their local place of worship. The next largest sector was education with $38.87 billion (up 4%).

- Donations were up to health charities (2.7%), to public benefit charities (4%), to arts, culture, humanities charities (4.1%), to International charities (7.6%), to human services charities (2.5%), to environmental and animal charities (4.6%).

For comparisons to Europe, check out: http://www.american.com/archive/2008/march-april-magazine-co...

- Per capita, Americans give 3.5x than the French, 7x Germans, 14x Italians.

- Americans are 15% more likely to volunteer than the Dutch, 21% more than the Swiss, 32% more likely than the Germans.

The pattern holds true across many demographics (education, age, income).

[rayiner]

So if the $298.42 billion donated world wide, almost half ($135 billion) went to fairly self-serving purposes (e.g. me donating to my alma mater to improve the stature of the school).

[caseysoftware]

First, those numbers were US exclusively as that was the situation you referred to.

Second, while many of the donations were to religious organizations, many food banks, shelters, etc are run by the same institutions. Assuming those categories are mutually exclusive is risky at best.

[jmathai]

I don't think data really helps you get to an answer. I can only go by my experience living in America.

My observations are that Americans definitely look out for themselves. People tend to give (as you stated) in ways that directly or indirectly benefit themselves.

These are broad generalizations but having lived here for 30 years I'd not consider our society to be generous by any stretch of the imagination.

[Shivetya]

All I can say is, I am glad I don't live where you do or hang around the people you do. Having lived here all my life I cannot count the number of people who bend over backwards to help others. I watch people with half my income give money to church, charity, and the like.

Now, in the techy world I work in, I can find a wealth of self centered pretentious types who are more concerned about how their seen that what they see.

[caseysoftware]

I was thinking he had pretty bad selection bias. If I applied the same to my day yesterday, you'd assume every software developer was a sharp female game hacker with a little too much caffeine in her system. ;)

[saraid216]

Charity is an excuse to keep the poor around in order to look good pretending to help them. As a stopgap in the immediate future? They're good things. As a long term strategy? It's intentionally ineffectual.

No charity has, or ever will, end major problems like hunger or poverty.

[rayiner]

Also, on a dollar per dollar basis, the government is vastly more efficient than nearly any charity. The Social Security Administration's overhead was 0.8-1.4% (depending on how you count) last year. Find me a private charity that efficient.

Make a Wish Foundation crows about spending 76% of funds on programs. If the SSA were as efficient as Make a Wish Foundation, it would have an overhead of an additional $185 billion a year (i.e. approximately equal to all federal payroll expenditures).

[kareemm]

The bulk of charitable spending is on programs and fundraising, usually in that order. The SSA doesn't have to worry about fundraising, hence the disparity in admin expenses.

[nazgulnarsil]

overhead is not the best measure of charity, QALYs saved is. If one charity has 50% overhead but saves 10 times the QALYs as one with 0% overhead you want the one with the overhead.

[danielweber]

Thank you.

The government probably has a worse QALY because it runs Medicare, but that's not the government's fault -- anyone who runs the medical care program for old people is going to have horrible numbers there.

(You are more likely to die if you are on Medicare than if you are uninsured. This isn't because Medicare is killing you, it's because old people are on Medicare.)

In addition, we'd have to examine marginal-QALY versus average-QALY. Depending on the question one or the other could be more important.

Americans freak out whenever anyone tries to do QALY measurements, so we don't know just how good (or bad) our various programs are, public or private.

[refurb]

What a ridiculous statement. Most of the charities' overhead is money spent on fundraising. The SSA doesn't have to fund raise since it's illegal to not pay into it.

[mikeash]

What's ridiculous? That seems like a compelling argument to forego fundraising in favor of taxes.

[tsotha]

>Not sure what charity really has to do with it. Americans aren't going to willingly give money to "help the poor" to the extent that medicare does.

"Medicaid" is the program you're looking for, not Medicare. Anyway, Americans did willing give money to "help the poor" get medical treatment. There were various organizations that operated charity hospitals (Shriners and the Catholic Church come to mind) where you paid what you could pay, and Americans donated generously to keep those hospitals running. It was normal for doctors to put in some amount of unpaid time in charity clinics because that was considered the right thing to do.

But the government crowded all that out, and since it's been a few generations people don't remember.

>I would imagine that the US is also among the greediest countries in the world.

This isn't even close to being right.

[cma]

Most of that "charity" is for religious brainwashing. Sending kids on thousand dollar flights to work on a cinder block indoctrination center and also get a beach vacation out of it.

Don't remember where I read it, but someone had a good line about youth pastors essentially playing the role of cruise ship activities coordinators.

[sp332]

Hospitals generally won't deny life-saving treatment. But they would deny anything less. Even, paradoxically, providing cheaper preventive care to avoid expensive emergencies later.

[fnordfnordfnord]

>Hospitals generally won't deny life-saving treatment. But they would deny anything less.

That's right, they will let you get sick enough to need intervention, and if you can't pay, they'll try in the meantime to find a gov't program to foot the bill.

[_delirium]

Isn't that just rationing in a different form? If someone has $X to spend on treatment, and the best treatment costs 10*$X, then they will not be able to receive that treatment.

[anonymoushn]

Do we expect that our medical professionals and facilities have the capability of providing the best treatment to everyone all the time? If they do not, how should we decide how to allocate the medical care?

[_delirium]

I agree, that's exactly the question. Well, unless we get to a situation where literally every person can receive the best treatment for every ailment, at high-quality facilities with no waiting. If we're not in that situation, then some people can't receive the best treatment for their condition, and the question is who and when.

[danielweber]

how should we decide how to allocate the medical care?

Our current method of deciding is to stick our fingers in our ears and pretend it doesn't matter. Anything has to be better than this.

[anonymoushn]

Actually, we are using money to allocate it, which seems pretty reasonable. This will be an even better idea if we can bring costs down substantially.

[mikeash]

People with serious diseases will outspend their voucher, and then many of them will die unnecessarily.

Give me a proposal that stops poor people from dying of treatable diseases (or at least gives the appearance of legitimately attempting to, as is the current state of things) while preserving market forces, and I'll change my mind. I've yet to see one, though. Not being allowed to refuse treatment screws up too much.

[burntsushi]

> Give me a proposal that stops poor people from dying of treatable diseases (or at least gives the appearance of legitimately attempting to, as is the current state of things) while preserving market forces, and I'll change my mind.

No such proposal exists. Any proposal that does requires a third party to intervene as either an angel to donate whatever resources are needed or as an agent enforcing policy that one group of people must provide services to another group of people regardless of means.

Both of the aforementioned scenarios do not exist within the realm of market forces because market forces cannot make guarantees.

People will always die because they don't have the resources to fix what ails them. We can only hope to lower the amount of resources to get treatment, and "market forces" are absolutely a legitimate solution to that.

But if you're stuck on "stop people from dying from preventable diseases" or "appearing to do so", then you've implicitly ruled out market forces completely.

[mikeash]

"But if you're stuck on "stop people from dying from preventable diseases" or "appearing to do so", then you've implicitly ruled out market forces completely."

We are in agreement. My point is that society is stuck on this (note that I have made no value judgment in these comments myself) and until and unless that changes, market forces are implicitly ruled out.

[beagle3]

Actually, the Israeli system does sort-of stop people from dying yet still lets market forces do some magic. It is single payer (gov) through taxes, every person chooses their HMO. The HMOs get paid per member (so they compete for the members) and they are also allowed to offer extra services to their members (which they also compete on). And finally - and I think this is also crucial - the government has a special fund for expensive life saving treatments that the HMOs tap into when needed - so they do not have an incentive to avoid those treatments.

[baddox]

People with sufficiently serious diseases will die, period, even if they're the wealthiest people on Earth. I don't see how the inevitability of death caused by disease is a useful argument. If there was some disease that one person had, and that could be cured only by pooling the entire wealth of the Earth, should we forcefully take that wealth to cure that one person?

[wpietri]

That would be an interesting hypothetical if anybody sensible had ever suggested anything close to that.

[mseebach]

> Give me a proposal that stops poor people from dying of treatable diseases while preserving market forces, and I'll change my mind.

See my comment elsewhere on the swiss model.

[sp332]

Death isn't preventable, you can only delay it. Should the people pay for someone's heart surgery if their kidneys are on track to fail in a few months anyway?

[Klinky]

Life expectancy estimates are often all over the board and wrong. Imagine it's a close relative who is having the heart surgery. Would you actively try to persuade them to not do the surgery to possibly extend their life because their kidneys might fail later, so they might as well die now because they're not worth the money that would go into the surgery?

It's easy to say a Big Mac isn't worth the cost on the menu, it's harder to say that your mom's life isn't worth the cost.

Keep in mind we're talking purely about economics here, as that is what your post is about. We're not talking about quality of life.

[sp332]

Economically speaking, I think it's fine for a person to spend huge amounts of their own money that way if they want. Also, it's fine if they ask around for friends, family, or even total strangers to finance their health. But forcing people to pay (via taxes) for an operation seems outrageous to me.

[Klinky]

Not really the point I was making. People will go to great lengths and effectively destroy their own life in the pursuit of saving a loved one. This makes it hard to take seriously the concept that a a free market full of economically rational consumers would exist when it comes to costly medical decisions.

It's easy to say "if you didn't want to be poor, you shouldn't have bought that plasma tv or new smartphone", versus "if you didn't want to be poor you should have let your wife die instead of taking a second mortgage out on your house".

Most people do not have a maximum price on something they consider priceless.

[vidarh]

You benefit immensely from society. To expect you to pay some portion of your income to help that society function is not unreasonable, and extensive healthcare is consistently one of the things people in most developed societies see as one of the top priorities for society to spend that money on.

I'd fully support your right to opt out of taxes if you also opt out of each and every benefit society otherwise provides you.

[sp332]

If the government starts paying (at least some) of people's medical bills, there will be a committee somewhere that determines who is deserving of care and who is not.

[mikeash]

I don't know, but people in general seem to think the answer is "yes". Until and unless that changes, market forces won't really work in health care.