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"This is precisely why we need universal healthcare. The incentive structure of private markets don't properly value human life." Government-run healthcare isn

"This is precisely why we need universal healthcare. The incentive structure of private markets don't properly value human life." Government-run healthcare isn't a panacea that will 'value human life' any more than the insurance companies. You are still a number in a database somewhere. Most new drugs come out of the US and socialized governments create generics at a fraction of the cost, because they don't have to put any money into R&D. The US is the back-bone of the medical system for the rest of the world and also has the best medical schools and best quality hospitals (the majority of people with money come to the US for life-saving surgeries..this has to tell you something). We need to push the true costs of things to the patient, which will force the price down...not replace the existing inefficient layer of the insurance companies with an even more inefficient layer called the government. This has worked with many cosmetic surgeries, which used to be very expensive, but aren't covered by insurance. Insurance should only cover rare surgeries that can't use the free market to reduce the costs. I can't think of anything that the government runs better than the private sector. Healthcare is no different.

NeedMoreTea 7y ago
Don't have to put money into R&D. Between the MRC and NIHR, the UK's NHS puts at least a couple of billions (Sterling) into clinical research each year, making them the largest clinical research funder in Europe. They're not researching generics. Oh and they were one of the original funders of PubMed Europe. I can think of lots of things the government does better than the private sector, although admittedly outside the US.
pgsbathhouse 7y ago
>Most new drugs come out of the US and socialized governments create generics at a fraction of the cost, because they don't have to put any money into R&D. This is a completely false right-wing talking point. It takes 10 minutes to uncover how just totally bullshit this is. Don't ever repeat again or anything remotely like it (aka the rest of your post). https://www.ncbi.nlm.nih.gov/books/NBK50972/ https://www.ncbi.nlm.nih.gov/books/NBK50972/ https://other98.com/taxpayers-fund-pharma-research-development/ https://other98.com/taxpayers-fund-pharma-research-developme... The government never sees a return in any form on the money taxpayers put forth. But private companies do. Just waiting like vultures to snag whatever makes it through the proof of concept phase and claim credit. >I can't think of anything that the government runs better than the private sector. ISP's? Roads? Social services? Schools? Emergency Services?
- sweeneyrod 7y ago
  Your second link has a pie chart that claims that pharma companies spend around 200x as much on advertising as clinical trials. Do you believe that is true?
  - wayoutthere 7y ago
    This has been known for a very long time in pharma circles. Marketing budgets are several orders of magnitude higher than R&D budgets. An extra dollar spent on marketing has much higher returns than an extra dollar spent on R&D. Most of the real "hard science" R&D is paid for with NIH grants.
    - sweeneyrod 7y ago
      > Marketing budgets are several orders of magnitude higher than R&D budgets. This is a lie. Marketing budgets are approximately equal to R&D (https://www.bbc.co.uk/news/business-28212223 https://www.bbc.co.uk/news/business-28212223) so you're off by several orders of magnitude. > Most of the real "hard science" R&D is paid for with NIH grants. Also not true. NIH grants are ~$40 billion/year whereas industry R&D are around $80 billion (https://www.statista.com/statistics/265085/research-and-development-expenditure-us-pharmaceutical-industry/ https://www.statista.com/statistics/265085/research-and-deve...). There are definitely lots of problems with the pharmaceutical industry, several of which are mentioned in that BBC article. But making hyperbolic claims that they essentially don't do any R&D isn't helpful.
      - pgsbathhouse 7y ago
        >This is a lie. Marketing budgets are approximately equal to R&D Your own source doesn't even say that. In the exact BBC article you linked: >But as the table below shows, drug companies spend far more on marketing drugs - in some cases twice as much - than on developing them Here's some very very basic reading on the subject that you can find in 10 seconds of googling: https://en.wikipedia.org/wiki/Pharmaceutical_marketing https://en.wikipedia.org/wiki/Pharmaceutical_marketing In the literally first sentence on this topic: >pharmaceutical company spending on marketing far exceeds that of its research budget Imagine living in a society where supposedly rational, intelligent people hold opinions that don't withstand the test of a few keystrokes; opinions that quite literally aid in the needless death and suffering of others while also just generally being a complete waste of time.
wayoutthere 7y ago
> The US is the back-bone of the medical system for the rest of the world and also has the best medical schools and best quality hospitals (the majority of people with money come to the US for life-saving surgeries..this has to tell you something). This just means American consumers end up subsidizing health care R&D costs for the rest of the globe — purely because our government prevents us from collectively bargaining the way pretty much every other country does. The people coming to the US for the “best quality” are generally going to doctors / surgeons in private practice, most of whom do not take insurance and can see you immediately. There is an almost entirely separate (and much higher quality) medical system available to those who can afford it. The system the rest of us belong to ranks right behind Morocco and Costa Rica in terms of outcomes (not joking — this is according to the WHO). We come in dead last among “first world” countries.
- Buge 7y ago
  If American consumers stop subsidizing health care R&D costs, what will happen to the R&D? Will it decrease? Will health care costs in other countries increase as they start to bear some of it?
  - wayoutthere 7y ago
    I assume it will continue because the drug companies need products to sell. It's not like they're just going to close up shop, but it may be the end of windfall profits. The other problem right now is that it's not profitable to create drugs that actually cure anything. It's far more profitable to research drugs that help control chronic conditions (like diabetes, hypertension or Alzheimers) rather than drugs that can cure a condition outright. This is one part of why nobody researches things like antibiotics anymore.
    - dreary_dugong 7y ago
      As stated in a thread above, while it is not directly profitable for drug companies to cure diseases, it is profitable for their insurance agency cohorts. The current system does not totally dis-incentivize cures.
deleted 7y ago
[deleted]
codegeek 7y ago
I am on the fence between Single Payer and your proposed solution of "push the cost to patient to force the price down". I do think the same but the appeal of universal healthcare is similar to the appeal of things like fire department. We don't really always need it but when we do, we don't want to worry about it. Honestly, as long we get rid of the mafia middleman a.k.a insurance company except for real catastrophic situations, I do agree that costs will plummet. Price transparency is another key aspect.
- tomp 7y ago
  The problem with the fire department is the freerider problem - if I pay for the fire department’s “protection” but my neighbor doesn’t, and his/her house is on fire, the fire department has to save my neighbor’s house in order to save mine, so the neighbor is not incentivised to pay. Healthcare doesn’t have this issue (except in emergency services), so public healthcare also doesn’t solve that. It solves problems such as the principal-agent problem, asymmetric information, improves collective bargaining, ...
gonational 7y ago
Take all my karma... Implementing something like what you describe, IMHO, would have the greatest positive impact on the health and welfare of Americans, of anything this century. I have a friend who is very high up in one of the largest health insurance providers in the US, and I have often debated over the years with this person that same point, that the insurance layer is what creates the model for inefficiency, and abuse at the provider level ($5 Tylenol pill, $10 Band-Aid, minor treatments and return visits of dubious value, etc.), and that if we treated medical care as an ordinary consumer good, outside of the extreme emergencies that are bankruptigly expensive, things would be a lot better. The person I know at the insurance company doesn’t necessarily disagree either.
- achillesheels 7y ago
  “Consumer driven healthcare” as the academic researchers call it. It is bewildering why we don’t have diagnostic labs doing email marketing campaigns, for instance. This is driven, I think, by an outmoded concept of the security of doctor’s knowledge. Now, doctors are so behind the ball and play defensive to protect themselves from malpractice. The idea that an individual cannot make educated decisions which are market driven (ie price driven) for most mild conditions is incomprehensible.
  - rtikulit 7y ago
    With respect to health care, you may be able to make such educated decisions, almost no one else can. There isn't enough signal, and almost no one has the ability to distinguish signal from noise, and correctly interpret it. What happens is that when given the opportunity, business will pollute the market with proxy signals (like brand trust, or fear based selling) that people instinctively respond to. These proxy signals will be subject to manipulation by well-capitalized actors and will not in general reflect outcomes or value. They will interfere with the fundamental signal, making it even harder to detect and interpret. Therefore the market will not work, in the sense of delivering the best outcomes for costs. (Note that I am strictly speaking of healthcare, where even experts are often unsure of causal relationships and the relative value of various therapies. In general I think markets are a wonderful thing. Here is an experiment to try... take a mild condition treatable by OTC medication, such as the symptoms of colds, allergies, etc, and see how long it takes you to identify, characterize and factor the available therapies, and then map this to available products. Evaluate interactions, cautions, effectiveness, risk, convenience, costs, etc. Now ask yourself, where did you get your information? Who did you have to trust? Why did you trust them? Is the basis for your trust and understanding available to the average person? I've done the experiment. My conclusion is that healthcare large and small is not like other goods.)
qaq 7y ago
The drug things is partially BS. The top 10 big Pharma (in random order) GlaxoSmithKline British Eli Lilly US Sanofi French AbbVie US Roche Swiss Pfizer US Novartis Swiss Merck & Co US AstraZeneca British/Swedish Johnson & Johnson US (edit spacing)
- jacobr1 7y ago
  Hard to say. These are all internationalized firms with a variety of global operations centers. I know GSK does a lot of their research in North Carolina. But that is beside the key argument, which is that the US pays more (in aggregated cost and volume) to these firms, such that the total revenue for a product line during the patent lifetime justifies the cost to both bring the drug to market and pay for a variety of failures that didn't make it to market. I'm not sure if this is true, but it does seem plausible. And even if it is true, it still might be better to, say, fund more university based research instead, or have lower per-unit costs and pay innovation bounties or any number of other schemes.
  - qaq 7y ago
    Is it more than aggregate of all other markets?
omegaworks 7y ago
>Government-run healthcare isn't a panacea I didn't claim it was. Only that our present standards incentivize fee-for-service and not outcomes-driven, as exemplified by the author's inability to sell his outcome optimizing software. ACA tried to remedy that with preventative care standards, but the current administration is actively dismantling it. Your model works for cosmetic surgeries because they are cosmetic - optional and not life threatening. When calculating price, the cost to produce a drug is the last thing on pharmaceutical companies' minds. The question they ask is how much are you willing to pay for something that allows you to continue living. The factors they actually consider: the patient's perceived cost-benefit of continued suffering, the credit/insurance-worthiness of the treatment cohort, and whether the company faces competitive pressures from others selling the drug on the market. Nothing better depicts the situation than what goes on when pharmaceutical companies merge or acquire the rights to rarely used drugs[1]. The only way to structurally combat this is with the monopsony power of a single payer system. >I can't think of anything that the government runs better than the private sector. Healthcare is no different. Government run care has the highest satisfaction rate of any healthcare coverage[2]. 1. https://www.nytimes.com/2015/09/21/business/a-huge-overnight-increase-in-a-drugs-price-raises-protests.html https://www.nytimes.com/2015/09/21/business/a-huge-overnight... 2. https://news.gallup.com/poll/186527/americans-government-health-plans-satisfied.aspx https://news.gallup.com/poll/186527/americans-government-hea...
DanBC 7y ago
> Most new drugs come out of the US How true is this though? https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2866602/ https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2866602/ > Objectives. We explored whether the United States, which does not regulate pharmaceutical prices, is responsible for the development of a disproportionate share of the new molecular entities (NMEs; a drug that does not contain an active moiety previously approved by the Food and Drug Administration) produced worldwide. [...] > Conclusions. Higher prescription drug spending in the United States does not disproportionately privilege domestic innovation, and many countries with drug price regulation were significant contributors to pharmaceutical innovation. And > In the United Kingdom, the pharmaceutical industry invests more of its revenues from domestic sales in research and development than do companies in the United States. The US pays a lot for medication, but a lot of that money is used for things that are not innovation (eg advertising). Countries that have better free markets for medications don't see less spending on innovation, they see more spending on innovation.
sumedh 7y ago
> with an even more inefficient layer called the government. Maybe in the US, other countries (e.g Australia) are not so inefficient.
nodemaker 7y ago
The government runs a lot of things better than the private sector. Even in the US, the government loosely or strongly manages Police, National Defense, Garbage Disposal, Water managenemt, Power Management, Internet infrastructure, Education, Telephone, Mail and many more. Any service that every citizen needs to live a healthy life is better and more cost effectively run by the government.
- goatlover 7y ago
  Some of those are run by monopolies such as power, telephone and internet providers.
  - thebean11 7y ago
    Telephone and internet are usually run by private companies no? I think the post meant that the few government run alternatives that exist tend to be better (cheaper, faster, better service etc).
Certhas 7y ago
> I can't think of anything that the government runs better than the private sector. Then you are not very good at thinking. There is no theoretical, practical or empirical evidence that this should be true. If you _feel_ this should be true, you should really investigate where that feeling comes from. Basically your post is just ideology without argument or evidence. All evidence shows that free markets in health care are terribly inefficient. If that doesn't align with your ideological priors, well, adjust your reality.
rtikulit 7y ago
I have worked in government (twice) and large and small companies, now working in the private sector for the last 20 years. There are structural inefficiencies and perverse incentives in both domains, though they are very different in style and visibility. In magnitude, not so much.
Data_Junkie 7y ago
In a true Democracy nothing would be valued more by government run health care than human lives and/or human suffering.

NeedMoreTea 7y ago

Don't have to put money into R&D. Between the MRC and NIHR, the UK's NHS puts at least a couple of billions (Sterling) into clinical research each year, making them the largest clinical research funder in Europe. They're not researching generics. Oh and they were one of the original funders of PubMed Europe. I can think of lots of things the government does better than the private sector, although admittedly outside the US.

pgsbathhouse 7y ago

>Most new drugs come out of the US and socialized governments create generics at a fraction of the cost, because they don't have to put any money into R&D. This is a completely false right-wing talking point. It takes 10 minutes to uncover how just totally bullshit this is. Don't ever repeat again or anything remotely like it (aka the rest of your post). https://www.ncbi.nlm.nih.gov/books/NBK50972/ https://www.ncbi.nlm.nih.gov/books/NBK50972/ https://other98.com/taxpayers-fund-pharma-research-development/ https://other98.com/taxpayers-fund-pharma-research-developme... The government never sees a return in any form on the money taxpayers put forth. But private companies do. Just waiting like vultures to snag whatever makes it through the proof of concept phase and claim credit. >I can't think of anything that the government runs better than the private sector. ISP's? Roads? Social services? Schools? Emergency Services?

sweeneyrod 7y ago
Your second link has a pie chart that claims that pharma companies spend around 200x as much on advertising as clinical trials. Do you believe that is true?
- wayoutthere 7y ago
  This has been known for a very long time in pharma circles. Marketing budgets are several orders of magnitude higher than R&D budgets. An extra dollar spent on marketing has much higher returns than an extra dollar spent on R&D. Most of the real "hard science" R&D is paid for with NIH grants.
  - sweeneyrod 7y ago
    > Marketing budgets are several orders of magnitude higher than R&D budgets. This is a lie. Marketing budgets are approximately equal to R&D (https://www.bbc.co.uk/news/business-28212223 https://www.bbc.co.uk/news/business-28212223) so you're off by several orders of magnitude. > Most of the real "hard science" R&D is paid for with NIH grants. Also not true. NIH grants are ~$40 billion/year whereas industry R&D are around $80 billion (https://www.statista.com/statistics/265085/research-and-development-expenditure-us-pharmaceutical-industry/ https://www.statista.com/statistics/265085/research-and-deve...). There are definitely lots of problems with the pharmaceutical industry, several of which are mentioned in that BBC article. But making hyperbolic claims that they essentially don't do any R&D isn't helpful.
    - pgsbathhouse 7y ago
      >This is a lie. Marketing budgets are approximately equal to R&D Your own source doesn't even say that. In the exact BBC article you linked: >But as the table below shows, drug companies spend far more on marketing drugs - in some cases twice as much - than on developing them Here's some very very basic reading on the subject that you can find in 10 seconds of googling: https://en.wikipedia.org/wiki/Pharmaceutical_marketing https://en.wikipedia.org/wiki/Pharmaceutical_marketing In the literally first sentence on this topic: >pharmaceutical company spending on marketing far exceeds that of its research budget Imagine living in a society where supposedly rational, intelligent people hold opinions that don't withstand the test of a few keystrokes; opinions that quite literally aid in the needless death and suffering of others while also just generally being a complete waste of time.

wayoutthere 7y ago

> The US is the back-bone of the medical system for the rest of the world and also has the best medical schools and best quality hospitals (the majority of people with money come to the US for life-saving surgeries..this has to tell you something). This just means American consumers end up subsidizing health care R&D costs for the rest of the globe — purely because our government prevents us from collectively bargaining the way pretty much every other country does. The people coming to the US for the “best quality” are generally going to doctors / surgeons in private practice, most of whom do not take insurance and can see you immediately. There is an almost entirely separate (and much higher quality) medical system available to those who can afford it. The system the rest of us belong to ranks right behind Morocco and Costa Rica in terms of outcomes (not joking — this is according to the WHO). We come in dead last among “first world” countries.

Buge 7y ago
If American consumers stop subsidizing health care R&D costs, what will happen to the R&D? Will it decrease? Will health care costs in other countries increase as they start to bear some of it?
- wayoutthere 7y ago
  I assume it will continue because the drug companies need products to sell. It's not like they're just going to close up shop, but it may be the end of windfall profits. The other problem right now is that it's not profitable to create drugs that actually cure anything. It's far more profitable to research drugs that help control chronic conditions (like diabetes, hypertension or Alzheimers) rather than drugs that can cure a condition outright. This is one part of why nobody researches things like antibiotics anymore.
  - dreary_dugong 7y ago
    As stated in a thread above, while it is not directly profitable for drug companies to cure diseases, it is profitable for their insurance agency cohorts. The current system does not totally dis-incentivize cures.

deleted 7y ago

[deleted]

codegeek 7y ago

I am on the fence between Single Payer and your proposed solution of "push the cost to patient to force the price down". I do think the same but the appeal of universal healthcare is similar to the appeal of things like fire department. We don't really always need it but when we do, we don't want to worry about it. Honestly, as long we get rid of the mafia middleman a.k.a insurance company except for real catastrophic situations, I do agree that costs will plummet. Price transparency is another key aspect.

tomp 7y ago
The problem with the fire department is the freerider problem - if I pay for the fire department’s “protection” but my neighbor doesn’t, and his/her house is on fire, the fire department has to save my neighbor’s house in order to save mine, so the neighbor is not incentivised to pay. Healthcare doesn’t have this issue (except in emergency services), so public healthcare also doesn’t solve that. It solves problems such as the principal-agent problem, asymmetric information, improves collective bargaining, ...

gonational 7y ago

Take all my karma... Implementing something like what you describe, IMHO, would have the greatest positive impact on the health and welfare of Americans, of anything this century. I have a friend who is very high up in one of the largest health insurance providers in the US, and I have often debated over the years with this person that same point, that the insurance layer is what creates the model for inefficiency, and abuse at the provider level ($5 Tylenol pill, $10 Band-Aid, minor treatments and return visits of dubious value, etc.), and that if we treated medical care as an ordinary consumer good, outside of the extreme emergencies that are bankruptigly expensive, things would be a lot better. The person I know at the insurance company doesn’t necessarily disagree either.

achillesheels 7y ago
“Consumer driven healthcare” as the academic researchers call it. It is bewildering why we don’t have diagnostic labs doing email marketing campaigns, for instance. This is driven, I think, by an outmoded concept of the security of doctor’s knowledge. Now, doctors are so behind the ball and play defensive to protect themselves from malpractice. The idea that an individual cannot make educated decisions which are market driven (ie price driven) for most mild conditions is incomprehensible.
- rtikulit 7y ago
  With respect to health care, you may be able to make such educated decisions, almost no one else can. There isn't enough signal, and almost no one has the ability to distinguish signal from noise, and correctly interpret it. What happens is that when given the opportunity, business will pollute the market with proxy signals (like brand trust, or fear based selling) that people instinctively respond to. These proxy signals will be subject to manipulation by well-capitalized actors and will not in general reflect outcomes or value. They will interfere with the fundamental signal, making it even harder to detect and interpret. Therefore the market will not work, in the sense of delivering the best outcomes for costs. (Note that I am strictly speaking of healthcare, where even experts are often unsure of causal relationships and the relative value of various therapies. In general I think markets are a wonderful thing. Here is an experiment to try... take a mild condition treatable by OTC medication, such as the symptoms of colds, allergies, etc, and see how long it takes you to identify, characterize and factor the available therapies, and then map this to available products. Evaluate interactions, cautions, effectiveness, risk, convenience, costs, etc. Now ask yourself, where did you get your information? Who did you have to trust? Why did you trust them? Is the basis for your trust and understanding available to the average person? I've done the experiment. My conclusion is that healthcare large and small is not like other goods.)

qaq 7y ago

The drug things is partially BS. The top 10 big Pharma (in random order) GlaxoSmithKline British Eli Lilly US Sanofi French AbbVie US Roche Swiss Pfizer US Novartis Swiss Merck & Co US AstraZeneca British/Swedish Johnson & Johnson US (edit spacing)

jacobr1 7y ago
Hard to say. These are all internationalized firms with a variety of global operations centers. I know GSK does a lot of their research in North Carolina. But that is beside the key argument, which is that the US pays more (in aggregated cost and volume) to these firms, such that the total revenue for a product line during the patent lifetime justifies the cost to both bring the drug to market and pay for a variety of failures that didn't make it to market. I'm not sure if this is true, but it does seem plausible. And even if it is true, it still might be better to, say, fund more university based research instead, or have lower per-unit costs and pay innovation bounties or any number of other schemes.
- qaq 7y ago
  Is it more than aggregate of all other markets?

omegaworks 7y ago

>Government-run healthcare isn't a panacea I didn't claim it was. Only that our present standards incentivize fee-for-service and not outcomes-driven, as exemplified by the author's inability to sell his outcome optimizing software. ACA tried to remedy that with preventative care standards, but the current administration is actively dismantling it. Your model works for cosmetic surgeries because they are cosmetic - optional and not life threatening. When calculating price, the cost to produce a drug is the last thing on pharmaceutical companies' minds. The question they ask is how much are you willing to pay for something that allows you to continue living. The factors they actually consider: the patient's perceived cost-benefit of continued suffering, the credit/insurance-worthiness of the treatment cohort, and whether the company faces competitive pressures from others selling the drug on the market. Nothing better depicts the situation than what goes on when pharmaceutical companies merge or acquire the rights to rarely used drugs[1]. The only way to structurally combat this is with the monopsony power of a single payer system. >I can't think of anything that the government runs better than the private sector. Healthcare is no different. Government run care has the highest satisfaction rate of any healthcare coverage[2]. 1. https://www.nytimes.com/2015/09/21/business/a-huge-overnight-increase-in-a-drugs-price-raises-protests.html https://www.nytimes.com/2015/09/21/business/a-huge-overnight... 2. https://news.gallup.com/poll/186527/americans-government-health-plans-satisfied.aspx https://news.gallup.com/poll/186527/americans-government-hea...

DanBC 7y ago

> Most new drugs come out of the US How true is this though? https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2866602/ https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2866602/ > Objectives. We explored whether the United States, which does not regulate pharmaceutical prices, is responsible for the development of a disproportionate share of the new molecular entities (NMEs; a drug that does not contain an active moiety previously approved by the Food and Drug Administration) produced worldwide. [...] > Conclusions. Higher prescription drug spending in the United States does not disproportionately privilege domestic innovation, and many countries with drug price regulation were significant contributors to pharmaceutical innovation. And > In the United Kingdom, the pharmaceutical industry invests more of its revenues from domestic sales in research and development than do companies in the United States. The US pays a lot for medication, but a lot of that money is used for things that are not innovation (eg advertising). Countries that have better free markets for medications don't see less spending on innovation, they see more spending on innovation.

sumedh 7y ago

> with an even more inefficient layer called the government. Maybe in the US, other countries (e.g Australia) are not so inefficient.

nodemaker 7y ago

The government runs a lot of things better than the private sector. Even in the US, the government loosely or strongly manages Police, National Defense, Garbage Disposal, Water managenemt, Power Management, Internet infrastructure, Education, Telephone, Mail and many more. Any service that every citizen needs to live a healthy life is better and more cost effectively run by the government.

goatlover 7y ago
Some of those are run by monopolies such as power, telephone and internet providers.
- thebean11 7y ago
  Telephone and internet are usually run by private companies no? I think the post meant that the few government run alternatives that exist tend to be better (cheaper, faster, better service etc).

Certhas 7y ago

> I can't think of anything that the government runs better than the private sector. Then you are not very good at thinking. There is no theoretical, practical or empirical evidence that this should be true. If you _feel_ this should be true, you should really investigate where that feeling comes from. Basically your post is just ideology without argument or evidence. All evidence shows that free markets in health care are terribly inefficient. If that doesn't align with your ideological priors, well, adjust your reality.

rtikulit 7y ago

I have worked in government (twice) and large and small companies, now working in the private sector for the last 20 years. There are structural inefficiencies and perverse incentives in both domains, though they are very different in style and visibility. In magnitude, not so much.

Data_Junkie 7y ago

In a true Democracy nothing would be valued more by government run health care than human lives and/or human suffering.