I’m a social democrat/democratic socialist, and I’m baffled by the health care system in the United States. I thought I’d jot down/brain dump my main arguments for public health care:
Everyone needs health care, but nobody seeks it out
Health care is a necessity in unpleasant circumstances. When you break your leg, you need health care. Very few people break their legs intentionally to stay at a nice hospital. Therefore, it is not a resource likely to be wasted once people are given free access to it. Given that everyone needs it when they need it and don’t when they don’t, paying it via the state budget is unlikely to cause waste.
Hospitals become badly run when run for profit
I think the point of motivation from the objective self-interest is overstated and harmfully over-emphasized, but the point bears making. For-profit hospitals are run… for profit. Fancy that. A for-profit institution has an interest in your using their services as much as possible, at the expense of who-ever is paying the bill, be it your health insurance, or your fifth mortgage. A public institution wants to get you out of the system as soon as possible – by curing you. So the self-interest of the patient aligns much better with a public hospital.
Although a certain measure of inefficiency is added when run by a governmental organization, I believe the inefficiency induced by the hospital’s profit motive is probably much greater, perhaps more so in countries without a “corporate culture” in the government that seems to accept ineptitude. “Close enough for government work” is *not* a phrase used in Norway – for a reason.
(Nevertheless, it bears mentioning that the most efficently-run hospital in the United States is the government-run Veteran’s Aid.)
Denying health care to people who need it is not nice
The justification that a system “has to be that way for the greater good” is dangerous and bad and wrong. People needing health care should have it under all circumstances, and I consider it a matter of elementary respect for the dignity of human life that health care should be a right of citizenship. What kind of society measures the worth of a human being by the size of their wallet?
Healthy people are more productive
If you’re the bean-counter sort, this point may appeal to you. I don’t think it very relevant, but it seems quite plausible. The societal cost of people calling in sick is probably greater than any potential cost in efficiency from nationalization.
One point specific to the US:
The current implementation in the US is, AFAICT, deeply flawed and needs Change (WCBI) anyway.
The US health care system is insanely flawed. It needs to change anyway – why not do so with a bang rather than a whimper. I think that the Democratic resurgency has given the party a mandate for quite a lot of bang. When a president wins on a single word, “change”, then… go change things.
Got any more points? Disagree? I’d love a conversation in the comments.
Michael Fisher | 06-May-09 at 10:46 pm | Permalink
I believe you are absolutely correct on all points, especially that healthy people are more productive. We, in the US, are at an important point in our political life. Not only is there a Democratic resurgency, the Republicans are self-destructing before our eyes. We will have a change in health care and it will be with a bang. The time is right.
desnotes
Wilhelm Damsleth | 06-May-09 at 10:50 pm | Permalink
Without going into the rest of the post because I’m to tired, you wrote:
The justification that it “has to be that way for the greater good” is dangerous and bad and wrong.
… but isn’t the argument “has to be that way for the greater good” the central argument for all of socialism? Anyway, I agree wholeheartedly that it is dangerous and bad and wrong
Albert | 06-May-09 at 10:53 pm | Permalink
I don’t know enough about health care or insurance to contribute in a meaningful way opinion-wise, but I’m very interested in this topic as well, and have noted some characteristics of the free and paid health care and insurance systems in my home state, Massachusetts.
If you can’t afford insurance, you by default get covered by “Mass Health” insurance which I’ve heard is very good – actually better than most insurance that is available in the state. And by better I mean it provides more coverage. For example, if you can afford and buy insurance, they may not cover your physical therapy or mental health therapy, whereas if you couldn’t afford it, it would be covered.
If you can afford insurance, but do not get it, you will get a fee levied upon your state tax return (or are denied a tax break). This is a new program and from what I’ve heard it is working incredibly well so far in getting more people insured.
One problem that isn’t directly related to insurance but affects it and care in general is the public reliance and misuse of the emergency room. I’m not sure if they are true or not, but I’ve heard stories about people going to the emergency room for pregnancy tests. Furthermore, I don’t know for sure, but I don’t think any hospital emergency room will (or can) turn away a patient, even if they are uninsured. The same can’t be said for outpatient care, so in this sense, the system is eating itself.
And one question of ethics that continues to perplex me: why is 90% of health care money spent on the last 10% of our lives?
toresbe | 06-May-09 at 11:05 pm | Permalink
Wilhelm, both yes and no; I realize the ambiguity, but what I was referring to was ignoring an obvious systemic problem because of the belief in an infallible system — not the Socialist concept of a societal commons to which one can (and you do, as a taxpayer and employee in the Armed Forces) contribute.
(Of course, some of the best/worst examples of that type of thinking is to be found in nominally Communist countries.)
Andrei Popescu | 06-May-09 at 11:23 pm | Permalink
While I mostly agree on the other points, to the argument that “Hospitals become badly run when run for profit” I have to say “and so are the state run”.
As I understand, you are comparing USA with Norway. I wonder how your views would change if your comparison would also include countries further east, say, from the former comunist block. I don’t think you can imagine the horrors that can happen in a hospital. Just to get a taste of it, try watching the movie “The death of Mr. Lazarescu”.
The fact is that hospitals are a monopoly: you can’t just build two hospitals next to each other and let them compete, there are no resources for that. And in case you have an emergency you *will* go to the nearest hospital *and they know it*.
toresbe | 06-May-09 at 11:29 pm | Permalink
I don’t think people turning up at the ER for a pregnancy test is a big problem; “get the fuck out of here” doesn’t take a nurse very long to say.
I’ve heard the “frivolous use” argument a lot, and I think it’s overstated – people generally don’t actively wish to seek medical aid, and for the people who do, a doctor consultation bill on the order of $20 (as it is here for visiting your doctor) should keep the dumbest stuff away.
toresbe | 06-May-09 at 11:38 pm | Permalink
Andrei, in fairness: at no point do I state that state-run hospitals are automagically perfectly run. Also of some importance, countries from the former Communist bloc are formerly communist – and in some cases, Romania being the chief example – catastrophically poor.
And sorry – I don’t know anything about the health care system of Romania (And Wikipedia doesn’t seem to know(!)) so I don’t really know how this fits into any of this.
But it’ll be at least another decade before the state of the United States is comparable to Romania
(Ehm, that is to say, I’m hoping Romania continues to improve)
tshirtman | 07-May-09 at 12:47 am | Permalink
I think you mix two different (but closely related) subjects here, The problem with private insurance is not the same as the problem with private hospital, the two things can be managed very differently. In fact private insurance policy can prevent you from getting treatment in the USA even if you chose to go for a public managed hospital, it’s the insurance company which decide if you deserve the treatment, and, as you may guess, it’s most of the time “not useful, too experimental, not essential” and lots of other bullshit, because in the end they pay, and they don’t like that.
Well I don’t live in the US, I live in France, but here, for years politics (and especially from Europe institutions) have been pushing for the “private” solution, and the public system is less and less useful, and nearly everybody is obligated to get a private “complement” I hope USA will show a new way… back to sanity.
Gunnar Wolf | 07-May-09 at 1:08 am | Permalink
I am also a socialist… And I’d love to see in our country what I have seen in others – yours included. Sadly, some points in your post are easily rebatable with people with the right(?) mindset. Now, I have no idea on how your blog works, so if this comes out completely out of format… bear with it
Umh… You don’t know how uncomfortable can public institutions be – For the patient and for the family. Granted, you won’t break your leg on purpose. And in case I did, I would make a point (trying to be consistent with what I expect from society) of going for attention at the public health care system I have the right to instead of paying for private attention. However, public health care can be so stressing over here (Mexico) that, even if it is vastly superior to most private cliniques, people prefer to go private except when it is a life-or-death situation. To illustrate, a friend of mine had a severe intestinal problem some years ago (he was 25 by then) where chunks of his intestin started dying. He was for two weeks in two private places – misdiagnosis and mistreatment almost got him killed. He was taken to the public hospital, and stayed for three months in intensive therapy – but survived. However, he was lucky to live in the capital – In this very big country, if something moderately sever happens to you in the rural areas… You might as well be taken to the graveyard instead.
I fully agree on this with you. Still, there are many kinds of profits. As an example, you might run the public healthcare system for a personal political profit. Or even you can administer the severe lackings of our system – Many doctors in public hospitals work for private institutions part-time (as they might be good people, but they must also get their money, and public sector pays way less). As subsequent medical appointments for any given condition are booked several months in advance (i.e. my mother in law was diagnosed with a severe hearth condition back in January and was scheduled for attention in May after simple medication… A joke, basically, but one that can cost your life), doctors invite patients to… pay for their services in the private hospital. Oh, and underprovision is also a great problem. The only medicine you will find ubiquitously is Paracetamol… Besides that, the public hospitals (which should cover for those expenses) will sometime ask the patients to buy some medicines. In some cases, even the surgical drapes have been requested.
Still, you know the social reality of Mexico is quite far away from what you have seen all your life in Norway. And still, even after many attempts, we still have public social security systems. Three separate systems, even (and most people have the right to use one or two of them). And they work, as I said, quite acceptably.
Of course you are familiar with our current health emergency situation, the new AH1N1 virus strain. Each time more, it becomes obvious that the epidemy started and spread (and has only had fatal victims in this country) because of the long delays in the system’s attention… And, yes, a consequence of this: People who cannot afford private healthcare are used to wait longer before going to the doctor. I know that if I want the doctor’s opinion on anything, I should be ready to devote a whole morning to it. And the further it needs to be escalated, the more I’ll have to wait.
Social healthcare is the only way to go. But for it to work, it needs funding. And if the country is being run by crooks, well… it just deteriorates endlessly.
toresbe | 07-May-09 at 2:08 am | Permalink
Gunnar, thanks for your long and interesting post.
Trust me, I know how uncomfortable public institutions can be.
We seem to agree that in your country’s social situation, a suboptimal public system is always better than an optimal private one since only your country’s richest could make use of it.
A good step could be outlawing private practice medication or restricting it to extremely well-defined niches; this way, the rich would have to use everyone else’s hospitals, and maybe some strong voices in the society would start protesting?
Simon | 07-May-09 at 5:18 am | Permalink
“Therefore, it is not a resource likely to be wasted once people are given free access to it.”
As someone living with a public health care service I think this point is naive.
Some waste does occur because it is cheap, or free. People fail to attend appointments etc.
But you also get the usual waste that can happen in large public institutions. Bureaucratic bloat, procedure rather than need driven treatment.
Sure it is better than no health cover, but the cost is such that only a few percent can afford decent private health cover on top of paying for the public service. So it had better be good enough for everything everyone needs. This raises big questions here over things like fertility treatment, which is expensive, and I (and many others) feel shouldn’t be offered by the state as we have enough people by any reasonable definition. However once you are taxed to pay for health care for everyone, don’t expect to be able to afford this privately. Thus the space for private care will shrink enormously.
I’ve seen public institutions well run, so I don’t think these problems are inevitable, but also so many public bodies are rife with such issues they are in some sense innate in the procedures and practices often followed.
After my latest procedure driven, penny pinching experience, I’ve vowed to get my own condition monitored via the private health care system, because I can order what the medical literature says are the correct tests to monitor my condition rather than those offered by the state.
Simon | 07-May-09 at 5:34 am | Permalink
I believe the ER room problem is largely an American issue due to procedural issues implemented to correct problems with their current mix of public/private health care.
Sure pregnancy tests are an extreme example. But I deal with patient support groups on the net, and it is fairly standard advice in the US that if you aren’t insured, and you have a serious condition, to use ER aggressively to get essential medications and monitoring. It isn’t good for ER, but if this is the only place to get essential treatment people would be stupid not to do it.
Telling them to go away sounds simple, but in reality even someone turning up for a pregnancy test may have good medical reasons. Do they have AIDS, or other untreated health condition that they might pass onto their child? Or a condition that makes pregnancy unduely dangerous. Or mental health issues which the pressure of pregnancy might cause them to self harm? If you didn’t check before telling them to go away you just failed as a medic, and condemned either another generation to unnecessarily suffering, or possibly are responsible for a life.
$20 for a consultation sounds good till you only have $19.99
Carl | 07-May-09 at 6:27 am | Permalink
I think I just threw up a little. I’m neither conservative nor liberal (what is the point of alignment anyway? does it make you feel better to be part of a group?), but I just don’t understand where these ideas come from. I’ll burn my money before letting someone else take it from me. And no I’m not against giving to charity. If you want to pay for all the unwed mothers and high school drop-outs have at it. Just leave me the hell out of it.
Jaldhar | 07-May-09 at 9:07 am | Permalink
Sorry for the long response but you gave much to think about.
My experience with European-style nationalized healthcare is from Great Britain so it might not be the best example plus it was 25 years ago but anyway…
The National Health Service was good for all the basics like yearly checkups, dental cleaning etc. Also I had a bad case of tonsilitis when I was about 5 and received excellent care. However when it came to anything more than that there
were shortages. I was told I needed braces for my teeth but because it was not a life-threatening need I was put on a waiting list. I was still on the waiting list 5 years later when we came to America. I got my braces two weeks after that. My father has diabetes and when he expressed dissatisfaction with his treatment in GB he was basically told to take it or leave it. He was amazed to learn that in the US he could pick any doctor he wanted and it was culturally expected that patients would have an active role in planning their treatment.
Another issue to be considered is that despite all the talk of equality, race and class were factors in the quality of care. Atleast in a free market system a sufficiently motivated poor or minority person can seek out alternatives but in a socialist system he remains at the mercy of bureaucrats whether they follow the egalitarian slogans or not. From experience I can
tell you such people would rather be measured by the size of their wallets than not measured at all.
All a socialist regime does is disguise the profit motive. It cannot deny it anymore than it can deny gravity. (Atleast until Star Trek style replicators abolish scarcity.) The money has to come from somewhere and traditionally it has come from heavy (I would say crippling) taxes. But your populations are rapidly aging, your young people are not having children, and you are not
bringing in enough immigrants to make up the shortfall. (I realize Europe is a big place and all these things do not apply to every single part of it but generally its true.) So even if you want to, you will not be able to maintain a high tax burden. A previous commentator notes increasing privatization.
This is a trend that will only increase in the future.
Coming to the US system, yes it does have flaws. However turning away sick people is not one of them. Hospitals, even for-profit ones, are required by law to accept any patient, even uninsured ones, in medical emergencies. The flaw is that it encourages people to seek out medical care only when there is
an emergency thus the problems hospitals see are much worse (and more costly to treat) then if they had been caught in the early stages. As well as the direct cost, hospitals also have to raise costs for their other patients to subsidize all this.
Another flaw is in the coverage for catastrophic long-term care. If you haven’t planned your insurance benefits exactly right you can find yourself heavily in debt if you need expensive and lengthy treatment.
The biggest health issue is not a flaw in the system itself but a cultural issue. Many Americans eat badly, exercise inadequately, and are overly stressed. This naturally leads to poor health.
I think all these problems can be solved without nationalized health care.My suggestions would be:
* Greater emphasis on preventive care. I actually wouldn’t mind if the government subsidized yearly physicals, dental visits and perhaps prenatal care. They would not cost so much and give a very high rate or return.
* Teach children about good nutrition and increase the availability of nutritional information on products, at restaurants (particularly fast food places.) etc.
* Easier availability of treatment for smoking, alcohol, and drug addiction.
* Some kind of emergency funding for people with catastrophic illnesses. Perhaps low interest loans like people in natural disasters get? Just enough that they don’t have to worry about losing their homes etc.
Such ideas would improve the current situation without destroying its advantages, such as greater freedom for the patient, lack of bureaucracy and corruption, and faster treatment.
Perhaps Obama might try to enact some modest reforms like this but even thats not 100% guaranteed. For a start he has already put all the money he has (plus billions he doesn’t have) into the banks and car companies. Where will the money for a national health service come from? As it is, Medicare —
subsidized healthcare for the elderly — is the biggest component of the Federal budget even bigger than Defence. A big chunk of the Defence budget itself goes towards healthcare for veterans.
Furthermore, the US also suffers from the demographic problems I mentioned before albeit at a lower level. Completely free healthcare for all is not sustainable here either.
Jan Hudec | 07-May-09 at 9:12 am | Permalink
Ad 1: It’s not generally true that nobody seeks out health care. Sure, it’s unlikely anybody would intentionally break their leg, but if it’s completely free, people will be coming to emergency with trivial injuries, goo see their GP when they have cold, or especially older people even because they just want to talk to somebody. A symbolic payment saves quite a lot of resources, as the example of several Central European countries that recently introduced them show.
Ad 2: Well, hospitals are badly run whenever they are not properly supervised, whether they are profit or public organizations. The health care organizations must be checked by government, the insurance companies and trustworthy information about their quality must be publicly available so patients can choose.
Than a for-profit hospital will be efficient, because if it provides bad care, patients will go elsewhere (and they loose profit) and if they will do useless therapy, the insurance company will cut their pay and they loose profit again. The second part requires, that the hospital bills directly to the insurance company, as is normal in the European system. And non-profit hospital will be efficient because the local politicians want to show off with it’s good rating. Without supervision, profit organization will try to get money it every way it can and public will simply not care, because people are lazy, so neither will be efficient.
I believe the big deal is not whether hospitals are profit or public (or a mix in any ratio), but how the insurance is set up. The state has to assure, that everybody can have at least basic health insurance and that once you have the insurance, the insurance company can’t exempt the care in any way.
Ian | 07-May-09 at 10:27 am | Permalink
The NHS in the UK mostly works well but could do better. Emergency Treatment is very good. Issues tend to be in the more routine area but waiting lists are a lot shorter than in years past. Lack of accountability to its users is partially addressed with local review bodies but most people don’t know they exist.
T – can you contact me with a better email address?
Raw Matter | 07-May-09 at 10:47 am | Permalink
Why Public Health-Care is Difficult…
A reply to Tore, who is probably partly wrong. I don’t claim the U.S. system is good or bad, I don’t know it. But I don’t think public (which he seems to imply means free) health care is as easy as he suggests. I’m starting at his assertion that…
toresbe | 07-May-09 at 2:19 pm | Permalink
I don’t contest that, but I don’t think it’s a big enough problem to justify tearing down a huge public system.
I think the systemic inefficiencies caused by hospitals run for profit are much greater than any of these points people make (frivolous use, etc).
Oh, yes, because bureaucratic bloat never occurs in large private organizations, especially not in hospitals!
I think that shrinking the private health sector is a good thing, so don’t expect me to sympathise with that point. I think the point of artificial insemination is a good one, but it’s not really an important one in the grand scheme of things, you’ll admit. I can live with private artificial insemination being either private or public, really.
The same could easily be said about private-sector companies.
Frankly, I’d say that a doctor is probably better qualified to order diagnoses than you are.
That’s a great argument for switching to a public system, then: People aren’t forced to use the emergency facilities for pedestrian worries, but can use their normal doctor who’s fees are now heavily subsidized.
At which point – in Norway, at least – the fees are waivered – though I don’t know the mechanics of that since I’ve miraculously always had money handy.
A Norwegian | 07-May-09 at 7:25 pm | Permalink
I’m from a country that implements public health care (Norway) and I’m afraid things aren’t as rosy as you think.
One problem is lines. This fall I was diagnosed with a medical condition. The doctor told me I needed surgery and that the longer I waited the higher the risk would be for it to become permanent. I’m still waiting. Norwegian “rightists” (the less socialistic parties) would here point out that during the previous administration (a “rightist” one) the lines were shorter. Thats not the point. The lines were still there when they ruled.
Another problem is that some people simply don’t get health care under our system. There was a case here not long ago about a little girl on life support. The doctors turned it off over her fathers objections (she was all he had left) since their resources were limited and they believed her chances were low. In a free (as in freedom, not as in free health care) country her father would have been able take her to a competing hospital to keep the life support on. Basically health care resources are finite. See http://translate.google.com/translate?prev=hp&hl=no&js=n&u=http%3A%2F%2Fwww.aftenposten.no%2Fnyheter%2Firiks%2Farticle2803110.ece&sl=no&tl=en for an article from a Norwegian daily about who won’t get help.
I’m not saying the American system is good as it is (big health care and big insurance cooperate with big government to keep out competitors by regulations) but in my opinion it would be better for them to go back to their roots and remove the regulations instead of adopting our system.
Adam Webb | 07-May-09 at 10:43 pm | Permalink
> Health care is a necessity [...]
Food is also a necessity, but would you advocate grocery stores funded by public?
> Hospitals become badly run when run for profit
> A for-profit institution has an interest in your using their services as much as possible[...]
We can establish such model, in which it is in best interest of for-profit institution to get you out of a hospital as soon as possible, e.g. some bonuses from insurance, tax returns, etc. If there are no such models now it doesn’t mean that there can’t be.
> The justification that a system “has to be that way for the greater good” is dangerous and bad and wrong.
You use this justification yourself: “I consider it a matter of elementary respect for the dignity of human life that health care should be a right of citizenship”
> Denying health care to people who need it is not nice
Then you can always establish your own hospital and be nice to all people who need help. You will only need some funding. Either by taxation or by charities. Which way of getting funds is more “nice” to general public?
Cheers,
Adam
toresbe | 10-May-09 at 11:56 am | Permalink
>> Health care is a necessity [...]
>Food is also a necessity, but would you advocate grocery stores funded by public?
No, and that should be extremely obvious if you include the rest of the sentence, “in unpleasant circumstances”. Most of that paragraph is dedicated to explaining why it’s not likely to be overused.
>> Hospitals become badly run when run for profit
>> A for-profit institution has an interest in your using their services as much as possible[...]
> We can establish such model, in which it is in best interest of for-profit institution to get you out of a hospital as soon as possible, e.g. some bonuses from insurance, tax returns, etc. If there are no such models now it doesn’t mean that there can’t be.
But they will be contrived, created models. I think a major strength of a free market is its “inherentness”; the way that a free market will create itself in a vaccuum.
The elegance of “I offer goods, you render service” disappears when the market is created, in my opinion.
>> The justification that a system “has to be that way for the greater good” is dangerous and bad and wrong.
>You use this justification yourself: “I consider it a matter of elementary respect for the dignity of human life that health care should be a right of citizenship”
Uhm, no, that’s really not the same. I elaborate on this in another comment.
>> Denying health care to people who need it is not nice
>Then you can always establish your own hospital and be nice to all people who need help. You will only need some funding. Either by taxation or by charities. Which way of getting funds is more “nice” to general public?
Charities are not a sustainable way to achieve societal improvement. Sir Clement Atlee wrote on it and I’ll stuff some quotes in here because he wrote better than I ever could:
‘Charity is a cold grey loveless thing. If a rich man wants to help the poor, he should pay his taxes gladly, not dole out money at a whim’.
‘In a civilised community, although it may be composed of self reliant individuals, there will be some persons who will be unable at some period of their lives to look after themselves, and the question of what is to happen to them may be solved in three ways – they may be neglected, they may be cared for by the organised community as of right, or they may be left to the goodwill of individuals in the community. The first way is intolerable, and as for the third: Charity is only possible without loss of dignity between equals. A right established by law, such as that to an old age pension, is less galling than an allowance made by a rich man to a poor one, dependent on his view of the recipient’s character, and terminable at his caprice’.
Adam Webb | 11-May-09 at 1:29 am | Permalink
>>> Health care is a necessity [...]
>>Food is also a necessity, but would you advocate grocery stores funded by public?
>No, and that should be extremely obvious if you include the rest of the sentence, “in unpleasant circumstances”.
IMO “unpleasant circumstance” is not a required condition for using health care services. Big part of health care – prevention of illness (healthy diets, inoculations, education, periodic checks, taking care of infants or pregnant women) – is dedicated to avoiding “unpleasant circumstances”. Health care is a necessity. Period. If you don’t consider it your priority (a necessity) – it is your choice, you will get result of this. Eating is a necessity. If you don’t consider it your priority (a necessity) – it is your choice, you will get results of this.
Even if we accept that “Health care is a necessity in unpleasant circumstances.”, i.e. if we talk about broken bones or flu or other bad conditions, you don’t give good explanation why free health care won’t be wasted and why it is the state that should fund it, not “customers”. You wrote: “Therefore, it is not a resource likely to be wasted once people are given free access to it. Given that everyone needs it when they need it and don’t when they don’t, paying it via the state budget is unlikely to cause waste.”. I read it as “because we use health care only when we really, really need it, it should be “free” health care.”
1. It is like saying that because we use car repair service only when we really, really need it, it should be “free” service. Why should one get free access to health care, but not car repair service? Or to free houses? Who will decide which service can be for free, which circumstances are unpleasant enough?
2. People tend to abuse and overuse and don’t respect things that come for free to them: free morning newspaper, cheap gas, cheap electricity, free t-shirts, free education, free speech. Why free health care would be any different? Because it is used “in unpleasant circumstances”? It will be abused anyway. But at that point we would start to argue about opinions.
3. “Given that everyone needs it when they need it and don’t when they don’t, paying it via the state budget is unlikely to cause waste.” Perhaps repeating point 1: we pay when we need to or don’t pay when we don’t for any service. We pay ourselves. Why not for health care? We pay ourselves for similar things, similar in terms of quantity and quality.
>>> Hospitals become badly run when run for profit
>>> A for-profit institution has an interest in your using their services as much as possible[...]
>> We can establish such model [...]
>But they will be contrived, created models. [...]
>The elegance of “I offer goods, you render service” [...]
Establishing consumer protection agencies is not necessarily “contriving”. Establishing other measures doesn’t have to be “contriving”. I can’t define such model here in one comment, this is totally beyond my skills, but perhaps free market (providers + consumers) can come up with that model, can evolve situation on the market to the point where there will be for-profit hospitals that get you out as soon as possible. If you want to have hospitals subsidized by state, you will never know. You won’t let this happen, you won’t let people try it. Factories can’t grow and improve its products when competing against subsidized factories. Third-world countries can’t compete on food market with subsidized food from EU. Free market hospitals can’t compete with subsidized hospitals.
>>> Denying health care to people who need it is not nice
>>Then you can always establish your own hospital and be nice to all people who need help. You will only need some funding. Either by taxation or by charities.[...]
>Charities are not a sustainable way to achieve societal improvement.
>”If a rich man wants to help the poor, he should pay his taxes gladly, not dole out money at a whim”
If a rich man (or any man) wants to help the poor, he should do this however he wants. Voluntarily. No PM, no politician should dictate him how to help other people. Taxation is not a moral way to achieve societal improvement. But I think that this is another place where we could argue over opinions.
So here is quote from me: “TANSTAAFL” (Robert A. Heinlein).