Watsi launches universal health coverage, funded by YC Research
blog.watsi.org
blog.watsi.org
Cost savings and scalability seem to come from:
* Easy to ensure treatment guidelines are being followed (so it's catch and eliminate non-administrative waste).
* Avoiding more expensive interventions by providing cheaper, early intervention.
* Easy to track who's enrolled (which also kills the free-rider problem).
* Overall less time (=money) spent on administration in general.
I'm curious if these can be teased apart. What percentage of savings is from early intervention vs. unnecessary treatments?
I'm also curious why 98% of people signed up. Was it good outreach/marketing, increased trust that the system would be beneficial to them (as opposed to bureaucratic delays), or free-riders no longer getting a free ride? Did it get cheaper? More reliable? Why didn't the other 2% sign up?
I'm sure these variables will all be fairly different when they go on to the next community, but they'd be interesting to look at.
I'm also eager to see what this does for the medical infrastructure (and economic growth) down the line. This should make it easier for places offering medical care to get their funding efficiently and quickly, so I would expect them to scale as need grows better than they would otherwise. I hope this means also much more stable school attendance and economic stability for families and communities. Is this more cost-effective and sustainable than just buying people bed nets? Track this and find out. A lot of funding will flow to whatever can be demonstrated to be maximally effective, and it's important for us to find those interventions.
Is there something in the works that would make it possible for 'donors' to cover the annual enrollment costs for others? Or would that defeat the purpose?
And this is off-topic but that's brilliant photography - kudos to the photographer(s)!
If you'd rather help cover enrollment costs for Watsi Coverage, please email connect@watsi.org and we'll respond right away. Thank you!
By the way, the link to "learn more" on the FAQ for "can I donate monthly?" links to http://wwww.https//watsi.org/universal-fund which confuses my browser so I get a connection error
This would mean a gift provides for operating returns perpetually (or as long as the financial markets continue to exist).
For example, a one time donation of $300 (invested) would provide for a health insurance member (at 78 cents/month) in perpetuity.
> Wouldn't it fundamentally change the company from a small, lean, product-driven global health nonprofit to a socially responsible investment (SRI) company (which there already are many of)?
Nothing would change except Watsi having more consistent funding and the ability to have a longer term strategy.
This has the same breathless and "six weeks of hacking to save babies" feel to it that every other project starts out with. What exactly is different? There are a zillion mini-EMRs operating in East Africa, especially Uganda, what most lack is real integration and cooperation with the government to make them sustainable and scale. What is the story there for Watsi? Why will Watsi avoid the complexity of a real EMR like OpenMRS? Are you integrating with them?
There's a slide somewhere that I think UNICEF put together of all the NGO (as in non-UG-government, not just non profit) health projects active in Uganda. It is this hilarious demonstration of the crazy amounts of bootstrapped projects exactly like this and just how much they overlap.
To the founders, have you read The White Man's Burden? If not, please bump it to the top of your list.
Source: I lived in neighboring Rwanda for 5 years and work in this space, including projects in Uganda. It is a fascinating space with lots of opportunity for good, but also one that requires real introspection on why you are pursuing particular strategies and whether that is being driven by ego or truly because you think it is the best for the people. Almost always the answer is that no, a new thing isn't required, but rather you should be pitching in with someone else or building upon an imperfect system to better it, because that system is government owned and managed and thus will be sustainable and gives the country and people agency. This is why aid is hard work, because most good organizations have moved past the "hey, look what we built you stage" to instead trying to build capacity and institutionalize changes. That is so much more difficult but much better tack, though my beliefs are still more in the camp of direct cash transfers these days.
The government (both the Ministry of Health and the district health office) were involved in the project and even drove out to speak at the launch. They are interested in national health insurance, and we've been invited to participate in their technical working group to share our learnings. At request of the government, our system will integrate with DHIS2 and EMR's like OpenMRS, however, we've found that very few providers actually have an EMR in use. Our system isn't an EMR - it's health insurance administration (enrollment, claims, etc.) which is very different and we haven't found anything like it for LMI countries, beyond CarePay which is mostly focused on payments.
Another government in East Africa has already approached us about using our software to administer their public health insurance system, but the Rwandan government would be an ideal next partner. I'd love to talk more if you're interested and we're always open to feedback, especially from people like you with lots of experience in the space. Please reach out at connect@watsi.org if you have a few minutes. Thanks again.
And yes, indeed, bringing small local NGOs to help one local community can be more harmful than not. Among other reasons because you are only adding to the fragmentation of health care services in a country that is desperately trying to unify them and just seeding confusion within that system.
EMR's like what it looks like Watsi is doing have been going on since before I was there in 2007 and like I said are constantly popping up because everybody is like "hey, I can build an EMR". That should be the first clue that it isn't the core problem at hand.
Way too many start-ups believe their own BS when it comes to sentences like 'changing the world' when in fact all they want to do is make their own stash of FY money. Most of these are a net negative when it comes to the change they impart on the world.
If you really want to change the world in a positive way a non-profit is a much better structure. Unless you plan on using your FY money to change the world afterwards, Bill Gates style.
The language used to describe this program seems to land it in the US' medical system debate. EG enrolling in health coverage. A lot of the comments here are focusing on that debate.
I imagine the situation is different enough (industry, patients, funding, etc.) to make the comparison something of an analogy.
In any case, I'd like to hear a bit more about watsi's role and goals. Is this a medical insurance/bureaucracy infrastructure governments can adopt? An alternative way to raise/use donor aid, funding insurance instead of clinics? Are "crowdfunding" and "coverage" separate initiatives?
With my admittedly limited knowledge, it appears to me that this is one of the best efforts in our industry, changing the world for the better and directly making a dramatic difference in the lives of the most vulnerable.
Watsi, and the people behind it, give me hope for our species, despite the state of politics (both in where I live, the US, and in the world in general) or whatever other cynical reason one could come up with.
When we come together, we really can do great things... don't give up hope.
Of course, many thanks to the Watsi team. I hope that I will have the opportunity to join you someday.
My last company (RIP) had a similar idea: ruthlessly cut costs typical for the industry (banking) and pass the savings along to create a product that works for the disadvantaged.
I want to take this chance to encourage people here to give Watsi a try. For the price of two or three beers you can help somebody every month.
Please cite the proposal introduced by any conservative senator or congressman that contains this argument.
http://www.cnn.com/videos/politics/2017/03/07/jason-chaffetz...
The other famous quote is people will choose to not buy insurance because it's not important enough.
https://www.yahoo.com/news/gops-cornyn-defends-americans-fre...
If I had time to watch CSPAN I could probably come up with an example from every GOP congressman/White House spokesman/conservative think tank to match these with video, since they all use the same talking points they use in public for the Obamacare repeal.
I guess you could interpret what they are saying to not mean what I think they mean.
“OK, I don’t know anything about your son, but as you described him, his skills are focused in an industry that doesn’t have the kind of options that you want him to have for health care. So, I don’t believe that these taxpayers here are entitled to give that to him. I believe he’s got the opportunity to go earn those health benefits,”
"how do you handle privacy?" "yes"
"We take patient privacy very seriously. It’s important to us that every patient posted on Watsi understands what Watsi is and how it works. Our medical partners are responsible for ensuring that every patient understands Watsi and explicitly wishes to participate in the program. If a Watsi Crowdfunding patient doesn’t wish to be featured on the website, we give them the option to have their healthcare funded via our General Fund without ever appearing on the website."
Is that different from when you looked at it?
Great work!
Silicon Valley VC-based universal coverage sponsored with crowdfunding: "wooooho that's super great! I love technology"
I would laugh if It wasn't for the milions not being able to afford basic healthcare.
My experience in Europe is limited to living in Denmark, Spain and Bulgaria, and in each place health care could certainly be improved. But most citizens don't worry as much about health care as they did when I lived in the US.
Having seen hospitals in those European countries and what is supposedly a top class Manhattan hospital, I would not trade the European model for the American. Just the humiliation of asking a woman in severe pain for her insurance before treating her; it's undignified.
But whereas the European models could - and in my opinion should - inspire in the US, they are not easily transposed to third world countries where you lack a strong government without too much corruption to collect taxes. Here, a private model might work better.
Anyways, kudos to anyone trying to improve healthcare in the third world or ours.
If you have a serious issue, like a heart condition or a broken bone or vomiting etc, you will be processed much faster.
I know that because I've been in both situations - once with pain in my left ear (waited 2 hours, got a prescription to ibuprofen) and another was chest pain and high blood pressure - processed immediately, all blood work done in minutes, etc.
I guess a lot of people go to the emergency room because they just need a doctor to confirm that they're all right.
My daughter broke her nose while playing and she had nose surgery and she had to stay a couple of nights in the hospital.
In both cases everything has been completely free (AKA paid by high taxes). Our current system has a lot of issues, but I wouldn't trade for a more private one. For sure I wouldn't trade it for the american system.
This is correct and an issue all over the world; without a proper network of local doctors and whatnot (with reasonable waiting times), people will jump to the ER, which is 10x as expensive as a local doctor. But when people have a pressing need for care, they don't have much other options.
Healthcare is hard and expensive.
Food was decent, care by staff was very good and WiFi was excellent!
Edit: Turns out that a deep cat bite can be very nasty!
Edit2: This was lunchtime on Wednesday - I know that if I had went at midnight on a Friday it wouldn't be quite so simple...
Side note: does the concept of "urgent care" exist outside the US?
One of the most baffling things about this whole debate is the assumption by some Americans that socialised medicine is somehow lacking. It really isn't. It's just better and cheaper.
I'm not saying that the fact these things are separate implies it's worse than the European system, just different.
Similarly there tends to be walkin clinics if you don't think you can wait for your GP, but don't think it's something you should go to A&E/ER for. Most of them will not be equipped to handle surgery of any kind, but whatever decisions they do as part of triage will certainly be passed on if they believe you need to be sent to hospital.
I think the big difference is that in most European countries the default is to triage everywhere, unless you pay extra to go private, while Americans seem to be more used to triage being somehow mostly restricted to emergencies.
Triage sucks when you have a minor problem and want quick attention without paying extra for private care, but it's quite great when you have an urgent problem and don't have to wait behind people with much less pressing needs.
Really, it's a fucking stupid question. Of course Europe's socialised medicine will treat broken arms.
If the question is about the time taken to treat these problems: England is going to through a bit of a scandal at the moment about missed waiting time limits in A&E departments.
The maximum time from arriving at A&E through to either being treated and discharged, or admitted into the hospital for further treatment, is 4 hours. And that time limit must happen for 95% of patients.
And we're currently worried because at the moment it's over 90% (but less than 95%) of patients get treated and discharged or admitted to hospital within 4 hours.
We have the advantage of free or low cost primary care, so most people don't need to leave minor problems to fester until it's turned into a severe problem.
Seriously, WTF? Where did I ever say broken arms don't get treated? Are you seeing a dumb American in my post because that's what you want to see?
The only thing I even wonder is where the appropriate place to go to get it treated would be. In the US, you can go to an emergency department or an urgent care facility. The urgent care facility is the most appropriate place: you will get seen promptly and they are equipped to handle it, and it will cost less than an ER visit (even after insurance, typically). You will get seen in the ER, but not quickly, and you will probably pay more.
To answer your point: in England we have:
NHS Choices, a website that provides evidence based advice
NHS 111: a free telephone helpline where health care professionals offer advice, or arrange a call back from a doctor, or recommends a visit to an doctor (and arranged an out of hours doctor if needed), or recommends minor injuries or A&E (and arranges ambulance treatment if needed)
Pharmacy: all pharmacies offer health advice
GP surgeries have GPs but also nurses who can provide a range of treatment including minor surgeries
Minor Injury Units provide treatment for minor Injuries
Accident and Emergency provide treatment for life threatening and other severe accidents - bit they're also misused as walk in treatment centres for a range of mild conditions. Some injuries would mean you get transported to a different hospital after being stabilised -- severe chemical burns would be one example.
I've missed out midwife-led birth units, and all the mental health stuff.
For a broken arm you'd go to A&E. They have to treat it and discharge you within 4 hours. Or you could go to minor injuries, where you'd probably get treated within 4 hours. A&E would have better scanning imaging options.
All of these are free at the point of delivery.
Same in USA, unless you still have a knife stuck in your chest. IN USA, that ibuprofen might cost you $250, along with the $XXXX for the doctor's visit. Maybe I'm exaggerating with $250, but having some outrageous bills, I wouldn't be surprised if they bill you separately for the pill AND for opening the bottle and getting one for you.
A week later, something else showed up at home: a $629 hospital bill for the Band-Aid and its placement on Colette's finger."
I am sure the opposite may apply to head injuries.
I have only gone to emergency services once, luckily, and it was a very brief wait. For more routine procedures, waiting times are even shorter.
On the other hand. I have had some trouble when I've needed certain specialities which have less available staff. Some relatives of mine have had to wait months for surgeries (not too urgent ones, luckily).
It's an imperfect system. Some hospitals are in terrible shape or overwhelmed, and some services or specialties have long waiting times. Many doctors are overworked and underpaid. But still I think the experience for most people is very positive.
If you only need ibuprofen you should not go to the hospital, you must go to a CAP (Centre d'Atenció Primària, Primary Assistance Center). My experience, in a small catalan city, is that sometimes you wait ten minutes, sometimes a couple of hours.
Hospitals can be croweded in Barcelona during flu epidemics or similar, but it is not often the case.
Since a visit to the doctor and medicine is rarely over $10-20 it means basic healthcare is something people don't have to worry about, and keeps people out of the ER (since it costs the same anyway).
I moved from the US to NL. I've had a (similar) knee operation in both places, on the same knee. Both times involved an ER visit, referral to specialist, planning an MRI, getting a diagnosis, consultation with specialists, surgery, and physical therapy. The Dutch system was approximately 15x faster than the US system (Kaiser): 10 days from ER to OR, vs 5 months in the US. My brother is currently going through a different problem which is following the same trajectory as my knee, when I ask my Dutch doctor friend he is astonished at the hoops my brother has to go through to get action taken.
US:
* ER - unable to straighten knee (incredible pain). Happened before but never for this long. After many hours and extreme pain, it finally clicked into place in the ER.
* Schedule GP visit for referral to specialist (can't go directly!) Took forever.
* Schedule Specialist visit. Took forever.
* Specialist said it happens sometimes, could be several things, best to wait and see.
* 2nd ER visit required. Scheduled a specialist (not available for 30+ days). Talked to a out-of-plan specialist, said the problem was clear: it's the meniscus, you need an MRI to confirm, and will probably need surgery to remove parts or stitch it in place.
* Specialist appointment. Still wanted to delay an MRI. Lots of foot-stomping, finally scheduled an MRI (30 days later).
* In the meantime, another ER visit.
* Quite some time between MRI and specialist consultation. Diagnosis was clear. Surgery scheduled for a month later.
* Operation. Gives me some crutches and tells me to schedule PT for 30 days from operation.
* PT can't be scheduled, 30 days haven't passed! Once 30 days passes, PT can be scheduled. First availability is 30 days in the future (AAAAAAH).
NL:
* ER visit (same issue again out of the blue).
* Specialist sees me the same day. MRI is busy with higher-priority issues, schedules me for 2 days later. No GP approval. Doesn't need or want my info from the US, doesn't want to 'wait and see', just get and MRI and we will probably see the problem clearly!
* MRI. I wait in the hospital, discuss the results with the specialist 2-3 hours later. Plans an operation less than a week away.
* Operation, immediately discusses PT. Two In-plan PT organizations that the surgeon recommends are not available (fully booked), so she schedules me with an (also recommended) out-of-plan PT, and writes a letter to my insurer. They cover it.
So yeah, socialized medicine rocks.
I can go to a specialist without referral on my PPO.
> Specialist appointment. Still wanted to delay an MRI. Lots of foot-stomping, finally scheduled an MRI (30 days later).
I got my shoulder MRI within 2 days after doctor visit.
> PT can't be scheduled, 30 days haven't passed! Once 30 days passes, PT can be scheduled. First availability is 30 days in the future (AAAAAAH).
Not sure what this is, I had surgery for my shoulder and was doing PT after 4 days post op. why did you have 30 day restriction?
> doesn't want to 'wait and see', just get and MRI and we will probably see the problem clearly!
MRI's often have high false positives, in my case a torn labrum would be seen in > 70% adults over 45 with no symptoms or pain. Scheduling surgery within a week merely from MRI sounds scary and irresponsible. Why would you want to jump to surgery first when its always available as a last resort. Wouldn't you want to see if something else would do the trick without surgery.
Also, did you research how experienced the doctor is in doing this particular type of surgery, is he upto date with latest techniques, whats his malpractice rate ect. Jumping into surgery with some doctor that you just happen to meet is scary. A botched up surgery is something you have to live with for rest of your life, its irreversible decision.
It could be that this is due to irresponsible MRI'ing and unneeded operations. If that were true it would be very interesting, since that's the opposite of what people assume when they think of socialized medicine.
I would also assume that it would be more expensive per capita, which it doesn't appear to be: https://data.worldbank.org/indicator/SH.XPD.PCAP?end=2014&lo...
It could be that all these super-fast decisions are more expensive, but kill a lot of people sooner, thus saving everyone on healthcare. This also doesn't appear to be the case (life expectancy at birth is higher). https://data.worldbank.org/indicator/SP.DYN.LE00.IN?location...
Anyway, to answer your specific points:
- PPO vs HMO: Nice that you have a PPO. That option wasn't available to me. In the Netherlands, I can pick my insurer freely, my employer has no say in the matter (costs are 100-150 euro a month). Some insurers have in-group agreements, some do not.
- On getting MRIs: I can't tell you when it's correct to order an MRI or not. All I can say is that both MRIs were hits for a torn meniscus, and both operations also bore out evidence of this. Both times it was also a textbook case of a torn meniscus based on my symptoms. Both
- Researching Surgeons: Yes, I researched both surgeons (and hospitals where the surgery was performed). In the US I had fewer options (Kaiser only), in the NL the specialist gave me a list of other specialists who I could get a second opinion from, should I want to.
Point I was trying to make is that you are comparing HMO to NL insurance that allowed you to see specialist directly. I don't think thats a fair comparison unless NL requires all insurance to cover self referral to a specialist.
I know nothing about NL healthcare but according to their website
https://www.govt.nz/browse/health-system/gps-and-prescriptio...
" In most cases, you need to visit your General Practitioner (GP) first so they can refer you."
What kind of insurance did you have that allowed you to self refer ?
You seem to have compared apples and oranges and came to the conclusion that oranges rock.
Is ibuprofen actually not OTC in some countries? It's like one of the safest painkillers ever.
We need better private solutions. We need yelp for medical comparative price shopping, with consumer and expert reviews.
Really well executed gov care can be OK but is rare and usually does nor stay good long term.
The current "free market" in healthcare is completely hamstrung by regulation and unspoken anti-competitve practices and broken intermediation via medical aid funds and gov medicare and other programs.
Most private health care avoid visible rationing by letting people pay to skip ahead in the queue based on economic means instead of urgency and clinical need. That the rationing and queuing isn't visible doesn't mean it's not there. Only that in the US people sit at home wondering how to afford treatment instead of wait in line based on triage based on urgency.
So yes, the US system is superior if you're one of the lucky ones that can afford to pay your way past those who need treatment more than you.
> and sucks up massive amounts of resources.
US healthcare is vastly more expensive for the users than most socialised options..
E.g. a significant portion of private care in the UK is provided in NHS hospitals by NHS staff either outside of their normal shifts arranged by private companies who pay the NHS for access to operating theatres and the like, and by NHS trusts themselves who are allowed to provide private services on top of their socialised care.
A market exception is Norway, which as one of very few countries have very strict limitations on what private services can be provided at all on the basis of an argument that as long as healthcare resources are limited (e.g. there is a practical cap on number of doctors - train too many and they don't get enough experience on real cases to gain the necessary skills), it is seen as immoral to allow people to queue jump.
"Free market" healthcare is "rationed" on the basis of ability to pay.
I'm sorry, this is the stupidest thing I've heard in a long time. What you need is being able to go to any doctor, any hospital, at any time, and knowing you won't pay for it at all, ever, as it is in many countries around the world. Not competitive comparative pricing. If you are in pain you don't want to be shopping around for a good price.
I mean, I'd be more than happy to learn more if I'm wrong about this, but at least this is my impression.
This is not at all how medical billing works.
First of all, many hospitals are structured as nonprofits. Whether or not they are, most hospitals are also barely staying afloat - a hospital that's turning 2 1-2% profit these days is doing astoundingly well. Many are going under and getting bought out by larger chains or by insurance companies.
The reason that they are doing so badly financially is because, in general, they are legally forced to lose money on half of their patients. Medicare sets its reimbursement rates unilaterally, and it reimburses about 7% less than COGS. In other words, if a vaccine costs the hospital $100/unit to purchase wholesale in bulk, Medicare pays them $93 for it. That means they've already lost money, even before they have to pay their doctors and nurses and building maintenance, etc.
Providers make up for this by over-billing the private insurers. That's why you see these stories of people who go to the ER and got charged an absurd amount for something. The hospital was presenting them with the same price they charge to private insurers (by law, they have to, at least on the initial bill). They don't actually expect individuals to be able to pay that, and in fact, an uninsured person is almost always able to negotiate that bill down if they know to try.
In short, yes, medical billing is totally fucked up. But it's not fucked up because the money goes to line corporations' coffers - it's fucked up because Medicare abuses the system to effectively pad its own budget instead of going to Congress to increase their budget.
And that's why, ultimately, Medicare will fight tooth and nail to prevent single-payer healthcare or any meaningful reform whatsoever in the US - they're the ones who stand to lose the most from it.
The problem is that it also mixed employer mandates and Medicaid with that stuff. In principle Medicaid is good, providing care to low income people, including millions of children. The problem is that it is a huge off the books tax scheme, mandating care that it doesn't fund. And with guaranteed issue individual insurance available, employer requirements should have been reduced, not increased.
It did not, because it still kept private insurance companies in control and still made it impossible to negotiate drug prices. It seems better than what came before it, but I'd argue it may have even done some damage, (in terms of the debate towards universal health care), since its failures are now ascribed to 'socialised healthcare' by its opponents and equated to a single payer system, whereas in reality it is in may ways the polar opposite.
Most Germans are covered by "sickness funds" but those with higher incomes have the option of buying private insurance. And the sickness funds aren't really single payer, spending is negotiated regionally, not at the national level.
Yeah, practically every country does, if you want it. The problem in the US is that it is practically the only option for many, not a choice.
> and all US insurance companies negotiate drug prices
But that's the problem, it should not be done by private companies, but by a state/national body with more power.
> Even the specific drug prices that the talking point says Medicare should be able to negotiate are negotiated (by the private companies that administer that part of Medicare...).
Yeah, private companies...
> Most Germans are covered by "sickness funds" but those with higher incomes have the option of buying private insurance.
I am not saying anything about the option of buying private insurance, I am saying it should not be a requirement for basic coverage.
> And the sickness funds aren't really single payer, spending is negotiated regionally, not at the national level.
That is semantics, the principle is the same.
Buying insurance is also a pain because unlike in the US under ACA, German insurance companies are able to charge higher premiums for pre-existing conditions up to a mandated Basispreis (approximately 3x a healthy person's rate - somewhere north of 600€ per month). Pre-existing conditions can include a hospital visit with a null diagnosis.
There's a lot more to it, but I get frustrated when people talk about European-style health care as if it means something concrete, when there are such a wide range of policies across Europe.
It's really only patented drugs where it matters, most generics in the US are all but free (the exceptions to that pattern mostly have few users).
Add in the Medicaid rebate and Medicaid pays almost the lowest price in the US for drugs. I think the VA is the only org paying a little less than that.
Drug costs are 10% of health expenditures in the US. Not sure this is a critical issue for controlling costs.
In Germany you're automatically enrolled in public insurance unless you opt out and choose private insurance, no? That's completely different from the ACA, which has no automatic enrollments (if you're application gets stuck at the exchanges, good luck), no option to keep public insurance (if you're on Medicaid and you're income rises, you might have a month long gap between being kicked off Medicaid and getting a new health plan), pushes people into employer provided plans, and generally has a host of problems and complications that lead to 10.9% of Americans still be uninsured (and those who are insured still facing massive problems with healthcare costs).
Automatic enrollment is rather obviously going to be more effective than a tax penalty, but the tax penalty is at least a mechanism designed to increase subscription.
There are a bunch of bad compromises in the ACA, but the comment I replied to was mystified that the US apparently isn't even trying things that have worked elsewhere, which is just wrong.
I'd say that they are right. The ACA is completely different from the German system. I mean, I could argue that the Republican healthcare plan is similar to the German healthcare system since it would have a public Government run system (Medicare and Medicaid) and subsidized private insurance (vouchers), but that's not a particularly compelling argument. When two systems are completely different, talking about a couple of ways they're slightly similar if you squint and don't look at the details doesn't seem particularly useful.
I'm certainly more concerned about the possible repeal of the federal insurance standards, the "essential health benefits" than I am eager for a public option to start competing with insurers (which I don't think insurers are doing a whole lot to either control or drive medical costs). I wouldn't mind a public option, I just don't expect it to matter much.
it massively increased everyone's premiums and deductible, and made it more or less impossible for many poor people to afford private insurance. If you ask many americans here how much they pay per month and how large their deductible is, you'll realize Obamacare actually wound up being absurdly expensive catastrophic insurance instead of universal coverage.
So what makes people charitable when it comes to charitable giving, not so when it comes to single payer?
[1] http://www.marketwatch.com/amp/story/guid/6EF5920A-87B8-11E5...
Socialized health coverage works better in some places outside North America because people have some sense of custodianship and duty. North America is full of irreverence, nobody gives a damn if they're doing what they ought to do as long as they're seen to do what they have to.
Ask yourself if you would like to do dermatology like the DMV; surgery like a typical post office.
Please, please, please stop the hyperbole. It does not help rational discussion.
I, my friends and family have been treated many, many times in Canada for everything from broken bones to just walk into the ER and say I don't feel good.
I have never heard of anyone waiting more than 45 minutes.
Last time I was in there I walked in and said "I got hit by a car 2 weeks ago and my leg still feels funny". I waited 15 minutes before a doctor poked a prodded me and said "you'll be fine, seeya".
Free, of course.
GPs/specialists in the US see me instantly. In Canada, they would make me wait 45mins-hour. Waiting a bit isn't the end of the world IMO.
One time I had a pretty bad accident (in the US) .. I remember going home to pick up my damn insurance card before rushing to the ER in a cab. Of course ... despite the fact I was bleeding, the first thing the hospital attendant asked me for was my insurance.
I personally prefer the Canadian model over the US one.
I'm in Yukon, also family/friends in BC.
Maybe it's just different in the East? (like so much of Canada...)
I'm still waiting to be called by a specialist for something I ran out of my prescription for two months ago. They simply never scheduled what they said they would schedule. I had to call the ER one week after the fact to get them to actually fax the request to the specialist, because they neglected to; then I had to call the specialist to acknowledge the fax, and after all that I still haven't received a call from them. I ended up researching the condition and treating myself, but I could have been wrong and done more damage; pharmaceuticals could also have been a safer approach.
In Calgary waits were a bit better, only about 3 hours instead of 4-5; but I needed stitches both times I went to an ER there.
The condition of the healthcare system is not for lack of trying, my own mother worked at hospitals for most of my childhood, and I know plenty of people who work in medicine; they all seem to try their best, but the chronic lack of oversight/accountability and lack of competition means that things just continue to fester. It's frankly amazing that we've survived this long and this well without a private system.
In reality, the people doing the actual work of health care wouldn't change -- the money to pay them would just come from a different place. Do you really think the folks at insurance companies have more custodianship and duty than people working in the public sector?
Also, something to keep in mind with fully socialized medicine is it would almost certainly reduce doctor pay, because the government would have almost all the leverage in pricing. I know some doctors in France well, they're extremely poorly paid compared to doctors in the same practice in the US.
And if you squeeze doctor salaries too much, what fraction of would-be doctors are going to decide that they don't want to go through the hassle and expense of medical school?
And yes, even the least paid doctors in France earn much more than the median French salary. Also in France, medical school is not expensive ("socialized" education). It just takes time...
French doctors still in the top 5% of earners in France, even higher when it comes to revenue from work. And the schools have to reject like 80% of the students at the end of first year.
http://www.pbs.org/newshour/rundown/health-costs-how-the-us-...
Does Canada under-funds it's health program?
For example public parks have bipartisan support and are funded by taxes. So why will the US tax people to care for wildlife, but not its own citizens?
At one time the US instituted a military draft, requiring citizens to carry out military service. Citizens are required to obey the law, pay taxes and serve the interests of society, as determined by the government. I believe that this places a responsibility on that government to care for and protect citizens. It must offer them the protection of the law, defend them in times of war and, I believe, provide basic health care. It should do so not just for the benefit of the individual, but for the benefit of society.
There's no point drafting people into the military if the health of the population isnt up to it. This was a major issue for the UK in WWI and a key factor in getting cross-party support for a national health service, because a shocking number of young men were unfit for duty. Currently not being in a time of war doesn't change the relationship though. The duties and responsibilities are still there.
I know governments are in a unique position to be able to print money, but that is not how the US government routinely funds it's budget, and certainly not how it mainly or exclusively does so or inflation would skyrocket.
The government can increase deficit to put more money into private sector, which boosts profits and savings, it can choose to take money out by taxing more or spending less. Which creates fewer savings and smaller profits, and more private debt.
Locke would disagree with your premise. You're an individual with the freedom to move to any society that you agree with the most. Unless your freedom has been alienated, you are tacitly consenting to a government's laws by remaining where you are.
Do they just happen to agree with the society they're born into, or is it possible there are stronger forces than political preference that constrain their movement?
[0] https://www.nytimes.com/interactive/2015/12/24/upshot/24up-f...
These are extremely powerful forces, despite the fact that they don't fit into the economics-101 thinking that libertarians are so fond of.
Have you ever taken that class?
Many countries have strict immigration and citizenship requirements, many of which revolved around wealth.
So whilst it may be true that very rich people have complete freedom to choose their favourite society, that's not the reality for the majority of people.
The counter-argument here is not one around taxes, but around the obligations of the state. If you don't believe in universal healthcare then you ipso facto believe the state has no obligation to provide it, and that's where the counter-argument needs to come from.
Police yes, army no.
In Costa Rica the answer to whether government have an army is no. In many other countries the answer is "not really" or "not required"
The USA stands alone when it comes to the amount of money spent on military. It is somewhat absurd.
What makes you say that?
You might see more territorial wars, such as with Russia invading former USSR states and China making stronger claims over the islands in the South China Sea, but there is no indication that other countries would not pick up the slack and fill in the gaps created by reduced American military presence.
The amount the US spends isn’t absurd on a percentage of GDP or even a per capita basis. It could be “absurd” when looking at it in raw dollar amounts, but you could say that American expenditures for movie tickets are absurd — Americans spend more money on movie tickets than the entire GDP of 65 different countries.
The US stands alone on the amount spent on the military, but it also stands alone for the amounts spent on everything: it’s the world’s largest economy and it would seem rather prudent to be able to defend that economy — and it does, at a reasonable level of military spending as a percentage of that economy.
A bank that protects $50 might not need a guard. A bank that protects $50,000 might need one guard. A bank that protects $5 trillion might need a few more guards.
Comparing Costa Rica to the United States is pretty ridiculous in terms of national defense. It’s rather naïve to suggest that militaries are not required. It’s never required, until it is.
If someone were to invade Costa Rica, who do you think would come to the rescue when asked? Costa Rican security is benefiting from the military of the United States. The Rio treaty gives Costa Rica the luxury of not having to worry about invasion since the US military is standing by to help.
Denmark doesn’t need much of a military because it’s part of NATO.. a risk to Danish national security wouldn’t last very long when you have the most advanced military in the world as your ally and treaty-bound to protect you.
These treaties and arrangements make it easier for countries to reduce their military since they are allied with the United States.
My point is that making comparisons isn’t very accurate without considering defense treaties that might exist and thus incentivize smaller military expenditures.
https://data.worldbank.org/indicator/MS.MIL.XPND.GD.ZS?year_...
The only thing holding them back is massive American firepower. In its absence every midsize Asian country is going to acquire nuclear weapons.
The army is also a huge wealth distribution machine: Raytheon or Boeing are businesses, and army personnel presumably is paid, too.
> tax its citizens to protect them
For example, from life threatening conditions.
Same statements, different cherry picking -> entirely different results.
Ah, so you are in favour of universal socialised health care!
(/joking, mostly. But I feel that protecting citizens only from other humans but not from the far more deadly problems of disease and ill-health is a very limited view. If the US really believed in the inherent superiority of the private model, it would use it for its troops. No medevac if you've not paid your premiums!)
This argument seems to be novel from the late 1800s. Before then, it seems to have been understood that the political system ran on taxes. It beggars the imagination that modern Americans seem to believe the old anarchist saw that cooperation and working with society via the ancient tradition of taxation is theft.
Before then the political system openly ran on violent coercion.
That tyranny has been "understood" is not a justification for the deliberate resurgence of tyranny. That you could take even more money from the public to fund your pet project is of no importance to the question of whether it is right or wrong to do so.
> This argument seems to be novel from the late 1800s.
Have you heard of the USA? It's been constituted since 1788, and it was more or less understood that the government wouldn't be getting involved in this sort of thing. If I'm not mistaken, 1788 is before the late 1800s.
I propose you use some other rethorical device to back your argument. it was also understood back then that government would not ban slavery and that only people with property and penises could vote.
And yet you enjoy GPS, roads, running water, bridges, numerous standards, air quality and pollution reduction by regulators, defense of property, fire departments...
This particular line of argument is tiresome unless you're willing to forgo all of the amenities others have paid (and sometimes died) for.
If you're not willing to give them up, adding healthcare to the tab is hardly a step too far.
Again, I don't believe this argument, but this is the argument.
Like, it's easy to say "well if somehow all of the public goods I enjoy were taken over by private companies then I'd be happy to pay them instead of taxes", but such a changeover doesn't really happen--you end up "freeloading" on the public dole until this future comes to pass.
And again, I know you aren't making this argument. It's just really annoying to have to hear it from otherwise intelligent friends when it comes up.
(Also, why the heck anybody would want to live in a world without a guarantee of basic services and rights is beyond me.)
Libertarianism is about the rights of an individual to engage in transactions they find beneficial. However, libertarianism is not about the right to infringe on others’ rights to do the same.
Libertarians support individual rights at a vastly greater level than anyone else. In collectivism, there are no individual rights or at least they are secondary to collective rights.
>Libertarianism is about the rights of an individual to engage in transactions they find beneficial.
>Libertarians support individual rights at a vastly greater level than anyone else
And who protects these rights? Who defines them? Is it really possible for everybody's rights to be protected simultaneously (whatever those rights may be)? Who decides ownership? Who guarantees the avenues for beneficial trade?
The rule of law cannot be enforced without an element of coercion. The best we can hope to do is to make it as enlightened as we can.
Specifically, Joseph Dejacques polemic against Proudhon [1] where the term libertarian was coined focused on the latter's willingness to talk loftily of liberty on one hand, but the next moment limiting to liberty related to capital rather than the emancipation of all, specifically throwing women under the bus because Proudhon did not see them as equals:
> Moderate anarchist, liberal, but not libertarian, you want free exchange of cotton and candles and you seek to protect man against woman in the exchange of affectional human passion. You cry against the great barons of capital, and you would rebuild a proud barony of man on vassal-woman.
Dejacques makes an impassioned (and poetic -- the letter is well worth a read even if you disagree with every word) argument both for anarchy, and against the monopoly on resources, and the turns Proudhon's own word against him in arguing that for men to monopolise power is the same thing - talk of liberty becomes meaningless when we allow there to be arbitrary limits on who are afforded said liberty based on ideas of who are worthy:
> Attribute not to him a stock of intelligence which belongs to him only by right of conquest, by the commerce of love, by usury on the capital that comes entirely from woman and is the product of the soul within her. Dare not to attribute to him that which he has derived from another or I will answer you in your own words: “Property is robbery!”
> Raise your voice, on the contrary, against the exploitation of woman by man.
Dejacques set the term "libertarian" up as a step beyond "moderate anarchists" (!) and "liberals" such as Mr "property is robbery" Proudhon:
The emancipation of human beings, according to Dejacques, comes from taking the ideas that Proudhon happily promoted in economy - to limit power, be it over persons or property - to the full conclusion with a focus on the emancipation of all humanity.
Mere de jure emancipation will not do, then, if people can not take advantage of it. Maximising liberty to Dejacques meant being uncompromisingly willing to take that which is being hoarded and share it, be it money or power, or authority.
As such, the idea of maximising liberty from a left libertarian viewpoint does not see property as the holy cow that right libertarianism does, but in fact has from the outset seen strict property-rights as a direct threat to liberty, rising to outright aggression (e.g. if you try to use force to prevent someone who is starving from eating to maintain life you are putting their life at risk).
Right-libertarianism makes a mockery of libertarianism by sacrificing the principle of maximising liberty in order to provide an ideological veneer for the protection of wealth and privilege.
[1] https://theanarchistlibrary.org/library/joseph-dejacque-on-t...
- military
- roads
- primary education
- secondary education
- criminal justice system
- research
Each and every one of those could in theory run entirely on a voluntary basis and has through history been doing so here and there from time to time.
I prefer to stick with what works in practice, even if it's imperfect.
Consider more rural areas, where there are less people to make these donations, and more roads are needed. Is it ok to say "pay for your own roads" when it unfairly shoulders them with the largest burden? It will end up with lower income rural areas having crappy or no roads. Same for all the others you listed, bar military. Also, who pays for the highways?
Having a justice system depend on donations from the populace is kind of a huge issue with impartiality.
Fyi, England used to effectively do what you suggest pre ~1700. It didn't work out well from a justice, education or infrastructure angle until the state got involved.
I think it works very well to pay all those things through taxes.
Same can be said about health care, at least in countries that (unlike Post-Thatcher UK) don't actively try to ruin their public health system.
I hate this argument, taxes are a fact of life in society, you're going to pay them and the only question is where are they being spent. If instead of spending so much on the military, some of that budget was spent on healthcare, than maybe there wouldn't even be a need for higher taxes.
But instead of lobbying for their taxes being spent appropriately at home, many in the US seem happy with going to sovereign countries instead of taking care of their own citizens.
There never seems to be a concern if you have money for the next invasion, but when it comes to healthcare or education, where's the money going to come from? (To be fair, it's not just the US that has this problem, but it is certainly one of the worst examples.)
My initial thought was that someone had tried to reinvent insurance, but this is not even that. Just charity destined to fail being a proper solution.
If our problem is "I want to feel good by helping someone to cover their health care costs", Watsi and other charity solutions obviously are viable solutions. (Note that state sponsored health care is also a good solution for this problem, with the downside that somebody else tells you how much you need to pay). So Watsi is a better solution to this problem than state sponsored health care only in the limited case where you have no interest on the outcome of the health care, but only your own feelgood and want to have precise control how much you want to spend to feel good. (If someone senses contempt here to charity givers, the sense is not unfounded)
Second potential problem we are discussing here would be "I want some more people get health care." Of course, here as well, Watsi and other charity programs obviously are a solution to the problem in question.
Third problem might be something in the lines of "I want every member of the society to have access to decent health care so that first, when I drive past hospital, I do not have to look beggars begging money to get their health problems addressed and second, when I get sick, I do not need to worry whether there was some small print in my insurance contract I did not understand"
The third problem is the one where charity based solutions are doomed to failure. There is simply no scenario where I am motivated to pay. One scenario is where there are enough people to pay to solve this without me, so so I can save my money to more important things and enjoy health care benefits. Other scenario is that there are not enough people to pay the beggars out of the street, and my money is not going to change that, so again, I am better spending my money somewhere else. Only path out is that all of us that want to solve the problem and get benefit from the problem [1] solving somehow coerce each other to pay for the solution. I.e. state sponsored health care. Or individual mandate & community rating & subsidies (obamacare).
[1] Note here that everyone gets benefit so everyone must be coerced. If you let people out who claim they enjoy looking beggars, the system collapses again, because obviously I say that I enjoy immensely looking beggars and actually you should pay me if you deprive my enjoyment of looking beggars if you otherwise get the system working without my money. And the ones who actually do enjoy looking beggars, let's just say I am a bad person and more than happy coercing them paying real money to get rid of beggars.
Yes, I am a cynical bastard. But I think i is safer to design important institutions in society assuming bad about people instead of assuming good about them.
1: I'm from Sweden so I'm obviously appalled at the state of healthcare and health insurance in US, but that's beside the point.
[0] https://www.gov.uk/government/statistics/public-expenditure-...
[1] https://resources.ehealthinsurance.com/affordable-care-act/m...
Things like community treatment orders are based on coercion.
This only applies to quite small numbers of people, but we can't say they don't happen.
Yes. And conversely, if you provide MY healthcare (by your taxes) I'm very much concerned about YOUR ability to work and pay taxes, which is effectively the same thing.
This is exactly why we have seatbelt laws. Your seatbelt just makes you less of a dead person so you can pay for your healthcare (and mine). And when/if you have an accident it makes you a person with two broken wrists that costs my taxes less than if you were a person with critical injuries - so I'd rather pay for your damages if you wear a seatbelt.
See this is also an important point: a high-tax society also requires a sense that tax money is well spent. This means that it can't feel like the money is spent "on someone else", you can't have a feeling among the population that tax money is often wasted, or that it's spent on wars (for example). If money was spent on healthcare for people who didn't want to use seatbelts - I'd be less willing to pay taxes. So my high taxes require these kinds of laws. Still, people are free to eat pizza and beer 24/7 and I still pay for their healthcare - because the alternative would be a too big government involvement in peoples lives. All they can do is tax beer higher, not much more.
Now, of course all of these limitations of your freedoms has to be weighed against the value they provide. The cost of people driving around without seatbelts is huge to socitey. The cost for an individual to wear as seatbelt is tiny. So it's a no brainer even in the most liberal societies.
You mean you won't be able to refuse paying for it (that might be the case) or not able to refuse actually receiving the care (no one will force you)
The only exception is vaccination possibly, which should be legally required.
I saw the link but didn't see the connection between "public universal healthcare" and "forced healthcare practiced on people". Can you elaborate on that connection?
publicly funded universal healthcare is about how healthcare is funded. How it's performed is a separate matter.
Or, to give an example of this actually taking place, look at the education. It's funded by the government and also is mandatory and enforced by the government. It does not necessary have to follow, in other countries with free public education you won't get arrested for not sending your kids to school. But it could turn the way it's turned in the US just as well.
These are two freedoms at play : the childs right to go to school vs. a parents right of refusing it. I'm of the opinion that the childs right is the stronger right here. Arresting parents might be a bit over the top (the childs right to have their parents at their side might be at risk instead which is worse) - but hefty fines or similar could be appropriate.
If there had not been publically funded schools it would be much harder or impossible to make compulsory attendance laws. As there is no public healthcare now it's very hard or impossible to make compulsory medical procedures laws. If health care becomes public - the sky is the limit.
Sorry I can't see that connection now. Publicly funded schools and publicly operated schools are two entirely different things.
> As there is no public healthcare now it's very hard or impossible to make compulsory medical procedures laws. If health care becomes public - the sky is the limit.
Again. a) The funds and the operation are two different thoigs and b) if you start doing medical procedures on people against their will, you are in some kind of dystopian society.
There is no slippery slope here.
The compulsory attendance laws do not depend on who operates the school. There are private schools enjoying the same laws.
>Again. a) The funds and the operation are two different thoigs and b) if you start doing medical procedures on people against their will, you are in some kind of dystopian society.
This is not an argument. You could just as well say "If you start sending children to school against their will and will of their parents you are in some kind of dystopian society". All the arguments I've seen here are of the nature "Free healthcare yay! Only idiots think it will come with strings attached from the government. Healthcare is good ergo it cannot turn bad, BTFO!" It's running in circles and if you cannot even consider all the consequences of government policies - good luck in the future, I am out of this thread.
"The police enforcing doctor's orders." Give me a break. I'm all for healthy debate but come on. This is the most inane argument I've ever heard about universal health care, and I've heard quite a few.
Sorry for not being more constructive, I just can't see this line of reasoning go anywhere useful.
I don't think people think of that as healthcare but as a sentence for doing something criminal. Just like we lock insane murderers up and force them to undergo psychologicalt treatment (instead of sending them to prison which is often legally dubious if someone is clinically insane) that kind of rehab is basically treatment forced on someone for committing a crime, not some part of a public/universal healthcare program. Separate topic.
Yes and dissenters were sent to labor camps involuntarily... I don't know why we are talking about a communist dictatorship here when we are discussing what would/can take place in a liberal democracy. The difference between a liberal democracy and a state that isn't, is that all measures that limit personal freedoms (such as mandatory basic education or whatever it might be) is subject to a democratic process.
> I'd like you to consider that people of the US had banned alcohol in the Constitution at one point, not so far in the past.
I don't consider it impossible that alcohol would be considered illegal in 50 or 100 years in the US. But I do find it very unlikely that some kind of forced treatment would be imposed on someone for an addiction that is not illegal in, in any country that is supposedly a liberal democracy. In fact - I'd probably hesitate to even consider that state a liberal democracy then, and the whole issue disappears (because as I explained above - we are only talking about liberal democracies here, and a US where people are sent to forced rehab without doing something illegal would not be a liberal democracy anymore)
So to be very clear: please don't go to the slipperly slope argument to suggest that public and universal healthcare in a democracy somehow ends up in involuntary treatment of law abiding citizens (Again vaccination possibly excepted).
Actually, to mental health institution from 1960s.
This argument against government-funded healthcare focuses on anecdata at best. And not very reliable.
So the US manages to have mandatory rehab without public healthcare. The two are really not related.
If so, let's try it on some other topic. E.g. "Government is already wiretapping and spying on citizens communications so providing public Internet is completely safe and in no way government is going to be spying on it!". Does it work for you?
0. https://www.cnbc.com/2017/05/02/how-us-defense-spending-stac...
1. https://www.reuters.com/article/us-iraq-usa-funding/u-s-cbo-...
2. https://en.wikipedia.org/wiki/Health_care_in_the_United_Stat...
Why are people more willing to fund punitive programs than assistance programs that could preempt crimes? I have several theories:
1. Post hoc measures are more inherently more certain. You know that the treatment is being applied in the specific cases you want. With prevention it's impossible to know if any given intervention accomplished something, and very difficult to assess if the overall program is effective.
2. The USA specifically has a strong individualist streak. This has roots in a combination of (1) the cowboy myth / fronteir legacy of relatively infinite living space, (2) Protestant Christianity, (3) capitalism, especially post WW2 consumerism.
I recently heard a talk that argued that Regan synthesized these very effectively, pushing us forward from the Great Society era, which was more collectivist. The emphasis on individualism created contrast with the communist Soviet Union.
I'd only correct your post by saying that it's not about paying extra, it's about paying the same amount and/or less to someone other than a for-profit insurance company. I am in Germany and am totally blown away by the German health insurance system. It seems to work really well for all concerned.
Exactly. But while it's called "insurance fee" not "tax", it's somehow OK, even though tax extra would amount to less than insurance -- yet another paradox I honestly don't get.
As an European, I find this kind of attitude towards fellow citizens really barbaric and strange, but this is my observation.
The issue is that government programs in the US have a history of being poorly run, abused, expensive and totally unable to be reformed once in place.
There is a separation between "wanting healthcare" and "wanting government healthcare." It's a lack of faith issue combined with a history devoid of contrary examples.
That is true, but isn't that because they're being used to play politics? ie. being poorly funded to prove that government programs don't work, or awarding massive contracts to private contractors that fail to deliver quality due to corruption, (campaign contributions etc. ) and lack of oversight?
The lack of reform is politically based because you can't even have the conversation without somebody jumping to "they want to take away...!"
The goal is to maintain the Pax Americana. The power and influence leads to a strong economy, which helps offset the cost.
Europe in general has been massively subsidized in different ways by the USA from the end of WW2. They turn around and love to show off their moral superiority while someone else picks up the bill.
The vast majority of US spending since 2001 has been wars in Iraq and Afghanistan that have nothing to do with the defense of Europe. This article has a good example of the spending increases specifically earmarked for Iraq/Afgahnistan: https://www.washingtonpost.com/news/wonk/wp/2013/01/07/every...
That ignores things like the excessively high hours on F-18 airframes from a higher than anticipated rate of deployment, causing increased repair/replacement costs and lower airframe availability, even after: http://breakingdefense.com/2017/02/62-of-f-18-hornets-unfit-...
> If Putin for whatever reason decided to become an expansionist power and the US had an european level military, no one could stop him.
There are other, much cheaper solutions to this - note that the US and EU have made it politically untenable for Russia to resolve the invasion of Ukraine in their favor, with extremely minimal deployments of military forces (a few show of force exercises in eastern Europe with NATO members or partners).
Even given that, the budget is massively overblown.
> If Putin for whatever reason decided to become an expansionist power and the US had an european level military, no one could stop him.
You seem to appeal to extremes. Ignoring how unlikely for that is to happen, you still don't need ~1000 military bases around the world, or would 500 be too little to stop Putin?
> Europe in general has been massively subsidized in different ways by the USA from the end of WW2. They turn around and love to show off their moral superiority while someone else picks up the bill.
That is the cost of being as global superpower and the world police, you pick up some bills, but you also get away with a lot of crap that others wouldn't.
Where do you get the idea that "average Joe" is okay with that? It's been a huge talking point for Trump and his supporters for the past two years.
This was also a talking point for Trump and his supporters for the past two years. ("we're going to have insurance for everyone", "No cuts to medicaid", "No one will lose coverage", "Nobody will be worse off financially", "I am going to take care of everybody … Everybody’s going to be taken care of much better than they’re taken care of now.")
Of course, in that case as well, he took them for the rubes they are and likely had no plan for delivering on his promises.
We simply don't trust government to provide good service overall. And a lot of experiences tend to come from this; trying to get a local government to do anything to benefit a community is like pulling teeth. We'll be in the middle of economic decline, and they'll be repurposing land into dog parks.
I think Europe has fundamentally different ideas about the cost/benefit of investment in military. If the US went all-in on isolationism and drastically cut back military spending, Europe likely wouldn't replace American spending dollar-for-dollar. Instead they would spend more on other things, such as health care.
It looks like they are just appifying the missionariy/charity elements already going on in african nations, not providing universal healthcare. To have real universal health care would involve a lot of infrastructure building and education which would be way beyond what a small start up could do.
What deficiencies do you see in the supply side right now, and why don't you think this addresses them?
I guess if you can import this stuff from China and India with minimal quality checking things are good. I am not being sarcastic about the China importing. In the U.S we have $500 bags of saline that the minimally checked bag from China would cost $5. Really you don't even need universal health care, just adequate supply and that means imports, cheaper schooling and deregulation to solve health care.
I'm not sure what to do about there being higher salaries for doctors in the US. Subsidizing education for medical students who promise to stay in Uganda for several years might be a good option. But it seems silly to complain that Watsi has only partially fixed healthcare in Uganda. I certainly don't see any basis for the blanket claim that "This isn't going to work." This is already working--it's just not a panacea.
[0] https://www.theguardian.com/global-development/2015/feb/10/u...
Rather than develop a long-term set of healthcare provider alternatives, they're depending on selling a story and getting funding from people sensitive to heart-warming stories on the internet to "change the world". If any link in their public relations chain is broken, there goes the project.
I really like the idea. But copying a Sally Struthers late-80s TV commercial probably isn't going to solve healthcare.
Watsi has been around since 2011.
>>Healthcare is complicated and expensive
Overall? Yes. Compartmentalized and decentralized, it does not have to be. That's the whole point of these types of initiatives.
Being compartmentalized and decentralized is what the story claims is inefficient and expensive.
Best money I ever spent.
There are many countries in the world without free health service, Watsi is helping spread that around the world. I don't think supporting watsi somehow precludes or reinvents paying taxes, so your comment is unfounded.