4 ms·

sorry but how then should the fire department be run? both seem resource constrained at both the macro and micro level. my understanding is that at a macro lev

sorry but how then should the fire department be run? both seem resource constrained at both the macro and micro level. my understanding is that at a macro level firefighters routinely "trade" regions for sake of better defending bigger or more important regions. it will have to be the same for health care: not everyone can afford a legion of 24/7 ICU nurses and ER physicians on standby when the end comes, even if .gov is footing the bill. IIRC dems got killed for "death panels" when ACA was getting played up. there will always be death panels - someone who decides whether or not an additional dollar is warranted for any particular individual - so what inputs should we use to make those decisions in your opinion?

polemic 7y ago
Well, not profit, clearly.
nitwit005 7y ago
Look back at how fire fighting was when it was fully private. The whole thing seemed kind of stupid to everyone. Multiple companies would show up at a house on fire, check insurance plaques, and then head home if they hadn't paid them. If no one had paid them they'd let things burn, which sounds fine conceptually, but it's much cheaper to put out a fire early, and it has that awkward tendency to spread.
lsiebert 7y ago
the so called "death panels" were Politfact's Lie of the Uear. They were AARP supported voluntary sessions, paid for by Medicare, where people could discuss stuff like living wills and other end of life issues. https://www.politifact.com/truth-o-meter/article/2009/dec/18/politifact-lie-year-death-panels/ https://www.politifact.com/truth-o-meter/article/2009/dec/18...
- lsiebert 7y ago
  /Uear/Year/
casmclas 7y ago
I think there's a difference between fire brigades that are private businesses and government owned fire brigades that have territorial jurisdiction and which apply common sense to their funding to ensure the most efficient service possible. For instance, given that fire brigades are commonly city-level in the US and that American cities often have highly irregularly and interlocking shapes, it is plainly more efficient to trade a certain amount of funding to have the other city look after your dog leg. But there is a mandate on them to look after all structural fires in a certain area. They can pay someone else to look after it on their behalf, but the mandate remains. Territory and funds are exchanged. In other places, where fire brigades are run nationally or regionally, perhaps even individual stations will trade — "we specialise in rural fires and you specialise in urban fires, so you should take this newly urbanised region off our hands" "okay, but we will also take your newly urbanised funding off your hands". But it might also occur at the national or regional level and thus be central planning rather than business like. But a fire brigade that is a private business will look after fires that are cheaper for them to put out than to burn. Perhaps they will put out a fire in a non-member's building since every neighbor is an important member — and then they might sue them for all their worth. But if they have no customers in an area because the people who live there do not have the money, then they might let the fire burn. Or they might say "we are liable for a hundred thousand dollars compensation if we don't put out this fire, but it will cost us at least a million to put out". (The local fire brigade will probably have to let some fires burn because they don't have the resources to put them out — it may be vastly too dangerous to get involved, but of a nature that, after a day of burning, it will be much safer. Here, the difference is the consideration — the question is the relative safety of attacking it vs waiting it out, rather than the relative costs of attacking it vs waiting it out.) A mediate position could exist, where private corporations are allowed to get involved in the firefighting business, but if that were permitted, it would be a situation where the mandate remains and the private firefighters would be paid by mandatory payments from the property owners of the relevant territory. Unlike most businesses, they aren't free to pick what they do. A private supermarket can decide if they want to stock Mildew Milk or not. But a private regulated/mandatory firebrigade would have to put out the fire at Mildew Milk even though they've had a long running feud.
pjc50 7y ago
> there will always be death panels Exactly. Currently they're for-profit death panels in the insurance industry. And their metric is profit, not minimising death and suffering. The UK approach to this is a board called NICE, which measures effectiveness and tries to set a cost-benefit level. What this means is that the UK is behind on leading-edge cancer drugs which cost a fortune for a few extra months of life, but makes sure that everyone has insulin. The US system is the other way round: some people get the life extension, some people die from lack of insulin. (A surprising amount of healthcare rationing in the UK is simple waiting)

polemic 7y ago

Well, not profit, clearly.

nitwit005 7y ago

Look back at how fire fighting was when it was fully private. The whole thing seemed kind of stupid to everyone. Multiple companies would show up at a house on fire, check insurance plaques, and then head home if they hadn't paid them. If no one had paid them they'd let things burn, which sounds fine conceptually, but it's much cheaper to put out a fire early, and it has that awkward tendency to spread.

lsiebert 7y ago

the so called "death panels" were Politfact's Lie of the Uear. They were AARP supported voluntary sessions, paid for by Medicare, where people could discuss stuff like living wills and other end of life issues. https://www.politifact.com/truth-o-meter/article/2009/dec/18/politifact-lie-year-death-panels/ https://www.politifact.com/truth-o-meter/article/2009/dec/18...

lsiebert 7y ago
/Uear/Year/

casmclas 7y ago

I think there's a difference between fire brigades that are private businesses and government owned fire brigades that have territorial jurisdiction and which apply common sense to their funding to ensure the most efficient service possible. For instance, given that fire brigades are commonly city-level in the US and that American cities often have highly irregularly and interlocking shapes, it is plainly more efficient to trade a certain amount of funding to have the other city look after your dog leg. But there is a mandate on them to look after all structural fires in a certain area. They can pay someone else to look after it on their behalf, but the mandate remains. Territory and funds are exchanged. In other places, where fire brigades are run nationally or regionally, perhaps even individual stations will trade — "we specialise in rural fires and you specialise in urban fires, so you should take this newly urbanised region off our hands" "okay, but we will also take your newly urbanised funding off your hands". But it might also occur at the national or regional level and thus be central planning rather than business like. But a fire brigade that is a private business will look after fires that are cheaper for them to put out than to burn. Perhaps they will put out a fire in a non-member's building since every neighbor is an important member — and then they might sue them for all their worth. But if they have no customers in an area because the people who live there do not have the money, then they might let the fire burn. Or they might say "we are liable for a hundred thousand dollars compensation if we don't put out this fire, but it will cost us at least a million to put out". (The local fire brigade will probably have to let some fires burn because they don't have the resources to put them out — it may be vastly too dangerous to get involved, but of a nature that, after a day of burning, it will be much safer. Here, the difference is the consideration — the question is the relative safety of attacking it vs waiting it out, rather than the relative costs of attacking it vs waiting it out.) A mediate position could exist, where private corporations are allowed to get involved in the firefighting business, but if that were permitted, it would be a situation where the mandate remains and the private firefighters would be paid by mandatory payments from the property owners of the relevant territory. Unlike most businesses, they aren't free to pick what they do. A private supermarket can decide if they want to stock Mildew Milk or not. But a private regulated/mandatory firebrigade would have to put out the fire at Mildew Milk even though they've had a long running feud.

pjc50 7y ago

> there will always be death panels Exactly. Currently they're for-profit death panels in the insurance industry. And their metric is profit, not minimising death and suffering. The UK approach to this is a board called NICE, which measures effectiveness and tries to set a cost-benefit level. What this means is that the UK is behind on leading-edge cancer drugs which cost a fortune for a few extra months of life, but makes sure that everyone has insulin. The US system is the other way round: some people get the life extension, some people die from lack of insulin. (A surprising amount of healthcare rationing in the UK is simple waiting)