How would you categorize the asymmetry of power and lack of real choice?
When I buy indoor plants or VOD subscriptions, I'm participating in a market. I can choose to not buy these things at all.
When I buy healthcare (via insurance or not), I'm basically doing what my doctor suggests, because well, it's about my _health_. The consequences and risks of not buying can be too great.
Is healthcare an actual market in the real sense, or are we just pretending it is?
Are there things that are inherently unsuitable for privatization?
My thinking is that public transport, healthcare, law enforcement (including prisons obviously), public education and so on are all to some degree or another unsuitable for competitive markets. The incentives, power relations, feedback loops etc. just don't fit.
The list of services in your last 'graph are all what are generally considered public goods, not in the sense that they are publicly provided, but that they are non-excludable and non-rivalrous. That is, an ideal public good cannot limit who benefits by it (directly or indirectly), and additional users don't affect total availability (much). These are both ideal conditions, and there may be some degree of excludability and/or rivalrousness in practice, but generally public goods have far less as a matter of degree.
Other notable public goods are national defence, information, other general infrastructure, communications technology, etc.
There's another class of goods and services which are often at least in part government-provided because of coordination problems when provided by independent entities. Examples would include standards (weights and measures, specifications, safety requirements, shipping containers), transactional interchange formats (e.g., billing and purchase codes), large-scale information gathering (census, economic data), and the establishment of laws, regulations, courts, and enforcement themselves. Max Weber's definition of government as having a monopoly on the claim to legitimate use of force is another such case: regions in which that legitimate claim monopoly doesn't exist, in any of its three variants (not a monopoly, illegitimate, ineffectual force) are effectively ungoverned.
And then there's the case of insurance services, especially over broad areas or long periods. Pensions, healthcare, and disaster insurance would be three areas in which governments often, though not always, play a role, largely because private provision of such services simply fails to meet social needs.
If one looks at national governmental budgets, the largest items are typically pensions (e.g., Social Security in the US), healthcare (Medicare), and defence, with all other spending (largely: collective-action regulatory roles) being about a quarter of the overall total.
"Is healthcare an actual market in the real sense, or are we just pretending it is?"
Who actually is pretending this is a real market? In a functioning market all participants have access to the relevant information, there is choice and competition.
* With employer based insurance you basically have no or minimal choice.
* Getting information from providers and hospitals to make a decision is extremely hard to impossible
* Pharmacies have contracts that forbid them to inform patients about alternatives
* Insurances' websites often list doctors that not in network anymore
The system in the US is very far away from anything resembling a market.
In all sane markets, the buyer is both the person who selects the goods to purchase, and the one who pays the price agreed upon. These things seem linked, but it turns out it's really easy for them to be separated.
When medical care is funded by health insurance, you are the person who selects the goods, but you're not the one that pays the price. In some cases, you will never even be informed of the price, you don't want to be. And you rarely find out unless there are "problems".
The insurer doesn't worry if the bills are high, they'll just raise your premiums... but your monkey brain never makes the connection that your poor goods selection resulted in the higher price. It might even be unfair to blame you, even if you are careful which products you purchase, someone else was curious and you're punished with them. This incentivizes you to be less careful, not more. But if bills are really getting out of hand, the insurance company can just deny the claim.
This incentivizes the medical care provider to raise the number on the bills. If half of claims are denied, just double the bills and the math works out. The medical care provider is incentivized to get tricky with the billing codes, to obfuscate, to over-complicate. Over decades, a culture of being borderline fraudulent develops, a mythology that it's impossible to even know the costs upfront.
If I wanted to invent a machine that would cause prices to spiral out of control at the fastest possible rate, I don't think I could beat this.
> public education
By all means, I wish medical care could be as wonderful as public education. We could have the excellence of inner city Baltimore schools, coupled with the overabundance of service we see in California schools and the high levels of compensation of the average nationwide teacher salaries. Never mind the great outcomes that institution provides.
I'm not American so I don't know whether the last paragraph is sarcastic or not. But from the tone I guess it is.
Public education where I live is not perfect, but it works well and teachers are compensated fairly. I consider it one of the bedrocks of a democratic society.
In know of people who went to public schools in America and have said good things about it. From my very limited knowledge it seems like the quality of public schools varies a lot from area to area though.
I am American and since it's been mumble mumble years since the public school system, I'm sure the situation is changed. I grew up in a factory town and they did a pretty good job teaching the basics of English, mathematics, and science. Going to college was a bit of a shock but that's a well-known problem.
Nowadays, it is incredibly variable because school systems are funded at the local level, most the curricula is decided at the local level so you can go from a very well-funded high-quality teacher school like the Newton, Wellesley, and Weston high schools to the low income areas out West where the public school system has been outsourced to Christian schools.
I also think the public school system is a bedrock of a democratic society if the curriculum is uniform and covers critical thinking, history, literature, and sciences without flinching. I feel like we need to draw a line in the sand and say what someone needs to know to be a citizen of this country. The problem is, there are lots of different opinions where that line should go ranging from the religious and racist to the equally dogmatic far left.
I think it's misguided to point at the failures of one chronically underfunded public function to say that another would also perform poorly, unless the point is to say we would probably underfund public health care as well.
When I buy indoor plants or VOD subscriptions, I'm participating in a market. I can choose to not buy these things at all.
When I buy healthcare (via insurance or not), I'm basically doing what my doctor suggests, because well, it's about my _health_. The consequences and risks of not buying can be too great.
Is healthcare an actual market in the real sense, or are we just pretending it is?
Are there things that are inherently unsuitable for privatization?
My thinking is that public transport, healthcare, law enforcement (including prisons obviously), public education and so on are all to some degree or another unsuitable for competitive markets. The incentives, power relations, feedback loops etc. just don't fit.