4 ms·

Misaligned incentives. The government I the only entity with the incentive to maintain the health of its citizens. Anything else is a farce.

tomohawk 5y ago
YOU are the only entity with the incentive to maintain your health. The government could care less. It's a giant unfeeling AI that follows rules and incentives laid down by politicians. The overriding concern when government gets involved is cost, not outcomes or quality of care.
- yohannparis 5y ago
  This is mostly an U.S.A. point of view. As an European, and now Canadian, of all the countries I lived in, the U.S.A. was the only one who did not think that the health, education, and opportunities of their citizens was good for the nation and more importantly the state.
  - BrianOnHN 5y ago
    > Education Is why they can't connect the dots in the US.
- Retric 5y ago
  Governments do have incentives to keep the population healthy, as seen by free covid vaccinations by a GOP administration. The dead don’t pay taxes. The important bit is a lot of healthcare makes minimal difference. People have a huge bias around doing something even if it doesn’t help. Governments on the other hand care a lot more about the cost/benefit from healthcare thus vaccination is considered an obvious win but Medicare puts limits on physical therapy etc.
  - makomk 5y ago
    Paying taxes can only act as an incentive for governments to keep the population healthy if it costs them less than they'll get from that person in taxes - so if you're old, retired, or not able-bodied enough to work, well... (This kinda resembles how the NHS in the UK decides what treatments to fund if you squint, though that's not the official justification.) There's also a lot of pressure to fund treatments of dubious effectiveness for high-profile diseases like cancer which politicians tend to give into because they care about being re-elected, whilst unglamorous but quality-of-life affecting stuff like physical therapy gets deprioritized.
refurb 5y ago
Of course that's not true. I mean, the Netherlands and Switzerland have private insurance for healthcare. Are you saying they have no incentive to maintain their health?!?
- matthewdgreen 5y ago
  The Netherlands subsidizes about 75% of healthcare costs using taxpayer money, and implements a system of price controls on private insurers while making coverage mandatory. This would certainly be called nationalized, universal healthcare by the standards of US politics.
  - refurb 5y ago
    If it’s private insurers and private doctors how can you call it “nationalized”?
    - matthewdgreen 5y ago
      Because the government stepped in and said “we are going to use the enormous power of the state to make sure every citizen in this country is covered”, whether that involves using private insurance but dictating how and when it can charge, or paying for service directly, or subsidizing costs and then allowing private insurance to administrate. It doesn’t matter to me if you call it “nationalized insurance” or “universal healthcare” or “healthcare that is overwhelmingly funded and controlled by the state but leverages some private components in controlled ways” -— that’s just semantics. All that matters to me is that we don’t try to fool people into thinking that the Netherlands or Sweden have anything like the broken medieval mess we have here in the US, when obviously what they’ve done is radically different.
      - refurb 5y ago
        Nationalized means “government owned”. Maybe pick a different word? The govt has strict rules around drug manufacturing but it’s not accurate to say the industry is “nationalized”.

tomohawk 5y ago

YOU are the only entity with the incentive to maintain your health. The government could care less. It's a giant unfeeling AI that follows rules and incentives laid down by politicians. The overriding concern when government gets involved is cost, not outcomes or quality of care.

yohannparis 5y ago
This is mostly an U.S.A. point of view. As an European, and now Canadian, of all the countries I lived in, the U.S.A. was the only one who did not think that the health, education, and opportunities of their citizens was good for the nation and more importantly the state.
- BrianOnHN 5y ago
  > Education Is why they can't connect the dots in the US.
Retric 5y ago
Governments do have incentives to keep the population healthy, as seen by free covid vaccinations by a GOP administration. The dead don’t pay taxes. The important bit is a lot of healthcare makes minimal difference. People have a huge bias around doing something even if it doesn’t help. Governments on the other hand care a lot more about the cost/benefit from healthcare thus vaccination is considered an obvious win but Medicare puts limits on physical therapy etc.
- makomk 5y ago
  Paying taxes can only act as an incentive for governments to keep the population healthy if it costs them less than they'll get from that person in taxes - so if you're old, retired, or not able-bodied enough to work, well... (This kinda resembles how the NHS in the UK decides what treatments to fund if you squint, though that's not the official justification.) There's also a lot of pressure to fund treatments of dubious effectiveness for high-profile diseases like cancer which politicians tend to give into because they care about being re-elected, whilst unglamorous but quality-of-life affecting stuff like physical therapy gets deprioritized.

refurb 5y ago

Of course that's not true. I mean, the Netherlands and Switzerland have private insurance for healthcare. Are you saying they have no incentive to maintain their health?!?

matthewdgreen 5y ago
The Netherlands subsidizes about 75% of healthcare costs using taxpayer money, and implements a system of price controls on private insurers while making coverage mandatory. This would certainly be called nationalized, universal healthcare by the standards of US politics.
- refurb 5y ago
  If it’s private insurers and private doctors how can you call it “nationalized”?
  - matthewdgreen 5y ago
    Because the government stepped in and said “we are going to use the enormous power of the state to make sure every citizen in this country is covered”, whether that involves using private insurance but dictating how and when it can charge, or paying for service directly, or subsidizing costs and then allowing private insurance to administrate. It doesn’t matter to me if you call it “nationalized insurance” or “universal healthcare” or “healthcare that is overwhelmingly funded and controlled by the state but leverages some private components in controlled ways” -— that’s just semantics. All that matters to me is that we don’t try to fool people into thinking that the Netherlands or Sweden have anything like the broken medieval mess we have here in the US, when obviously what they’ve done is radically different.
    - refurb 5y ago
      Nationalized means “government owned”. Maybe pick a different word? The govt has strict rules around drug manufacturing but it’s not accurate to say the industry is “nationalized”.