You may not like it, but this is what peak private-markets-for-public-goods looks like.
Edit: Technically oligopoly, not monopoly, though it may tend towards one.
Second, what exactly do you mean by "an otherwise public service?" Are you simply saying, in the absence of private medical care, that "medical care" would be purely owned by the government? This seems uninformatively tautological and I get the feeling some other meaning or implication is meant to be attached but I cannot pin it down.
Those 2 are conflated because Citizens United permits lobbyists to sidestep campaign donation limits by allowing industry groups to effectively spend unlimited amounts of money on behalf of or in opposition to candidates.
At the core of this problem is that speech can be amplified with money. Even if we ban selling of speech to others, organizations can still spend the money to host/print/post/billboard/telecast their own messages. Those with money will out message those without.
Is there a way to fix this that doesn't result in government control of political speech?
The first amendment has only been loosely upheld throughout our history. There are many types of speech that are regulated in spite of it.
>Is there a way to fix this that doesn't result in government control of political speech?
We had a system in place prior to Citizens United that didn't turn into government control of political speech. Many other developed countries have limitations on spending money on political speech that don't turn into complete government control of political speech.
There's no reason to assume that a few men in the 1780s got everything right. And a slippery slope argument is no reason to throw up our hands and stop trying to advance egalitarianism.
Granted, all of this is pretty much meaningless when you have a government overstepping its bounds and doing what it wants. In that case, it seems the blame of the corrupted system would fall on those corrupting it (the corrupt government allowing itself to be bribed in exchange for monopolies).
Those laws exist because capitalist forces incentivize healthcare providers to limit competition.
> which is likely impossible to keep from being corrupt (easy to believe if you've ever met an actual human being).
Have you met any human beings? Try not to be so cynical, damn.
This is peak political corruption.
And of course even where the govt is not funding the product, they are stipulating in detail what it must include. E.g. insurance must include a long list of things from mental health care to nicotine patches, forcing people to go through their insurance rather than through a market where they would negotiate prices.
Instead health plans market to EMPLOYERS (not the consumers of the actual product). Trust me - the service there is pretty amazing! Tax law is designed to in many cases benefit these employer negotiated plans.
Buying people off is the essence of capitalism.
Sadly, no. It's been all of them, including Experian. This seems flat-out mad to me.
https://www.theguardian.com/business/2015/oct/01/experian-ha...
Periodic reminder that there are more bureaus than just Equifax, Experian, and TransUnion, and all of them buy and sell your data every day. One of them [3] even sells your salary data to prospective employers so that they can negotiate against you more effectively.
1. https://www.thebalance.com/6-small-credit-reporting-agencies...
2. https://www.doctorofcredit.com/two-credit-bureaus-you-should...
All in all, we spend about half the median household income each year in health care. When my wife got pneumonia after the flu, we had to drop thousands on an ER visit.
If I wasn't well paid, between our allergies and asthma, we'd probably dead.
In other words, it's the same as a tax to pay for healthcare for the country, except it goes to insurance companies, and you have to deal with in network and out of network. Except this tax goes up the older you get (but capped at 3x what youngest/healthiest person pays).
Presumably, if you add up all the insurance premiums paid for every year of a person's life, it should theoretically add up to close to how much the insurance company expects to spend on you (plus some profit, capped at 20% by ACA).
There's always the anecdata that floats around the internet claiming that you can fly to Spain, live their for 6 months, get a hip replacement, and fly back to the US for the same amount as the outpatient surgery costs in the US. It's basically true, though the numbers may have drifted slightly since it first started making the rounds.
> it's the same as a tax to pay for healthcare for the country, except it goes to insurance companies, and you have to deal with in network and out of network
I think this is one of the strongest ways to frame government-provided healthcare. It's no different paying a tax vs paying the company directly, and in the former case you have the whole US government bargaining on your behalf for reasonable healthcare costs (in the case of single-payer a la M4A).
> capped at 20% by ACA
20% is a lot when we're talking about these outrageous numbers.
It’s not 20% net income, it’s 80% of premiums have to be paid out to healthcare providers. There’s still all the costs of operating the insurance organization, and financials of publicly listed health insurance companies show net income in the 3% to 6% range.
For my high wage, my NHS fee would be just under £7k for the year, my taxes just about at 30%.
Granted here in the US, my taxes are ONLY 25%, but my healthcare costs are close to $30k/year.
That $20k difference is ridiculous ($11k more than in the UK when comparing tax+health), and I HAVEN'T gone to the hospital for a heart attack or premature baby or hemophilia, but if my wife did have a baby, it would cost us out of pocket around $8k (according to the likely VERY skewed numbers in my insurance packet).
A colleague I know is 54, he is single, has only catastrophic coverage and pays $1200/mo. Nothing is covered except 40% of any emergency hospitalizations. The bronze plan was $2000 and had a $15k deductible, and also was basically only co-insurance with $30 generics.
The way we are doing this here in the US is literally killing people. Medical debt is increasing.
My little sister-in-law was on vacation and walking along a path on a jetty with handrails, and benches, and dozens of other people. A rogue wave came and hit her and her friend. She was taken under, knocked unconscious and drowned (and died), until a random stranger who was standing near her finally found her and resuscitated her. She was medivaced to a hospital by helicopter that insurance only covered 10% of because she was out of network, she was then treated by a dozen or so doctors for multiple days as she got pneumonia and broken bones, and head trauma, all out of network. She ended up owing close to $100k with her insurance only covering the first $25k. In any other first-world country, she'd be out of pocket maybe a few hundred bucks. Not in collections for being unable to pay $75k for a freak accident.
I'm no fan of insurance/hospital bureaucracy, but at least I can go to any specialist doctor I want without having to see a GP first. And I pick the job and insurance provider I want to reduce the amount my family pays each year.
Emergency situations like the last one you mentioned, if they are out of network, are still covered at in network rates, thanks to my insurance plan specifically stating that in their plan documentation. I feel bad for your sister-in-law and am glad she survived, but she did have a not so great insurance plan. I would strongly consider getting a different job or lobbying hard with my workplace HR if I had a plan that would only pay 10% in true emergency situations.
Look at what it would cost to cover you and your family on the individual market without government or employer subsidies. As a contractor, I pay double what you do on the individual market, and that is only coverage for myself.
And everyone would get a different job with nice health insurance offerings, if they could.
If my math is correct, employer + employee national health fee for £140k salaried employee is a few quid short of £10k which is still half of my annual health care expense, so my original point still stands.
Being forced to ruin your credit because you got sick or had an accident is sociopathic.
And to that I say: fine. I will happily subsidize, through my tax dollars, health care to pregnant women, addicts, the obese, down-and-outers, whoever, so long as it means that everyone has access to doctors and hospitals when they need it.
I am far less worried about paying a few bucks a year to support someone whose condition I will never have, than I am about sustaining this spider's web of private health insurance, with its unaffordable deductibles and an endless list of shady practices. America doesn't need health insurance companies to act as intermediaries between us and our doctors. They add nothing.
Replace "male" with "child free" and this makes sense but suggesting men are subsidizing childbirth is ridiculous.
> and other women specific costs.
https://www.health.harvard.edu/newsletter_article/mars-vs-ve...
> Men die younger than women, and they are more burdened by illness during life. They fall ill at a younger age and have more chronic illnesses than women. For example, men are nearly 10 times more likely to get inguinal hernias than women, and five times more likely to have aortic aneurysms. American men are about four times more likely to be hit by gout; they are more than three times more likely than women to develop kidney stones, to become alcoholics, or to have bladder cancer. And they are about twice as likely to suffer from emphysema or a duodenal ulcer. Although women see doctors more often than men, men cost our society much more for medical care beyond age 65.
I assumed that because before ACA, childbirth was not covered by insurance and insurance pricing based on gender was allowed, and post ACA, childbirth was mandatory and insurance pricing based on gender disallowed, that it must mean that, in general, healthcare costs more for women than it did for men.
But perhaps that's only true for young men and women, if true at all?
[1] https://www.kff.org/medicaid/issue-brief/status-of-state-med...
Good luck if you fall outside of that list.
Oligarchs know that money has to be spent to keep the plebs just well enough to prevent revolt.
There was a survey that went around a few years, asking Republican voters something along the lines of:
"Would you vote for an Affordable Care Act if it was offered as an alternative to Obamacare?"
A significant amount said "Yes".
Can't revolt if you're disabled and untreated, tied to your job to keep your kids healthy, incapacitated by treatable illness or weak from hunger.
like I said, they'll call it something else. repeal obamacare and make something new that will basically be medicare for all in some shape or form. it will be a handout to the big insurance, drug, and healthcare companies, I'm sure.
I didn't specify before but I'm talking like 8-12 years down the line.
Or are we more the token outlier with a "worst of all worlds" system?
Around the world, it appears that low costs lead to universal healthcare, not the other way around.
What America needs to do is make it cheaper and easier to become a medical practitioner without taking on half a million dollars in debt and wasting half of one's pre-retirement life. No fancy government program will work without first addressing that issue.
And Medicaid, Medicare, and the Veterans Administration (the three big government run healthcare systems here) all run more efficiently by every measure than any private health insurance system.
Note that I fully recognize the problems that the VA has had, but when you really look at it fairly, they have many parallels to problems in the commercial side of the system, we just don't tolerate that when it comes to government (nor should we).
After Canada implemented universal healthcare, costs rose rapidly before stabilizing: https://www.ncbi.nlm.nih.gov/pubmed/379054
Both private insurance and taxpayer-subsidized programs pay astronomically high prices for healthcare; I haven't seen any examples of Medicare paying European-level prices for services.
I know this feels true because laissez-faire and commie-bashing rhetoric is still common in the Western world, but there have been numerous studies recently showing that the US is the most costly per capita. The next 3 countries (by 2016 numbers) are all places where most things are more expensive because the country and its citizens are relatively rich: Switzerland, Luxembourg, and Norway.
There's even a Wikipedia article about it: https://en.wikipedia.org/wiki/List_of_countries_by_total_hea...
Of particular interest is this graph, which breaks it down by public vs private spending: https://en.wikipedia.org/wiki/List_of_countries_by_total_hea...
I feel like you didn't read and fully understand my comment.
"Please don't submit comments saying that HN is turning into Reddit. It's a semi-noob illusion, as old as the hills."
Yes, I can see that your account was created in 2011 :)
Regardless, I don't think silent downvotes really cut it anymore either - nowadays I tend to run out of them after reading only a couple submissions with active comment threads.
It's those long chains that end up being an out-of-order recital of some famous TV/movie scene that really irk me, personally. Those and similar are cases where the value is only in recognizing the source and getting that dopamine hit, and not in any further contribution to the discussion.
The various healthcare leaders use their wealth to strengthen their position through laws.
Most sectors cannot operate like US medical, they are their own beast.
Everyone who can does that. Laws and politics aren't a separate magisterium from business; there are no hard borders here.
That one difference is all that matters.
As a businessman, as much as you can direct the behavior of both your customers and your employees, you can influence the lawmakers. After all, they too want money or things that money can buy.
Violence is just one side of the coin that is power. The other side is voluntary (or technically voluntary but not quite) participation, which is primarily controlled by money. That's what makes politics and markets intertwined.
The doctor runs credit on you before providing treatment, and because of this erroneous bankruptcy that you may not even know about(credit reports can only be reviewed once per year), you are placed in the hallway instead of being given a private bay despite the increased risk of infection. The hospital wanted to make room for paying customers, you see.
So while it's natural to want to "sell" to "profitable customers" in this case applying free market principals to this makes a complete mockery of our health care system. And given the credit bureaus' track records of high inaccuracy and difficulty in disputing the reports, you're likely to get poorer treatment inexplicably, and entirely by accident.
Street lights? Police and Fire protection? Water access?
I remember there was a big outrage about Martin Shkreli's actions. Meanwhile the CEOs of these companies probably get lauded in business magazines.
Calling these miserable, greedy, selfish bastards out for what they are could be a first step. God, how I'm hoping for a socialist revolution to take place within my lifetime...
We've seen that this is something that absolutely doesn't work. They (that's the people who matter) just find a scapegoat and everyone else carries on just as before. Shkreli ended up in prison, but Valeant is still busy making profit off the backs of patients, and despite Hillary Clinton's professed outrage prices for such drugs as Syprine haven't gone down a penny. Netflix has a documentary on the case.
Where is the revolution? Where is single-payer healthcare?
Americans are getting exactly what they voted for.
Also, let's be clear about one more thing. Martin Shkreli is not a free market capitalist, he's a crony. Leveraging state patent systems to create abusive monopolies is not free market capitalism, that is textbook crony capitalism and the enemy of a free market. Without arbitrary state enforcement of medical patents on insulin and epipens, do you think that these would be exceedingly expensive items? Are you being bankrupted by Benadryl? Hardly.
There are absolutely elements of healthcare that are far better serviced by a command economy than a free market, and I think the weird hybrid system in the US is the worst of both worlds in many such cases. But a socialist revolution? Socialism is an authoritarian nightmare that cannot suitably answer any question related to scarcity or competence.
As for "socialism", again you're disagreeing on definitions. To most Americans, Sweden, Norway, Canada, etc. are "socialist".
As far as definitions go, my definition of "socialism" is actual socialism, not social democracy. This quote is overused at this point, but Danish PM Rasmussen explicitly clarifies "I know that some people in the US associate the Nordic model with some sort of socialism. Therefore I would like to make one thing clear. Denmark is far from a socialist planned economy. Denmark is a market economy." Adding central planning to ameliorate some of the rough edges of market economies does not create a socialist state.
Again, most Americans will disagree with you. The definition of a word is whatever most people agree it is.
>This quote is overused at this point, but Danish PM Rasmussen explicitly clarifies
No one in Denmark has any authority to define a word in the English language as used by Americans.
>Adding central planning to ameliorate some of the rough edges of market economies does not create a socialist state.
According to Americans, it absolutely does.
>So no, free market capitalism is not indistinguishable from crony capitalism.
Again, according to many Americans it is.
Here's a challenge for you: pick out 100 different rural counties across America. Go to each county, and take a poll, asking them, "Is Denmark a socialist country?" I guarantee you that a clear majority of those polled will answer "yes".
Just try having a conversation with the average American voter (esp. in rural districts) about "socialism" vs. "social democracy" vs. whatever, and see how far you get. They're probably going to say Denmark is "socialist" because they saw it on Fox News. But these are the people electing the leadership here (or about half of it anyway). We have two "sides", and even many on your side probably would have a hard time with these concepts. It's no wonder things are so broken here, and I don't see how it can get better any time soon when the two sides can't even have a rational discussion because they can't even agree on basic language or concepts.
"In economics, a public good is a good that is both non-excludable and non-rivalrous"
"A good is considered non-rivalrous ... if, for any level of production, the cost of providing it to a marginal (additional) individual is zero"
"... a good or service is non-excludable if non-paying consumers cannot be prevented from accessing it."