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> some industries just work better and more efficiently as a centralized common: electricity, water, rail, healthcare... That's an empirical fact. Not a fact.

> some industries just work better and more efficiently as a centralized common: electricity, water, rail, healthcare... That's an empirical fact. Not a fact. Easily demonstrated by falsification by examples of each of those where they have failed because of centralization. Infrastructure is deviously hard to get right. Edit: we can find examples of decentralized infrastructure that works great (internet, Apps, banking). Healthcare in particular must always fail because there's an unreasonably infinite cost for and ideal service. There's no good answer to what price (what resource limitations) we should put on fixing little Jimmy's cancer. Governments struggle to make compromises in healthcare, and plenty of citizens are super unhappy with any compromises made. Of course a free market can't fix that problem either. Disclosure: I'm not a free market zealot. Too many people want to define sides and then get idealist about "their side"; how tiresome. Perhaps you are similar to the free market zealots? > I believe housing too could be on the Be careful of what you wish for. Government housing is rarely brought out as an example of success? Maybe Singapore. "Too much government" is a common reason for housing (market) failure. Supply availability is mostly constrained by regulations. Demand is driven by desirability. House prices are driven by mortgage availability in developed countries. House unavailablity is often because of governmental choices over regulations and interest rates. Governments obviously mostly fail to get those right. What makes you believe a government can get socialised housing right? We don't have infinite resources. Neither government provided services nor free markets solve that. Anyone answering with either of those solutions is the same. You might find this article interesting: https://washingtonmonthly.com/2020/08/30/libertarians-took-control-of-this-small-town-it-didnt-end-well/ https://washingtonmonthly.com/2020/08/30/libertarians-took-c...

thrance 2y ago
It certainly is a complex topic, with no perfect solution. My personal answer to how much we should be willing to pay for little Timmy's cancer is "whatever it costs". By "empirical fact", I meant that our socialized healthcare system here in France seems to do a better job than America's in two key metrics: cost (we dedicate a lesser part of our income to healthcare than Americans, through taxes) and life expectancy (ours is slightly higher). The one caveat I would concede is that we have less access to experimental treatments for rare diseases, but we eventually get most of them. And at a better bargain than Americans too. For electricity, we had a very cheap, clean grid thanks to our nuclear reactors. It started going downhill the instant Europe asked us to "liberalize" our national monopoly. "Private companies" began reselling electricity for a premium. These are essentially useless parasites. Price got up, all else equal. As for housing, I know we already have more vacant homes than homeless people (from our national statistics agency). So the issue is only one of repartition. I don't care about any rationalization or gesturing about "market forces" or whatever. We ought to distribute housing to those that lack it. I'll read your article, thanks.
- Plasmoid 2y ago
  > whatever it costs This isn't an appropriate answer because it can't be applied to the whole of society. You can't spend an unlimited amount of money on everyone and suggesting shows a certain amount of naivete. Every medical systems grades treatments based on life extensible compared to cost. If it's over the limit you can't have it. You need to do the most good for the most people and you don't have unlimited funds.
  - thrance 2y ago
    By "whatever it costs" I meant that we all get a shot at chemotherapy, at the very least. We don't refuse the treatment to a 65 years old who just retired because his death would alleviate strain on our retirement fund, if it's what you think.
    - robocat 2y ago
      > We don't refuse the treatment to a 65 years old We certainly do: because they have unlimited demand for healthcare so there needs to be a budget. I've had indirect experience with the New Zealand healthcare system avoiding treatments due to cost. Cost is often not given as the reason, instead waiting lists and other palatable reasons are given. NZ spends 11% of GDP on healthcare. Health NZ’s cost pressure uplift is 6.2% across all of Health NZ's operating budget Higher than inflation or tax increases. The unsupportable trend is towards 100% of taxes being used for healthcare? It is unrealistically idealistic to pretend we can afford infinite cost pressures. The wealthy pay the majority of the taxation base so they mostly fund public healthcare. People that have chosen unhealthy lifestyles are often the recipients (e.g. my poor friend with COPS from smoking). Not just the unlucky. > all get a shot at chemotherapy Great example. New Zealand does fund cheap chemotherapy options. There are expensive chemotherapy options that are not available through Pharmac (our public healthcare drugs purchaser). For expensive drugs you need to pay yourself either directly or indirectly via private health insurance policies (e.g. I noted a policy that covered up to $600000 for unfunded chemotherapy drugs). Two drugs that our health care system won't pay for due to expense: * Eribulin can be a useful option after ‘standard’ breast-cancer chemotherapy has failed. * Atezolizumab (Tecentriq®) useful for women with locally advanced or metastatic triple-negative breast cancer that cannot be treated surgically and whose tumors are positive for a protein called PD-L1 https://sweetlouise.org.nz/drugs-not-funded-in-nz/ https://sweetlouise.org.nz/drugs-not-funded-in-nz/ I have private insurance (through a non-profit provider). The unlucky collectively get the benefit from that, and I sincerely hope I never need to benefit from it.

thrance 2y ago

It certainly is a complex topic, with no perfect solution. My personal answer to how much we should be willing to pay for little Timmy's cancer is "whatever it costs". By "empirical fact", I meant that our socialized healthcare system here in France seems to do a better job than America's in two key metrics: cost (we dedicate a lesser part of our income to healthcare than Americans, through taxes) and life expectancy (ours is slightly higher). The one caveat I would concede is that we have less access to experimental treatments for rare diseases, but we eventually get most of them. And at a better bargain than Americans too. For electricity, we had a very cheap, clean grid thanks to our nuclear reactors. It started going downhill the instant Europe asked us to "liberalize" our national monopoly. "Private companies" began reselling electricity for a premium. These are essentially useless parasites. Price got up, all else equal. As for housing, I know we already have more vacant homes than homeless people (from our national statistics agency). So the issue is only one of repartition. I don't care about any rationalization or gesturing about "market forces" or whatever. We ought to distribute housing to those that lack it. I'll read your article, thanks.

Plasmoid 2y ago
> whatever it costs This isn't an appropriate answer because it can't be applied to the whole of society. You can't spend an unlimited amount of money on everyone and suggesting shows a certain amount of naivete. Every medical systems grades treatments based on life extensible compared to cost. If it's over the limit you can't have it. You need to do the most good for the most people and you don't have unlimited funds.
- thrance 2y ago
  By "whatever it costs" I meant that we all get a shot at chemotherapy, at the very least. We don't refuse the treatment to a 65 years old who just retired because his death would alleviate strain on our retirement fund, if it's what you think.
  - robocat 2y ago
    > We don't refuse the treatment to a 65 years old We certainly do: because they have unlimited demand for healthcare so there needs to be a budget. I've had indirect experience with the New Zealand healthcare system avoiding treatments due to cost. Cost is often not given as the reason, instead waiting lists and other palatable reasons are given. NZ spends 11% of GDP on healthcare. Health NZ’s cost pressure uplift is 6.2% across all of Health NZ's operating budget Higher than inflation or tax increases. The unsupportable trend is towards 100% of taxes being used for healthcare? It is unrealistically idealistic to pretend we can afford infinite cost pressures. The wealthy pay the majority of the taxation base so they mostly fund public healthcare. People that have chosen unhealthy lifestyles are often the recipients (e.g. my poor friend with COPS from smoking). Not just the unlucky. > all get a shot at chemotherapy Great example. New Zealand does fund cheap chemotherapy options. There are expensive chemotherapy options that are not available through Pharmac (our public healthcare drugs purchaser). For expensive drugs you need to pay yourself either directly or indirectly via private health insurance policies (e.g. I noted a policy that covered up to $600000 for unfunded chemotherapy drugs). Two drugs that our health care system won't pay for due to expense: * Eribulin can be a useful option after ‘standard’ breast-cancer chemotherapy has failed. * Atezolizumab (Tecentriq®) useful for women with locally advanced or metastatic triple-negative breast cancer that cannot be treated surgically and whose tumors are positive for a protein called PD-L1 https://sweetlouise.org.nz/drugs-not-funded-in-nz/ https://sweetlouise.org.nz/drugs-not-funded-in-nz/ I have private insurance (through a non-profit provider). The unlucky collectively get the benefit from that, and I sincerely hope I never need to benefit from it.