Public vs. Private institution discussion

[nwdiver]

Question, when the government is involved is anything ever run efficiently and well?

- Eliminating Smallpox
- Transcontinental Railroad
- Getting a man on the moon
- GPS
- Interstate Highway System
- Elimination of Malaria from the US
- Elimination of Polio from the US
- Defeating Hitler

I'm sure I could name a few dozen more....

Sometimes the only way to accomplish something is the public working together without profit as the primary motive. The public doesn't necessarily have to 'control' the solution but it does need to fund it. The VA is an example of a system where the government 'runs' healthcare but a system where the public 'funds' healthcare like medicare would work too. If privately driven universal access to healthcare was possible someone would have done it by now.... the US tried... it doesn't work. The US is the only country in the world were you can lose your home by getting sick.... it's pathetic.

There are some things most people agree our society should have that market forces cannot provide. Access to quality healthcare for everyone is one of those things.

 

[trils0n]

Anyone that has ever been a part of the VA Medical System should understand how "Single Payer" Gov healthcare would run.

The VA is government run heathcare, not single payer insurance. Single Payer means the govt takes the role of the insurer, not running the hospital/employ the doctors, etc., like the VA. I agree the government shouldn't run heathcare. Delivery of care would remain private under single payer. Delivery of care isn't the major problem with our healthcare system -- it is affordability, or insurance. AFAIK, the government (Medicare) is already more efficient (cheaper) than private industry at providing insurance.

 

[bkp_duke]

- Eliminating Smallpox
- Transcontinental Railroad
- Getting a man on the moon
- GPS
- Interstate Highway System
- Elimination of Malaria from the US
- Elimination of Polio from the US
- Defeating Hitler

I'm sure I could name a few dozen more....

Sometimes the only way to accomplish something is the public working together without profit as the primary motive. The public doesn't necessarily have to 'control' the solution but it does need to fund it. The VA is an example of a system where the government 'runs' healthcare but a system where the public 'funds' healthcare like medicare would work too. If privately driven universal access to healthcare was possible someone would have done it by now.... the US tried... it doesn't work. The US is the only country in the world were you can lose your home by getting sick.... it's pathetic.

There are some things most people agree our society should have that market forces cannot provide. Access to quality healthcare for everyone is one of those things.

Having trained and worked in this industry, I completely DISAGREE.

Counterpoint to some of your "points":

Man on moon - NASA did great work there, but look how things have stalled since. Now look at SpaceX - they are doing rocketry better, and cheaper than NASA ever did. I'm sure they will beat NASA to a manned Mars mission. Competition is the key, and there is robust competition here.

Polio - interesting you bring that one up, the original Polio vaccine (the Salk vaccine) was both privately and publicly funded, but the majority of funding came from individual donations through the newly (at the time) founded March of Dimes.



Anyway, the ROOT of the issue here is the 3rd party payer system. You have a group of individuals (insurance companies) that have a vested interested in keeping payments low to providers, but not necessarily a vested interest in improve the quality of care and outcomes. Give people control of their healthcare, and not the government, and you will see a plethora of companies rise up to the challenge and innovate to truly improve care. Replacing the 3rd party payer system, however, with an even less efficient system (gov control) is NOT the answer.

 

[bkp_duke]

The VA is government run heathcare, not single payer insurance. Single Payer means the govt takes the role of the insurer, not running the hospital/employ the doctors, etc., like the VA. I agree the government shouldn't run heathcare. Delivery of care would remain private under single payer. Delivery of care isn't the major problem with our healthcare system -- it is affordability, or insurance. AFAIK, the government (Medicare) is already more efficient (cheaper) than private industry at providing insurance.

I guarantee you that if the Gov becomes the payer, they will want to become the provider as well. It's a natural evolutionary step for "cost cutting".

And Medicare is NOT cheaper than private insurance. Not by a long shot. You should look up "Medicare fraud" to see how many billions are wasted yearly due to the horrible inefficiencies of this system. It's far worse than private insurance fraud.

When was the last time you were at the DMV? Now think of that for healthcare, and you have a good idea how a government sponsored / administrated / insured / run system would look like.

 

[bkp_duke]

While the retirement stuff is a huge debacle and I don't really know if the rest could be run better, I have to say that mail delivery has been reasonably priced, reliable, and on time most of my life.

Mail delivery is unprofitable, year after year. You should pick a better example if you want to make your point.

 

[bkp_duke]

re:gov't past inefficiencies - with advanced AI systems in place, this problem should take care of itself and the gov't could actually run these types of programs like they should be run.

ROFLMAO

HA HA HA HA HA HA

Do you ACTUALLY believe this? Seriously, you have to be joking, right? I'm dead serious in asking that question.

The US Gov computer systems at BEST still run Windows NT era for critical infrastructure (and things like nuclear defense are on 1970s gear). There is no way on earth that someone is going to pay for AI development for something like this in the next 30 years. Not when it would eliminate so many pension-eligible government jobs. Even the Dems would laugh that idea out of committee.

 

[ggies07]

ROFLMAO

HA HA HA HA HA HA

Do you ACTUALLY believe this? Seriously, you have to be joking, right? I'm dead serious in asking that question.

The US Gov computer systems at BEST still run Windows NT era for critical infrastructure (and things like nuclear defense are on 1970s gear). There is no way on earth that someone is going to pay for AI development for something like this in the next 30 years. Not when it would eliminate so many pension-eligible government jobs. Even the Dems would laugh that idea out of committee.

Well, we are not talking about what ifs with the technology, this whole thread is based on the fact that WHEN it happens, how will society act. Plus, you can't stop progress. Businesses will start to use it, then states, then the gov't will have to.

 

[bkp_duke]

Well, we are not talking about what ifs with the technology, this whole thread is based on the fact that WHEN it happens, how will society act. Plus, you can't stop progress. Businesses will start to use it, then states, then the gov't will have to.

I don't fully agree with your "not if but when" statement.

I'm neck deep in IT (run a Cloud infrastructure company, and am a retired physician). The most out-of-date customers I have ever seen are medical groups and hospitals. And that's PRIVATE sector, not government, so by your reasoning that should be the "efficient" end of the technology adoption curve. The management in healthcare is extremely resistant to change, no matter how much is implemented elsewhere. HIPAA only made this worse, not better, since there is a perpetual fear for being sued about a data breach, etc. The people that make these decisions would flat out not consider AI, not until the legal landscape improves considerably.

Furthermore, regarding the AI technology itself, I have yet to see any AI in the healthcare space that was remotely close to "alpha" technology. The decision-making tree is just too complex right now for them. It's the classic IT problem of GIGO (garbage in, garbage out).

 

[nwdiver]

Replacing the 3rd party payer system, however, with an even less efficient system (gov control) is NOT the answer.

A 3rd party private profit driven system has yet to work anywhere. Medicaid is extremely efficient compared to private insurance. ~7% of medicaid funding goes to maintain the system vs 14% for private insurance. Those $30M CEO bonuses gotta come from somewhere

More vs less efficient is the wrong way to look at it anyway. The question to ask it would to private sector do it at all? The 'invisible hand' doesn't care if insurance is affordable for everyone. The 'invisible hand' doesn't care if you lose your house when you get sick. As a society we've decided that people shouldn't die in the streets from preventable diseases.... now we need to figure out how we pay for it.

 

[Skotty]

Thanks skotty.....

LOL. Most of the trouble I've heard about the last few years was largely due to how the USPS retirement is all screwed up. But generally speaking, sometimes conservatives whine too much about the feds. If I couldn't afford to send mail, and the mail I did send was getting lost and delivered late, that would be worth complaining about. But I've been sending mail for over 30 years and it has worked exactly as I wanted it to. Also, the mail service doesn't have to be profitable. It's a public service. It just needs to try to break even. Recent trouble comes from 2 sources -- their messed up retirement situation, and the digital age which hurts their business in much the same way it's hurt newspapers. Anyhow, recent troubles aside, the mail has worked for decades. They have plans to improve the financials. We'll see how that goes over the next few years.

 

[Skotty]

BTW, you all want to know what a functioning federal government would look like?

Democrats determine what public services are needed.
Republicans run the services and police those services for abuse.

BAM! I just solved America.

 

[nwdiver]

But I've been sending mail for over 30 years and it has worked exactly as I wanted it to. Also, the mail service doesn't have to be profitable. It's a public service. It just needs to try to break even.

I'd argue that email has had more to do with the downfall of the USPS than their retirement plan. Times change; the primary function of the post office is effectively obsolete. I can't remember the last time I sent anything via mail. The only reason I still have a PO Box is to get my production checks from Xcel... which could easily be direct deposited.

Many Conservatives I've spoken to don't mind a government institution that has mostly outlived its usefulness because it's existence is written in the Constitution. ~200 years ago healthcare was more likely to kill you than heal you. It's a safe bet that if the founders thought 'post offices and post roads' were critical enough to be written into the constitution they would have thought the same of modern healthcare.

 

[bkp_duke]

But I've been sending mail for over 30 years and it has worked exactly as I wanted it to. Also, the mail service doesn't have to be profitable. It's a public service.

The problem here is that the law REQUIRES the USPS to be profitable, or at least strive to run itself in such a manner. It is more of a GSE (Government Sponsored Entity) than an actual branch of the government.

Ironically, it's all those piss-poor pension plans on the USPS books that keeps it from being profitable. If the USPS had transitioned to a 401k-based system 20 years ago like private businesses did, we would actually have LOWER postal rates, better service, and a profitable postal system.

Ironic how those bad decisions of the past keep haunting us, huh?

 

[deonb]

I'd argue that email has had more to do with the downfall of the USPS than their retirement plan.

Doubt it. I've had the same amount of mail yesterday than I did 20 years ago.

But now it's 99.99% junkmail. It used to only be 99.98%. So I guess, yeah, times have changed a bit.

 

[nwdiver]

Plain and simple, I make it a POINT to provide high-quality health care to every employee I have. I cover 100% of their premiums for the employee, and 75% for their family. It may be expensive, and I've personally taken a pay cut to do it, but it is the "right thing". Altruistic reasons aside, why would I do this? Because a healthy employee is a productive employee, and one that will stick with you longer.

My post had nothing to do with employer sponsored insurance. The point was that private insurance is less efficient than medicare in large part due to the profit motive of insurance companies. Multi-Million dollar bonus are fine in some sectors of the economy... just not in the pay me or die parts....

Medicaid is a safety net. I misspoke... meant medicare. Medicare is not and was originally intended to be slowly expanded to encompass all ages.

Doubt it. I've had the same amount of mail yesterday than I did 20 years ago.

But now it's 99.99% junkmail. It used to only be 99.98%. So I guess, yeah, times have changed a bit.

How did you send letters before email? Carrier pigeon?

 

[deonb]

Republicans run the services and police those services for abuse.

Great. Then everything will be run like the ATF.

 

[bkp_duke]

My post had nothing to do with employer sponsored insurance. The point was that private insurance is less efficient than medicare in large part due to the profit motive of insurance companies. Multi-Million dollar bonus are fine in some sectors of the economy... just not in the pay me or die parts....

Then you clearly failed Econ 101.

Private industries that compete with government ones are almost universally more efficient than GSEs, with the one exception being monopolies.

I would, in fact, argue that Obamacare created a bunch of local monopolies by forcing insurance carriers to cover everyone in the nation. Notice how there are many counties with ONLY one insurer? Those are monopolies with zero competition, created by the government (ironically).

I know for fact that the premiums I pay for 1st-rate Blue Cross Blue Shield for my employees is LESS than what comes out of their checks for Medicare/Medicaid. Fact, not fiction.

 

[bkp_duke]

The question, really, comes down to this:

Is healthcare coverage a RIGHT, or is it a privilege?

What criteria are used to determine when someone has a RIGHT to something, vs. has to work hard to obtain it? Historically, healthcare has not been something that was viewed as being even close to an entitlement, until the last 10-20 years. Some of us have been around long enough to have seen our parents work hard to be able to purchase insurance (before it was included in employee benefits) for their families, but they always reminded us that it was something "to be thankful for", not something that we were "entitled to."

Having practiced medicine, I agree that some VERY BASIC net needs to be there, but that does not mean that everyone should have a right to multi-million dollar therapies. Should society be forced to pay for the absolute cutting edge therapy for a chain smoker with advanced lung cancer (i.e. how much of this situation is that person's individual responsibility for "doing something they knew could / would kill them"?) Sorry, but there are simply finite healthcare resources and they simply have to be rationed. The most logical rationing is for people that can pay some (or all) of their costs until more cost-effective therapies for expensive diseases are available that can cover a broader group of people.


Now, I do not necessarily ascribe to the following view point, but I have heard it over and over again from various "high income" earners:
********NOT MY VIEWPOINT*****************
As a top earner, why should I have to pay for 10 other people's healthcare? Isn't that forcing your "moral standard" of right and wrong upon me? I.e. "he makes more, therefore he should not only pay more, he should pay DISPROPORTIONATELY more."

I already pay a disproportionate share of taxes (and many of these people will point out that less than 50% of people in this country pay ANY tax), and you want me to pay more? The general population doesn't understand that I can just take all my money (and the industry that I built) to another country with a lower tax rate. And to be frank, there's not a damn thing you or anyone else could do about it.
********NOT MY VIEWPOINT*****************

Now, that's not what I'm going to do, but I put that out there as food for thought that many people with the power to change or control industries in this country feel that way. You can only tax them so much before they simply pack up and leave, and then your tax base for all these "social programs" evaporates. The top 1% could easily move away with little "pain". What do you do then when that 1% that contributes about 40-50% of your tax revenue leaves?

 

[nwdiver]

I know for fact that the premiums I pay for 1st-rate Blue Cross Blue Shield for my employees is LESS than what comes out of their checks for Medicare/Medicaid. Fact, not fiction.

?????? Yeah...... because they're not COVERED by Medicare/Medicaid....

EVERY WORKER ~150M pays into Medicare/Medicaid... only ~70M are covered. My 401k payments were much larger than what I paid into SS too... not really the same thing.....

It's easy to say what's wrong with a system... if single payer isn't the answer to ensuring universal access.... what is?

 

[nwdiver]

Is healthcare coverage a RIGHT, or is it a privilege?

Seems like the lowest bar would be that we should treat our law abiding citizens with the same level of dignity we give to our criminals...

In Brown v. Plata Justice Kennedy wrote, “Prisoners retain the essence of human dignity inherent in all persons,” and human dignity includes a right to adequate health care.

The top 1% could easily move away with little "pain". What do you do then when that 1% that contributes about 40-50% of your tax revenue leaves?

We spend more on healthcare per capita than any other nation and achieve worse results. It's how the system is funded that's the biggest problem not the level of funding. Any country you move to is going to have universal health care unless you intend on relocating to a capitalist paradise like Somalia.