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Comment by notsohugedeal22 | Hacker News Reader

Exactly why we need universal healthcare in the US

It’s something every worker should be fighting tooth and nail for

It would go a long way to breaking up the neoliberal corporate hegemony

Sadly, and regardless of education and political leanings, Americans seem in love with a fictional account of the countries history. That it was all great 50 yrs ago without universal healthcare (when they were kids and not really paying attention) so of course it’s just fine to keep it that way.

I encounter people of all ages and backgrounds with that notion kicking about, every day. Having lived and traveled the world, Americans are unique in their ignorance that the world was just as corrupt a generation ago.

Now let’s go watch some TVLand and chill

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We need more than universal healthcare; we need straight-up universal care. The idea should be that periods of unemployment or uncertainty are not terrifying gray areas for an average person. If people felt comfortable that they would have support for finding better pastures from a shitty job, they'd be more likely to seek them. If they felt more confident that they had prospects after a layoff, they'd be more likely to look for alternate employment instead of sitting around in an abandoned factory town as it rots to the ground around them.

I think it comes down to the fact that risk-taking cannot be a luxury, if we want the United States to remain a competitive and dynamic society. "Party of jobs?" How about a party for workers?

After all, as many conservatives will happily tell you, true value comes from the heads, the hearts, and the hands of individuals. Why are we giving so much free stuff to Big Jobernment?

> How about a party for workers?

Possible principles for a workers party:

- maximize after-rent and after-tax disposable income of workers

- shift all taxes off of wages from labor and onto ground rent from private enclosures of land and natural resources

- support a universal public savings account for all citizen residents over 20

- democratically divide and deposit all surplus natural resource rents directly into the universal savings accounts

- have the Federal Reserve conduct monetary policy by setting the interest rate on the universal citizen savings accounts, rather than by buying up assets from investors

This should increase the disposable income for a super-majority of workers by decreasing rent, making acquiring a house more affordable, making land for new small farms and businesses near competitive markets easier to obtain, increasing private savings to ensure workers have access to a large-runway of cash and high bargaining power while in between jobs, reducing the severity of economic depressions and recessions created by idle land speculation, and by directing capital flows away from mortgages and mortgage-backed assets and into productive businesses which will actually increase the demand for labor and raise wages.

>- support a universal public savings account for all citizen residents over 20

Thiss could not possibly be more wrong. Experience has shown that if a "public savings account" can be raided by its controllers to support some more powerful constituency (shareholders, current voters and taxpayers, etc.) it will. We've seen with this corporate pensions, state government pensions, and Social Security. A workers' party would immediately and forcefully end all "public savings account" schemes which are really wealth transfers away from workers in disguise, and (at most) force workers to save in accounts for which they are the custodians.

- Seize the means of production

wait no, you aren't suggesting communism.

I don't think switching to a property tax system is the way to go. Wouldn't it end up hurting people as you just see rents rise?

I am advocating a land value tax, not a property tax. This is the most progressive tax possible as the incidence of the tax does not fall upon labor at all.

> Wouldn't it end up hurting people as you just see rents rise?

No, rents would not rise in proportion to the tax. Adding a tax as a carrying cost on a good of fixed supply such as land produces the opposite effect of a tax of goods and services. It increases the supply of available land and decreases prices because the tax makes land less attractive as a speculative investment and store of wealth. It encourages land holders to sell off any underutilized land being held for speculative purposes, thus increasing the supply of land available for actual use and improvement by workers, and lowering its price.

The 'ground rent' collected by landholders is the surplus profit above what is necessary to bring the land into use. If no one paid ground rent to private landholders, the supply of land would still remain the same, and there would still be just as much land available for everyone to use. Confiscating private ground rent simply shifts this payment from private parties to the state, and the tax cannot be passed on to renters through higher prices at all.

This increases the disposable income of a super-majority, because once all private ground is instead paid to the government for the provision of essential goods and services, all other taxes which fall upon the labor of workers, such as payroll and consumption taxes, can be eliminated.

So I buy some land. I plop an apartment building down on it. I pay "land tax" on the land.

Why would I not just raise rents to preserve my profits?

You will still be competing against everyone else who does the same, and your competition will be vastly increased. It will no longer be profitable for other nearby land holders to hold on to idle, vacant, or under-utilized land. For instance, if someone is holding on to a vacant building, a parking lot, or low density commercial development such as a strip mall, it may no longer be profitable to hold on to these under a land value tax.

The vacant building may be replaced with several small town houses, the low density commercial buildings may be replaced with multi-story mixed used buildings with additional housing built-in, as property owners seek to increase the value of their buildings relative to surrounding buildings in order to acquire a profit larger than the land value tax. They would pay the same tax regardless of whether they left the land vacant or put it to use, so there is a strong incentive for them to put it to the best use possible.

When land is actually improved and put to use, this increases the demand for labor and raises wages so that wages increase faster than rent. When land is held idle for speculative purposes, rent increases faster than wages and the average worker becomes poorer even if the output of the economy is increasing. Nominal prices may change in reaction to market condition, but what is important is wages relative to rent.

Communism is anti-worker because it leads to rampant rent-seeking by political organizers responsible for coordinating the provision of collectively owned capital goods, which is a necessarily a complex problem, since a capital good could refer to any manufactured good which is 'durable' and not immediately consumed.

However the base means of production for any economy as recognized by the Physiocrats and all classical economists is land and natural resources, which are non-produced resources of fixed supply that are a wholly distinct factor of production than capital.

While it is not necessary or desirable for the state to seize capital or private interest payments paid for the use of capital, it should sieze the 'ground rent' which is acquired from private enclosures of natural resources, as unlike interest on capital the surplus ground rent paid to landholders does nothing to increase the supply of land, and is collected even if the land were to remain idle and the landholder invested nothing in its actual improvement.

>Communism is anti-worker because it leads to rampant rent-seeking by political organizers responsible for coordinating the provision of collectively owned capital goods

Can you expand on what you mean by this, please? If I understand it correctly, you're saying that organisers of the means of production would draw benefit which is not distributed to the collective of people who "own" the means of production. How would they do this?

I think it is important also to note that capital requires circulation, as in M-C-M', which not only requires money but also the value-form - these two things are what the Communists desire to render useless through the collective control of means of production.

There are strong currents in Communism which are anti-bureaucracy, and insist on models which do not place the economic organisers of a lower-stage Communist society to be above others in terms of access to goods. As I understand it, within Communist society a line is drawn between end goods and goods which will be used for further production.

What is the justification for separating natural resources from other forms of capital? They require labour to extract, transport and refine so in my view they are as much capital as outputs from previous industrial processes.

It's an issue of central planning and information arbitrage I guess. Unless the entire society is equally involved in economic central planning (which is absurd), a small group of people will be doing it, thus having access to more information, which is power.

Which is not to say that is not a problem in capitalist society or something that strong democratic foundations cannot alleviate.

Of course not everyone can be directly involved with the allocation of resources, however as with all scarce resources decisions need to be made from time to time on which usage would best benefit society; in this case, I'm an advocate for democratic management of such resources. I don't think that power only comes with information, the power comes when people are given extra abilities to deal with that information (such as using personal preference to dictate allocation) so I think that protections are needed.

I think the problem with central planning stretches further; the goal of the Communists is to avoid alienation from one's labour, the non-commodity of labour-power, however having labour being externally imposed (whether by the capitalist and the "market" within capitalist society, or by the central planner within Socialist society) is alienation by definition. Therefore some change in the method of planning is required. Marx wrote that there are four forms of alienation, one which I think is important here is alienation of the worker from the act of production; the Communist movement aims to reject this alienation through making the whole productive capacity of society available to all such that the worker can in almost all cases direct his own labour, all production is social therefore, as all workers contribute.

So the kind of planning in higher stage Communism is much past the idea of a government planning, rather, as Marx wrote (to what some consider a contradiction), society regulates general production. To quote,

>For as soon as the distribution of labour comes into being, each man has a particular, exclusive sphere of activity, which is forced upon him and from which he cannot escape. He is a hunter, a fisherman, a herdsman, or a critical critic, and must remain so if he does not want to lose his means of livelihood; while in communist society, where nobody has one exclusive sphere of activity but each can become accomplished in any branch he wishes, society regulates the general production and thus makes it possible for me to do one thing today and another tomorrow, to hunt in the morning, fish in the afternoon, rear cattle in the evening, criticise after dinner, just as I have a mind, without ever becoming hunter, fisherman, herdsman or critic.

Sure, Marx was smart and all, but practically, what it comes down to, is a few options.

- Capitalist markets

- USSR style central planning

- Anarchist-leaning gift economy, not scaleable beyond n=1000 or so

- Market socialism strains like mutualism or ParEcon, both of which have major issues of their own

- Any mix of the above, e.g. "Socialism with Chinese characteristics", which has been the best economic performer of the last 30 years or so.

In other words, at some point you need to come down from pie in the sky Marx quotes and make physical implementations, which is always more difficult than theory.

So if central planning is problematic, what do you choose then?

We need guaranteed minimum income, its the most freedom enhancing way of solving these problems. Give people cash, give them financial literacy training, the rest ought to work out okay.

This solution also sidesteps the atrocious incentives of unemployment payouts.

You might be making more from unemployment than by working a min wage job so why take it?

Most states do not require you to take the first job that comes along - you are only required to take that if you have tried and cannot otherwise find work

Let's put it as fighting for the abolition of wage slavery.

> Americans seem in love with a fictional account of the countries history.

This shouldn't be about historical narratives or ideology, that's largely why public health insurance is dead-on-arrival in US politics. Both sides are terribly ideological about it and unrealistic as a result.

The healthcare industry is already the most heavily regulated of all industries in the US. Saying it's been held back from government intervention is equally a myth as the US modern history as a free-market friendly place is a myth.

This debate should be about whether certain market niches make the more sense as public entities. NOT as an example of "free markets" failing as a general rule and trying to sell the idea "you just need to accept that government knows best" (I'm paraphrasing).

Rather it should be sold as an exception to the rule. The simple fact is government should not be in the vast majority of industry. But healthcare (specifically health insurance) has many unique and perverse incentives making it poorly suited for markets and the public alternative offers plenty of benefits to a society, including a capitalist society. Healthy workers are good workers, small business is less burdened with expensive healthcare packages, the morality of treating a seriously sick person who can't work then billing their family $10k, etc, etc.

I believe there is still a good argument to be made in favour of public health insurance without alienating those who put their trust in markets. It's a unique exception and is already far from operating as a free market in the US. So why not bite the bullet and entirely subsidize it for everyone? That is a much smaller ask than the typical democrat "corporations are evil" pitch on this matter.

Messaging is important.

> Rather it should be sold as an exception to the rule.

I've said this before: Society has already made it's choice. Society doesn't want people dying in the streets. Once you've made that decision, universal healthcare in some form or another just flows from that. The US has a form of it right now, it's just extremely perverse and expensive.

Water, food, clothing, and shelter are all more important to people not dying in the streets than health care, and we don't have government single-payer versions of any of those.

So I agree with the parent: it's not enough to just say that health care is important, therefore it should be single payer. There are too many counter examples for such a simple argument to pass muster. Discussions of health care policy need to start with a detailed and honest accouting of the health care market specifically.

> Water, food, clothing, and shelter are all more important to people not dying in the streets than health care

And nearly all governments provide countless services from welfare, public housing, shelters, the foster care system, food stamps, etc for that as well.

Society has already made the decision about socialized healthcare; the only real question is how to implement it. The current implementation where you have socialized healthcare but deny it's existence is the worst possible and least efficient system.

Wouldn't universal health care and public health insurance be completely different things? The primary issue with "insurance" as I see it is that it separates where the cost is generated from who pays it. This removes the responsibility and incentive to keep costs low. I'd hope if we had a universal health care system this would not be the case.

I don't think the average person would understand those distinctions off-hand.

The features of 'basic care' that I think everyone should have:

    * Everyone has it
    * It's only paid for by taxes
    * There are still systems in place for keeping costs low.
    * MOST doctors in the area should be options for care, assuming they're open.
    * /bad/ doctors (those who don't produce good results) shouldn't get to stay doctors.
    * The malpractice part of the equation is covered by a combination of
    * * social disability (care for the victim) and
    * * criminal justice (doctor is guilty of malpractice).

For cost controls:

    * Government care/doctors (military docs) should be possible.
    * Mass bulk procurement / manufacture of basic supplies.
    * No more billing, lawyers fighting for/against costs, etc.
    * Some kind of auction bid for the services of doctors performing classes of common work.

https://en.wikipedia.org/wiki/Dutch_auction

I thought this was called a Dutch Auction, but it seems that what I'm thinking of is some kind of combination of second-price and other types of auction. In this case the buyer of services (the government) wants to buy a projection of X units within a given geographic region and wants the option of exceeding that by a factor of Y.

X units would set the minimum cost paid out (doctors would be paid for the minimum work they're expected to do irrespective of need), but more work might be required. Disaster rates would be a third category of bid.

The way that the cost for a procedure would be set would look something like this.

    * Geographic regions are defined.
    * Doctors/Clinics within all regions report their current and potential capacity
    * *as well as the rate they would prefer to charge for known services.
    * Expected rates of need for regions are calculated.

Based on the above three points, the least expensive but still qualified bids are the winners, with the most expensive winning offer setting the price rates for that region, which all winners receive.

If there is major discrepancy in price between areas, investigation of collusion and/or re-locating those who can to other areas for some procedures could be determined.

Yes, because corporate & state hegemony is so much less in countries with universal healthcare /s

Universal healthcare is a good thing, but it won't really change things in that way.

Government should have its own infra and hire medical professionals. They should leave the private sector alone.

We have that now, it's called the Veteran's Association (VA). It's kind of a mess.

Out of curiosity I looked up and found that the estimated VA budget (in 2014) for "Hospital and Medical Care" was $55.4 billion. This covered ~22m Vets at the time. So a rough estimate for a national equivalent of VA care would be $800B/yr or maybe $850B-1T in todays dollars.

> Exactly why we need universal healthcare in the US

I agree but the political will to do it is just not there. Not yet, anyway.

> It would go a long way to breaking up the neoliberal corporate hegemony

No, it wouldn't. Neoliberal corporate hegemony rules all of the developed world, all of which, except the US, has universal healthcare.

neoliberal corporate hegemony?

You need to define what you mean with universal and what you mean with healthcare. Does it mean ex that you can't have private insurance and private hospitals? What does it cover? Who does it cover (Tourists, illegal immigrants?) and what does it cover?

I have lived in both systems and have experienced pro and cons with both of theem.

What's a worker to do? I live in a blue city in a blue state and vote for the blue people that say they're going to help out with this. They are not the majority and the other party are hell-bent on destroying what little advancements have been made.

Not to mention, it's pretty hard to reshape ideas that have been adopted or bred into the culture over the years. Health care should not be tied to employment but it's been that way for years with a lot of large incentives to keep it that way.

As an unemployed person, it sucks and you're looked down upon as it being your fault instead of a working for a poorly-run company or something else. You're not a victim, you're a perpetrator with a flaw. An undesirable.

That's the beauty of the 'real' Christian society of America - it's all black and white, good and evil. It's God's grace that they have their jobs and some flaw in your that you don't. It's not about luck, or business downturn, etc.

Maybe reply instead of downvoting folks.

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