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>But the fact that Germany or Denmark can do it doesn’t mean we can.

Where is the evidence of this? Healthcare is not the same as infrastructure. Medicare and Medicaid do a better job controlling costs than private insurers: https://www.modernhealthcare.com/article/20190211/NEWS/19021...

The entire second half of the comment you're responding to addresses this. You don't have to agree, but you can't reasonably rebut the whole comment by pretending he didn't address it.

The second part of OP's comment deals with the funding sources for public healthcare. I'm responding to the allegation that our government couldn't provide it in a cost effective manner in the first place. Where in the second half is this addressed?

There's a large political organization that intentionally sabotages govt effectiveness because they feel that is the best way to eliminate govt.

I'm not saying that is the cause of all govt failure in the US bit it's a significant one.

Having lived Chicago, Philadelphia, New York, Baltimore, and DC, where you have to search far and wide to find a republican, but where public services still suck (despite high taxes), I think the causation runs in the other direction. I think if you took a bunch of Danes and made them live in Baltimore for a few decades, they’d vote down any attempt at expanding government services too.

this is so naive. wealth has no borders and they are in every municipality in the us.

Sounds like you're inventing anti-Republican conspiracy theories to explain the failure of states and cities that have been totally dominated by the Democratic Party for 50 years.

In doing so you're preventing the Democratic Party from being held accountable, so that they may be pressured to fix the serious problems that exist with their ideology and political structure, which ensures that more people are drawn to the Republican party, simply as the less unpalatable one of the two.

The people who are going to agree with your tenuous explanations for the failure of Democratic-run cities were always going to vote Democrat anyway. It's those people who are on the fence who are not in your political bubble who you are going to push away by turning the Democratic party into one that does not accept criticism and does not operate in the realm of evidence and reality.

Cities can’t overcome national policy that is directed at broadly destroying social safety net programs, disenfranchising large percentages of the population, driving income and asset concentration, eliminating collective bargaining and facilitating automation and international supply chains all of which rob local communities of the resources and opportunities necessary to rebound.

A mayor has no chance of fixing the city when the tax base is decimated because of these national policies.

For example, consider the housing and mortgage policies over the last 50 years where redlining literally systematically destroyed the real estate and tax base of the very cities you cite as examples of the democratic parties failure to effectively manage city services. When no one can get a mortgage to buy property in a city, prices drop, which means the tax base erodes, which means social services are reduced, which means property values drop further; very nasty negative cycle. Then add a national highway bill that gives preference to suburbs and exurbs and you should clearly see that the cause is not local party mismanagement but broad national policies.

Sure, cities can’t make up for federal labor laws. But they should be able to run basic municipal services, like schools, transit, etc., that in other countries are overwhelmingly paid for by municipal and local governments.

Median household income in Baltimore is about double that of Spain or Italy. Median household of African American households in Baltimore, though much less than that of white households in the city, is still about as much as Spain or Italy. There is an ample tax base there to support good municipal services if the government was capable of doing so efficiently.

(I should clarify—I’m not trying to diminish the magnitude of the problem that black households have half the income of white households in Baltimore. That’s a separate issue from whether Baltimore’s tax base is sufficient to support decent public services—somehow, Spain and Italy make due with less.)

Economics usually work in ratios not absolute dollars. Comparing services in Spain and Baltimore can only go so far as the cost of those service have drastically different inputs and those inputs may comprise very different ratios making the unit economics worse in what otherwise appears to be a wealthier area.

>>Cities can’t overcome national policy that is directed at broadly destroying social safety net programs,

1. Some of these cities spend huge amounts of money per capita on public services. You need to actually look at the statistics and not just make assumptions that fit your preconceived ideological narrative.

2. Social welfare spending as a percentage of GDP has massively grown since the 1950s, which totally contradicts this idea that the social safety net has been dismantled. Before 1967 there wasn't even a Medicare in the US.

3. The most dysfunctional major cities in the US have been strongholds of the Democratic Party for decades. If the problems in Democrat-run cities are attributable to federal policy then Republican-run City should be doing just as poorly but they're not.

For all these reasons, I repeat my charge you're inventing conspiracy theories to blame Republicans instead of accepting facts that condemn the Democratic Party

1. You need to cite statistics instead of just saying they exist and systematically disprove my argument. In fact I think cities spend a lot per capita exactly for the reason I describe. Federal policies that hollow out city centers and job opportunity means more people will need services and per capita spending will increase as those that can afford to relocate (and don’t need services leave). Those that stay by definition need more services; this distorts the per capita spending and decouples it from causation. You have to look at all government policy for accurate causation not just local government policy.

2. Yes, some government social safety net programs are new. But they weren’t designed to fix or replace local services or bring the cost of those services down. In fact since they were enacted elderly and child poverty is drastically lower. Generally very successful result as what they were intended to address. But other many programs like food stamps, Medicaid, housing benefits have been drastically cut. Those that haven’t have been tied to work requirements that end up pushing people out of the system. The US has among the lowest social mobility among peer nations because the safety net isn’t there when people need it. So my point stands.

3. I did not refer to any conspiracy theory. - Republicans policies have been clear and public. Reagan vilified welfare queens and said government was the problem. - The rhetoric about “starve the beast” is as out in the open as you could ever have. - The recent tax bill that explicitly targeted democratic states is easy to find. - The history of the damage from highways cutting through minority neighborhoods and destroying their business districts is as clear and documented as anything in social science as is the racist motive and attitude of the leadership that pushed the actual design. - Redline mortgages to prevent lending in minority communities was explicitly in the contract and you can read examples. You can find actual maps that were used to approve or reject loan origination based on race.

- There is a Supreme Court case dealing with property covenants that made it impossible to sell property to non-white buyers. Many suburbs were +90% white until these provisions were ruled unconstitutional. -Should I go on? You’re telling me Baltimore should be able to single handedly fight these trends?

By all means hold the Democratic Party accountable. But first be accurate and complete in was is causing the problem. I never even said these were republican policies. I merely said federal vs local.

However, In reality only the Republican Party is on record saying they want to literally destroy the government because it shouldn’t exist in its present form. Only the Republican Party is on record supporting policies that target “takers” and target people based on race.

I don’t have a preconceived ideological narrative. I have an informed, descriptive theory of political economy based on years of fact gathering, research, and predictive testing. I was a libertarian when I started, now I am here.

The wealthy in all those cities are overwhelmingly Democrats.

Well, this is a very vague and ambiguous statement, and doesn't have a citation.

By "wealthy", you could mean billionaires, you could mean people making a couple million a year, or you could mean people making $300K a year.

I believe the latter are a large part of what make large cities wealthy and underpin the tax base, and I'm not so sure they are mostly Democrats.

dunno about the rest of the cities, but I tried to find some data on wealthy republicans in baltimore. only about 8% of all the people in baltimore are registered republicans. pew forum doesn't even break down republicans by income, presumably because there are so few. [0]

it's true that wealthy people dominate politics in pretty much every municipality in the US, but at least in baltimore the shot callers are likely all dems.

[0] https://www.pewforum.org/religious-landscape-study/metro-are...

Gore Vidal said the Property party has two wings, D and R.

That's not really fair. American cities have "high taxes" in the sense that they are higher than in non-cities, but that's really not that much money. New York City raises something like $55 billion / year, but that's only around 4% of its GMP. New Yorkers are still taxed overall rather low for very big city in a very rich country.

As for public services sucking...it's easy to point to obvious failings but hard to compare public service suckiness overall. Americans are generally unhappy with their public services but so are most Europeans.

I don't think you can say that Democrats in big cities cause big city problems unless you can point to some big cities that are mostly Republican and do better. It's my impression that if you map political affiliation at a granular level, the US has a consistent pattern everywhere of blue neuron-like clusters everywhere people live, in a sea of much less populated red. I don't think that pattern varies substantially in any region of the country, and the rhetoric about states and other subdivisions being "red" or "blue" obscures the reality.

When A and B are correlated, it's not necessarily the case that A -> B or B -> A, it may be that C -> (A and B).

Also see: https://xkcd.com/1138/

Note the assertion that I was responding to, which is the idea that government is ineffective because Republicans sabotage it. To refute that assertion, I pointed out that government services in heavily blue cities in heavily blue states are still bad. That doesn’t mean that Democrats cause those problems, only that those problems exist even where there are few republicans to “sabotage” government.

There are urban areas controlled by Republicans, and they don’t do public services any better—they just don’t do public services. E.g. Phoenix.

That's because both of the parties are pro-business, against regulation and getting more similar on the key economics all the time.

USA hasn't had a left wing party since 60s or so.

What does being “pro business” or “against regulation” have to do with the quality of public services? These cities and states spend a ton of money on public services—they just do a bad job running them.

Besides, Western European countries manage to have good public services even though they:

1) Are more “pro business” in key respects, especially from the point of view of taxation. Western European countries generally have lower reliance on corporate taxation than the US, and much higher reliance on consumption taxes (VAT). They also rely much more heavily on payroll taxes paid for by middle class individuals than on corporate taxes.

2) Are more deregulatory in key respects. There is an E.U.-wide directive that requires rail to be deregulated and opened up to competition. If we had something similar here, instead of having government departments operate commuter rail service in say Virginia, the state would have to separate ownership of the tracks and allow for-profit companies to bid to actually operate the service. In DC, the WMATA Union is fighting tooth and nail to prevent one part of one line from being operated under contract to a private company. By contrast, the entire Stockholm subway is operated by private companies (one being MRT, the Hong Kong rail operator).

In another example, Germany, France, Spain, Italy, and Sweden have school vouchers: https://www.edchoice.org/school_choice_faqs/how-does-school-...

> Scholar Charles Glenn noted that “governments in most Western democracies provide partial or full funding for nongovernment schools chosen by parents; the United States (apart from a few scattered and small-scale programs) is the great exception, along with Greece.”2 Or as Diane Ravitch pointed out in a 2001 article, “The proportion of students in government-funded private schools is sizable in countries such as Australia (25 percent), Belgium (58 percent), Denmark (11 percent), France (16.8 percent), South Korea (21 percent), the Netherlands (76 percent), Spain (24 percent), and the United Kingdom (30 percent).”

“Businesses” are a total red herring. Those nice public services in Europe aren’t paid for by “businesses” they’re paid for by taxes on the middle class. The middle class agrees to pay those extra taxes, because the government has proven it can run the public services effectively. Democrats would love to raise taxes and expand public services. (See, e.g., the Democratic primary.) They just can’t convince voters that voters would get their money’s worth.

Likewise, the idea that public services in US cities is bad because Democrats aren’t far left enough is totally absurd when in Germany you can ride around on a partially-privatized passenger rail system and send your kid to a private school 85% subsidized by the government.

"There is an E.U.-wide directive that requires rail to be deregulated and opened up to competition. If we had something similar here, instead of having government departments operate commuter rail service in say Virginia"

My impression is that in the US, the existing system basically gives priority to freight, and that passenger rail is poor because of that.

I have been on an Amtrak train that had to wait and wait for a (private) freight train, and of course people blame Amtrak and the government for the delay which is a little unfair.

But in the big picture, I think it's not intuitively obvious that prioritizing freight in the US is the wrong decision for the country. I mean, you could argue it, but maybe freight is the best use of rail given the overall lack of density of the country.

Are you assuming the state and federal governments don't have any impact on cities?

I just looked up information on Phoenix, and it seems that it more or less corresponds to the 7th and 9th congressional districts, which seem to have had Democratic congresspeople since they were created, and also voted for Democratic presidential candidates in every election.

Isn’t part of the lack of efficiency of the US system the eye-watering prices for treatment? There seem to be all kinds of incentives for overtreating (eg, using more expensive diagnostics equipment for a simple broken bone), drug costs are unhinged, etc. It’s not only about creating a universal system but also an efficient one, and I did hear Sanders on the Joe Rogan podcast the other day mention some of these things, so maybe not all politicians are so oblivious to this?

"we're uniquely bad at government."

I 100% blame the decades long hollowing of the civil service by republican administrations.

That isn't purely partisanship. It's been a stated goal, publicly, of the republicans, their propaganda wings, think tanks, and most importantly, their noxious donor overlords.

"In Europe, universal healthcare is typically paid for with social insurance taxes primarily imposed on people making under $70,000"

I wonder what segment of the population in Europe provides the lion's share of tax revenue overall.

It made an impression on me that I once ran across IRS charts showing that the US relies heavily on taxpayers who are between roughly $200-500K in yearly income. So, not CEOs and billionaires, but not people making $70K either. These are the people who have to be, and are, taxed heavily to keep the system running, but not to the point where it kills the golden goose.

I don't know whether this is how Europe works, or whether they don't have nearly as many people in that income bracket.

I have a hard time believing that you can build a healthcare system in a country with income distribution like the US with the 200-500k bracket as the backbone.

Here in the EU (Spain, but also lived in Germany and the UK) we are quite heavily taxed and there’s always talk about having the rich pay more but we (the middle class) have also accepted that we get what we pay for. Our healtchare systems are far from perfect, but no one with cancer or a serious liver condition is left behind. Never ever seen one of these feel-good stories on this side of the Atlantic.

I think the root cause for all of this is Group Cohesion vs Individuality.

America and Americans are deeply optimized for the Individual, including giving them more flexibilities and freedoms, but also sparing them the burden of societal obligation.*

I think this choice is why America is responsible for so much innovation and why it's a fantasy for immigrants to come and achieve their dreams.

I would venture a guess that America is relatively the easiest place in the world to become a millionaire or a billionaire.

However it's also why it's a dystopian hellscape if you ever slip and stumble off the path. It's also the easiest place in the developed world to become homeless, destitute, or die from a preventable disease.

So what does it mean. Should this kind of society exist? Conservatives always optimize for people who opt into this by choice. Privileged entrepreneurs, working hard to make their mark, without the same obligations and burdens that exist in other flatter egalitarian societies.

But most humans, even in America, don't choose their circumstances. They are born into them.

Which means that for them, the American Dream is a delusion, a fantastical tease, as likely as winning the lottery.

So I would venture that the American system is a net negative for their citizens, and for world humanity at large (not that other intervening super powers like China are any better).

Student loan debt, lack of healthcare, private individuals actively working to undermine the government from effectively operating, government contractors using public funds to fuel their entrepreneurial growth, all of these are symptoms of a deeper societal sickness.

But only 30% of the country (at best) wants to see it fixed. Another 30 thinks everything is just fine. The last third actually wants to make things even worse, and is inspired by either Atlas Shrugged or The Old Testament or The Handmaid's Tale.

So what now? The cynic in me thinks that "the American dream" will become in the 21st century that "the British empire" became in the 20th. A historical relic of past relevance, while the country slowly decays.

* Except when religious-based policies Trump everything else (E.g. "Personal freedom to live your life, unless you're gay."

Add average health care costs to taxes and tell me if we have low ‘taxes’ still.

By EU standards, these are medium-low taxes still, by percentage. The difference is not in healthcare though, but in other social spending, esp. pensions. US healthcare is extremely expensive by percentage. It's a policy failure, not money failure.