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What makes you so sure government bureaucracy is even capable of doing this? It never had a great track record to begin with.

by starkd 4y ago

jeromegv 4y ago
They have actively worked at crippling it. Now that it’s crippled they tell you.. oh but surely the government can’t fix it, we need private enterprises to fix it! You walked right into it. What makes you think private business are capable of delivering something cheaper than what the government can do? The most expensive health care in the world is private.
- Folcon 4y ago
  To be honest I'd be ok with private healthcare if they had to also obey the same constraints as public healthcare. IE they had to provide care to everyone at a reasonable price. I'm deeply suspicious of healthcare that gets to exclude people for cost reasons. I too can provide great healthcare if everyone is mandated to pay me for my services and I get to exclude those I treat, that's a great business, the healthy pay and I exclude the sick, what wonderful pure profit business! The insurance model bothers me for that reason, they really shouldn't be allowed to exclude anyone, if they're taking on the business of healthcare, then that's that, they are providing a utility service, which means they supply to everyone and they make money by spreading the cost between everyone. There are nuances to that, but practically that's the goal they should aspire to, but unfortunately that model isn't the most profitable. I mean take a look at the original US health insurance that existed: > The first plan guaranteed teachers 21 days of hospital care for $6 a year, and was later extended to other employee groups in Dallas, and then nationally [0] That insurance model worked, it just happened to get outcompeted by entities who were willing to undercut them by aiming to capture only the most healthy people, which is in effect a tragedy of the commons. Which is a real problem in my book, I'd be fascinated to see what innovations a private company could come up with under that model. We might have missed out on a whole slew of interesting ideas if we kept going down that route, which would still have been a pretty profitable business and would have been a great success for those who do believe that the private space can do healthcare better. As it stands I don't believe the current private model meets that criteria as it fails at the first hurdle of being a health care service, it doesn't care about health. So it seems like the choices are bad private care, good public care and bad public care. So yea, I'm leaning to the good public care. - [0]: https://en.wikipedia.org/wiki/Blue_Cross_Blue_Shield_Association https://en.wikipedia.org/wiki/Blue_Cross_Blue_Shield_Associa...
- raffraffraff 4y ago
  Exactly. Why would it be cheaper or better to run healthcare as a for-profit business? If you have to take a profit, then by definition there's less funds available for the actual service.
  - robertlagrant 4y ago
    The point of private enterprise is it has to cost less or be a better product to survive, which is why things like cars are unbelievably better than they were 50 years ago, or even 10 years ago. E.g. saying a state-run car company would've done better because all that profit money would've been perfectly allocated is not right. Otherwise the government's perfect decision-makers would be starting car companies left and right and making a fortune, instead of working for the government.
    - MattPalmer1086 4y ago
      Only if there is both competition and consumers can make informed judgements on the service. In things that affect your health, I don't want to be the guinea pig that discovers the service I paid for wasn't up to standard. That provider may go bust in the long run, but in the meantime will do a lot of damage.
    - ZeroGravitas 4y ago
      If fossil fueled cars burning leaded fuel on state funded roads and then getting bailed out not that long ago is your idea of free enterprise triumphing over the state, you might not be as capitalist as you think you are. "Bob Lutz compares Tesla to socialism after GM took $11B from taxpayers under his reign" https://electrek.co/2016/08/18/bob-lutz-compares-tesla-socialism/ https://electrek.co/2016/08/18/bob-lutz-compares-tesla-socia... I agree that cars are much better than they were 10 years ago. Thanks mostly to government regulations that the incumbent industry fought strongly, while Chinese state owned firms were taking advantage of the opportunity.
      - robertlagrant 4y ago
        > on state funded roads Roads aren't cars? I'm not saying that central planning is never a good idea, just that it's mostly not a good idea. "Where to put roads that a private company will build" is a reasonable role of government in a capitalist society. > and then getting bailed out I don't think they should've been bailed out. That was politicians buying car worker votes by doing politician things, like inflating the currency to make everyone's wages worth less. Cars are better not mostly because of regulations, but because of manufacturing improvements, electronic/chip hardware and software improvements, and, most of all, competition.
- starkd 4y ago
  It is the organizing structure that is more efficient. It's not perfect, but just more resonspive to changes over time.
- pharmakom 4y ago
  This makes me wonder… if Conservative strategy is to run it into the ground and then privatise, which is an unpopular plan with the public, then how are they able to consistently win elections?
  - etc-hosts 4y ago
    Probably because the opposition party has poor leadership and most UK newspapers are aligned with the Tories.
  - solar-ice 4y ago
    Largely because the Tories are also willing to be fairly openly xenophobic, which is very popular with a large portion of the public. "Making sure the poors don't take more than they deserve" is another one of their popular policies. The more-well-off also think Tory policies will get them a house and security. In practice, the UK housing market is completely fucked and gets more so every year, but... it doesn't stop people believing it. Basically the health of the NHS is about the tenth thing on some people's minds when voting, until they get cancer or break an arm, at which point they start complaining about it.
  - ayngg 4y ago
    It is more nuanced than that. The issue is that a lot of western societies are falling into debt traps because of a lot of social and economic factors which are already straining these systems to the point that they cant keep up, and the conservative strategy (in my good faith interpretation) regarding this is reducing the cost of programs that they consider to be bloated. This can be interpreted as running it into the ground as the bloat is often in bureaucracy which can easily pass the buck to actual service providers which then suffer from lack of funding. In contrast a more liberal solution would likely involve increasing spending then trying to recover that through additional taxes, which conservatives would say doesn't solve the cost problem but rather exacerbates it since bloat remains and is paid for by more debt or taxes. Of course this is just a general simplification of the conflict. Clearly the solution is probably somewhere in between, but political polarization has simply pushed people to their party lines and entrenched their positions such that no real progress can happen while things continue to fall apart.
Folcon 4y ago
I don't wish to be snarky, but you are aware that the NHS as an institution has existed since the late 1940's and has been working reasonably well for a long time? An institution does not become beloved by the public for failing to provide a good standard of care for a long enough time that people become used to it doing so. So when you say: > It never had a great track record to begin with. Are you talking about government institutions in general or the NHS? I maybe wrong, but I suspect you're speaking of US institutions which are an entirely different dynamic to UK and European ones. If you are speaking of the NHS, then please outline how it doesn't have a great track record commensurate with its lifespan.
- ChrisLomont 4y ago
  Isn't it possible that demographics have changed enough that funding requirements have changed enough that the 1940s-2000 or so system is no longer viable? I know the demographics in the US has vastly changed some cost models over that time, making some earlier social program hit major funding problems through no evil from govt actors.
  - Folcon 4y ago
    The demographics have changed, but they take that into account in terms of how they handle and manage care. There's a lot of thinking and work that goes on to cover working out the changing needs of your population that has to be handled by any well managed healthcare service. In the NHS specifically I am aware that they also have change management procedures that exist to try and understand how to provide continuous improvement as needs and situation change. That's not to say things are perfect, by any stretch of the imagination. For example the NHS still has a big blindspot when it comes to tech. Most people aren't willing to take the effective pay-cut of being a techie and working in the NHS, a lot of people inside the service don't really respect people with tech skills and there's still a bit of a holdover of not paying much for anyone that isn't a doctor. That's not to say the situation remains static, some doctors for example are slowly accumulating tech skills as a result, so what will probably happen is that success for a tech person in the NHS is going to require a prerequisite medical degree, at least in the near term. Which though I don't think it's the best strategy, I can't also argue it's a terrible one to expect people who provide tech services into the NHS have a reasonably high level of domain knowledge. This is a large institution with a substantial mandate, we should expect to pay a reasonable amount proportional to what it provides us. The fact that it's substantially cheaper than other healthcare services while still providing a very high quality of care leads me to believe that it's doing a pretty good job meeting that mandate. So I don't think blindly questioning it without taking such things into account is helpful, nor do I think that pointing to costs as being "too high" are helpful without considering what is happening and why they are being paid for in the first place. Chesterton's fence and all that, it's not enough to just cut costs, you have to ask what doing so gains you. There are too many social programs which we cut because "spending less is good" without asking if the spending actually gives us a positive return as a society.
ajross 4y ago
NHS and Medicare have historically had both very efficient allocation of resources and excellent health outcomes. This NHS argument is about new data that to me seems impossible to deconflate with a global pandemic. Basically, libertarians are just wrong on this. Government-run health care works great and we have many decades of evidence showing that.
- pclmulqdq 4y ago
  This is the first time I have ever heard of Medicare being held up as efficient. Medicare is 13% of the US government budget. More federal money goes to Medicare than to the Department of Defense. In contrast, the care that people get from Medicare is substantially worse than what you get from private insurance in the US.
  - creato 4y ago
    > In contrast, the care that people get from Medicare is substantially worse than what you get from private insurance in the US. I don’t think they are comparable. Medicare exists because private insurers refuse to cover old people at a reasonable price. It’s a good scam the private insurers have going: take peoples money when they are generally healthy and productive, drop them like a sack of shit onto the government’s lap when they aren’t.
    - pclmulqdq 4y ago
      The price of elder care in the US is not due to insurance companies, but due to the amount of attention someone demands before them die in a US hospital. Many socialized healthcare systems do not allow doctors to waste nearly as many resources this way. That is why the life expectancy of the average obese, unhealthy American is about the same as the life expectancy of the average (much healthier) Japanese or European person. Americans are allowed to eat their way to an early grave and then have medical resources thrown at them to desperately keep them alive a few days longer. EDIT: Also, I should point out that doctors generally demand a lot less end-of-life care than members of the general US population. They seem to understand that it is merely prolonging the inevitable rather than helping.

What makes you so sure government bureaucracy is even capable of doing this? It never had a great track record to begin with.

by starkd 4y ago

What makes you so sure government bureaucracy is even capable of doing this? It never had a great track record to begin with.

jeromegv 4y ago

They have actively worked at crippling it. Now that it’s crippled they tell you.. oh but surely the government can’t fix it, we need private enterprises to fix it! You walked right into it. What makes you think private business are capable of delivering something cheaper than what the government can do? The most expensive health care in the world is private.

Folcon 4y ago
To be honest I'd be ok with private healthcare if they had to also obey the same constraints as public healthcare. IE they had to provide care to everyone at a reasonable price. I'm deeply suspicious of healthcare that gets to exclude people for cost reasons. I too can provide great healthcare if everyone is mandated to pay me for my services and I get to exclude those I treat, that's a great business, the healthy pay and I exclude the sick, what wonderful pure profit business! The insurance model bothers me for that reason, they really shouldn't be allowed to exclude anyone, if they're taking on the business of healthcare, then that's that, they are providing a utility service, which means they supply to everyone and they make money by spreading the cost between everyone. There are nuances to that, but practically that's the goal they should aspire to, but unfortunately that model isn't the most profitable. I mean take a look at the original US health insurance that existed: > The first plan guaranteed teachers 21 days of hospital care for $6 a year, and was later extended to other employee groups in Dallas, and then nationally [0] That insurance model worked, it just happened to get outcompeted by entities who were willing to undercut them by aiming to capture only the most healthy people, which is in effect a tragedy of the commons. Which is a real problem in my book, I'd be fascinated to see what innovations a private company could come up with under that model. We might have missed out on a whole slew of interesting ideas if we kept going down that route, which would still have been a pretty profitable business and would have been a great success for those who do believe that the private space can do healthcare better. As it stands I don't believe the current private model meets that criteria as it fails at the first hurdle of being a health care service, it doesn't care about health. So it seems like the choices are bad private care, good public care and bad public care. So yea, I'm leaning to the good public care. - [0]: https://en.wikipedia.org/wiki/Blue_Cross_Blue_Shield_Association https://en.wikipedia.org/wiki/Blue_Cross_Blue_Shield_Associa...
raffraffraff 4y ago
Exactly. Why would it be cheaper or better to run healthcare as a for-profit business? If you have to take a profit, then by definition there's less funds available for the actual service.
- robertlagrant 4y ago
  The point of private enterprise is it has to cost less or be a better product to survive, which is why things like cars are unbelievably better than they were 50 years ago, or even 10 years ago. E.g. saying a state-run car company would've done better because all that profit money would've been perfectly allocated is not right. Otherwise the government's perfect decision-makers would be starting car companies left and right and making a fortune, instead of working for the government.
  - MattPalmer1086 4y ago
    Only if there is both competition and consumers can make informed judgements on the service. In things that affect your health, I don't want to be the guinea pig that discovers the service I paid for wasn't up to standard. That provider may go bust in the long run, but in the meantime will do a lot of damage.
  - ZeroGravitas 4y ago
    If fossil fueled cars burning leaded fuel on state funded roads and then getting bailed out not that long ago is your idea of free enterprise triumphing over the state, you might not be as capitalist as you think you are. "Bob Lutz compares Tesla to socialism after GM took $11B from taxpayers under his reign" https://electrek.co/2016/08/18/bob-lutz-compares-tesla-socialism/ https://electrek.co/2016/08/18/bob-lutz-compares-tesla-socia... I agree that cars are much better than they were 10 years ago. Thanks mostly to government regulations that the incumbent industry fought strongly, while Chinese state owned firms were taking advantage of the opportunity.
    - robertlagrant 4y ago
      > on state funded roads Roads aren't cars? I'm not saying that central planning is never a good idea, just that it's mostly not a good idea. "Where to put roads that a private company will build" is a reasonable role of government in a capitalist society. > and then getting bailed out I don't think they should've been bailed out. That was politicians buying car worker votes by doing politician things, like inflating the currency to make everyone's wages worth less. Cars are better not mostly because of regulations, but because of manufacturing improvements, electronic/chip hardware and software improvements, and, most of all, competition.
starkd 4y ago
It is the organizing structure that is more efficient. It's not perfect, but just more resonspive to changes over time.
pharmakom 4y ago
This makes me wonder… if Conservative strategy is to run it into the ground and then privatise, which is an unpopular plan with the public, then how are they able to consistently win elections?
- etc-hosts 4y ago
  Probably because the opposition party has poor leadership and most UK newspapers are aligned with the Tories.
- solar-ice 4y ago
  Largely because the Tories are also willing to be fairly openly xenophobic, which is very popular with a large portion of the public. "Making sure the poors don't take more than they deserve" is another one of their popular policies. The more-well-off also think Tory policies will get them a house and security. In practice, the UK housing market is completely fucked and gets more so every year, but... it doesn't stop people believing it. Basically the health of the NHS is about the tenth thing on some people's minds when voting, until they get cancer or break an arm, at which point they start complaining about it.
- ayngg 4y ago
  It is more nuanced than that. The issue is that a lot of western societies are falling into debt traps because of a lot of social and economic factors which are already straining these systems to the point that they cant keep up, and the conservative strategy (in my good faith interpretation) regarding this is reducing the cost of programs that they consider to be bloated. This can be interpreted as running it into the ground as the bloat is often in bureaucracy which can easily pass the buck to actual service providers which then suffer from lack of funding. In contrast a more liberal solution would likely involve increasing spending then trying to recover that through additional taxes, which conservatives would say doesn't solve the cost problem but rather exacerbates it since bloat remains and is paid for by more debt or taxes. Of course this is just a general simplification of the conflict. Clearly the solution is probably somewhere in between, but political polarization has simply pushed people to their party lines and entrenched their positions such that no real progress can happen while things continue to fall apart.

Folcon 4y ago

I don't wish to be snarky, but you are aware that the NHS as an institution has existed since the late 1940's and has been working reasonably well for a long time? An institution does not become beloved by the public for failing to provide a good standard of care for a long enough time that people become used to it doing so. So when you say: > It never had a great track record to begin with. Are you talking about government institutions in general or the NHS? I maybe wrong, but I suspect you're speaking of US institutions which are an entirely different dynamic to UK and European ones. If you are speaking of the NHS, then please outline how it doesn't have a great track record commensurate with its lifespan.

ChrisLomont 4y ago
Isn't it possible that demographics have changed enough that funding requirements have changed enough that the 1940s-2000 or so system is no longer viable? I know the demographics in the US has vastly changed some cost models over that time, making some earlier social program hit major funding problems through no evil from govt actors.
- Folcon 4y ago
  The demographics have changed, but they take that into account in terms of how they handle and manage care. There's a lot of thinking and work that goes on to cover working out the changing needs of your population that has to be handled by any well managed healthcare service. In the NHS specifically I am aware that they also have change management procedures that exist to try and understand how to provide continuous improvement as needs and situation change. That's not to say things are perfect, by any stretch of the imagination. For example the NHS still has a big blindspot when it comes to tech. Most people aren't willing to take the effective pay-cut of being a techie and working in the NHS, a lot of people inside the service don't really respect people with tech skills and there's still a bit of a holdover of not paying much for anyone that isn't a doctor. That's not to say the situation remains static, some doctors for example are slowly accumulating tech skills as a result, so what will probably happen is that success for a tech person in the NHS is going to require a prerequisite medical degree, at least in the near term. Which though I don't think it's the best strategy, I can't also argue it's a terrible one to expect people who provide tech services into the NHS have a reasonably high level of domain knowledge. This is a large institution with a substantial mandate, we should expect to pay a reasonable amount proportional to what it provides us. The fact that it's substantially cheaper than other healthcare services while still providing a very high quality of care leads me to believe that it's doing a pretty good job meeting that mandate. So I don't think blindly questioning it without taking such things into account is helpful, nor do I think that pointing to costs as being "too high" are helpful without considering what is happening and why they are being paid for in the first place. Chesterton's fence and all that, it's not enough to just cut costs, you have to ask what doing so gains you. There are too many social programs which we cut because "spending less is good" without asking if the spending actually gives us a positive return as a society.

ajross 4y ago

NHS and Medicare have historically had both very efficient allocation of resources and excellent health outcomes. This NHS argument is about new data that to me seems impossible to deconflate with a global pandemic. Basically, libertarians are just wrong on this. Government-run health care works great and we have many decades of evidence showing that.

pclmulqdq 4y ago
This is the first time I have ever heard of Medicare being held up as efficient. Medicare is 13% of the US government budget. More federal money goes to Medicare than to the Department of Defense. In contrast, the care that people get from Medicare is substantially worse than what you get from private insurance in the US.
- creato 4y ago
  > In contrast, the care that people get from Medicare is substantially worse than what you get from private insurance in the US. I don’t think they are comparable. Medicare exists because private insurers refuse to cover old people at a reasonable price. It’s a good scam the private insurers have going: take peoples money when they are generally healthy and productive, drop them like a sack of shit onto the government’s lap when they aren’t.
  - pclmulqdq 4y ago
    The price of elder care in the US is not due to insurance companies, but due to the amount of attention someone demands before them die in a US hospital. Many socialized healthcare systems do not allow doctors to waste nearly as many resources this way. That is why the life expectancy of the average obese, unhealthy American is about the same as the life expectancy of the average (much healthier) Japanese or European person. Americans are allowed to eat their way to an early grave and then have medical resources thrown at them to desperately keep them alive a few days longer. EDIT: Also, I should point out that doctors generally demand a lot less end-of-life care than members of the general US population. They seem to understand that it is merely prolonging the inevitable rather than helping.