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Comment by toasted | Hacker News Reader

Keep in mind that, well-paid and satisfied specialists aside, there is another side to this picture - important to remember with state-run healthcare systems such as NZ, so often a poster child for socialist policy.

For example this IT department head of a major district health board who embezzled ~$17 million dollars over a period of 6 years, with which to buy, among other things, luxury vehicles.

http://www.odt.co.nz/news/tags/michael-swann-0

http://www.odt.co.nz/news/dunedin/32268/fake-invoices-made-p...

Can you imagine this sort of thing happening in a free market for healthcare? I can't.

That's unfortunate but the bottom line for patients is that the NZ works excellently.

Sure, it sucks that someone committed fraud and got rich in a dishonest manner but preventing that is not the goal. In the end, this fraud doesn't really affect the healthcare given.

NZ works excellently.

That is a pretty big claim... Have you ever actually lived in NZ and experienced the realities of paying for this system via taxes and claiming its services? Have you monitored the incessant demands for more services at better quality, the incessant complaints about being over-worked and underfunded, the endless criticisms and debates about inefficiency, long wait times, burdensome bureaucracy, poor outcomes, and unhappy doctors?

Outright fraud and corruption is just the tip of the iceberg of problems that naturally develop when a society decides to sever the act of consumption from the actual purchase of a service.

You're not afraid of making some pretty big claims yourself. Wikipedia[1] supports my claim that while the situation might not be perfect it works quite well and that's the most important thing. Compared to other countries, the US in particular, the NZ healthcare system delivers good results. Which in my view makes it excellent.

Then what about the negative aspects you mention. Well, in the Netherlands we have a similar system and to be honest I don't care about all the whining you mention. Sure, people complain and things probably can be better. There is always room for improvement. Unfortunately people will complain about healthcare if they stub their toe. Fuck 'em, you can't stop these people from complaining and policy should not accommodate their every whim.

Can you support your claim that bad things happen and go unpunished

> when a society decides to sever the act of consumption from the actual purchase of a service.

I'm not feeling them, my family is not feeling them and my MD friends are happy with their jobs. And don't forget: the private sector is still an option so there is a choice.

[1]: http://en.wikipedia.org/wiki/Health_care_in_New_Zealand

You're confusing ideology (dogma) with market design and (lack of) incentives.

Markets are good for determining price. Not finding efficient solutions. You've heard of "rent seeking"?

Single payer systems enable the capitation model of care services. Because wellness is incentivized, vs the treatment of disease.

You... can't imagine embezzlement happening in the private sector?

That's bold.

> Can you imagine this sort of thing happening in a free market for healthcare? I can't.

That's one hell of a lack of imagination. You mean stuff like this, which happens all the time here? http://www.buffalonews.com/city-region/federal-court/william...

Single payer accounting is greatly simplified, so is easier to audit, so has less fraud. Comparatively. In the real world.

http://www.amazon.com/Healthcare-Fraud-Auditing-Detection-Gu...

Also, you misspelled "corporatist oligarchy" as "free market". Easy mistake.

Yes. Bad actors are present everywhere, and fraud happens everywhere. There's always a kink in the system.

There was a dentist a few years ago who was treating 2,000 patients a day, and stole several million dollars from several insurance companies.

I worked at a midsize company in a highly competitive market... one of the call center manager embezzled something like $75k over a period of 3 years by fraudulently purchasing telephone headsets. He paid for $$$$ plantronics, and delivered $ no-name brand.

I expect there'd actually be more fraud under a free market system because catching fraud (past a certain point) is expensive and companies are only going to put the resources into catching fraud if it continues to exhibit a positive ROI. Or maybe NZ bureaucrats are insulated and dedicated enough to do the right thing rather than listen to the outrage of the voters when fraud makes the news, but I wouldn't expect that to be true in the US.

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