A ticking time bomb: healthcare under threat across western Europe | Hacker News Reader

A ticking time bomb: healthcare under threat across western Europe

theguardian.com

34 pointsingve72 comments

Services, such as healthcare, public infrastructure, public transport, energy etc should be run by the state. There is always a conflict of interest when companies run these things because they care about profit / shareholder return more than they care about the people.

Now, the fact that the state is often corrupt is another problem that should also be fixed but i just don’t buy the argument that companies should run public services because they’re more efficient.

The UK is suffering badly with this. I’m old enough to remember how badly some state run things were but i still believe that it was then due to underinvestment as it is with healthcare now.

False binary. Under capitalism, the state is always beholden to the interests of capital, i.e. "private" capital.

State has conflict of interest as well. It is entity that is trying to save and extract money, just like big corporation. Lets not pretend it is somehow more moral!

But in democratic states the people also hold the reins on the other end via elections. You don’t get to vote for CEOs or their boards or their boards largest shareholders for $0.

So yeah they’re characteristically different.

The problem with state-run healthcare (as well as education) is that costs (especially salaries) can become a political issue. In parts of Canada we’re experiencing severe shortages of healthcare workers (such as nurses) because governments have frozen their pay for political reasons.

Why does the electorate vote for politicians who won’t pay nurses what they’re worth?

Because they campaign on promises to “cut the fat” from government. Lots of people earn less than nurses and are resentful of that fact.

Yes the point where people have a say is:

- state -> elections

- corporations -> competition

There are many possible scenarios in both cases where the interest of the people becomes irrelevant because of corruption, cartels, etc...

Ireland is another example. Healthcare services have €20B a year budget for 5M population. It's rife with non performance, wrong diagnosis and being borderline ineffective.

Element of running a welfare state is how far you take it or make it restrictive so capitalism can thrive. Many doctors run private practice together with their lucrative government jobs. UK on similar level seems lost between running state run programs vs letting private sector thrive.

Private sector is certainly not an answer to education and health. But government ones need some private sector like spirit, incentives and sticks. Many of the medical staff don't perform because these are jobs for life with little to no long term effects on their career.

> when companies run these things because they care about profit / shareholder return more than they care about the people.

We can accept that without also accepting that governments care about the people either. The top-level care about re-election, and the managers that survive party transitions care about their budgets, their fiefdoms, and maybe sometimes their employees rather than the public write large.

Corporations are kept in line with proper competition, where possible. What feedback mechanism is their to keep government bureaucracy in line? Sometimes they have audits, but those are never detailed or frequent enough.

> Corporations are kept in line with proper competition, where possible. What feedback mechanism is their to keep government bureaucracy in line? Sometimes they have audits, but those are never detailed or frequent enough.

No they aren't. This flies in the face of all the evidence right in front of you. They just form cartels and monopolies. The US where everything is private and is the most expensive (by far!!) with the least covered and worst outcomes compared to the one's we're talking about. You're ignoring ALL the evidence just to bolster your ideological nonsense.

> The US where everything is private and is the most expensive (by far!!) with the least covered and worst outcomes compared to the one's we're talking about. You're ignoring ALL the evidence just to bolster your ideological nonsense.

Do AMD and Intel have have a cartel, or do they have a healthy competition that drives down prices and improves product quality? That's direct evidence against your claim that a) I'm ignoring "ALL evidence", and b) that all corporations form cartels to avoid competition.

The fact that sometimes corporations form cartels does not entail that they always form cartels. The evidence is in fact overwhelming that this usually doesn't happen, but where it does I agree that the government should enforce its competition laws.

Finally, you didn't provide an argument refuting the point that government bureaucracy has an equally large problem in monotonic growth. Even if it were true that corporations always formed cartels, which it's not, it's not clear that this would always be a worse situation than that presented by monotonic growth and the inefficiencies that follow. Yes, the US has a serious healthcare problem. Other countries with privatize health insurance don't suffer from these problems, eg. consider Switzerland and Singapore.

The previous post was making descriptive claims about US healthcare but then you responded with an abstract principle supported by an example in chips. It’s much more apt to go straight to your very last sentence.

No, I made a general point about government and private interests having different failure modes, this person responded by calling my point devoid of evidence and that private interests form monopolies and cartels and that healthcare somehow disproves my general argument, and I showed an existence proof that their single example is not generalizable and not reflective of the common case.

The US has the best 5-year survival outcomes for most forms of cancer.

Because so many people can't even afford diagnosis and those that do manage get help are put into debt slavery. You can't seriously think that that is comparable to what is actually available to actually everyone in Europe.

I wonder how much of this reflects more screening?

See Gigerenzer 2013[1] for issues with 5-year survival rates.

I would be more interested in how mortality rates compare. EDIT: This[2] suggests US cancer mortality rate is lower but overall mortality rate is higher.

[1]: https://www.bmj.com/content/346/bmj.f548.full https://sci-hub.se/10.1136/bmj.f548 [2]: https://www.healthsystemtracker.org/chart-collection/mortali...

The problem with applying regular market economics to healthcare is that it doesn’t take into account the actual market conditions.

Healthcare is heavily regulated and for a good reason which means that the barrier to entry and the entire playing field is controlled by the regulators.

It also isn’t as scalable as other industries and extracting efficiency comes at a real human cost. You can’t deliver healthcare by offshoring it, and you can’t make it much more efficient by taking out people from the process and replacing them with automation at least not on any feasible timescale.

Healthcare also has a very inelastic market people can’t go without it’s not a luxury or something you can go without.

Also unlike many other industries healthcare becomes more expensive as it develops as you develop new treatments for previously untreatable conditions and people generally live longer.

Whilst the private sector does have a role to play in healthcare it’s not as simple as let the market take care of it.

Markets in general are pretty bad at favoring long term gains over short term ones and healthcare is really not suited for short term thinking.

>> Services, such as healthcare, public infrastructure, public transport, energy etc should be run by the state.

That is a bold claim and from where I'm standing, it doesn't seem to be rooted in reality. The countries with the best health care system seem to be the ones where insurance (or state) pays for competing doctors. Those countries where doctors only work in state owned hospitals look terrible by comparison.

I, for the life of me, cannot understand how something as essential as healthcare does not take priority over comparatively less essential things.

It must be an unintended result of our complex societal setup with each stakeholder pursuing their own limited gain with no regard for the bigger picture, because it just makes no sense.

Same is true for other essentials such as firefighting, basic infrastructure, etc.

Why would I rather have 5G/Fibre/stadiums/TV shows/[any other less essential contrasting example] than proper healthcare?

If I cannot pay for both, let's have the more important one.

I know I'm oversimplifying. I believe my core point still stands.

Healthcare is expensive and have massive fines built in for good reasons. Government jobs are for life with little to no repercussions. Also they might not align people correctly with incentives. We need government run programs with private sector like efficiency.

> Government jobs are for life with little to no repercussions.

This is one of the main problems: without some kind of feedback mechanism, this means bureaucracy can only monotonically grow which means inefficiency can only increase. At some point that inefficiency starts making private healthcare look competitive.

That's pretty much it. Government jobs are lower paid because money comes from taxing private sector. Career growth there is all about how big of a team in numbers someone has reporting to them.

We’re paying a ton of money in America and have worse results.

The examples you listed are nearly free compared to the cost of social welfare programs, free/affordable education and infrastructure.

Eg it is not obvious to me that we should close schools (or let them go to shit) to pay for health care.

The human race managed to survive pretty well for millennia without any sort of healthcare system. So how essential is it? Most of the major modern gains in life expectancy have been due to public sanitation and childhood vaccination. Everything else we get from healthcare is marginal.

Healthcare is certainly important, and we ought to provide affordable access to at least basic healthcare to everyone. But it's not essential in the same way as water, food, housing, and energy.

Italian health care costs 125B€ per year, defense costs about 26B, pensions about 300B. We already spend an insane amount of money, everything else is peanuts, including defense, which btw will have to be increased thanks to russian invasion.

If governments can’t afford health care, how can individuals? Will medical care be limited to the wealthy? Or, as others here say, is it just a not terribly transparent effort to privatize and thus profit from the the problems of others?

The same thing is happening to NZ healthcare, i personally welcome means testing for elective surgeries. A lot of boomers needing healthcare here are sitting on significant gains from holding property, a boomer was recently complaining to me about his hip op being delayed twice through public, he owns a big $1m house, $2m in rentals and has $500k in a savings account, he could easily get it done this week with his own money.

You're saying that if you're in a high enough tax bracket then you should pay the most to support everyone else's healthcare but have no right to access it yourself.

Property has been a tax loophole in NZ for decades, so they haven't necessarily ever been in a high tax bracket.

No, gp is saying that if you have choices, you should be deprioritised in the queue for limited public resources.

Edit: I took out a loan to have cataract surgery. I don't understand why someone would sit idle and crippled if they have the means to do something about it. You don't win by dying with all the money.

He’s clearly not saying that though. The statement was that a wealthy person was complaining about having to wait. Everyone else is also having to wait. They could speed things up by paying privately if they so wish.

Also the wealthy should have a larger tax burden in absolute terms compared to the less well off. I say this as someone how is very fortunate - I don’t think we are taxed enough to make things sane and fair.

> means testing for elective surgeries

this means they shouldn't be allowed to access the healthcare that they're paying for.

The amount you pay in is not the amount you are entitled to. It’s about having a better, fairer society.

It is interesting though because it’s hard to draw a line between elective stuff that should be covered vs what should not. Breast implants for cancer survivors who had mastectomy? Sure. What about people who have self image trouble? Harder to draw the line. Some people might be having serious mental anguish that diminishes health in turn.

In general i think there needs to be limits on what public healthcare pays for. I don’t know how to draw that line. It is by no means certain that a wealthy person can or should have the public purse pay for elective surgery.

It feels like you are reacting as if it’s cut and dry that since they paid in they are entitled to everything, which sort of defeats the purpose of this sort of distribution of health / wealth.

Covid isn't helping. There is a constant stream of infected patients in A&E and intensive care, vast growing numbers of disabled Long Covid patients and a lot of healthcare staff have been impacted. Its a big increase in the needs for healthcare and will be for the foreseeable future. Healthcare staff have been heavily impacted by Long Covid and since there is no treatment let alone cure they are being lost at a faster rate than in most other industries.

> In Germany, which spends more on healthcare than almost any other country in the world

Really?

This graph: https://en.wikipedia.org/wiki/List_of_countries_by_total_hea...

...seems to say what you expect: there is only one outlier and it's the US.

This graph: https://en.wikipedia.org/wiki/List_of_countries_by_total_hea...

...is even more damning. Maybe it's just the US who has a problem?

For profit health insurance is IMO not pro social.

It is slowly decaying here, in a central european country with socialized healthcare. It isn't because of COVID or aging or anything like that, but rather because of a systemic 'privatization' where taxes collected via mandatory private insurance companies are used to fund an alternative privatized healthcare system that then offers higher pay to healthcare workers.

Does it boil down to physicians and other care staff not being paid enough?

it boils down on the competition always being able to pay more because of how it is financed (for the state its an expense, for private health its an investment)

I think it's similar, but obviously not nearly as extreme, as doctors in Cuba being paid nothing and constantly trying to flee to the USA while there is a perception that Cuba has a good healthcare system. The practice and care itself may be good but if you can't take care of the workers then it will still fall apart. Cuban doctors are actually slaves though. European doctors just leave the public services.

It's an organized dismantle coming from the right wing parties, they cut resources and spending creating waiting lists and the deviate people to private services. The promotion of private healthcare it's all over, super cheap prices for now, till the destroy the system and then I guess we will get a super expensive scamming healthcare like in the USA. In Spain several hospitals that turned private were returning to being public because the super efficient capitalist owners could not make it work.

In Poland we have waiting list for more than a decade and recently private sector pricing accelerated wildly while any complications are being sent back to public healthcare.

Right wing parties haven't had much say in western Europe as of recent, unless you've re-defined right wing. We're having the same issues here in NZ and it accelerated with a left wing govt.

NZ has never had a left wing government. NZ's government is neoliberal, which is not left wing in any way. Neoliberalism is in all actuality right wing.

If you're calling Jacinda Ahern a right-winger, the term has lost all meaning. Do you need the state to seize the means of production in order to call a government left-wing?

At least a few explicit examples would be a good place to start. I look forward to it.

Examples of what? You're just using a word wrong. There's nothing more to it.

Examples of any practical reason to categorize Jacinda Ahern's government as left wing.

https://jacobin.com/2021/05/new-zealand-labour-party-sociali...

I've seen those terms redefined so many times that now I think right-wing and left-wing don't mean anything really, outside the context of US politics.

I feel like left wing/right wing is basically now defined as “if you don’t believe in what I believe in then you’re right wing and wrong”

Defending social healthcare left wing - Promoting private healthcare right wing. In this case it's not that difficult.

Interestingly, right-wing . left-wing is usually defined specifically for the European political spectrum. The United States has a liberal - conservative divide, but it is vastly different from what we see in Europe.

If anything, left/right does not mean anything in the US due to the radically different Overton window. As a European, I would consider the Democrat party to be right-wing. If you want left-wing, you have to go as far as Sanders or AOC.

And even then, Sanders and AOC are 'third way' left, like Blair, DSK and Holland (who is left of the two others, but still). At most center-left.

Since 2000, left-wing parties have ruled for the past X years in:

Ireland: 0 years

The Netherlands: 2 years (Kok - 2000-2002)

Belgium: 3 years (Di Rupo, 2011-2014)

France: 5 years (Hollande - 2012-2017)

Germany: 6 years (Schröder - 2000-2005, Scholz - 2021-now)

United Kingdom: 10 years (Blair - 2000-2007, Brown - 2007-2010)

Austria: 18 years (Fischer, 2004-2016, Buren - 2016-2017, Van der Bellen - 2017-now)

So yeah, with the exception of Austria and arguably perhaps the UK, western Europe is pretty right-wing. In general, Western Europe has been very heavily on the neoliberal train since the 90s, including a significant amount of privatization. The current state of healthcare is a direct result of this.

Agreed. One correction => Blair 1997-2007

I appreciate the effort you put into compiling this list, but need to point out some flaws:

You listed the Austrian presidents rather than Prime Ministers. Under normal circumstances, the Presidents dutys are mostly of representative nature. They don't need to come from the same party and are not elected at the same time.

> left-wing parties have ruled for the past X years in ...

The Schüssel governments from 2000 to 2007 were composed exclusively of right-wing parties, every government since then was a coalition of both right- and left-wing parties.

https://en.wikipedia.org/wiki/Government_of_Austria

It's not a matter of left-wing or right-wing. It's a matter of whether the ruling party is neo-liberal. In the US, both parties are neo-liberal. In Canada, both parties are neo-liberal. There is only a small difference in how neo-liberal these parties are.

https://en.wikipedia.org/wiki/Neoliberalism

Malice aforethought

And this is with then sucking eastern europe dry off almost all capable medical personnel.

Lets face it Western European healthcare is a scam. They are barely existing with millions of qualified people from CEE and now they are eyeing countries like Philippines, Indonesia and such.

It is all a ponzi

It's not a Ponzi, reality is western europe is not really rich, not as much as it seems. Debt is over the roof, demography is a disaster, politicians worse and worse every year passing, corruption even inside EU parliament. China is now much richer as a whole.

You are projecting the views of riches in China on the very few factors you are allowed to see go further than 100 miles from a big city and you are basically in the 1900s.

Come to Italy, there's people from the hills sellings eggs from their cars. Btw, China has a space station all alone, only country in the world. How so?

See they have cars... everyone else knows that it's not a good investment?

I have a 16yo car and I'm a sw engineer with a decent salary, italian avg is 12yo, which is a lot. And I live in a comparatively rich northern region, southern Italy is much, much poorer. Less and less people can afford to buy a new car, let alone a BEV. We are back to 1970s cars selling numbers.

I don’t have any specific information on the current situation, and regarding future developments, well my crystal ball is currently in service — but regarding the situation up until at least recently, I will go on record any time: I have lived the past 44 years in the context of the German health care system, and it was basically perfect, period.

Compared to the US (hearsay), and the Eastern European systems (first hand knowledge through the wife), I‘ll take the Western European system any day.

Cant speak for Germany but the situation in Austria has been more or less the same. Perfect.

But I think we are increasingly slipping into a two class medcare system.

The comment you responded to was not saying that Eastern European systems are better than Western European ones, but that Western European ones are better because they benefit from getting personnel educated in Eastern Europe and elsewhere for free.

We are talking about sustainability not quality here. German health care system is barely functioning (and it always was like that. Remember the korean nurses in Western Germany?) living off of other countries labor. And per capita germany is the 2nd behind the US on healthcare expenditure.

There's louder and louder voices in other countries to fix this problem by mandating the medical personnel trained in those countries to practice medicine for X number of years. It's simply not sustainable.

Before, being a doctor or a nurse was probably more of a vocation or calling. As that attitude had been destroyed, healthcare professionals expect proper/normal work times and conditions, which is extremely costly. I think secularism plays a part in this, and Christian organizations still provide a lot of care which the government is not capable of giving

Utter nonsense. If nurses didn't previously expect decent work conditions, what on Earth motivated them to unionize? Your comment is just total garbage all the way through.

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