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Comment by proc0 | Hacker News Reader

This is hilarious. I'm no universal healthcare idealist, but there is something to be said about health services having the wrong incentives in doing it for-profit. What incentives do for-profit pharmaceuticals have to keep people healthy? Potentially none. What incentives do they have to keep people sick? Probably billions of dollars if not more.

The problem is you can't risk your health. When buying a product you can risk a "clever" company that sells you a subpar product, but you can't really risk a "clever" pharmaceutical that sells you a subpar medicine or service.

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> What incentives do for-profit pharmaceuticals have to keep people healthy?

In a competitive market when people aren't happy with a product or service they take their business elsewhere. Over time companies with bad intentions get weeded out or never get off the ground.

You really can’t do that with pharmaceuticals that aren’t out of patent.

Lots of conditions only have a single drug, and for some classes of pharmaceuticals big pharma has exited entirely (antibiotics)

> I'm no universal healthcare idealist ...

I'm from Canada, so actually I am.

> In a competitive market ...

Doesn't apply to healthcare. Try shopping around for a trauma hospital after a car accident.

"Doesn't apply to healthcare."

Yes, it absolutely does. The vast majority of 'healthcare' is operationally mundane, and not hyper-specialized such as those who are in car accidents might require.

Most public systems are quite inefficient, and without any possible market pressures (Canada healthcare act makes it technically illegal to sell healthcare services that are provided by the gov.) then those inefficiencies sink in.

Because there's a weird inelastic demand for certain services, pure market-oriented solutions won't work for 'car crashes' but they definitely could for most other things.

Walmart taking on healthcare is a very meaningful event, they could feasibly operationalize the more mundane issues to the point wherein it's the cheapest in the world for such services. This is hugely positive news.

The problem is you shouldn't be making that decision when you are already sick and you discover your insurance won't cover. Additionally the current healthcare market is not what I would call competitive. Only a handful of insurance companies have some kind of monopoly, not to mention how it's tied to having a job. All of this assumes that getting sick is a choice like driving a car.

I'm curious why the reasons you elucidated aren't enough to make you a universal healthcare idealist. Do you mean by this that you don't want universal care or that you don't care about the issue or something else? If you mean by this that you don't want universal healthcare under what circumstances would you want this?

I ask not to engage in a debate or to try to change your mind. I won't respond to anything you write. I'm just curious about people who don't advocate for universal healthcare what their reasoning is.

For the record, I think everyone should have access to the healthcare system and that no one should profit by denying a person care. I also don't think that being rich ought to grant you better access or quicker access to the system since resources are limited and the type of care or quickness or care should not be influenced by money.

I think it's a logistics problem. Perhaps every state could offer a free healthcare option. Private healthcare is available in single-payer countries but you still pay taxes, and in the U.S. health insurance companies have changed the system so that they are always in control and there isn't any real competition for any other insurance. For prices to go down there should be real competition for these services, but I don't see that anywhere. Either government fully controls and taxes, or private companies control the government and in turn the market.

> What incentives do for-profit pharmaceuticals have to keep people healthy?

Having better outcomes than the other for-profit pharma down the street, thus more customers, thus more money. Of course, if there is no competition at all then the incentives change, but this is not (yet?) the case.

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