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This aspect of economics is critically important as the supposed engine for growth changes from private to public domains. Where I live, the public sector far o

by Cyder 7y ago

This aspect of economics is critically important as the supposed engine for growth changes from private to public domains. Where I live, the public sector far outweighs the private sector in providing jobs. As such, the voters follow the ever curricular pattern of growing the government to the demise of the private sector. The subject of this book being the public sector, my interest would be the balance of the private and public. Just how large can the public sector grow ( with their overpaying for outsourcing, as the review stated) before becoming unsustainable? Another good aspect of this book is it's analysis of healthcare systems. In the US, healthcare is often used as the poster boy for failed capitalism. The fact is that healthcare is overregulated and not at all capitalist in most Western societies. But that would be another book entirely....

Ididntdothis 7y ago
The US health system had managed to merge bad attributes from different systems into a system that’s incredibly bad. Highly regulated, tons of unaccountable bureaucracy, lots of barriers for market entry , protectionist, lack of consumer choices and also highly capitalistic. The problem is that the US can’t decide what it wants so we have a system where a lot of people make a lot of money whole being protected from competition or even scrutiny by customers.
- hogFeast 7y ago
  I think that is largely a misconception from people who live in the US and think the US is the worst of all possible worlds (based largely on the politics of the last decade or so)...it isn't. Not even close. The US is an extreme example of a system that optimizes totally for choice...and it achieves that aim. The UK is an extreme example of system that optimizes totally for access. They both achieve their aims but there is a necessary cost. The most successful systems are mixed ones (Mazzucato is prone to make extremely reductionist statements about this: the private sector has this disadvantage, the solution is all public...in the UK, we know this doesn't work...we have tried it).
  - AmpsterMan 7y ago
    >The US is an extreme example of a system that optimizes totally for choice...and it achieves that aim. I'm not sure this is true, or at least, I don't understand what pre-requisites for this to be true the U.S. posseses. Insurance is not allowed to trade across state lines, the private marketplace has a small selection of plans, most people get their insurance from their jobs meaning they only know the details of their medical plans AFTER a non-trivial time down payment (in other words, the transaction costs are high) I think the criticism that the U.S. system doesn't really have that many positives is a fair enough assessment.
    - hogFeast 7y ago
      > I'm not sure this is true Have you been to a place that doesn't optimise for this? The US is one of the only places in the world where if you are sick, the medicine (if it exists) is 100% available. I have a relative who lives in a place that doesn't have this aim...she is sick, medicine exists but "policy" is not to cure people who have that illness because the return on investment isn't high enough...in fact, she can't receive treatment at all for it outside of primary care. This happens quite frequently with cancer/epilepsy outside the US too...the medicine exists, you just can't get it... ...and you are complaining about only having a "small selection of plans"...must be nice. Try selecting from one plan that might not cover you when you get sick (and if you get very sick, there might be nothing beyond primary care i.e. your local doctor who isn't a specialist).
      - AmpsterMan 7y ago
        Wait. You've moved the goal post. Your original statement was about optimizing for choice. I'm not sure the United States optimizes for choice and so provided some counter-examples. The topic of availability of drugs or treatments didn't come into play at all. Furthermore, there is no "complaining" as you put it. Moreover, I also contend that the U.S. has 100% availability. There are many rural areas which lack access to more specialist care. Many states are limiting Planned Parenthood services beyond abortions which is itself a form of care. Some medicine is too expensive to be affordable, and so on.

by Cyder 7y ago

Ididntdothis 7y ago

The US health system had managed to merge bad attributes from different systems into a system that’s incredibly bad. Highly regulated, tons of unaccountable bureaucracy, lots of barriers for market entry , protectionist, lack of consumer choices and also highly capitalistic. The problem is that the US can’t decide what it wants so we have a system where a lot of people make a lot of money whole being protected from competition or even scrutiny by customers.

hogFeast 7y ago
I think that is largely a misconception from people who live in the US and think the US is the worst of all possible worlds (based largely on the politics of the last decade or so)...it isn't. Not even close. The US is an extreme example of a system that optimizes totally for choice...and it achieves that aim. The UK is an extreme example of system that optimizes totally for access. They both achieve their aims but there is a necessary cost. The most successful systems are mixed ones (Mazzucato is prone to make extremely reductionist statements about this: the private sector has this disadvantage, the solution is all public...in the UK, we know this doesn't work...we have tried it).
- AmpsterMan 7y ago
  >The US is an extreme example of a system that optimizes totally for choice...and it achieves that aim. I'm not sure this is true, or at least, I don't understand what pre-requisites for this to be true the U.S. posseses. Insurance is not allowed to trade across state lines, the private marketplace has a small selection of plans, most people get their insurance from their jobs meaning they only know the details of their medical plans AFTER a non-trivial time down payment (in other words, the transaction costs are high) I think the criticism that the U.S. system doesn't really have that many positives is a fair enough assessment.
  - hogFeast 7y ago
    > I'm not sure this is true Have you been to a place that doesn't optimise for this? The US is one of the only places in the world where if you are sick, the medicine (if it exists) is 100% available. I have a relative who lives in a place that doesn't have this aim...she is sick, medicine exists but "policy" is not to cure people who have that illness because the return on investment isn't high enough...in fact, she can't receive treatment at all for it outside of primary care. This happens quite frequently with cancer/epilepsy outside the US too...the medicine exists, you just can't get it... ...and you are complaining about only having a "small selection of plans"...must be nice. Try selecting from one plan that might not cover you when you get sick (and if you get very sick, there might be nothing beyond primary care i.e. your local doctor who isn't a specialist).
    - AmpsterMan 7y ago
      Wait. You've moved the goal post. Your original statement was about optimizing for choice. I'm not sure the United States optimizes for choice and so provided some counter-examples. The topic of availability of drugs or treatments didn't come into play at all. Furthermore, there is no "complaining" as you put it. Moreover, I also contend that the U.S. has 100% availability. There are many rural areas which lack access to more specialist care. Many states are limiting Planned Parenthood services beyond abortions which is itself a form of care. Some medicine is too expensive to be affordable, and so on.