Comment by robocat | Hacker News Reader

Comment by robocat | Hacker News Reader

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> some industries just work better and more efficiently as a centralized common: electricity, water, rail, healthcare... That's an empirical fact.

Not a fact. Easily demonstrated by falsification by examples of each of those where they have failed because of centralization. Infrastructure is deviously hard to get right. Edit: we can find examples of decentralized infrastructure that works great (internet, Apps, banking).

Healthcare in particular must always fail because there's an unreasonably infinite cost for and ideal service. There's no good answer to what price (what resource limitations) we should put on fixing little Jimmy's cancer. Governments struggle to make compromises in healthcare, and plenty of citizens are super unhappy with any compromises made. Of course a free market can't fix that problem either. Disclosure: I'm not a free market zealot.

Too many people want to define sides and then get idealist about "their side"; how tiresome. Perhaps you are similar to the free market zealots?

> I believe housing too could be on the

Be careful of what you wish for. Government housing is rarely brought out as an example of success? Maybe Singapore. "Too much government" is a common reason for housing (market) failure. Supply availability is mostly constrained by regulations. Demand is driven by desirability. House prices are driven by mortgage availability in developed countries. House unavailablity is often because of governmental choices over regulations and interest rates. Governments obviously mostly fail to get those right. What makes you believe a government can get socialised housing right?

We don't have infinite resources. Neither government provided services nor free markets solve that. Anyone answering with either of those solutions is the same.

You might find this article interesting: https://washingtonmonthly.com/2020/08/30/libertarians-took-c...

It certainly is a complex topic, with no perfect solution. My personal answer to how much we should be willing to pay for little Timmy's cancer is "whatever it costs".

By "empirical fact", I meant that our socialized healthcare system here in France seems to do a better job than America's in two key metrics: cost (we dedicate a lesser part of our income to healthcare than Americans, through taxes) and life expectancy (ours is slightly higher).

The one caveat I would concede is that we have less access to experimental treatments for rare diseases, but we eventually get most of them. And at a better bargain than Americans too.

For electricity, we had a very cheap, clean grid thanks to our nuclear reactors. It started going downhill the instant Europe asked us to "liberalize" our national monopoly. "Private companies" began reselling electricity for a premium. These are essentially useless parasites. Price got up, all else equal.

As for housing, I know we already have more vacant homes than homeless people (from our national statistics agency). So the issue is only one of repartition. I don't care about any rationalization or gesturing about "market forces" or whatever. We ought to distribute housing to those that lack it.

I'll read your article, thanks.

> whatever it costs

This isn't an appropriate answer because it can't be applied to the whole of society. You can't spend an unlimited amount of money on everyone and suggesting shows a certain amount of naivete.

Every medical systems grades treatments based on life extensible compared to cost. If it's over the limit you can't have it. You need to do the most good for the most people and you don't have unlimited funds.

By "whatever it costs" I meant that we all get a shot at chemotherapy, at the very least. We don't refuse the treatment to a 65 years old who just retired because his death would alleviate strain on our retirement fund, if it's what you think.

> We don't refuse the treatment to a 65 years old

We certainly do: because they have unlimited demand for healthcare so there needs to be a budget. I've had indirect experience with the New Zealand healthcare system avoiding treatments due to cost. Cost is often not given as the reason, instead waiting lists and other palatable reasons are given. NZ spends 11% of GDP on healthcare.

  Health NZ’s cost pressure uplift is 6.2% across all of Health NZ's operating budget

Higher than inflation or tax increases. The unsupportable trend is towards 100% of taxes being used for healthcare?

It is unrealistically idealistic to pretend we can afford infinite cost pressures.

The wealthy pay the majority of the taxation base so they mostly fund public healthcare. People that have chosen unhealthy lifestyles are often the recipients (e.g. my poor friend with COPS from smoking). Not just the unlucky.

> all get a shot at chemotherapy

Great example. New Zealand does fund cheap chemotherapy options. There are expensive chemotherapy options that are not available through Pharmac (our public healthcare drugs purchaser). For expensive drugs you need to pay yourself either directly or indirectly via private health insurance policies (e.g. I noted a policy that covered up to $600000 for unfunded chemotherapy drugs).

Two drugs that our health care system won't pay for due to expense:

* Eribulin can be a useful option after ‘standard’ breast-cancer chemotherapy has failed.

* Atezolizumab (Tecentriq®) useful for women with locally advanced or metastatic triple-negative breast cancer that cannot be treated surgically and whose tumors are positive for a protein called PD-L1

https://sweetlouise.org.nz/drugs-not-funded-in-nz/

I have private insurance (through a non-profit provider). The unlucky collectively get the benefit from that, and I sincerely hope I never need to benefit from it.

Why are you talking about New Zealand so much?

I believe the wealthy paying for the majority is fair, after all their are made wealthy by the labor of the working class. Why should Amazon get to destroy the backs of its delivery persons and then have the workers foot the healtcare bill themselves?

"People that have chosen unhealthy lifestyles". There we go, it always boils down to basic empathy. As if people rationally chose to destroy their health. What's the point of living in a society if it's everyone for themselves? I want to know that someone will always have my back whatever sad situation I fall into.

My point still stands, we pay less and live longer than in America. Something true for every country with socialized healthcare.

NZ? I use examples I'm familiar with because I'm from Christchurch.

> we pay less and live longer than in America

It's a common myth that this is due to healthcare costs: but the implied cause/effect is a lie.

Americans die younger due to a variety of preventable factors (the term lifestyle factors is commonly misused and societal factors is likely better). The ambulance and doctors don't fix those factors. For example "Two years difference in life expectancy probably comes from the fact that firearms are so available in the United States,". The maternal mortality rate in the US is considerably higher than the rate in other wealthy countries such as the UK. The infant mortality rate in the United States is also grim.

  Based on self-reported illnesses and biological markers of disease, US residents are much less healthy than their English counterparts and these differences exist at all points of the [socioeconomic] distribution.

The poor and the wealthy are unhealthier in the US. Cherrypicked health decisions don't help explain fairness.

It isn't just childhood upbringing, because the statistics for immigrants trend towards the American mean.

I'm ignoring your strawman implications: you don't know me or what I believe or how much empathy I have.

I guess the point I'm trying to make is that we all want more healthcare. How do we choose how much to spend? My strawman is that I think you are saying we should spend more (especially on the poor). And specifically I'm guessing you think that we should make anyone wealthier than you pay more and more. There is no limit to how much is fair to pay for things we can't easily value like our time and our lives.

https://pubmed.ncbi.nlm.nih.gov/16670412/

https://www.ahajournals.org/doi/10.1161/CIRCULATIONAHA.117.0...

https://www.npr.org/sections/health-shots/2023/03/25/1164819...

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