Comment by cs137 | Hacker News Reader

Comment by cs137 | Hacker News Reader

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Which leads to antibiotics being over prescribed because parents don’t want to leave the doctors office without something to do afterwards.

You're not wrong, but sometimes this is purely preemptive and might still be a sound decision. For example, influenza almost never directly kills anyone--the monster flu in 1918 is an exception--whereas secondary bacterial infections (leading to pneumonia) can and do. Antibiotics are often prescribed as an extra precaution; given the atrocious financial resources of most Americans, most doctors know that they only get one shot with most patients, because they can't afford the copays or get the time off work, and that if they under-prescribe and are read to have missed something, they'll face malpractice suits from the desperate. So, they err on the side of immediate caution, since antibiotic resistance is one of those diffuse long-term problems.

Life is worth living well, but it’s also worth accepting the end, something to which many people are openly hostile.

Part of the problem is that capitalism creates a collapse of trust from which there is no recovery. Is the hospital denying or rationing care based on sound medical reasoning (i.e., that the requested procedures won't work, and will divert resources away from people who need them) or because they don't think the patient will be able to pay? Is the doctor performing a surgery because it will improve the patient's quality of life, or because he needs to generate fees? I'm sure most doctors are ethical and try to make the best decisions for the patients--I imagine, at least 90 percent of them do--but, as soon as the profit motive gets involved, distrust becomes endemic and personally mandatory.

Medicine is, to put it bluntly and factually, too important to trust to the profit motive and capitalism.

Are you sure it was "capitalism" that led to the "collapse of trust"? Did Soviet citizens trust the local healthcare system when the quality of care you received depended on your party rank?

From a Wikipedia article on the Soviet healthcare system[1]

"Many medical treatments and diagnoses were unsophisticated and substandard (with doctors often making diagnoses by interviewing patients without conducting any medical tests), the standard of care provided by healthcare providers was poor, and there was a high risk of infection from surgery. The Soviet healthcare system was plagued by shortages of medical equipment, drugs, and diagnostic chemicals, and lacked many medications and medical technologies available in the Western world. Its facilities had low technical standards, and medical personnel underwent mediocre training. Soviet hospitals also offered poor hotel amenities such as food and linen. Special hospitals and clinics existed for the nomenklatura which offered a higher standard of care, but one still often below Western standards"

I think the problem more generally is that of adverse incentives, whether in "capitalist" or "socialist" systems. I worked in the UK National Health Service which is "free at the point of use" which often results in rationing via waiting list. In my experience, many patients believe that their GP is inappropriately limiting their treatment to save money, particularly with respect to limiting testing, which is unsurprising because "gatekeeping" is often an explicit responsibility for general practitioners in the NHS [2][3]

[1] https://en.m.wikipedia.org/wiki/Healthcare_in_Russia#Early_S...

[2] https://www.theguardian.com/society/2001/sep/15/NHS

[3] https://bjgp.org/content/69/681/e224

Everything you're saying about the Soviet health system is true of capitalism's health system now. The difference is that, in the US, we go into debt for our mediocre care.

The main reason for the discrepancy in care quality during the midcentury is... drumroll please... that the Soviet Union was poor, due to initial conditions. It encompassed countries that had long been impoverished. The US had a middle class to build on; the USSR did not. It built a middle class where none had ever existed. Not to mention, the US was in the historically rare situation of winning a war (since, in economic and humanitarian terms, wars are negative-sum and most often only have losers). The USSR, on the other hand, consisted of nations that had taken a beating in World War II.

If you compare Kyrgyzstan to Alabama, the Soviet Union looks bad, but that's not really a fair comparison. Capitalism, as a sea empire, could dominate people from afar and keep them in nominally separate nations while exacting tribute; the Soviet system, as a land empire, could not. It had to integrate them. That's a harder problem. If you make a fairer comparison--say, if you compare Kyrgyzstan to Honduras or Haiti, the picture lines up a lot better. I imagine the quality of healthcare in the poorest countries under capitalism's thumb is even worse than it was in the poorest SSRs as of 1989.

This isn't to say the USSR was great. It was an authoritarian regime, and it launched some really ugly wars (such as the one in Afghanistan). It remained poor (relative to the West) throughout its lifespan because, ultimately, there is no magical economic system that guarantees 12% annual GDP growth--doesn't exist, never has. Socialism solves one set of problems--and a big set of very ugly problems--that capitalism lets fester, but does it automatically bring about utopia? No, not even close. On the other hand, socialism iterates toward a better standard of living for the common people; capitalism, unless heavily checked (as it was in the Cold War) iterates toward a worsening standard of living. So, on that dimension alone, capitalism loses. Everything said above about shortages and nosocomial infections and substandard care applies to capitalism's medical system today.

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