I assume you mean profit. DARPA’s budget is over $3B/annual.
God, how stupid can you be? The internet would have most likely never come to fruition if it wasn’t for the public sector.
Yes because the government is responsible for every invention ever. That’s completely ridiculous. Who invented the computer? I’ll give you a hint. His name is Charles and he didn’t work for the government.
Dumb as usual.
Here, since you’re a fucking idiot, read the history. The government played a role, but they didn’t invent the internet and the notion that without the government the internet wouldn’t exist is fucking laughable.
Oh, look, a corporation was contracted to develop ARPANET. It’s shocking you can’t even get the history of something correct.
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False. Corporations only steal coerce and destroy. They cannot develop things comrade. #staywoke
/s
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While that would make a bit more sense, I doubt it.
Seen the NHS and the UK get mentioned on a few threads and thought I should clear up a few things as I see the same several people across all of them.
- UK is not some extreme left mess, it’s had a tory government for 8 years. It is, however, a mess but that’s because all parties seem to lack trusted leaders. Brexit alone is a books’ worth of problems.
- NHS is single payer but that doesn’t mean you don’t get a choice. For example, my friend recently had an appointment and was offered 3 hospitals to choose from, that’s just the local area, probably others if he enquired. We also choose our GP surgery and dentists. When my wife gave birth we where offered several options. Hospitals are regularly inspected and reports published.
- The inefficiencies in the system aren’t always the fault of the clinical staff. Political parties seem to plan in four year cycles depending on their view. For example a Tory government may try to privatise the NHS by stealth. Also, how the politicians have messed with the recruitment and training of medical staff is awful, look at our deportation problems at the moment. I understand if you don’t trust your own politicians with this influence.
Are the posters who are strongly anti single payer count themselves as republican, or possibly libertarian? I’m wondering as I don’t think this thread will ever end and it’s interesting to see the thoughts about politics from other countries.
I’ve seen usa obesity mentioned? The NHS does lead a lot of community education to support matters like this. Not sure if that would work over the pond?
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This is the thought experiment I always get hung up on. How much of governmental inefficiencies is purely driven by politicians instead of the process itself.
It’s just become kind of a know thing that “govt is inefficient” irt things like HC. How much of that inefficiency is intentionally driven by those whose ideologies don’t want it in the first place. Reminds me of Ocare. Ofc it was going to fail, people were making sure it failed. But what would it have looked like without the sabotage.
This is obviously not a problem with only one party. Both sides do it
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I think this is basically the crux for many of us.
I’m not really “anti-single payer” as much as I’m anti-more powerful government. I’m not a big fan of labels, but I think classical liberal fit better than most.
Doubtful. Americans have a lot of great qualities, but our almost universal need for excess is not a strength in this area.
I don’t think it’s necessarily just politicians. Bureaucrats shouldn’t get a pass and frankly neither should your average government worker.
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Yep, I’m there with you. What to do about it is where some fork. Do you put up a fence and tell those without integrity to stay out or engage more in local politics and hold them responsible?
I just don’t think there’s an ideal system also when you take into account local culture and politics.
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Right, but with the size and scale of our govt/society a bureaucrat and/or govt worker doesn’t exist with the power to significantly impact the overall efficiency.
I’d say lowering the caliber of worker (ala lazy govt employee stereotype) is a Dem sabotage, while Republicans tend to sabotage by fucking with the funding.
It’s not like there’s a fix, since the problem is human nature, but damn it’d be cool to be able to quanitfy the inefficiencies and their causes
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I think another thing that needs to be considered is the scale of current single-payer systems and the relatively homogeneous populations being served. I’ve said this in other threads, we have approximately 12M illegal immigrants in the US (some estimates are much higher even). That’s more than the population of some countries, like Finland, that have a single-payer system. That’s almost 20% of the UKs population. That matters in terms of cost and who will bear the cost.
The US is 5x larger than the UK in terms of population. That will matter. Obesity is a huge factor even if a particular poster wants to ignore it. There are a lot of others.
I’ve also said, comparing the US to individual countries makes little sense. Do you (general you) think the EU could support a EU single-payer system? That would be much more similar to what the US would need to do. I’m not convinced that it could.
@pfury I donno, man. I think the high ranking bureaucrats in say the Department of the VA, for example, have quite a bit of influence over said departments efficiency.
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Under the assumption they all magically convert to the same language and are now led by a single leadership group, what would stop them? What do you think these single payers do that would be hindered by the scaling?
What do these bureaucrats do individually that really has the power to pose a large weight of the inefficiencies in the grand scheme? Are they all not just operating under the laws Dems and Reps have spelled out in nearly every scenario?
Would they be lead by a single leadership group? We aren’t and it causes problems in terms of program efficiencies.
If they magically achieved what you wrote, they would face a number of challenges. For example, Greece has a debt to GDP ratio of about 170%. Italy’s over 130%. Germany is really the only strong country in this regard at 64%. Most of the larger countries, like the UK, are right at about 95%-100%.
Providing coverage to all of the EU (not all of which currently have single-payer systems as far as I know) is going to require taking on debt or raising taxes, buuuut, places like the UK already have pretty high tax rates and I’m guessing the Germans are gonna be pretty pissed about paying more to support places like Greece.
It’s not necessary that single-payer systems do something that would be hindered by scale. It’s simply the scale itself and new factors that have to be addressed. For example, very few Syrian refugees have been relocated to the UK, but if there was an EU single-payer vs a state single-payer the UK would have to help foot their medical bill. As it stands, it appears the Germans foot most of this cost. If we put that in term specifical to the US, it would be if Texas had a single-payer system and Texas taxpayers supported all 12M illegal immigrants, we implement single-payer, and now Alabama has to help pay for said illegals. I have a hard time seeing that fly all that well.
They inact policy. Congress/POTUS might make law, but they carry it out and my understanding is that they have pretty significant leeway in how they do it. Bureaucrats quite often have to testify in front of Congress because of how they conduct business (Lois Lerner for example). I don’t believe in the deep state nonsense, but Bureaucrats do have a significant amount of influence over how policy is carried out.
When the law is written it is often the job of a Bureaucrat to interpret said law and figure out how to actually implement that law. I think this gives them quite a bit of power. One example I can think of is tax law and the IRS. Often time, tax accounts are stuck waiting on the IRS to provide guidance on tax law changes as they themselves interpret what Congress passed. At the end of the day, it’s the head of the IRS, in this examples, job to interpret and implement the law giving them quite a bit of freedom to do as they please.
That’s my understand of the situation anyway.
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I meant akin to us in the sense that they have a “National” electorate that governs all states. EU countries have independent national political structures.
Which would just mean it’s more expensive? I don’t see how that in itself leads to extra inefficiencies
Are refugees able to claim national level public assistance that isn’t specifically earmarked for them? Could a Syrian refugee walk into an unemployment office behind a German and collect a check?
Could the law just not be wrote to not give them leeway? Seems like the leeway is by design (would fall into the ‘Dem sabotage’ camp for me).
Right, “bureaucrats” as a whole maybe. Not sure if that would have any ability to show any significant weight per head. Could you point to a single bureaucrat name and say that person is responsible for more than .001% of the inefficiencies?
Ya, I follow. I meant we aren’t really lead by a single leadership. Sure we have the Executive branch led by a party, but Congress is split with party power in flux regularly. There are road blocks to “single leadership” overseeing programs. Particularly a program like healthcare, which in theory will span lifetimes.
It would definitely mean more expensive, but it could mean more people being seen, more treatment options available, more hospital beds, etc… Once something becomes "free’ people tend to use it more.
It was just an example and probably not the best one. I was just trying to illustrate unique problems nations would face if the system were to span all of the countries of the EU like they would span all of the states of the US.
I don’t know.
I guess, but that’s asking a lot of Congress…
I think every head of every major department could improve department efficiencies by greater than .001%. Do I have a list of names and accompanying research, no, but I don’t think it’s any different than when a new CEO is named and the ensuing cultural/policy shakeup results in better efficiencies.
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Thanks guys, interesting answers, I appreciate the time. I was almost magically aligned in thought with USMC when I wrote Brexit as I’m pro Europe and couldn’t think of a way to get healthcare to work. However we do have a system where I get some healthcare across Europe, think I have to fill out a E111, why I can’t show my passport I don’t know.
Is there something about this that would imply more inefficiencies that we wouldn’t see at a lower head count? In nearly every other aspect of life, having a higher market share means HIGHER efficiency, not lower.
Unless the EU is paying for things like refugees as a whole, instead of country by country, I don’t see how a scenario like this would impact “EU single payer.”
What issues do we see irt efficiency by adding in multiple states? Federal govt supersedes state govt, so if you don’t give the states wiggle room like we did with Ocare how does multiple states matter?
I feel like it’s not asking that much. It’s only what the majority of Republicans have been preaching about for the past decade.
Although to your point, after seeing the budget and tax bill, it’s not like they know what to do with the car they finally caught after chasing for so long.
As a CEO almost always (always?) has to be voted in by a BoD, wouldn’t it make more sense to compare a CEO to an elected pol?
I don’t necessarily agree. Yes, with greater numbers you get economies of scale, which is useful for negotiating lower costs/better contracts. Centralizing has a lot of positive cost saving attributes.
However, as numbers grow, from an administrative standpoint, you also have negative attributes. Mind-boggling “red tape”, SOP that makes no sense, people that take more than they contribute, etc…
Greater market share also doesn’t necessarily = greater efficiency. There are a lot of examples of large companies with significant market shares that, through complacency, were very inefficient and it ultimately reduced their Mkt share. See GM’s bankruptcy, the role the UAW union played in ensuring GM (Ford?) failed (they paid people 100’s/hour to sit in classrooms and do nothing), and the ability for the more efficient Japanese companies to take significant market share.
Does one outweigh the other? I think healthcare is a particularly difficult beast to analyze in this regard. Plainly, because government can just throw money at the problem. They don’t have to be efficient. See the Joint Strike Fighter for a recent example of this.
Okay, imagine if the Syrians weren’t refugees, but poor migrants making a mass exodus out of the Middle East and into the EU and the EUs single-payer coverage now covers them (as ours would cover illegal immigrants I assume).
Does Alabama provide the same level/standard of care that Massachusetts does? You would need to standardize care and then spend time and resources bring care up in areas that are sub-standard.
Can Arkansas’ citizen afford an additional x% of their income going to pay for an illegal immigrants care in California? Can the Department of Single-Payer Services effectively insure Mexican-American Californian’s, Hillbilly Alabamian’s, and the Mid-western rancher? There are cultural difference, differences in natural hazards, and even potential genetic diseases one might only see in parts of the country. The same would be true in the EU.
This isn’t the EU, but imagine if Australia was in the EU and the administration of this imaginary EU single-payer system was in the UK. Would you feel confident that snake anti-venom would be properly accounted for and supplied in the event you were bitten by any of the handful of deadly snakes in AUS? I wouldn’t.
Centralization, as mentioned above, can be a good thing (I happen to really like centralization of corporate overhead departments for cost savings purposes), but administrators are removed from the environments they are managing. Meaning, they lack the intimate knowledge a local would have. That’s built-in inefficiency, imo. Even at the state level administrators would have a better grasp on the needs of all of the citizens of a state than the fed would.
But Republican’s aren’t the only party in Congress and there is dissent even in the Republican party. What Rand Paul wants is not necessarily what Paul Ryan wants and it’s certainly not what Bernie Sanders wants.
It’s difficult enough for them to pass a simple piece of legislation without everyone’s pork project attached…
Lol, that’s exactly my point. It becomes the IRS’ job to figure it out.
I would say they are more like an appointed official (Justice, SecDef, etc…) being confirmed or denied by politicians (BofD).
The CEO runs the company at the behest of the Board, but they generally have pretty wide latitude to run the company as they see. Afterall, that is why they were voted in in the first place. I think that’s very similiar to how the various departments are run.
Point taken, misspoke. I was thinking more along the lines of potential for more efficiency, not that it was automatic by virtue of gaining market share.
To your point though, nothing ensures anyone actually takes advantage of the potential when there’s no competition.
I haven’t actually seen a version of single payer that covers non citizens. Is that how it works in the places that have enacted UHC?
Would our current medical nation wide programs not have already done this?
In this scenario, is the state (austrailia) forbidden from putting money into snake antivenom? Does austrailia not have the ability to elect pols in this EU leadership scenario?
Isn’t wanting less govt waste and lower spending a pre requisite to even putting the R next to your name?
And if they stray from how it’s been written irt Congress’ intentions, are they not free to challenge via judicial or rewrite the law? Hell fire the head of the IRS and start over?
Fair point. Agreed