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The situation on the ground is unchanged - the amount of labor being generated per person has not really changed, but the overall pie has grown massively around us.
https://equitablegrowth.org/new-data-reveal-how-u-s-economic...
"The past three economic expansions have largely benefitted the top 10 percent. In each, the top decile received between 47 percent and 59 percent of all income growth in the expansion."
Automation, robots, software etc. they are all capital share.
I highly doubt automation and robots are a meaningful factor here, but IP and outsourcing have the exact same as automation.
There's a return on capital than is not spent on employees. That reflects how much capital is growing and how much can be spent on employees in the future.
For me personally, I am in the top 10%; but a few decades ago, I was not.
[1] https://www.epi.org/publication/strong-wage-growth-for-low-w...
Saying that billionaires "disproportionately" have more assets than non-billionaires is a tautology that says nothing. You might as well say that tall people have disproportionately more height than people who are not tall. Billionaire is a statement about wealth, not income.
> In fact wage growth for the top decile has been recently slower than bottom deciles
Which is a very good thing, but also doesn't address anything. The bottom deciles live from their wages. The top decile either put most of their wages into assets, are already so wealthy that their wages don't matter, or live in luxury they can't afford.
The macroeconomic purpose of inflation as a tool is to lower the wages of high wage earners - because socially you can't really lower people's wages, at best you can refuse refuse them raises. It's easy to raise the income of lower deciles to offset inflation, either through legislation or safety net. Middle-high wage earners who do nothing under inflation face an effective pay cut.
> The guy who's at the 9.99th percentile is a normal salaried worker not doing better.
He is not normal, he is in the top 10%. His income triples or quadruples a median income. He is of course not doing better than himself, but he is doing better than 90% of other people by definition.
It means having sufficient liquid capital that you can invest it in uncertain outcomes, generally without fear of poverty or perhaps any real negative effects on one's life at all.
Owning a very expensive home in a very high cost-of-living place (or even in a not-so-high cost-of-living place) does not place a person in that position.
the most accepted way to divide in socialist circles is based off where your income comes from, your relation to capital. if you have to work for someone else thats working class (proletariat), if you can be independent you are professional or middle class, if you own the means of production for others that makes you a capitalist. owning a house is only capital class if you rent it out.
from that pov almost all tech workers are professional or working class. with founder ceos its more complicated because they own capital but also work for themselves through their company so you can take them as either. i guess it depends on if you like that person.
not true, labor productivity has been steadily increasing: https://fred.stlouisfed.org/series/OPHNFB
workers are simply capturing less of the economic value generated by their labor.
- The amount I'm working hasn't increased. Still an 8 hour day.
- My job honestly is easier than it used to be; certainly less menial.
- Strictly speaking, the education requirement is actually lower. It's easier and a lower bar to learn to become a decent designer in AutoCad than to learn to effectively use old drafting tools (even though the formal four year engineering degree still takes four years).
But it's also true that in spite of this, my output is higher. Should I capture the increased output or should the innovators of the tools? What about the firms that invest in procuring these tools and production technology? Should the customers capture the increased output through lower prices? Or should the innovators, firms, and customers all get less, and instead my wages should get bigger?
Those in control will try to capture as much of the return as possible. How much value the worker captures is based on their relative power (ability to move to a higher paying employer, scarcity of skillset, laws such as minimum wage, etc).
In almost all of the cases the "innovators" are themselves workers whose share of the outcome has been dropping. And the "customers" have never gotten a piece of the profits; we are already past the point where reduced prices would have happened (competition) in this system.
And I think that by "firms" you really mean some combination of executives and investors/shareholders. That is where the gains have been centralized. Do you really want to argue that management and investors deserve to have more of the gains? What have they done that makes them so much more valuable than similar groups in bygone days?
But for this to work, employers have to believe that hiring better workers matters.
Where the benefits of that end up is one of the most fundamental questions of politics. As you note, there are arguments for it to flow to any combination of several different groups. Deciding how much goes to each group is what politics is all about, in the end.
You do capture the increased output by benefiting from a society where the cost to build safe buildings has drastically reduced.
Just because you don't get an immediate financial benefit doesn't mean you haven't benefitted from the increased output.
yes
As someone trading labour for a wage should I adjust my productivity to match the tools I’m using? That is to say if I’m using CAD should I bother using the tool to raise my productivity? Or should I just match my old hand drafting productivity rates? Should I attempt to raise my productivity rates with these new tools to meet or exceed the best rates from my coworkers?
What can we do to align my interests with those of my employer?
https://fred.stlouisfed.org/graph/?g=tjto
So in terms of how much consumers are making in relation to their expenses, it's been remarkably steady this whole time.
household expenses have been increasing without commensurate wage growth, resulting in lower savings: https://fred.stlouisfed.org/series/PSAVERT
observation_date OPHNFB_PC1
2000-01-01 2.99256
2001-01-01 2.58092
2002-01-01 4.27146
2003-01-01 3.68422
2004-01-01 2.97991
2005-01-01 2.18582
2006-01-01 0.99665
2007-01-01 1.58927
2008-01-01 1.30737
2009-01-01 4.07061
2010-01-01 3.15513
2011-01-01 -0.02491
2012-01-01 0.93870
2013-01-01 0.59941
2014-01-01 1.00795
2015-01-01 1.27023
2016-01-01 0.61567
2017-01-01 1.49513
2018-01-01 1.40965
2019-01-01 2.13337
2020-01-01 5.30657
2021-01-01 2.06281
2022-01-01 -1.46786
2023-01-01 2.13277
2024-01-01 2.91010
2025-01-01 2.25154
Ford now makes more cars, with fewer people. Sears used to have people who took photos, laid out catalogs, opened envelopes (with checks in them).... Amazon has none of that. We replaced switch board operators, with mechanical, then digital switching. More calls routed, fewer people required. go back 45 years and "draftsmen" was a job - replaced by auto cad.
All these industries have seen massive productivity.
Are the people flipping burgers more productive? Plumbers? Welders? Teachers? Nurses? -- to some extent yes, because of technology but not to the same extent as the previous businesses. Anything that qualifies as "service economy" work has not seen the same gains as Ford (see: https://www.aei.org/carpe-diem/phenomenal-gains-in-manufactu... )
There's a variant of this, however, in activities that are done essentially by 1 person (as is true for most of the examples you mention in your last paragraph). You can improve their individual productivity - more pipes fixed, more joints welded, more patients well-attended to (*) - but in the end you cannot get rid of the individual doing the work in the way automated manufacturing has.
(*) even with a nurse though, this starts to break down for activities where time is a critical part of whatever is being done. Sometimes caring well for a person is primarily a matter of spending time with them, and this is certainly true for teaching as well. In such cases, you cannot make the person "more productive" no matter what technologies you might provide them with.
"It's pretty simple: If you're paying $12, $13, $14 an hour for factory workers and you can move your factory South of the border, pay a dollar an hour for labor, ... have no health care, that's the most expensive single element in making a car, have no environmental controls, no pollution controls and no retirement, and you don't care about anything but making money, there will be a giant sucking sound going south."
While Perot was warning about NAFTA, the jobs did go elsewhere: China and other countries with cheaper labor. Globalization led to labor competition, which increased the supply of workers.
Meanwhile, companies captured the value of the increased supply of workers. More cheap labor = more production, for a world that had latent demand for cheaper output. It ended up a net benefit for businesses (capital owners), and overseas workers. This is at least partially if not significantly where the growing gap between wage growth % and GDP growth % comes from.
The macro economists were right that globalization would be more efficient overall for the world, economically. But that came at the expense of the US labor that saw its wage growth eroded as a consequence.
My understanding is that "fixed" costs like rent and groceries have gone up and taken more of people's budgets, while wages failed to catch up with this inflation.
If that's the case, it's markedly different from "situation on the ground is unchanged". I don't know how the overall pie is doing, but it has not grown enough to compensate for the labor share drops shown in the article. The slice on my plate is certainly lighter.
I don't see where the article made that claim. Are you making it yourself and can you support it? That sounds like something that would happen when technology improves. What the article does do, is pose a question that it never answers: "When the labor share falls, it means that productivity, prices, or both [which?] are growing faster than wages."
Unit cost on labor has increased at a more or less steady pace this whole time. Ergo, it's not so much that labor is decreasing as other things are increasing faster.
It's hard to argue that technology is increasing labor productivity an order of magnitude faster than it was in the 50s. It's more likely something else in the dataset (returns on capital/rent) is exploding in value.
I would encourage you to go work with average Americans in average towns. The facts on the ground are stark and eroding.
There is a pretty clear down-trend post-COVID here.
https://www.federalreserve.gov/publications/2025-economic-we...
A lot of the US looks like they're doing great but fits into the category above.
Non-poverty would look like:
* You make enough money to pay for your own food, housing, and transportation in full, with enough buffer for emergencies, without needing to borrow a cent
* You make enough money to be on trajectory to save up to pay for your own food, housing, transportation, and medical expenses in retirement when you are physically unable to serve the workforce
The best approximation would be the homeless population in the US (about 500k people), but even then most homeless would not even qualify.
"Half" is a gross exaggeration.
I assure you that when your basic housing and nutrition are uncertain and missing even a few days of income will result in cascading effects of hunger and homelessness, the underlying stress is overwhelming.
It doesn’t have to be this way, we don’t let bullies steal all the toys on the playground and destroy the very ecosystem that they want to have fun in, why are we letting capital accumulate in the hands of the most effective capitalists at the risk of destroying the very markets that let them succeed.
I say that as a capitalist, if we lose the system because we allow unchecked Monopoly and wealth concentration, we won’t get it back.
I find it hard to believe that half the US would meet the criteria for any reasonable definition.
Any definition of "abject poverty" that includes a comfortable lifestyle and $12-15k excess income every year is not a serious definition.
Source? All the ones I know of use questionable methodology like: "being able to afford a 2 bedroom apartment at median wage".
Well, that's (at minimum) what you need to raise a family and replace yourself in the labor pool.
https://www.census.gov/library/publications/2025/demo/p60-28...
The 350 million Americans looking at the top of the US economy and crying need to turn around and take a look at what's behind them.
There are something like 7 billion people behind them, worse off.
Anyone who believes this has absolutely no concept of what abject poverty looks like.
That is a very common reality.
https://www.federalreserve.gov/releases/z1/dataviz/dfa/distr...
>link for "Distribution of Household Wealth in the U.S. since 1989"
income =/= wealth
im not really understanding what you mean. i dont get how labor is generated, in particular. do you mean to say the amount of total hours dedicated to labor per person or something else?
however, unit labor costs has also been increasing (although they remain variable): https://www.bls.gov/opub/ted/2026/productivity-up-0-3-percen...
Rent for the homes we live in (including "rent" as mortgage payments to the bank)
Rent passed through as costs to the consumer for the businesses we patronize.
We're stuck at home more affording to be able to do less so the people who own don't have to work.
But the underlying problem that people aren't paid enough is still true. Outside a few fields, most people are underpaid. It's even more stark when measured against productivity increases during the same time periods. That wealth went somewhere. It wasn't to most people.
People have a tendency to get upset when they realize these kinds of things.
Rents in general are part of this. Both for housing and commercial property. Somehow getting profit from both rent and appreciation is the goal of the system.
Well that is what population voted for and choose not to overthrow system for so maybe they deserve it.
You can say restaurant workers need to be paid more, and ok sure, but where is that money coming from? You pay labor, food suppliers, rent, utilities, taxes, and... where exactly is the money to pay workers more coming from?
With the number of empty storefronts in my city (not to mention restaurant closures) it's clear owners aren't making money hand over fist or there would be many more restaurants.
Restaurant workers in my experience are more likely to go to more restaurants and they can't because... their rent is too high and the price of food at restaurants is too high.
The common denominator with all of it is money being sucked away from people doing work and people hiring work by... rent seekers.
The "labor share of income" is exactly this. How much money is getting sucked out of the rest of the economy to prop up the do-nothing class. Retired people whose retirement investment was selling a house for much more labor than they bought it for and real estate owners doing as little as they can to maximize income they aren't earning.
https://sdhc.org/wp-content/uploads/2025/04/107_Workshop_RAN...
Office buildings sit mostly empty for the same reason.
Tax the owners to punish the bad bets and eternal growth expectations of banks to force them to use the space to the benefit of the community or be forced to sell when they run out of money. Use zoning laws to prevent the destruction of units to avoid taxes.
The US Federal Housing and Urban Development Department was intimately involved in the Savings and Loan collapse of the late 1980s. It was punted around and repeated in the 1990s, but the stock market gains of the late 1990s diluted the news in public. That phase culminated with a dot-com bubble collapse and ultimately, the 2007 dollar credit crisis. Leveraged purchases of real estate were part of that financial soup. Many of the players from that time were "boomers" and their seniors, so living memory of those circumstances are now fading. There are many, many non-fiction books about these topics.
AI is going to further exacerbate this inequality.
Time to re-read Capital In the 21st Century.
In the video he describes how when people like Elon Musk get to the level of wealth that they are at, it becomes far more beneficial for them to take from (or stunt) the spending power of lower classes than it is to add to their own net worth dollar figure - simply put, the former moves the needle far more in their favor than the latter.
Definitely explained the idea of our slice remaining the same while the overall pie around us is getting larger.
*Edit: Benn not Ben
Before anyone says inflation, there will be more consumer spending and thus more cash flow in the middle and lower class
"Is this decline a distinct change from the recent behavior of the labor share in the U.S.? Along the two key dimensions we investigate, our answer is no. <later> ... and they provide little evidence that it will evolve differently from past episodes."
This conclusion seems to be against "this time is different" arguments. Should we be generally encouraged by similarity to past declines pre-2000 or bearish and think that there is more drop to come like the 2000-2007 and 2007-2019 periods they graph out?
I guess there is no way to predict other than check back in after time passes.
Welcome to the dismal science of economics, where the rear-view mirror is crystal clear but the windshield is totally fogged up.
> Is this decline a distinct change from the recent behavior of the labor share in the U.S.? Along the two key dimensions we investigate, our answer is no. First, the labor share’s trajectory post-COVID broadly follows the cyclical patterns observed in earlier recessions, with a decline during the recovery phase that mirrors historical dynamics. Second, the decline in the labor share since COVID is driven primarily by within-industry changes rather than shifts in economic activity across sectors. Taken together, these results suggest that the post-COVID decline follows the same cyclical patterns as earlier recessions and is driven by the same within-industry forces, and they provide little evidence that it will evolve differently from past episodes.
What I find more interesting is the sharp drop around the early 2000s
> The labor share of income in the U.S. is currently at its lowest-ever level in the post-war period.
Agreed on the 2000 drop though. Would be interesting to read a retrospective on that.
May the low-waged ever be trodden upon and forever know their true place.
Those that died or became disabled during covid are mewling degenerates.
Their cries of 'illness', 'poverty', and 'homelessness' are precisely as useless as the wailing and lamentation of women in their menses, a farcical thing to be dismissed and ignored.
May the Fed be ever in your favor, Amen
"Related to or marked by Hysteria" https://www.merriam-webster.com/dictionary/hysterical
Hysteria being "behavior exhibiting overwhelming or unmanageable fear or emotional excess" which seems to be exactly what OP was trying to say.
It has nothing to do with the IRS or taxes.
Silicon Valley Is Obsessed with 'Trust Stacking,' and the IRS Doesn't Like It - https://news.ycombinator.com/item?id=48727963 - June 2026
Small-time landlords are an example, as would be anyone who owns a small business and draws cash from profits rather than taking a salary.
anything you can do thats useful to society counts as labor (but not vice versa, you can work as a robber or corporate lobbyist). from line cooks to wall street ceos to open source volunteers and stay at home moms who dont get paid but still work. landlords and executives count because management is labor too.
if your income comes from a trust fund or owning properties that you dont manage thats a passive reward for doing nothing. you are not productive. you are a parasite living on the back of everyone else and expecting indefinite rewards for a fixed amount of work you or your parents did years ago.
> landlord
If you think these two things are compatible you need to talk to more people outside of your bubble.
If I was talking about "ultra obese" people, you wouldn't assume I was talking about everybody who has a couple of extra pounds?
To be fair their were good reasons at the time to think it wasn't working either.
https://fred.stlouisfed.org/series/PRS85006173
Corporate profit vs Labor income divergence (only up to 2018)
https://fredblog.stlouisfed.org/2018/08/corporate-profits-ve...
I think in the case of US literally killing workers and union people is a huge part of why US workers lack power and why US unions are so impotent.[0]
[0] see Battle of Blair Mountain and what work Pinkerton mainly did from its founding to WW2, as examples.
Such as? They might have managed to maintain it for privileged subgroups of the workforce but not for the average worker.
the capital/labor class gap increases when total returns on capital investment exceed total wages+redistribution to the labor class, and the gap shrinks when that's reversed. the market ~controls the capital gains and labor wages knobs, and society decides where to set the redistribution knob.
the article investigating the post-covid drop and concluding that it's normal is an interesting rhetorical device. on one hand, relief that nothing crazy is happening. on the other hand, disappointment that we've accepted a growing inequality gap as normal. the gap was already at a post-war max going into covid, the floor gave out 20 years earlier and covid was just gas on the fire.
advancements in automation and tax codes that benefit capex over payroll will continue to incentivize business to shift budgets from labor to robots.
https://www.brookings.edu/wp-content/uploads/2016/07/2013b_e... https://home.treasury.gov/system/files/131/wp-107.pdf https://eml.berkeley.edu/~yagan/LaborShare.pdf
That said, it's a huge pet peeve of mine when someone makes a statement, and then provides sources to back up that statement, but the actual sources contradict their original statement.
You stated "but AIUI this is mostly a statistical illusion caused by changes to US tax law- previously income that was attributed to 'labor' shifted over to LLCs/S corps for more beneficial tax rates." But then your very first linked article states "First, about a third of the decline in the published labor share appears to be an artifact of statistical procedures used to impute the labor income of the self-employed that underlies the headline measure."
I think there is a huge difference between 1/3 (while still a lot and an important factor) and what you wrote, "mostly a statistical illusion", especially since other substantial factors proposed in that article are things like offshoring.
How much of an effect it has at the national statistical level I'm not sure.
https://bfi.uchicago.edu/insight/research-summary/the-rise-o...
That is, if they're successful.
Who knows. I think it's better to err on the side of optimism despite the grim outlook.
Why would someone want to collect promises? That seems rather silly, right? What having a lot of promises gives you is social standing. People treat you differently — better — when they give you their promises. If traditional labor goes away, the economy simply becomes you promising to hold those who have things in the highest regard; to be there as their friend when they call for you to. That is the same modern economy we already have but with less steps.
I think it's becoming clear that we are reaching a point where UBI must be debated in Congress subsidized by something that doesn't wreck economic growth and probably doesn't target capital investment.
Where do I sign this petition?
In general, though, I'd be perfectly fine with time being frozen in ~August 2001. Was it perfect? No. Was it better than where we are and looks like we're heading? Yes. Without a doubt.
Ie, why can one guy who is insanely wealthy due to stock valuations take loans against that to pull various levers of power. We didn't elect him, we need a way to control that outsized influence.
No political administration in my lifetime (!) has made policy decisions against the interests of tech monopolists. The closest we got was Lina Kahn's FTC.
We shouldn't just be pointing at the (very much real) stupid greed, there are many rotten components occurring simultaneously.
There's nothing about being in the C-suite that magically endows one with motivation based upon stock price, but we pretend that there is.
How much of the trend is due to employment trends vs. printing money for the wealthy to get their hands on it first(and profit) post recession?
One would assume the difficulty of building housing has gone down with the general progress of technology - and if all else fails, you can just do what they did 50, 100 years ago where affordability was far less a struggle - people, who had less income in real terms spent proportionally less on it.
So did society devolve that an unit of industrial output has become more expensive? Or did money and resources just go into a parallel 'rich people economy', that has created a constant drain on the resources of average people?
I'm not sure if this addresses the point you're trying to make though. If not, please clarify your argument for me.
Why would you own them, instead of some well capitalized billionaire?
To the extent that you do have capital, why do you assume that your 'minimal direction and guidance' would outcompete a full time specialist working for that billionaire?
And in this world of abundant agents, what advantage does the billionaire have exactly over the non-billionaire? Their employees are less motivated than owner-operators, and they no longer have the scale advantage that large corporations used to have. Each individual can effectively operate like a large corporation, because each individual can have their own large synthetic workforce at very low cost. The scarce resource here then becomes uniquely human insights and real motivation, which entrepreneurs are always going to have more of than employees.
There is a need for proper pricing for the rich, i.e. Elon can pay a million dollars per meal. Someone is leaving money on the table.
A king goes hunting but fails to catch anything. Hungry, he goes to a nearby village. He enters the inn and orders some quail eggs. After finishing the meal, he goes to pay. The innkeeper tells him that the meal costs ten gold coins.
"I did not know quail eggs were so rare in these parts," says the king.
"They are not," replies the innkeeper, "but kings are."
Parking and speeding tickets should have income brackets, at least.
In the early Internet I saw this thing, no idea if it’s true but it sounds good (someone can math check it), goes something like:
A person pays $2 to play basketball on a public court.
Michael Jordan gets paid $2k to play on the same one.
A person pays $100 for basketball shoes.
Michael Jordan gets paid $100k to wear the same ones.
A person pays $40 to go see a basketball game.
Jordan gets paid $400k to attend the same game.
Michael Jordan makes about $5 per second.
If Michael Jordan saved all his money without spending a penny for 250 years…
He wouldn’t even have half as much as Bill Gates!
It made me think differently about money and consumer spending.
AFAIK in some countries this exist but my case is more capitalist oriented. Rich people obviously can pay more since they keep accumulating wealth. It is an obvious sub optimal pricing since the low and even middle class rent/mortgage and other services quickly approaching the most they can pay so they can’t actually save and make wealth.
Thank you for coming to my Ted Talk, please leave a downvote to indicate I caused you emotional distress.
How deeply puerile.
capitalism will always seek to reduce labor cost. during the epoch of neoliberalism it achieved great strides in this by reducing labor power through union busting by both thatcher and reagan in the UK and US respectively. it has also effectively curtailed any increase in the minimum wage for nearly 20 years as well as reduced protections, regulation and prosecution for wage theft and overtime pay violations which it maintains as exclusively as civil matters while ensuring theft itself from a merchant in turn is always a criminal matter through the primacy of private property.
to learn more i recommend reading Marx's "Das Kapital," albeit its rather academic. Engels "wage labor" is also a good read to understand why housing is so persistently unaffortable but helps to understand why any other good or service slowly becomes so as well.
So basically you are squeezed between the public demanding lower prices and the investors demanding record returns. If you are not a monopoly, that is an impossible ask
Basically the only truly profitable businesses left out there is selling hopes and dreams to investors, and shovels to those who build them, which just about describes tech & AI, with companies who regularly manage to 10x their valuations (and P/E ratios)
His worldview is primarily that capitalists 'steal' the valuable labor. However it doesn't seem that that is actually the world we are in. Instead the intrinsic value of human labor seems to be slowly trending towards zero.
And it kind of makes sense, same has happened with oxen labor, horse labor, etc.
Sounds like we should start imagining a world where we don't treat people like literal livestock, and then figure out how to get there fast
We tend to have a pretty human-centric worldview so if there's a single human working to keep a hotel running, our default is to attribute all the generated value to them when it really isn't the case. You can imagine that hotel at some point in the near future goes from requiring 1 worker to keep it running to zero.
If you landscaper had one like the plumbers do he'd have his own yacht.
Or he wouldn't exist because you'd buy about as much of his services as you do a plumber's.
Marxism was an idea formulated especially as a reaction against a world where labor has lost almost all of its value. Which is precisely the origin of capitalism - the idea that money itself can be productive, and thus people who have lots of money can be expected to get more of it.
This was an untrue idea for most of human history, outside of the circles of moneylending and banking.
What's changing is how much of that surplus value is captured by the workers doing the labor.
Labour theory of value is useless. Falling rate of profit is not empirical. Capitalism didn’t go away as he predicted.
Workers enjoy highest living standards of any time in history.
It's entirely possible for someone to be paid a lot in absolute terms, while at the same time paid very little relative to the value that they produce which is monetarily captured by their organization. The truth of the first does not invalidate the injustice of the second.
This is why I think the billionaire oligarchs are literally mentally ill. They've won the entire game. They control everything. They live like gods, they twitch a pinky and millions dance.
But their response to all of this power is to seek even more of it, destabilizing the very system that has them on top. You would think self-preservation would kick in. The fact that it is not and that their greed knows apparently no bounds is going to lead to their extinction.
For a long time I thought it was hyperbolic to say so, but no longer -- the billionaires are mentally ill.
[1] https://work.news/post/project-2031/
There will be a few who brand themselves as such. But actually seizing the means of production and handing them over to the people? -- The oligarchs will burn this country to the ground before they permit that to happen.
All companies are rent-seeking. Selling something is no longer a goal.
Prices go up up up up up.
Oligopolies and price fixing is normal.
Monopolies are normal with little/no controls.
People are getting paid a pittance to the work done.
Unions are their weakest in a century.
NLRB is basically frozen due to no quorum on the head board.
Companies routinely scam and lie at multiple places in hiring pipeline. FTC does nothing.
Neither party (Republicans or Democrats), save the DSA, fights for the American people.
Its all coming to a head, and baskets, and guillotines. Anybody who studies history knows what kind of powderkeg this situation is. Its also the reason the Ancient Romans made panem et circunses (bread and circus) cheap or free. You get riots and revolts otherwise.
The big picture here is increasing wealth inequality and that has been on steroids since the pandemic.
The only shocking part to me is how people continually and intentionally don't see it or, worse, think they'll be unaffected by it so don't care. You see this on HN where so many people seem to think they'll be Jeff Bezos one day.
But even if that's true, don't you want to live in a society where you don't need armed guards at your house and you don't need armed escorts to go anywhere? Because that's what we're heading towards. One of the problems with American society (in particular) being so car-centric is that it lets people insulate themselves from the rest of society more easily. In cities like NYC you're forced to see and deal with the less fortunate. You can't hide from it so easily.
We don't need trillionaires. We need to raise basic living standards so people have food and shelter and we don't need to separate society into slums and armored compounds.
[1]: https://www.epi.org/productivity-pay-gap/
Software engineers are a special kind of stupid: the kind that thinks they're smarter than everyone else.
Do you have a source?
And no, there's no simple solution to this problem. The notion that something like "Medicare for All" would solve the problem is a total fantasy, disconnected from actual US healthcare economics. Any real solution will have to work on multiple angles including preventive care, PBMs, provider wages, rationing, drug prices, fraud, malpractice insurance, interoperability technology, etc.
Provider organizations spend a huge amount of effort dealing with Medicare and Medicaid, which are pretty close to being a "single-payer solution" already in many cases. From an administrative overhead perspective they aren't always easier to work with than commercial health plans. Plus they have enormous problems with fraud, waste, and abuse.
How many man-hours are spent dealing with insurance paperwork? How much do hospitals and doctors spend each year just dealing with that interaction, rather than treating patients?
> Plus they have enormous problems with fraud, waste, and abuse.
I'd say "enormous" requires some evidentiary proof. Obviously there is fraud and waste. But almost all large scale systems have that. We should certainly try to minimize it wherever we can but I don't think "waste and fraud exist" are a reason to not pursue a path.
That said!
1) In the big picture isn't the US clearly paying more than other countries? I'm sure some of this is eg a janitor in the US costs more than a janitor elsewhere, but still...
2) Isn't the cap for the margin that insurance companies can take 20%? That is, they have to pay out 80% as claims take 20% for overhead
3) Doesn't insurance also induce more work done by everyone else who has to deal with them? So the margin the insurance company itself takes is not the only cost they add. Maybe they make providers do more paperwork, or let patients order tests etc that they would not if they were not spending other people's money, or some other reason. Say insurance pays out 80%, but 30% of documentation or actual work is not done by insurance but only exists because of them, now we're down to 56%.
I say this because literally yesterday, my wife, a pediatrician, after she spent the day seeing patients and got home to go through notes, had to leave a message with an insurance company: she saw they faxed her clinic on Saturday, when the clinic was closed, to cancel care for a patient with an ongoing chronic condition with no changes unless the insurance company got a reply in 48 hours (again, while the clinic was closed!). Now she has to schedule some kind of I don't even know what with them, to confirm the condition is the exact same, except she sees patients all day so it's a pain to schedule...
idk the fact that BCBS is a non profit and has no margin in some technical sense does not seem like a big consolation, something is rotten no?
(edit - the insurance company in the anecdote is not BCBS)
i am not familiar with universal system. In that system if your doctor thinks something is medically necessary then thats the end of it and its gets done?
So in my book since we get to speculate about what the system should look like, it should absolutely result in people getting care without all of this run-around. It's about eliminating as much misery as possible from the system and letting people just get treated and providers just get paid. We can talk about efficiency once the misery is gone.
In most countries where there is universal coverage with a single payer, certain expensive treatments have long waiting lists or are simply unavailable at any price. Thus we see wealthy Canadians coming to the USA as medical tourists and paying cash for procedures like MRI scans or joint replacements in order to avoid the queue back home. There are always trade-offs, it's just a matter of what we want to prioritize.
Employers might be contributing more to healthcare costs, but that's because they have to in order to keep coverage for their employees at all as premiums increase, and individual out-of-pocket costs are still rising as a result of coverage denial and high deductibles.
[0] https://www.bls.gov/opub/hom/opt/calculation.htm
Too much money in the system being flawed, look at pricing for any HIPAA safe products and thats just technology. Money is so hard to get for healthcare providers it is its own industry of revenue cycle management and thrid party billers. Most of these physician lead practices charge more is because planning your account around reemburcement cycles from insurance companies are 30-120 days if your lucky is an advanced accounting problem. (Thats excluding complexities of audits, LOPs, network rates etc.) Medicare/medicaid the fraud side has lots of tiny wins through leaning on tax information more, taking the model from the successful basic income studies and trials worked out.
There aren't as many physician-led practices anymore. Most of them have been rolled up into larger health systems in order to achieve economies of scale and increase negotiating power with commercial health plans. Which is one of the factors driving up overall healthcare system costs.
It may not be simple but it's clear the United States is doing something catastrophically wrong. All the other healthcare systems on the planet in developed countries have problems, sure. But we spend magnitudes more money to receive middling-to-shit healthcare. Medical debt and bankruptcy is a unique American problem that also happens to be the most reliable way for otherwise productive and prosperous members of our society to end up fucking homeless. Because they got SICK. I rarely use the word "evil" but that really fits IMO.
Like you cannot tell me with a straight face that the insurance industry couldn't be blown the fuck off the map tomorrow and literally everyone who doesn't own an insurance company isn't instantly better off.
Significantly increasing the supply of doctors would solve that, though.
I'm sure he'll manage.
The insane thing is denying it to half of the population doesn't really mean the other half gets to save that much money in real terms.
It fails to follow logically that one specific way the government got involved that drove costs up means that any possible intervention is worse than completely being hands-off. How do you explain pretty much every other developed country in the world having more government involvement but lower costs than the US?
When something is paid for from a big nebulous ball of money rather than straight out of people's pockets, the downward pressure on prices just isn't there in the same way. The conversations between practitioners and insurers are about whether something is necessary, not about whether or not the practitioner is charging too much for it.
Here in the UK we see it, too - not so much in human healthcare since we have the NHS - but very definitely in animal healthcare; vets' bills have skyrocketed over the last couple of decades, in a mutually-reinforcing feedback loop with the rise in pet health insurance.
This is not some spurious speculation. That market-based systems drive down costs enormously is replicated across dozens upon dozens of industries. It's one of the most replicable results in economics to the extent that economics can be replicable. As for why the costs in other countries are not quite as high as the U.S., it's because health care costs also increase as per capita GDP increases and the U.S. has higher per capita GDP. Moreover, because the U.S. has some aspects of its health care system still living more in the private sector, there is less top-down rationing. Other countries see very clear examples of rationing, so people spend less on end-of-life care.
It would eliminate the tens of billions that are wasted on insurance company profits.
I have been saying this for years. I'm so tired of social media memes turning into sage wisdom for an entire generation who can barely spell healthcare, let alone have any vague understanding of it.
I'm and-then'ing, not disagreeing, but the big healthcare cost fix, IMO, still centers around education cost reform, and fixing the supply of mid-levels+ across the country.
The idea seems to have merit, but it's unconvincing to people outside your bubble and I'm dubious.
This is a complex topic with no tl;dr possible. If you want to be able to participate in discussions on a rational, quantitative basis then a good starting point is "The Price We Pay: What Broke American Health Care--and How to Fix It" by Marty Makary, MD. It goes into the numbers far better than I can cover in a short HN comment.
https://www.bloomsbury.com/us/price-we-pay-9781635574128/
That's what all partisans think. Nonetheless you put needless scare quotes around Medicare for All, dismissed it as a "total fantasy", and, I guess, helpfully suggested I read a book by (literally!) the head of the Trump administration's FDA as a reference for "What Broke American Health Care".
If that was all done in good faith, then you're in an echo chamber and need to escape.