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Comment by ptaipale | Hacker News Reader

Not everywhere, though. In Denmark, private operators have been handling emergency services since 1926; currently one company (Falck) is handling 65 percent of municipal fire brigades and 85 percent of ambulance services. No particular nastiness has been reported afaik.

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Right, but that's not paid for by the end customer (at the point of use), is it? There could be single payer with private doctors they'll just get paid with public money, which is entirely different to Joe paying his doctor.

The US has lots services that are provided by regulated monopolies. My garbage company, power company are all regulated monopolies. A key thing is you're required to have garbage and power service but the rates are negotiated by a public utilities commission or the city or county.

However Healthcare in the US isn't a regulated monopoly like that.

And there was an entire thread about how those regulated monopolies are not working well. In particular PG&E in California.

I think it was this one

https://news.ycombinator.com/item?id=18690916

My point was just we do have regulated monopolies in the US. But healthcare in the US isn't a fully regulated monopoly.

I'll argue whatever PG&E problems are they don't rise at all to the level of healthcare. And their problems are due to poor regulation and the US's current terrible management culture.

Denmark is quite different than US. In terms of size, culture and corruption issues [1].

This works in Denmark because of Denmark, but it's still a system that has obvious weakness.

[1]: https://en.wikipedia.org/wiki/Corruption_Perceptions_Index

I think this is because the culture is quite different in DK compared to the US. There is an expectation of how it will work which is very different by everyone involved.

No, it's because ambulance service in Denmark is a public contract. Private citizen don't pay out of pocket.

Essentially, the state (or region) contracts a company to deliver ambulance services. The contracts usually last a few years and are limited to a region.

Furthermore, the company that wins the contract (usually lowest bidder) is held accountable is too many responses are too slow, etc.. usually with hefty fines.

I guess you can call it privatization, but it's more of a regulated monopoly. Ultimately, these things outsources uncertainty from the state to the private sector. I'm not convinced it's always a good idea, since companies can just factor the cost of fines into the contract... Granted if there is competition, it can drive the prices down a LOT.

British Columbia, Canada, does this as well. Ambulatory services are provided by contractors. So are most paramedical services.

And public contract it is in many other places, like where I live (Finland). Local government pays ambulances, I pay a sum to the local government out of my pocket after I have used ambulance.

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