6 ms·
It's funny how privatizing space travel made costs plummet. Privatized healthcare, on the other hand, is a disaster.
by bluedino 6y ago
It's funny how privatizing space travel made costs plummet.
Privatized healthcare, on the other hand, is a disaster.
- lifeplusplus 6y agoone is a necessity and other one is not. If it's too expensive to launch stuff to space, most companies won't. If it's expensive to get a drug, well you will either pay up or suffer until you die.
- DubiousPusher 6y agoExactly. One market is elastic the other is inelastic.
- lifeplusplus 6y agoI had forgotten those terms.. yea nothing mysterious going on here. This is well understood situation. Everyone should take micro-economics not matter the profession.
- savanaly 6y agoBut we have markets in necessities and they work just fine. What's the difference from healthcare?
- lifeplusplus 6y agosuch as?.. give an example.. milk - regulated water - regulated electricity - regulated education - k12 regulated most of it .
- atonse 6y agoWell before space X, we did have private companies, but they were government contractors and a monopoly. So they had no incentive to reduce prices. It’s almost like SpaceX took rockets from being a consulting business to a product business.
- macksd 6y agoThere's an excellent book (well it had bad reviews, actually, because it was perhaps overly detailed and tedious, but I enjoyed it) about the Gemini project called On The Shoulders of Titans. Reading through the notes of how NASA interacted with contractors was terrifying: here's some money to study something. Turns out it was very subtly different from what NASA had intended them to study. Here's more money to do another study. Now here's money to build a prototype. Oh you're 90% done and out of money? Here's twice as much money. Oh now you're 99% done and out of money? He's the same amount again. Oh it doesn't work but you can argue it's NASA's fault? Here's more money to start over. You're done? Actually we're gonna scrap this particular mission objective now. Space X owns something much close to an end-to-end objective: it's not a study, or a build, it's getting the thing to orbit, end of story. I think if you could set up the situation so that a company owns the end-to-end story of your health, things might be better off. That sounds more like Kaiser Permanente and my impression is that's exactly what happened. In reality our healthcare system is typically more like Gemini: contractors, tons of regulations, but none of them really own the end result so it's a public/private mix of bureaucratic mess, misaligned incentives, and buck-passing.
- rtkwe 6y agoPart of that is it was very very hard to know back then what was needed and what would work. Now a lot of the fundamentals are well hammered out and the big challenge for SpaceX was the landing not figuring out how to build rockets in the first place. Also the ACA did have some successes in doing kind of what you're talking about. There were incentives in there to avoid readmittance before 30 days and to all appearances it's been a success. https://www.statnews.com/2016/12/27/obamacare-success-penalties-readmissions/ https://www.statnews.com/2016/12/27/obamacare-success-penalt...
- goatcode 6y agoPrivate healthcare existed long before prices skyrocketed. Health insurance did not.
- DubiousPusher 6y agoNot really though. Not in the way it does today. Medicine up to 1900 was largely ineffective. And most of what we consider modern medicine has its roots in the 1940s. Which coincidentally is about the same time employer provided health insurance started becoming common.
- notsureaboutpg 6y agoI agree to some degree about how standardized and effective medicine is now. But it's not at all true that medicine up to 1900 was largely ineffective... Medicine even way way back in ancient times was pretty effective (not the level it is now but neither was it "largely ineffective" that's just not historically true).
- deleted 6y ago[deleted]
- goatcode 6y agoMany procedures that are common between today and circa 1960s have grown exponentially in cost. It was about this time that public insurance became a thing, and private insurance approximately the same time, in terms of actual usage. The median cost to individuals has gone up significantly since any insurance was mandated.
- hkt 6y agoActually, throughout history (at least 500 years in the UK, since the end of the guild system) people have paid what was essentially a premium in order to access medical care at the point of need - effectively insurance, if not always named as such. Most of these organisations were mutuals, eg, member owned, and would have pre-existing relationships with doctors etc that would control costs. In this way, there were no perverse incentives - people had "insurance", and they wanted that money to cover as many eventualities as possible. The bigger the pot of money, the more resilient the community. So actually, health insurance has a long legacy. The problem, I would suggest, is shareholders who are not the principal beneficiaries of the service. FWIW, in the UK we found that a system of mutuals and municipally owned hospitals was sufficiently imperfect that we created the NHS anyway. Probably best to skip to single-payer in the US, imo.
- eloff 6y agoIt turns out markets are a great solution to some kinds of problems and not so much for others. There's a lot of reasons why healthcare doesn't approximate a free market very well, and why government intervention here tends to do better than the US system. Yes I know there is plenty of government intervention in the US healthcare system - it's just not the right kind of intervention. The US is actually the only developed nation without a public healthcare system, it also has the highest healthcare costs of any nation on earth. Coincidence? It seems like a pretty big mess at the moment.
- bravo22 6y agoYou are assuming that healthcare is a free market. There is tremendous regulation, encouraged by incumbants, to keep away the competition. You should look at historical healthcare expenditure by the US. The problem isn't providing healthcare for all... it is the method and the cost. Universal payer is one way. It is not the best way and in fact Medicare is one reason costs are currently high. It is a bit like a car that used to get 30MPG and now gets 15MPG, and getting worse, and the solution being offered is for all of us to collectively chip in and buy gas for those who can't -- which is not tenable in the longterm because you're spending more and more of the GDP on transportation. There are other ways of giving everyone coverage. One scheme, would be giving people money. Enough to cover average cost of healthcare plans and say education plans. The individual is then responsible for their own healthcare and has the funds to purchase health insurance. Then you have a healthy market and have mechanisms for the costs to come down.
- luma 6y agoA free market involves a customer that has the option to simply not buy what is on offer. Healthcare can never be a free market in this sense, because the customer is faced with a choice of "buy service and/or product" or "be dead". That is entirely unlike the choice involved in buying something like a refrigerator and seriously skews the applicability of traditional free market thinking to the problem.
- bravo22 6y ago
- deleted 6y ago[deleted]
- breck 6y agoHealthcare is a disaster because of copyright and patent laws, not necessarily because of privatization. https://longbets.org/855/ https://longbets.org/855/
- pasabagi 6y agoI think the space successes have far less to do with privatization, and far more to do with Space X, specifically the combination of a massive amount of capital sloshing about, Elon Musk being good at getting his hands on that capital, and there being an absolute army of engineers who would walk over coals to build rockets. That NASA hasn't been able to capitalize on this situation is more about NASA's failures than anything else.
- maxerickson 6y agoGerman healthcare has private providers and insurance and so on. It just has sensible regulation to go with it. There are subsidies and everyone is required to pay into the system, but the administration is privately run.
- bhupy 6y agoExcept...it's not obvious that the root cause of the US's current healthcare disaster is "privatization". I work in the industry, and by far the #1 most jarring misconceptions I see floating around forums like this is conflating of "privatized" with "employer sponsored because of decades of tax incentives and mandates". The US is not the only country that has a public-private mix of healthcare, but it is pretty much the only developed country where private health insurance is predominately received through employers rather than on the individual market. If you want a true apples-to-apples cost of public vs private healthcare, you should look at Medicare Advantage vs Original Medicare. When you turn 65, you have the option to enroll either in "Original Medicare", which is what we usually think of when we talk about "single payer healthcare in America", or you can enroll in Medicare Advantage (aka Medicare "Part C"), where the premiums that would go to the CMS instead go to private insurers like Humana, United, Oscar Health, Aetna, Clover, etc. These plans replace Original Medicare, also cover Part D prescription drug benefits, and often include supplemental benefits that Original Medicare doesn't already cover. There are some interesting findings so far: - 39% of Medicare beneficiaries are on private Medicare Advantage plans instead of the public "Original Medicare". Because everyone is entitled to "Original Medicare", this is purely voluntary. This number has been growing so rapidly, that we expect by 2025, more seniors to be on a private plan than the public one. There's also great variance by State. In Florida, Pennsylvania, Wisconsin, Michigan, Minnesota, Oregon, Alabama, Hawaii, and Connecticut — nearly 50% of beneficiaries are on Medicare Advantage. By 2022, we expect more seniors in those States to be on a private plan than a public one. https://www.kff.org/medicare/issue-brief/a-dozen-facts-about-medicare-advantage-in-2020/ https://www.kff.org/medicare/issue-brief/a-dozen-facts-about... - For most beneficiaries, Medicare Advantage costs about 39% less than Original Medicare. https://healthpayerintelligence.com/news/medicare-advantage-costs-40-less-than-fee-for-service-medicare https://healthpayerintelligence.com/news/medicare-advantage-... - Medicare Advantage plans are, on average, of higher quality than the public Original Medicare. https://healthpayerintelligence.com/news/medicare-advantage-enrollment-quality-continue-upward-trend https://healthpayerintelligence.com/news/medicare-advantage-... - In Urban areas, Medicare Advantage costs less per capita to administer than Medicare — and that's not including the extra Medicare Part D insurance that you would have to buy if you're on the Original Medicare plan. https://www.commonwealthfund.org/publications/issue-briefs/2016/jan/does-medicare-advantage-cost-less-traditional-medicare https://www.commonwealthfund.org/publications/issue-briefs/2...
- mhh__ 6y agoThe US healthcare "market" seems to be the worst of any imaginable healthcare system combined.
- fallingknife 6y agoPrivatization doesn't make costs plummet, competition does. In most cases, our healthcare system is not competitive even when it is private. e.g. emergency rooms. You will just go to the closest one. If you look at areas where healthcare actually is a competitive market, e.g. Lasik surgery, the situation is very different.
- s1artibartfast 6y agoManufacture of rockets and space travel has always been privatized. It is really a testament to spacex PR that that there is so much confusion on this topic. They SpaceX is "private" in the sense that they are not listed on the stock exchanges. Previous manufactures were all "public" in the sense that they had gone through an IPO and you could buy stock. People confuse this with public, as in the the government owned public pool.