Comment by ivape | Hacker News Reader

Comment by ivape | Hacker News Reader

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This is an impossible argument to make in America because the mindshare and persuasion behind the idea that free markets are best have clouded all humane judgement.

We have to move the argument to “this is an illegal business”. The Right is an amalgamation of extreme Libertarianism and race-centric Nationalism currently, and making a persuasive argument to them requires breaking everything they think they know about what is “good” in the world.

I say this with respect to actually politically reshaping the discourse dynamic (it has to start at debate).

The Right is the obstacle to solving this, not the Left. This is not a universal issue, it’s only a universal issue for people to politely agree and get along, but all actionable items are against the ideology of the Right. To put it simply, to get to where we need to get, we have to chisel and whither away their narratives and mindshare in debate, they skate freely on this topic. Their stance and narrative actually have no place in a problem-solving environment (we can’t solve it if the underlying ideology holds free markets paramount, over humanity).

I agree but I find it odd.

I don’t hear anyone (well some, but very few and usually not taken seriously) suggest police and fire departments should be for profit, so clearly it’s understood that some services should not be profit driven.

But apparently it’s a huge leap to extend that to healthcare.

This is an excellent point. We all seem to grasp that private fire and cops would be a an awful idea.

And as I'm sure you know, the answer to why it's a huge leap for healthcare is the obscene profits that healthcare companies make off of the healthy, the sick, and the dying.

Now let's recognize that we live in a system that fully supports this trading of health and lives for money.

Certain aspects of their jobs absolutely could and perhaps should be privatized.

Getting the patrol aspect of policing privatized would cut down a lot of the worst of the stuff cops get caught doing.

You don't see rent-a-cops going off and killing people.

The inspection and compliance related clerical work that a lot of municipal fire departments do could probably be privatized but I don't see an argument for it like I do with cops since they're less abusive. Nobody ever wrote a song called fuck the fire department.

> You don't see rent-a-cops going off and killing people.

Haha, I just saw a video the other day of a couple of “bounty hunters” (bailbondsmen) pulling up with tactical gear and rifles and kidnapping some kid because he had the same name/ethnicity.

Naturally (and thankfully) these idiots are being charged, but one of the kidnappers sat in an interview whining about how his job was too hard because he lacked qualified immunity.

> Getting the patrol aspect of policing privatized would cut down a lot of the worst of the stuff cops get caught doing.

Are you referring to something like the current private security patrol or an actual police? If it's the former it already is there, if it's the latter I'm not sure how that'd cut down on the amount of bad things police do today.

We already have private prisons. It's not much of a leap to also privatize other parts of the judicial system, including certain police forces.

> This is an impossible argument to make in America because the mind share and persuasion behind the idea that free markets are best have clouded all humane judgement.

Is this according to something like Gallup polling? Or according to what the talking heads on cable news say? Americans can be very progressive according to polling data, despite all the best efforts of the propaganda machine.

The implicit assumption in libertarian perspectives is that all parties are rational and have similar levels of information. In healthcare, this is simply not true. The average person isn't capable to judge what is and isn't necessary for them (outside of the small amount of very routine and elective care).

Likewise, if a hospital hands you a bill for 30k and you need help, are you really going to be able to negotiate and find a better price?

Healthcare is fundamentally an in-elastic good.

Most American hospitals are nonprofits and all of them operate in the free market.

What’s your point?

That a market setting and the non-profit status of market actors are orthogonal issues.

It's actually not particularly a free market.

Check out Certificates of Need. You need one to open a new hospital in an area.

The other existing hospitals in the area get to comment on how it would affect their business and if it would cause them to reduce their investment.

This is all framed as "ensuring communities are appropriately served with healthcare capacity," but CoNs were an idea that was conceived by and lobbied for by ... hospital owners.

I'm the last person here who would defend provider chains, who I believe are in fact at the root of the problems in the American health care system, and certainly the Certificate of Need system --- which applies variably to about half the states in the US --- is stupid, and does restrict the market (most markets are somewhere on a spectrum between free and unfree).

But the alternate problem exists too: hospitals with too many vacant beds, and hospitals shutting down because lack of utilization makes it impossible to pencil out keeping them up and running. That's happening where I am right now.

How is that not just a consequence of market based healtcare? Winners and losers is a natural consequence of market competition, and the instability it brings is natural as well.

If by majority you mean 48%

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