18 ms·

> but I don't think we'd like the outcome The NHS is fantastic.

by kennydude 10y ago

talmand 10y ago
The NHS may be fantastic for one country, doesn't mean it would be for another.
- Ntrails 10y ago
  I'm pretty sure it would be fantastic for the majority - but not for a vocal minority who have a large amount of power.
  - talmand 10y ago
    I would agree for the most part.
  - r_smart 10y ago
    Milton Friedman has some interesting points about welfare programs and how they interact with immigration. Particulary, that you can have massive unchecked immigration, or extensive welfare programs, but the two don't interact well. The NHS is probably a good example. The UK has historically had low to moderate rates in immigration and the NHS. The US has had a ton of immigration, but no NHS. It seems like half of the country wants to have unchecked immigration and extensive welfare programs, but the consequences of that kind of policy will quickly become bankrupting. I would imagine that vocal minority would be fine with a single-payer system. Again, look at what happens to pricing when the government is your sole customer. And given the influence they can wield, it would be a bonanza for them.
    - abritinthebay 10y ago
      > look at what happens to pricing when the government is your sole customer. Based on the available evidence for healthcare: it drops like a stone because the sole customer has all the leverage.
      - AnimalMuppet 10y ago
        You already see this with Medicare. For some treatments, they reimburse less than the doctor's direct costs. But if you try to do that with all the doctor's customers, it doesn't work.
        brianwawok 10y ago
        I mean, it will work. That is not working because you have Medicare interacting with private practice doctors.. the same problems with ACA + private health insurance offices. If the government directly pays the Doctor a salary.. he doesn't care what the "profit" on a procedure is. In fact, base his pay on how good his outcomes are and how efficient he is.. i.e. pay him more to do better. Then we don't need to worry about some doctors not offering some procedures, because they are paid by salary and not salesmen. Right now private practice doctors are salesmen. They are compensated MORE for selling unnecessary procedures. If the they can sneak it by the insurance? They do it.
        r_smart 10y ago
        That's the nationalization I was referring to earlier. Also, government workers are rarely held to a high standard and rarely fired, so why you think that's going to happen with healthcare when it doesn't happen anywhere else is beyond me. Most doctors make a salary, they don't care what the 'profit' on a procedure is. They probably don't even know what most of the stuff costs. It's like college professors and textbooks. Also, who's worrying about some doctors not offering some procedures?
        abritinthebay 10y ago
        There is no healthcare in the US where the government is the sole (or even primary) customer. So using anything from the US as a counter example is going to fall flat.
      - talmand 10y ago
        Well, some would say that based on available evidence that government-based price controls doesn't always turn out well. Especially for people trying to obtain the product or service under said price control.
    - Ntrails 10y ago
      As a foreigner I always think of the US as having extremely restricted immigration. Is this the "Mexico problem" or are the legal migrant numbers also very high?
      - talmand 10y ago
        Historically, no, immigration has been fairly open as compared to much of the world. The laws and influx have changed from time-to-time, but it hasn't seemed coming to America was that difficult. Recently it's tightened up, but I only say historically as to relate to the comment you are responding to. America has the highest number of immigrants by a large factor, depending upon the source you trust. Although, becoming a citizen has become a chore because it takes too freaking long for so many. Of course, this is from the viewpoint of a citizen so take that into account as I don't see it from the other side.
        r_smart 10y ago
        This is pretty spot on. I honestly don't remember the legal immigration numbers off the top of my head, I think it's something like a million, certainly hundreds of thousands a year, and as you point out, illegal immigration numbers are all over the map (I think the range is something like 10 - 30 million total, not annual but don't quote me). It is important to remember that the US is huge, so it's not the same as Germany taking in 500,000 people by any stretch of the imagination.
- kennydude 10y ago
  If it's implemented correctly, an american national health service would work fine. If anything, it'd do some good to the country (healthcare being shockingly high on reasons for people defaulting)
  - talmand 10y ago
    >> If it's implemented correctly That's the problem, I have trust issues with the people in power being capable of doing such a thing.
    - brianwawok 10y ago
      On the flip side, the current system is totally broke. Get to free universal healthcare, then iterate on it to make it better and better. You have to move to make progress.
      - AnimalMuppet 10y ago
        The current system is bad in many ways, all right? I think we can agree on that. But it's not so bad that it can't get much worse. Getting worse is not abstract - it translates into people dying needlessly. (So does the current system being bad.) "Just change something" is only good advice if you're currently at a local minimum. And "iterate rapidly to improve" doesn't work when each change takes an act of Congress. In particular: The last change was, what, six years ago? And the last change before that was, what, in the 1970s? You may only get one or two more chance to change this in your lifetime.
        r_smart 10y ago
        This is a hugely important point that people seem to miss. The US government is huge and frequently gets things wrong, and when they do, it's a political failure to admit it later. Furthermore, there's no real punishment for anyone that screwed up. That's a problem, and that's why fixing this is so hard.
      - r_smart 10y ago
r_smart 10y ago
I agree with you. The NHS is fantastic (so far as I know). But I'm talking about the US and how things work here. I just don't think it would work out.

> but I don't think we'd like the outcome The NHS is fantastic.

talmand 10y ago

The NHS may be fantastic for one country, doesn't mean it would be for another.

Ntrails 10y ago
I'm pretty sure it would be fantastic for the majority - but not for a vocal minority who have a large amount of power.
- talmand 10y ago
  I would agree for the most part.
- r_smart 10y ago
  Milton Friedman has some interesting points about welfare programs and how they interact with immigration. Particulary, that you can have massive unchecked immigration, or extensive welfare programs, but the two don't interact well. The NHS is probably a good example. The UK has historically had low to moderate rates in immigration and the NHS. The US has had a ton of immigration, but no NHS. It seems like half of the country wants to have unchecked immigration and extensive welfare programs, but the consequences of that kind of policy will quickly become bankrupting. I would imagine that vocal minority would be fine with a single-payer system. Again, look at what happens to pricing when the government is your sole customer. And given the influence they can wield, it would be a bonanza for them.
  - abritinthebay 10y ago
    > look at what happens to pricing when the government is your sole customer. Based on the available evidence for healthcare: it drops like a stone because the sole customer has all the leverage.
    - AnimalMuppet 10y ago
      You already see this with Medicare. For some treatments, they reimburse less than the doctor's direct costs. But if you try to do that with all the doctor's customers, it doesn't work.
      - brianwawok 10y ago
        I mean, it will work. That is not working because you have Medicare interacting with private practice doctors.. the same problems with ACA + private health insurance offices. If the government directly pays the Doctor a salary.. he doesn't care what the "profit" on a procedure is. In fact, base his pay on how good his outcomes are and how efficient he is.. i.e. pay him more to do better. Then we don't need to worry about some doctors not offering some procedures, because they are paid by salary and not salesmen. Right now private practice doctors are salesmen. They are compensated MORE for selling unnecessary procedures. If the they can sneak it by the insurance? They do it.
        r_smart 10y ago
        That's the nationalization I was referring to earlier. Also, government workers are rarely held to a high standard and rarely fired, so why you think that's going to happen with healthcare when it doesn't happen anywhere else is beyond me. Most doctors make a salary, they don't care what the 'profit' on a procedure is. They probably don't even know what most of the stuff costs. It's like college professors and textbooks. Also, who's worrying about some doctors not offering some procedures?
      - abritinthebay 10y ago
        There is no healthcare in the US where the government is the sole (or even primary) customer. So using anything from the US as a counter example is going to fall flat.
    - talmand 10y ago
      Well, some would say that based on available evidence that government-based price controls doesn't always turn out well. Especially for people trying to obtain the product or service under said price control.
  - Ntrails 10y ago
    As a foreigner I always think of the US as having extremely restricted immigration. Is this the "Mexico problem" or are the legal migrant numbers also very high?
    - talmand 10y ago
      Historically, no, immigration has been fairly open as compared to much of the world. The laws and influx have changed from time-to-time, but it hasn't seemed coming to America was that difficult. Recently it's tightened up, but I only say historically as to relate to the comment you are responding to. America has the highest number of immigrants by a large factor, depending upon the source you trust. Although, becoming a citizen has become a chore because it takes too freaking long for so many. Of course, this is from the viewpoint of a citizen so take that into account as I don't see it from the other side.
      - r_smart 10y ago
        This is pretty spot on. I honestly don't remember the legal immigration numbers off the top of my head, I think it's something like a million, certainly hundreds of thousands a year, and as you point out, illegal immigration numbers are all over the map (I think the range is something like 10 - 30 million total, not annual but don't quote me). It is important to remember that the US is huge, so it's not the same as Germany taking in 500,000 people by any stretch of the imagination.
kennydude 10y ago
If it's implemented correctly, an american national health service would work fine. If anything, it'd do some good to the country (healthcare being shockingly high on reasons for people defaulting)
- talmand 10y ago
  >> If it's implemented correctly That's the problem, I have trust issues with the people in power being capable of doing such a thing.
  - brianwawok 10y ago
    On the flip side, the current system is totally broke. Get to free universal healthcare, then iterate on it to make it better and better. You have to move to make progress.
    - AnimalMuppet 10y ago
      The current system is bad in many ways, all right? I think we can agree on that. But it's not so bad that it can't get much worse. Getting worse is not abstract - it translates into people dying needlessly. (So does the current system being bad.) "Just change something" is only good advice if you're currently at a local minimum. And "iterate rapidly to improve" doesn't work when each change takes an act of Congress. In particular: The last change was, what, six years ago? And the last change before that was, what, in the 1970s? You may only get one or two more chance to change this in your lifetime.
      - r_smart 10y ago
        This is a hugely important point that people seem to miss. The US government is huge and frequently gets things wrong, and when they do, it's a political failure to admit it later. Furthermore, there's no real punishment for anyone that screwed up. That's a problem, and that's why fixing this is so hard.
    - r_smart 10y ago

r_smart 10y ago

I agree with you. The NHS is fantastic (so far as I know). But I'm talking about the US and how things work here. I just don't think it would work out.