Heeeeeeere's Obamacare!

[RandFan]

Is it logical to think a system run by the government is going to be more efficient and cost less?

Yes.

This is a common misconception. It results from putting too much trust in the invisible hand and not understanding the full range of human psychology. It results from not understanding monopolies and the tendency for industries to become staid and engage in collusion both explicitly between parties but secret to others or a tacit form of collusion which is the most wide spread form.

The following is a real world example of how humans can, without explicitly doing so, actually collude to the benefit of both parties. It's starts at the 8:00 mark.

Competition and capitalism are not the same thing. We want and need competition for the self regulating features it gives to us and the powerful incentive to be innovative in order to win long term rewards. However, competition is not a magical panacea.

 

[Mark6]

Is it logical to think a system run by the government is going to be more efficient and cost less?

Ah yes, the reason we'll soon have no more antibiotics.

See, there are two problems here: one is that it costs over US $1,000,000,000 to market a new drug, due to those pesky government requirements to demonstrate that drugs are safe before marketing them. This came about, in part, because of the tens of thousands of birth defects caused by thalidomide, but who cares about that? I mean, having a drug that alleviates morning sickness should be worth having a few percent chance that your baby is horribly deformed, right? Why complain if someone wants to market snake oil or something that's poisonous, if it profits them? The government shouldn't be in the business of protecting its citizens' health.

Anyway, antibiotics have been known to have a short efficacy period since the 1950's. Bacteria evolve resistance so fast that you need a steady stream of new antibiotics in the pipeline to keep up with them.

Unfortunately, unlike, say, Viagra, cholesterol meds, or antidepressants which work about as well as placebos, there's not much of a profit in selling antibiotics. Sure, farmers give them to cattle to plump them up, but that's not enough to justify blowing $1 billion on developing a new one.

Hence, it's not profitable to make more antibiotics, and soon we won't have any. That will be sad, of course, because it will have follow-on impacts, like, oh, no transplant surgeries, and, in fact, the risk of death due to hospital infection will rocket back to 1920's levels. As with your grandparents or great grandparents, a scratch in 20 years will have a real chance of killing you, if you get a multidrug resistant infection. Your death will be slow and painful, but at least, no one will lose a profit by curing you with a few pills, and the government won't be able to interfere.

This is the logic of profit without government control. Incidentally, finding new drugs is getting so unprofitable that non-profits such as the Gates Foundation (and the US government) are paying for a lot of drug development. Obviously, this is stupid socialism and a frivolous waste of hard-earned capitalist gains, but whatever. Gates, at least, can choose how he wants to waste his fortune.

Or, just possibly, there's something wrong with the logic of getting the government out of the way? I think HL Mencken put it reasonably well, back in the 1920's: "For every complex problem, there is an answer that is clear, simple, and wrong."

 

[Fudbucker]

When it comes to Logger...

Why feed the troll?

 

[logger]

And yet, that sounds like the situation now!

How ironic.

Why is it we have it now, not from more freedom.

 

[logger]

Cooperation, helping your neighbor, feeding the poor, volunteering, charity, etc., these do not make us slaves. They make us empathetic human beings. We have the capacity for empathy because we are a social species and it is in the best interest of us all to see to the health and well-being of the most vulnerable.

This is the disconnect, I expect people to do this, not have government force us too.

 

[logger]

When it comes to Logger...

Why feed the troll?

We're actually having a great conversation, I know you're not used to that.

 

[logger]

Yes.

This is a common misconception. It results from putting too much trust in the invisible hand and not understanding the full range of human psychology. It results from not understanding monopolies and the tendency for industries to become staid and engage in collusion both explicitly between parties but secret to others or a tacit form of collusion which is the most wide spread form.

Isn't creating a level playing field what government does well, one of the few things it does really well.

Taking over and owning the field of players is when government goes to far.

 

[ehcks]

Isn't creating a level playing field what government does well, one of the few things it does really well.

Taking over and owning the field of players is when government goes to far.

And yet many of those field-leveling measures are treated as evils. Progressive taxes, welfare programs, minimum wages, regulated minimums for what counts as insurance; all efforts to prevent races to the bottom. All insulted and threatened with repeal by republicans.

 

[asydhouse]

Why is it we have it now, not from more freedom.

You work for a boss who pays you the minimum he can get away with. A tiny number of people grow exponentially richer at the expense of the squeezed middle classes, who work ever harder for ever less return.

So you are a worker in a system which dangles the carrot of possible success which is predicated on exploiting the differential between supply and demand which depends on scarcity and institutionalised poverty, to keep unemployment at a level which can keep the wages down through competition for jobs.

That's the capitalist system whose greatest success has been in deluding the workers into thinking they are free when really they are the workers in a system which traps people like yourself into a lifetime of slaving for money in order to maintain a fantasy of independence which ignores the interdependent nature of all life and culture.

It's getting worse. It's an unsustainable system heading for a collapse, if the status quo thinking continues to blunder on wearing rosy glasses such as you have been trumpeting here. Immature thinking masquerading as adult, when really it's a simple cartoon of macho frontiersman fantasy standing on privilege, inherited conditions of wealth in your society which supports your delusion of independence.

You asked, I've answered.

 

[logger]

You work for a boss who pays you the minimum he can get away with. A tiny number of people grow exponentially richer at the expense of the squeezed middle classes, who work ever harder for ever less return.

So you are a worker in a system which dangles the carrot of possible success which is predicated on exploiting the differential between supply and demand which depends on scarcity and institutionalised poverty, to keep unemployment at a level which can keep the wages down through competition for jobs.

That's the capitalist system whose greatest success has been in deluding the workers into thinking they are free when really they are the workers in a system which traps people like yourself into a lifetime of slaving for money in order to maintain a fantasy of independence which ignores the interdependent nature of all life and culture.

It's getting worse. It's an unsustainable system heading for a collapse, if the status quo thinking continues to blunder on wearing rosy glasses such as you have been trumpeting here. Immature thinking masquerading as adult, when really it's a simple cartoon of macho frontiersman fantasy standing on privilege, inherited conditions of wealth in your society which supports your delusion of independence.

You asked, I've answered.

First of all, I'm not a "worker" I own my own business, I also used to be an "employee"

Anyone can own their own business, except in communist countries.
The human spirit yearns to be free. you may think it Immature thinking, that's because it really does take a "real man" to be able to take care of his family. Besides we don't have the best most powerful country ever in the shortest amount of time for nothing. That's why EVERYONE wants to be here, even you.

Answer this, what system is better?

 

[logger]

And yet many of those field-leveling measures are treated as evils. Progressive taxes, welfare programs, minimum wages, regulated minimums for what counts as insurance; all efforts to prevent races to the bottom. All insulted and threatened with repeal by republicans.

What you mentioned doesn't give a level playing field, it steals from another to give to who the government favors at that particular time. What I'm talking about is laws.

 

[sunmaster14]

<snip>

Average cost of providing education to a student in Canada - $12,000
Cost of a private school in Canada with a comparable curriculum - $15,000

I suspect you are confusing cost with price. I don't know much about private schools in Canada, but private school teachers in the US tend to make a lot less than public school teachers. The price of private school in the US is grossly inflated by restricted supply. Also, of course, the consumer is getting a much better product.

 

[ehcks]

What you mentioned doesn't give a level playing field, it steals from another to give to who the government favors at that particular time. What I'm talking about is laws.

That's what a level playing field is, unless you want the level floor to be at zero.

 

[RandFan]

This is the disconnect, I expect people to do this, not have government force us too.

We are the government. We elect our leaders through a democratic process. It's very difficult for people to come up with the resources to meet all of the needs of society without some kind of organization. The government has the ability to marshal resources to build roads and bridges, atomic weapons, travel to the moon, find cures for diseases, invest in advanced technology, etc., etc..

The government is just us organized.

 

[sunmaster14]

Indeed, and there have been papers comparing the admin costs of the US and Canadian systems (the tldr version is that the US system has higher admin costs)

First, the difference in administrative costs account for a small part of the difference in per capita health care costs (your paper claims $752). Second, it's unclear that more government control would reduce administrative costs. Much of the additional administrative overhead in the US is caused by excessive government regulation, and much of it is probably caused by the greater economic, cultural, and health diversity in the US population. Third, we have an imbalance between demand for healthcare and supply of healthcare, which is driving up healthcare costs much faster than inflation. Pruning a bunch of administrators and paper shufflers isn't necessarily going to increase supply, since they aren't generally capable of doing medically useful work themselves. Although it's true that there is an administrative burden borne by the doctors themselves, and alleviating that would increase the supply of healthcare, from what I've heard Obamacare has greatly increased that burden, so it seems we've headed in the wrong direction.

Also one could just look at the figures in my sig.

Apples and oranges. I bet if you hand the NHS a cross section of the US population, you'll see much higher per capita costs.

 

[RandFan]

Isn't creating a level playing field what government does well, one of the few things it does really well.

Taking over and owning the field of players is when government goes to far.

Government can and does go too far. I'm not by any means an apologist for bureaucracy. Government can be and often is corruptible. It's fair to note that private industry provides a lot of the money for elections. I think a case can be made that American government is more sensitive to the needs and wishes of businesses first and citizens second than it is an independent entity beholden only to itself.

It's a big ugly mess.

'People who love sausage and respect the law should never watch either one being made,' — Mark Twain

'Democracy is the worst form of government, except for all the others.' —Winston S. Churchill

 

[sunmaster14]

We are the government. We elect our leaders through a democratic process. It's very difficult for people to come up with the resources to meet all of the needs of society without some kind of organization. The government has the ability to marshal resources to build roads and bridges, atomic weapons, travel to the moon, find cures for diseases, invest in advanced technology, etc., etc..

The government is just us organized.

"Government" is simply the name we give to the things we choose to do together. "Corporation" is simply the name we give to the things we choose to do together without coercion.

 

[sunmaster14]

Ah yes, the reason we'll soon have no more antibiotics.

See, there are two problems here: one is that it costs over US $1,000,000,000 to market a new drug, due to those pesky government requirements to demonstrate that drugs are safe before marketing them. This came about, in part, because of the tens of thousands of birth defects caused by thalidomide, but who cares about that? I mean, having a drug that alleviates morning sickness should be worth having a few percent chance that your baby is horribly deformed, right? Why complain if someone wants to market snake oil or something that's poisonous, if it profits them? The government shouldn't be in the business of protecting its citizens' health.

Anyway, antibiotics have been known to have a short efficacy period since the 1950's. Bacteria evolve resistance so fast that you need a steady stream of new antibiotics in the pipeline to keep up with them.

Unfortunately, unlike, say, Viagra, cholesterol meds, or antidepressants which work about as well as placebos, there's not much of a profit in selling antibiotics. Sure, farmers give them to cattle to plump them up, but that's not enough to justify blowing $1 billion on developing a new one.

Hence, it's not profitable to make more antibiotics, and soon we won't have any. That will be sad, of course, because it will have follow-on impacts, like, oh, no transplant surgeries, and, in fact, the risk of death due to hospital infection will rocket back to 1920's levels. As with your grandparents or great grandparents, a scratch in 20 years will have a real chance of killing you, if you get a multidrug resistant infection. Your death will be slow and painful, but at least, no one will lose a profit by curing you with a few pills, and the government won't be able to interfere.

This is the logic of profit without government control. Incidentally, finding new drugs is getting so unprofitable that non-profits such as the Gates Foundation (and the US government) are paying for a lot of drug development. Obviously, this is stupid socialism and a frivolous waste of hard-earned capitalist gains, but whatever. Gates, at least, can choose how he wants to waste his fortune.

Or, just possibly, there's something wrong with the logic of getting the government out of the way? I think HL Mencken put it reasonably well, back in the 1920's: "For every complex problem, there is an answer that is clear, simple, and wrong."

I don't see any of the usual reasons for a market failure (i.e. externalities) here that require government intervention. If drug companies don't think that a new antibiotic could be profitable, it's either because they don't think the future demand/need will justify the investment (whether or not they are right is irrelevant; their best guess is presumably an expert guess), or because they think the government will artificially cap the price of a new, successful antibiotic. Perhaps if they didn't have to worry about the government capping the price of new drugs, there would be more drug development.

 

[RandFan]

What you mentioned doesn't give a level playing field, it steals from another to give to who the government favors at that particular time.

Our wealth is greater, in part, because we do help the poor. Not in spite of it.

|Nation|Nominal GDP|

| United States | 16,244,600 |
| China | 8,358,400 |
| Japan | 5,960,180 |
| Germany | 3,425,956 |
| France | 2,611,221 |
| United Kingdom | 2,471,600 |
| Brazil | 2,254,109 |
| Russia | 2,029,812 |
| Italy | 2,013,392 |
| India | 1,875,213 |
| Canada | 1,721,445 |
| Australia | 1,584,419 |
| Spain | 1,322,126 |
| Mexico | 1,183,655 |
| South Korea | 1,129,598 |
| Indonesia | 878,043 |
| Turkey | 788,299 |
| Netherlands | 770,067 |
| Saudi Arabia | 711,050 |
| Switzerland | 631,183 |

 

[jimbob]

First, the difference in administrative costs account for a small part of the difference in per capita health care costs (your paper claims $752). Second, it's unclear that more government control would reduce administrative costs. Much of the additional administrative overhead in the US is caused by excessive government regulation, and much of it is probably caused by the greater economic, cultural, and health diversity in the US population. Third, we have an imbalance between demand for healthcare and supply of healthcare, which is driving up healthcare costs much faster than inflation. Pruning a bunch of administrators and paper shufflers isn't necessarily going to increase supply, since they aren't generally capable of doing medically useful work themselves. Although it's true that there is an administrative burden borne by the doctors themselves, and alleviating that would increase the supply of healthcare, from what I've heard Obamacare has greatly increased that burden, so it seems we've headed in the wrong direction.

31% in 1999 in the US. Other papers have put non-productive costs (advertising and admin) at up to 38% in the US.

Int J Health Serv. 2004;34(1):65-78.

Abstract

A decade ago, U.S. health administration costs greatly exceeded Canada's. Have the computerization of billing and the adoption of a more business-like approach to care cut administrative costs? For the United States and Canada, the authors calculated the 1999 administrative costs of health insurers, employers' health benefit programs, hospitals, practitioners' offices, nursing homes, and home care agencies; they analyzed published data, surveys of physicians, employment data, and detailed cost reports filed by hospitals, nursing homes, and home care agencies; they used census surveys to explore time trends in administrative employment in health care settings. Health administration costs totaled at least dollar 294.3 billion, dollar 1,059 per capita, in the United States vs. dollar 9.4 billion, dollar 307 per capita, in Canada. After exclusions, health administration accounted for 31.0 percent of U.S. health expenditures vs. 16.7 percent of Canadian. Canada's national health insurance program had an overhead of 1.3 percent, but overhead among Canada's private insurers was higher than in the U.S.: 13.2 vs. 11.7 percent. Providers' administrative costs were far lower in Canada. Between 1969 and 1999 administrative workers' share of the U.S. health labor force grew from 18.2 to 27.3 percent; in Canada it grew from 16.0 percent in 1971 to 19.1 percent in 1996. Reducing U.S. administrative costs to Canadian levels would save at least dollar 209 billion annually, enough to fund universal coverage.

I'd say that is an evidence that public systems can be more efficient than private ones.

Apples and oranges. I bet if you hand the NHS a cross section of the US population, you'll see much higher per capita costs.

The populations are not as dissimilar as you think. What is so exceptional about the US that public systems wouldn't work? Canada covers a larger area with a smaller population. The UK has a higher population density, and 64-million people is a significant fraction of the US. The EU as a whole has a larger population.