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Comment by virgilp | Hacker News Reader

But how is that not "expected"? Feels like the argument that "communism is good, it just wasn't implemented well anywhere so far". Well, sorry, but by this point I chose to believe that a full state-run system is vulnerable to under-funding in the long term.

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Long term everything fails, Malthusian pressure gets us all.

But in the medium term, the NHS was doing pretty well until Austerity became the dominant U.K. policy:

https://fullfact.org/election-2019/ask-fullfact-nhs-waiting-...

https://ifs.org.uk/publications/15557

(That said, I don’t have longer graphs to hand, and I am slightly concerned by the convenient start date on the graph in the second link).

NHS was a great initiative and idea!! I'm not advocating against public healthcare, at all. I'm saying is that it's not surprising it became underfunded - there needs to be constant effort to prevent (or compensate) that tendency, because it _is_ the natural tendency of such systems.

Fair enough, I assumed you were trying to differentiate it from private sector given the use of the quote about communism :)

It's clear that a strong public system is needed, to keep the private ones in check. But e.g. Italy shows that they can co-exist well, and maybe that's a better solution?

No doubt. I know nothing of the Italian system; I’m in Germany now, which seems to be not just what all the left wingers I know in the U.K. are afraid the Tories want to do to the NHS, and what all the right wingers in the USA have been complaining about when they say Obamacare is too socialist, and what the one British anarcho-capitalist I knew didn’t like about UK National insurance: there are a bunch of private healthcare providers, insurance of some sort is mandatory, the providers don’t have clear differences beyond branding, it’s not called “a tax” despite being on end of year tax forms, and rich people are allowed to do some sort of shenanigans that makes it cheaper.

But… it works.

The NHS is cheaper, but — and here I wander dangerously into opinion — I suspect that’s short-term benefits with long-term problems which will bite the U.K. in the backside rather than better overall cost-benefit decisions.

So we should just expect people to be greedy and try to ruin systems for their own benefit. That raises the question of how to make these systems more robust to defend against that sort of attack.

Exactly. Expecting people to be generous and collaborative and selfless and whatnot is just asking for trouble.

Note that I'm not saying that people are not/ cannot be generous, selfless etc. I'm saying that relying on them being so is a crappy strategy. You need a system that continues to work in the presence of greedy people.

That is the pro of a market system. A market with a malbehaving dominant party is liable to be upset by a new contender who will undercut them, thus depriving the misbehaving party of income.

That's what would happen theoretically.

In the real world what will happen is the malbehaving dominant party will capture the market by any means available to them. In thoroughly corrupt countries they will bribe legislators, in less corrupt countries they donate to the legislators' election campaigns.

This is true, but I haven't seen any coordinated efforts at market based healthcare reform. Some of the needed reforms are patently obvious (eg make arbitrary post-facto charges illegal, like every other industry), and yet there are no popular campaigns advocating for them. There are a few comments in this thread chiming in with lists of reforms, and I could write one of my own, but politically it's crickets (likely because the Parties are partially employed by the healthcare industry).

Instead I'm forced to reluctantly support single payer healthcare, despite it being a huge corporate giveaway. It's really saying something when "have the government take it over" is the clearest path to restoring a more functional market.

> make arbitrary post-facto charges illegal,

Hospitals now are required to make pricing transparent and surprise bills (out of network charges) are now prohibited, both are recent reforms.

Out of network charges are only one possible surprise, and it's yet to be seen how the cartels wriggle out of the new regulation.

As far as I am aware, you're still unable to get straightforward answers for questions like "how much will this procedure cost?". Furthermore, this "transparent pricing" revolves around publishing a fake list of inflated prices that nobody actually pays and so is effectively useless.

Meanwhile in every other industry you either get a flat fee ($30 for an oil change), or at the very least an estimate and a contract that fixes the rate (the shop rate is $80/hour, we think this will take 2 hours). Materials are often overcharged (eg $140 for a part that is easily available for $100, because it's delivered from a special supplier) but still within a workable bound, unlike say fraudulent aspirin.

This is a straightforward reform - the reason healthcare doesn't operate like this is they bought laws creating the ability to charge you without needing to establish a contract.

That's assuming that the methods used to undercut are beneficial when in reality they're just optimizing for profits over health outcomes. People don't have enough of a choice for it to matter, most people can't just find new providers. Same with ISPs

Yet we have cities with multiple ISPs which have incredibly cheap internet at blazing speeds. In my city we have 1Gbps fiber for $70/mo and the price goes down quickly as you reduce the speed. That's better than some areas of SF I think, and we only have 2 major ISPs here.

Amazing what a little competition can do. The city was smart enough when the competitor moved in to install the capacity for more ISPs to utilize the existing conduits in the future.

In Romania competition + initial lack of regulation and lucky timing led to incredible speed + cost (my ISP just launched 10Gbps fiberlink for 10EUR/mo; 2.5Gbps is 9EUR/mo, 1Gbps is 8EUR/mo, 500Mbps is 6EUR/mo and the slowest option). That said, I think we just got incredibly lucky and I wouldn't advocate "lack of regulation" in general.

Just because there are a couple exceptions doesn't mean you can write off the rest of the country's experience as irrelevant or incorrect

We can ask why those areas with no competition are so, and it is due to overwhelming anti-market bias that makes it hard for other ISPs to compete or even outlaws it directly. Meanwhile cities that have setup one touch laws or fixed right-of-way have seen robust competition emerge.

One area where markets do poorly are where the cost of service exceeds profit, like rural areas. This is an area where government intervention in the form of subsidies can help, but these can also cement single ISP marketplaces if not managed well.

Sounds to me like ISPs should be regulated or managed the same way as telephone and electricity providers

Along with healthcare

People don't seem to have issues getting electricity service or telephone service in those regions. In this case, the special treatment of those services means that people don't get left out

Rich people aren't the only ones who deserve healthcare or good internet

I would rephrase that argument as, "communism is good, it has just been ruthlessly sabotaged by capitalist interests every time an ideologically communist regime forms".

In the case of the NHS, my understanding is that neoliberal politicians have been pushing to privatize it, and have underfunded it to make it look like it's not working in order to make privatization more appealing. The same is true for many programs in the US too.

Nah, Stalin and the communist leadership were perfectly capable saboteurs, didn't need help from capitalist interests. In a system where "the state" has the capability to enforce "public good" policies above anything else, it's only natural that the following will happen:

- individual freedom will be suppressed (because "public good"; can't have greedy people doing greedy things, them weeds need to be killed early).

- since individual freedom is suppressed the regime is naturally going to be autocratic, which means that "the state" is actually a handful of people... who now get to freely decide how they define "public good".

The fundamental error of communism is that in any implementation, it doesn't really have mechanisms to "punish" greedy leadership, only greedy individual citizens. Which is an idea as good as it sounds.

The Bolshevik revolution was carried out under the assumption that world revolution would follow, particularly in Germany. This assumption did not hold, and Russia did not have the needed technological developments to sustain themselves.

Cuba is the best example of a successful communist-ish state. Most if its struggles are due to sanctions imposed by the US and enforced via its allies across the world.

> This assumption did not hold

"if the entire world is a sh*thole, nobody will be able to tell it's due to communism"?

I fail to see what "needed technological developments" would West Germany give them.

> Cuba is the best example of a successful communist-ish state

Successful as in "not completely failed, unlike all the others". Look, I sympathize with their struggles being so close to the US & all, but the fact that this is the best-case for you have should give you a bit of pause, because Cuba is by no means close to being a paradise.

To put things in context, both the largest & most populated countries in the world used to be communist. They both had to abandon it & switched to a form of crony capitalism, which, as bad as it is, seems to actually work better for them than the alternative.

Actually, forget I said anything about communism. My intent was to address the original topic, but I just couldn't resist inserting my take on communism to the original analogy used.

Why wouldn't a private system suffer from the same price pressures?

Because government actors have agency, parent is implying that they made the choice to underfund the NHS. Such a choice was not inevitable. Contrary to “true communism has never been tried” the NHS was successful, and would be if the dominant austerity ideology had not taken hold.

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