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Comment by mabbo | Hacker News Reader

A great example of how for-profit healthcare (or anything else) can fail.

Corporate entities have an obligation to do whatever they can legally get away with in order to maximize profits. They do not have a prerogative to benefit society, or help human beings apart from what they choose to do.

Every country has to decide whether the benefits of privatisation of the various services outweighs the societal costs caused by private entities having different goals.

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Public psychiatric institutions suffer from the same problem though, because the salaries of the employees running the institution are dependent upon a consistent occupancy.

There's a difference though- if their boss finds out that they did this, in the private sector they'd be rewarded, and in the public sector they'd be fired.

That's a pretty bold assertion, do you have any basis for it?

... this very article? Where they said that management were explicitly telling doctors to keep patients in longer to make more money?

Not really. Public sector employees aren't as incentivised to maximise profits for their employer as private sector employees are. This ultimately makes some public services superior because the employees have no reason to pretend you are are walking wallet instead of a human being.

The history of public institutions has shown otherwise.

Not to anything like the same manner and extent. In almost all public systems the salaries are dependent upon political considerations first and actual demand is a long way down the list - the system tends to be underprovisioned and demand rarely falls unless there is mass exodus from an area.

This is a problem localized to psychiatric care, general healthcare has obligations and quality controls, and it doesn't fail in the ways you describe. The fact that medical practitioners take out enormous malpractice insurance policies proves that there is accountability, at least if you're considered sane enough to press charges.

For psychiatric care specifically, the problem is that the patient has no agency by definition. The patient can not complain about the hospital, because people think he's too crazy to take care of himself.

Nearly everything you have written is incorrect.

It's rare to find a psychiatric hospital, public or private, that's not accredited by JCHO. This group has the same standards for general and psychiatric hospitals about patient rights, and due process for any hands-on or involuntary interventions.

Psychiatric patients can, and do, complain. The assumption is that they are making a genuine report until proven otherwise.

And if you want to see examples of how government run healthcare (or anything else) can fail, just look at the history of atrocities of public psychiatric hospitals.

Or visit emergency in most any Canadian hospital.

I live in Toronto. I've been to the ER here. We were seen promptly, given the right care, and paid no bill.

The efficiencies gained by not wasting time on unneeded treatments, not having a billing department and not paying million dollar CEO compensations, these outweigh, in my opinion and experience, any gains we might have via privatization.

4 to 8 hour waits are fairly routine from what I've heard (Western Canada anyways). Not advocating privatization, just pointing out that the Canadian system is far from the utopia that many Canadians tend to suggest (when the topic is socialized medicare in an international forum.....when the topic is discussed within Canada, many people's opinions deteriorate significantly.)

Well, the Western provinces are very Conservative and don't want to properly fund their health care system. It saves them money on taxes, at the cost of their health. It's a choice they make.

If you ask me, their governments do this so that they can argue "See? this is broken! We need to privatize!"

Are you pointing this out as a vulnerability of the public model?

Oh, definitely. It's probably it's biggest catch- you have to have a people who want to pay the taxes needed to fund it, knowing that in the long run they'll save money.

But that requires long term thinking, which we're bad at as a species...

This article suggests spending is fairly uniform across provinces, with the west not really standing out as spending less, Alberta being even higher, and I know there are long wait times in Alberta.

http://www.cbc.ca/news/canada/calgary/conference-board-of-ca...

So money seems not to be the problem. I'm pro-single-payer, but I also have a very large philosophical problem with the fact that people who would like to choose to spend their discretionary income on extra/better/faster healthcare are not allowed to. If I've worked my ass off my whole life, I don't think I should have to wait in line behind someone who sat on the couch eating chips their whole life. I'm happy to pay his bill, just don't make me wait in line behind him. There should be additional resources for those of us willing to spend additional money.

>Corporate entities have an obligation to do whatever they can legally get away with in order to maximize profits...

I love how people generally agree upon this, but when it comes to specific topics, they seem to have a blind spot for this. For ex. Vaccines and how people seem to blindly believe what ever the authority tells them...

I mean. Look at this thread.

https://www.reddit.com/r/worldnews/comments/6c5k10/italy_mak...

I don't really expect the crowd here to be much better...but anyways...

You're coming to hacker news to argue that vaccines are actually a conspiracy?

Best of luck with that.

Actually I am just noting the curious juxtaposition of these two statements and how the same persons/community can accept both of them at the same time..

>Corporate entities have an obligation to do whatever they can legally get away with in order to maximize profits...

>There is nothing remotely dubious regarding the enormous push for vaccinations, and we should applaud any measures that mandate the same.

Some kind of cognitive dissonance, I guess...

The argument for mandatory vaccines is that herd immunity protects everyone; if you allow a small population of a disease to survive it will mutate and new vaccines will be needed for everyone else.

Wouldn't no vaccines be the most profitable for medical companies since many more people would then require constant treatment?

Ok. But you are still trusting that the concerned vaccines has been tested well by benevolent agents, and produced with 100% concern for the consumers/kids, right? Or you would not be so accepting of the same. Is that correct?

I was asking about this trust. Where does it come from. And how can it exist among people when the same people believe that "Corporate entities have an obligation to do whatever they can legally get away with in order to maximize profits..."

>Wouldn't no vaccines be the most profitable for medical companies since many more people would then require constant treatment?

Well. Think about it. You are a company producing 10 drugs that people get occasionally. Some of them have some kind of outbreak rarely. How will you mange production of these 10 drugs, when you have no idea of what the demand is going to be.

Contrast it with vaccines. That have a constantly growing (possibly at a known rate) demand. Also, it seems that companies are sheielded from vaccine related injuries [1]. So what would you prefer?

Just a thought.

[1] http://product-liability.lawyers.com/drug-medical-device-lit...

>The VICP was created by the National Childhood Vaccine Injury Act. The Act is designed to shield pharmaceutical companies from lawsuits in exchange for their continued efforts to make the vaccinations we need. So, because injured patients can't sue the drug companies, the VICP was created to pay them money damages.

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