> Inequality does not mean we need to have people who can't satisfy their most basic things. It is possible for people to be allowed to compete for wealth and at the same time ensure those that don't want or can't compete have their basic needs like food, shelter and medical care satisfied.
How?
I get that there's a lot of waste and inefficiency in those industries. Whenever zoning laws prevent a developer from building new housing, that's a third party actively preventing someone's basic needs from being satisfied. Whenever med-school admissions hold the number of new doctors below that needed to service all the uninsured, that's a third party actively preventing basic needs from being satisfied. Whenever food just gets thrown out because nobody bought it or it didn't meat the supermarket's quality standards, those were peoples' basic needs that could've been satisfied.
But in most cases this inefficiency happens because of a quality/quantity tradeoff that society has collectively made in the past. When the Bay Area was first settled in the 1930s-50s, it was common for workers to move here, setup tents, and then go to Orchard Supply Hardware, buy some lumber, and build their own houses. Can people do that today? Absolutely not - we have building codes, year-long permitting processes, zoning requirements. Much of that original housing stock still remains, and is a disaster waiting to happen in an earthquake.
Similarly, a common response these days to the shortage of health care and the need to provide affordable health care is for nurse practitioners to get certified (often via online courses) to be a physician's assistant, and to use PAs for much of the routine medical care (coughs, colds, rashes, etc.) that takes up the bulk of a doctor's time. I have several doctor friends who have railed at length about this practice. They have an obvious self-interest in doing so, but they also have a compelling argument: children will die. For most visits, the PA just needs to tell you to take some ibuprofen, but in some rare cases, those recurrent bloody noses are actually a sign of a serious medical condition that needs treatment ASAP. A doctor will have run across those conditions in their training & practice and know what to look for, but a PA is very likely to miss it. Thus, you are literally killing children if you relax the regulations that set the bar for becoming a licensed MD.
Many of our current societal ills come because "the perfect is the enemy of the good". Unrestricted capitalism is very effective at "good enough" solutions, where the product is good enough for you to buy but may be a little rough around the edges or have corner cases that, well, kill you if you get unlucky. To mitigate the corner cases, we've added a lot of regulations that generally prevent suppliers from killing their customers through negligence, but a side-effect is that it's dramatically reduced the population of people who could be potential suppliers. That lets those few trained practitioners dictate the terms of supplying the service, so they can raise their prices until only the wealthy can afford to pay.
You could safely relax the regulations that set the bar for becoming a licensed MD.
Knocking 2 or 3 years off would be easy. Right now, the first step to becoming a licensed MD is to get a BS or BA degree. Any degree will do the job, though it is expected that certain classes will have been taken. This is taking 4 years, but meeting the legitimate needs for medical school should only take about 1 or 2 years.
I'll work it out, based on what Yale specifies:
These are bright people, so assume that they have AP credit for all 3 basic sciences. That leaves 1 semester of organic chemistry and 1 semester of biochemistry. That's it. Checking prerequisites at UCF, biochemistry requires Organic Chemistry II. We could thus be looking at 3 semesters. Do the biochemistry over the summer, and it's just one year.
Despite this, Yale requires attending at least 3 years for an undergraduate degree. Yale doesn't care at all what the degree is. It could be music history, military science, creative writing, or whatever. You just need to put in the time, a minimum of 3 years. To help you waste time, not even a "5" on the AP tests will be accepted by Yale.
All we're accomplishing here is a supply limitation. We jack up the time and expense to become a licensed MD. We also shorten the resulting career by 2 or 3 years.
You're not answering the "How?" Who is providing the services? How are they trained? How do new people enter the field? What incentive do they have to provide a good job? What do you do if they do a shitty job?
Throwing money at problems usually means that the people providing the solutions make more money. It does not necessarily mean that the problems get fixed. In many cases, it means that those people now have more resources to ensure that the problem does not get fixed, so that the government will keep throwing money at them to mitigate it.
Everybody chips in or the ones that are wealthiest provide support for the weakest. That's how. How is this so difficult to understand?
In many cultures this is standard. For example, families taking care of their less fortunate family members (as long as they don't do something really stupid). Or another example, in many cultures, historically, the status came from being able to support weaker members of society. Especially in tribal societies the status would frequently be tied to how well you can make sure your tribe prospers as a whole.
This works up until you get a big enough group where freeriding can pass undetected and unpunished.
The thing about lazyness & cynicism is that it's viral. When everybody sees everyone else around them pitching in to the best of their ability, they're inclined to pitch in as well. When one person starts enjoying the benefits of this without contributing, contributors start getting angry. When multiple people start doing this but there's no way to either punish or evict them from the group, contributors get depressed, and often switch their worldview. Why bother working hard for other people when the other people are not working hard in return?
Empirically, this seems to happen at a few thousand people, well below the size of a modern nation-state. The cultures you cite all have internal subdivisions (villages, tribes, clans) of around this size. Beyond it, the complexity of society grows to the point where freeriding cannot be detected & punished other than by institutional means (money, contracts, lawsuits), and so there's an incentive for everyone to freeride.
It doesn't even require malicious intent. Take the health care example, and imagine you're a physician's assistant. 99% of the patients who come to you just have a cough that they could've taken care of with bedrest & fluids. After seeing 99 patients, most of whom come from the more well-to-do if neurotic segments of society and none of them needing actual medical treatment, you start thinking "Man, all these folks don't have any actual problems, but they keep coming for medical care because it's free. What's the point in doing anything other than sending them home for rest & fluids?" The 100th person has aggressive lung cancer, but you send them home for bedrest and fluids, where they die. The PA's malpractice insurance covers the inevitable lawsuit, so they don't face any consequences for their cursory examination. They do, however, end up even more bitter about patients who are not only lazy but litigious too. The family of the deceased tells all their friends that the healthcare system is irretrievably broken, but there's nothing they can do about it - since it's a government institution, it's not like there's anywhere else they could go. Instead, it trickles down into how they do their own jobs: they get just a little bit more cynical about how much everyone else is pitching in to the common good, and decide they're going to pitch in a little bit less to keep the score even.
How?
I get that there's a lot of waste and inefficiency in those industries. Whenever zoning laws prevent a developer from building new housing, that's a third party actively preventing someone's basic needs from being satisfied. Whenever med-school admissions hold the number of new doctors below that needed to service all the uninsured, that's a third party actively preventing basic needs from being satisfied. Whenever food just gets thrown out because nobody bought it or it didn't meat the supermarket's quality standards, those were peoples' basic needs that could've been satisfied.
But in most cases this inefficiency happens because of a quality/quantity tradeoff that society has collectively made in the past. When the Bay Area was first settled in the 1930s-50s, it was common for workers to move here, setup tents, and then go to Orchard Supply Hardware, buy some lumber, and build their own houses. Can people do that today? Absolutely not - we have building codes, year-long permitting processes, zoning requirements. Much of that original housing stock still remains, and is a disaster waiting to happen in an earthquake.
Similarly, a common response these days to the shortage of health care and the need to provide affordable health care is for nurse practitioners to get certified (often via online courses) to be a physician's assistant, and to use PAs for much of the routine medical care (coughs, colds, rashes, etc.) that takes up the bulk of a doctor's time. I have several doctor friends who have railed at length about this practice. They have an obvious self-interest in doing so, but they also have a compelling argument: children will die. For most visits, the PA just needs to tell you to take some ibuprofen, but in some rare cases, those recurrent bloody noses are actually a sign of a serious medical condition that needs treatment ASAP. A doctor will have run across those conditions in their training & practice and know what to look for, but a PA is very likely to miss it. Thus, you are literally killing children if you relax the regulations that set the bar for becoming a licensed MD.
Many of our current societal ills come because "the perfect is the enemy of the good". Unrestricted capitalism is very effective at "good enough" solutions, where the product is good enough for you to buy but may be a little rough around the edges or have corner cases that, well, kill you if you get unlucky. To mitigate the corner cases, we've added a lot of regulations that generally prevent suppliers from killing their customers through negligence, but a side-effect is that it's dramatically reduced the population of people who could be potential suppliers. That lets those few trained practitioners dictate the terms of supplying the service, so they can raise their prices until only the wealthy can afford to pay.