1. I believe very strongly in the sovereignty of the individual.

2. I prefer more open and incentive-driven markets.

3. I’m skeptical of governments, particularly large and powerful ones, because they’re inefficient, rely on coercion, and are too tempting as prizes to be captured for power, prestige, and wealth.

However, these are all on a spectrum and I’m open to trying other points along that spectrum if they work better than our current system. I also recognize that the optimal system may be too distant from where we are today to even move towards it directly.

So for healthcare for example, our system is dreadful, but I’m not sure that pure free markets would be better. But I’d strongly prefer a public option (and maybe even single payer), or a well-designed hybrid system like Singapore or Switzerland has to fully nationalized healthcare like UK.

Similarly, I’m open to trying basic income, a land value or VAT instead of income tax, and other alternative systems. I’m particularly in favor of systems that are more stable and resistant to changing from the whims of the current government.

I personally don’t understand how anyone who thinks the government is awesome can continue to believe that when they watch episode after episode of unchecked police brutality, or constant encroachments on civil liberties, or the entire Trump administration.

* GP surgeries (doctors offices) are private businesses, and may provide NHS services or private services.

* The NHS contracts out for a growing number of services, ranging from operating whole departments (e.g. Virgin operates the out-of-hours walk in centre for non-emergency care next door to the A&E/ER at my local hospital) to cleaning.

* The NHS rents out facilities to private providers, and individual NHS trusts may derive income from carrying out private work (though the proportion of this income is limited, and the revenue goes back into their budgets). This is in addition to NHS staff often renting NHS facilities to carry out private surgeries outside their normal rotation.

* Dentists are mostly private and generally dentists that do NHS work also do private work, and often mix and match with the same patient (e.g. the NHS does not reimburse more expensive types of fillings, so your dentist may recommend e.g. things like porcelain veneers on visible teeth and stick to NHS options for less visible work).

* Pharmacies are mostly private - the NHS mostly operates pharmacies only in hospitals etc. but they too can be privately operated.

* 10% of the population have private health insurance. This is mostly "top up" insurance offering additional services or faster turnaround for non-essential surgeries etc. than the NHS.

* Many types of healthcare services are mostly private. E.g. while you can get some types of cosmetic surgery on the NHS

As it stands, the NHS is the most cost-effective hybrid or private system in any developed country. Too cost-effective some would say; to the point where it comes at the cost of making things more miserable for patients. But that's what you get when we pay far less than any other countries at a comparable income level.

1. Maybe "fully nationalized" isn't technically true, but my understanding was that the UK was widely regarded to have a nationalized healthcare system. Not really interested in whether that's technically true at the margins unless there's some major policy impact.

2. "Cost-effective" is an interesting term, because it assumes we agree on what "effective" means. I want choice, innovation, better health outcomes, more convenience, shorter wait times, etc., and I'm willing to pay some premium (but not 4x or something) for them. For these reasons, I don't want want the NHS system here (nor do I think it'd work here), despite it being better for some values of "cost-effectiveness".

3. If by "cost-effectiveness", you just mean per-capita spending on healthcare, are you sure the NHS is the most cost-effective of any developed country? Doesn't seem to be the case here: https://en.wikipedia.org/wiki/List_of_countries_by_total_hea... -- maybe you're using some more complicated measure of spending per health outcomes?

Which countries do you consider not to have a nationalized healthcare system, then we can make a comparison?

Note that even in the US, the government covers roughly half of all healthcare expenditure. The UK government covers about 79%.

> 2. "Cost-effective" is an interesting term, because it assumes we agree on what "effective" means. I want choice, innovation, better health outcomes, more convenience, shorter wait times, etc., and I'm willing to pay some premium (but not 4x or something) for them. For these reasons, I don't want want the NHS system here (nor do I think it'd work here), despite it being better for some values of "cost-effectiveness".

Even if you for some reason believe you don't get this with the NHS (meanwhile most people here considers the US system to be terrifying), you have all of that by combining the NHS with private top-up insurance. The average cost of combining NHS and private insurance in the UK is far lower than the average cost of healthcare in the US.

So you can get the benefits that socializing services have in ensuring universal coverage and ensuring nobody drives up overall costs by waiting until things get more expensive to treat, with the ability to pay for whatever extra services you want.

Fewer people go without coverage, and you get cheaper coverage and more choice since you can still pick and choose from private providers but also get a public option if you prefer that.

In fact, because of the ability of the NHS to rent out resources, even privately paying for operations etc. tends to be so much cheaper even at top end London specialists that if you're in the US and need elective care it is worth checking the cost of flying to London, having it done, and staying in a nice hotel while recovering. For a lot of conditions that'll be cheaper.

Personally I find it telling that it is almost impossible to find people holding your positions in places where people have experienced these socialized systems unless they have the money to pay far more for care that is out of reach of most people.

For 3., note that you're referring to PPP adjusted numbers. The UK costs have also increased more the last few years than I realized. Even so, while the PPP adjusted data does not have the UK stand out as much as it used to, the gap between the UK and e.g. the US still illustrates the most important point.

Personally I find it telling that it is almost impossible to find people holding your positions in places where people have experienced these socialized systems unless they have the money to pay far more for care that is out of reach of most people.

Really? Then I think you've misunderstood my positions and you might want to try another read through my original comment. Unless you think that every other developed country in the world is clamoring for the exact NHS system? Because my point is that I'd prefer single payer or a robust public option to nationalized systems, not that I want the current US system.

note that you're referring to PPP adjusted numbers

Yes, because that's what makes sense. Why wouldn't you use PPP-adjusted numbers?

the gap between the UK and e.g. the US still illustrates the most important point

As I suspected, you're just defending the UK system as being superior to the US system. On this we agree, but it's irrelevant to my broader point.

Side note: why are Europeans so freaking defensive about their systems of governance? I swear that you can't have a reasonable discussion online about healthcare, taxes, employment law, etc, etc. without a mob of people from Europe jumping in to assure everyone that their system is the best and the US system for everything is horrible and we all unknowingly live in a terrifying dystopia.

We get it, you love the way you do things. I tend to agree on a number of issues, but I'm so tired of the condescending chatter about it. It just comes off as really insecure.

I've lived in Europe, I'd do it again, I LOVE Europe, but I don't think you've got it all figured out, or that your systems will always work everywhere.

What are you trying so hard to prove?

In that case the NHS is a lot less nationalized than you might think: a huge proportion of NHS services are provided by private firms under NHS contracts.

> Really? Then I think you've misunderstood my positions and you might want to try another read through my original comment. Unless you think that every other developed country in the world is clamoring for the exact NHS system? Because my point is that I'd prefer single payer or a robust public option to nationalized systems, not that I want the current US system.

The vast majority of developed countries have systems very similar to the UK, with a mix of public and private service provisions. The exact mix of public and private varies, but then again even in the US about half all healthcare expenditure is through the government.

> As I suspected, you're just defending the UK system as being superior to the US system. On this we agree, but it's irrelevant to my broader point.

That wasn't anything to "suspect" - it was there in plain sight. But that was also just as an example. Pretty much every developed country have socialized healthcare that is both cheaper and providing proper care for a large proportion of the population than the US system.

> Side note: why are Europeans so freaking defensive about their systems of governance?

Because the prospect of "US conditions" is terrifying, to the point that "US conditions" is actually a term used in politics in some European countries used to scare voters with the thought of what happens if you let the right wing run rampant over public services.

>I swear that you can't have a reasonable discussion online about healthcare, taxes, employment law, etc, etc. without a mob of people from Europe jumping in to assure everyone that their system is the best and the US system for everything is horrible and we all unknowingly live in a terrifying dystopia.

Equally, you can't have such a discussion without a bunch of Americans trying to push the kind of deregulation that led to the festering mess that is the US healthcare system.

> What are you trying so hard to prove?

It's not that we're trying so hard to prove anything. It's that we find it offensive that you let people die on the streets to avoid applying known working solutions out of fear they're too left wing.

You don't need to pick the UK solution. Any solution from any of the wealthier developed countries is superior to the US system. And they span the range from almost totally socialized (Norway) to mostly private healthcare with a mix of private and public insurance (Germany, France for example).

What they all have in common is that they provide universal coverage and a regulatory system that put people first. Most of them are cheaper than the US. Most of them are

Sounds like garden variety ignorance.

I liked the way conversation started, but this is pointless.

This is where I think some libertarians wander off from what those largely in favour of state actually think.

I think a lot of people would agree there's a lot wrong with government, but most would also rather have one. They just want one that's run better.

Your libertarianism seems quite pragmatic and I personally sympathise with the ideas behind libertarianism - lack of coercion, lack of people making arbitrary moral decisions (like drug laws) and imposing them on society.

However I also like public services, welfare safety nets (BI is indeed interesting) and various other things that only come with state-level cooperation.

I would argue that most libertarians aren't anarchists, but it's a popular strawman tactic from those arguing against it (particularly on the left). It's almost a cliche: "You know where is a libertarian paradise with no government? Somalia! Hurr durr!"

I think we all agree that government has problems. Libertarians just think that the problems of government are inherent and fundamental, so the solution is usually in less government (but not no government), while "liberals" (huge spectrum here, I know) seem to think that the answer is more government.

And we all agree that we need better government, but libertarians think that public accountability works better the closer the citizenry is to the decisions being made, and liberals seem to favor more centralized decision-making, I guess for efficiency? I'm not entirely clear on why :)

Universal healthcare being one example (at least our system seems simpler than your deductible / premium / medicare / medicaid / etc. chaos), UBI being another.

Also, don’t know what “our system” or “your chaos” refers to, but if it’s the setup for another screed about how universal healthcare is superior to the current US system, save the wear and tear on your keyboard. I’ve heard it many times and I agree.

I'm not saying it's all libertarians, but I have interacted with quite a number on the net, over the years, who would scrap those things entirely. I, personally, think inefficient government is a price worth paying for such things, but that we must seek to do better.

You should be very interested then where your sovereignty comes from. At the moment it comes from having above yourself an entity so powerful that you and others around you (that are 10 times, 100, 1000 times as powerful as you) are equally insignificant and uninteresting as long as you pay your dues and don't make a fuss, ie don't try to overtake one another in violent way (even in some non-violent ways that in the past proved bothersome for the overlord so they were forbidden).

The world is full of military technology that just invites anyone with a goal to put the finger on the trigger. So far best invention to control this state of affairs is to have the most dangerous weaponary in hands of just few actors preferably with non-overlapping geographical zones of interest.

You are open to trying basic income.

Do you think we should have laws and regulations to protect the environment?

If so, then I think you have graduated from Libertarian to Liberal. Ha ha! I did the same thing after I realized that a true free market libertarian ideal is easily abused by corporations and the wealthy, and the common man has no chance.

Ultimately, Libertarians stand for the freedom of people. Currently, when a government takes and uses 1/3 of every dollar earned, the society is not free. Note: that ratio would be a lot higher in expensive areas like the bay area, etc.

1/3 doesn't sound like much oppression, but when you add in the multiplicative effect on the spending side, it becomes more onerous because everything is more expensive. The day care has to charge 50% more, etc.

It's about Maslow's hierarchy of needs. Most people, 99% are still working on their bottom tier. It would be morally, ethically, and economically wrong to stop their progress, by taking 1/3 of their productive efforts.

As the above posts mentioned, we do differentiate between natural resources and earned resources. Natural resources like Land should be taxed because you didn't create it from your own labor. On Earnings However, if you make your bed in the morning, you should be able to keep that labor - no one should be allowed to come over and use 33% of your bed.

See, this is just nonsense. You follow this to its logical conclusion and the only free people have no government. You're free to reject it all. There's plenty of places where you can just say "fuck it" and nobody will come bother you. Go ahead. Nobody does, though, because they quite like the security of living in a city, where no matter what the emergency help is just a phone call away, and one can watch live video from the surface of Mars on a smartphone.

The existence of ultra-wealthy people isn't inherently bad.

The question is about the alternative. If everyone's quality of life improves (including relative to the ultra-wealthy), I'd rather that happen than reduce everyone's quality of life out of a sense of "fairness."

Claiming most libertarians act against their own interests because they think they can become ultra-wealthy is straw-manning the view.