[ExI] Why is “cost of living” such a big problem?

[John Clark]

On Mon, Nov 2, 2026 at 5:06 PM <spike at rainier66.com> wrote:


> *>…But w**hy are we the only country that has that problem? Why is our
>> medical qualification system so enormously more expensive than every other
>> rich country on the planet when our cumbersome system does NOT produce
>> better doctors? In fact, judging from the results Doctors in Japan,
>> Germany, the UK and many other nations are BETTER than US doctors.  And if
>> the law allowed AI to diagnose patients and prescribed drugs they could do
>> a better job than even foreign doctors, and do it for less than 1% of the
>> cost.  **John K Clark*
>
>
> *> I can offer recent firsthand experience.  The doctors here do use AI. *
>

*But that's backwards from the way things should be. AI should use doctors,
but only 6% of them, because in the US only 6% of physicians are surgeons.
Today, not in some distant science fiction era, 94% of physicians are
unnecessary and in a rational society they would be unemployed. There is
only one reason that hasn't happened, societal inertia.*

*> the medics also have access to enormous piles of capital in the form of
> instrumentation.  All that must be paid for,*
>

*And medics in Canada and the rich countries in Europe and Asia don't have
that problem because they get all their high-tech medical equipment for
free from Instrumental Santa Claus?*

*> One of the benefits we were told would result from the “Affordable”
> “Care” Act was that the poor could get health insurance.  The problem is
> that most of them don’t.  They never apply for the health insurance, even
> if they can get it free.*



*ME*: Is it true that after the affordable care act was passed most poor
people never applied for health insurance, even if they can get it free?

*GROK: "No, that is not true. After the Affordable Care Act (ACA), Medicaid
take-up (enrollment among those eligible) rose substantially, and uninsured
rates among low-income people fell sharply. Most eligible poor people who
could get free or near-free coverage via Medicaid expansion did enroll; a
minority did not.*

*Why some eligible people still do not enroll (even when coverage is free
or heavily subsidized): lack of awareness of eligibility or the application
process, administrative hurdles or paperwork, belief that they do not need
coverage (especially younger/healthier people), confusion about
costs/eligibility, immigration-status concerns or fear of public-charge
rules, language/cultural barriers, or living in non-expansion states.
Affordability perceptions persist for some even when subsidies make
premiums zero or near-zero, and outreach/assistance levels have varied over
time.*

*In short, the data show the opposite of “most poor people never applied.”
Enrollment and take-up among the eligible increased meaningfully after the
ACA, producing large coverage gains for low-income populations—though
incomplete take-up, state variation (expansion vs. non-expansion), and
other barriers mean some eligible people remain uninsured."*

Sorry Spike, it looks like reality has a left-wing bias.

* John K Clark*
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