27 ms·

Yes, but government ran healthcare is not the answer...

by hugh4life 16y ago

jonknee 16y ago
What is the answer and is there anywhere in the world that it's currently functioning?
- hugh4life 16y ago
  I'm kind of fond of Singapore's health care system... http://econlog.econlib.org/archives/2008/01/singapores_heal.html http://econlog.econlib.org/archives/2008/01/singapores_heal.... http://blog.jparsons.net/2009/08/why-singapores-health-care-system-beats.html http://blog.jparsons.net/2009/08/why-singapores-health-care-...
  - jonknee 16y ago
    Me too, but it's government run... Seems like your previous statement would preclude you from liking it.
    - lawnchair_larry 16y ago
      Some governments are good at running some things. The US government seems to screw up everything. I don't know why this is, but if public health care ever becomes reality, and it is anything like the DMV, or any government services in California for that matter, or VA hospitals...may [deity] help us all. I am in no way a fan of the perverse incentives created by a for-profit private health care system, but I am worried that the alternative might be even worse.
      - Experimentalist 16y ago
        What wrong with a for-profit system? There should be MORE profit, not less. High profits attract entrepreneurs to compete for customers by offering lower prices and innovating - consumers benefit. The current system is the exact opposite - there is relatively little and uncertain profit (and high barriers to entry) in insurance and hospitals, and a ton of government interference and regulation. Few entrepreneurs want to get involved, which reduces competition and innovation and keeps prices higher. "Plunging revenues from investments have forced median profit margins for U.S. hospitals to zero, according to a Thomson Reuters analysis of hospital finances published on Monday. And half of the more than 400 hospitals studied are losing money, the analysis found." http://www.reuters.com/article/2009/03/02/us-hospitals-usa-idUSTRE5216G320090302 http://www.reuters.com/article/2009/03/02/us-hospitals-usa-i...
        natrius 16y ago
        What evidence is there that few entrepreneurs want to get involved in hospitals? Here's some evidence to the contrary: http://www.bizjournals.com/houston/news/2011/01/18/emerus-hospital-gets-30m-from-austin.html http://www.bizjournals.com/houston/news/2011/01/18/emerus-ho... http://www.emerus.com/ http://www.emerus.com/
        Experimentalist 16y ago
        That's one example. There are 5,500+ hospitals in the US, so one example is hardly representative. There would be many more investments if it was more profitable. As the link I posted states - many are not profitable and many have a very low profit margin. Higher profits would bring more entrepreneurs and investment.
        natrius 16y ago
        You are assuming that because the industry has many unprofitable participants, there must be few new entrants. You're guessing. You haven't shown that there are indeed few new entrants, nor have you shown that low profit margins are the main factor that discourages them. Any industry that is as capital intensive as hospitals are will have relatively few new entrants, so a convincing argument of the causal relationship you're claiming will be difficult to make. I mostly agree with you that healthy profits are desirable if we want to have an effective healthcare system, but I don't think hospital profit has much to do with it. The profit that healthcare technology companies and actual care providers make seems more important.
        Experimentalist 16y ago
        Investors/entrepreneurs are attracted to businesses that show promise to be profitable, and turn away from making investment in unprofitable businesses. This is a basic economics principle - I'm not assuming anything. I cited hospitals as an example to illustrate this, because there are many stats, such as what I posted (not an assumption, but a study), which show it's not a very profitable business (relative other businesses) - and btw, neither is health insurance. If you disagree, then look it up in a basic economics or finance textbook, here are a few explanatons of the relationship of investment, profitability and ROI: "In other words, profit-seeking businesses operating in the private sector of the economy will be prepared to go ahead with an investment if they believe that the project will over its projected lifetime yield a real rate of return greater than if the money tied up in an investment project had been invested in the next best alternative way." Macroeconomics - Capital Investment http://tutor2u.net/economics/revision-notes/a2-macro-capital-investment.html http://tutor2u.net/economics/revision-notes/a2-macro-capital... "The owners of a company and the company’s creditors share a similar goal: to increase wealth. They are thus very concerned about profitability in all phases of operations. Creditors are specifically concerned that the company use its resources profitably so that it can pay interest and principal on its debt. Owners are concerned that the company be profitable so that stock values will increase. Company managers must show they can manage the owners’ investment and produce the profits that owners and creditors demand. Because top management must meet the profit expectations of company owners, it passes down to the lower levels of management those profitability goals, which are then spread throughout the company. All managers, therefore, are expected to meet profitability goals, which are often increased and tightened as each level of management seeks a margin of safety." PDF - The Importance of Return on Investment: ROI http://media.wiley.com/product_data/excerpt/50/04712037/0471203750.pdf http://media.wiley.com/product_data/excerpt/50/04712037/0471...
      - danssig 16y ago
        When's the last time you were in a US hospital? I'd say the nightmare you fear is already here.
      - jonknee 16y ago
        Singapore is the size of a city in the US, it's hard to compare the efficiencies of government programs. Medicare's enrollment alone is over 10x the size of Singapore's population.
- davidw 16y ago
  Anecdotally, the best system I've ever experienced was in Austria, which is some weird mish-mash of public and private which I never fully understood the details of. You have to have health insurance, but those companies are non-profits... or something like that. Here in Italy, it's government run, and suffers a bit from that, at times, although on the other hand, you have complete "peace of mind" in terms of not worrying about losing your job or something and being unable to take your child to the doctor.
- axod 16y ago
  The UK health system is absolutely fantastic FWIW.
  - scraplab 16y ago
    +1 - it's fantastic. The thought of being freelance/starting a startup whilst having to pay health insurance is terrifying.
mcculley 16y ago
I think context is important. As a US citizen I agree with the general sentiment that the US government isn't competent to run healthcare. Comparisons with Canada and the UK are not helpful because they are different kinds of governments. The notion in the US that government should be as small as possible has yielded a government which cannot be trusted. The proponents of a single payer system in the US don't address this sufficiently. A solution for the US would be reform of the health insurance market. Require that health insurance providers be disallowed to refuse coverage to individuals for any reason. Disallow health care providers from charging lower rates to health insurance providers than they do to individual payers. A free market would work. A single payer system would work. What we have now is in between and will always be bad.
- rdouble 16y ago
  As a US citizen I agree with the general sentiment that the US government isn't competent to run healthcare. The VA hospitals are actually very well run.
  - anamax 16y ago
    > The VA hospitals are actually very well run. Some VA facilities are well run, some aren't. (And some are a mix - Walter Reed, which is where CongressCritters go, had some horrific wards as of a couple of years ago.) The Indian Health Care service, on the other hand, is a complete horrorshow.
  - mcculley 16y ago
    That's a good point. I have no experience with VA hospitals. If it is true then I think it would be reasonable to endorse expanding the VA infrastructure to support everybody.

Yes, but government ran healthcare is not the answer...

jonknee 16y ago

What is the answer and is there anywhere in the world that it's currently functioning?

hugh4life 16y ago
I'm kind of fond of Singapore's health care system... http://econlog.econlib.org/archives/2008/01/singapores_heal.html http://econlog.econlib.org/archives/2008/01/singapores_heal.... http://blog.jparsons.net/2009/08/why-singapores-health-care-system-beats.html http://blog.jparsons.net/2009/08/why-singapores-health-care-...
- jonknee 16y ago
  Me too, but it's government run... Seems like your previous statement would preclude you from liking it.
  - lawnchair_larry 16y ago
    Some governments are good at running some things. The US government seems to screw up everything. I don't know why this is, but if public health care ever becomes reality, and it is anything like the DMV, or any government services in California for that matter, or VA hospitals...may [deity] help us all. I am in no way a fan of the perverse incentives created by a for-profit private health care system, but I am worried that the alternative might be even worse.
    - Experimentalist 16y ago
      What wrong with a for-profit system? There should be MORE profit, not less. High profits attract entrepreneurs to compete for customers by offering lower prices and innovating - consumers benefit. The current system is the exact opposite - there is relatively little and uncertain profit (and high barriers to entry) in insurance and hospitals, and a ton of government interference and regulation. Few entrepreneurs want to get involved, which reduces competition and innovation and keeps prices higher. "Plunging revenues from investments have forced median profit margins for U.S. hospitals to zero, according to a Thomson Reuters analysis of hospital finances published on Monday. And half of the more than 400 hospitals studied are losing money, the analysis found." http://www.reuters.com/article/2009/03/02/us-hospitals-usa-idUSTRE5216G320090302 http://www.reuters.com/article/2009/03/02/us-hospitals-usa-i...
      - natrius 16y ago
        What evidence is there that few entrepreneurs want to get involved in hospitals? Here's some evidence to the contrary: http://www.bizjournals.com/houston/news/2011/01/18/emerus-hospital-gets-30m-from-austin.html http://www.bizjournals.com/houston/news/2011/01/18/emerus-ho... http://www.emerus.com/ http://www.emerus.com/
        Experimentalist 16y ago
        That's one example. There are 5,500+ hospitals in the US, so one example is hardly representative. There would be many more investments if it was more profitable. As the link I posted states - many are not profitable and many have a very low profit margin. Higher profits would bring more entrepreneurs and investment.
        natrius 16y ago
        You are assuming that because the industry has many unprofitable participants, there must be few new entrants. You're guessing. You haven't shown that there are indeed few new entrants, nor have you shown that low profit margins are the main factor that discourages them. Any industry that is as capital intensive as hospitals are will have relatively few new entrants, so a convincing argument of the causal relationship you're claiming will be difficult to make. I mostly agree with you that healthy profits are desirable if we want to have an effective healthcare system, but I don't think hospital profit has much to do with it. The profit that healthcare technology companies and actual care providers make seems more important.
        Experimentalist 16y ago
        Investors/entrepreneurs are attracted to businesses that show promise to be profitable, and turn away from making investment in unprofitable businesses. This is a basic economics principle - I'm not assuming anything. I cited hospitals as an example to illustrate this, because there are many stats, such as what I posted (not an assumption, but a study), which show it's not a very profitable business (relative other businesses) - and btw, neither is health insurance. If you disagree, then look it up in a basic economics or finance textbook, here are a few explanatons of the relationship of investment, profitability and ROI: "In other words, profit-seeking businesses operating in the private sector of the economy will be prepared to go ahead with an investment if they believe that the project will over its projected lifetime yield a real rate of return greater than if the money tied up in an investment project had been invested in the next best alternative way." Macroeconomics - Capital Investment http://tutor2u.net/economics/revision-notes/a2-macro-capital-investment.html http://tutor2u.net/economics/revision-notes/a2-macro-capital... "The owners of a company and the company’s creditors share a similar goal: to increase wealth. They are thus very concerned about profitability in all phases of operations. Creditors are specifically concerned that the company use its resources profitably so that it can pay interest and principal on its debt. Owners are concerned that the company be profitable so that stock values will increase. Company managers must show they can manage the owners’ investment and produce the profits that owners and creditors demand. Because top management must meet the profit expectations of company owners, it passes down to the lower levels of management those profitability goals, which are then spread throughout the company. All managers, therefore, are expected to meet profitability goals, which are often increased and tightened as each level of management seeks a margin of safety." PDF - The Importance of Return on Investment: ROI http://media.wiley.com/product_data/excerpt/50/04712037/0471203750.pdf http://media.wiley.com/product_data/excerpt/50/04712037/0471...
    - danssig 16y ago
      When's the last time you were in a US hospital? I'd say the nightmare you fear is already here.
    - jonknee 16y ago
      Singapore is the size of a city in the US, it's hard to compare the efficiencies of government programs. Medicare's enrollment alone is over 10x the size of Singapore's population.
davidw 16y ago
Anecdotally, the best system I've ever experienced was in Austria, which is some weird mish-mash of public and private which I never fully understood the details of. You have to have health insurance, but those companies are non-profits... or something like that. Here in Italy, it's government run, and suffers a bit from that, at times, although on the other hand, you have complete "peace of mind" in terms of not worrying about losing your job or something and being unable to take your child to the doctor.
axod 16y ago
The UK health system is absolutely fantastic FWIW.
- scraplab 16y ago
  +1 - it's fantastic. The thought of being freelance/starting a startup whilst having to pay health insurance is terrifying.

mcculley 16y ago

I think context is important. As a US citizen I agree with the general sentiment that the US government isn't competent to run healthcare. Comparisons with Canada and the UK are not helpful because they are different kinds of governments. The notion in the US that government should be as small as possible has yielded a government which cannot be trusted. The proponents of a single payer system in the US don't address this sufficiently. A solution for the US would be reform of the health insurance market. Require that health insurance providers be disallowed to refuse coverage to individuals for any reason. Disallow health care providers from charging lower rates to health insurance providers than they do to individual payers. A free market would work. A single payer system would work. What we have now is in between and will always be bad.

rdouble 16y ago
As a US citizen I agree with the general sentiment that the US government isn't competent to run healthcare. The VA hospitals are actually very well run.
- anamax 16y ago
  > The VA hospitals are actually very well run. Some VA facilities are well run, some aren't. (And some are a mix - Walter Reed, which is where CongressCritters go, had some horrific wards as of a couple of years ago.) The Indian Health Care service, on the other hand, is a complete horrorshow.
- mcculley 16y ago
  That's a good point. I have no experience with VA hospitals. If it is true then I think it would be reasonable to endorse expanding the VA infrastructure to support everybody.