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The services could be worse but aren’t necessarily worse. It’s foolish to think that any government service is worse than a private one. Also, universal healt

by sykh 8y ago

The services could be worse but aren’t necessarily worse. It’s foolish to think that any government service is worse than a private one. Also, universal healthcare doesn’t necessarily mean government run.

conanbatt 8y ago
It's foolish to believe the state is more efficient that private actors, that is just contrary to real life experience.
- Frondo 8y ago
  It's foolish to believe that private actors can by definition ever be as efficient as the state. Private actors, by definition, must extract something from any service to pay themselves. The government has no overhead. It can run with absolutely no profit and that is its intended model. A private health care company that returns zero profit to its shareholders? Shut 'er down. A private transit company that returns zero profit to its shareholders? Shut 'er down. And yet, government services can run indefinitely at break-even because they're not beholden to the market. Only government can be so efficient--the private sector always loses efficiency through someone scraping something off the top.
  - conanbatt 8y ago
    > The government has no overhead Realz.
- sykh 8y ago
  It’s foolish to believe that private enterprise is always more efficient than a government run program and it’s foolish to think that government is always more efficient. One should not live in a world of such extremes. Sometimes government is the efficient solution. Sometimes private enterprise is.
- monocasa 8y ago
  And yet, NHS is about twice as efficient than the US's system.
  - conanbatt 8y ago
    Is Medicare twice as efficient as private healthcare?
    - monocasa 8y ago
      It's not a great comparison for a lot of reasons (not least of which the first being that Medicare is legally not able to negotiate drug prices), but despite all of that, yes Medicare is dramatically more efficient.
      - conanbatt 8y ago
        Medicare is the core of all regulatory and pricing issues in the healthcare space. And if medicare were expanded to the entire population of the us, its expenditures could be 40-45% of gdp.
        dragonwriter 8y ago
        > Medicare is the core of all regulatory and pricing issues in the healthcare space. I can't see a reasonable argument for that. > And if medicare were expanded to the entire population of the us, its expenditures could be 40-45% of gdp. Even with a naive covered-population-number based extrapolation that ignores that Medicare currently covers the elderly, who tend to have greater medical needs than average, that's not right; national health expenditures are about 18% of GDP, Medicare is about 20% of NHE, and Medicare currently covers around 15% of the population, so a naive population-based extrapolation would put Medicare-for-all at about 24% of GDP.
        conanbatt 8y ago
        Medicare is the reason there is fee-for-service, which is the biggest administrative overhead design if there is one. Also all private insurance works based of of medicare in the rates they pay, the way they code themselves etc. On the extrapolation, of course they are all simplistic and wrong, both mine and yours. You are capping the NHE of GDP to cap medicare, as if the expansion of medicare were going to eliminate out of pocket or private health. Because it doesnt, if it replaced only half of expenditures, the 24% becomes 33%. Its true Medicare takes care of older patients, but also private insurance subsidizes medicare all along the path to that because it pays more than medicare to every provider, which means on the pool of patients, the medicare patients tend to represent losses and the rest profit. Furthermore there is the argument that if medicare expanded 7 fold, it would also be less efficient the bigger it gets, which is true of private and public organizations alike. We cant know, its messy and even expert economists cannot get this right: but it has to be in the order of magnitude of 25 to 40% of gdp. That is state-crushing expenditures.
- throwaway-hn123 8y ago
  What's foolish is making statements like that when the evidence suggests otherwise. Educate yourself.
- soru 8y ago
  Like the real life experience of those private Russian mercenaries who went up against the US military in Syria? Some things governments simply do better; health care is one of them. Denying that fact in the face of the mountain of supporting evidence is nothing but dogma.

by sykh 8y ago

conanbatt 8y ago

It's foolish to believe the state is more efficient that private actors, that is just contrary to real life experience.

Frondo 8y ago
It's foolish to believe that private actors can by definition ever be as efficient as the state. Private actors, by definition, must extract something from any service to pay themselves. The government has no overhead. It can run with absolutely no profit and that is its intended model. A private health care company that returns zero profit to its shareholders? Shut 'er down. A private transit company that returns zero profit to its shareholders? Shut 'er down. And yet, government services can run indefinitely at break-even because they're not beholden to the market. Only government can be so efficient--the private sector always loses efficiency through someone scraping something off the top.
- conanbatt 8y ago
  > The government has no overhead Realz.
sykh 8y ago
It’s foolish to believe that private enterprise is always more efficient than a government run program and it’s foolish to think that government is always more efficient. One should not live in a world of such extremes. Sometimes government is the efficient solution. Sometimes private enterprise is.
monocasa 8y ago
And yet, NHS is about twice as efficient than the US's system.
- conanbatt 8y ago
  Is Medicare twice as efficient as private healthcare?
  - monocasa 8y ago
    It's not a great comparison for a lot of reasons (not least of which the first being that Medicare is legally not able to negotiate drug prices), but despite all of that, yes Medicare is dramatically more efficient.
    - conanbatt 8y ago
      Medicare is the core of all regulatory and pricing issues in the healthcare space. And if medicare were expanded to the entire population of the us, its expenditures could be 40-45% of gdp.
      - dragonwriter 8y ago
        > Medicare is the core of all regulatory and pricing issues in the healthcare space. I can't see a reasonable argument for that. > And if medicare were expanded to the entire population of the us, its expenditures could be 40-45% of gdp. Even with a naive covered-population-number based extrapolation that ignores that Medicare currently covers the elderly, who tend to have greater medical needs than average, that's not right; national health expenditures are about 18% of GDP, Medicare is about 20% of NHE, and Medicare currently covers around 15% of the population, so a naive population-based extrapolation would put Medicare-for-all at about 24% of GDP.
        conanbatt 8y ago
        Medicare is the reason there is fee-for-service, which is the biggest administrative overhead design if there is one. Also all private insurance works based of of medicare in the rates they pay, the way they code themselves etc. On the extrapolation, of course they are all simplistic and wrong, both mine and yours. You are capping the NHE of GDP to cap medicare, as if the expansion of medicare were going to eliminate out of pocket or private health. Because it doesnt, if it replaced only half of expenditures, the 24% becomes 33%. Its true Medicare takes care of older patients, but also private insurance subsidizes medicare all along the path to that because it pays more than medicare to every provider, which means on the pool of patients, the medicare patients tend to represent losses and the rest profit. Furthermore there is the argument that if medicare expanded 7 fold, it would also be less efficient the bigger it gets, which is true of private and public organizations alike. We cant know, its messy and even expert economists cannot get this right: but it has to be in the order of magnitude of 25 to 40% of gdp. That is state-crushing expenditures.
throwaway-hn123 8y ago
What's foolish is making statements like that when the evidence suggests otherwise. Educate yourself.
soru 8y ago
Like the real life experience of those private Russian mercenaries who went up against the US military in Syria? Some things governments simply do better; health care is one of them. Denying that fact in the face of the mountain of supporting evidence is nothing but dogma.