4 ms·

Here's the only thing I'm confused about. Do we have examples of the government running a service better than the private sector? I'm not 100% on this, but it

by jbhatab 10y ago

Here's the only thing I'm confused about. Do we have examples of the government running a service better than the private sector? I'm not 100% on this, but it seems all of the best aspects of American services come from competition and letting capitalism thrive. Would love a counter opinion.

toomuchtodo 10y ago
> Would love a counter opinion. Every other first world country? https://en.wikipedia.org/wiki/List_of_countries_with_universal_health_care https://en.wikipedia.org/wiki/List_of_countries_with_univers...
- maxerickson 10y ago
  Several of those countries implement universal coverage using a private insurance model.
  - toomuchtodo 10y ago
    In almost all European countries, its provided by the government and funded by taxation. My point stands.
    - maxerickson 10y ago
      Netherlands, Germany and Switzerland are 3 counter examples.
      - unclenoriega 10y ago
        Germany doesn't have single-payer, but it does have a highly-regulated, mostly public health insurance industry. Most people are covered by the public system, which, while multi-payer, has premiums set by the government and based on income, as well as a fixed set of services determined by the government. In effect, it's not that different from a single-payer system funded by a progressive income tax. I have thought the German system might be a better fit for the US, since sickness funds can still compete with each other, mostly on customer service and the like.
  - luckydata 10y ago
    All the best systems are single payer. Italy, France, Spain, the UK. The countries with private insurance like Germany are middle of the pack. Clearly single payer is the superior option.
    - MagnumOpus 10y ago
      Back that up with numbers please. At best, the former four are better in terms of value-for-money, but with experience living in both the former and the latter, the German system is superior in terms of outcomes, waiting times, choice. (Yes, mediterranean countries have a higher life expectancy due to diet and physical activity, but that wouldn't change much with a different health care model.)
    - maxerickson 10y ago
      My primary contention is that Every other first world country? is a little too lacking in nuance, I wasn't trying to express an opinion about what works best.
    - dx034 10y ago
      Having lived in both countries, I wouldn't say that the UK system is in any way better than the German system. Rather the opposite. In addition to that, the German system isn't really a private system. The premium and health coverage is set by law and the insurances are not-for-profit entities. There's the possibility to get private insurance for parts of the population, but you're not dependent on private companies.
  - r00fus 10y ago
    Parent comment still addresses the point. Majority of first-world countries have single-payer model. Exceptions prove the rule.
neltnerb 10y ago
Off the top of my head, and certainly some are up for debate. But consider how well these systems worked prior to government intervention. You may think medicare, for instance, is run horribly -- but I'm pretty confident that seniors are far happier with it than they were pawning off their possessions to get medical treatment prior to it being created. - Medicaid - Medicare - The USPS (which, let's be honest, is freaking amazing for the price) - Social security - Basic research - The military (remember our private security contractors and how much more horrible they were?) - The fire department - The police (can you imagine how horrible a private police force would be?) And on the flip side, consider how atrocious private prisons are compared to federally operated ones. I'm sure there are many, many others...
- chimeracoder 10y ago
  > You may think medicare, for instance, is run horribly -- but I'm pretty confident that seniors are far happier with it than they were pawning off their possessions to get medical treatment prior to it being created. Sure, but empirically, seniors are far happier with privatized Medicare plans than they are with publicly-administered Medicare plans. Original Medicare has the lowest satisfaction rates of all major Medicare plans - far lower than the lowest of the privately-managed plans. Medicaid is run at the state level, but the same applies there as well - privately managed Medicaid plans are gaining popularity because they deliver better medical results at lower prices. > The USPS (which, let's be honest, is freaking amazing for the price) USPS is a mixed bag, but it isn't a straightforward comparison, because the USPS is statutorily protected from competition. For example, by law, all private carriers are required to charge at least twice what USPS charges for a first-class letter - so when you say it's "amazing for the price", we're already dealing with a warped perception of what mail delivery costs. Most of the other examples you list don't address OP's question ("Do we have examples of the government running a service better than the private sector"), because there hasn't been a private sector for those in modern history for us to compare them with.
  - neltnerb 10y ago
    If the proposals on the table were to simply allow private companies to offer competing options, I would have few concerns that I could back up with factual analysis. I suspect it would be highly case-by-case, which is fine and how a deliberative legislative body should function. I'd still be extremely leery of private police, military, fire, or infrastructure, it just seems like a transparently bad idea. Like our security contractors paid by the military, who cost vastly more than public employees and have far less oversight. And who (possibly coincidentally, but come on) are to blame for the worst abuses by our forces overseas. But for some specific, narrow market (like space travel or health care or even retirement funds) I'd be absolutely willing to give them a chance as long as it didn't break the existing government system. Charter schools seem like a good case study in that, which I say not because the data completely backs up the idea that government run is always better, but because it's a very complex system with many examples that provide insight in both directions.
alexqgb 10y ago
Many. Start with highways, aviation safety, and prisons. Oh, and the history of private fire departments is a carnival of horrors. I mean, the list goes on (and on, and on).
chimeracoder 10y ago
> Here's the only thing I'm confused about. Do we have examples of the government running a service better than the private sector? Medicare is a good case study, because Medicare has both publicly managed plans and privately managed plans. As it turns out Medicare Advantage (the privately managed plans) consistently beat Original Medicare on the three primary metrics: cost, medical outcomes, and patient satisfaction scores. (In fact, Original Medicare has the lowest satisfaction rates of all major Medicare plans).
enraged_camel 10y ago
You would do well to start questioning the idea that the private sector does anything "better". After all, it was them that gave us Enron, Deepwater Horizon, and most recently, the subprime mortgage crisis, which brought the entire world economy to its knees. Those are only a few examples that spring to mind. In addition, comparing the government with the private sector is pretty silly. They have different goals. Private companies try to maximize profit, even if it comes with massive externalities (which, barring regulations, they happily pass on to others). Governments aim to serve their citizens, even if it comes at the expense of efficiency. This means that any given problem will be handled very differently by the private sector compared to the government. The route we pick really depends on our priorities as a society.
- refurb 10y ago
  After all, it was them that gave us Enron, Deepwater Horizon, and most recently, the subprime mortgage crisis, which brought the entire world economy to its knees. That's a pretty poor argument if you line it up against gov't waste, incompetence and corruption.
  - enraged_camel 10y ago
    Can you provide any arguments (or, even better, empirical evidence) as to why the government has more waste, incompetence and corruption than the private sector?
    - refurb 10y ago
      I'm not arguing one is better than the other. Just that both system are run by humans so I wouldn't say you'd have less corruption or waste in one or the other.
      - enraged_camel 10y ago
        Well, yeah, we aren't really disagreeing then.
      - 10y ago
FullMtlAlcoholc 10y ago
Prisons for one. You seem to misunderstand the role of governments though. Citizens and taxpayers are not shareholders seeking to maximize return on investment. The government exists to provide for national defense, rule of law, postal service, and domestic security. Private industry would have an incentive to not provide these services for free riders (the poor, those who dodge payment, etc.) Private industry also ignores externalities in their pricing, which is why we have regulation. I quite like not having to pay for relatively clean air.

by jbhatab 10y ago

toomuchtodo 10y ago

> Would love a counter opinion. Every other first world country? https://en.wikipedia.org/wiki/List_of_countries_with_universal_health_care https://en.wikipedia.org/wiki/List_of_countries_with_univers...

maxerickson 10y ago
Several of those countries implement universal coverage using a private insurance model.
- toomuchtodo 10y ago
  In almost all European countries, its provided by the government and funded by taxation. My point stands.
  - maxerickson 10y ago
    Netherlands, Germany and Switzerland are 3 counter examples.
    - unclenoriega 10y ago
      Germany doesn't have single-payer, but it does have a highly-regulated, mostly public health insurance industry. Most people are covered by the public system, which, while multi-payer, has premiums set by the government and based on income, as well as a fixed set of services determined by the government. In effect, it's not that different from a single-payer system funded by a progressive income tax. I have thought the German system might be a better fit for the US, since sickness funds can still compete with each other, mostly on customer service and the like.
- luckydata 10y ago
  All the best systems are single payer. Italy, France, Spain, the UK. The countries with private insurance like Germany are middle of the pack. Clearly single payer is the superior option.
  - MagnumOpus 10y ago
    Back that up with numbers please. At best, the former four are better in terms of value-for-money, but with experience living in both the former and the latter, the German system is superior in terms of outcomes, waiting times, choice. (Yes, mediterranean countries have a higher life expectancy due to diet and physical activity, but that wouldn't change much with a different health care model.)
  - maxerickson 10y ago
    My primary contention is that Every other first world country? is a little too lacking in nuance, I wasn't trying to express an opinion about what works best.
  - dx034 10y ago
    Having lived in both countries, I wouldn't say that the UK system is in any way better than the German system. Rather the opposite. In addition to that, the German system isn't really a private system. The premium and health coverage is set by law and the insurances are not-for-profit entities. There's the possibility to get private insurance for parts of the population, but you're not dependent on private companies.
- r00fus 10y ago
  Parent comment still addresses the point. Majority of first-world countries have single-payer model. Exceptions prove the rule.

neltnerb 10y ago

Off the top of my head, and certainly some are up for debate. But consider how well these systems worked prior to government intervention. You may think medicare, for instance, is run horribly -- but I'm pretty confident that seniors are far happier with it than they were pawning off their possessions to get medical treatment prior to it being created. - Medicaid - Medicare - The USPS (which, let's be honest, is freaking amazing for the price) - Social security - Basic research - The military (remember our private security contractors and how much more horrible they were?) - The fire department - The police (can you imagine how horrible a private police force would be?) And on the flip side, consider how atrocious private prisons are compared to federally operated ones. I'm sure there are many, many others...

chimeracoder 10y ago
> You may think medicare, for instance, is run horribly -- but I'm pretty confident that seniors are far happier with it than they were pawning off their possessions to get medical treatment prior to it being created. Sure, but empirically, seniors are far happier with privatized Medicare plans than they are with publicly-administered Medicare plans. Original Medicare has the lowest satisfaction rates of all major Medicare plans - far lower than the lowest of the privately-managed plans. Medicaid is run at the state level, but the same applies there as well - privately managed Medicaid plans are gaining popularity because they deliver better medical results at lower prices. > The USPS (which, let's be honest, is freaking amazing for the price) USPS is a mixed bag, but it isn't a straightforward comparison, because the USPS is statutorily protected from competition. For example, by law, all private carriers are required to charge at least twice what USPS charges for a first-class letter - so when you say it's "amazing for the price", we're already dealing with a warped perception of what mail delivery costs. Most of the other examples you list don't address OP's question ("Do we have examples of the government running a service better than the private sector"), because there hasn't been a private sector for those in modern history for us to compare them with.
- neltnerb 10y ago
  If the proposals on the table were to simply allow private companies to offer competing options, I would have few concerns that I could back up with factual analysis. I suspect it would be highly case-by-case, which is fine and how a deliberative legislative body should function. I'd still be extremely leery of private police, military, fire, or infrastructure, it just seems like a transparently bad idea. Like our security contractors paid by the military, who cost vastly more than public employees and have far less oversight. And who (possibly coincidentally, but come on) are to blame for the worst abuses by our forces overseas. But for some specific, narrow market (like space travel or health care or even retirement funds) I'd be absolutely willing to give them a chance as long as it didn't break the existing government system. Charter schools seem like a good case study in that, which I say not because the data completely backs up the idea that government run is always better, but because it's a very complex system with many examples that provide insight in both directions.

alexqgb 10y ago

Many. Start with highways, aviation safety, and prisons. Oh, and the history of private fire departments is a carnival of horrors. I mean, the list goes on (and on, and on).

chimeracoder 10y ago

> Here's the only thing I'm confused about. Do we have examples of the government running a service better than the private sector? Medicare is a good case study, because Medicare has both publicly managed plans and privately managed plans. As it turns out Medicare Advantage (the privately managed plans) consistently beat Original Medicare on the three primary metrics: cost, medical outcomes, and patient satisfaction scores. (In fact, Original Medicare has the lowest satisfaction rates of all major Medicare plans).

enraged_camel 10y ago

You would do well to start questioning the idea that the private sector does anything "better". After all, it was them that gave us Enron, Deepwater Horizon, and most recently, the subprime mortgage crisis, which brought the entire world economy to its knees. Those are only a few examples that spring to mind. In addition, comparing the government with the private sector is pretty silly. They have different goals. Private companies try to maximize profit, even if it comes with massive externalities (which, barring regulations, they happily pass on to others). Governments aim to serve their citizens, even if it comes at the expense of efficiency. This means that any given problem will be handled very differently by the private sector compared to the government. The route we pick really depends on our priorities as a society.

refurb 10y ago
After all, it was them that gave us Enron, Deepwater Horizon, and most recently, the subprime mortgage crisis, which brought the entire world economy to its knees. That's a pretty poor argument if you line it up against gov't waste, incompetence and corruption.
- enraged_camel 10y ago
  Can you provide any arguments (or, even better, empirical evidence) as to why the government has more waste, incompetence and corruption than the private sector?
  - refurb 10y ago
    I'm not arguing one is better than the other. Just that both system are run by humans so I wouldn't say you'd have less corruption or waste in one or the other.
    - enraged_camel 10y ago
      Well, yeah, we aren't really disagreeing then.
    - 10y ago

FullMtlAlcoholc 10y ago

Prisons for one. You seem to misunderstand the role of governments though. Citizens and taxpayers are not shareholders seeking to maximize return on investment. The government exists to provide for national defense, rule of law, postal service, and domestic security. Private industry would have an incentive to not provide these services for free riders (the poor, those who dodge payment, etc.) Private industry also ignores externalities in their pricing, which is why we have regulation. I quite like not having to pay for relatively clean air.