The purpose of government is not to require the most efficient option. Government isn't capable of it anyway. Government is force - nothing more. The purpose of government is to protect our rights. "Single payer" (a euphemism for socialized medicine) by definition violates rights by forcing people to do things against their will. For example, in Canada (until recently) people were prohibited from using private health care even if they want to.
The health systems in Europe are not radically different from the US system. The efficiencies of each are difficult to quantify without context. For example, the US invents most of the drugs and medical technology used by the world. Would this still happen if there was more invasive regulation? We can't know.
Besides all of this, think of every other area of the market where the government insinuates itself. Are public schools better than private schools? Almost never. Is the US postal system better than FedEx? Of course not. The government is not a commercial entity. The incentives and influences on it are not conducive to producing quality products at good prices.
Until recently. This means that all people can obtain health care regardless of their ability to pay, and that the system is flexible enough to continue to experiment with the ideal implementation.
Are public schools better than private schools?
Public schools are exactly 100% better than private schools for students who can't afford to attend private schools.
Is the US postal system better than FedEx?
They are if you want to get a letter delivered anywhere in the world cheaply.
You have made a lot of good arguments for socializing care here.
1. Try getting an MRI in Canada. Canada rations care via wait lists.
2. Your argument implies that there wouldn't be low cost schools in the absence of public schools. The evidence is overwhelming that the opposite is true.
3. I live in Panama. When I need something mailed here I use FedEx or DHL. The USPS is unreliable and takes far too long. If there weren't laws against private first class mail in the US they'd be undercut in that market as well.
Firstly, diagnostic care is often privately managed throughout the provinces, so if you don't want to wait, you can often pay to expedite. It's about $900 for a joint MRI.
Secondly, if you really need an MRI for a critical diagnosis, as I once did in 2012 as a hospital inpatient, I got it within 2 days.
Canada's health system is a point of national pride.
It depends where you live. I know many Canadians who've had different experiences. This points to a major problem with socialized products - how they perform depend not on merit or ability to pay, but where you live, how good your representative is, etc. That is much worse.
I really don't agree. I've lived in three Canadian provinces, and four U.S. states, from towns of 1000 people, small cities of 10k, medium cities of 100k, to large cities of 1m+.
Having lived through the Ontario cuts in health care in the 90s ("the Harris common sense revolution"), I don't really think political reps Federally or Provincially had any say on quality of care or what hospitals we got, it was all redesigned top down (not all that different from an HMO really, in my experience). Did care access and waits times suffer at the time? Yes. Still wouldn't trade it for a private system.
The difference in access and amount of supply between a rural market and a city in Canada is not too different than in the US. There's a lot of land mass to cover in either country if you're not in a major population centre.
The Canadian system blows away the US system by an order of magnitude, IMO, in terms of what really matters - access and outcomes. Obamacare made the US a bit better, but that's not a tall order.
What's the worst condition (if you don't mind saying) you've had where you had to use the Canadian system? Generally, socialized medicine works fine for routine care but badly for catastrophic (i.e. expensive) care.
- Severe pneumonia (1 day in emerg, 9 days in ICU followed by 8 in an inpatient ward)
- Total pericariectomy (2 days in postop ICU, 3 days in ward)
Among other stays/issues prior to these.
The latter surgery was the culmination of outpatient medical care over 3 years with multiple specialists (cardiologist, internist, and cardiac surgeon), along with multiple CT, MRI, cardiac catheterization, countless blood tests, many of which were sent to Winnipeg (the equivalent of the CDC) for rare disease scanning, and over a dozen echocardiograms ... none of which I had to wait for longer than a day or two ... And none of which I had to pay for (just my medication through private insurance). In fairness the surgery itself wasn't critical, so I waited 6 months. They were willing to expedite if my condition deteriorated (it didn't). And after regular cardiologist visits , after I was stable, it could take 8-10 months. If I had an issue they'd expedite me in though.
I am not saying the Canadian system is ideal. Just that it is a reasonably functioning system.
There are some cases where it is both very frustrating and inspiring. I have a dear friend who has a child with a congenital heart defect due to an extremely rare genetic connective issue disorder that is similar (but different) to Marfan syndrome. The Canadian system has been fantastic to senior levels of provincial administration in managing this case, involving international hospitals, breeding zebrafish to replicate the specific mutation, working to manage the treatment of this complex child who is close to turning 5 but likely would have died in the first few weeks after birth in another era.
Keeping this child alive (he is in and out of the hospital about 50%) has easily cost a tremendous amount of public money, but the insurance system risk pool is designed to handle these sorts of outlier cases to ensure future cases can benefit and that this child can have (mostly) a good life in between and during hospital stays. This child gets world class care and has been kept alive due to the system mostly working.
That's the good part. The bad part is that managing complex care in general is a mess as in many health systems, making it a full time job for at least one parent to juggle the various specialists, appointments, tests, medications, history, etc... Which is difficult if you're a single parent. It's almost easier to go on welfare than to work if you are a parent to a critically ill child. So you can get nursing staff to help at home but it's debatable what is covered and what is not, medical expense deductions have some arcane regs like you can't expense a trip under 40km, yet this child has on average 280 trips to the hospital or a clinic a year... Adding up to a lot of expense. Some things like specialized child formula weren't covered by health insurance either until recently (which can cost upwards of $1400 monthly, really sucks when your child can't eat anything due to esophageal issues and has a G-tube and needs this formula to stay alive..)
So, not ideal... But Is this all socialized medicine ills? Sort of I guess? I can see the same problems in a private system.
I live in Hawaii. When I need something mailed to or from here, I use USPS. FedEx or UPS are an order of magnitude more expensive and, in my experience, not faster or more reliable.
>Try getting an MRI in Canada. Canada rations care via wait lists.
Exactly. Health care in Canada is a crap shoot. If you're in a major centre and are able to get a family physician I'm sure you think the system is great. Try being sick somewhere where the only option is an over-worked ER staffed by locums.
> Government is force - nothing more. The purpose of government is to protect our rights. "Single payer" (a euphemism for socialized medicine) by definition violates rights by forcing people to do things against their will.
"Rights" are basically just freedoms we've decided we like a whole lot and want the government to guarantee, so that's not exactly a static category. So on the one hand we can just decide whichever rights are being violated are—at least conditionally—not rights. Boom, done.
On the other hand, is there any such thing as a government that does not force people to do things they wouldn't voluntarily do? I'm pretty sure if you take that away what's left has lost the single most important trait of a government, and what's left is... I don't know, a non-profit begging for money on TV and utterly incapable of fulfilling any of the usual roles of a government? In that case, the fact that single-payer would force people to do things doesn't per se remove it from the realm of legitimate government activity.
As for the utility of the term "single payer", I believe it's distinct enough from the much broader "socialized medicine", which could include things like seizing hospitals and making doctors exclusively state employees, to make it substantially more than just a euphemism.
"'Rights' are basically just freedoms we've decided we like a whole lot and want the government to guarantee" - as I said below, the logical conclusion of that argument is not a world you'd want to live in. -- "is there any such thing as a government that does not force people to do things they wouldn't voluntarily do?" - no there isn't. That's why it should be limited to protecting other people's rights.
> "'Rights' are basically just freedoms we've decided we like a whole lot and want the government to guarantee" - as I said below, the logical conclusion of that argument is not a world you'd want to live in.
How is that not the world we live in? What is the alternative? At some point someone's deciding what's a right and what isn't. Other people may disagree. Rights aren't a law of nature, they're a fuzzy category, subject to conditions and caveats and shifting over time.
> "is there any such thing as a government that does not force people to do things they wouldn't voluntarily do?" - no there isn't. That's why it should be limited to protecting other people's rights.
But a lot of the things government does that don't fall within that narrow limit really, really appear to make my life and the lives of the people I care about much better, at relatively little cost (for a broad definition of cost). Few or none of the OECD states seem too bad, to put it mildly. None are unqualified disasters, or even close. Meanwhile a "drown it in a bathtub" government coexisting with an advanced economy (correct me if I'm wrong) remains hypothetical—indeed, I think it's fair to call mainstream the view among experts that governments' special ability to overcome coordination problems and take action to nurture markets is vital to an advanced economy—as do the effects of such a system. So it's definitely going to be an uphill battle convincing me that our government "should be limited to protecting other people's rights", without some other state practicing that and full of citizens telling me "no, really, it's pretty great".
"What is the alternative?" - a system of rights based on the nature of human beings. Human beings survive by producing the things we need to survive. We need governments to protect others from initiating force against us in opposition to our primary needs of living.
Will we ever see this in reality? No. But, the closer humans have gotten in history the better off they've been.
> "What is the alternative?" - a system of rights based on the nature of human beings. Human beings survive by producing the things we need to survive. We need governments to protect others from initiating force against us in opposition to our primary needs of living.
I'm having trouble figuring out how this doesn't still boil down to people making judgement calls on what is and isn't a right, just with a level of indirection, so maybe this other question will help me see what you mean:
> Will we ever see this in reality? No. But, the closer humans have gotten in history the better off they've been.
Do you have an example in mind of when and where we've come especially close to this ideal?
"I'm having trouble figuring out how this doesn't still boil down to people making judgement calls on what is and isn't a right" - at the end of the day we're ruled by people. But, there should be a standard by which decisions are made other than "whatever the majority decides".
> But, there should be a standard by which decisions are made other than "whatever the majority decides".
It seems like a standard is just a reason for choosing a given set of things to call rights and a given role for government, and we're all set to circle right back to where we were—the people with the power to affect government choosing those things, based on reasons (which was implicitly the case before, anyway). At some point there must be compelling evidence for selecting a given standard over any other, and one would hope that standard may change in the face of new evidence.
"Do you have an example in mind of when and where we've come especially close to this ideal?" The USA of course - though it's quickly moving away. Hong Kong (though China is ruining it). England before the Fabians took over. Japan after the war. There are many others.
How can you logically have a right to the services of someone else? Health care is a product - doctors, hospitals, medicine, etc. These must all be produced by people.
You can't divine rights out of some fundamental logic. The only ones who can decide what rights humans have are the humans themselves, and then we structure our society to make sure those rights aren't violated.
Maybe I should have been clearer: Just because you say it's derivable "from logic" doesn't mean it is. No logic system can do anything without axioms, and the adoption of those axioms is an arbitrary choice.
Also, here in Connecticut (the place where the rich historically sent their kids to school), there are plenty of public schools that are at least as good or better than at least some nearby private schools. When you get into preschool, for instance, the public schools are a HUGE improvement over all but the top-tier private ones. Likewise, the "magnet" program schools are a public option that is as good or better than most private schools nearby (they are special, well-funded by the state, and use a lottery to get in, though).
This is coming from someone who agrees with you in principle, too. Reality is nuanced, though.
I believe your examples of public services being worse than their private counterparts is a specious argument. Most private schools are paid for by rich people. The cost to attend is higher than public school so it would reason that the quality is better. Same for USPS vs FedEx. The shipping rates for USPS are much cheaper.
Some people are price sensitive. Cheaper is all they can manage to afford and are willing to accept less quality in return. As a healthy person I'd rather take a two percent annual increase in insurance premiums for lower quality of care since I do not have much need for services.
Where's your evidence that most private school is paid for by rich people? Anecdotally, the people that I know that use private schools are middle class. Also, if there weren't public schools there would be more varieties of private schools.
"As a healthy person I'd rather take a two percent annual increase in insurance premiums for lower quality of care since I do not have much need for services." --
And I wouldn't. Why do your views trump others who disagree?
People state this as if it's some obvious truth, and it makes no sense to me. My statement would be:
Government is a mechanism which we, as a group, have decided should handle certain functions of society.
It's the logical extension of a group of people in the jungle deciding "you know what, it would be awesome if we got together and built a trail between all our huts so we can visit each other."
Part of that agreement might be "hey, when these barbarians show up we should all protect each other", but to arbitrarily say that the only purpose of government is those kinds of agreements I think speaks to a very warped sense of community.
The purpose of government is about whatever the governed of the current day decide that purpose is. Your view of government is just that, your opinion, not a fact. Liberals in particular tend to see the purpose of government as providing options for those who don't have any other options because the market fails many people. As such social programs have existed for decades, it's factually self evident that the purpose of government as decided by the majority of the population, far exceeds protecting rights.
> Are public schools better than private schools?
Yes, they are far better than private school, for those who can't afford private schools.
> Is the US postal system better than FedEx?
Yes, it's far better than FedEx for those who live in place FedEx wouldn't and couldn't operate profitably because the postal system's aim isn't efficiency, it's coverage to "everyone" everywhere, something no market solution will offer because that's not a profitable mission.
So it sounds to me like you don't understand the purpose of government and don't understand why government is necessary in such situations, because you can't think outside of your own self and realize that markets don't serve everyone.
"The purpose of government is about whatever the governed of the current day decide that purpose is" - I believe you can see that the logical conclusion of that point of view is not a world you'd want to live in. In the US, at least, we have a Constitution that prevents the worst uses of government (though not as much as it used to).
Wrong, it's exactly the world I want to live in and the Constitution happens to agree, which is why we've amended it many a time, because the governed decided it was outdated. The notion that we should still be living by the dictates of men long dead is simply absurd, every generation has a right to decide for itself how its government works as it should, and as we have done.
So, if the majority votes to take away the rights of, oh I don't know, Japanese citizens -- that's a world you want to live in? You're not thinking clearly about the issue.
No, you're not thinking clearly; the constitution requires a super majority, and yes, if a super majority of people want to be governed a particular way, then they deserve that right, even if it's stupid; but you'd never get a super majority to agree to such a stupid bigoted rule and it conflicts with other parts of the constitution and would be ruled unconstitutional by the courts. Without the notion that the rules can and do change for each generation, we'd still have slaves, thankfully, we don't live under a set of rules that can never be changed.
The will of the majority, and especially the super majority, is far better a thing to live under than the will of a handful of people from 238 years ago and any suggestion to the contrary is the definition of not thinking clearly.
"you'd never get a super majority to agree to such a stupid bigoted rule and it conflicts with other parts of the constitution" - oh really? Please open a US history book.
Personal attacks like this (and "you're not thinking clearly", above) are not allowed on Hacker News. We ban accounts that do this, so please don't do it again. Instead, please (re-)read the HN guidelines and post civilly and substantively, or not at all—regardless of the clarity of someone else's thinking.
Please try and think for 2 seconds instead of responding to the first stupid idea that jumps into your brain; obviously I'm referring to passing such a law today, what happened historically isn't relevant. But you've shown your colors, you have no intention of actually hearing anything said to you because you're more interested in arguing utterly stupid diversions of the main topic. You ignored everything said except the one thing you could find to disagree with, you're a child. Goodbye.
As we've told you many times, you can't comment like this here. And certainly you can't create separate accounts to do it with. I've banned this one.
You're a longstanding user and we've bent over backwards not to ban you, despite serious abuses on your part. The situation isn't going to stay this way.
You're being absurd, all I said was "no you're not thinking clearly" in response to being accused of not thinking clearly. I was perfectly civil, and I created another account because of your unjustified slow ban on me. I've bent over backward conforming to your absolutely inhuman and ridiculous civility rules that expect people to never ever ever have the slightest conflict with one another. I behaved fine, check yourself, I didn't start this conflict, he did.
As you seem to be dying to ban me, then ban me already; I'll just bounce through a proxy and open another account, you know as well as I do there's really nothing you can do to keep me off the site and that your best option is to keep me civil, which I've been doing for quite a while, so drop the empty threats please.
So you'd be perfectly ok with certain people being counted as only 3/5 of a person, and only white, landowning males having the right to vote? What about that whole slavery thing? Cause the Constitution shouldn't be changed and all.
The health systems in Europe are not radically different from the US system. The efficiencies of each are difficult to quantify without context. For example, the US invents most of the drugs and medical technology used by the world. Would this still happen if there was more invasive regulation? We can't know.
Besides all of this, think of every other area of the market where the government insinuates itself. Are public schools better than private schools? Almost never. Is the US postal system better than FedEx? Of course not. The government is not a commercial entity. The incentives and influences on it are not conducive to producing quality products at good prices.