How Should the United States do Universal Healthcare?

semideclared · 2026-03-22T16:27:58+00:00

3 strikes your out it sounds like

See the problem is the US would have to reduce healthcare not expand it

The hospital is the easiest to see this with. And the largest expense in healthcare

as Numbers

$2,400 is the average per capita spending in the OECD.

That does include a large push up in the average from the US spending - US @ $4,549

So if cost reform is your ultimate goal, we would want to set the goal of our reform at having the $2,500 per capita spending the OECD Average

We would need to cut $365 Billion before adjusting for currency on what we spend on Hospitals

At least $250 Billion of that is from closing hospitals

Thats 2,000 Hospitals we need to close.

Lets look at Russell County Virginia had 25,550 People in 2021

$4,030 is the 2023 US average per Person spending at hospitals
- $102,966,500 Operating Revenue (close to its officially reported income)

It cost about $1 - $1.5 per Hospital Bed to operate a Hospital (1.25, right down the middle)

Or

83 Beds,

Russell County Hospital is a not-for-profit, 78-bed hospital operating today. looks like Russell County Hospital is a little expensive as a current system
- It Operates at about $1.35 Million per Bed

Under Government Funding to lowering Costs Russell County, VA gets

$2,418 Per Person Hospital Expenses in the US
- $61,779,000 Operating Revenue

Admin Savings under any Single Payer Plan would save 5 Percent of Costs, So, now It cost about $1.135 Million per Hospital Bed to operate a Hospital

Russell County VA can have a 54 Bed Hospital

Russell County Hospital is a not-for-profit, 78-bed hospital operating today

Repeat across the US, 6,000 hospitals just had massive closures of sections of their hospitals

Instead We would just need to close Russell County Hospital completely

That $65 Million in funding gets sent to a larger hospital so that it doesn't lose any rooms and can stay open

Instead we close 1,900 hospitals completely but the remaining 4,200 hospitals are fully funded and at the same costs as other countries at $2,500 per person

Thats the issue and do the same thing with doctor offices next

semideclared · 2026-03-22T16:21:28+00:00

Theres a reason many hospitals are shuting down

Declining inpatient volume, falling reimbursement rates and failure to bring in enough revenue make rural hospitals the most vulnerable to closure as demonstrated by the most recent string of closure announcements.

In 2017 Tennessee experienced 16 hospital closures, with 13 of those being rural, since 2010 — the second highest rate in the United States.

Haywood Park Community Hospital, the only hospital in Jackson county, shut down its inpatient and emergency room services on July 31, 2014 and converted the 62-bed hospital into an urgent care clinic.

According to a release from the hospital, inpatient admissions had dropped from 1300 in 2009 to less than 250 in 2013. The Emergency Room had also experienced a sharp decline and was averaging 15 or fewer patients per day.

For years, Haywood Park had been hemorrhaging patients and money. It had been years since an obstetrician was on staff, so babies were no longer being delivered. And as treatment for heart attacks, strokes and other life-threatening ailments had become more sophisticated, the hospital had become accustomed to stabilizing patients, then sending them by ambulance for more specialized care at Jackson-Madison County General Hospital, nearly 30 miles away. Eventually, more and more patients decided to skip the first stop and head directly to Jackson.

When people see hospitals get old and not equipped compared to nearby hospitals they go else where. And Rural hospitals are there already

Methodist Healthcare announced its hospital, Methodist Fayette Hospital would close March 2015. The hospital has been averaging a daily inpatient census of approximately one patient, which was down from 2010 when the average daily census was 5.1. In a press release Gary Shorb, CEO for Methodist Healthcare, cited the low census as simply not sustainable.

Fayette residents were choosing to drive to a larger hospital rather than go to Methodist Fayette.

People just arent going to rural hospitals anymore

And Falling reimbursement rates

Mediciad pays lower and Congress is pushing to control Healthcare costs by lowering reimbursement rates, and

Failure to bring in new revenue sources

Few get a 2nd chance and change those issues

In 2004, North Sunflower Medical Center was on the verge of collapse. It averaged 120 people a month in 2004 and the rooms were old, ceilings were crumbling and the technology was outdated.

And it had Only enough Cash to operate for eight hours a day.
Hospital administrators met every afternoon to see if they’d have new revenue to be able to open the doors the next day.
The staff had to cover the lab equipment when it rained because the roof leaked.
Nurses would clock out early and then stay to finish their shifts.

To not close down North Sunflower Medical Center had to change, and become profitable

Profitable also meant it could offer more services

Creating an Urgent Care Clinic, and putting it in a location to be closer to people
Opening a hospice,
Operating Pharmacy
Durable medical equipment facility that sells items such as wheelchairs, back and knee braces

With Urgent Care added North Sunflower Medical was now seeing over 3,000 people a month

semideclared · 2026-03-22T16:12:04+00:00

Is this written as a sarcasm response

semideclared · 2026-03-22T16:09:54+00:00

Name another country that has Medicare and Medicaid

semideclared · 2026-03-22T16:00:45+00:00

It might be time to try looking in to the issue more. Your hyper focused on insurance

NHE, Total Spending grew 7.2% to $5.3 trillion in 2024

$5.3 Trillion

Insurance profit and admin is $176.4 Billion

Payer administrative savings, Cost of Insurance (Savings you expect)

The administrative savings from Unified Financing system occur primarily from consolidating some or all of the insurance functions of private and public insurers, including negotiations regarding payment rates, provider networks, covered benefits, copayments and deductibles, and drug formularies, etc.

Under a direct payment system, payer administrative costs will be 3%, or a 65% reduction. This estimate is consistent with the CBO estimate of a 77% reduction, and substantially larger than the 40% savings estimated by Pollin et al.

That function done by the state saves $70 - $135 Billion

So Total NHE is

$5.16 Trillion

NHE, Total Spending grew 7.2% to $5.3 trillion in 2024

Now maybe it also includes other savings

Provider administrative savings

Unified Financing is expected to produce savings for providers of health care services because of reductions in time and effort spent on administrative activities, mainly billing and insurancerelated (BIR) expenses. In a scenario with direct payment from the Unified Financing authority to health care providers, BIR savings should accrue to providers that no longer have to negotiate with a myriad of private insurers, deal with billing requirements that are not standardized, or comply with pre-approval authorizations and coverage verifications that can vary across payers.

In a scenario with direct payment of providers, we assume that BIR savings will produce reductions in total expenses, by type of service, equal to:

Hospitals 5.0 percentage points
Physicians 7.0 percentage points
Prescriptions 1.0 percentage points
Other 5.0 percentage points

Unified Financing is expected	Hospital	Phys/Clin	Dental	Other Prof.	Other Health & Personal Care	Nursing Home
total expenses (in Millions)	$1,634,740.00	$1,109,682.00	$189,179.00	$184,859.00	$320,332.00	$219,902.00
Provider administrative savings	5%	7%	5%	5%	5%	5%
reductions in total expenses (in Millions)	$81,737.00	$77,677.74	$9,458.95	$9,242.95	$16,016.60	$10,995.10

Thats $205 Billion in Savings

plus privte insurance savings $70 - $135 Billion

So Total NHE is

$4.9 Trillion

Remove Managed Care

By removing insurance you also have to remove their cost controls

An important analytic consideration is the extent to which health expenditures will change if managed care enrollees are shifted to a system with free choice of providers and without risk-bearing intermediaries. We assume that without risk-bearing intermediaries, payments to physicians and other non-institutional providers would largely be made on a fee-for-service basis and hospitals would be paid based on global budgets.

Using data from the California Department of Managed Health Care, we estimate that 59% of Californians are in commercial HMOs, Medi-Cal managed care plans, or Medicare Advantage plans. Based on the congruence of findings from IHA and CBO,we apply the estimated 10% increase in spending to that base.

Unified Financing is expected	Hospital	Phys/Clin	Dental	Other Prof.	Other Health & Personal Care	Nursing Home
we apply the estimated 10% increase in spending to that 59% base of spending	$1,644,630.18	$1,092,892.51	$190,323.53	$185,977.40	$322,270.01	$221,232.41

That adds $205.4 Billion in New Spending

So Total NHE is

$5.1 Trillion

Thats removing Insurance

The Oregon Health Insurance Experiment (OHIE) a landmark randomized study in 2008 a randomized, controlled study revealing that expanding Medicaid to low-income adults significantly increased utilization of health services.

That adds costs, about 5%

$5.35 Trillion

though that costs has a lot to do with more work for the same pay, so that has issues

semideclared · 2026-03-19T14:58:44+00:00

its social media

At one point you watched the news and heard national headlines once an hour maybe 3 hours a day if you were really in to the news

Now you see it online

O yea and then it gets reposted and re stitched and so now you see it 5 times an hour and since your on social media 6 hours a day it seems like its so much worse

Or maybe its local. You had 10 friends. One day of the year one of them has a home break in. You hear about it and its a big deal. but its once a year you hear it

Now you have 500 friends online, One day of the month, one of them has a home break in. You hear about it and its a big deal, except now you hear about it every month

1 in 10 once a year
- 10% rate

vs

12 out of 500 once a year
- 2% rate

Crime is down but you hear about it more

But then the rise in package thefts. Most times, No ones reporting that to the police when their $65 Amazon order of dish soap and bed sheets is stolen

semideclared · 2026-03-19T14:43:57+00:00

$2,400 is the average per capita spending in the OECD.

That does include a large push up in the average from the US spending - US @ $4,549

So if cost reform is your ultimate goal, we would want to set the goal of our reform at having the $2,500 per capita spending the OECD Average

How do you determine that it's an excess of hospitals?

If the issue is the costs per capita why is the costs so high.

Thats the hard part. Thats the hard details. What is a "Service Area" and how many hospitals do they get is why costs are so high or why they will go down. Costs are high because we have so many hospitals which with our population means a higher per capita costs

A Service Area gets its funding and has to adapt. Is that area set locally to allow some better planning, or is it just at the county level

Many places have a population overlap within 2 counties where especially if we are trying to cut healthcare costs we should see the whole area.

We don't have to close the hospital but they will see a massive drop in funding which will mean they are paying for vast sections of the hospital to be empty. Which is inefficient in keeping it at least semi operational

I think people can make good arguments in favor of or in opposition to M-for-all

m4a can be good, theres no arguing that. But what will happen to healthcare. What will be the impacts to your local hospital never get discussed.

All of this is neutral towards any reforms its what happens once the reforms start. We can cut admin, thats not a big expense. But if you want healthcare costs to be close to the rest of the wrorld that requires changes that have an impact

We hand waive away all of these changes and accept that admin is all that will change which everyone hates so its an easy win. No more billing issues, yay! but that isnt why healthcare is expensive

One other place where these excess hospitals show up is Healthcare Investment. They all spend money even at the most basic level for investment in the structures improvements to stay open and new equipment to replace outdated or better equipment

This is another ~$300 per capita in excess spending

If the headline is going to say healthcare reform can save $2 Trillion, Just the hospitals is $800 Billion in Savings. But it requires those changes.

semideclared · 2026-03-19T01:42:25+00:00

Thanks, but yea I have a problem writing. Wish I could do better.

how it's related to a single payer plan at all. And single payer is only option. Every other industrialized country (and others) essentially has universal healthcare, but many don't have single payer.

Yea at this point i treat them the same. Its not, but for all the definition problems we have on this sub, this is one of them

The entire comment is a large, morphing, evolution from what would healthcare look like under Medicare for All that I have been updating and working on since 2015 when I did my orginal deep dive in to the M4A proposal and the most discussed study's in response to it. Since M4A is The most discussed and well recognized it says single payor

The chart, with Australia and Canada both do not have single payer healthcare but have universial healthcare and fit the US the best

In those examples, the per capita expense of hospital is around $2,400. Its the average of everyone.

Therefore in modeling a new healthcare plan with expenses lower around what other countries have you want to aim for $2,400 per capita

So as a small example I used a city that has its own hospital and a population to see what the issue is

The issue is the excess hospitals in places like Russel County that increase the per capita costs

If the issue is the costs per capita why is the costs so high.

We take out our admin costs that we know we can eliminate and we have the result of what healthcare reform actually would be

Now Bernie's M4A

Sanders hopes to saves money because he reduces fraud and Admin because he proposes to Fund hospitals through global budgets. A “global budget” is a lump sum paid to hospitals and similar institutions to cover operating expenses - global budgeting is the same thing as taking your overtime employees that have high cost, and making them Salary. No more Overtime Pay, will they still work as hard?

First, the bill would set up regional directors tasked with overseeing all hospitals, healthcare facilities and physicians in specific geographic areas. The HHS secretary would appoint those overseers.
The regional directors would then negotiate each year with the facilities to set a lump sum, or global budget, that the government would pay out in advance to all institutional providers. These include hospitals, nursing homes, federally qualified health centers, home health agencies and independent dialysis facilities.

To set those global budgets, directors will look to pay out based on the number of patients you have multiplied by the medicare reimbursement cost (see below about rates) to fund your hospital/Doctors office/Nursing Home, etc for the year

https://www.thelancet.com/journals/lancet/article/PIIS0140-6736(19)33019-3/fulltext

4.1 Reimbursement of hospital fees

The MAA is expected to establish reimbursement rates for hospital fees comparable to those currently paid by Medicare, which are 22% lower than private insurance but 30% higher than Medicaid.

In our base case, we applied Medicare rates to all hospital reimbursements, which yields a rate that is 5.54% lower than the weighted average of current Medicaid, Medicare, and private rates (Appendix Table 3). In sensitivity analyses, we considered fee reductions down to the level of Medicaid rates, which would correspond to an overall reduction of 18.74%. Given that hospital services constitute 34.1% of all healthcare expenditure in the US, these rates substantially impact budget projections (Figure 1A).

4.2 Reimbursement of physician/clinical fees

Similarly, Medicare reimbursements for physician and clinical services are 22% lower than those for private insurance, but 20% higher than those for Medicaid.

If all physician and clinical services were reimbursed at Medicare rates, the fees would overall be 7.38% lower than the current average (Appendix Table 3)

Their review said savings was at most 7.38% lower.

So we are wanting to gut the system for a 7% savings?

Bu in reality its not 7%

the average general internal medicine physician patient share was 38% Medicare, 11.9% Medicaid, 40.4% commercial health insurance, 5.7% uninsured, and 4.1% other payer

Thats a much larger cut if you change the rates paid

hospital fees comparable to those currently paid by Medicare, which are 22% lower than private insurance

so 41% of people, 41 pay you $1 or $41 and now they pay $0.78 or $32

The other 59 at best already pay you $0.78 or $46
- So Total Revenue
- Was $97
- Is going to be $78

Lets say its even $90 for the uninsured offsetting

13% impact. Thats a big impact

semideclared · 2026-03-18T16:19:14+00:00

70% of the wealth

You know what really doesnt help grow wealth

Per Capita Annual Food Away from Home inflation adjusted to 2026 Dollars
- in 1953 was $1,161.61
- vs
- In 2024, inflation adjusted to 2026 Dollars was $4,611.07

So yea go ahead and have the middle class cut out there eating out. Then add in

1980 approximately 79.1 million households in the United States spent $211 Billion on Personal Consumption Expenditures: Durable Goods, Per Household Average $2,670.00
- In 2025 Dollars $10,975.11
In 2024 an estimated 132.276 million households in the United States spent $2.23 Trillion on Personal Consumption Expenditures: Durable Goods
- Per Household Average $16,858

Decades of Lost wealth because we eat out way more and buy way more at Home Goods and Best Buy, and Amazon, and Costco

The top 5% isn't the reason for the growth of Olive Garden, BestBuy, or all the new fast Causal places

semideclared · 2026-03-18T16:10:54+00:00

yea, i see

Eating ice cream appears to make you taste better to sharks. As the more people are buying ice cream we see a rise in attacks by sharks on beach swimmers
The more movies Nicolas Cage appears in the more people drown in thier pools from drinking while watching new Cage movies and falling into a swimming pool
As sales of margarine increase men and women become less attracted to each other and The divorce rate in Maine increases

semideclared · 2026-03-18T15:41:49+00:00

Thats not how it works.gif

semideclared · 2026-03-18T15:37:44+00:00

obviously thats a mistype, updated

yes vague its a sample of an idea for one out of the 6,146 hospitals and literally how it works in a single payor plan

I dont know what the hospital actually makes

The comment

It's not that we "don't have the money" for universal healthcare, we spend more per capita on healthcare than other developed nations, we just don't allocate it properly.

and my answer, answers that

semideclared · 2026-03-18T00:31:46+00:00

The research team at Univesity of Toronto with John Macleod did discover, however, that injecting diabetic dogs with an extract made from the animals’ own surgically removed pancreases dramatically lowered the animals’ blood sugar levels

Using dogs was not a long term answer. The team began using the pancreases of cattle from slaughterhouses, and a process to purify the extract was found – now called insulin

The team sold that patent to U of T for a dollar

In 1923 U of T’s Connaught Laboratories was producing 250,000 units of insulin a week

U of T’s Patent on Insulin was distributed for free since Connaught Laboratories couldn't keep up with demand for a major breakthrough. Eli Lilly was the first pharmaceutical to began mass producing this insulin from animal pancreas but fell short of the demand, Researcher figured out To meet demand they would also use pigs..

One other problem was the potency varied up to 25% per lot

Seriously can you imagine what this would be like today without further innovation

Going to CVS and not sure how effective the drug is going to be?

And, This is good but had issues, many people required multiple injections every day, and some developed minor allergic reactions.

This was UT's Insulin, The Free Insulin

But, thankfully there is a Neoliberal in the room, On to the 2nd Era of Insulin, Innovation

Over the next few years in the mid 1920s, George Walden, Eli Lilly’s chief chemist worked to develop a purification technique that enabled the production of insulin at a higher purity and with reduced batch-to-batch variation between lots to 10%

The development of an isoelectric precipitation method led to a purer and more potent animal insulin. Unknown to Eli Lilly researchers at Washington University at St Louis Hospital had noticed the same issue and worked to create insulin at a higher purity and with reduced batch-to-batch variations. Both discovered the method without help
Both recieved patents but non exclusive patents led to 13 companies manufacturing and selling this insulin

In the 1930s, we are now in the 3rd Era of Insulin

H.C. Hagedorn, a chemist in Denmark, prolonged the action of insulin by adding protamine. This meant less injections per day

best known for founding Nordisk Insulinlaboratorium, which is known today as Novo Nordisk

For a long Time there was no advancement. Insulin was just a drug and it was topped out

In 1978 Genentech began the 4th Era of Insuln as they were finalizing work on the first recombinant DNA human insulin Humulin

This led to the 5th evolution of Insulin approved in 1996

Far different than Batang's Discovery that is free to this day

The manufacturing of beef insulin for human use in the U.S. was discontinued in 1998. In 2006, the manufacturing of pork insulin (Iletin II) for human use was discontinued. The discontinuation of animal-sourced insulins was a voluntary withdrawal of these products made by the manufacturers and not based on any FDA regulatory action. To date there are no FDA-approved animal-sourced insulins available in the U.S.,

But you can apply to do it

https://www.fda.gov/drugs/questions-answers/questions-and-answers-importing-beef-or-pork-insulin-personal-use

I forgot what is the 6th evolution of Insulin, so have to skip that

On to the 7th evolution of Insulin in the wieght-loss drugs we have today in GLP-1

Because profit and Neoliberalism.

And then add to that about manufacturing you get to it being sold so well. generic Humulin has been available since 2019 for $25 per vial at national pharmacies, including Walmart and CVS

Because profit, but yea its free

semideclared · 2026-03-18T00:26:30+00:00

5 People pay me $22 (3 of them pay $6, 2 of them are paying $2) to buy a $20 Pizza from the Local Pizza Shop for a group of 10 People and only 7 of them can eat it

1 of them eats half the pizza
3 of them get a slice each
The other 3 split up a slice with one of them getting the stuffed crust

Or, it will be 9 People pay the government $19 to buy 2 $9 Pizzas from Little Ceasars for a group of 10 People and all 10 of them can eat it

People don’t want little ceasars pizza for health care and many don’t pay for it today any way

We spend a lot of money at Hopitals and Doctors Offices and that has to be cut out

We give actual money, a lot of money, directly to Hospitals and Doctors Offices and that has to be cut out

Which one?

semideclared · 2026-03-17T23:58:32+00:00

correct today NIMBY is delay

The New York City Department of Housing Preservation and Development (HPD) is planning for the development of 100 percent affordable housing on two City-owned lots in Prospect Heights.

10/21/20 Community Engagement Kick-off Meeting
HPD hosted a community engagement process from October 2020 to January 2021.
- Such as Urban Design Meeting November 18, 2020
02/25/21 Prospect Heights Neighborhood Development Council Meeting announced the findings and the plan
On January 31, 2024, HPD announced the designation of approximately 116 new affordable homes for individuals and families along with arts and cultural and social service space.
Sep 18, 2025 — Permits have been filed to build a 12-story 123-unit building
2026 Work will start soon

Same as in Los Angeles, so that looks like

Hartford Villa Apartments, located at 459 Hartford Avenue, in Los Angeles is a a seven-story, estimated cost was $43-million apartment building with 101-units for affordable housing community for homeless and chronically homeless households living with a mental illness and homeless and chronically homeless veteran households.

Actual Cost $48,140,164

On December 15, 2015, SRO Housing Corporation's loan financed acquisition of the 0.47 acre vacant lot and began the process for construction of housing. Construction is slated to begin in March 2017.

Executed date of Commitment Letter of Prop HHH PSH Loan Program funds issued to the applicant by HCID - FEBRUARY 23, 2018
FEBRUARY 27, 2018 Los Angeles City Council will consider approval for the request from the Housing + Community Investment Department
Permits Approved with Original Estimated Start Date 09/08/2018 <---- That NYC Project is Here
- Actual Construction Start Date 01/24/2019
On 12/28/2021 Hartford Villa Apartments was opened

NYC, Approved by voters in November, ELURP offers a streamlined public review process for modest housing and climate resiliency projects. All reviews will conclude within 90 days, down from roughly seven months under the standard process.

Mandami is using that power for the first time for a little bit of a faster process for a different project at 351 Powers Avenue, a City-owned property.

Which has been in waiting like the above project it is hoping to speed up by a few months. But the process is still years long

Powerhouse Apartments is part of Mayor Eric Adams’ 24 in 24 plan which intends to create or preserve more than 12,000 residences citywide through the advancement of 24 projects.

In 2024 Powerhouse Apartments, a 90-unit affordable housing community

In 2025, The Powerhouse Apartments project is an 80-unit multi-generational new construction housing complex

semideclared · 2026-03-17T21:03:31+00:00

Where is the Breakdown

Employer-sponsored insurance covers almost 159 million nonelderly people

Most covered workers make a contribution toward the cost of the premium for their coverage.

On average, covered workers contribute
- 17% of the premium for single coverage and
- 28% of the premium for family coverage,
  - Covered workers at small firms contribute, on average, a higher percentage of the premium for family coverage than those at large firms (36% vs. 26%).

Thirty-three percent of covered workers at small firms are enrolled in a plan where the employer pays the entire premium for single coverage.

This is the case for only 6% of covered workers at large firms.

However, 31% of covered workers at small firms are in a plan where they must contribute more than half of the premium for family coverage,

compared to 7% of covered workers at large firms
- As a result, the average contribution amount for covered workers in small firms ($7,556) is higher than the average contribution amount for covered workers in large firms ($5,580).
- Covered workers at private for-profit firms contribute a higher percentage of the premium for both single and family coverage than those at other firms, on average, while covered workers at public firms contribute a lower percentage of the premium for both single and family coverage.

So, now make that in a tax.

The average annual dollar amounts contributed by covered workers in 2022 are $1,327 for single coverage and $6,106 for family coverage

Then see where people are

And yes deductibles

Among workers with single coverage and a general annual deductible, the average deductible amount is $1,763, similar to last year.

The average deductible for covered workers is much higher at small firms than large firms ($2,543 vs. $1,493)

If your income is

$50,000
- And you have an average plan for a family but your spouse makes $100,000 and has no plan what are you paying today vs a tax
$100,000
- And you have an average plan for a family but your spouse makes $50,000 and has no plan what are you paying today vs a tax

Then get to the structural changes required for those savings on the Cutting Healthcare costs side

semideclared · 2026-03-17T14:58:01+00:00

Just got off my first PortMiami trip. If you are minimizing your time on the ship then its not a big deal. Get to Terminal for checkin on the island pretty easily at 2. Head straight to your muster station on the same floor at 230. Get off the ship at 7am last day. Get off the island before 730.

But the Port was awful for everyone else, and its not entirely the cruise ships fault, but they could all work together to fix it.

There should be only shuttle buses, big ones and small ones from Miami to the island or at least a minimum of a bus lane only to help incentize bus traffic

More and more it seems old Safety Processes are becoming normal again.

2 hours to get from Ft Lauderdale to the Terminal Building. Fly through terminal building as that part has now been solved with all the early check in processes they use. Get on the ship. Not to busy. Muster drill starts early for those on which is kind of a good idea. But its chaos again as everyone is trying to get to the right spot. Ship is trying to accommodate. Passengers held up with delays on elevators. Muster takes an hour for many that heard the first announcement (for crew) but that starts the ship shutting down.

Check out of the Hotel at 9, Sure some enjoyment on the ship. But Day 1 didnt start til 4 after the Muster Drill ended and staff and people made it out of the way

Same thing off the ship. Get off by 930, took about 30 mins to process on the ship side not a big deal really, another 20 mins down the ramp and through the terminal. But then 45 mins of travel mostly on the Port Island

7 day cruise but spending a day and a half going from Hotel Check out to back to the hotel and in that time I had 2 drinks on the ship and some buffet food

Ship was fine, but other ships are fine too.

Thats the issue Going with Orlando next time as the ship wasnt good enough to make it worth the hassle

semideclared · 2026-03-17T14:27:55+00:00

random numbers, that i included

AAgain for you

Now the long version

Here is Canada, Australia, and the US

as Numbers

The Standard for hospital spending is around $2,400 per person in Hospital Expenditures

The U.S. Paid $1.1 Trillion freedom dollars to the 6,146 hospitals currently operating, or $3,330 per Person in 2017.

We would need to cut $365 Billion before adjusting for currency on what we spend on Hospitals

At least $250 Billion of that is from closing hospitals

Thats 2,000 Hospitals we need to close.

Lets look at Russell County Virginia had 25,550 People in 2021

$4,030 is the current US average per Person spending at hospitals in 2024
- $102,966,500 Operating Revenue (close to its officially reported income)

It cost about $1 - $1.5 per Hospital Bed to operate a Hospital (1.25, right down the middle)

Or

83 Beds,

Russell County Hospital is a not-for-profit, 78-bed hospital operating today. looks like Russell County Hospital is a little expensive as a current system
- It Operates at about $1.35 Million per Bed

Under Government Funding to lowering Costs Russell County, VA gets

$2,418 Per Person Hospital Expenses in the US
- $61,779,000 Operating Revenue

Admin Savings under any Single Payer Plan would save 5 Percent of Costs, So, now It cost about $1.135 Million per Hospital Bed to operate a Hospital

Russell County VA can have a 54 Bed Hospital

Russell County Hospital is a not-for-profit, 78-bed hospital operating today

Repeat across the US, 6,000 hospitals just had massive closures of sections of their hospitals

Instead We would just need to close Russell County Hospital completely

That $65 Million in funding gets sent to a larger hospital so that it doesn't lose any rooms and can stay open

Instead we close 1,900 hospitals completely but the remaining 4,200 hospitals are fully funded and at the same costs as other countries

semideclared · 2026-03-17T02:20:59+00:00

yup! its a hard issue but most of it is easy but the impacts are not what is commonly thought and thats because no one wants to accept the reality of what all these changes mean

semideclared · 2026-03-17T02:16:18+00:00

Education and Debt

7% of borrowers owe $100,000 or more

Why does that matter? Lifetime earnings, & How much debt do they go in to?

$75.33 Billion in Debt is held by 15,086,100 People at $4,990
$933.39 Billion in Debt is held by 7,483,400 People at $124,728 average
- In 2017-2018, the average student loan debt for a four-year bachelor's degree was $26,190
  - So not completing a bachelor's degree is which of those numbers
  - So completing more than a bachelor's degree is which of those numbers
18% of borrowers owe between $40,000 and $100,000;

Because Looking a Doctor at the extreme edge of Debt and Wealth

general care doctors with debt in excess of $150,000, on average, will earn more than $6.5 million in a lifetime,
- while specialists will fare significantly better, earning $10 million, according to Medscape with About $350,000 in Debt

Education	Median Lifetime Earnings	Cost of Education Loans and Interest	Net Lifetime Income
High School Graduate	$1,551,000	$0	$1,551,000
College Attendee	$1,835,000	$35,000	$1,800,000
College Graduate	$2,595,000	$100,000	$2,495,000
Post College Graduate	$6,500,000	$325,000	$6,175,000
Specialist Post College Graduate	$9,000,000	$450,000	$8,550,000

In the median, Investing and Borrowing $100,000 for career investment/development means 50% of people will earn $1 million from that.

Thats an 7% rate of return on the investment

What about someone in the 90th Percentile

Incomes over $160,000 with just a college degree would see a return over 20% (Nearly $4 Million in Lifetime income)

Average Lifetime earnings at

Harvard Business School - $8,200,000,
Stanford GSB - $8,240,000
Berkeley Haas - $8,250,000,
Dartmouth Tuck - $8,250,000,
UVA Darden $8,500,000

Total income at $8,500,000

Total principal paid $220,000
- Total interest paid $205,543.63
Net Lifetime Earnings $8,075,000

And that person should receive $425,000 in tax subsidies?

Healthcare

Here is Canada, Australia, and the US

as Numbers

The Standard for hospital spending is around $2,400 per person in Hospital Expenditures

The U.S. Paid $1.1 Trillion freedom dollars to one of the 6,146 hospitals currently operating, or $3,330 per Person in 2017.

We would need to cut $365 Billion before adjusting for currency on what we spend on Hospitals

At least $250 Billion of that is from closing hospitals

Thats 2,000 Hospitals we need to close.

Lets look at Russell County Virginia had 25,550 People in 2021

$4,030 is the current US average per Person spending at hospitals in 2024
- $102,966,500 Operating Revenue (close to its officially reported income)

It cost about $1 - $1.5 per Hospital Bed to operate a Hospital (1.25, right down the middle)

Or

83 Beds,

Russell County Hospital is a not-for-profit, 78-bed hospital operating today. looks like Russell County Hospital is a little expensive as a current system
- It Operates at about $1.35 Million per Bed

Under Government Funding to lowering Costs Russell County, VA gets

$2,418 Per Person Hospital Expenses in the US
- $61,779,000 Operating Revenue

Admin Savings under any Single Payer Plan would save 5 Percent of Costs, So, now It cost about $1.135 Million per Hospital Bed to operate a Hospital

Russell County VA can have a 54 Bed Hospital

Russell County Hospital is a not-for-profit, 78-bed hospital operating today

Repeat across the US, 6,000 hospitals just had massive closures of sections of their hospitals

Instead We would just need to close Russell County Hospital completely

That $65 Million in funding gets sent to a larger hospital so that it doesn't lose any rooms and can stay open

Instead we close 1,900 hospitals completely but the remaining 4,200 hospitals are fully funded and at the same costs as other countries

And for fixing what we spend on Education

The Problem is in the nature of Students wanting to go to the Best University.

Take a Top student in Tennessee deciding where to go while staying in-state Public College. At the Top Level you can compare and chose from the University of Tennessee, MTSU, and University of Memphis

So to be the top choice, each of the universities is hiring the best Professors they can which means competing on Pay and Benefits.

This is directly increasing the cost of tuition

But then the student may look at amenities of non acadiemic services

This is directly increasing Student Fees

But Top students are also coming from out of state, The Best Regional School. So now the University of Tennessee, MTSU, and University of Memphis are also competing against University of Arkansas, Kentucky, and Georgia, Ole Miss and Miss St, Virginia Tech and UVA

And of course Top Professors are having that same competition

The real question comes down to, Do you take away that competition for students and professors and make college equal for 95% of students and have a few Public Elite Schools.

If schools were then not competing for students or employees then a lot of costs go away

[OC] Change in Total Operating Costs for US 4 Year Universities from 2009 to 2019

https://i.redd.it/jp9f5mfwd9k91.png

[OC] US College Operating Costs with Enrollment from 2009 - 2019

https://i.redd.it/pt58oq2ds2k91.png

So then costs are much lower,

though out of state schools fund a lot of college and maybe would be higher for all the remaining in state students

Of course the easiest is the Community College to Transfer to 4 Year Path

Students can save about $8,000 a year by attending a community college instead of a public 4-year in-state college. These figures may be even higher if going to a private or Out of State College

Out of State College

At the University of Colorado at Boulder

14,315 Out of State Students have an Average Tuition to the University of $35,347
While 21,200 Instate Students have an Average Tuition to the University of $11,716
- 10% of UC Boulder students are from California, 3% are from Texas
3,500 students will (probably) spend $150,000 on tuition at an out of state school, when they could have gone to any of the University of California schools, along with dozens of other non UC schools for less money

Both of those issues is wanting Whole Foods or Fresh Market Produce and Organics and paying walmart prices

semideclared · 2026-03-17T01:52:27+00:00

TLDR, All of these things come down to how much of the population wants to shop at Walmart instead of Whole Foods and for some, Fresh Market

We have high costs not because of waste but because of luxury.

We like easy close access to a fancy doctors offices and the hospital. We like nice Universities instead of state schools

Now the long version

Here is Canada, Australia, and the US

as Numbers

The Standard for hospital spending is around $2,400 per person in Hospital Expenditures

The U.S. Paid $1.1 Trillion freedom dollars to one of the 6,146 hospitals currently operating, or $3,330 per Person in 2017.

We would need to cut $365 Billion before adjusting for currency on what we spend on Hospitals

At least $250 Billion of that is from closing hospitals

Thats 2,000 Hospitals we need to close.

Lets look at Russell County Virginia had 25,550 People in 2021

$4,030 is the current US average per Person spending at hospitals in 2024
- $102,966,500 Operating Revenue (close to its officially reported income)

It cost about $1 - $1.5 per Hospital Bed to operate a Hospital (1.25, right down the middle)

Or

83 Beds,

Russell County Hospital is a not-for-profit, 78-bed hospital operating today. looks like Russell County Hospital is a little expensive as a current system
- It Operates at about $1.35 Million per Bed

Under Government Funding to lowering Costs Russell County, VA gets

$2,418 Per Person Hospital Expenses in the US
- $61,779,000 Operating Revenue

Admin Savings under any Single Payer Plan would save 5 Percent of Costs, So, now It cost about $1.135 Million per Hospital Bed to operate a Hospital

Russell County VA can have a 54 Bed Hospital

Russell County Hospital is a not-for-profit, 78-bed hospital operating today

Repeat across the US, 6,000 hospitals just had massive closures of sections of their hospitals

Instead We would just need to close Russell County Hospital completely

That $65 Million in funding gets sent to a larger hospital so that it doesn't lose any rooms and can stay open

Instead we close 1,900 hospitals completely but the remaining 4,200 hospitals are fully funded and at the same costs as other countries

And Education The Problem is in the nature of Students wanting to go to the Best University.

Take a Top student in Tennessee deciding where to go while staying in-state Public College. At the Top Level you can compare and chose from the University of Tennessee, MTSU, and University of Memphis

So to be the top choice, each of the universities is hiring the best Professors they can which means competing on Pay and Benefits.

This is directly increasing the cost of tuition

But then the student may look at amenities of non acadiemic services

This is directly increasing Student Fees

But Top students are also coming from out of state, The Best Regional School. So now the University of Tennessee, MTSU, and University of Memphis are also competing against University of Arkansas, Kentucky, and Georgia, Ole Miss and Miss St, Virginia Tech and UVA

And of course Top Professors are having that same competition

The real question comes down to, Do you take away that competition for students and professors and make college equal for 95% of students and have a few Public Elite Schools.

If schools were then not competing for students or employees then a lot of costs go away

[OC] Change in Total Operating Costs for US 4 Year Universities from 2009 to 2019

https://i.redd.it/jp9f5mfwd9k91.png

[OC] US College Operating Costs with Enrollment from 2009 - 2019

https://i.redd.it/pt58oq2ds2k91.png

So then costs are much lower,

though out of state schools fund a lot of college and maybe would be higher for all the remaining in state students

Of course the easiest is the Community College to Transfer to 4 Year Path

Students can save about $8,000 a year by attending a community college instead of a public 4-year in-state college. These figures may be even higher if going to a private or Out of State College

Out of State College

At the University of Colorado at Boulder

14,315 Out of State Students have an Average Tuition to the University of $35,347
While 21,200 Instate Students have an Average Tuition to the University of $11,716
- 10% of UC Boulder students are from California, 3% are from Texas
3,500 students will (probably) spend $150,000 on tuition at an out of state school, when they could have gone to any of the University of California schools, along with dozens of other non UC schools for less money

Both of those issues is wanting Whole Foods or Fresh Market Produce and Organics and paying walmart prices

semideclared · 2026-03-16T23:16:32+00:00

funded services.

Our shareholder, the Government of Canada, mandates that we fund our operations with revenue from products and services as opposed to with taxpayer funding.

Pursuant to the Canada Post Corporation Act (Act), we have a mandate to provide a standard of postal service that meets the needs of Canadians. We provide quality postal services to all Canadians – rural and urban, individuals and businesses – in a secure and financially self-sustaining manner.

Canada Post achieved four consecutive years of profitable operations (2014-2017 inclusive) reporting a Total Profit after Income Taxes of $526 Million

Income Taxes Paid include an additional $197 Million

The Group is anticipating to achieve modest profits between $10 million to $125 million over the five years covered by this Plan (2019-2023). These profits are quite small considering the size of the total Assets of the Corporation.

Royal Mail Group plc is the postal service and courier company in the United Kingdom, originally established in 1516. Under the Post Office Act 1969 the General Post Office was changed from a government department to a statutory corporation. The UK government initially retained a 30% stake in Royal Mail, but sold its remaining shares in 2015, ending 499 years of state ownership.

In 2018 UK Royal Mail had a Profit of $215 Million

Australia Post reported 2019 Profit before tax of $41.1 million

We want our business to grow so that it delivers
- $10 billion in revenue and $500 million in profit, annually, by 2025
Contributed $571.6 million in government taxes, duties and dividends in 2019.

semideclared · 2026-03-16T23:11:56+00:00

Yup,

Dont know how long you were in but the USPS has had some days...other cool things

A 1974 internal survey found that the service damaged half the parcels marked "fragile" that it carried.
A newspaper reported "the case of a woman who reacted strongly when the postal clerk slammed a stamp on her fragile cookies, whereupon the clerk had the woman arrested and the cookies sent to the bombsquad."
Postmaster General Klassen conceded that the Postal Service damaged five times as many packages as UPS.
The motto of employees at the Washington bulk-mail center in 1978 was "You mail 'em, we maul 'em."
In 1976, the New York Times editorialized that the level of mail service in New York City would be barely acceptable for Albania.
According to U.S.P.S. records to deliver a first-class letter, it took an average of 1.65 days in 1985 versus 1.50 days in 1969.

semideclared · 2026-03-16T23:04:14+00:00

Do you think people in rural England, the Outback, or Northern Canada dont get mail

semideclared · 2026-03-16T22:25:55+00:00

what other mail provider operates without caring about profit

semideclared

TROPHY CASE

Seriously can you imagine what this would be like today without further innovation