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Comment by moorhosj | Hacker News Reader

==I'm interested to know why you think the government is incentivized to negotiate the best pricing for citizens.

I can think of two. First, so they can spend the money on other things they want (military, social security, education, etc.). Second, is so they can get re-elected by those same citizens.

==There is no way to tell if the price we are paying is at all good value for money compared to what it could cost.

We could look at the dozens of other developed countries who work like this, should give us some clues.

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> I can think of two. First, so they can spend the money on other things they want (military, social security, education, etc.). Second, is so they can get re-elected by those same citizens.

Respectfully, is there any reason to think that the US government would actually do this, based on past behavior? Government spending is famously wasteful, both parties spend like it's going out of style when it aligns with their interests, government debt continues to explode, and spending continues to grow year-over-year effectively unchecked. I may just be overly cynical here, but I don't think that responsible spending is the primary election issue for hardly anyone today.

I don't think "frugal" fits the description of many or any of our lawmakers. With few exceptions, they all want either higher taxes or higher debt to pay for their favorite things.

Because HHS / CMS negotiates all of these rates I think it might be hard for voters to draw a path between rates / expenditures and their care, for the same reasons they fail to draw a line between their current insurer's negotiated rates and cost of care. A single negotiator will likely only make pricing more opaque, rather than less, so there will not be a strong incentive to perform better at the HHS level without transparency. Further, if Medicare for all is biased toward removing private plan competition there will be no incentive whatever for Medicare to be more efficient. Rate issues can be easily blamed on the providers.

==for the same reasons they fail to draw a line between their current insurer's negotiated rates and cost of care.==

Insurance companies are not subject to FOIA requests like the government. People tie Medicare to the Government, why would this be different?

==A single negotiator will likely only make pricing more opaque==

Not sure it's possible to be more opaque than today. All of the other country's who do it this way have far more transparent pricing than the US, so I'm not sure I buy this reasoning.

> Second, is so they can get re-elected by those same citizens.

American politicians are not elected by voters or citizens, they're elected by contributors. This unhinging is either a root or partial cause to many problems.

Sorry, that's total BS. Complain all you want about "campaign contributions", but the politicians absolutely are elected by voters on Election Day. The only thing contributors can do is try to change opinions by funding campaigns which goes to advertising. The final choice is made by the voters, and they are the ones ultimately to blame for the results.

That's fantastic, are they also to blame for the duopoly of political parties in America? Because the way our system is set up, first past the post, it is almost guaranteed. Are the voters to blame for the structure of our government which was written 250 years ago?

Yes, they absolutely are. If they didn't like it, they would fight to have it changed. They've fought to have many other things changed, and various Constitutional Amendments have been passed as a result. Did you forget the 18th Amendment, which was passed because of a bunch of Temperance activists? (and then the 21st that was passed because the result was a disaster) The system is set up this way because the voters don't want to change it.

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