8 ms·

> The whole system has to be torn down and rebuilt from scratch, with the state the main owner of hospitals and provider of healthcare. The kind of things that

> The whole system has to be torn down and rebuilt from scratch, with the state the main owner of hospitals and provider of healthcare. The kind of things that you read about the current system are just absurd, How involved are you with other US government organizations? Do they usually strike you as highly competent and efficient? Are you sure that if we did what you suggest we wouldn't have a whole different set of monstrous absurdities?

rootusrootus 7y ago
We could choose to staff them with competent people instead of deliberately sabotaging it. There are viable alternatives to the GOP strategy.
- b_tterc_p 7y ago
  If only someone had thought of that before
- deleted 7y ago
  [deleted]
mikeash 7y ago
Maybe we could run it similarly to the government-run air traffic control system, which is superb. “Government” doesn’t have to mean “incompetent and inefficient.”
- AnimalMuppet 7y ago
  Maybe we could. Or maybe we'd run it like the VA. [Edit: enraged_camel said that the VA is pretty good. Is that accurate? I've heard otherwise, but I don't know firsthand. If the VA example isn't accurate, though, replace it with "California high speed rail" or "Amtrak" or "the Department of Education".] It doesn't have to mean incompetent and inefficient, but it seems that it often does.
  - rootusrootus 7y ago
    Perhaps we could call it "Medicare" and it would be way more efficient than any of the private insurers.
  - mattkrause 7y ago
    Along the Northeast corridor, taking Amtrak downtown-to-downtown takes about as long as flying and is vastly more pleasant. The service out west is bad because it's a gongshow of interactions between Amtrak and a bunch of private companies, which seems...oddly reminiscent of something. My only direct experience with the Department of Education was college financial aid. The FAFSA wasn't particularly awful and I appreciate the help I got--the work study job not only paid for my books and food, but got me started in my career.
  - mikeash 7y ago
    How often? People love to act as though government can’t do anything right. Government does plenty of things right, those just don’t get much attention. I sit here next to my government road with government postal service, lights powered by a private utility heavily regulated by the government, and wish the government provided trash service to me like they do for my neighbor because I’m getting fed up with the shoddy trash service I get from the company I pay, and think, yeah, government health care could be pretty good, just like it is in so many other countries. The US is not uniquely incompetent here.
    - AnimalMuppet 7y ago
      > Government does plenty of things right, those just don’t get much attention. Fair point.
    - refurb 7y ago
      That gov’t road was likely built by a private company. And being heavily regulated doesn’t make a private utility a good example.
- opo 7y ago
  Air traffic control is not a great example to cite here. The USA is one of the few countries where the regulator also provides the ATC service. In comparison to Canada, the US government run air traffic control is noticeably less productive and more expensive. Some examples here: https://jdasolutions.aero/blog/guest-author-robert-poole-faa-atc-productivity/ https://jdasolutions.aero/blog/guest-author-robert-poole-faa... Some more descriptions of the problems with US air traffic control: >...Much of the system still depends on radar technology developed in the 1940s. A new system called NextGen has taken so long to develop and install that controllers are still operating a clunky patchwork that combines antiquated and updated equipment. >...You could hardly find a more egregious example of serial mismanagement than the history of NextGen. Between 2004 and 2006 the FAA spent nearly $26 million just planning the system. Since 2010 it has spent nearly a billion dollars a year on attempting to implement it, frequently missing deadlines and, according to government watchdogs, exceeding budgets. https://www.thedailybeast.com/lobbyists-and-congress-just-killed-the-best-hope-for-ending-your-airport-nightmares https://www.thedailybeast.com/lobbyists-and-congress-just-ki...
  - hollerith 7y ago
    >Between 2004 and 2006 the FAA spent nearly $26 million just planning the system Or less than .10 USD per American. Nor does spending a billion USD a year since 2010 scream mismanagement to me given the magnitude of the public benefit if it eventually works. By far the most important barometer of the quality of the US's air-traffic control system is how many fatal collisions there have been between aircraft being controlled by the system, and you haven't offered any data about that.
    - opo 7y ago
      I agree that safety is paramount here. This is why other countries like Canada have implemented newer technology like GPS flight tracking and digital messaging between pilots and controllers. Improvements like this makes flights safer. In the US, they try to mitigate the dangers of the aging air traffic control system by spacing the planes out further. As the American Airline CEO has said: >“Today to fly from DFW to Philadelphia is about 30 minutes longer than it was in 1979,” Parker said, “simply because we have an [air traffic control] system that hasn’t kept pace with the rest of the world.” https://www.dallasnews.com/business/american-airlines/2017/03/31/american-airlines-ceo-continues-push-reform-broken-air-traffic-control-system-cnbc https://www.dallasnews.com/business/american-airlines/2017/0... This wired article also has some more background on the US air traffic control system: https://www.wired.com/2015/02/air-traffic-control/ https://www.wired.com/2015/02/air-traffic-control/ The US is the last major country to still have government act as the regulator and provider of air traffic control. This is an inherent conflict of interest for the regulator that other countries avoid. By having political control of air traffic control, it also means air traffic control is routinely held hostage to government shutdowns and budget impasses which can also impact safety. For example: https://www.theatlantic.com/ideas/archive/2019/01/how-shutdown-impacting-air-safety/579616/ https://www.theatlantic.com/ideas/archive/2019/01/how-shutdo... Doing a google search on air traffic safety brought up this paper which examined the air traffic control systems of the US and Australia, Germany, New Zealand, and Switzerland: >…An analysis was made to determine the effect privatization had on operating cost and air MIC safety involving the privatized ATC systems of Australia, Germany, New Zealand, and Switzerland. The study showed reduced operating cost and increased safety would result from corporate structuring of the ATC system. It was concluded that corporate style policy regarding personnel management and equipment procurement procedures would increase efficiency, which would reduce operating cost and increase ATC flight safety. https://commons.erau.edu/cgi/viewcontent.cgi?article=1521&context=jaaer https://commons.erau.edu/cgi/viewcontent.cgi?article=1521&co... Considering that every other major country has separated the regulation and provision of air traffic control, those who are opposed to it should cite some evidence why the US should be different in this regard.
mattkrause 7y ago
Yes, actually. NOAA and NASA do a great job forecasting weather and tides. The CDC does a ton for public health: no recent pandemics I can recall. The NIH is one of the best biomedical research agencies in the world—-and the NSF, NASA, DoE, and DoD research divisions are no slouches either (GPS, internet, etc). The Library of Congress and Smithsonian make a lot of American heritage accessible to everyone—-and also do serious research of their own. The National Parks are awe-inspiring. The USPS can reliably get something to my family on the other side of the continent for $0.50. The USDA has kept our food supply wholesome, and the FAA/NTSB have made flying—an intrinsically crazy activity, absurdly safe. The SEC and FDIC have keep American markets aboveboard and attractive to investors from around the world. There’s more to the government than the DMV and taxes. In fact, if you’ve ever had to interact with the IRS, they are astonishingly pleasant—-I got a question answered and a (small) amount of money refunded in a ten minute phone call. It was vastly better than calling Comcast or the insurance company.
enraged_camel 7y ago
Medicare and VA, while not perfect, are both well-run and extremely popular. So yes, the US government is in fact capable of handling healthcare.
- refurb 7y ago
  Much of the Medicare business is funded by the gov’t, but executed by private insurers (Part C and Part D). And based on the scandal around the VA a few years ago, no it wasn’t well run at all.
  - enraged_camel 7y ago
    >>And based on the scandal around the VA a few years ago, no it wasn’t well run at all. Scandals aren't unique to government. The private sector has them all the time. In fact, sometimes private sector scandals are so massive they crash the entire economy.
    - Scoundreller 7y ago
      I tell myself there are easily hundreds or thousands of Front Page NYT stories every day, but they never leak to the public.
    - refurb 7y ago
      Of course, but the VA is the largest gov’t run healthcare system in the US and the scandal impacted tens of thousands of veterans. Doesn’t exactly engender confidence.
bsder 7y ago
> Are you sure that if we did what you suggest we wouldn't have a whole different set of monstrous absurdities? Most people on Medicare are generally quite happy with it. The idiocies generally start when the government let private companies get involved (Medicare Part D). In addition, the person who brought "socialized medicine" to Canada is regarded as as a hero. Talking points without citation are not data.
- rootusrootus 7y ago
  At the rate we are going, whoever finally brings Medicare to everyone in the US will be regarded as a hero as well. I have what qualifies as pretty good coverage by US standards and I still won't shed a single tear when it gets replaced with single payer. In fact I look forward to having more flexibility to switch jobs or start my own business without having that consideration.
rat87 7y ago
> Do they usually strike you as highly competent and efficient Far from all but,a decent number of them yes

rootusrootus 7y ago

We could choose to staff them with competent people instead of deliberately sabotaging it. There are viable alternatives to the GOP strategy.

b_tterc_p 7y ago
If only someone had thought of that before
deleted 7y ago
[deleted]

mikeash 7y ago

Maybe we could run it similarly to the government-run air traffic control system, which is superb. “Government” doesn’t have to mean “incompetent and inefficient.”

AnimalMuppet 7y ago
Maybe we could. Or maybe we'd run it like the VA. [Edit: enraged_camel said that the VA is pretty good. Is that accurate? I've heard otherwise, but I don't know firsthand. If the VA example isn't accurate, though, replace it with "California high speed rail" or "Amtrak" or "the Department of Education".] It doesn't have to mean incompetent and inefficient, but it seems that it often does.
- rootusrootus 7y ago
  Perhaps we could call it "Medicare" and it would be way more efficient than any of the private insurers.
- mattkrause 7y ago
  Along the Northeast corridor, taking Amtrak downtown-to-downtown takes about as long as flying and is vastly more pleasant. The service out west is bad because it's a gongshow of interactions between Amtrak and a bunch of private companies, which seems...oddly reminiscent of something. My only direct experience with the Department of Education was college financial aid. The FAFSA wasn't particularly awful and I appreciate the help I got--the work study job not only paid for my books and food, but got me started in my career.
- mikeash 7y ago
  How often? People love to act as though government can’t do anything right. Government does plenty of things right, those just don’t get much attention. I sit here next to my government road with government postal service, lights powered by a private utility heavily regulated by the government, and wish the government provided trash service to me like they do for my neighbor because I’m getting fed up with the shoddy trash service I get from the company I pay, and think, yeah, government health care could be pretty good, just like it is in so many other countries. The US is not uniquely incompetent here.
  - AnimalMuppet 7y ago
    > Government does plenty of things right, those just don’t get much attention. Fair point.
  - refurb 7y ago
    That gov’t road was likely built by a private company. And being heavily regulated doesn’t make a private utility a good example.
opo 7y ago
Air traffic control is not a great example to cite here. The USA is one of the few countries where the regulator also provides the ATC service. In comparison to Canada, the US government run air traffic control is noticeably less productive and more expensive. Some examples here: https://jdasolutions.aero/blog/guest-author-robert-poole-faa-atc-productivity/ https://jdasolutions.aero/blog/guest-author-robert-poole-faa... Some more descriptions of the problems with US air traffic control: >...Much of the system still depends on radar technology developed in the 1940s. A new system called NextGen has taken so long to develop and install that controllers are still operating a clunky patchwork that combines antiquated and updated equipment. >...You could hardly find a more egregious example of serial mismanagement than the history of NextGen. Between 2004 and 2006 the FAA spent nearly $26 million just planning the system. Since 2010 it has spent nearly a billion dollars a year on attempting to implement it, frequently missing deadlines and, according to government watchdogs, exceeding budgets. https://www.thedailybeast.com/lobbyists-and-congress-just-killed-the-best-hope-for-ending-your-airport-nightmares https://www.thedailybeast.com/lobbyists-and-congress-just-ki...
- hollerith 7y ago
  >Between 2004 and 2006 the FAA spent nearly $26 million just planning the system Or less than .10 USD per American. Nor does spending a billion USD a year since 2010 scream mismanagement to me given the magnitude of the public benefit if it eventually works. By far the most important barometer of the quality of the US's air-traffic control system is how many fatal collisions there have been between aircraft being controlled by the system, and you haven't offered any data about that.
  - opo 7y ago
    I agree that safety is paramount here. This is why other countries like Canada have implemented newer technology like GPS flight tracking and digital messaging between pilots and controllers. Improvements like this makes flights safer. In the US, they try to mitigate the dangers of the aging air traffic control system by spacing the planes out further. As the American Airline CEO has said: >“Today to fly from DFW to Philadelphia is about 30 minutes longer than it was in 1979,” Parker said, “simply because we have an [air traffic control] system that hasn’t kept pace with the rest of the world.” https://www.dallasnews.com/business/american-airlines/2017/03/31/american-airlines-ceo-continues-push-reform-broken-air-traffic-control-system-cnbc https://www.dallasnews.com/business/american-airlines/2017/0... This wired article also has some more background on the US air traffic control system: https://www.wired.com/2015/02/air-traffic-control/ https://www.wired.com/2015/02/air-traffic-control/ The US is the last major country to still have government act as the regulator and provider of air traffic control. This is an inherent conflict of interest for the regulator that other countries avoid. By having political control of air traffic control, it also means air traffic control is routinely held hostage to government shutdowns and budget impasses which can also impact safety. For example: https://www.theatlantic.com/ideas/archive/2019/01/how-shutdown-impacting-air-safety/579616/ https://www.theatlantic.com/ideas/archive/2019/01/how-shutdo... Doing a google search on air traffic safety brought up this paper which examined the air traffic control systems of the US and Australia, Germany, New Zealand, and Switzerland: >…An analysis was made to determine the effect privatization had on operating cost and air MIC safety involving the privatized ATC systems of Australia, Germany, New Zealand, and Switzerland. The study showed reduced operating cost and increased safety would result from corporate structuring of the ATC system. It was concluded that corporate style policy regarding personnel management and equipment procurement procedures would increase efficiency, which would reduce operating cost and increase ATC flight safety. https://commons.erau.edu/cgi/viewcontent.cgi?article=1521&context=jaaer https://commons.erau.edu/cgi/viewcontent.cgi?article=1521&co... Considering that every other major country has separated the regulation and provision of air traffic control, those who are opposed to it should cite some evidence why the US should be different in this regard.

mattkrause 7y ago

Yes, actually. NOAA and NASA do a great job forecasting weather and tides. The CDC does a ton for public health: no recent pandemics I can recall. The NIH is one of the best biomedical research agencies in the world—-and the NSF, NASA, DoE, and DoD research divisions are no slouches either (GPS, internet, etc). The Library of Congress and Smithsonian make a lot of American heritage accessible to everyone—-and also do serious research of their own. The National Parks are awe-inspiring. The USPS can reliably get something to my family on the other side of the continent for $0.50. The USDA has kept our food supply wholesome, and the FAA/NTSB have made flying—an intrinsically crazy activity, absurdly safe. The SEC and FDIC have keep American markets aboveboard and attractive to investors from around the world. There’s more to the government than the DMV and taxes. In fact, if you’ve ever had to interact with the IRS, they are astonishingly pleasant—-I got a question answered and a (small) amount of money refunded in a ten minute phone call. It was vastly better than calling Comcast or the insurance company.

enraged_camel 7y ago

Medicare and VA, while not perfect, are both well-run and extremely popular. So yes, the US government is in fact capable of handling healthcare.

refurb 7y ago
Much of the Medicare business is funded by the gov’t, but executed by private insurers (Part C and Part D). And based on the scandal around the VA a few years ago, no it wasn’t well run at all.
- enraged_camel 7y ago
  >>And based on the scandal around the VA a few years ago, no it wasn’t well run at all. Scandals aren't unique to government. The private sector has them all the time. In fact, sometimes private sector scandals are so massive they crash the entire economy.
  - Scoundreller 7y ago
    I tell myself there are easily hundreds or thousands of Front Page NYT stories every day, but they never leak to the public.
  - refurb 7y ago
    Of course, but the VA is the largest gov’t run healthcare system in the US and the scandal impacted tens of thousands of veterans. Doesn’t exactly engender confidence.

bsder 7y ago

> Are you sure that if we did what you suggest we wouldn't have a whole different set of monstrous absurdities? Most people on Medicare are generally quite happy with it. The idiocies generally start when the government let private companies get involved (Medicare Part D). In addition, the person who brought "socialized medicine" to Canada is regarded as as a hero. Talking points without citation are not data.

rootusrootus 7y ago
At the rate we are going, whoever finally brings Medicare to everyone in the US will be regarded as a hero as well. I have what qualifies as pretty good coverage by US standards and I still won't shed a single tear when it gets replaced with single payer. In fact I look forward to having more flexibility to switch jobs or start my own business without having that consideration.

rat87 7y ago

> Do they usually strike you as highly competent and efficient Far from all but,a decent number of them yes