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Comment by virtual_void | Hacker News Reader

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.

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> 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.

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.

>> 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.

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

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