military spending

Patriotism for dark times

PNRJ core principles, current events, ethics, inequality, politics, public policy , , , , , , , , , , , , , , , , , , , , , , , ,

May 18 JDN 2460814

These are dark times indeed. ICE is now arresting people without warrants, uniforms or badges and detaining them in camps without lawyers or trials. That is, we now have secret police who are putting people in concentration camps. Don’t mince words here; these are not “arrests” or “deportations”, because those actions would require warrants and due process of law.

Fascism has arrived in America, and, just as predicted, it is indeed wrapped in the flag.

I don’t really have anything to say to console you about this. It’s absolutely horrific, and the endless parade of ever more insane acts and violations of civil rights under Trump’s regime has been seriously detrimental to my own mental health and that of nearly everyone I know.

But there is something I do want to say:

I believe the United States of America is worth saving.

I don’t think we need to burn it all down and start with something new. I think we actually had something pretty good here, and once Trump is finally gone and we manage to fix some of the tremendous damage he has done, I believe that we can put better safeguards in place to stop something like this from happening again.

Of course there are many, many ways that the United States could be made better—even before Trump took the reins and started wrecking everything. But when we consider what we might have had instead, the United States turns out looking a lot better than most of the alternatives.

Is the United States especially evil?

Every nation in the world has darkness in its history. The United States is assuredly no exception: Genocide against Native Americans, slavery, Jim Crow, and the Japanese internment to name a few. (I could easily name many more, but I think you get the point.) This country is certainly responsible for a great deal of evil.

But unlike a lot of people on the left, I don’t think the United States is uniquely or especially evil. In fact, I think we have quite compelling reasons to think that the United States overall has been especially good, and could be again.

How can I say such a thing about a country that has massacred natives, enslaved millions, and launched a staggering number of coups?

Well, here’s the thing:

Every country’s history is like that.

Some are better or worse than others, but it’s basically impossible to find a nation on Earth that hasn’t massacred, enslaved, or conquered another group—and often all three. I guess maybe some of the very youngest countries might count, those that were founded by overthrowing colonial rule within living memory. But certainly those regions and cultures all had similarly dark pasts.

So what actually makes the United States different?

What is distinctive about the United States, relative to other countries? It’s large, it’s wealthy, it’s powerful; that is certainly all true. But other nations and empires have been like that—Rome once was, and China has gained and lost such status multiple times throughout its long history.

Is it especially corrupt? No, its corruption ratings are on a par with other First World countries.

Is it especially unequal? Compared to the rest of the First World, certainly; but by world standards, not really. (The world is a very unequal place.)

But there are two things about the United States that really do seem unique.

The first is how the United States was founded.

Some countries just sort of organically emerged. They were originally tribes that lived in that area since time immemorial, and nobody really knows when they came about; they just sort of happened.

Most countries were created by conquering or overthrowing some other country. Usually one king wanted some territory that was held by another king, so he gathered an army and took over that territory and said it was his now. Or someone who wasn’t a king really wanted to become one, so he killed the current king and took his place on the throne.

And indeed, for most of history, most nations have been some variant of authoritarianism. Monarchy was probably the most common, but there were also various kinds of oligarchy, and sometimes military dictatorship. Even Athens, the oldest recorded “democracy”, was really an oligarchy of Greek male property owners. (Granted, the US also started out pretty much the same way.)

I’m glossing over a huge amount of variation and history here, of course. But what I really want to get at is just how special the founding of the United States was.

The United States of America was the first country on Earth to be designed.

Up until that point, countries just sort of emerged, or they governed however their kings wanted, or they sort of evolved over time as different interest groups jockeyed for control of the oligarchy.

But the Constitution of the United States was something fundamentally new. A bunch of very smart, well-read, well-educated people (okay, mostly White male property owners, with a few exceptions) gathered together to ask the bold question: “What is the best way to run a country?”

And they discussed and argued and debated over this, sometimes finding agreement, other times reaching awkward compromises that no one was really satisfied with. But when the dust finally settled, they had a blueprint for a better kind of nation. And then they built it.

This was a turning point in human history.

Since then, hundreds of constitutions have been written, and most nations on Earth have one of some sort (and many have gone through several). We now think of writing a constitution as what you do to make a country. But before the United States, it wasn’t! A king just took charge and did whatever he wanted! There were no rules; there was no document telling him what he could and couldn’t do.

Most countries for most of history really only had one rule:

L’Etat, c’est moi.

Yes, there was some precedent for a constitution, even going all the way back to the Magna Carta; but that wasn’t created when England was founded, it was foisted upon the king after England had already been around for centuries. And it was honestly still pretty limited in how it restricted the king.

Now, it turns out that the Founding Fathers made a lot of mistakes in designing the Constitution; but I think this is quite forgivable, for two reasons:

  1. They were doing this for the first time. Nobody had ever written a constitution before! Nobody had governed a democracy (even of the White male property-owner oligarchy sort) in centuries!
  2. They knew they would make mistakes—and they included in the Constitution itself a mechanism for amending it to correct those mistakes.

And amend it we have, 27 times so far, most importantly the Bill of Rights and the Fifteenth and Nineteenth Amendments, which together finally created true universal suffrage—a real democracy. And even in 1920 when the Nineteenth Amendment was passed, this was an extremely rare thing. Many countries had followed the example of the United States by now, but only a handful of them granted voting rights to women.

The United States really was a role model for modern democracy. It showed the world that a nation governed by its own people could be prosperous and powerful.

The second is how the United States expanded its influence.

Many have characterized the United States as an empire, because its influence is so strongly felt around the world. It is undeniably a hegemon, at least.

The US military is the world’s most powerful, accounting for by far the highest spending (more than the next 9 countries combined!) and 20 of the world’s 51 aircraft carriers (China has 5—and they’re much smaller). (The US military is arguably not the largest since China has more soldiers and more ships. But US soldiers are much better trained and equipped, and the US Navy has far greater tonnage.) Most of the world’s currency exchange is done in dollars. Nearly all the world’s air traffic control is done in English. The English-language Internet is by far the largest, forming nearly the majority of all pages by itself. Basically every computer in the world either runs as its operating system Windows, Mac, or Linux—all of which were created in the United States. And since the US attained its hegemony after World War 2, the world has enjoyed a long period of relative peace not seen in centuries, sometimes referred to as the Pax Americana. These all sound like characteristics of an empire.

Yet if it is an empire, the United States is a very unusual one.

Most empires are formed by conquest: Rome created an empire by conquering most of Europe and North Africa. Britain created an empire by colonizing and conquering natives all around the globe.

Yet aside from the Native Americans (which, I admit, is a big thing to discount) and a few other exceptions, the United States engaged in remarkably little conquest. Its influence is felt as surely across the globe as Britain’s was at the height of the British Empire, yet where under Britain all those countries were considered holdings of the Crown (until they all revolted), under the Pax Americana they all have their own autonomous governments, most of them democracies (albeit most of them significantly flawed—including the US itself, these days).

That is, the United States does not primarily spread its influence by conquering other nations. It primarily spreads its influence through diplomacy and trade. Its primary methods are peaceful and mutually-beneficial. And the world has become tremendously wealthier, more peaceful, and all around better off because of this.

Yes, there are some nuances here: The US certainly has engaged in a large number of coups intended to decide what sort of government other countries would have, especially in Latin America. Some of these coups were in favor of democratic governments, which might be justifiable; but many were in favor of authoritarian governments that were simply more capitalist, which is awful. (Then again, while the US was instrumental in supporting authoritarian capitalist regimes in Chile and South Korea, those two countries did ultimately turn into prosperous democracies—especially South Korea.)

So it still remains true that the United States is guilty of many horrible crimes; I’m not disputing that. What I’m saying is that if any other nation had been in its place, things would most like have been worse. This is even true of Britain or France, which are close allies of the US and quite similar; both of these countries, when they had a chance at empire, took it by brutal force. Even Norway once had an empire built by conquest—though I’ll admit, that was a very long time ago.

I admit, it’s depressing that this is what a good nation looks like.

I think part of the reason why so many on the left imagine the United States to be uniquely evil is that they want to think that somewhere out there is a country that’s better than this, a country that doesn’t have staggering amounts of blood on its hands.

But no, this is pretty much as good as it gets. While there are a few countries with a legitimate claim to being better (mostly #ScandinaviaIsBetter), the vast majority of nations on Earth are not better than the United States; they are worse.

Humans have a long history of doing terrible things to other humans. Some say it’s in our nature. Others believe that it is the fault of culture or institutions. Likely both are true to some extent. But if you look closely into the history of just about anywhere on Earth, you will find violence and horror there.

What you won’t always find is a nation that marks a turning point toward global democracy, or a nation that establishes its global hegemony through peaceful and mutually-beneficial means. Those nations are few and far between, and indeed are best exemplified by the United States of America.

Trump has proposed an even worse budget

PNRJ current events, politics, public policy , , , , , , , , ,

May 11 JDN 2460807

I didn’t really intend for my blog this year to be taken over by talk about Trump. But all the damage that Trump is doing to America and the world is clearly the most important thing going on in economics right now, and it’s honestly just hard for me to think about anything else.

Trump has proposed a budget. (Read at your own risk; what’s on the White House website is more screed than budget proposal. And it’s pretty clearly written by Trump himself, perhaps with some editing.)

It will come as no surprise to all of you that it is a terrible budget, even worse than what the Republicans recently passed.

First of all, Trump is cutting discretionary spending by $163 billion. This is a huge cut—it removes almost one-fourth of all non-military discretionary spending. Trump naturally claims that he’s just reducing waste, shutting down DEI programs (for the right wing this is considered a good thing), what Trump calls “Green New Scam funding” (read: anything remotely related to environmental sustainability or climate change), and what Trump claims are “large swaths of the Federal Government weaponized against the American people” (read: any other departments Trump doesn’t like, whether or not he actually understands what they are for).

And lest you think that these draconian cuts are being done for fiscal responsibility in the face of an utterly massive federal deficit, Trump also proposes to increase military spending by 13%; multiplying that by our current $850 billion budget means he’s adding $110 billion to the military; and he also says he wants to add a further $119 billion in the mandatory budget. This means he’s cutting $163 billion from non-military spending and adding $239 billion in military spending—which will actually increase the deficit.

Trump is ending programs like the Cybersecurity and Infrastructure Security Agency (sure, let’s just let Chinese hackers in! Why not? It’s not like there’s anything important on those Pentagon servers!) and Fair Housing (amid a historic housing crisis), as well as slashing the EPA (because who needs clean air and water anyway?).

Unsurprisingly, he’s also ending anything that resembles DEI, which includes both some really good necessary programs, and also some stuff that is genuinely ineffective or even counterproductive. Most people who work at firms that have DEI programs think that the programs do more good than harm, but there are big partisan differences, so cutting DEI will play well with the Republican base. But I for one do not want to play the word game where we say out loud every time “diversity, equity, and inclusion”, because there is a big difference between the fundamentally laudable goals of diversity, equity and inclusion, and the actual quite mixed results from DEI programs as they have been implemented. It’s awful that Trump is cutting DEI with a chainsaw, but we really should have been cutting it with a scalpel for awhile now.

Trump is also throwing money at the border, increasing the budgets of CBP (whatever) and ICE (very, very bad!). This is probably the worst thing about the budget, though it also isn’t a big surprise. Part of the increased ICE spending is “50,000 detention beds”, which since ICE lately has been arresting and detaining people without warrants or trials and courts have specifically ruled that they are violating due process, I believe we can fairly say constitutes a concentration camp. If and when they start actually giving everyone—everyone, dammit—due process, then you can call it a detention center.

Trump is eliminating USAID and folding what’s left of it into DFC; but these institutions had quite different goals. USAID had two goals: Advance America’s interests, and make the world a better place. And while it did have significant flaws, overall it did quite a good job of achieving both of those goals—and indeed, publicly making the world a better place can advance America’s interests. DFC’s goal is to promote economic development by financing investments that otherwise could not be financed. That can also promote America’s interests and make the world a better place, but it excludes many of the vital roles that USAID has played in providing humanitarian aid and disaster relief as well as promoting democracy and advancing environmental sustainability. (And when I say “promoting democracy”, I don’t mean the way the CIA does it, by orchestrating coups; I mean things like helping Ukraine remove its dependency on Russia.) There is more to life than money—but I don’t think Trump really understands that.

Trump is canceling a bunch of subsidies to renewable energy, but honestly I’m not too worried about that; the technology has matured so much that renewable energy is actually the cheapest form of energy for most purposes. (And it kinda makes sense: The sun and wind are already there.) Removing the subsidies will make it harder to compete with oil (because oil is still heavily subsidized); but I still think renewables can win. Basically the past subsidies have done their job, and it’s probably okay to remove them.

There’s a really weird proposal involving food, which I think I will just quote in its entirety:

The Budget also supports the creation of MAHA food boxes, that would be filled with commodities sourced from domestic farmers and given directly to American households.

This sounds… kinda… Maoist? Definitely some kind of communist. Why are we circumventing the highly-functional capitalist market for food with massive in-kind transfers? (Despite scaremongering, groceries in the US are still pretty affordable by world standards.) And how are we going to do that, logistically? (Produce does need to be kept fresh, after all.) Does Trump think that markets have trouble providing food in this country? Does he not understand that SNAP exists, and already prioritizes healthier food?(Or does he plan to get rid of it?) Does he think that the reason most Americans don’t eat a very good diet (which is objectively true) is that they aren’t able to get fresh produce? (And not, say, subsidies for factory-farmed meat and high-fructose corn syrup, or mass marketing campaigns by corporations that make junk food?) I’m not so much against this program as I am really baffled by it. It seems like it’s trying to solve the wrong problem by the wrong means. (I’m guessing RFK Jr. had a hand in this, and I recently learned that he doesn’t believe in germ theory. He is a god-tier crank. Like, his views on vaccines and autism were bad enough, but this? Seriously, you put this guy in charge of public health!?)

There are some things in the budget that aren’t terrible, but they’re mostly pretty small.

One actually good thing about Trump’s new budget is the expansion of VA services. I don’t really have any objection to that. It’s a fairly small portion of the budget, and veterans deserve better than they’ve been getting.

Trump says he won’t be cutting Social Security (so perhaps we dodged a bullet on that one). Of course, if he actually cared in the least about the budget deficit, that’s probably what he would cut, because it’s such a huge proportion of our spending—about one-fifth of all federal spending.

I’m not sure what to think about the changes Trump is making to education funding. He’s shutting down the Department of Education, but it seems like most of what it does (including offering grants and handling student loans) is just going to be folded into other agencies. It doesn’t actually seem like there have been substantial cuts in their services, just… a weird and unnecessary reorganization. My guess is that after Trump had already publicly committed to “end the Department of Education”, some staffer quietly explained to him what the Department of Education actually does and why it is necessary; since he’d already committed to shutting it down, he didn’t want to pivot on that, so instead he shut it down in name only while preserving most of what it actually does in other agencies.

Trump is also investing heavily in charter schools, which… meh. Some charter schools are really good, some are really bad. There isn’t a clear pattern of them being better or worse than public schools. Overall, the preponderance of evidence suggests that the average charter school is worse than the average public school, but there’s a lot of variation in both, so the odds that any particular charter school is better than any particular public school are still quite high. (I recently learned about this measure of effect size, probability of superiority, and it’s now my new favorite measure of effect size. Eat your heart out, Cohen’s d!)

Trump is also diverting funding to apprenticeships; he’s introducing a new “Make America Skilled Again” (ugh) grant that States would be required to spend at least 10% on apprenticeship. I’m pretty okay with this in general. 10% is not a lot, and we totally could use more apprenticeship programs in fields like welding and pipefitting.

Another good thing Trump is doing is increasing funding for NASA; he’s clearly doing it out of a sense of national pride and hatred of China, but hey, at least he’s doing it. We might actually be able to pull off a human Mars mission (several years from now, mind you!) if this higher funding continues.

Trump is also redirecting DEA spending to Mexico, Central America, South America, and China; since most fentanyl in the US is made in Latin America from Chinese ingredients, this actually makes sense. I still don’t think that criminalization is the best solution to drug abuse, but fentanyl is genuinely very dangerous stuff, so we should definitely be doing something to reduce its usage.

Finally, and somewhat anticlimactically, Trump is creating some kind of new federal fire service that’s supposedly going to improve our response to wildfires. Given that we already have FEMA, a significant improvement seems unlikely. But hey, it’s worth a try!

These small good things should not distract us from the massive damage that this budget would cause if implemented.

It was not necessary to shift $160 billion from non-military to military spending in order to increase funding for NASA and the VA. It was not necessary to cut hundreds of programs and eliminate USAID—the agency which did what may literally be the very best things our government has ever done. DEI programs had their flaws, but it was wrong to eliminate all of them, instead of finding out which ones are effective and which ones are not.

And while it’s a tiny portion of the budget, the cuts to the EPA will kill people. Most likely thousands of Americans will die from the increased air and water pollution. It will be hard to pinpoint exactly who: Would that kid with asthma have died anyway if the air were cleaner? Was that fatal infection from polluted water, or something else? But the statistics will tell us that there were thousands of unnecessary deaths. (Unless of course Trump falsifies the statistics—which he very well might, since he routinely calls our world-class economic data “fake” when it makes him look bad.)

The large federal budget deficit will be in no way reduced by this budget; in fact it will be slightly increased. If we were in a recession, I’d be okay with this kind of deficit; it was actually a good thing that we ran a huge deficit in 2020. But we aren’t yet—and when one does inevitably hit (given the tariffs, I think sooner rather than later), we won’t have the slack in our budget to do the necessary Keynesian stimulus.

I don’t see any mention of what’s going to happen to Medicare and Medicaid; given that these two programs together constitute roughly one fourth of the federal budget—and nearly twice the military budget—this is a very conspicuous absence. It’s possible that Trump’s leaving them alone because he knows how popular they are, but this once again reveals the emptiness of Republican deficit hawkishness: If you really wanted to reduce the deficit by cutting spending, you’d do it by cutting the military, Social Security, Medicare, and Medicaid. Those four things together comprise the majority of the federal budget. Yet it seems that Trump’s budget cuts none of them.

Mind you, I don’t actually want to cut Social Security, Medicare, or Medicaid; so I’m relieved that Trump isn’t doing that. I’m pretty okay with cutting the military, but I’ll admit I’m less enthused about that since the start of the Ukraine War (I think some moderate cuts are still in order, but we should still have a very big military budget to protect ourselves and our allies). But these are the only budget cuts that could realistically reduce the deficit.

What I actually want to happen is higher taxes on rich people. That’s how I want the budget to be balanced. And Trump very obviously will not do that. Indeed he’s almost certainly going to cut them, making our deficit even larger.

So we’re building a concentration camp, the Chinese are going to hack the Pentagon, we’re going to buy more tanks we don’t need, we won’t be able to properly respond to the next recession, and thousands of people will die from air and water pollution. But at least we got more NASA funding!

PNRJ core principles, market failure, public policy , , , , , , , , , , , , , , , , ,

There should be a glut of nurses.

Jan 15 JDN 2459960

It will not be news to most of you that there is a worldwide shortage of healthcare staff, especially nurses and emergency medical technicians (EMTs). I would like you to stop and think about the utterly terrible policy failure this represents. Maybe if enough people do, we can figure out a way to fix it.

It goes without saying—yet bears repeating—that people die when you don’t have enough nurses and EMTs. Indeed, surely a large proportion of the 2.6 million (!) deaths each year from medical errors are attributable to this. It is likely that at least one million lives per year could be saved by fixing this problem worldwide. In the US alone, over 250,000 deaths per year are caused by medical errors; so we’re looking at something like 100,000 lives we could safe each year by removing staffing shortages.

Precisely because these jobs have such high stakes, the mere fact that we would ever see the word “shortage” beside “nurse” or “EMT” was already clear evidence of dramatic policy failure.

This is not like other jobs. A shortage of accountants or baristas or even teachers, while a bad thing, is something that market forces can be expected to correct in time, and it wouldn’t be unreasonable to simply let them do so—meaning, let wages rise on their own until the market is restored to equilibrium. A “shortage” of stockbrokers or corporate lawyers would in fact be a boon to our civilization. But a shortage of nurses or EMTs or firefighters (yes, there are those too!) is a disaster.

Partly this is due to the COVID pandemic, which has been longer and more severe than any but the most pessimistic analysts predicted. But there shortages of nurses before COVID. There should not have been. There should have been a massive glut.

Even if there hadn’t been a shortage of healthcare staff before the pandemic, the fact that there wasn’t a glut was already a problem.

This is what a properly-functioning healthcare policy would look like: Most nurses are bored most of the time. They are widely regarded as overpaid. People go into nursing because it’s a comfortable, easy career with very high pay and usually not very much work. Hospitals spend most of their time with half their beds empty and half of their ambulances parked while the drivers and EMTs sit around drinking coffee and watching football games.

Why? Because healthcare, especially emergency care, involves risk, and the stakes couldn’t be higher. If the number of severely sick people doubles—as in, say, a pandemic—a hospital that usually runs at 98% capacity won’t be able to deal with them. But a hospital that usually runs at 50% capacity will.

COVID exposed to the world what a careful analysis would already have shown: There was not nearly enough redundancy in our healthcare system. We had been optimizing for a narrow-minded, short-sighted notion of “efficiency” over what we really needed, which was resiliency and robustness.

I’d like to compare this to two other types of jobs.

The first is stockbrokers.Set aside for a moment the fact that most of what they do is worthless is not actively detrimental to human society. Suppose that their most adamant boosters are correct and what they do is actually really important and beneficial.

Their experience is almost like what I just said nurses ought to be. They are widely regarded (correctly) as very overpaid. There is never any shortage of them; there are people lining up to be hired. People go into the work not because they care about it or even because they are particularly good at it, but because they know it’s an easy way to make a lot of money.

The one thing that seems to be different from my image may not be as different as it seems. Stockbrokers work long hours, but nobody can really explain why. Frankly most of what they do can be—and has been—successfully automated. Since there simply isn’t that much work for them to do, my guess is that most of the time they spend “working” 60-80 hour weeks is actually not actually working, but sitting around pretending to work. Since most financial forecasters are outperformed by a simple diversified portfolio, the most profitable action for most stock analysts to take most of the time would be nothing.

It may also be that stockbrokers work hard at sales—trying to convince people to buy and sell for bad reasons in order to earn sales commissions. This would at least explain why they work so many hours, though it would make it even harder to believe that what they do benefits society. So if we imagine our “ideal” stockbroker who makes the world a better place, I think they mostly just use a simple algorithm and maybe adjust it every month or two. They make better returns than their peers, but spend 38 hours a week goofing off.

There is a massive glut of stockbrokers. This is what it looks like when a civilization is really optimized to be good at something.

The second is soldiers. Say what you will about them, no one can dispute that their job has stakes of life and death. A lot of people seem to think that the world would be better off without them, but that’s at best only true if everyone got rid of them; if you don’t have soldiers but other countries do, you’re going to be in big trouble. (“We’ll beat our swords into liverwurst / Down by the East Riverside; / But no one wants to be the first!”) So unless and until we can solve that mother of all coordination problems, we need to have soldiers around.

What is life like for a soldier? Well, they don’t seem overpaid; if anything, underpaid. (Maybe some of the officers are overpaid, but clearly not most of the enlisted personnel. Part of the problem there is that “pay grade” is nearly synonymous with “rank”—it’s a primate hierarchy, not a rational wage structure. Then again, so are most industries; the military just makes it more explicit.) But there do seem to be enough of them. Military officials may lament of “shortages” of soldiers, but they never actually seem to want for troops to deploy when they really need them. And if a major war really did start that required all available manpower, the draft could be reinstated and then suddenly they’d have it—the authority to coerce compliance is precisely how you can avoid having a shortage while keeping your workers underpaid. (Russia’s soldier shortage is genuine—something about being utterly outclassed by your enemy’s technological superiority in an obviously pointless imperialistic war seems to hurt your recruiting numbers.)

What is life like for a typical soldier? The answer may surprise you. The overwhelming answer in surveys and interviews (which also fits with the experiences I’ve heard about from friends and family in the military) is that life as a soldier is boring. “All you do is wake up in the morning and push rubbish around camp.” “Bosnia was scary for about 3 months. After that it was boring. That is pretty much day to day life in the military. You are bored.”

This isn’t new, nor even an artifact of not being in any major wars: Union soldiers in the US Civil War had the same complaint. Even in World War I, a typical soldier spent only half the time on the front, and when on the front only saw combat 1/5 of the time. War is boring.

In other words, there is a massive glut of soldiers. Most of them don’t even know what to do with themselves most of the time.

This makes perfect sense. Why? Because an army needs to be resilient. And to be resilient, you must be redundant. If you only had exactly enough soldiers to deploy in a typical engagement, you’d never have enough for a really severe engagement. If on average you had enough, that means you’d spend half the time with too few. And the costs of having too few soldiers are utterly catastrophic.

This is probably an evolutionary outcome, in fact; civilizations may have tried to have “leaner” militaries that didn’t have so much redundancy, and those civilizations were conquered by other civilizations that were more profligate. (This is not to say that we couldn’t afford to cut military spending at all; it’s one thing to have the largest military in the world—I support that, actually—but quite another to have more than the next 10 combined.)

What’s the policy solution here? It’s actually pretty simple.

Pay nurses and EMTs more. A lot more. Whatever it takes to get to the point where we not only have enough, but have so many people lining up to join we don’t even know what to do with them all. If private healthcare firms won’t do it, force them to—or, all the more reason to nationalize healthcare. The stakes are far too high to leave things as they are.

Would this be expensive? Sure.

Removing the shortage of EMTs wouldn’t even be that expensive. There are only about 260,000 EMTs in the US, and they get paid the apallingly low median salary of $36,000. That means we’re currently spending only about $9 billion per year on EMTs. We could double their salaries and double their numbers for only an extra $27 billion—about 0.1% of US GDP.

Nurses would cost more. There are about 5 million nurses in the US, with an average salary of about $78,000, so we’re currently spending about $390 billion a year on nurses. We probably can’t afford to double both salary and staffing. But maybe we could increase both by 20%, costing about an extra $170 billion per year.

Altogether that would cost about $200 billion per year. To save one hundred thousand lives.

That’s $2 million per life saved, or about $40,000 per QALY. The usual estimate for the value of a statistical life is about $10 million, and the usual threshold for a cost-effective medical intervention is $50,000-$100,000 per QALY; so we’re well under both. This isn’t as efficient as buying malaria nets in Africa, but it’s more efficient than plenty of other things we’re spending on. And this isn’t even counting additional benefits of better care that go beyond lives saved.

In fact if we nationalized US healthcare we could get more than these amounts in savings from not wasting our money on profits for insurance and drug companies—simply making the US healthcare system as cost-effective as Canada’s would save $6,000 per American per year, or a whopping $1.9 trillion. At that point we could double the number of nurses and their salaries and still be spending less.

No, it’s not because nurses and doctors are paid much less in Canada than the US. That’s true in some countries, but not Canada. The median salary for nurses in Canada is about $95,500 CAD, which is $71,000 US at current exchange rates. Doctors in Canada can make anywhere from $80,000 to $400,000 CAD, which is $60,000 to $300,000 US. Nor are healthcare outcomes in Canada worse than the US; if anything, they’re better, as Canadians live an average of four years longer than Americans. No, the radical difference in cost—a factor of 2 to 1—between Canada and the US comes from privatization. Privatization is supposed to make things more efficient and lower costs, but it has absolutely not done that in US healthcare.

And if our choice is between spending more money and letting hundreds of thousands or millions of people die every year, that’s no choice at all.