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Milton Friedman has some interesting points about welfare programs and how they interact with immigration. Particulary, that you can have massive unchecked immi

by 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.
  - abritinthebay 10y ago
    While that may be true in certain exceptional cases the available evidence (every other 1st world country) would say it isn't the regular case. Even IF that's the case it's still wildly better than the current system.
    - r_smart 10y ago
      Firstly, the US is different, and the way it would get structured would be different. Second, what evidence do you have that it would be cheaper in those countries than if they were using a private medical system? Are there numbers from before the NHS was put together? That would be an interesting analysis.
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.

by r_smart 10y ago

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.
- abritinthebay 10y ago
  While that may be true in certain exceptional cases the available evidence (every other 1st world country) would say it isn't the regular case. Even IF that's the case it's still wildly better than the current system.
  - r_smart 10y ago
    Firstly, the US is different, and the way it would get structured would be different. Second, what evidence do you have that it would be cheaper in those countries than if they were using a private medical system? Are there numbers from before the NHS was put together? That would be an interesting analysis.

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.