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Comment by andy99 | Hacker News Reader

Government is probably the worst actor to run healthcare facilities. It’s not that different from PE, except with more administrative bloat. I’d be curious to compare US PE run facilities with government run facilities in Canada.

There is not an easy answer here, it basically a cost centre that whoever runs it, the welfare state is incentivized to spend as little as possible on it. PE is almost certainly a bad solution. If they can destroy a restaurant or other low impact business, I hate to think what they’d do to businesses that care for people. You’d get the healthcare equivalent of Burger King. But with government you get the equivalent of the DMV.

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Canada's healthcare is generally cheaper per capita, pays healthcare workers less and has far lower administrative costs than the US. The US spends 5x the average of other wealthy countries on administrative costs [1]. This line that the government is automatically inefficient and terrible at anything at all is not true, is not set in stone and does not preclude private industry being even more greedy, stupid, amoral and inefficient than the government.

[1] https://www.pgpf.org/article/how-does-the-us-healthcare-syst...

> The US spends 5x the average of other wealthy countries on administrative costs [1]. This line that the government is automatically inefficient and terrible at anything at all is not true

It's a line that tends to be mainly parroted by... the US. Quelle fucking surprise.

> I’d be curious to compare US PE run facilities with government run facilities in Canada.

You don't have to do that, we have US government ran facilities. It's the VA.

And if you look at the costs associated with the VA, they are much much cheaper than almost any private care [1].

And if you know a few vets, you know they almost universally love the VA. It's one of the best perks of serving in the military.

[1] https://www.herc.research.va.gov/include/page.asp?ID=inpatie...

Free market ideologues are too dumb to understand local minima.

An ideal free market is a global minima (in theory). It's the best.

A non-ideal free market (heavily subsidised and regulated) might be close (in parameter space) to a global minima, but might be highly suboptimal compared to a local minima.

It's not even that. Free markets by themselves (as implemented thus far) DO NOT ACCOUNT FOR EXTERNALITIES.

I have yet to see reasonable fix to the tragedy of the commons in a free market situation, and that's one of the most basic things one is fucking introduced to when studying economics and game theory.

Anybody who thinks health care is best served solely privately should have to pay to be diagnosed for something; either that or they've been failed in their privately funded education.

In the past I have read some libertarian literature that suggested the answer to the tragedy of the commons was that there should be no commons. Everything should be privately owned. How that would actually work in practice is way beyond my tiny brain.

Former libertarian here. The issue with libertarianism is that it does not explain the state of the world. The world is inherently unregulated. If libertarianism was superior it would have outcompeted other systems and it would have been the dominant system right now.

Historic explanations are even more problematic. How does libertarianism explain nomadic cultures or rice growing cultures (that tend to be highly collectivist)?

It doesn't matter if it works in practice - it's religion, so it doesn't have to be true. We sent rockets up into space and there wasn't a giant man there watching us, but people still believe God exists. We tried living in a free market and everything turned to shit, but people still believe in libertarianism.

I think the theory is that if people owned the forest, the rivers, etc, they would have an incentive to take care of them for the long term. As we've seen with how companies have had all the value sucked out of them by private equity, leaving nothing but husks, I think this is a pipe dream.

> Free market ideologues are too dumb to understand local minima

…or Nash equilibriums.

Huh the government is the ideal party to do that. Because it can set its goals to best serve its constituents instead of making money.

Don't forget there are so many countries with government healthcare and their care is a lot more accessible than the US's. I've lived in many countries and a nationalised healthcare system is one of the things I select for.

Even a poor country like Cuba has one of the highest numbers of doctors per capita. Unfortunately a bit hamstrung by the US's illegal and needless sanctions so they can't get proper equipment but I've been told healthcare is still pretty excellent there.

it’s that first paragraph which is really the bugaboo. In an ideal world that first paragraph is 100% true. In reality, what you get is the government getting its own people on the inside, raking in tons of contract money and doing very little for that, then squeeze the services on the inside to win political points from their constituents by drumming up hatred for the system in which they work. While they take in "campaign contributions" from private entities who benefit from people falling out of the system or being fed up with it.

so I agree with you in theory, but in practice, there was a whole host of other issues that would need to be dealt with somehow. I don’t know that more bureaucracy is the solution, but I would like to think it can be handled.

Actual competition and monopoly breaking/preventing.

"Free" markets tend to have transparent pricing : US healthcare does not.

"Free" markets tend to have large numbers of independent players that compete with each other : This is disappearing in the US market.

We have the worst of both systems currently. It's not ran by the government to control costs to the end user. And it's ran by a few monopolistic insurance/medical companies to reap as much profit as possible.

You're both right: government-run healthcare works okay, except when it's the US government.

Canadian healthcare is horrible, pretty sure public healthcare in the UK is also very bad. It’s not a given that somehow switching to public healthcare will make the US like Finland, Canada is much more likely.

Yes, when the government politicians hate public healthcare they can successfully sabotage it. That just means we need to structure it in a way that they can't. The examples given were all successful in their missions in the past before they were actively targeted.

It's all about the execution - UK NHS public healthcare was once easily the envy of the world (I'm from Australia, not the UK) and then it suffered decades of being white anted by Conservatives.

> then it suffered decades of being white anted by Conservatives

On what planet does this not happen in America?

Of course it happens in the USofA, and more widely in the Americas.

The challenge for citizens is active participation in oversight of management of the commons - rats will sneak into every granary otherwise.

That’s where they got the idea.

Government is probably the worst actor to run healthcare facilities

Are those your gut feelings, or do you have an argument to back it up?

In reality, the outcomes from Government operated hospitals in Scandinavian Countries do not need to hide behind those of other countries, especially not with the US

https://jamanetwork.com/journals/jamainternalmedicine/fullar...

A better way to put this is

"The government is the best entity to run healthcare, except, when the voters elect people who's motto is fuck you, I've got mine"

So backing up a couple of levels in the conversation here, may I paraphrase.

Not "Government is probably the worst actor to run healthcare facilities"

but:

"Americans are probably the worst actors to run healthcare facilities"

I hope it's not true.

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