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State-sponsored universal coverage: "that's for commies! Not acceptable!" Silicon Valley VC-based universal coverage sponsored with crowdfunding: "wooooho tha

State-sponsored universal coverage: "that's for commies! Not acceptable!" Silicon Valley VC-based universal coverage sponsored with crowdfunding: "wooooho that's super great! I love technology" I would laugh if It wasn't for the milions not being able to afford basic healthcare.

brucephillips 9y ago
I don't agree with it, be the counter-argument would be that state-sponsored coverage involves taking money from people without their consent (taxes), whereas charity doesn't. You should always address the strongest version of the argument you're refuting.
- forapurpose 9y ago
  I fully consent to paying my taxes, even when the money goes to things that I don't want my government to do. Everyone consents to the rules of democracy: Debate it, take a vote, majority wins. Sometimes I'll win, sometimes I'll lose, but I fully support the outcome every time (even if when I'm trying to change it for next time).
  - pitaj 9y ago
    Not everybody consents to those rules. The founding fathers thought those rules were fundamentally broken which is why they encoded a stringent restrictive constitution including checks and balances and the bill of rights.
    - wildrhythms 9y ago
      In what way do you think the Bill of Rights is restrictive?
      - pitaj 9y ago
        It restricts the power of the government to do things it otherwise would have the power to do.
    - simonh 9y ago
      The founding fathers thought the rules of democracy were fundamentally broken? Isn't the Constitution and Bill of Rights precisely a set of rules for democracy?
      - pitaj 9y ago
        Yes, they did. Based on what happened in Greece, Rome, etc.
- angersock 9y ago
  > involves taking money from people without their consent (taxes) And yet you enjoy GPS, roads, running water, bridges, numerous standards, air quality and pollution reduction by regulators, defense of property, fire departments... This particular line of argument is tiresome unless you're willing to forgo all of the amenities others have paid (and sometimes died) for. If you're not willing to give them up, adding healthcare to the tab is hardly a step too far.
  - brucephillips 9y ago
    Most libertarians would give those up, in favor of private solutions. Again, I don't believe this argument, but this is the argument.
    - deleted 9y ago
      [deleted]
    - vidarh 9y ago
      Most right libertarians would. Left wing libertarianism (what libertarianism started out as in the 1850's) started from the socialist and anarchist premise that de jure rights without the access to resources to enjoy them are not real rights - for rights to have meaning, people need to be able to take advantage of them. Specifically, Joseph Dejacques polemic against Proudhon [1] where the term libertarian was coined focused on the latter's willingness to talk loftily of liberty on one hand, but the next moment limiting to liberty related to capital rather than the emancipation of all, specifically throwing women under the bus because Proudhon did not see them as equals: > Moderate anarchist, liberal, but not libertarian, you want free exchange of cotton and candles and you seek to protect man against woman in the exchange of affectional human passion. You cry against the great barons of capital, and you would rebuild a proud barony of man on vassal-woman. Dejacques makes an impassioned (and poetic -- the letter is well worth a read even if you disagree with every word) argument both for anarchy, and against the monopoly on resources, and the turns Proudhon's own word against him in arguing that for men to monopolise power is the same thing - talk of liberty becomes meaningless when we allow there to be arbitrary limits on who are afforded said liberty based on ideas of who are worthy: > Attribute not to him a stock of intelligence which belongs to him only by right of conquest, by the commerce of love, by usury on the capital that comes entirely from woman and is the product of the soul within her. Dare not to attribute to him that which he has derived from another or I will answer you in your own words: “Property is robbery!” > Raise your voice, on the contrary, against the exploitation of woman by man. Dejacques set the term "libertarian" up as a step beyond "moderate anarchists" (!) and "liberals" such as Mr "property is robbery" Proudhon: The emancipation of human beings, according to Dejacques, comes from taking the ideas that Proudhon happily promoted in economy - to limit power, be it over persons or property - to the full conclusion with a focus on the emancipation of all humanity. Mere de jure emancipation will not do, then, if people can not take advantage of it. Maximising liberty to Dejacques meant being uncompromisingly willing to take that which is being hoarded and share it, be it money or power, or authority. As such, the idea of maximising liberty from a left libertarian viewpoint does not see property as the holy cow that right libertarianism does, but in fact has from the outset seen strict property-rights as a direct threat to liberty, rising to outright aggression (e.g. if you try to use force to prevent someone who is starving from eating to maintain life you are putting their life at risk). Right-libertarianism makes a mockery of libertarianism by sacrificing the principle of maximising liberty in order to provide an ideological veneer for the protection of wealth and privilege. [1] https://theanarchistlibrary.org/library/joseph-dejacque-on-the-human-being-male-and-female https://theanarchistlibrary.org/library/joseph-dejacque-on-t...
- pnathan 9y ago
  > involves taking money from people without their consent (taxes), whereas charity doesn't This argument seems to be novel from the late 1800s. Before then, it seems to have been understood that the political system ran on taxes. It beggars the imagination that modern Americans seem to believe the old anarchist saw that cooperation and working with society via the ancient tradition of taxation is theft.
  - brucephillips 9y ago
    I'm not sure what you mean by "understood". Everyone has always understood that the government works on taxes. But if you mean "agreed with", that's certainly not the case. The line between taxes and theft in the middle ages, for instance, was extremely blurry.
  - microcolonel 9y ago
    It was also "understood" not long ago that the women of the villages you ransacked would become your property, that the king could do approximately whatever he wanted, that approximately all your kids would die seemingly out of nowhere before the age of five. That tyranny has been "understood" is not a justification for the deliberate resurgence of tyranny. That you could take even more money from the public to fund your pet project is of no importance to the question of whether it is right or wrong to do so. > This argument seems to be novel from the late 1800s. Have you heard of the USA? It's been constituted since 1788, and it was more or less understood that the government wouldn't be getting involved in this sort of thing. If I'm not mistaken, 1788 is before the late 1800s.
    - fsloth 9y ago
      "it was more or less understood that the government wouldn't be getting involved in this sort of thing." I propose you use some other rethorical device to back your argument. it was also understood back then that government would not ban slavery and that only people with property and penises could vote.
  - lmm 9y ago
    > This argument seems to be novel from the late 1800s. Before then, it seems to have been understood that the political system ran on taxes. Before then the political system openly ran on violent coercion.
- objclxt 9y ago
  But I don't think that is the strongest version of the argument: it's based on the rather weak premise that taxes are inherently unconscionable. Imagine we were talking about the army, instead of healthcare. The argument would start with the question "is the state obliged to protect its citizens?", not "my taxes shouldn't pay for it". The counter-argument here is not one around taxes, but around the obligations of the state. If you don't believe in universal healthcare then you ipso facto believe the state has no obligation to provide it, and that's where the counter-argument needs to come from.
  - brucephillips 9y ago
    It's not based on that premise, no. A person can think that the country should tax its citizens to protect them, while simultaneously think that the country should not tax its citizens to redistribute wealth.
    - bocajuniors 9y ago
      Societies with more evenly distributed wealth tends to have lower crime rates.
    - pgeorgi 9y ago
      > the country should not tax its citizens to redistribute wealth. The army is also a huge wealth distribution machine: Raytheon or Boeing are businesses, and army personnel presumably is paid, too. > tax its citizens to protect them For example, from life threatening conditions. Same statements, different cherry picking -> entirely different results.
    - pjc50 9y ago
      > A person can think that the country should tax its citizens to protect them Ah, so you are in favour of universal socialised health care! (/joking, mostly. But I feel that protecting citizens only from other humans but not from the far more deadly problems of disease and ill-health is a very limited view. If the US really believed in the inherent superiority of the private model, it would use it for its troops. No medevac if you've not paid your premiums!)
- simonh 9y ago
  All laws are coercive. Why are you picking out specific ones, what are the criteria? For example public parks have bipartisan support and are funded by taxes. So why will the US tax people to care for wildlife, but not its own citizens? At one time the US instituted a military draft, requiring citizens to carry out military service. Citizens are required to obey the law, pay taxes and serve the interests of society, as determined by the government. I believe that this places a responsibility on that government to care for and protect citizens. It must offer them the protection of the law, defend them in times of war and, I believe, provide basic health care. It should do so not just for the benefit of the individual, but for the benefit of society. There's no point drafting people into the military if the health of the population isnt up to it. This was a major issue for the UK in WWI and a key factor in getting cross-party support for a national health service, because a shocking number of young men were unfit for duty. Currently not being in a time of war doesn't change the relationship though. The duties and responsibilities are still there.
  - bduerst 9y ago
    >All laws are coercive Locke would disagree with your premise. You're an individual with the freedom to move to any society that you agree with the most. Unless your freedom has been alienated, you are tacitly consenting to a government's laws by remaining where you are.
    - soVeryTired 9y ago
      So why does the typical American live within 18 miles of home? [0] Do they just happen to agree with the society they're born into, or is it possible there are stronger forces than political preference that constrain their movement? [0] https://www.nytimes.com/interactive/2015/12/24/upshot/24up-family.html https://www.nytimes.com/interactive/2015/12/24/upshot/24up-f...
      - simonh 9y ago
        It depends what you mean by constrain. What constraints are they under that are not voluntary?
- MindOfAllDogs 9y ago
  The problem with charity is that no one will think they need to give money to it if no one else gives it money. Also, people don't necessarily feel an obligation to pay anything whereas taxes are enforced by a government and regardless at this point pretty much anything is more efficient than US healthcare
- flexie 9y ago
  Money is taken from citizens against their consent to pay for - military - roads - primary education - secondary education - criminal justice system - research Each and every one of those could in theory run entirely on a voluntary basis and has through history been doing so here and there from time to time.
  - wavefunction 9y ago
    >Each and every one of those could in theory I prefer to stick with what works in practice, even if it's imperfect.
    - AsyncAwait 9y ago
      Agreed and it seems to me that "free-market healthcare" doesn't work well in practice.
  - orf 9y ago
    It's rather ridiculous to argue that point. None of those could or should be ran on a 'voluntry' basis in today's society. Consider more rural areas, where there are less people to make these donations, and more roads are needed. Is it ok to say "pay for your own roads" when it unfairly shoulders them with the largest burden? It will end up with lower income rural areas having crappy or no roads. Same for all the others you listed, bar military. Also, who pays for the highways? Having a justice system depend on donations from the populace is kind of a huge issue with impartiality. Fyi, England used to effectively do what you suggest pre ~1700. It didn't work out well from a justice, education or infrastructure angle until the state got involved.
    - pgeorgi 9y ago
      > Fyi, England used to effectively do what you suggest pre ~1700. It didn't work out well from a justice, education or infrastructure angle until the state got involved. Same can be said about health care, at least in countries that (unlike Post-Thatcher UK) don't actively try to ruin their public health system.
    - 9y ago
- AsyncAwait 9y ago
  > the counter-argument would be that state-sponsored coverage involves taking money from people without their consent (taxes) I hate this argument, taxes are a fact of life in society, you're going to pay them and the only question is where are they being spent. If instead of spending so much on the military, some of that budget was spent on healthcare, than maybe there wouldn't even be a need for higher taxes. But instead of lobbying for their taxes being spent appropriately at home, many in the US seem happy with going to sovereign countries instead of taking care of their own citizens. There never seems to be a concern if you have money for the next invasion, but when it comes to healthcare or education, where's the money going to come from? (To be fair, it's not just the US that has this problem, but it is certainly one of the worst examples.)
- mempko 9y ago
  This is plain wrong. At the federal level I in the USA, taxes are not used to pay for anything. Federal government spends first and then collects taxes. If you haven't noticed, the government ran a deficit for the good part of the last 150 years with no issue. In fact the government MUST run a deficit if we want our economy to grow, or even stay out of recession/depression.
pandaman 9y ago
One thing people miss about government provided healthcare is that it's easy to be made mandatory. If government provides your health care it's only natural if it directs you to a healthier life to save people's money. I, for one, don't want "doctor's orders" to become actual orders enforced by police.
- nothrabannosir 9y ago
  Yes, these kind of theoretical arguments are so important and constructive when scores of people are actually in serious trouble today, in the real world. "The police enforcing doctor's orders." Give me a break. I'm all for healthy debate but come on. This is the most inane argument I've ever heard about universal health care, and I've heard quite a few. Sorry for not being more constructive, I just can't see this line of reasoning go anywhere useful.
  - pandaman 9y ago
    Theoretical? I've been living in the USSR. It's been very practical there.
    - colde 9y ago
      And perhaps that viewpoint has skewed your outlook somewhat. I haven't seen anything close to that nightmare scenario in Denmark, and indeed the rest of Scandinavia. What comes closest is taxing unhealthy food, which i tend to agree with.
    - gattilorenz 9y ago
      Maybe the fact that it was a dictatorship, not public healthcare, has something to do with that?
      - pandaman 9y ago
        I assure you, there was public healthcare in the USSR and I don't see how it's being a dictatorship has anything to do with the healthcare enforcement? You think people won't vote a representative who will want to establish mandatory rehab for drug users in the USA, for example?
avenius 9y ago
I've never quite understood how so many americans appear to oppose a communally paid healthcare system. It should be a win-win for everyone, right? Is it just a severe lack of empathy?
- microcolonel 9y ago
  No, it's the lack of quality. I dare you to try to receive care in Canada for anything which isn't a visible emergency. Even if you could pay for it you still couldn't get it. Socialized health coverage works better in some places outside North America because people have some sense of custodianship and duty. North America is full of irreverence, nobody gives a damn if they're doing what they ought to do as long as they're seen to do what they have to. Ask yourself if you would like to do dermatology like the DMV; surgery like a typical post office.
  - panic 9y ago
    This anti-government ideology is self-reinforcing. We underfund government programs, then hold them up as examples: "Look, government funding doesn't work. I told you so!" In reality, the people doing the actual work of health care wouldn't change -- the money to pay them would just come from a different place. Do you really think the folks at insurance companies have more custodianship and duty than people working in the public sector?
    - ericd 9y ago
      I agree about the frequent use of the tactic of making government dysfunctional to persuade people that they don't want to pay the taxes necessary to expand government services, but that tactic probably isn't going away. You can thank people like Grover Norquist who really, really want taxes lowered. Also, something to keep in mind with fully socialized medicine is it would almost certainly reduce doctor pay, because the government would have almost all the leverage in pricing. I know some doctors in France well, they're extremely poorly paid compared to doctors in the same practice in the US. And if you squeeze doctor salaries too much, what fraction of would-be doctors are going to decide that they don't want to go through the hassle and expense of medical school?
flexie 9y ago
Thank you. It beats me that Americans when looking for alternatives to their current system(s) or the lack of systems in third world countries overlook the European models where "socialized medicine" in various forms works well and has done so since around WW2 (different from country to country). My experience in Europe is limited to living in Denmark, Spain and Bulgaria, and in each place health care could certainly be improved. But most citizens don't worry as much about health care as they did when I lived in the US. Having seen hospitals in those European countries and what is supposedly a top class Manhattan hospital, I would not trade the European model for the American. Just the humiliation of asking a woman in severe pain for her insurance before treating her; it's undignified. But whereas the European models could - and in my opinion should - inspire in the US, they are not easily transposed to third world countries where you lack a strong government without too much corruption to collect taxes. Here, a private model might work better. Anyways, kudos to anyone trying to improve healthcare in the third world or ours.
- reducesuffering 9y ago
  What are your thoughts on wait times? I was very ill in Barcelona and was told by relatives there wasn't a point in going to the hospital unless I wanted a 6 hour wait for ibuprofen.
  - pmiller2 9y ago
    What makes you think it would be any better in a US hospital? Unless you're literally dying, emergency room treatment is not known for its short wait times. Side note: does the concept of "urgent care" exist outside the US?
    - fergie 9y ago
      Yes of course 'urgent care' exists outside the US (assuming that you mean A&E). One of the most baffling things about this whole debate is the assumption by some Americans that socialised medicine is somehow lacking. It really isn't. It's just better and cheaper.
snomad 9y ago
To be fair, have you read about the VA system? That is a system with limited scope, understood problems, strong bipartisan support, that can easily pull the public's hearts for budget. And it still falls way too short in its mission and regularly fails to provides adequate care.
- AsyncAwait 9y ago
  As an outsider, if you're talking about care for veterans, it seems it is often used as a tool to play politics, rather than actually provide care.
afsina 9y ago
State sponsored health care is very inefficient, coercive, unfair and open to abuse no matter the good intentions. I salute Watsi and YCombinator for making this without direct state support.
- matthewmacleod 9y ago
  That’s a gross generalisation. The NHS in the UK for example - while far from perfect - is none of those things.
  - DanBC 9y ago
    There are large amounts of coercion in care for people with mental illness or people with learning disabilities. Things like community treatment orders are based on coercion. This only applies to quite small numbers of people, but we can't say they don't happen.
    - notahacker 9y ago
      There's also a large amount of coercion in keeping mentally ill people locked up in a prison because the government won't pay for them to receive treatment in the community, of course...
    - matthewmacleod 9y ago
      You're right that we can't say "no coercion happens in the NHS", but we can reasonably say "any coercion that happens in the NHS is orthogonal to its single-payer nature". CTOs are definitely in the grey area between the legal and healthcare systems.
  - lucaspiller 9y ago
    Just for clarification, the NHS budget in the UK for 2016/17 was £120 billion[0], which works out to be about £1800 per person. Seems like a pretty good deal, given that in the US, health insurance for an individual would be around double that [1]. [0] https://www.gov.uk/government/statistics/public-expenditure-statistical-analyses-2017 https://www.gov.uk/government/statistics/public-expenditure-... [1] https://resources.ehealthinsurance.com/affordable-care-act/much-health-insurance-cost-without-subsidy https://resources.ehealthinsurance.com/affordable-care-act/m...
beefield 9y ago
There is also this thing called game theory and prisoner's dilemma which pretty much guarantees that the silicon valley version is limited to "make me feel good doing my part" instead of being an actual solution to universal health care. My initial thought was that someone had tried to reinvent insurance, but this is not even that. Just charity destined to fail being a proper solution.
- michaelmior 9y ago
  Could you explain more why you think the probability of failure is so high?
  - beefield 9y ago
    First we have to define the problem we want to solve before we can discuss whether a potential solution to the problem is likely to succeed or not. If our problem is "I want to feel good by helping someone to cover their health care costs", Watsi and other charity solutions obviously are viable solutions. (Note that state sponsored health care is also a good solution for this problem, with the downside that somebody else tells you how much you need to pay). So Watsi is a better solution to this problem than state sponsored health care only in the limited case where you have no interest on the outcome of the health care, but only your own feelgood and want to have precise control how much you want to spend to feel good. (If someone senses contempt here to charity givers, the sense is not unfounded) Second potential problem we are discussing here would be "I want some more people get health care." Of course, here as well, Watsi and other charity programs obviously are a solution to the problem in question. Third problem might be something in the lines of "I want every member of the society to have access to decent health care so that first, when I drive past hospital, I do not have to look beggars begging money to get their health problems addressed and second, when I get sick, I do not need to worry whether there was some small print in my insurance contract I did not understand" The third problem is the one where charity based solutions are doomed to failure. There is simply no scenario where I am motivated to pay. One scenario is where there are enough people to pay to solve this without me, so so I can save my money to more important things and enjoy health care benefits. Other scenario is that there are not enough people to pay the beggars out of the street, and my money is not going to change that, so again, I am better spending my money somewhere else. Only path out is that all of us that want to solve the problem and get benefit from the problem [1] solving somehow coerce each other to pay for the solution. I.e. state sponsored health care. Or individual mandate & community rating & subsidies (obamacare). [1] Note here that everyone gets benefit so everyone must be coerced. If you let people out who claim they enjoy looking beggars, the system collapses again, because obviously I say that I enjoy immensely looking beggars and actually you should pay me if you deprive my enjoyment of looking beggars if you otherwise get the system working without my money. And the ones who actually do enjoy looking beggars, let's just say I am a bad person and more than happy coercing them paying real money to get rid of beggars.
oskarth 9y ago
I'm not arguing for either being better or worse [1], but do you honestly not see the difference in it being voluntary or forced? You as an individual don't have to have anything to do with Watsi if you disagree with their implementation. This type of argument seems like a very dishonest strawman to me. 1: I'm from Sweden so I'm obviously appalled at the state of healthcare and health insurance in US, but that's beside the point.
privateprofile 9y ago
The day I saw this post get buried under the traditional sheep-y "tap in the back" posts like 'This makes my heart happy to hear!' was the day I was finally convinced of how biased (censored?) HN really is...

brucephillips 9y ago

I don't agree with it, be the counter-argument would be that state-sponsored coverage involves taking money from people without their consent (taxes), whereas charity doesn't. You should always address the strongest version of the argument you're refuting.

forapurpose 9y ago
I fully consent to paying my taxes, even when the money goes to things that I don't want my government to do. Everyone consents to the rules of democracy: Debate it, take a vote, majority wins. Sometimes I'll win, sometimes I'll lose, but I fully support the outcome every time (even if when I'm trying to change it for next time).
- pitaj 9y ago
  Not everybody consents to those rules. The founding fathers thought those rules were fundamentally broken which is why they encoded a stringent restrictive constitution including checks and balances and the bill of rights.
  - wildrhythms 9y ago
    In what way do you think the Bill of Rights is restrictive?
    - pitaj 9y ago
      It restricts the power of the government to do things it otherwise would have the power to do.
  - simonh 9y ago
    The founding fathers thought the rules of democracy were fundamentally broken? Isn't the Constitution and Bill of Rights precisely a set of rules for democracy?
    - pitaj 9y ago
      Yes, they did. Based on what happened in Greece, Rome, etc.
angersock 9y ago
> involves taking money from people without their consent (taxes) And yet you enjoy GPS, roads, running water, bridges, numerous standards, air quality and pollution reduction by regulators, defense of property, fire departments... This particular line of argument is tiresome unless you're willing to forgo all of the amenities others have paid (and sometimes died) for. If you're not willing to give them up, adding healthcare to the tab is hardly a step too far.
- brucephillips 9y ago
  Most libertarians would give those up, in favor of private solutions. Again, I don't believe this argument, but this is the argument.
  - deleted 9y ago
    [deleted]
  - vidarh 9y ago
    Most right libertarians would. Left wing libertarianism (what libertarianism started out as in the 1850's) started from the socialist and anarchist premise that de jure rights without the access to resources to enjoy them are not real rights - for rights to have meaning, people need to be able to take advantage of them. Specifically, Joseph Dejacques polemic against Proudhon [1] where the term libertarian was coined focused on the latter's willingness to talk loftily of liberty on one hand, but the next moment limiting to liberty related to capital rather than the emancipation of all, specifically throwing women under the bus because Proudhon did not see them as equals: > Moderate anarchist, liberal, but not libertarian, you want free exchange of cotton and candles and you seek to protect man against woman in the exchange of affectional human passion. You cry against the great barons of capital, and you would rebuild a proud barony of man on vassal-woman. Dejacques makes an impassioned (and poetic -- the letter is well worth a read even if you disagree with every word) argument both for anarchy, and against the monopoly on resources, and the turns Proudhon's own word against him in arguing that for men to monopolise power is the same thing - talk of liberty becomes meaningless when we allow there to be arbitrary limits on who are afforded said liberty based on ideas of who are worthy: > Attribute not to him a stock of intelligence which belongs to him only by right of conquest, by the commerce of love, by usury on the capital that comes entirely from woman and is the product of the soul within her. Dare not to attribute to him that which he has derived from another or I will answer you in your own words: “Property is robbery!” > Raise your voice, on the contrary, against the exploitation of woman by man. Dejacques set the term "libertarian" up as a step beyond "moderate anarchists" (!) and "liberals" such as Mr "property is robbery" Proudhon: The emancipation of human beings, according to Dejacques, comes from taking the ideas that Proudhon happily promoted in economy - to limit power, be it over persons or property - to the full conclusion with a focus on the emancipation of all humanity. Mere de jure emancipation will not do, then, if people can not take advantage of it. Maximising liberty to Dejacques meant being uncompromisingly willing to take that which is being hoarded and share it, be it money or power, or authority. As such, the idea of maximising liberty from a left libertarian viewpoint does not see property as the holy cow that right libertarianism does, but in fact has from the outset seen strict property-rights as a direct threat to liberty, rising to outright aggression (e.g. if you try to use force to prevent someone who is starving from eating to maintain life you are putting their life at risk). Right-libertarianism makes a mockery of libertarianism by sacrificing the principle of maximising liberty in order to provide an ideological veneer for the protection of wealth and privilege. [1] https://theanarchistlibrary.org/library/joseph-dejacque-on-the-human-being-male-and-female https://theanarchistlibrary.org/library/joseph-dejacque-on-t...
pnathan 9y ago
> involves taking money from people without their consent (taxes), whereas charity doesn't This argument seems to be novel from the late 1800s. Before then, it seems to have been understood that the political system ran on taxes. It beggars the imagination that modern Americans seem to believe the old anarchist saw that cooperation and working with society via the ancient tradition of taxation is theft.
- brucephillips 9y ago
  I'm not sure what you mean by "understood". Everyone has always understood that the government works on taxes. But if you mean "agreed with", that's certainly not the case. The line between taxes and theft in the middle ages, for instance, was extremely blurry.
- microcolonel 9y ago
  It was also "understood" not long ago that the women of the villages you ransacked would become your property, that the king could do approximately whatever he wanted, that approximately all your kids would die seemingly out of nowhere before the age of five. That tyranny has been "understood" is not a justification for the deliberate resurgence of tyranny. That you could take even more money from the public to fund your pet project is of no importance to the question of whether it is right or wrong to do so. > This argument seems to be novel from the late 1800s. Have you heard of the USA? It's been constituted since 1788, and it was more or less understood that the government wouldn't be getting involved in this sort of thing. If I'm not mistaken, 1788 is before the late 1800s.
  - fsloth 9y ago
    "it was more or less understood that the government wouldn't be getting involved in this sort of thing." I propose you use some other rethorical device to back your argument. it was also understood back then that government would not ban slavery and that only people with property and penises could vote.
- lmm 9y ago
  > This argument seems to be novel from the late 1800s. Before then, it seems to have been understood that the political system ran on taxes. Before then the political system openly ran on violent coercion.
objclxt 9y ago
But I don't think that is the strongest version of the argument: it's based on the rather weak premise that taxes are inherently unconscionable. Imagine we were talking about the army, instead of healthcare. The argument would start with the question "is the state obliged to protect its citizens?", not "my taxes shouldn't pay for it". The counter-argument here is not one around taxes, but around the obligations of the state. If you don't believe in universal healthcare then you ipso facto believe the state has no obligation to provide it, and that's where the counter-argument needs to come from.
- brucephillips 9y ago
  It's not based on that premise, no. A person can think that the country should tax its citizens to protect them, while simultaneously think that the country should not tax its citizens to redistribute wealth.
  - bocajuniors 9y ago
    Societies with more evenly distributed wealth tends to have lower crime rates.
  - pgeorgi 9y ago
    > the country should not tax its citizens to redistribute wealth. The army is also a huge wealth distribution machine: Raytheon or Boeing are businesses, and army personnel presumably is paid, too. > tax its citizens to protect them For example, from life threatening conditions. Same statements, different cherry picking -> entirely different results.
  - pjc50 9y ago
    > A person can think that the country should tax its citizens to protect them Ah, so you are in favour of universal socialised health care! (/joking, mostly. But I feel that protecting citizens only from other humans but not from the far more deadly problems of disease and ill-health is a very limited view. If the US really believed in the inherent superiority of the private model, it would use it for its troops. No medevac if you've not paid your premiums!)
simonh 9y ago
All laws are coercive. Why are you picking out specific ones, what are the criteria? For example public parks have bipartisan support and are funded by taxes. So why will the US tax people to care for wildlife, but not its own citizens? At one time the US instituted a military draft, requiring citizens to carry out military service. Citizens are required to obey the law, pay taxes and serve the interests of society, as determined by the government. I believe that this places a responsibility on that government to care for and protect citizens. It must offer them the protection of the law, defend them in times of war and, I believe, provide basic health care. It should do so not just for the benefit of the individual, but for the benefit of society. There's no point drafting people into the military if the health of the population isnt up to it. This was a major issue for the UK in WWI and a key factor in getting cross-party support for a national health service, because a shocking number of young men were unfit for duty. Currently not being in a time of war doesn't change the relationship though. The duties and responsibilities are still there.
- bduerst 9y ago
  >All laws are coercive Locke would disagree with your premise. You're an individual with the freedom to move to any society that you agree with the most. Unless your freedom has been alienated, you are tacitly consenting to a government's laws by remaining where you are.
  - soVeryTired 9y ago
    So why does the typical American live within 18 miles of home? [0] Do they just happen to agree with the society they're born into, or is it possible there are stronger forces than political preference that constrain their movement? [0] https://www.nytimes.com/interactive/2015/12/24/upshot/24up-family.html https://www.nytimes.com/interactive/2015/12/24/upshot/24up-f...
    - simonh 9y ago
      It depends what you mean by constrain. What constraints are they under that are not voluntary?
MindOfAllDogs 9y ago
The problem with charity is that no one will think they need to give money to it if no one else gives it money. Also, people don't necessarily feel an obligation to pay anything whereas taxes are enforced by a government and regardless at this point pretty much anything is more efficient than US healthcare
flexie 9y ago
Money is taken from citizens against their consent to pay for - military - roads - primary education - secondary education - criminal justice system - research Each and every one of those could in theory run entirely on a voluntary basis and has through history been doing so here and there from time to time.
- wavefunction 9y ago
  >Each and every one of those could in theory I prefer to stick with what works in practice, even if it's imperfect.
  - AsyncAwait 9y ago
    Agreed and it seems to me that "free-market healthcare" doesn't work well in practice.
- orf 9y ago
  It's rather ridiculous to argue that point. None of those could or should be ran on a 'voluntry' basis in today's society. Consider more rural areas, where there are less people to make these donations, and more roads are needed. Is it ok to say "pay for your own roads" when it unfairly shoulders them with the largest burden? It will end up with lower income rural areas having crappy or no roads. Same for all the others you listed, bar military. Also, who pays for the highways? Having a justice system depend on donations from the populace is kind of a huge issue with impartiality. Fyi, England used to effectively do what you suggest pre ~1700. It didn't work out well from a justice, education or infrastructure angle until the state got involved.
  - pgeorgi 9y ago
    > Fyi, England used to effectively do what you suggest pre ~1700. It didn't work out well from a justice, education or infrastructure angle until the state got involved. Same can be said about health care, at least in countries that (unlike Post-Thatcher UK) don't actively try to ruin their public health system.
  - 9y ago
AsyncAwait 9y ago
> the counter-argument would be that state-sponsored coverage involves taking money from people without their consent (taxes) I hate this argument, taxes are a fact of life in society, you're going to pay them and the only question is where are they being spent. If instead of spending so much on the military, some of that budget was spent on healthcare, than maybe there wouldn't even be a need for higher taxes. But instead of lobbying for their taxes being spent appropriately at home, many in the US seem happy with going to sovereign countries instead of taking care of their own citizens. There never seems to be a concern if you have money for the next invasion, but when it comes to healthcare or education, where's the money going to come from? (To be fair, it's not just the US that has this problem, but it is certainly one of the worst examples.)
mempko 9y ago
This is plain wrong. At the federal level I in the USA, taxes are not used to pay for anything. Federal government spends first and then collects taxes. If you haven't noticed, the government ran a deficit for the good part of the last 150 years with no issue. In fact the government MUST run a deficit if we want our economy to grow, or even stay out of recession/depression.

pandaman 9y ago

One thing people miss about government provided healthcare is that it's easy to be made mandatory. If government provides your health care it's only natural if it directs you to a healthier life to save people's money. I, for one, don't want "doctor's orders" to become actual orders enforced by police.

nothrabannosir 9y ago
Yes, these kind of theoretical arguments are so important and constructive when scores of people are actually in serious trouble today, in the real world. "The police enforcing doctor's orders." Give me a break. I'm all for healthy debate but come on. This is the most inane argument I've ever heard about universal health care, and I've heard quite a few. Sorry for not being more constructive, I just can't see this line of reasoning go anywhere useful.
- pandaman 9y ago
  Theoretical? I've been living in the USSR. It's been very practical there.
  - colde 9y ago
    And perhaps that viewpoint has skewed your outlook somewhat. I haven't seen anything close to that nightmare scenario in Denmark, and indeed the rest of Scandinavia. What comes closest is taxing unhealthy food, which i tend to agree with.
  - gattilorenz 9y ago
    Maybe the fact that it was a dictatorship, not public healthcare, has something to do with that?
    - pandaman 9y ago
      I assure you, there was public healthcare in the USSR and I don't see how it's being a dictatorship has anything to do with the healthcare enforcement? You think people won't vote a representative who will want to establish mandatory rehab for drug users in the USA, for example?

avenius 9y ago

I've never quite understood how so many americans appear to oppose a communally paid healthcare system. It should be a win-win for everyone, right? Is it just a severe lack of empathy?

microcolonel 9y ago
No, it's the lack of quality. I dare you to try to receive care in Canada for anything which isn't a visible emergency. Even if you could pay for it you still couldn't get it. Socialized health coverage works better in some places outside North America because people have some sense of custodianship and duty. North America is full of irreverence, nobody gives a damn if they're doing what they ought to do as long as they're seen to do what they have to. Ask yourself if you would like to do dermatology like the DMV; surgery like a typical post office.
- panic 9y ago
  This anti-government ideology is self-reinforcing. We underfund government programs, then hold them up as examples: "Look, government funding doesn't work. I told you so!" In reality, the people doing the actual work of health care wouldn't change -- the money to pay them would just come from a different place. Do you really think the folks at insurance companies have more custodianship and duty than people working in the public sector?
  - ericd 9y ago
    I agree about the frequent use of the tactic of making government dysfunctional to persuade people that they don't want to pay the taxes necessary to expand government services, but that tactic probably isn't going away. You can thank people like Grover Norquist who really, really want taxes lowered. Also, something to keep in mind with fully socialized medicine is it would almost certainly reduce doctor pay, because the government would have almost all the leverage in pricing. I know some doctors in France well, they're extremely poorly paid compared to doctors in the same practice in the US. And if you squeeze doctor salaries too much, what fraction of would-be doctors are going to decide that they don't want to go through the hassle and expense of medical school?

flexie 9y ago

Thank you. It beats me that Americans when looking for alternatives to their current system(s) or the lack of systems in third world countries overlook the European models where "socialized medicine" in various forms works well and has done so since around WW2 (different from country to country). My experience in Europe is limited to living in Denmark, Spain and Bulgaria, and in each place health care could certainly be improved. But most citizens don't worry as much about health care as they did when I lived in the US. Having seen hospitals in those European countries and what is supposedly a top class Manhattan hospital, I would not trade the European model for the American. Just the humiliation of asking a woman in severe pain for her insurance before treating her; it's undignified. But whereas the European models could - and in my opinion should - inspire in the US, they are not easily transposed to third world countries where you lack a strong government without too much corruption to collect taxes. Here, a private model might work better. Anyways, kudos to anyone trying to improve healthcare in the third world or ours.

reducesuffering 9y ago
What are your thoughts on wait times? I was very ill in Barcelona and was told by relatives there wasn't a point in going to the hospital unless I wanted a 6 hour wait for ibuprofen.
- pmiller2 9y ago
  What makes you think it would be any better in a US hospital? Unless you're literally dying, emergency room treatment is not known for its short wait times. Side note: does the concept of "urgent care" exist outside the US?
  - fergie 9y ago
    Yes of course 'urgent care' exists outside the US (assuming that you mean A&E). One of the most baffling things about this whole debate is the assumption by some Americans that socialised medicine is somehow lacking. It really isn't. It's just better and cheaper.

snomad 9y ago

To be fair, have you read about the VA system? That is a system with limited scope, understood problems, strong bipartisan support, that can easily pull the public's hearts for budget. And it still falls way too short in its mission and regularly fails to provides adequate care.

AsyncAwait 9y ago
As an outsider, if you're talking about care for veterans, it seems it is often used as a tool to play politics, rather than actually provide care.

afsina 9y ago

State sponsored health care is very inefficient, coercive, unfair and open to abuse no matter the good intentions. I salute Watsi and YCombinator for making this without direct state support.

matthewmacleod 9y ago
That’s a gross generalisation. The NHS in the UK for example - while far from perfect - is none of those things.
- DanBC 9y ago
  There are large amounts of coercion in care for people with mental illness or people with learning disabilities. Things like community treatment orders are based on coercion. This only applies to quite small numbers of people, but we can't say they don't happen.
  - notahacker 9y ago
    There's also a large amount of coercion in keeping mentally ill people locked up in a prison because the government won't pay for them to receive treatment in the community, of course...
  - matthewmacleod 9y ago
    You're right that we can't say "no coercion happens in the NHS", but we can reasonably say "any coercion that happens in the NHS is orthogonal to its single-payer nature". CTOs are definitely in the grey area between the legal and healthcare systems.
- lucaspiller 9y ago
  Just for clarification, the NHS budget in the UK for 2016/17 was £120 billion[0], which works out to be about £1800 per person. Seems like a pretty good deal, given that in the US, health insurance for an individual would be around double that [1]. [0] https://www.gov.uk/government/statistics/public-expenditure-statistical-analyses-2017 https://www.gov.uk/government/statistics/public-expenditure-... [1] https://resources.ehealthinsurance.com/affordable-care-act/much-health-insurance-cost-without-subsidy https://resources.ehealthinsurance.com/affordable-care-act/m...

beefield 9y ago

There is also this thing called game theory and prisoner's dilemma which pretty much guarantees that the silicon valley version is limited to "make me feel good doing my part" instead of being an actual solution to universal health care. My initial thought was that someone had tried to reinvent insurance, but this is not even that. Just charity destined to fail being a proper solution.

michaelmior 9y ago
Could you explain more why you think the probability of failure is so high?
- beefield 9y ago
  First we have to define the problem we want to solve before we can discuss whether a potential solution to the problem is likely to succeed or not. If our problem is "I want to feel good by helping someone to cover their health care costs", Watsi and other charity solutions obviously are viable solutions. (Note that state sponsored health care is also a good solution for this problem, with the downside that somebody else tells you how much you need to pay). So Watsi is a better solution to this problem than state sponsored health care only in the limited case where you have no interest on the outcome of the health care, but only your own feelgood and want to have precise control how much you want to spend to feel good. (If someone senses contempt here to charity givers, the sense is not unfounded) Second potential problem we are discussing here would be "I want some more people get health care." Of course, here as well, Watsi and other charity programs obviously are a solution to the problem in question. Third problem might be something in the lines of "I want every member of the society to have access to decent health care so that first, when I drive past hospital, I do not have to look beggars begging money to get their health problems addressed and second, when I get sick, I do not need to worry whether there was some small print in my insurance contract I did not understand" The third problem is the one where charity based solutions are doomed to failure. There is simply no scenario where I am motivated to pay. One scenario is where there are enough people to pay to solve this without me, so so I can save my money to more important things and enjoy health care benefits. Other scenario is that there are not enough people to pay the beggars out of the street, and my money is not going to change that, so again, I am better spending my money somewhere else. Only path out is that all of us that want to solve the problem and get benefit from the problem [1] solving somehow coerce each other to pay for the solution. I.e. state sponsored health care. Or individual mandate & community rating & subsidies (obamacare). [1] Note here that everyone gets benefit so everyone must be coerced. If you let people out who claim they enjoy looking beggars, the system collapses again, because obviously I say that I enjoy immensely looking beggars and actually you should pay me if you deprive my enjoyment of looking beggars if you otherwise get the system working without my money. And the ones who actually do enjoy looking beggars, let's just say I am a bad person and more than happy coercing them paying real money to get rid of beggars.

oskarth 9y ago

I'm not arguing for either being better or worse [1], but do you honestly not see the difference in it being voluntary or forced? You as an individual don't have to have anything to do with Watsi if you disagree with their implementation. This type of argument seems like a very dishonest strawman to me. 1: I'm from Sweden so I'm obviously appalled at the state of healthcare and health insurance in US, but that's beside the point.

privateprofile 9y ago

The day I saw this post get buried under the traditional sheep-y "tap in the back" posts like 'This makes my heart happy to hear!' was the day I was finally convinced of how biased (censored?) HN really is...