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None of that is true. Firstly it's clearly not true in a practical sense. Collective health care is far more efficient than private health care with donations,

None of that is true. Firstly it's clearly not true in a practical sense. Collective health care is far more efficient than private health care with donations, because collective health care can bypass executive greed and set sensible prices. Individual health care is at the mercy of markets run by amoral people, so you end up with 500,000 people being bankrupted every year, even though they have health insurance. Ask any diabetic in the US how well that's working for them. Secondly it's not true ethically. Some people will do anything for friends and family, others won't lift a finger. Should the friends and family of the latter not be helped? Thirdly the "more people -> less action" argument is clearly wrong on a collective scale, precisely because you employ individuals who are paid to provide professional help. So your heart attack patient isn't rescued by a caring amateur who may have no clue what to do, but by a professional paramedic and eventually a doctor who does. The doctor and paramedic are paid with taxes because all the evidence shows that is cheaper, more efficient, and more reliable universal option than privatised health care with copays and exclusions and all the other scams. Taxes are better than charity because in a collectively oriented system even with inefficiencies you don't get the patchy, random, whimsically motivated and unreliable care offered by charity and philanthropy. And it's not as if corporations aren't also bureaucracies - but without any possibility of democratic accountability.

fallingknife 4y ago
Profit margins of the healthcare industry as an aggregate are a single digit percentage. If you got rid of the "executive greed" (whatever that is) portion then you get a very small drop in prices, at best.
- germandiago 4y ago
  Of course this is not true, there are other possible setups: https://en.wikipedia.org/wiki/Devi_Shetty https://en.wikipedia.org/wiki/Devi_Shetty :) https://www.bloomberg.com/news/features/2019-03-26/the-world-s-cheapest-hospital-has-to-get-even-cheaper https://www.bloomberg.com/news/features/2019-03-26/the-world... This just shows that it can be much cheaper than it is. The rate of success of those hospitals is not correlated to their price compared to their american counterparts. It is arranged in the most efficient way possible. This expands the reach of the people that can access health care in India. I do think it is a revolution. It is in the lines of (of course, with limitations) "what if health care could be as cheap as food?" Imagine the revolution. How come they built this? Yes, the profit motive is there. Without that incentive probably it would not be the same. Human incentive again. "Shetty aims to trim costs with such measures as buying cheaper scrubs and using cross ventilation instead of air conditioning.[17] That has cut the price of coronary bypass surgery to 95,000 rupees ($1,583), half of what it was 20 years ago.[3] In 2013 he aimed to get the price down to $800 within a decade. The same procedure costs $106,385 at Ohio's Cleveland Clinic" We can do better, right? No, it does not need to be public, just efficient.
  - fallingknife 4y ago
    I'm not saying we can't do better. We absolutely can. I'm saying that blaming it on greed is ridiculous, as greed is a constant of human behavior. It's an organizational and incentive issue.
    - germandiago 4y ago
      > I'm not saying we can't do better. We absolutely can > Profit margins of the healthcare industry as an aggregate are a single digit percentage Link these two together and what you are saying is that we can assist fewer people because of efficiency problems. A failure in my eyes. I would be willing to put my money in a system like Shetty hospitals (as an investor) to improve the lives of people. But no, I have to do it through a tax system because yes and this has consequences. Even you recognize it in some way if you link those two propositions.
germandiago 4y ago
> Collective health care is far more efficient than private health care with donations This is not my point either. I mean, I know there is scale playing there. > Secondly it's not true ethically. Some people will do anything for friends and family, others won't lift a finger. It is a trend, not an absolute. Also, none of us can be blamed for all the bad things in the world. We act as we deem appropriate and we can even interpret or understand things different, let alone have a different value scale. > Thirdly the "more people -> less action" argument is clearly wrong on a collective scale There are experiments. In psychology. When you add to a group, the responsibility starts to be "fuzzy" and we act different. > because you employ individuals who are paid to provide professional help. Yes, like psychologists without a license here in Spain for mistreatment of women in Andalucia put by friends of the administration without a need even to publish the name, surname, test score and ID. Curious, right? I wonder if I had to search one for a relative or friend if I would choose such "professionals" that I paid coactively with my money or I'd rather go for what I think is appropriate. What happens is that there is an enormous incentive for client systems in the public administration. And it shows clearly. Being democracies the most corrupt of those systems, since the more favors you do, the more chances you have to stay, without any care for taking fair decisions. Not meaning I am against or for democracies though, but it is clearly their worst defect. Of course I say all this with a good knowledge of Spain, other countries may vary. > So your heart attack patient isn't rescued by a caring amateur who may have no clue what to do The topic is not about that. The topic is about how fast are people willing to react to gather help depending on the safe nets they have among them. When people know noone else will do it, they react faster. In the opposite direction, they start to ignore the problems. > The doctor and paramedic are paid with taxes because all the evidence shows that is cheaper, more efficient, and more reliable universal Really? In Spain, btw my sis is a doctor, they get a shitty bill. Now we are in lack of doctors because they are not paid what they should and go abroad. Are you sure it is "cheaper"? Or what you mean is that it looks cheap bc they pay a sh*t and people keep leaving and there is a lack of them? > Taxes are better than charity because in a collectively oriented system even with inefficiencies you don't get the patchy No, taxes are not better because they are allocated by bureaucrats according to their criteria and you pay coactively. They pay no penalty for their bad decisions either. It is the worst possible system. Of course, it is not the same if they spend 10-30% of your taxes than if they use over 50% (like they do with me). The criteria to allocate is different. Remember that the administration is managed by humans, not gods, with the same defects and incentives we have: they might (and they do! as in the psychologists in Andalucia thing) prefer to have a few friends in the administration that will favor them over having good treatment for mistreated women. It works like this. I see you believe in collective systems. Me too. But just in the ones where: 1. you have effective control on where the expenses go. 2. they are planned like a private business, with non-infinitely flexible budgets paid 3. if someone does not do a good job, they must be out of that management, paying for their mistakes As long as those incentives do not hold, things will not work the way we think they are working.

fallingknife 4y ago

Profit margins of the healthcare industry as an aggregate are a single digit percentage. If you got rid of the "executive greed" (whatever that is) portion then you get a very small drop in prices, at best.

germandiago 4y ago
Of course this is not true, there are other possible setups: https://en.wikipedia.org/wiki/Devi_Shetty https://en.wikipedia.org/wiki/Devi_Shetty :) https://www.bloomberg.com/news/features/2019-03-26/the-world-s-cheapest-hospital-has-to-get-even-cheaper https://www.bloomberg.com/news/features/2019-03-26/the-world... This just shows that it can be much cheaper than it is. The rate of success of those hospitals is not correlated to their price compared to their american counterparts. It is arranged in the most efficient way possible. This expands the reach of the people that can access health care in India. I do think it is a revolution. It is in the lines of (of course, with limitations) "what if health care could be as cheap as food?" Imagine the revolution. How come they built this? Yes, the profit motive is there. Without that incentive probably it would not be the same. Human incentive again. "Shetty aims to trim costs with such measures as buying cheaper scrubs and using cross ventilation instead of air conditioning.[17] That has cut the price of coronary bypass surgery to 95,000 rupees ($1,583), half of what it was 20 years ago.[3] In 2013 he aimed to get the price down to $800 within a decade. The same procedure costs $106,385 at Ohio's Cleveland Clinic" We can do better, right? No, it does not need to be public, just efficient.
- fallingknife 4y ago
  I'm not saying we can't do better. We absolutely can. I'm saying that blaming it on greed is ridiculous, as greed is a constant of human behavior. It's an organizational and incentive issue.
  - germandiago 4y ago
    > I'm not saying we can't do better. We absolutely can > Profit margins of the healthcare industry as an aggregate are a single digit percentage Link these two together and what you are saying is that we can assist fewer people because of efficiency problems. A failure in my eyes. I would be willing to put my money in a system like Shetty hospitals (as an investor) to improve the lives of people. But no, I have to do it through a tax system because yes and this has consequences. Even you recognize it in some way if you link those two propositions.

germandiago 4y ago

> Collective health care is far more efficient than private health care with donations This is not my point either. I mean, I know there is scale playing there. > Secondly it's not true ethically. Some people will do anything for friends and family, others won't lift a finger. It is a trend, not an absolute. Also, none of us can be blamed for all the bad things in the world. We act as we deem appropriate and we can even interpret or understand things different, let alone have a different value scale. > Thirdly the "more people -> less action" argument is clearly wrong on a collective scale There are experiments. In psychology. When you add to a group, the responsibility starts to be "fuzzy" and we act different. > because you employ individuals who are paid to provide professional help. Yes, like psychologists without a license here in Spain for mistreatment of women in Andalucia put by friends of the administration without a need even to publish the name, surname, test score and ID. Curious, right? I wonder if I had to search one for a relative or friend if I would choose such "professionals" that I paid coactively with my money or I'd rather go for what I think is appropriate. What happens is that there is an enormous incentive for client systems in the public administration. And it shows clearly. Being democracies the most corrupt of those systems, since the more favors you do, the more chances you have to stay, without any care for taking fair decisions. Not meaning I am against or for democracies though, but it is clearly their worst defect. Of course I say all this with a good knowledge of Spain, other countries may vary. > So your heart attack patient isn't rescued by a caring amateur who may have no clue what to do The topic is not about that. The topic is about how fast are people willing to react to gather help depending on the safe nets they have among them. When people know noone else will do it, they react faster. In the opposite direction, they start to ignore the problems. > The doctor and paramedic are paid with taxes because all the evidence shows that is cheaper, more efficient, and more reliable universal Really? In Spain, btw my sis is a doctor, they get a shitty bill. Now we are in lack of doctors because they are not paid what they should and go abroad. Are you sure it is "cheaper"? Or what you mean is that it looks cheap bc they pay a sh*t and people keep leaving and there is a lack of them? > Taxes are better than charity because in a collectively oriented system even with inefficiencies you don't get the patchy No, taxes are not better because they are allocated by bureaucrats according to their criteria and you pay coactively. They pay no penalty for their bad decisions either. It is the worst possible system. Of course, it is not the same if they spend 10-30% of your taxes than if they use over 50% (like they do with me). The criteria to allocate is different. Remember that the administration is managed by humans, not gods, with the same defects and incentives we have: they might (and they do! as in the psychologists in Andalucia thing) prefer to have a few friends in the administration that will favor them over having good treatment for mistreated women. It works like this. I see you believe in collective systems. Me too. But just in the ones where: 1. you have effective control on where the expenses go. 2. they are planned like a private business, with non-infinitely flexible budgets paid 3. if someone does not do a good job, they must be out of that management, paying for their mistakes As long as those incentives do not hold, things will not work the way we think they are working.