Comment by ansible | Hacker News Reader

Comment by ansible | Hacker News Reader

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The debate in the USA is framed with the implication that if you (the health care consumer) does not have "choice" then you will be forced to only see a really terrible doctor, and get substandard care at a high price. And that, with a little effort on your own part, you will be able to select a better doctor at a affordable price.

Therefore, if you have a bad doctor or expensive care, it is your own damn fault. You just didn't try hard enough to find a good one.

It is the same thing with the debate about school vouchers vs. a standard public education for everyone. A heaping dose of "the free market fixes everything", for all life's problems.

I would rather not have a "choice". I would like to be able to select any nearby doctor, and be assured of getting competent care.

I'm not often in the situation where I have a wacky tropical disease that presents odd and incongruous symptoms, which would take a Dr. House to figure out. I am far more likely to have run-of-the-mill heart disease or a common form of cancer. I just need a doctor with some basic level of competence, who can just listen to me and help me through the common health problems of modern life.

Are you against school vouchers? Why would you want parents to not be able to select the school their children go to?

If parents want to send their kids to religious schools, they can pay for it themselves.

They are. Their taxes pay for the vouchers.

No, only a small portion of an individual parent's taxes pays for a small portion of their own kid's education.

Religious schools aren’t the only use of vouchers either. There are also charter schools. Charter schools can often provide specialized programs. Montessori schools seem awesome as well.

Charter schools are public schools and do not require vouchers. They are not considered private schools.

I never understood the concept of vouchers. Taxes are connected from everyone to pay for public schools, which can be used by anyone's children. They're not to pay for the schooling of your own children.

I don't have children at all, and I don't mind paying taxes to fund schools, because when I'm old I want the doctor who is younger than to have gotten a good education. I don't expect any vouchers just because I don't have kids consuming public education.

Vouchers always seemed to me like an obvious scheme to defund public schools and let them rot, thereby punishing kids who were unlucky enough to be born poor.

*taxes are collected

I guess it depends on what you all vouchers, most people advocate backpack funding. The same amount of money per student is spent, but the parents get to choose the school their kid goes to. Instead of being forced to send their kid to failing schools, new schools can be created to cater to the desires of the parents/children.

So it doesn't defund public schools, but it does break the public school monopoly and allows competition among schools - they can cater to the needs of the community and experiment.

> Instead of being forced to send their kid to failing schools, ...

The real issue is: Why are schools failing?

When I was growing up, the vast majority of kids were educated in public schools. They weren't perfect, but they worked at least decently for the large majority of students, and did so for decades. Across the entire region. And they did that as a monopoly system you seen to despise so much.

So we had a system that worked, was scalable, replicable, and maintainable. What happened?

I don't have all the answers there, but at least once thing is clear, there is now an over-emphasis on testing. We had a system that was designed to give citizens important life skills, and turned it into a system that tries to produce drones that can pass tests.

This is exactly the kind of thing we used to criticize Asian school systems about. And now we are trying to replicate their failings. WTF

That's the thing that frustrates me about this debate. People seem to think that educating children well it's such a difficult problem, that it requires constant innovation. That it requires the "power of the free market" to solve. No, it doesn't. We have known how to do it for a long time. It just requires political will.

And that brings us to another factor, one political party is actively anti-science and actively anti-education. This was definitely not the case 30 - 40 years ago. Back then, they were both pro-public education.

In my experience, doctors are like programmers.

Nobody really has any effective way to evaluate them, or at least, nobody does so on a broad basis or consistently. Some of them can’t pass fizzbuzz. Some of them can churn out CRUD apps, but have no idea what they’re doing when it comes to anything else. Some of them are extremely dogmatic about design patterns and tooling and ignore anything they don’t like. Some of them are inattentive or poor listeners. Some of them assume it’s Problem X they’ve seen a million times, but it’s not. Some of them are assholes. Some of them are really sharp and really engaged, but get overly excited and reinvent the wheel or spend a lot of time doing stuff that’s completely unnecessary and maybe even harmful.

I don’t know how to evaluate doctors until I see them, I have no idea if better doctors cost more or less, I doubt there’s a strong correlation because nobody else can evaluate them either. They either help me or they don’t.

I think it absolutely is necessary that I should be able to have a history and see the same doctor, and that I should be able to see another doctor any time I want for the same condition for a second, third, or fourth opinion. I have seen this be absolutely necessary for myself and others with common conditions that were resolved after seeing a different doctor.

I assume this is still possible in most if not all public health care systems (I live in the US but local doctors and hospitals are all government run, an interesting aside), but I am not sure. I recently had a conversation with a Canadian friend who has debilitating autoimmune disease his specialist is doing basically nothing for and he made it seem like it wasn’t possible, but I didn’t want to press.

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