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Comment by javert | Hacker News Reader

The actual experience in the US has been that healthcare functioned best when it was closest to a free market, and the more we socialize it, the worse it gets. (We have been slowly socializing it for many decades through regulation.)

You can argue that we haven't been socializing it "properly," but the way we are doing it is just the way government works in the US, and that's not going to change.

In general, we don't have an efficient, honest, effective government, so it can't do anything right on a large scale. Though there are some exceptions, those are exceptions. Look at the Obamacare website scandal. That is the rule.

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There is very little about the health care industry, at any level, that is "free market". The government funds much of the basic research that generates new medicines and medical devices and then regulates which ones can be sold. It works hand in hand with medical professional associations to determine who can practice medicine and in what capacity; it also funds residencies, the crucial gateway to becoming a physician. It pays for a hefty portion of medical care (for the young, the old, the very poor, and veterans) directly and regulates how the rest is paid for (out of pocket, through employer-provided insurance, or privately purchased insurance).

There are a few islands of private industry in healthcare, but between the regulation and the direct payments, it's a government sea.

Barring the most radical dissolution of the current system, the question isn't whether the government should be involved, but how.

You're right that the current healthcare industry is far from a free market, but javert too is right that the golden age of American healthcare was when it was far closer to a free market.

Interestingly, the golden age for physicians' personal wealth was during the socialisation phase, as they were able to pocket fees increasingly paid by insurers, leading to a quintupling in income. They went from lower-middle class at $50,000/year in 2010 terms to $250,000 in 2010 terms. Doors anyone seriously suspect that we'll ever get back to $50,000/yr physicians? This illustrates why industries are often keen to socialise: they can guarantee outsize personal success.

What our system absolutely rewrites is radical dissolution.

When were doctors ever 'lower-middle class' in any western society?

Any time right up until the 1950s I would say. I don't know what you'd call the status of mid-19th century doctors in Britain, for example, but they definitely weren't upper class.

'lower-middle class' is the lower part of the middle class. It's not "lower or middle class". Lower-middle, middle-middle, upper-middle. If it was 'lower or middle', that'd make even less sense - university-educated professionals being part of the working class demographic, at a time when university was an oddity rather than the norm?

When I was a kid in the '50s, our family doctor lived and had his office in a house little larger than ours, in much the same neighborhood as ours: definitely middle class.

I didn't say not middle class, I said not lower-middle class. Doctors as a demographic have never been lower-middle class.

From the article physicians averaged $50,000/year in 2010 dollars back in the 30s or 40s. $50,000/year in 2010 was lower middle class. It's enough to live on, but certainly not enough to be comfortable, especially with a family, not is it enough to save much.

So we can't but Canada can?

As straining-of-credulity as such a bumper-sticker is, isn't that the logical conclusion?

Very Serious People ( with whom I happen to agree) actually say such things in "Fragile By Design". Calomiris/Haber are good writers and good thinkers. They do not call out medical nor political leadership there, but it's not exactly a stretch.

It's a short drop from this to the view of America from "V for Vendetta".

Downvoted, here is why:

I find your statements to be over general to an almost crazy degree -- "the actual experience"? Everywhere? "In general we don't have an honest effective government" -- really? Got data? Etc, etc.

Also, I would be interested in specific metrics of worse and better -- you make the claim it is worse because of regulation, which you imply is basically the same as socialized funding (which it isn't). So where is the data?

No offense, but this sounds like canned right wing bullshit rhetoric straight off Fox News. Granted, there is plenty of canned rhetoric on all "sides" to go around, but that doesn't make this any better.

"Granted, there is plenty of canned rhetoric on all "sides" to go around, but that doesn't make this any better."

The problem is that certain sides get way less flak for "canned rhetoric". Particularly populist viewpoints.

>The actual experience in the US has been that healthcare functioned best when it was closest to a free market,

When was this?

>the way we are doing it is just the way government works in the US, and that's not going to change.

That's some nice fatalism you've got there.

>In general, we don't have an efficient, honest, effective government, so it can't do anything right on a large scale.

Except for all the things you forget to mention, or even to think of as government programs, because they tick quietly away, working perfectly, in the background.

It's not a free market if you're forced to participate in it. Which we all are, by virtue of being alive.

You mean like food, housing, etc? Free markets don't mean they're optional, it means that participants interact freely and voluntarily.

Not really. Every human being can survive with the same minimal allotment of food and housing, but that's not true of health care. Some people will use very little while some will use a lot more through no fault of their own.

You're still free to choose who you get healthcare from.

It's like saying the food/farming industry isn't a free market because "some people will use very little while some [fat people] will use a lot more through no fault of their own." It's a ridiculous argument, and sounds more along the lines of Peter Joseph's "structural violence" mantra. The whole "you're not truly free until you get all this free shit given to you so you can be free to do nothing/be lazy".

Granted, it isn't actually a truly free-market, anyways. Government subsidies, minimum prices, etc, all distort the market and affect peoples' actions.

I hear what you're saying and agree in part, certainly where things other than health care are concerned. Both sides of the argument are deeply flawed. The fact remains, though, that we in the US pay more for our health care and get less in return for it than residents of countries with real "socialized medicine." We are indisputably doing it wrong. We owe it to ourselves to consider the problem more deeply than we can by comparing it to traded commodities like food and housing.

In US you have socialized the costs. Not the healthcare system. I think the only social type of medicine in US is the VA (they have the purse, their own hospitals and staff IIRC) and last time I read their costs of delivered product were much lower that the US average.

Socialized some of the costs.

Some systems in the US, especially Kaiser, are basically a socialized system supported by premiums, and seem to work pretty well.

lets be honest, the VA is not a shining example of health care. Much lower costs are not worth it considering the stories coming out of the VA.

The VA is not a good example of a working system though, it has been heavily in the news for denying timely treatment, see http://en.wikipedia.org/wiki/Veterans_Health_Administration_...

Pre-Iraq/Afghanistan the VA was considered quite effective and people were very satisfied with their treatment there. A massive influx of injured/disabled soldiers from those wars (where death has largely been replaced by wounds thanks to good body armor) without a parallel ability to scale treatment up probably hurt them more than poor administration.

Bad press about a few VA clinics does not mean that the entire system is garbage. In fact, as recently as last year, veterans rated their satisfaction with VA care higher than the general public rates private care[1]. Also according the the Inspector General, while no one denies that delays in care happen at the VA (it should be noted that delays happen in the private sector as well), that the deaths at those hospitals can not be directly linked to the delay in care[2].

Finally, my anecdotal evidence: I am highly satisfied with the care that I receive at the VA. I have 20% disability due to a significant loss of peripheral vision in my right eye. I am scheduled yearly for an annual physical including urine and blood work, a field scan with my eyes to test regressions, and two general appointments with an optometrist. I also have free access to nutritionists and weight support groups since weight management can be an issue for veterans. Is it perfect, no, but I have never felt that I didn't get the care that I needed in a reasonable amount of time.

[1] http://www.va.gov/opa/pressrel/pressrelease.cfm?id=2537

[2] http://online.wsj.com/articles/no-deaths-caused-by-delays-at...

edit: formatting

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