US cities pay too much for buses

"Federal funding typically covers 80% of bus purchases, with agencies responsible for the remainder."

Well, there is your answer. The one making the purchase isn't the one primarily paying for the purchase. This makes them less sensitive to pricing.

Kinda like how expensive healthcare is since it is paid for by insurance.

Or how you don't care how much you put on your plate or what you choose to eat at an all you can eat buffet.

The second you detach the consumer from the price of something, even through an intermediary such as health insurance, that is when they stop caring about how much something costs, and so the price jumps.

It's even worse, I will use my healthcare just because it is free. I would feel like a moron not get my free physical, bloodwork and other labs every year. If it was $20 I wouldn't bother but its almost obligatory to take something "because its free".

Once I learn something is free it is like I already own it, so now I don't get it if I take it, I lose it if I don't.

Preventative care is free because it saves a tremendous amount of money for the insurance company and physical and emotional hardship for yourself by catching bad things early.

Your view is a commonly-held one, and makes a lot of sense; unfortunately there is very little support for it. One data point to the contrary is the Oregon Health Care Study, which showed that 'free' preventative care increased healthcare spending, but did not improve lifespan or reduce long-term cost.

Such a counterintuitive study, when there are highly motivated political actors trying to deprive people of social benefits, makes me highly skeptical. Catching bad things early is almost always better. Diabetes, cancer, heart disease, etc, cost hundreds of thousands to millions of dollars to treat caught late and prevent people from working or doing things they like to do, and mere thousands to treat early while preserving their quality of life.

Cancer, in particular, can be practically free to insurance if caught early. Colon and skin cancer are the poster children. Colon cancer can be treated in the process of doing the screening when caught early. And skin cancer is a pretty minor "just lop off that mole" procedure that also ends up being the treatment.

Letting it grow and catching it when symptoms arise is terribly expensive. The chemo, surgery, scans, and frequent doctors visits are all crazy expensive.

About the only way I could see preventative care not costing less is if you just let the people die and call it god's will rather than calling it a death that could have been prevented.

Another variation of this are GLP 1 drugs.

Obesity costs USA $1.75T (https://milkeninstitute.org/content-hub/news-releases/econom..., grossed up for inflation)

Number of people that are obese: 100M

Annual economic impact from obesity per person: $17,500 per year

GLP-1 "For All": $6,000 per year (assuming multiple vendors, and some will be over vs under)

Savings: $11,500 per year per person.

Economic impact: Around $1T

This should free up around 3% of GDP for better uses of money rather than just fixing up people.

Obviously, the devil is in the details, but the potential impact is so massive that it should be deeply studied.