Why the U.S. Spends So Much More Than Other Nations on Health Care - <AUTHOR> https://www.nytimes.com/2018/01/02/upshot/us-health-care-expensive-country-comparison.html <comment><USER3> I think the US could easily solve this if they wanted to, but from my (Dutch) point of view:

\- The US is philosophically much more egotistic than other developed countries

\- Politically the US is the most divided western country with its two party system

\- Money in politics means it's one of the most corrupt, preventing solutions that could serve its citizens

\- Conservative media does a very good job at keeping at least 50% of the country comically uninformed

\- The "American Dream" gives people the impression that working hard solves everything and that their country is the best in the world period

\- Religion is not focussed on empathy at all anymore, if it ever was

The billionare .0001% will probably do their utmost to keep the status quo, as evidently, they are the ones that are profiting from the current situation and they are the ones calling the shots for the next 3 years.

The US is doing very good in a lot of areas, but I think collective egotism is preventing it from reaching its true potential.

<comment><USER4> Counterpoint from a fellow european. I found americans to not be more selfish, but more appreciative of self-reliance. In europe in most countries the philosophy is that of the nanny state, taking care of its citizens no matter what got them into a care-needing situation. In much of the US there's much more a perception of responsibility for your own success, with negative individual outcomes being considered a necessary evil linked to personal freedom.

Looking at the stats clearly the US needs a little more nanny state to generate better outcomes for the bottom half of the country. But equally europe needs more appreciation of self-reliance and entrepreneurship to enable a richer startup culture and let the EU become an economic leader instead of follower.

<comment><USER5> Sweden and Norway, both flagship nanny states are extremely entrepreneurial and not just by volume but success. This goes against the logic you can't have social support and people reaching for entrepreneurial success.

I think, though know this is anecdotal, US startup success is based largely on its market size of both consumers and venture capital.

<comment><USER6> How on earth is Norway entrepreneurial by volume OR success?

<comment><USER7> It's not. They have a lot of oil which allows them to give back to their citizens.

<comment><USER8> and shit on the environment. this comment thread is full of the exact condescension that conservatives and libertarians are sick of. People who uphold the Constitution and the vision of the Founders are comically uninformed? Stanford's Hoover Institute is comically uninformed? What a joke.

<comment><USER9> Given every libertarian/conservative economic theory that's been advanced since Reagan entered office has been tried and without exception resulted in increased income inequality and bricking the economy, comically uninformed seems pretty accurate. Given conservatives collective track record of having legislation thrown out in court on constitutional grounds claims of upholding it are likewise clearly unfounded.

<comment><USER8> Totally and utterly false and uninfotmed nonsense. Quite accurate if leftist policies - the failures of which can be measured and hundreds of millions of dead bodies and collapsed economies.

Is Peter Thiel comically uninformed?

<comment><USER9> Fascinating. So we should ignore Kansas' state economy going belly up due to grotesque mismanagement by "conservatives" attempting to implement libertarian-inspired economic policies? What about the sharp (and enduring) spikes in income inequality and the market crashes provoked by the Reagan and Bush Jr. regimes? We pretending basic economic indicators are hard to track or something?

Incidentally, you probably don't want to drag body counts into a conversation that's teetering on the brink of a larger critique of capitalism. Unless, that is, you'd like to review deaths world-wide from preventable illness due to lack of access to healthcare? In the US alone it's estimated to be 45,000 deaths annually. Meanwhile Texas (in all it's staunch conservative glory) has 3rd world infant mortality rates.

Regarding collapsed leftist economies, what percentage of these are attributable to inherent failures of socialist policy vs simple economic sabotage and regime tampering by the US and it's allies? Would you like to review what the CIA has been up to since the 1950's?

Or would you rather simply review the number of times conservative legislators have run afoul of the constitution just in the last 5 years? We can start with the electoral maps of North Carolina getting chucked over illegal racist gerrymandering, and a thick stack of executive orders that have died in a judge's trash can this year.

</comment></comment></comment></comment></comment></comment></comment></comment></comment><comment><USER10> "The US spends more on healthcare because the prices are higher!"

Um, okay. Duh. A better question to ask would be: Why are prices not falling? In the "normal" economy, people can't offer any arbitrarily high price they want: They have to compete with others to offer their good or service at a low price. The more you raise your price, the more you invite competition and give them room to run a profitable business.

Anyone who has gone to a doctors office or hospital lately knows why there is so much overspending in health care: The health care system is the most fucked up, overcomplicated, ridiculous system you could possibly imagine. You start out by filling out a big paper form with all your info on it... They use that to bill your insurance, which then says okay, we're going to pay you half of what you asked for. What ridiculously perverse incentives. Now the provider will naturally ask for twice as much, knowing they won't get everything they bill for.

Health Care will be fixed not by laws or insurance companies, but by technical innovation and good old fashioned economics. You know, those old ideas Adam Smith had. If there was serious technical and economic / business model innovation in the industry (an Apple of health care) prices would go down, outcomes would improve, etc.

<comment><USER11> > _" The US spends more on healthcare because the prices are higher!"_

> _Um, okay. Duh. A better question to ask would be: Why are prices not > falling?_

It's an excellent observation, and it begs your excellent question.

Unfortunately, we can't get to an excellent answer. The US is ideologically incapable of acknowledging that "market failure" exists.

<comment><USER12> Health care is the absolute prime example of a Veblen good as people are willing to pay for perceived quality. After all would you prefer the heart surgeon who charges $5000 or the one who can charge $25000

<comment><USER13> Seems like a bad example. All board certified cardiothoracic surgeons have to report their mortality rates from procedures (there are problems with that, but one could easily look this up). Not to mention most work for a hospital and therefore have a fixed salary. On top of this, most healthcare consumers in America are directed by their insurance provider as to who they can even go to for these sort of procedures.

<comment><USER14> Mortality rate is a poor metric.

First, it "penalizes" doctors/hospitals that take on the most severe cases. There is no objective metric for "we saved X people who would have died at an average facility." Do you _want_ a metric that would encourage a doctor/hospital to _deny_ an aggressive procedure for fear of taking a hit in its mortality metrics?

Secondly, it ignores ongoing quality of life. A cardiac surgery can have a later death that does not count in its mortality rate, even if it was due to a complication caused by, or significantly contributed to, by inferior medicine.

<comment><USER13> Oh, I'm in agreement, and should have made my point about this more clear. The reason I brought it up at all is that there are other external factors that influence a patients decision, or lack thereof, in choosing a CT surgeon for their non urgent (or emergency I guess, but there's even less choice there) procedure.

</comment></comment></comment></comment></comment></comment><comment><USER15> Are you familiar with the path that an American needs to take in order to become a cardiologist capable of financially supporting a family in a city where their children can realize their potential? The system that creates an American cardiologist is designed such that the cardiologist and it's respective delivery system will charge as much as economically possible for services. There aren't many cardiologists in the country and that is by design. A hospital can't even establish itself without the explicit consent of other hospitals already operating in a region -- healthcare entrepreneurs require a "certificate of need" issued before they are permitted to open a new hospital -- and dare not compete. The American Medical Association, medical schools, lenders, cardiologist fellowship programs, and others play a role in manufacturing a cardiologist. Everyone is participating in the system as a profit seeking, economic growth oriented player. Long ago, their objectives shifted to maximizing shareholder value and honoring fiduciary responsibilities.

No one has managed to control the cost of care in a system like this.

<comment><USER16> CONs aren't required in all states (and none at the federal level since the 1980s).

[http://www.ncsl.org/research/health/con-certificate-of- need-...](http://www.ncsl.org/research/health/con-certificate-of-need-state- laws.aspx)

States that don't have them don't have dramatically lower prices.

<comment><USER17> Every state except LA had a CON law.. You can't restrain supply for a couple of decades, then repeal the law, and immediately say: see, there's no difference.

We're already seeing a difference in prices after a few years[0].. and it takes years and hundreds of millions of dollars (up to $1B+) for a hospital to go from a proposal to operating:

 _CON laws raise overall healthcare spending by 3.1 percent—5.0 percent for physician care. As for type of provider, while CON has little effect on Medicaid spend- ing, it increases overall Medicare spending by 6.9 percent._

 _States that repealed CON laws have seen overall healthcare spending reduced by 0.8 percent per year, leveling out to a 4 percent drop after year five. The greatest decline in spending is with physicians at 1.4 percent per year, compared to a drop of 0.3 percent per year in hospital expenditures._

And by constraining supply of beds, hospitals redirected investment into equipment, increasing per-unit costs of providing care [1,2]. Arguably CON laws have contributed to unnecessary tests (since hospitals need to use the equipment they buy to pay for it), and use of more expensive equipment than necessary.

Of course this isn't the sole problem with our health system... there are many that contribute to the problem. But CON laws are negative, and are one of the issues we need to deal with if we want to reduce health costs.

0\. [https://www.mercatus.org/publication/health-spending- reined-...](https://www.mercatus.org/publication/health-spending-reined-in- CON-laws)

1\. [https://jhu.pure.elsevier.com/en/publications/impact-of- stat...](https://jhu.pure.elsevier.com/en/publications/impact-of-state- certificate-of-need-laws-on-health-care-costs-and-4)

2\. [https://www.mercatus.org/publication/do-certificate-need- law...](https://www.mercatus.org/publication/do-certificate-need-laws-limit- spending)

</comment></comment></comment><comment><USER18> It's hard to contain costs when there is no transparency regarding them.

Just try to figure out the price of a medical procedure. The prices of procedures vary depending on who you are.

Having the need to get a particular type of MRI every few years, I call around looking for 1) the equipment the facility has to do the MRI, and 2) the cost. It's hard enough to get #1 (there's a large disparity in quality of MRI based on equipment). #2 is practically impossible to get, and has no correlation to the equipment quality.

If providers were required to be fully transparent on pricing, and provide the same price to all, then you might see cost containment.

</comment><comment><USER19> As someone who worked for CareFirst, I had a privilege to accidentally overhear the panel of doctors who work for C.F. deciding if C.F. will cover procedure for the patient....fuck those guys. Next to the building, there was a helicopter landing platform for CEO. US insurance system anti-humane.

<comment><USER20> How much of that egregiousness has been fixed by ACA's cap on insurance company's profits, in your opinion?

<comment><USER21> Wouldn't a profit cap encourage profligate spending on things like corporate helicopters?

<comment><USER22> The ACA requires the somewhat perversely called Medical Loss Ratio (MLR) to be at least 80% (and 85% for large group plans). The MLR is the percentage of revenues from insurance premiums that are being used on actual healthcare benefits (and thus can't go towards profits, hence the name). Corporate helicopters don't increase the MLR and reduce profits.

<comment><USER23> This is a perverse incentive. If I'm running an insurance company and my goal is to maximize absolute profit, how do I do that when my profit margin is capped by law in this manner?

Well, I certainly don't have an incentive to reduce healthcare costs; quite the opposite. 20% of a larger cost leaves me with more profit, and most of my customers won't drop my service. It's required by law and subsidized in a lot of cases.

<comment><USER22> This is why there are marketplaces where you have to compete against other insurers. And companies in particular will evaluate their group plans critically.

</comment></comment></comment></comment></comment></comment><comment><USER24> Living in the US and having to pay the high deductibles for health care, here is my idea: \- price transparency - The problem is not easily being able to shop around for procedures and doctors. It is extremely difficult to know how much things will cost. If the prices have to be published in some way so the cost is known up front, the price will go down. Many people's insurance doesn't start paying until after the deductible. Most people just pay the price whatever it is because it is impossible to know how much something will cost until after. Of course, this means that hospitals can charge whatever they want with no recourse. When insurance companies pay, they fight back and get lower prices, but people can't do that. Voting with their feet will increase competition and drive down costs.

<comment><USER25> Price transparency doesn't help when you don't realistically have a choice. If I'm going to ER or taking an ambulance I can't check prices to decide what hospital to go to. If I'm in hospital and need surgery I can hardly decide to change hospital because their surgery is cheaper. When my I discover on my bill that my doc consulted with an expensive expert, it's too late for me to ask her to use a cheaper one.

Hospital's aren't like grocery stores.

<comment><AUTHOR> When it comes to emergency, you probably right we can't shop around. But when it comes to taking medication, there should be a price. In HK, we can find out the price of a treatment or a surgery from the hospital's website. Maybe not the full exact amount, but close enough for someone to know what to expect. There shouldn't be a "we will take care of the rest of your treatment and send the bill to you" as in your own story.

<comment><USER26> Even with regard to emergencies, there is no reason you can't shop around in advance so that you already know which hospital you want when the emergency occurs, given that there is more than one in your area.

<comment><AUTHOR> I understand your point. but let me refer you to a previous discussion: [https://news.ycombinator.com/item?id=16007125](https://news.ycombinator.com/item?id=16007125)

In short, if you call 911, the operator will call for an ambulance. You can't choose. If you have a minor stroke, you can certainly choose to have a friend to drive you there, or you can call a specific ambulance (I have never done that before and I am not even sure if that's even possible). But risk is on you.

I can't go to Mount Sinai West Hospital (midtown in NYC) if I am in Brooklyn at this moment. You understand emergency means racing with time. I can be _transferred_ to Mount Sinai West later after I am discharged though. Also, I believe there is protocol for how far an ambulance is allowed to serve on active duty, unless another area is requesting additional availability, but don't quote me on this.

If only we can teleport...

<comment><USER26> > In short, if you call 911, the operator will call for an ambulance. You > can't choose.

That is merely a procedural issue. There is certainly no reason why the 911 operator can't honor your request for an ambulance from a specific hospital, provided that it's within their range. In the absence of a specific request, the operator has a duty to look out for your interests, which should include not sending you to a hospital known for over-charging when there are other reasonable options available. (This is the same logic that says they shouldn't just send you to the hospital that pays them the most kickbacks.) Their default balance between cost and care might reasonably differ from yours, but if you have expressed a preference then they have a responsibility to honor it.

Of course, not every emergency is quite as time-sensitive as a stroke or heart attack, and depending on your location, and the locations of the hospitals, the difference in travel time may not be significant. Even if price is not the determining factor in the majority of cases, competition over the patients for whom where it _is_ a factor can help keep costs in check for everyone.

</comment></comment></comment></comment></comment></comment><comment><USER27> I have a friend who worked with the billing system at a major hospital in Florida. Beyond the obvious practice of providers billing for much more than the actual cost of service, to maximize insurance reimbursement after rounds of "negotiations" after each client, there is something more insidious going on as an industry.

My friend (anecdote, sure, but something like this will never be written in policy, so I can't cite) said "we were told NOT to send anything to collections unless the amount was "very high." He was then told that the hospital was made whole with every insurance reimbursement, and that any amount "owed" from clients aren't actually a big deal- if they pay it, great, if not, it's alright. Furthermore, the impetus for not sending to collections was because there is a certain threshold where if the populous found out about their many shady billing practices, they would be exposed, and would rather not deal with that.

I'd like to say that I am surprised nothing has been done about this, but I'm honestly not surprised because the incentives and economics are there in your face.

<comment><AUTHOR> I am sorry, but I read it three times and I am still unsure how the practice helps the providers? I was looking for "stealing more from clients", but I can't deduce any from this anecdote.

</comment></comment><comment><USER28> Much of the cause of the high cost of care in the US is not social, or political, or demographic, but economic:

The single biggest line item in the US healthcare budget is hospital care

The price of hospital care (as measured by cost of inpatient bed day, [1]) in the US is on the order of twice as high as that of France, Germany and the U.K.

The time period where the cost of US healthcare in OP article separated from other countries coincides with the increase in hospital consolidation in the US

Hospital consolidation is demonstrated to lead to increase in price without commensurate increase in care [2]

There are other factors as well, but this is probably the single biggest cause of high US healthcare cost, and it's almost never discussed

Good article with historical context here: [https://www.nationalaffairs.com/publications/detail/the- peri...](https://www.nationalaffairs.com/publications/detail/the-perils-of- hospital-consolidation)

1: [http://www.who.int/choice/country/country_specific/en/](http://www.who.int/choice/country/country_specific/en/)

2: [https://www.rwjf.org/en/library/research/2012/06/the- impact-...](https://www.rwjf.org/en/library/research/2012/06/the-impact-of- hospital-consolidation.html)

<comment><USER29> > _The price of hospital care (as measured by cost of inpatient bed day, [1]) > in the US is on the order of twice as high as that of France, Germany and > the U.K._

And why do you think that is? Everything is political, including economics.

<comment><USER28> the articles i linked suggest it is in part because of hospital / health system consolidation leading to higher negotiating power. i think that is an economic factor, although i think i can see where you are coming from

i assume youre suggesting that having a single payer would balance out the negotiating dynamic? that could certainly be the case. to be pedantic, if the US does get a single payer system, one could argue that the political act of creating a single payer system is driven by economic factors (local provider monopolies increase cost of care, payers adopt high deductible plans in response, people suffer financially as a result, therefore vote with their wallets)

i dont think politics supersedes economics or vice versa, theyre very intertwined

</comment></comment></comment><comment><USER30> Some guy was telling me how IBM Watson was going to make healthcare more efficient by helping doctors make smart choices. I replied that that wasn't going to help profits, so it probably wouldn't be adopted. Hospitals and insurers really should be merged so the incentives are all properly aligned. Kaiser Permanente works this way and, IMHO, it's actually not that bad.

<comment><USER31> I always wonder why kp hasn't expanded more.

<comment><USER14> They've been doing a _huge_ amount of infill in Northern California, replacing whole facilities with brand-new complexes in existing core patient areas. (One example is their Santa Clara facility, which replaced a predecessor less than a mile away with one maybe _5 times_ its size.)

It must be an _insane_ amount of capital expenditure.

<comment><USER31> just passed by the SC facility (the one on Homestead?) and it did indeed look massive.

Great to hear that they are expanding in their core practice and geographies. Hope they continue to do well.

<comment><USER14> That new residential neighborhood on Kiely Boulevard across the street from Central Park is where the prior Kaiser medical center was, going back to at least the 1960s.

</comment></comment></comment></comment></comment><comment><USER32> Lack of price transparency feels like a big part of the problem here. It's nearly impossible for a consumer to shop around based on price, allowing prices to go up freely.

I'm actually surprised healthcare providers can legally be as opaque as they are: how is it okay to charge arbitrary amounts after the fact and require the consumer to pay? Even car mechanics make upfront estimates and get them signed by the consumer, because otherwise the consumer might refuse to pay. Why doesn't the same happen in healthcare for at least non-emergency procedures?

<comment><USER33> I see a retina specialist twice a year. I recently changed to a high deductible plan with an HSA. I called to see what the cost of my appointment would be. They could not or would not tell me. Incall three separate times, talking to different people and different departments. I went in and continued asking the front desk. "It depends on the services you end up getting." Ok, sure, but for a standard appointment, what then? "I can't say." Listen lady, I'm looking for a ball park. $50? $100? $1000? $5000? "Oh, I can't imagine it will be that much." Which one? "We will have to just bill you after." So absolutely frustrating. It ended up being like $150. Without price transparency like a public menu, we won't get better.

<comment><USER34> Had the same experience with my son's ear infection on a holiday weekend. Received a bill for $900. I refused to pay it, I wrote them and said I had asked to receive an itemized list of charges for a typical ear infection and had been refused and that if these prices were known at the time of the service I wouldn't've undertaken the service.

So of course they came down to $450 without even batting an eye. Complete madness. I've still never paid it, with no apparent consequences.

</comment></comment></comment><comment><USER35> Doctors, surgeons, nurses, lab techs, hospital bureaucracy and staff, etc....

All of these people need to get paid, and in the US they get paid very well.

High health care costs are not a mystery or a conspiracy. There are just many people in the industry that make a lot of money, and they charge high fees to maintain their incomes.

<comment><USER36> That's such a simple thing and yet no one seems to acknowledge it. Look at Obamacare, it's going to lower health care costs. How? Savings! What does that mean? Everyone you don't like won't make as much money. All the people you like will keep getting paid. I understand we all hate health insurance and pharmaceutical CEO's but taking them out back and shooting them will save less then is commonly understood. The same goes for money wasted on advertising.

Saving money on health care is (to repeat an oft told joke) like going to heaven. Everyone (Republicans and Democrats both) wants to do it but no one wants to die.

</comment></comment><comment><USER37> There is no competition. The day there is competition is the day you walk in to your doctor's office and the prices are posted above the reception desk like a restaurant menu. $50 general visit, $75 for a broken arm, $100 treat common infection, etc. You don't see prices because you don't pay. Insurance pays. If you are ever without insurance and have to pay, they always have different, lower rates. Doctor's scamming insurance companies, insurance companies scamming the government, the government scamming all its citizens.

<comment><USER38> This is the root cause, the fact people don't pay for their own healthcare and there's no competition. Then we layer on this huge complicated system to try to contain costs other ways.

</comment></comment><comment><USER39> Now can we have a "Why the U.S. Spends More than the Next _Eight_ countries _combined_ , and 63.7% More than The Entire Rest of The World on Defense"?

[https://en.wikipedia.org/wiki/List_of_countries_by_military_...](https://en.wikipedia.org/wiki/List_of_countries_by_military_expenditures)

        ---

Oh wait, we spend _even more_ now:

[http://clerk.house.gov/evs/2017/roll378.xml](http://clerk.house.gov/evs/2017/roll378.xml)

<comment><USER40> The US gets that much more military for its money. Look at the diagram on the bottom of [https://www.globalsecurity.org/military/world/carriers.htm](https://www.globalsecurity.org/military/world/carriers.htm) . Or remember that the US Air Force is the world's biggest air force, the US Navy is the world's second-biggest air force, and the US Marines are the world's third-biggest air force.

There's space for people to disagree on whether what we get out of the military is worth what we spend on it, but there's no mystery about where the money's going.

<comment><USER39> I grew up on a US Army base.

Believe me: There is _plenty_ of mystery, and _plenty_ more obvious waste. The most obvious is called "use or lose".

Why in the hell do we need it?

China has a _billion_ more people, borders Russia, North Korea, Afghanistan, and Pakistan, yet spends less than a quarter as much as the US on defense, even by the most liberal estimates.

I can see arguing the merit of spending more than every country on Earth. I would still disagree, but it would definitely be a discussion.

However, the US contributes more than a third (closer to 1/2 now) of defense spending for _the entire goddamn world._

It disgusts me that my country takes so much money from its citizens, and throws it at all into a machine of death, whilst simultaneously blaming its egregious debt on Social Security.

<comment><USER40> > China has a billion more people, borders Russia, North Korea, Afghanistan, > and Pakistan, yet spends less than a quarter as much as the US on defense, > even by the most liberal estimates.

Sure. But it has no (conventional) power projection capacity, whereas the US has been engaged in two simultaneous occupations of outright hostile foreign countries literally on the other side of the world for a decade, at the same time as deploying troops to defend dozens of friendly nations all around the world, enforcing freedom of the seas again all around the world... . The front line of a US-China conflict would likely be Taiwan, that's what spending 4x as much is buying us. Again, we can argue over whether that's something we should be spending money on, but on the whole (of course there is some level of waste, as there is in all large organizations) we're getting what we're paying for.

<comment><USER39> > the US has been engaged in two simultaneous occupations of outright hostile > foreign countries literally on the other side of the world for a decade

And spying on the entire world, including its own citizens, etc.

Even if you believe the US should play world police, and demand a group of people with a totally different culture and history pay by it's rules, there are _plenty_ of _significant_ areas where we are _clearly_ wasting _significant_ amounts of tax dollars, all under the umbrella of "defense". Instead, Congress overwhelmingly decided, after Trump asked for a $20 billion increase, to have a $100 billion increase.

> We're getting what we're paying for

I don't buy that. We are paying an unfathomable about * 5.

There is extremely significant and obvious waste. Even what is not "waste" does not clearly help taxpayers in any way. Very significant portions are clearly to the detriment of taxpayers.

</comment></comment></comment></comment></comment><comment><USER41> The thing I keep wanting to bring up:

>Higher prices aren't all bad for consumers. They probably lead to some increased innovation, which confers benefits to patients globally. Though it's reasonable to push back on high health care prices, there may be a limit to how far we should.

Fundamentally speaking, much like education, while I agree that healthcare is unaffordable to many, I point out that this is different from being too expensive. I think the idea that we are spending too much of our wealth on education and healthcare is... wrong.

I mean, sure, there are limits on what we want to spend, as a society, on healthcare, and yes, I personally think that a lot of the public money being spent on healthcare (and I think a lot of public money _should_ be spent on healthcare) should be spent on research that benefits all, but overall? as a society? I don't think spending 17% of our GDP on healthcare is a problem (assuming we're receiving good benefits from that, which I think we are)

And yeah, maybe there needs to be 'community college' equivalent of healthcare; a system where anyone can show up and get care that is good but not the best for next to nothing. And yes, we do need more and better-funded research for the public good. I certainly don't have a problem with private industry researching new drugs for us, but we have to understand that their incentives are... different, and that there's a place for public-funded work for the public-interest.

<comment><USER42> > I think the idea that we are spending too much of our wealth on education > and healthcare is... wrong.[...]I don't think spending 17% of our GDP on > healthcare is a problem (assuming we're receiving good benefits from that, > which I think we are)

You're missing a dimension to both of these numbers: Outcome. The U.S. spends more on healthcare than any other country — but not with better health outcomes [0].

"The US stands out as an outlier: it spends far more on health than any other country, yet the life expectancy of the American population is not longer, but actually shorter than in other countries that spend far less." [1]

[0][http://beta.latimes.com/nation/la-na-healthcare- comparison-2...](http://beta.latimes.com/nation/la-na-healthcare- comparison-20170715-htmlstory.html)

[1][https://ourworldindata.org/the-link-between-life- expectancy-...](https://ourworldindata.org/the-link-between-life-expectancy- and-health-spending-us-focus)

<comment><USER41> One explanation of the difference in outcomes, especially your "Number of deaths per 100,000 from preventable diseases or complications had adequate healthcare been available, in 2013" statistic has mostly to do with accessibility. Lack of access. That, and a cultural avoidance of seeking help, but I bet it's mostly the lack of access.

If you have bad insurance? there's huge variance in what a procedure will cost, and in my experience, hospitals aren't setup to deal with the "how much is this going to cost me?" question.

The ACA may have helped with this. With my yearly out of pocket limits, I have some peace of mind that it won't, at least, go over that.

Personally, I think we can continue to compare this to the education system, we need something like 'community colleges' \- Sure, you need paperwork and to go through a bunch of hoops if you want to go to Stanford- and you get a better product than at the community college, if you can make it, but anyone can walk into the community college and get half a pretty decent education that is almost completely paid for by the government. I think we need something similar in medicine... a place anyone can walk in where they know they can get care that meets minimal government standards that is next to free.

But... my point is just that making the whole system cheaper is not the best way to solve that. We don't want to replace Stanford with the University of Phoenix.

To continue my analogy, the private sector does beautifully at the high end, in both schooling and medicine. To bring back the University of Phoenix example, at the low end? I would much rather have the low end government product than the low end private sector product.

<comment><USER42> It's precisely about lack of access, hence the conclusion of the quote: ".. had adequate healthcare been available." There is a cultural avoidance of seeking help because the help will bankrupt you. Because it's too expensive.

Making it cheaper = better access = better health outcomes. How do we know? Every other industrialized nation does it better than we do for cheaper.

<comment><USER41> >Making it cheaper = better access = better health outcomes. How do we know? Every other industrialized nation does it better than we do for cheaper.

My understanding was that the nations that have better outcomes for the poor tax people and use that money to pay for government supervised medical care, and that it's the government paying for and supervising the care that leads to better access.

Private sector solutions, as I said before, seem to work extraordinarily well for the rich, both in medicine and education. If Stanford will let me in, sign me up. But, when I am shopping on the low end? I want some government intervention. Cheap private sector medicine, I suspect, would look a lot like cheap private sector education... ITT tech, Corinthian Colleges, or at best, the university of phoenix.

</comment></comment></comment></comment></comment><comment><USER43> It spends so much more on healthcare because of its obsession with possessive individualism and the ridiculous notion that a government of the people is out to get them.

It'll change one the USA resembles India and China leads the world.

<comment><USER44> "It'll change one" -> "it'll change once"

It took me 15+ seconds to make this correction and parse the last sentence, here's it so that you don't have to spend them.

</comment></comment><comment><USER45> You have huge variation in the life expectancy between rich and poor individuals in the US. Here you have a lot of poor people with no healthcare and then you have more affluent people who may be spending hundreds of thousands of dollars a year on healthcare. If I have a few million dollars saved and I can spend a couple hundred thousand to live a few more years there's a good chance that I'll take that option. This system is not intended to provide the greatest benefit to the most people but rather to provide the greatest benefit to those people who can afford it. Coming from Canada and seeing the quality/detail of care you get with private insurance here is astounding. There is certainly a lot of fat in the US system but it's also incredibly comprehensive if you're fortunate enough to have good insurance.

</comment><comment><USER46> It's simple economics: third party payment. Patients want as much care as possible, doctors are incentivised to provide it and insurance companies pay for it. Until that changes healthcare costs will not decrease

<comment><USER36> I used to think that. My only argument of skepticism is sort of weird. Animal health care costs. Apparently the cost of vets is going up just as fast as that of humans. And in that case it's mainly first party payment. It could be that the two have no connection but for me, it raises doubts.

Honestly my current theory about health care costs is that they're high - <USER2> are inflating - because people like health care. There's a basket of potential goods and people really like that particular item. To get it they spend what they have and then pressure politicians to get them ways to spend money they don't have. They complain more and so the politicians find ways to hide the costs from them.

<comment><USER38> I agree with you, as people get richer they spend more on health, for themselves and their pets.

But just because vet costs are _increasing_ at a similar rate (or more) than human costs doesn't mean the third party vs first party thing isn't the issue. Absolute overall human health care costs are still way higher then vet costs for similar services(1), despite the rates of increase the past few years.

Also, anecdotally, some vets are going the other way. There's a vet near my house, for example, that just started weekend + holiday hours with rates the same as to their normal ones. We hadn't even gone their before, but when my dog woke up last Easter with some eye problem, we called around, found them, and got some ointment that helped. The other two options would have been: wait a day, or go into an emergency clinic that's k's of dollars. If we had pet insurance I'm sure we just would have gone in without thinking.

1: [http://parkhillvet.com/2012/09/comparing-costs-of-human- vs-p...](http://parkhillvet.com/2012/09/comparing-costs-of-human-vs-pet- health-care/)

</comment></comment></comment><comment><USER47> Could this problem be attacked by a goodwill billionaire with a long-term plan? Open several private medical schools that will offer "free" med education in exchange for multi-year contracts. Open many small copycat clinics. Manufacture your own generics if possible, import whatever is cheapest, focus on things you can do cheap, be transparent about pricing, build awareness and brand.

McDonaldize/Amazonize American healthcare.

</comment><comment><USER48> Something I've always heard but not mentioned in this article is that America is a very litigious culture, everyone sues everyone for nearly any reason, which is uncommon in most parts of the world, and doctors must have lots of malpractice insurance to guard against this; and when doctors pay a lot for insurance, they must increase their prices to help cover that, and the wheel spins that way.

</comment><comment><USER49> A lot of these comments due a great job of hitting the nail on the head on most issues, but I have not seen someone talk about the fact that the United States believes in _treating_ versus _prevention and or curing_.

<comment> wu-ikkyu >he sacrifices his health in order to make money. Then he sacrifices money to recuperate his health. And then he is so anxious about the future that he does not enjoy the present; the result being that he does not live in the present or the future; he lives as if he is never going to die, and then dies having never really lived.

-Dalai Lama

</comment></comment><comment><USER50> Part of the reason it is more expensive in the US is because medical school is very costly in the US. This increases the financial risk of those aquiring a medical degree. Higher risks usually demands higher profits in the market.

Hence free university education could be a factor in reducing US health care costs.

Fundamentally you see how the free market approach to everything drives up costs everywhere.

Or more specifically drives up costs in industries/services which don't naturally have functioning markets.

Free market approaches to health care found in Europe or Asia that works tend to be strongly regulated. E.g. max prices for procedures

<comment><USER51> Part, but definitely not the main reason. If the doctors worked for free, US would still be more expensive than Germany or Japan.

<comment><USER13> Agreed. There are around 80,000 medical students in any given year in the US. Assume that all of them pay $50,000 per year in tuition. That's maybe $4b per year. The costs of health insurance, diagnostic testing, pharmaceuticals, etc more than eclipse that number.

<comment><USER52> And the bigger problem is that there is profiteering at every step of the way... Medical Insurance, devices, private testing labs, hospitals, doctors, pharma...it all adds up. As someone else said, it's a free market without a real market for competition... I don't remember where I heard it, so citation needed, but the number that sticks on my head is that we spend 25% on administration alone. Lots of billing companies exist just to handle the complicated mess we have created... More profits in the system.

</comment></comment></comment></comment><comment><USER53> Bertolini the CEO of Aetna walked away with a $500 million parting gift. Courtesy of your healthcare premiums. There's the fox guarding the henhouse off to a new henhouse. STOP THIS OBSCENITY of administrators paying themselves so much to work in a risk free environment. When they run red ink, the government bails them out. Taxpayers again - shafted from both ends. We should find this guy and put him in a stock, the kind the puritans used, not the Wall Street kind,

</comment><comment><USER54> The math in the article is not quite right. Growth from 1.2 trillion to 2.1 trillion in 17 years (1996-2013) only amounts to 3.3% annual growth, which is not that far away from the 2.4% of the overall economic growth.

The U.S. does spend more per capita than any other country, with Switzerland, Luxembourg and Norway being the runners up.

[https://www.npr.org/sections/goatsandsoda/2017/04/20/5247741...](https://www.npr.org/sections/goatsandsoda/2017/04/20/524774195/what- country-spends-the-most-and-least-on-health-care-per-person)

I think that statistics gives a hint: the richer the country, the more it can afford to spend. Also the mostly private health care sector in the U.S. doesn't have similar incentives to cap their spending at a certain point as their publicly funded counterparts in Europe. There must be a lot of cases where a rich person buys expensive treatments for a terminal illness that would be deemed hopeless and left untreated elsewhere, and that has to show in the statistics somehow. I don't consider this a big flaw in the U.S. system.

<comment><USER55> _There must be a lot of cases where a rich person buys expensive treatments for a terminal illness that would be deemed hopeless and left untreated elsewhere, and that has to show in the statistics somehow. I don 't consider this a big flaw in the U.S. system._

Probably not a _lot_ , since most people aren't rich. But more to the point: That stuff happens other places as well. I'm in Norway, and there is a private healthcare system. Most of the time, I hear it being used for shortened waiting times or more luxury in the hospital, but I'm pretty sure rich folks can go to other lengths - on their own dime. This doesn't affect the state much because it isn't their freaking money.

 _Also the mostly private health care sector in the U.S. doesn 't have similar incentives to cap their spending at a certain point as their publicly funded counterparts in Europe._

I think this is correct, but I think the fragmentation is what causes it. The fragmentation means there is no incentive to combine resources to make things cheaper and easier. Where I live in Norway, people can have - free - up to 6 nurse visits a day. Even if you live on an island or are spending your summer in a remote cabin. All because overall, the outcomes are good. People live longer, happier lives the longer they can be at home and it is cheaper than sending the same people to a nursing home.

<comment><USER56> Actually in Norway there is relatively little you can do _in_ Norway, as private providers are highly restricted in what services they can legally provide in areas that are covered by public healthcare, in part because it's long been seen as immoral to let people buy preference to what is effectively a limited resource as long as the number of doctors available is limited (and the answer is not to drastically increase the pool of doctors either, as the problem there is training - you don't have enough heart transplant cases, say, to train a much larger pool of transplant surgeons). I believe the restrictions are lighter than they were, but it's still far more regulated than most places.

But of course rich people can easily fly to get private treatment abroad.

Healthcare in Norway is close to US costs mostly for other reasons: A much flatter salary curve means the services that are typically cheap elsewhere, like e.g. cleaning staff, is much closer to the cost of higher level staff, driving up overall staff costs significantly; this also drives up costs of goods and services bought externally by the healthcare system. The population density is also extremely low - less than half the US, and the US is extremely low too - and that affects cost to e.g have good hospital coverage and emergency services. Providing service _at all_ in some places is an ongoing challenge, with the Northern regions finding it hard to hire and retain staff despite the tax breaks (for the non-Norwegians: people in the Northernmost regions gets various tax breaks and other benefits such as student debt write- downs to get people to stay/move there)

<comment><USER55> Thanks for the information. Most of what I know about the private system here (Norway) is from language & civics classes - though I hear rumors of tourism as you've mentioned.

</comment></comment></comment></comment><comment><USER57> > There are ways to combat high health care prices. One is an all-payer > system, like that seen in Maryland. This regulates prices so that all > insurers and public programs pay the same amount. A single-payer system > could also regulate prices. If attempted nationally, or even in a state, > either of these would be met with resistance from all those who directly > benefit from high prices, including physicians, hospitals, pharmaceutical > companies — and pretty much every other provider of health care in the > United States.

And then end up like Venezuela has after implementing price controls? How about you let intelligent macroeconomics majors who have spent years in college studying exactly the ideal solution to this predicament give thoughtful and effective solutions. I understand the writer was likely good intentioned, but:

1) The road to hell is paved with good intentions.

2) For every complex problem there is an answer that is clear, simple, and wrong.

While some liberal arts majors have their own theories and hunches to inject on how our world economy should run, a well-studied economist would give the best answer for providing a solution that establishes the perfect price-point between satisfying as much of the medical demand as possible while having a never-extinguished supply of medical care.

A little history: During the great depression, the US implemented price controls on wages; capping the wages. So companies started adding in health coverage in with the job as a perk instead. The great depression was extended and the health insurance in our country has been forever screwed up by that event.

Btw, I'm not pro government or anti-government, left or right. I'm pro-lets- get-the-facts-straight-before-we-jump-to-conclusions-that-affect-the-whole- country. Admitting that you don't know the answer to something goes a long ways.

</comment><comment><USER58> Because it's a business designed to make maximum profit?

</comment><comment><USER59> Because of the fraudulent agents in the insurance, healthcare and government. And the innocent american citizens who nod yes for every crap policy and rule that is thrown at them. Isn't it obvious?

Same medical service costs 10 times less in other countries for same or better quality. Because they have kept the service of a price 1$ as 100$.

We need some disruptor to simply crush the insurance industry.

If you don't take insurance you may become medical bankrupt if somewhere you screw up your health.

They started with 1 $ few decades back and slowly increased and since world has majority of un smart people people collectively couldn't find a just system.

And everyone and every future generation has to pay the price for the mistakes previous generations made.

Its just is hell guys.

</comment><comment><USER60> Simply because it is acceptable to maximize profit from people fears and misery, coupled with shameless politicians that support/bend to the will of the health care mafia with a regulation environment that diffuse any incentive to lower cost

</comment><comment><USER61> "Because it's more expensive" seems like a non-answer to me. Why is it more expensive, and who's getting the money, and what rules are allowing this to take place, and who made those rules? That's what we need to know.

</comment><comment><USER62> the problem is that the people telling you what to do (the healthcare providers / docs) are getting paid to provide services to you. additionally, insurers are not smart enough to communicate the costs and benefits to patients appropriately.

we need a decoupling of the guide (maybe insurers that are actually good) that tells patients what to do next for optimal care and the org that provides the care. that way providers (docs) dont have an incentive to say do more if more isnt helpful

</comment><comment><USER63> It's a simple reason: Monopsony

Power of collective bargaining drives the price down.

The AMA and other collectivizations of providers drive the price up (cartels). That's why becoming a doctor in the USA is such a long and hard ordeal, relative to other countries. And also why litigation is so high.

Oh and of course... THE PATENT SYSTEM causes the USA to pay for most of the innovation that scientists in the redt of the world are prevented from building upon with open source.

<comment><USER64> It's fascinating, and kind of horrifying too. I've of course been a patient, and I saw the initial bill for a neck injury that led to no treatment other than Tylenol - $16,000. My HMO paid about half that, I believe. I was not on the hook for the difference. This is negotiated by contract between the HMO and the hospital. The high bill is the beginning of negotiations between two large and powerful organizations.

Here's the thing - lacking access to good health care in the US is even worse than not being able to pay the bill. It means you get stuck with the higher bill, and no pre-negotiated contract or negotiators to knock it down. I've talked to people who work at hospitals, and they say their billing department may knock it down a bit, but it means that the person not represented by an HMO or similar gets hit not with an $8,000 bill but one much closer to $16,000.

I know I'm supposed to hate my HMO and everything, and they can be irritating, but there's no way I'd want to experience the US medical system as an "independent".

As you said, you're already dealing with a Monopsony. It's worse, because you don't know what they're charging, whether it's important, whether it should be done, none of it. And it is run by something closely resembling a cartel, the AMA and hospitals simply do not operate in anything remotely resembling a free market. I guess my HMO is my government backed cartel. I pay through the nose for the insurance (well, my employer "pays" some of it, but it's all through the employer, so what does it matter the portion that is added to and then deducted from my actual paycheck vs the part that never makes it to my paycheck and is paid on my behalf?). But as a result, I have a powerful cartel on my "side".

When I describe the AMA as a cartel, people often think this means I oppose occupational licensing entirely. No, not necessarily. That's an interesting discussion, but there is _plenty_ of room to criticize the AMA (and other professional and trade licensing bodies). while supporting some limited form of occupational licensing (actually, you could support substantial licensing and still be appalled with the AMA and ABA).

</comment></comment><comment><USER65> I think a lot of it is due to America being so litigious. Doctors and hospitals are afraid of being sued, so they need lots of insurance to protect them, and they order lots of arguably unnecessary tests to cover all their bases. This drives up costs for consumers.

</comment><comment><USER66> My guess:

People with some money will pay through expensive insurance, and everybody else can't pay at all.

This way, pharma and hospitals have near 0 incentive to focus on people with anything less than mid to high tier insurance plans.

And everything else results from that, like regulatory capture by insurance companies and everybody teaming up with them.

Even without draconian restrictions on generic drugs, labour mobility in medical professions, and needlessly elevated standards of care in hospitals for many conditions, medical treatment in US will still be out of reach of majority, and the market will still be skewed towards high tier insurance plan holders.

A more radical, slash and burn reforms will be required by US to reach countries with private, but affordable to masses healthcare.

I can draw a parallel with restaurant or affordable clothing markets in my home country - Russia.

In the centre of Moscow, you have countless fancy restaurants that are nearly always empty. Those ones have $30 average price for a basic meal.

At around 10 km away from the Kremlin, you begin to see rare soup kitchens serving <$1 meals with 100+ people line ups during lunch hours accommodating everybody with less than $2k USD of monthly income.

See, if a fancy restaurant will serve even two customers per hour, it will get more money than a soup kitchen.

The same situation, if not worse goes for affordable apparel. Most people can't afford anything more than an "Abibas" tracksuit for $2, yet you genuinely can't find anything that cheap in Moscow's urban core. Putin ordered the only public market in Moscow serving the masses to be crushed, and its owner prosecuted in a show trial, just out of resent for its existence showing the extend of poverty in the country.

</comment><comment><USER67> This and expensive education as well. Nust take a look at Germany or France you will see free gratis high quality college education. Oh well...

</comment><comment><USER68> Government setting rates for medicare/medicaid reimbursement is what has driven up prices. One of the brilliant aspects of market economics is that, if allowed to operate freely, the market would establish price points for all levels of service. Government involvement is preventing the market from functioning as it should.

</comment><comment><USER69> ..And US is not more healthy than the other advanced nations.

</comment><comment><USER70> that's what subsidies to a private sector do, duh

</comment><comment><USER71> This is a classic american problem - keep throwing money at something until it works.

This conundrum plagues their healthcare, their education, their military, their welfare spending and so on. For example, they spend more on their military than the next 15 highest spending countries combined, and don't get proportionally better results. They spend a lot more on education (per student) than most European countries, but suffer from worse education quality than some developing nations. There is a fundamental problem with how this money gets spent, instead of how much of it is available.

<comment><USER72> I do not understand why insurance companies are not able to or do not wish to exert downward pressure on prices?

<comment><USER73> Their margins are limited by law and the people paying (employers) are mostly price inelastic.

This puts them in a position where they're incentivized for costs to go up, because 15% of $2000 is more than 15% of $1000. In other industries, you'd see insurance companies push back because ultimately consumers will push back and either drop insurance or switch to another provider.

Switching insurance at an employer, though, is a colossal undertaking that is bound to frustrate employees, so often it isn't done. And until recently, individuals would be fined for not having insurance, so dropping insurance wasn't really an option.

If consumers were the ones paying for it, switching weren't a pain to do, and insurance companies weren't incentivized to maximize costs, that'd go a long way toward fixing this.

</comment></comment></comment><comment><USER74> It's not that Americans spend the most, either, but also the fact that unlike other governments, the U.S. government has little incentive to fix national healthcare crisis, especially when Big Pharma benefits from those crisis and lobbyists against the fixes.

In countries where the government foots the bill for healthcare, and healthcare is obviously a big portion of their expenses, the government will usually scramble to do everything it can to improve the population's general health. That includes trying to limit pollution, better regulating the "food" that comes on the market, and so on.

<comment><USER26> > In countries where the government foots the bill for healthcare, and > healthcare is obviously a big portion of their expenses, the government will > usually scramble to do everything it can to improve the population's general > health.

That is actually one of the bigger problems with the single-payer system. Your health is fundamentally related to everything you do, and consequently giving the government an interest in your health opens the doors to monitoring and controlling every aspect of your life in the name of regulating health care costs. In forfeiting the liberty to do things which may negatively impact your health then you become not a free individual, but more akin to the government's pet, your every action subject to their approval.

</comment></comment><comment><USER75> >Why the U.S. Spends So Much More Than Other Nations on Health Care

The conclusion of the article: Because prices are higher.

Seriously?

</comment><comment><USER76> tl;dr: US spends so much more than other nations because US hospitals (and by extension, doctors, which NYT is too chicken to say out loud), keep increasing prices for the same care.

There is nothing here about insurance companies. It's lack of competition on the supply side.

<comment><USER77> There's no competition at all on the supply side in Canada or Taiwan. Why are their health care costs microscopic compared to the US?

<comment><USER76> Because a large single payer fixes prices for most people.

<comment><USER78> Most? Could you specify how someone loses out?

<comment><USER26> Shortages, as with any price ceiling—when someone is willing and able to pay more but there is none available at the fixed price.

</comment></comment></comment></comment></comment><comment><USER79> The US jumped the shark in 1971. A comeback is very unlikely.

After WW2, the US established a system that was used extensively for its own economic advantage: Bretton Woods.

Many countries could use dollars as their reserve currency, and those dollars could be redeemed for gold.

The US abused this system by printing more dollars than what it had in gold, giving rise to the concept of "exorbitant privilege" (virtually unlimited money with no chance of accountability).

This started some sort of bank run and since the US did not have enough gold, Nixon suspended the convertibility of dollars into gold. After that, dollars were allowed to float, and if it wasn't for exclusive deals (e.g: oil), it would have a much lower value.

Now spending on healthcare, education, infrastructure, science, space exploration: all gone.

</comment><comment><USER80> It doesn't spend it on 'other nations'.. it spends the money on US billionaires. 'Other Nations' is just a facade, as it's much easier to loose track of a few billions here and there in a god forsaken country, than it is in the middle of NY. The military industrial complex costs a lost, but a BIG chunk of that money goes to US billionaires. The US population (aka military people) only get their wages paid, everything else is paid directly to Y and Z billionaire's tank/gun/warship/plane/drone/software/encrypted computer/add stuff to this list manufacturer. And these manufacturers buy a lot of politicians' vote to keep the war machine going.

..the same with pharma...

<comment><USER81> Looks like you had so much to say about billionaires that you didn't have time to read the headline.

It doesn't say anything about spending _on_ other nations. The U.S. spends more on health care _of its own citizens_ than other nations do. The system is clearly not very efficient, at least in terms of what it offers to poorer citizens, although at the top end, results are excellent and the U.S. still is in the front lines in research and technological progress of medicine.

<comment><USER82> Depends on what you take the word efficient to mean, even at the top end I don't find medical care very efficient. Basic procedures can be very expensive for my insurance company. I'll define efficient here as results to cost. In the US, there are groups at every level between patient, doctor, insurance and big pharma where often their goal is to create inefficiencies because the less efficient the treatment, the more money make. Look at something like insurance billing codes; I have a friend who's entire business is telling Dr's which codes to book procedures under so they make more money from insurance. His company is make 10s of million a year. There is stuff like that at every level.

<comment><USER83> GP didn't say the top end was efficient, just that their results were excellent.

<comment><USER81> Yes, that was my point.

And I might add that the inefficiency (in terms of national health outcomes vs. national public and private spending) is partially the reason, or explanation, that U.S. is the forefront of medical technology. The U.S. spends on things that develop technology but do not contribute much to national health.

Things like transplants, or cures for rare diseases, are generally not important for national health outcomes, but U.S. does a lot of work on these. You achieve low child mortality by forcing relatively simple things done for every child and family, even those who are not very receptive to care. U.S. does not do that as much as many other countries with lower spending but better national health outcomes.</comment></comment></comment></comment></comment>


Ask PG: please add the option to open links in new window/tab - <AUTHOR>

I'm often frustrated about the fact that links (titles but links in comments as well) open in the same window. Fully aware of the fact that some users actually prefer the current setting, but could you consider making it an option?<p>(and yes, I know I can right-click, use a plugin for chrome/ff/etc, etc etc, but I want it to be the same across all devices I use when logged in)<p>Thanks for listening! <comment><USER2> There are many things which frustrate me. This is not one of them. HN does what pretty much every other link site does, so you must be plenty frustrated. FWIW, control-click / command-click should open in new tab, and is just about as fast as click.</comment>


Hundreds of luxury Vancouver mansions being rented for cheap - <AUTHOR> https://www.ctvnews.ca/canada/why-are-hundreds-of-luxury-vancouver-mansions-being-rented-for-cheap-1.4329800#_gus&_gucid=&_gup=twitter&_gsc=av92XSY <comment><USER2> Seems like the housing tax is working as intended.

The most interesting part is how this is one of the few serious sources of backpressure on rent. Normally landlords are so loathe to reduce rents that they'll let a property sit vacant for months, but this tax makes that extremely painful so they're forced to instead meet the market on rent prices.

<comment><USER3> > Normally landlords are so loathe to reduce rents

What's the reasoning here? I've tried to talk landlords down by less than a month's rent when taken over the course of a typical year lease, been told to shove off, only to watch the unit go unrented for months until they finally drop the price.

<comment><USER4> Something I've heard a landlord argue was that if he lowered his rent that would mean his property value would go down which would mean his loans/mortgages would not be covered. He would rather take a couple months of losses than devalueing his property.

I have no idea if the math works out for that, and he was negotiating, but he didn't budge a cent and we took our business elsewhere so it did seem like his hands were tied the same as your example.

<comment><USER5> I have heard similar arguments from developers in Sydney. They will give you a car, or guaranteed rental income for x months, rather than dropping the price of the property.

</comment></comment></comment></comment><comment><USER6> I have been following [https://twitter.com/mortimer_1](https://twitter.com/mortimer_1) for a bit. He paints a pretty crazy picture with data of what is happening in the Vancouver housing market. People asking millions over assessed value, people selling at massive losses, and mansions renting for pretty cheap.

An example: Bought 2013 $2,275,000 now asking $6,888,000, Bought 2016 $5,200,000 now asking $4,888,888, Bought 2016 $3,590,000 and sold for $3,250,000, etc.

<comment><USER7> [https://twitter.com/vanreflipflops](https://twitter.com/vanreflipflops) is also great for this.

</comment></comment><comment><USER8> Related: "What can/do governments do to address house prices being driven up by foreign investors?" on the Politics StackExchange:

[https://politics.stackexchange.com/q/24073/15531](https://politics.stackexchange.com/q/24073/15531)

</comment><comment><USER9> I once rented a $1.6m mansion apartment in Shenzhen for $500 a month. I guess, Chinese influence...

For some locals, the math behind earning money from property in other ways than resale don't tell them anything. They got too used to the idea of flipping properties at six digit gain every few years.

Naturally, the "measly income" from rent doesn't look much in comparison to that to simply bother thinking about.

<comment><USER10> Do you mean "Chinese influence" like you got the apartment because of guanxi? Or like the situation in Vancouver now is influenced by what you saw in Shenzhen?

<comment><USER9> The second one, and not only Shenzhen, but all of big cities in China.

I often went into long discourses with recent immigrants about that. Their idea of how market work is long pass the level of sane, and rational.

I keep telling them about "investing into a bubble is dumb thing to do" only to be greeted back by some bizarre "economic conspiracy theory."

Most do that on advises of some "esteemed economic gurus" from China.

That looks silly, but only until you you begin to think just how many thousands of multimillion buck properties were bought thanks to such "gurus"

<comment><USER11> Investing in a bubble can be great, as long as you're early enough and not the one holding the bag a† the end.

It's one of the quickest and easiest ways to make money, actually. I wouldn't always call investing into a bubble foolish.

<comment><USER12> If you do well investing into a bubble, it just means you were a lesser fool, rather than the greater one that holds the investment when the bubble pops.

</comment></comment></comment></comment></comment><comment><USER13> I'm sure the fact the Vancouver housing market is rolling over helps in addition to the occupancy tax.

Vancouver sfh prices are down 20% from peak and even more at the top end homes.

In the past you could take the hit from leaving it empty when you were seeing $100-200k appreciation per year.

Not any more!

</comment><comment><USER14> I have a question though. The pictures with the article list the rentals as $1000/room not $1000 for the entire house and the article says that many owners do not want to rent to groups. So this is useless to the single renter. I don't know how the housing activist got his 800 results.

<comment><USER15> I believe what they're saying is that they don't want to rent to you and a bunch of your friends as a group but as an individual you can rent a room and you will be sharing the house with other individuals to whom they rent individual rooms. I'd guess this is because they don't want a big group of students renting the place together and turning it into a frat house.

</comment></comment><comment><USER16> There was a ton of anti-Chinese bashing because they were seen as being the cause of empty homes, and this issue was linked to the housing crisis in Vancouver. But looking at the examples of empty homes, I doubt that the South Surrey place for example was owned by a Chinese owner. It would be interesting to see statistics.

Also, a few hundred or even thousand homes rented to non-groups is hardly going to ease the tight vacancy rate in Vancouver. The housing issue has more to do to poor urban planning.

</comment><comment><USER17> This sounds close to a land value tax. If you look around most US cities you will see a lot of land not being used for housing as compared to European cities. Land used for parking, lawns, roads, and vertical space not filled with bedrooms all contribute to higher rents. True, there are zoning laws that restrict these housing uses, but there is also no encouragement from the tax code. Land value taxes encourage more efficient use of valuable space.

</comment><comment><USER18> We need to tax foreign-owned, non-owner-occupied properties in the San Francisco Bay Area. Some sort of scale:

Foreign Owned, Non-Owner Occupied - 10% Per Year of Assessed Value

Foreign Owned, Non-Occupied - 25% Per Year

Foreign Owned, Owner Occupied - 0% Per year

<comment><USER19> Or, you know, start taxing all properties based on fair market value.

<comment><USER20> True, phasing out prop 13 would help a lot.

<comment><USER18> Agreed! Prop 13 needs to die.

</comment></comment></comment></comment><comment><USER21> Title should be anti-speculator legistlation has intended side effects.

</comment><comment><USER22> It's extremely common for "too good to be true" listings like this on Craigslist to be scams, where if you inquire they'll try to get you to wire money for the rental. The person behind the listing doesn't have any connection to the property, they take the photos/info from legitimate listings on other sites (often real estate listings, not rentals at all).

I'm sure it's possible that some of these listings are legitimate, but finding a bunch of listings on Craigslist isn't proof of anything and I think it's strange to base a story on it.

<comment><USER23> They have an interview with a person that actually moved into a unit, so that helps. Scams can easily be thwarted by asking to see the place in person.

</comment></comment><comment><USER24> Anyone have a list of these mansions that are being rented, google searching isn't showing anything?

Sounds like a place to go for the summer now.

</comment><comment><USER25> > The city of Vancouver is facing a crisis in housing affordability, with one > bedroom units averaging about $1,730 per month.

I'll take that any day over SF. That's a crisis I can sign up for.

<comment><USER26> Yeah but salaries are far lower than SF.

<comment><USER27> Who cares about a bigger salary if most of the difference gets directly deposited in your landlord's bank account?

<comment><USER28> Having 1/3rd of $100k is more spending money than having 1/3rd of $50k. Prices for things that _aren 't_ rent, don't change by market. You can buy more smartphones, donate more money to charity, whatever you want.

</comment></comment></comment></comment><comment><USER29> > a single room in a multi-bedroom house for anywhere between $700 and $1,500

And that's called cheap?

This article is a clickbait ad, IMHO.

<comment><USER30> For Vancouver? Yes, that's cheap. You may only get one bedroom, but you also have shared access to the rest of the luxury mansion. It's not $1500 for one room.

</comment></comment><comment><USER31> I wonder if it has to do.with the new speculator tax in BC for empty homes? Tax season's here. Seems like they're trying to avoid the fairly hefty new tax that would be levied on them for having an empty mansion.

<comment><USER32> The end of the article confirms exactly that point.

<comment><USER31> Yeah...it's pointless though. As soon as they're able to they'll raise the rent or kick them out. That's how shit works here.</comment></comment></comment>


Ten years after the financial crisis, GSE securities have expanded $804B - <AUTHOR> http://creditbubblebulletin.blogspot.com/2018/09/weekly-commentary-approaching-10-year.html <comment><USER2> This is the opposite of surprising and writing scare headlines betrays an extremely shallow understanding of the mortgage market. Simply put, the GSEs were created to underwrite high quality mortgages, in fact they are legally compelled to do so. That's why they exist.

There are more conforming, high quality mortgages than there were in the run up to the financial crisis. You don't hear about zero interest or liar loans any more because they're mostly not available any more. It's a good thing that those products aren't available any more. The average quality of mortgages is much, much higher. The flip side of that is that of course the GSEs have increased the size of their balance sheets: that's exactly what they were designed to do! This is like getting mad at a tree you planted for growing leaves.

<comment><AUTHOR> You're bringing your own interpretation to the headline. I intentionally used impartial words when writing it. I just think it's a noteworthy fact and wanted to see what HN thought about it. Noland (the author of the article) sees it as a bad thing, but that's a different story.

</comment></comment><comment><USER3> GSEs may be bigger but also healthier than before. Though still a huge market, I also think the global OTC derivatives market has become smaller since 2014 (you can check some estimates at the BIS). That being said, it's 10 years after 2008 and there are plenty of signs that we're in the 3rd bubble in 20 years time.

Nosebleed valuations in tech. Second highest Shiller PE in S&P. The median PE of the S&P is higher than in 2001; so it's more broadly carried (can't find source right away).

It's also the age of the ETF, which was a good thing. Except that by now the industry may have created some real beauties. Remember XIV?

Also government bonds; as much as I love Italy, somebody bought the 10yr of that country for a 1% yield in 2016. Somebody also bought those Mexican 100yr bonds.

Even something as silly as Dogecoin's marketcap standing at $600 million suggests that the entire world is in the middle of a speculative binge.

<comment><USER4> It's absolutely crazy bonds are being bought at negative real rates but large sums of money must be parked somewhere by huge funds. Plus they often have bond to equity to commodity to fixed asset mandates so they have to enter what they know to be money losing positions.

<comment><USER3> What's also interesting this time is the relationship between bond markets and modern ETFs.

Especially in Europe, ETFs can be synthetic. In some cases this means they're made up of generic filler material (e.g. German bunds), with some secret hobo spices (derivatives) to provide the ETF's specific flavouring.

Because of 10 years of central bank buying, all these bonds have been priced to perfection for deflationary scenarios. And as the world is mostly calibrated for small, well-announced yield changes, I wonder what an unexpected discontinuous "jerk" in yields would do to such ETFs.

</comment></comment></comment><comment><AUTHOR> I took the $804B figure from this quote:

> It's worth noting that total GSE (MBS and debt) Securities ended Q3 2008 at > $8.070 TN, having about doubled from year 2000. The government agencies were > integral to the mortgage finance Bubble - fundamental to liquidity excess, > pricing distortions (finance and housing), general financial market > misperceptions and the misallocation of resources. GSE Securities did > contract post-crisis, reaching a low of $7.544 TN during Q1 2012. Since > then, with crisis memories fading and new priorities appearing, GSE > Securities expanded $1.341 TN to a record $8.874 TN. Of that growth, $970 > billion has come during the past three years, as financial markets boomed > and the economy gathered momentum. A lesson not learned.

<comment><USER5> The vast majority of bad mortgages from the "crisis" were not GSE conforming mortgages, they were "private label" mortgages by the big banks. Moreover, a huge number of the failed GSE mortages during that era were fraudulently underwritten. Hence the GSE lawsuits that the big banks uniformly lost (actually the banks settled for billions in fines). I really do not understand what "lesson" was not learned. People buy houses. It's silly to have a cash market for such a big asset. Home loans are a thing. Having a regulated entity that provides liquidity into this market and sets minimum standards has greatly reduced transaction costs.

</comment></comment><comment><USER6> The writer correctly identifies the issue as a failure of policy, not markets, so comments that markets are working seem to miss the point.

At a policy level, we are largely powerless to effect any change, simply because the numbers at stake are so huge ($8T US mortgage market, $40T global trade, $80T investment assets) and the control of these so concentrated.

But the flip side is that the Fintech opportunity is so huge, because it can exploit the same economics. Grab the opportunity to build services that offer simple value. Create transparency, empowerment, sharing... and you can do good.

<comment><USER5> failure? How so?

</comment></comment><comment><USER7> The question is - if you think problems from all this are going to occur, what is the place to be in from an investment standpoint? I see a lot of handwringing but not a ton of action and advice.

<comment><USER8> The smart thing to do is liquidate your investments and keep a nice pile of cash ready to reinvest when there is a bailout. And I guarantee you there will be a bailout.

Usually you will hear news of a bailout and the president will come out and tell people everything is okay so buy buy buy!

That's what Bush said a few weeks after the 9/11\. That's what Obama said on the first friday of March 2009. Before the president speaks, the FED chair will give hints as well. I'm too young to remember what happened during the savings and loan crisis of the early 90s but I'm told something similar happened.

Just buy and hold and hold and hold. Crashes tend to be short lived. Recoveries take years and years.

Of course if you are greedy/ambitious, you could try to make money on the way down as well by shorting the market. But that's for the degenerate gamblers. Don't do it as it's nigh impossible to predict when the markets will crash and you may go broke betting against the market.

<comment><USER5> > The smart thing to do is liquidate your investments and keep a nice pile of > cash ready to reinvest when there is a bailout.

Good luck with that plan

<comment><USER3> What's wrong with having a nice pile of cash at this point in time?

</comment></comment></comment></comment><comment><USER9> This word "inflationism" is new to me. Interestingly there doesn't seem to be a clear term for what the US system currently is. It doesn't look like free market capitalism, but on the flip side, nobody can accuse the US of being socialist or communist.

Something is happening where the government is picking winners and losers with their inflation policies. As I enjoy repeating, new money is appearing as measured by the M1/M2 monetary aggregates, and so logically _someone_ has a very happy balance sheet.

<comment><USER3> Yep inflationism :-) Though I prefer Soviet Monetarism.

It's an accurate description of the mindset, up to and including the existence of a whole army of Kremlinologists who specialise in interpreting the tones, nuances and choice of words of the apparat's public statements.

But it's not limited to the US. The effort to increase the size and lower the quality of central bank balance sheets was global. At various times in the last 10 years it was even coordinated. But of course, the special role of the US dollar in the global monetary system ensures that all capital roads still lead to NYC.

</comment></comment><comment><USER10> > _...it seemed natural to presume that American finance might be subsequently > humbled. Not so. American investment banks today eclipse their European > rivals in almost every sense… and the financial centres of New York and > Chicago continue to swell "_

If you're thrown off the horse, stand up, dust yourself off, and get back on that horse.

<comment><USER11> I'd rather shoot the horse and get a cab.</comment></comment>


Motion Stills – Now on Android - <AUTHOR> https://research.googleblog.com/2017/07/motion-stills-now-on-android.html <comment><USER2> I'm confused. Does this imply that photos within this app can be taken similar to 'live photos' \- where a single tap records both a full-res still pic AND a video? Or is this app just for recording stabilized / loopable videos?

I recently switched to iOS after using Android for years and live photos are a huge draw for me. I don't care if they're stabilized or loopable, I just love the context they add in (audio, movement) while also having a still photo.

<comment><USER3> I've got an Android phone and unfortunately no, it's just video, there's no still.

I sorely miss the real Live Photos I had on iOS for the same reasons as you. There are camera apps on Android that do it (like Camera MX) but the UX isn't really comparable and you can't use Motion Stills on stuff taken outside the app.

</comment></comment><comment><USER4> Seems like an productized implementation of Hyperlapse: [https://www.youtube.com/watch?v=SOpwHaQnRSY](https://www.youtube.com/watch?v=SOpwHaQnRSY)

<comment><USER5> [https://play.google.com/store/apps/details?id=com.microsoft....](https://play.google.com/store/apps/details?id=com.microsoft.hyperlapsemobile)

has existed for years

</comment></comment><comment><USER6> I think it's kinda funny that the dreaded Pixel lens flare issue is clearly apparent in the stabilization demo.

</comment><comment><USER7> The UI on this is pretty novel for an Android app; a longtime Android dev I usually get pretty pissy about UIs that feel too 'iOS'y but this one does a pretty good job of feeling 'fresh' instead of just like another iOS port. The stabilization stuff is pretty good too.

</comment><comment><USER8> I'm assuming the GIF showing a phone taking a Motion Still was itself made using Motion Stills. Fun.

</comment><comment><USER9> The camera app I truly miss on Android is Instagram's Hyperlapse. They should make it happen!

</comment><comment><USER10> > _In order to display your Motion Stills stream immediately, our algorithm > computes and stores the necessary stabilizing transformation as a low > resolution texture map. We leverage this texture to apply the stabilization > transform using the GPU in real-time during playback, instead of writing a > new, stabilized video that would tax your mobile hardware and battery._

But doesn't this mean videos can only be shared/viewed within the app? How does one share videos with users that are not on Android 5.1+ then (and who therefore can't even install the app)?

<comment><USER11> I think the keyword is

>> "immediately"

The GPU texture mapping thing is the strategy employed for immediate feedback in the app. The stabilized video can still be rendered to a file in the background (and/or while plugged in) later.

</comment></comment><comment><USER12> So I hadn't heard of this and I thought the name was for taking a still photo from a video. Sadly, that's not what this does, so does anybody know a good solution that does this?

It's 2017, I feel like "hit spacebar in VLC and screenshot" is a really poor way of extracting still images from video. So what is the highest-quality way to extract a still from a video?

<comment><USER13> Photoshop can extract frames from a video, from which you can save animated gifs or just single frame stills.

Premiere or Final Cut can easily export single frames as stills.

As for doing it with free tools, I don't know, but I wouldn't be surprised if there are a number of good ways.

</comment></comment><comment><USER14> It's a good thing this is getting supported on non-Apple platforms too. In time, maybe they'll all get common formats, and then we'll all have the same stuff again.

This isn't about 'stealing' or who 'came first', it's about everyone getting everything.

<comment><USER15> This is not the same thing, though. I hope you realize. This is not bringing Live Photos to Android nor allowing cross-platform playback.

It's just giving Android users a handy app to loop videos.

</comment></comment><comment><USER16> Whatever happened to that gimmick where an image from both the front and rear cameras was saved?

<comment><USER17> I can do that on my phone. Samsung allows you to download modes for the camera. One of those is dual camera. It's fun sometimes.

</comment></comment><comment><USER18> I texted a GIF from my Pixel and it was really blocky, even at the highest setting. It doesn't look bad during playback or when uploaded to Photos though.

Is this an MMS issue or something?

<comment><USER17> I just used it on my S7 and shared it on whatsapp: looks very high quality to me. You can try changing the gif quality from settings, although the default worked fine for me.

<comment><USER18> I tried at the medium (default) and highest. Oddly enough the highest quality setting was the most blocky so I'm guessing the MMS or Pixel->Iphone text did something weird?

Either way, the app is neat and I think this is just an artifact in the MMS stage rather than the files.

</comment></comment></comment><comment><USER19> I'm wondering how it competes with the stabilization algorithm available in the default video editor for Nexus/Pixel (is it in the Google Camera app for other devices?).

</comment><comment><USER20> I find it so weird that an oxymoron is accepted as product name.

<comment><USER21> I think that's the idea.

<comment><USER20> I'm sure it is

</comment></comment></comment><comment><USER22> "We listened to your feedback and today, we're excited to announce" \- doesn't anyone have a functioning cliche detector anymore? Maybe my ears are oversensitive but I find this kind of bilge insincere and off-putting. Is it a UK vs US thing? Or am I just getting cranky in old age?

<comment><USER23> As a product manager who writes sentences just like these, genuine question -- what would you prefer instead?

Let's say this has been by far the #1 app request for the past year, and the reason you've built it is literally because it's what people have been asking for. And as a team, you're actually excited to ship it after months and months of development.

Really curious how else to phrase it? Without sounding immature or unprofessional ("it's here WOOT!") -- or too self-absorbed ("Drum roll please...").

<comment><USER24> "This has been by far our #1 request for the past year. It's been a long haul and we're very proud of what we've put together. We think you're going to like it."

<comment><USER25> How is this meaningfully different, other than the fact that your statement takes twice as many words to express the same thing?

<comment><USER24> It doesn't contain the horrendously-overused word "excited".

<comment><USER26> But it does contain the highly annoying and redundant -"We think you are going to like it"

Which both annoys me because you are telling me how I should feel and it's a new feature what other emotion are you hoping for in a customer.</comment></comment></comment></comment></comment></comment>


Rise of Bitcoin Competitor Ripple Creates Wealth to Rival Zuckerberg - <AUTHOR> https://www.nytimes.com/2018/01/04/technology/bitcoin-ripple.html?module=WatchingPortal&region=c-column-middle-span-region&pgType=Homepage&action=click&mediaId=thumb_square&state=standard&contentPlacement=12&version=internal&contentCollection=www.nytimes.com&contentId=https%3A%2F%2Fwww.nytimes.com%2F2018%2F01%2F04%2Ftechnology%2Fbitcoin-ripple.html&eventName=Watching-article-click <comment><USER2> I thought I missed out on bitcoin. Clearly what I really missed out on is making my own block-chain currency. Who wants some ShaneCoin?</comment>


Hans Litten - The Man Who Crossed Hitler - <AUTHOR> http://en.wikipedia.org/wiki/Hans_Litten

<comment><USER2> Thank you for posting this. I somehow managed to never hear of this man.</comment>


The Cloud is a Lie - <AUTHOR> http://www.snipe.net/2010/03/the-cloud-is-a-lie/ <comment><USER2> It seems the author is unaware of the multitude of managed vps and dedicated server options out there that would be a perfect fit for his needs. But I tend to agree with his general point about cloud services not fulfilling promises of performance. The general logic of what it's supposed to be is sound, but it just seems that no one has figured out how to really optimize it.

<comment><USER3> I am aware of VPS/Dedicated server options, and addressed that in my comments. They're a good fit for me personally, but not for my company, whose clients want to see long lists of well-known clients for their hosts. Rackspace has that, but their only managed solution other than a dedicated managed server is the cloud. Media Temple also has an impressive client list, but it's the same boat.

I'm just frustrated that I have to considering moving 100 sites _again_ when I just went through this a year ago, specifically because the one thing the cloud keeps promising is performance and scalabilty and that's the one thing is sucks the most at. Its amazing to me that more people haven't called bullshit on it.

Fabulously, we only have a few sites on the box at work, so moving them will be easy enough. We're on a managed dedicated box at The Planet, which has been okay but not ideal. My own personal server, for which an impressive client liist is less important, has a huge pile of sites that will take forever to move. Again.

Also, s/his/her/.</comment></comment>


Shenzhen Tech Girl Naomi Wu, Part 3: Defunding, Deplatforming, and Detention - <AUTHOR> https://medium.com/@therealsexycyborg/shenzhen-tech-girl-naomi-wu-part-3-defunding-deplatforming-and-detention-140fed4b9554 <comment><USER2> Some high points of the admittedly not very concise post:

> The [US show] Patriot Act included the footage in such a way as to make it > appears I was a willing participant in a video attacking Chinese leadership. > [..] Unsurprisingly, sometime after this, while near my home I was placed > into a police van and detained.

> This got me noticed by some Chinese tech companies who were willing to offer > some sponsorships to help make up what I had lost when Vice Magazine's > lawyers got my Patreon account closed. [1]

> Unfortunately, once you have the tool and can use it with impunity, without > the person being targeted being able to prove anything, of course, it will > be abused to protect the powerful and influential. This has happened every > time I have called out the New York Times for theft of my content- suddenly > my YouTube videos are no longer recommended and my channel starts to die, > even if there is no video posted even remotely controversial.

[1] [https://www.reddit.com/r/KotakuInAction/comments/898na9/vice...](https://www.reddit.com/r/KotakuInAction/comments/898na9/vice_gets_patreon_to_remove_naomi_wu_who_blasted/)</comment>


Rate my (friends) idea - Simple Ipad Stand - <AUTHOR> http://www.simpleipadstand.com

<comment><AUTHOR> My friend @kevmoss came up with the idea for the stand and is giving it away via a CC licence and/or selling the final product via a cool 'makers' service - ponoko.com. Pretty cool tech there!

Any tips / feedback from the HN community would be really appreciated, thanks!</comment>


Ask HN: Can someone explain the economics of AppSumo from founder's perspective? - <AUTHOR>

I keep getting these awesome deal emails - that if I were interested I would get them, about various webapps.
Buy 1 month, and get 6 months free, or pay $49 and get 10 apps in 1.
I would love to hear some real data from people that have listed their app with AppSumo and what the results have been like. What does your Acquistion Cost per Customer look like, in comparison to other channels (say Facebook, Google Adsense, etc.)?
Also, what is the rationale behind it ? Do you only do the buy 1 month, get 6 month deals when you know your Lifetime Value/customer is much longer than 6 months ?
What metrics would I want to look at, from the founder's perspective, before deciding what type of deal to run, and whether or not it makes sense ?
I understand how this could work for downloaded software, because the marginal costs per license is effectively 0. But for hosted web apps, kinda trying to get some real data about that.
Thanks. <comment><USER2> The marginal cost per license for hosted apps is also almost 0, for many Saas apps.

<comment><USER3> The cost of hosting a new customer might be almost 0, but the cost of customer acquisition is anything but. That's what AppSumo is presumably helping with. It's an advertising platform, much like Groupon.

<comment><AUTHOR> That's what I am trying to figure out...how good are they at doing this.</comment></comment></comment>


Ask HN: What features would you like to see in Email? - <AUTHOR>

We're developing a web-based mail client which is currently integrated with Gmail. Was wondering if there are features not currently available in Gmail or your typical email setup that you would like to see.
Our current direction is aimed at simplifying email and how it's used (aka Facebook messages). We also want to speed up the way you find emails through UI simplications.
Thanks for any suggestions. <comment><USER2> I'd like to see mail clients disappear from production ... or if people insist on making them make them simple ... build one that does what chrome first did as a browser.

Make it get out of the way. We do not want to see it we want it to work. Plain and simple no "extra functionality" that we did not ask for. have it simply interface with things we already use, whether that be services or websites and have it let us get back to our work faster.

As it stands email is what drags productivity down in a lot of offices and that is not what it was meant for, integrate your system where we can read and respond no matter what computer we're on or operating system we're running quickly and then get out of our way so we can go back to our tasks.

maybe features that will alert us to emails from certain users with a pop up while not alerting us of others where we know the mail will be less important.

just a few thoughts, there is tons more I could say here but I'm sure most people could care less what I think. hope that helps with your research

<comment><AUTHOR> I agree. Our aim is not to create just another mail client with extra features but to innovate the way people interface email entirely.

The type of innovation I'm talking about is analogous to what Facebook has done with messages. We're not taking this exact approach _but_ we are looking at doing similar types of simplifications.

</comment></comment><comment><USER3> I'd love to see "non-email" things living in the inbox.

I'd receive or could create a new Google doc, a wiki, a blank 'pastebin' type document, a Google Wave type thing, etc. It would sit in my inbox, exactly like an email. But clicking the subject would load the new type of file right there rather than take me to an email.

I don't want links/notifications of the new service, I want to click on an 'email' in my inbox and have it instead load the other service, right there. Does that make sense?

<comment><AUTHOR> Interesting idea. So the rows in your inbox would also function as links to other kind of objects instead of just using them to open an email.

It would certainly make getting at the content inside an email faster. This would mean you'd have to put enough smarts in the email parser to determine what kind of content is inside the email and then take the appropriate action.

<comment><USER3> Yeah, exactly what I mean. Rows in the inbox = links to a type of content.

This is in my opinion why Google Wave failed. No one wants another inbox to check. But, instead of an email, having the option to send a "super email" with advanced features? And right from your same email inbox? Yes please.

</comment></comment></comment><comment><USER4> I had an email idea before- don't know if this might help.

It was to create a tagging system where you would tag the emails you find important with words of your own choosing. For example, if you get a lot of dinner invites, and you need to find a specific one- it helps tagging that email as Mary, Japanese festival, banana to show results that filter out those keywords

</comment><comment><USER5> Blackberry's have a simple feature that shows when a text has been opened/viewed by the recipient. Genius - I would love to see this in email.

</comment><comment><USER6> I wish I could add notes to an email and while searching my mailbox also have the option to search my notes add to a message.</comment>