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Here in the UK you have a choice on whether to rely on the government or not - you are perfectly free to go private, and plenty of people do. In the US you do n

Here in the UK you have a choice on whether to rely on the government or not - you are perfectly free to go private, and plenty of people do. In the US you do not have an equivalent choice.

mikeash 9y ago
So many Americans do not understand this, and think that universal health care means the government imposes a monopoly.
- tyingq 9y ago
  If you choose private healthcare, are your taxes reduced accordingly?
  - mikeash 9y ago
    No.
    - tyingq 9y ago
      Ok. So there's choice. But is it really not a monopoly if paying in is compulsory, whether you use it or not?
      - TheOtherHobbes 9y ago
        No. Because it's not - well, it wasn't until recently, anyway - run as a for-profit business. And also because public health insurance is a relatively low, fixed cost. It's not a variable cost that can bankrupt you if you ever need to use it, like health insurance in the US. A monopoly is exploitative. A public service can't be exploitative - it can only be inefficient. In fact the British NHS provides some of the most efficient cost outcomes in the world. It's impossible to overstate how incredibly beneficial this is, especially for startups and entrepreneurs. In the UK I literally do not have to worry about the cost of health care. There are some relatively small employment taxes to pay, but that's all there is to it.
        tyingq 9y ago
        "A monopoly is exploitative" I think that's the part where we're misunderstanding each other. To me, a monopoly isn't inherently exploitative. The NHS looks like a monopoly to me. Whether it's a net good is a different discussion.
      - mikeash 9y ago
        Would you say that Social Security has a monopoly on retirement saving, or HUD has a monopoly on housing?
        tyingq 9y ago
        You get social security benefits back, regardless. It would be comparable if you took away my benefits once I opted for a 401k. I guess it's somewhat comparable to those that use NHS for most things, but supplement with private. But social security isn't enough to retire on for most, so "marketshare" isn't dominant. It sounds like NHS is enough for most healthcare needs. HUD would be comparable, if almost everyone qualified for it. They don't. A monopoly implies dominant marketshare.
        mikeash 9y ago
        Why would SS need to take away your benefits to be comparable? It’s not like government health systems kick you out if you ever go to a private hospital.
        tyingq 9y ago
        Poor analogy on my part. They are different in that Social Security doesn't provide for most retirement needs. Therefore, it doesn't dominate the market. And, so people from many income brackets choose other forms of retirement to supplement. I suspect only a very few supplement NHS since it's comprehensive. That market dominance makes it a monopoly. Edit: I disagree with the conclusion below. A compulsory deduction that's large enough to address all your needs for a particular service creates a monopoly. The issue just seems to be that the word sounds "bad" to those that like the NHS system. If social security deducted enough that it resulted in a reasonable living retirement plan, it would be similar. It would make any other activity in the retirement market very narrow and mostly for rich people.
        mikeash 9y ago
        Seems like that also makes your original question irrelevant: if what matters is market dominance, then it doesn't matter whether your taxes are reduced if you opt out. In any case, it seems to me that the important thing about a monopoly is most people having no choice. Standard Oil was a monopoly because most people had no choice but to buy their oil from that company. AT&T was a monopoly because that was the only company you could get phone service from. Market dominance is a cause of this key thing, not the key thing itself. A company might have a "monopoly" with 80% of the market because the nature of that market means that 20% isn't enough to provide most customers with a choice. On the other hand, a company might not have a "monopoly" with 95% of the market in a market where scale is less important and 5% of the market is enough to give every customer a choice, and customers choose the dominant player because they want it. Seems to me that the situation with health care in places like the UK is in that second category. The government system is dominant not because people have no choice, but because people don't want to pay for private care.
  - Mediterraneo10 9y ago
    No, because that would defeat the purpose of having public healthcare: a universal safety net for those who for some reason lose out on private healthcare. But because private healthcare has to compete with public healthcare in countries with such a dual system, the price for private insurance is driven very low, so it isn't as disastrously expensive as in the United States, for example, and demanding a large tax refund for this would seem extreme.
    - tyingq 9y ago
      I'm not debating whether public healthcare is a good thing. Just specifically objecting to claims that it's not a monopoly. If everyone pays in, it is. That doesn't negate every upside.

Here in the UK you have a choice on whether to rely on the government or not - you are perfectly free to go private, and plenty of people do. In the US you do not have an equivalent choice.

mikeash 9y ago

So many Americans do not understand this, and think that universal health care means the government imposes a monopoly.

tyingq 9y ago
If you choose private healthcare, are your taxes reduced accordingly?
- mikeash 9y ago
  No.
  - tyingq 9y ago
    Ok. So there's choice. But is it really not a monopoly if paying in is compulsory, whether you use it or not?
    - TheOtherHobbes 9y ago
      No. Because it's not - well, it wasn't until recently, anyway - run as a for-profit business. And also because public health insurance is a relatively low, fixed cost. It's not a variable cost that can bankrupt you if you ever need to use it, like health insurance in the US. A monopoly is exploitative. A public service can't be exploitative - it can only be inefficient. In fact the British NHS provides some of the most efficient cost outcomes in the world. It's impossible to overstate how incredibly beneficial this is, especially for startups and entrepreneurs. In the UK I literally do not have to worry about the cost of health care. There are some relatively small employment taxes to pay, but that's all there is to it.
      - tyingq 9y ago
        "A monopoly is exploitative" I think that's the part where we're misunderstanding each other. To me, a monopoly isn't inherently exploitative. The NHS looks like a monopoly to me. Whether it's a net good is a different discussion.
    - mikeash 9y ago
      Would you say that Social Security has a monopoly on retirement saving, or HUD has a monopoly on housing?
      - tyingq 9y ago
        You get social security benefits back, regardless. It would be comparable if you took away my benefits once I opted for a 401k. I guess it's somewhat comparable to those that use NHS for most things, but supplement with private. But social security isn't enough to retire on for most, so "marketshare" isn't dominant. It sounds like NHS is enough for most healthcare needs. HUD would be comparable, if almost everyone qualified for it. They don't. A monopoly implies dominant marketshare.
        mikeash 9y ago
        Why would SS need to take away your benefits to be comparable? It’s not like government health systems kick you out if you ever go to a private hospital.
        tyingq 9y ago
        Poor analogy on my part. They are different in that Social Security doesn't provide for most retirement needs. Therefore, it doesn't dominate the market. And, so people from many income brackets choose other forms of retirement to supplement. I suspect only a very few supplement NHS since it's comprehensive. That market dominance makes it a monopoly. Edit: I disagree with the conclusion below. A compulsory deduction that's large enough to address all your needs for a particular service creates a monopoly. The issue just seems to be that the word sounds "bad" to those that like the NHS system. If social security deducted enough that it resulted in a reasonable living retirement plan, it would be similar. It would make any other activity in the retirement market very narrow and mostly for rich people.
        mikeash 9y ago
        Seems like that also makes your original question irrelevant: if what matters is market dominance, then it doesn't matter whether your taxes are reduced if you opt out. In any case, it seems to me that the important thing about a monopoly is most people having no choice. Standard Oil was a monopoly because most people had no choice but to buy their oil from that company. AT&T was a monopoly because that was the only company you could get phone service from. Market dominance is a cause of this key thing, not the key thing itself. A company might have a "monopoly" with 80% of the market because the nature of that market means that 20% isn't enough to provide most customers with a choice. On the other hand, a company might not have a "monopoly" with 95% of the market in a market where scale is less important and 5% of the market is enough to give every customer a choice, and customers choose the dominant player because they want it. Seems to me that the situation with health care in places like the UK is in that second category. The government system is dominant not because people have no choice, but because people don't want to pay for private care.
- Mediterraneo10 9y ago
  No, because that would defeat the purpose of having public healthcare: a universal safety net for those who for some reason lose out on private healthcare. But because private healthcare has to compete with public healthcare in countries with such a dual system, the price for private insurance is driven very low, so it isn't as disastrously expensive as in the United States, for example, and demanding a large tax refund for this would seem extreme.
  - tyingq 9y ago
    I'm not debating whether public healthcare is a good thing. Just specifically objecting to claims that it's not a monopoly. If everyone pays in, it is. That doesn't negate every upside.