7 ms·

> You simply don't get to "shop around" for emergency services You do actually, by where you choose to live and also by the services as detailed in [1]. I thi

> You simply don't get to "shop around" for emergency services You do actually, by where you choose to live and also by the services as detailed in [1]. I think there's merit to investigating public health care. That line stops for me in eliminating private care. 1] https://www.theatlantic.com/technology/archive/2018/11/kim-kardashian-kanye-west-history-private-firefighting/575887/ https://www.theatlantic.com/technology/archive/2018/11/kim-k...

neurotrace 8y ago
A lot of people don't get much choice in where they live.
- justtopost 8y ago
  Are they on felony probation? I have moved a few times with little money for better opprotunities. It seems like most people are just psychologically conditioned to die near where they were born. Most people just think the hardship is worth it, which is very much a choice. It is literally cheaper to move to most of the USA than live another month in places like california or nyc.
  - msla 8y ago
    > Are they on felony probation? So that's what they call "Taking care of an elderly relative" these days!
  - __jal 8y ago
    This ignores a huge array of practical reasons why people stay where they are. Family networks are probably the number one reason. Child/elder care, food/housing/etc. sharing and a lot more are all major factors that by definition do not show up in economic reports. And that's before people's "psychological conditioning" (which some people refer to as "being part of a family") is considered. I, too, have moved around a lot - across the US three times, overseas and back once, with smaller cross-state moves in between. And it has worked out for me. I am also not married, have no kids, am not very close to my family, have a high degree of risk tolerance and high attraction to novelty, and seem to need a smaller community of folks in my life than many others. I'm also well aware that I am an abnormally-unattached person. Most people have significantly more difficulty uprooting and moving somewhere else. Writing that off as conditioning that interferes with economic concerns not only fails to recognize very real economic aspects that don't show up a bank account, but also fails to recognize that humans value things other than money.
ademup 8y ago
Although most humans are perfectly ambulatory, there are innumerable reasons why they don't get to "choose where to live". Income levels, employment availability, schooling, racial pressure, and many more factors come in to play. Not everyone can physically fit into the best areas. The best areas for emergency services don't necessarily align with the best education (although very high income levels tends to align with both). This comment essentially amounts to "Well if you don't like being poor, then just obtain more money". While everyone cannot live in the best places, nearly everyone will need emergency services at some point in their lives. Also, OP didn't suggest getting rid of private care entirely. A public option does not preclude a private system. If the private system provides value, it will likely survive.
- vec 8y ago
  > If the private system provides value, it will likely survive. And if it doesn't survive, good! Industries don't have an inherent right to keep existing if they don't fill some useful function. Refusing to implement an otherwise desirable social program because it might cause an existing industry to become obsolete is far and away the most anti-capitalist argument I see self avowed capitalists make.
  - nybble41 8y ago
    You haven't rendered private health care "obsolete", you've just forced people to join your public system. Obviously people aren't going to pay for two health providers (unless the public system is completely inadequate). That does not imply that the private service is uncompetitive. There can be no competition when one service must find willing customers while the other takes its funding by force. This is the same issue with toll roads vs. public roads. Imagine there are two similar roads leading from A to B, one a toll road and the other public. The toll road charges drivers $1 per 100 miles. The public road is free to use but costs every driver $5 per 100 miles in taxes. Which one do you think drivers will take? The more expensive public road, of course—because they're already paying for it, whereas the toll road would be an additional expense.
    - 8y ago
ncallaway 8y ago
> I think there's merit to investigating public health care. That line stops for me in eliminating private care I haven't seen a proposal yet that would eliminate private care (or even supplementary private insurance).
- phd514 8y ago
  Canada did. It's not that far-fetched.
  - bdamm 8y ago
    That's a stretch. There are still a lot of private clinics operating in Canada for various grey-area medical needs. Also, Canadian (really, provincial) healthcare doesn't typically cover dental, and there's a massive grey area in rehab and injury recovery where private clinics abound. Certainly it is true, I agree, that emergency hospitals and ambulances are public-option only.
    - ncallaway 8y ago
      That's fair, and this is I suppose more what I meant. My original statement might have been more accurate had I said "fully eliminate private care and private insurance". Certainly with medicare for all both of those would be drastically reduced. With the medicaid buy-in they would both be moderately reduced. I still think private care and private insurance will exist under both models, but like you said, they may be different in terms of what they cover.
    - refurb 8y ago
      Doctors in Canada have to choose to participate in either the public system or private system. They can’t straddle both. Hence there are VERY few private clinics in Canada except for services where the govt realized it was in their benefit to allow it (MRIs).
      - ceejayoz 8y ago
        That sounds like the market for private care isn't really as big as is often claimed, then.
PhasmaFelis 8y ago
> I think there's merit to investigating public health care. That line stops for me in eliminating private care. Has anyone proposed that? If not, I'm not sure why you mentioned it. Anyway, I suppose I can see the benefit to private doctors, but if private emergency response services for individuals are popular, then something is fucked, as your link demonstrates. Not saying they should be banned, but they shouldn't have to exist in a properly-run society.
- ams6110 8y ago
  Yes, many people who advocate for "single payer" intend that to mean eliminating any private-pay option.
  - pjc50 8y ago
    Do they? Are you sure? Who? The UK's single payer system coexsists OK with private care. It's not a necessary part of the process.
  - ncallaway 8y ago
    I don't believe that's true. What serious single payer proposals have been put forward that would eliminate private-pay, private insurance, or private care? I've never seen one. In fact, almost all "single payer" health systems that exist in other countries have private care and private insurance options. For example, such options are available in both the UK with the NHS and in Canada. I've never once spoken with an advocate of single payer who wants to eliminate private pay, private insurance, or private care. I am also an advocate of single payer, and I wouldn't advocate eliminating any of those things.
    - ams6110 8y ago
      Bernie Sanders, for one, has advocated for the elimination of private health insurance by essentially putting everyone on Medicare.
      - ncallaway 8y ago
mulmen 8y ago
"Move to a better market" seems like an argument that some local marketplaces have failed. The whole value proposition of the free market is that it improves the available services and prices through competition. If I have to move somewhere else to find a market where this is true then the local market is clearly failing and the free market idea doesn't work. Said another way: Should I then also move when I want to find a better price on milk?
- krupan 8y ago
  I mean, I know people that moved away from Hawaii precisely because they couldn't afford the milk there. Believe it or not there are people who move into cities because of better fire departments, police departments, etc.
  - mulmen 8y ago
    Did they leave Hawaii only because of the price of milk or because staple goods in general were more expensive than other places? In this case the market is working but it is a market where cities compete on cost of living, not milk. In that case moving makes sense.
- munk-a 8y ago
  "Move to a better market" also fails with regards to the fact that you may need the services when not at home. If you were working in sales would you refuse to do an onsite meeting with a client because their office is near a terrible hospital?
tivert 8y ago
>> You simply don't get to "shop around" for emergency services > You do actually, by where you choose to live That's wrong on so many different levels: 1) The emergency service provider is unlikely to tell you how much anything costs in reality ahead of time. 2) Not all emergency services providers offer the best price for all services, or are even equipped offer all services. 3) Many medical emergencies are completely unexpected, you have no idea what kinds of services you'll actually need in an emergency. 4) You're not really talking about "where you choose to live," but rather "where you choose to be at all times." Do you really have a choice of ER if you have to stay within a couple miles of it at all times to make sure you'd always be taken there in an emergency? 5) etc.
pjc50 8y ago
I don't think there are many places outside repressive states where private healthcare is actually banned? Even the UK's extremely centralized NHS runs alongside a private system. It actually has the effect of making the private system cheaper since they don't have to cover everything or everyone.

neurotrace 8y ago

A lot of people don't get much choice in where they live.

justtopost 8y ago
Are they on felony probation? I have moved a few times with little money for better opprotunities. It seems like most people are just psychologically conditioned to die near where they were born. Most people just think the hardship is worth it, which is very much a choice. It is literally cheaper to move to most of the USA than live another month in places like california or nyc.
- msla 8y ago
  > Are they on felony probation? So that's what they call "Taking care of an elderly relative" these days!
- __jal 8y ago
  This ignores a huge array of practical reasons why people stay where they are. Family networks are probably the number one reason. Child/elder care, food/housing/etc. sharing and a lot more are all major factors that by definition do not show up in economic reports. And that's before people's "psychological conditioning" (which some people refer to as "being part of a family") is considered. I, too, have moved around a lot - across the US three times, overseas and back once, with smaller cross-state moves in between. And it has worked out for me. I am also not married, have no kids, am not very close to my family, have a high degree of risk tolerance and high attraction to novelty, and seem to need a smaller community of folks in my life than many others. I'm also well aware that I am an abnormally-unattached person. Most people have significantly more difficulty uprooting and moving somewhere else. Writing that off as conditioning that interferes with economic concerns not only fails to recognize very real economic aspects that don't show up a bank account, but also fails to recognize that humans value things other than money.

ademup 8y ago

Although most humans are perfectly ambulatory, there are innumerable reasons why they don't get to "choose where to live". Income levels, employment availability, schooling, racial pressure, and many more factors come in to play. Not everyone can physically fit into the best areas. The best areas for emergency services don't necessarily align with the best education (although very high income levels tends to align with both). This comment essentially amounts to "Well if you don't like being poor, then just obtain more money". While everyone cannot live in the best places, nearly everyone will need emergency services at some point in their lives. Also, OP didn't suggest getting rid of private care entirely. A public option does not preclude a private system. If the private system provides value, it will likely survive.

vec 8y ago
> If the private system provides value, it will likely survive. And if it doesn't survive, good! Industries don't have an inherent right to keep existing if they don't fill some useful function. Refusing to implement an otherwise desirable social program because it might cause an existing industry to become obsolete is far and away the most anti-capitalist argument I see self avowed capitalists make.
- nybble41 8y ago
  You haven't rendered private health care "obsolete", you've just forced people to join your public system. Obviously people aren't going to pay for two health providers (unless the public system is completely inadequate). That does not imply that the private service is uncompetitive. There can be no competition when one service must find willing customers while the other takes its funding by force. This is the same issue with toll roads vs. public roads. Imagine there are two similar roads leading from A to B, one a toll road and the other public. The toll road charges drivers $1 per 100 miles. The public road is free to use but costs every driver $5 per 100 miles in taxes. Which one do you think drivers will take? The more expensive public road, of course—because they're already paying for it, whereas the toll road would be an additional expense.
  - 8y ago

ncallaway 8y ago

> I think there's merit to investigating public health care. That line stops for me in eliminating private care I haven't seen a proposal yet that would eliminate private care (or even supplementary private insurance).

phd514 8y ago
Canada did. It's not that far-fetched.
- bdamm 8y ago
  That's a stretch. There are still a lot of private clinics operating in Canada for various grey-area medical needs. Also, Canadian (really, provincial) healthcare doesn't typically cover dental, and there's a massive grey area in rehab and injury recovery where private clinics abound. Certainly it is true, I agree, that emergency hospitals and ambulances are public-option only.
  - ncallaway 8y ago
    That's fair, and this is I suppose more what I meant. My original statement might have been more accurate had I said "fully eliminate private care and private insurance". Certainly with medicare for all both of those would be drastically reduced. With the medicaid buy-in they would both be moderately reduced. I still think private care and private insurance will exist under both models, but like you said, they may be different in terms of what they cover.
  - refurb 8y ago
    Doctors in Canada have to choose to participate in either the public system or private system. They can’t straddle both. Hence there are VERY few private clinics in Canada except for services where the govt realized it was in their benefit to allow it (MRIs).
    - ceejayoz 8y ago
      That sounds like the market for private care isn't really as big as is often claimed, then.

PhasmaFelis 8y ago

> I think there's merit to investigating public health care. That line stops for me in eliminating private care. Has anyone proposed that? If not, I'm not sure why you mentioned it. Anyway, I suppose I can see the benefit to private doctors, but if private emergency response services for individuals are popular, then something is fucked, as your link demonstrates. Not saying they should be banned, but they shouldn't have to exist in a properly-run society.

ams6110 8y ago
Yes, many people who advocate for "single payer" intend that to mean eliminating any private-pay option.
- pjc50 8y ago
  Do they? Are you sure? Who? The UK's single payer system coexsists OK with private care. It's not a necessary part of the process.
- ncallaway 8y ago
  I don't believe that's true. What serious single payer proposals have been put forward that would eliminate private-pay, private insurance, or private care? I've never seen one. In fact, almost all "single payer" health systems that exist in other countries have private care and private insurance options. For example, such options are available in both the UK with the NHS and in Canada. I've never once spoken with an advocate of single payer who wants to eliminate private pay, private insurance, or private care. I am also an advocate of single payer, and I wouldn't advocate eliminating any of those things.
  - ams6110 8y ago
    Bernie Sanders, for one, has advocated for the elimination of private health insurance by essentially putting everyone on Medicare.
    - ncallaway 8y ago

mulmen 8y ago

"Move to a better market" seems like an argument that some local marketplaces have failed. The whole value proposition of the free market is that it improves the available services and prices through competition. If I have to move somewhere else to find a market where this is true then the local market is clearly failing and the free market idea doesn't work. Said another way: Should I then also move when I want to find a better price on milk?

krupan 8y ago
I mean, I know people that moved away from Hawaii precisely because they couldn't afford the milk there. Believe it or not there are people who move into cities because of better fire departments, police departments, etc.
- mulmen 8y ago
  Did they leave Hawaii only because of the price of milk or because staple goods in general were more expensive than other places? In this case the market is working but it is a market where cities compete on cost of living, not milk. In that case moving makes sense.
munk-a 8y ago
"Move to a better market" also fails with regards to the fact that you may need the services when not at home. If you were working in sales would you refuse to do an onsite meeting with a client because their office is near a terrible hospital?

tivert 8y ago

>> You simply don't get to "shop around" for emergency services > You do actually, by where you choose to live That's wrong on so many different levels: 1) The emergency service provider is unlikely to tell you how much anything costs in reality ahead of time. 2) Not all emergency services providers offer the best price for all services, or are even equipped offer all services. 3) Many medical emergencies are completely unexpected, you have no idea what kinds of services you'll actually need in an emergency. 4) You're not really talking about "where you choose to live," but rather "where you choose to be at all times." Do you really have a choice of ER if you have to stay within a couple miles of it at all times to make sure you'd always be taken there in an emergency? 5) etc.

pjc50 8y ago

I don't think there are many places outside repressive states where private healthcare is actually banned? Even the UK's extremely centralized NHS runs alongside a private system. It actually has the effect of making the private system cheaper since they don't have to cover everything or everyone.