In the past, fire companies would show up and demand payment before putting out fires. If a payment couldn't be made, the company might negotiate the purchase of the burning property at a steep discount.
Later, insurance companies hired brigades to only put out fires on insured properties. Fire companies might have fought or sabotaged one another in order to win the right to put out a fire and get paid for it.
While it isn't perfect, and it's often underfunded, I definitely prefer the system we have now.
However Healthcare in the US isn't a regulated monopoly like that.
I think it was this one
I'll argue whatever PG&E problems are they don't rise at all to the level of healthcare. And their problems are due to poor regulation and the US's current terrible management culture.
This works in Denmark because of Denmark, but it's still a system that has obvious weakness.
[1]: https://en.wikipedia.org/wiki/Corruption_Perceptions_Index
Essentially, the state (or region) contracts a company to deliver ambulance services. The contracts usually last a few years and are limited to a region.
Furthermore, the company that wins the contract (usually lowest bidder) is held accountable is too many responses are too slow, etc.. usually with hefty fines.
I guess you can call it privatization, but it's more of a regulated monopoly. Ultimately, these things outsources uncertainty from the state to the private sector. I'm not convinced it's always a good idea, since companies can just factor the cost of fines into the contract... Granted if there is competition, it can drive the prices down a LOT.
Usually credited to Marcus Licinius Crassus, who had a fire brigade for just that purpose. Contemporary of Julius Caesar.
In some parts of the world, insured properties were marked with metal plaques (generically termed "Fire Insurance Marks" [1]) bearing the insurer's symbol/logo. This enabled the insurer's firefighting service to verify that they should protect the building. I've occasionally seen them on old buildings here in the UK. One I remember was a stylised representation of the sun, denoting The Sun Fire Office - which was founded in the 1700s and still exists as RSA Group plc.
There are analogies (with smaller consequences) in private tow truck operation.
However the policy of negotiating for property at bargain basement prices while there was a fire next door was very notably one of the ways that Marcus Licinius Crassus (a political ally of Julius Caesar) enriched his fortune.
Supposedly Crassus, the richest Roman of his day, made rather a lot of money like this.
The same as a concert promoter hiring off-duty cops.
https://www.latimes.com/local/lanow/la-me-ln-private-firefig...
(I certainly prefer publicly funded fire service)
https://en.wikipedia.org/wiki/Broad_Street_Riot
Here is a comedian's take on it in podcast form: https://thedollop.net/wp/episode-138-dollop/
This creates the perverse incentive to demand an outrageous price so they can get an property for cheap. Next step would be setting fires to buy even more property.
Now, if two crews showed up and bid against each other, things start to get interesting.
It also means it might be that nobody shows up, because it's a holiday, so nobody was on duty.
Well surely public services are more incentivized to display this behavior
Sabotage and physical fights broke out between fire companies while fires burned. That's a pretty gritty situation.
Allowing fire sales gives way to perverse incentives, like the profitability of arson and predatory pricing of fire fighting fees such that certain portion of victims will always have to sell their property at a discount.
But suppose that you have an honorable firefighting department run by an honorable man. Why could he not have set up a private firefighting company instead, doing pro bono work when required? Given the honorable behavior of his company, why would consumers not want to prefer him for insurance than shady competition, which may be cheaper but is also more likely to screw you over when you most need them?
Government-run agencies can be good or bad; private companies can be good or bad. There is no silver bullet and much depends on the prevailing culture. But government can use the threat of force to compel you to pay for their services. If a private company attempts the same, we would call it an organized crime group.
Then there's another problem: who defines what is considered "cosmetic"? Most insurance companies currently don't cover e.g. facial feminization surgeries for transgender women, even though they're considered medically necessary by WPATH, a document drafted largely by insurance companies [0].
[0]: https://www.wpath.org/media/cms/Documents/SOC%20v7/SOC%20V7_..., p. 58
So my 15 minutes $600 allergy appointment that insurance refused to cover (after covering the same damn appointments for 12 years) is that high because of others, or so I keep hearing...
If this is true, the system is completely broken.
If it's not true, then the system is completely broken, but in a different way.
Of course, it's absurd that all 3 out of 4 paths require you to take extra, often really painful steps (collection + bankruptcy, maintaining insurance, or long drawn-out negotiation) just to pay a reasonable price for something that is 100% non-optional and most countries provide for much-closer-to-free. But that's kinda what happens when the system is broken
Worse, the police aren't going to arrest people who pay them.
[0] https://en.wikipedia.org/wiki/Kensington_and_Chelsea_(UK_Par...
[1] https://www.theguardian.com/public-leaders-network/2018/feb/...
The "free market" (in a libertarian sense) does not permit the initiation of force against people who have not resorted to force themselves. If that is a significant restriction on your police department's activities then there is something seriously wrong with your police department.
> Worse, the police aren't going to arrest people who pay them.
If they aren't willing to arrest anyone who pays them then no one will bother to pay them. Resolving disputes between two paying customers is part of their job description, and they won't retain customers if they're seen as biased or corrupt.
There are private police forces, we call them the "mafia", and people pay them for "protection". Sure, they're corrupt, but with no government funded police, whatcha going to do about it?
If the suspect is eventually convicted (of something at least as serious as kidnapping) then that conviction retroactively justifies the arrest.
If the suspect is never convicted then arresting them is little better than kidnapping. If the police at least had a reasonable belief that the person they arrested would be convicted then it falls under the heading of accidental harm rather than negligence or malicious intent, which shields them from retribution, but that doesn't avoid the need to pay restitution to make their victim whole.
In short: Be sure you're arresting the right person, and don't do anything to them in the process which you'd find difficult to set right.
Enforcing laws is the point of government, and a free market requires enforcement of laws. This is why countries with a non-functioning government are an anathema to business, not a paradise.
What state? In Washington (and many, though definitely not all), ambulance prices are regulated, for this reason. When I worked private ambulance a couple of years ago it was $680 + $8/mi.
You do actually, by where you choose to live and also by the services as detailed in [1].
I think there's merit to investigating public health care. That line stops for me in eliminating private care.
1] https://www.theatlantic.com/technology/archive/2018/11/kim-k...
The wealthy with their ability to influence politics will lobby to undermine/weaken the public system to save their tax dollars.
You are better off with one system so that everyone is entitled to the same level of care. We do this with fire/police, same applies to health.
Another way of looking at it is we don't have private firehalls. I'd argue healthcare is the same.
Interestingly we are moving towards having private security forces, enabling some to be more safe than others. I don't agree with that either. So, maybe it's a philosophical difference, I feel strongly that for basic rights (e.g. health, safety) we should all be treated equal, and money should not grant me special treatment.
And if it doesn't survive, good! Industries don't have an inherent right to keep existing if they don't fill some useful function. Refusing to implement an otherwise desirable social program because it might cause an existing industry to become obsolete is far and away the most anti-capitalist argument I see self avowed capitalists make.
This is the same issue with toll roads vs. public roads. Imagine there are two similar roads leading from A to B, one a toll road and the other public. The toll road charges drivers $1 per 100 miles. The public road is free to use but costs every driver $5 per 100 miles in taxes. Which one do you think drivers will take? The more expensive public road, of course—because they're already paying for it, whereas the toll road would be an additional expense.
Imagine your hypothetical were reversed. Imagine we already had a network toll roads priced at an average of $5/100 miles, and that we had a plan to build and maintain public roads at an expected cost of $1/100 miles. There might be plenty of good reasons not to prefer the more efficient public plan, but the fact that it would put toll road vendors out of business isn't one of them.
Capitalists don't mindlessly prefer private things just because they're private. We like them because they tend to self-optimize for efficiency more effectively than a centrally managed system can. Usually. There are a whole thread's worth of reasons to believe health care is one of the exceptions, both in theory and in practice. If that's the case, then refusing to implement a superior public system solely because it would decimate the inferior private one is just another flavor of the same anticompetitive protectionist bullshit that makes tarrifs and professional licensing and restrictive zoning and a dozen other types of cronyism distasteful.
I have no particular sympathy for any private provider that can't compete with other private providers in the market. However, from my point of view private and public providers aren't in the same market, or even providing the same product: one is simply selling access to roads, or health care, while the other is giving these things away bundled with the dubious "service" of compelling other people to pay the bill. To me that bundled "service" is of immense negative value, and the existence of the public system is driving the providers of the unalloyed product I actually do want out of the market. So, from my point of view, the fact that the public plan would put the toll road vendors out of business and thus leave me with no decent travel options that don't involve externalizing the cost onto others is actually a good reason to oppose the public plan. (There are others: While I don't want to participate in this externalization process as an unwilling beneficiary on moral grounds, I'd also prefer not to become one of its victims.)
Of course, if there exists a way to build and maintain a road at a cost of $1 per 100 miles, there is no particular reason why that cost couldn't be payed through tolls instead of taxes, thus giving us the best of both worlds. There are basically only two ways which public services can manage to cut costs compared to a private provider. One is by externalizing the cost of the service onto non-users, and the other is by being exempt from regulations which private providers would be forced to follow (or, equivalently, having the regulations tailored to suit the public service by sympathetic legislators).
> Capitalists don't mindlessly prefer private things just because they're private.
Whereas libertarians such as myself do prefer private things simply because they're private, which is to say: because they don't involve the use of force. Which is not to say that there aren't practical reasons to prefer private systems as well—just that, to me, any system which involves force is automatically more costly than any voluntary system, which makes these other reasons more-or-less irrelevant.
> You do actually, by where you choose to live
That's wrong on so many different levels:
1) The emergency service provider is unlikely to tell you how much anything costs in reality ahead of time.
2) Not all emergency services providers offer the best price for all services, or are even equipped offer all services.
3) Many medical emergencies are completely unexpected, you have no idea what kinds of services you'll actually need in an emergency.
4) You're not really talking about "where you choose to live," but rather "where you choose to be at all times." Do you really have a choice of ER if you have to stay within a couple miles of it at all times to make sure you'd always be taken there in an emergency?
5) etc.
I haven't seen a proposal yet that would eliminate private care (or even supplementary private insurance).
Certainly it is true, I agree, that emergency hospitals and ambulances are public-option only.
Hence there are VERY few private clinics in Canada except for services where the govt realized it was in their benefit to allow it (MRIs).
My original statement might have been more accurate had I said "fully eliminate private care and private insurance".
Certainly with medicare for all both of those would be drastically reduced. With the medicaid buy-in they would both be moderately reduced.
I still think private care and private insurance will exist under both models, but like you said, they may be different in terms of what they cover.
Said another way: Should I then also move when I want to find a better price on milk?
Believe it or not there are people who move into cities because of better fire departments, police departments, etc.
Has anyone proposed that? If not, I'm not sure why you mentioned it.
Anyway, I suppose I can see the benefit to private doctors, but if private emergency response services for individuals are popular, then something is fucked, as your link demonstrates. Not saying they should be banned, but they shouldn't have to exist in a properly-run society.
What serious single payer proposals have been put forward that would eliminate private-pay, private insurance, or private care?
I've never seen one.
In fact, almost all "single payer" health systems that exist in other countries have private care and private insurance options. For example, such options are available in both the UK with the NHS and in Canada.
I've never once spoken with an advocate of single payer who wants to eliminate private pay, private insurance, or private care.
I am also an advocate of single payer, and I wouldn't advocate eliminating any of those things.
Plus the whole point is to eliminate dealing with the adminsitrative burden of claims and billing. IF you just add another insurance, you just make it worse.
In the case that Medicare is expanded and is optional, medicare will have the following fair challenges: it has to compete with other private insurances, which means is has to pay as much, and any administrative cost dissipates, in fact it gets worse, as providers still have to do multiple billing. If it has to charge ,it will also have to turn away patients. It it doesnt charge, everyone will have medicare, and private insurance will not provide services that medicare gives for free or without restriction.
Up to this point, "single payer" has not provided a single cost reduction means.
That's absolutely not true.
https://www.congress.gov/bill/115th-congress/senate-bill/180...
If I understood this text correctly, this will be:
An optional insurance plan (SEC. 105) An insurance that gets tax benefits (SEC. 701) An insurance that has incredibly perverse utilization incentives (SEC. 202)
I would be quite on board on this plan if it weren't funded with special taxation, and it gave itself no promise of benefit for being the state, not because I think its a good one, but because it will confirm its a terrible one.
I'm sure there are plenty of things to dislike about Sanders or anyone else whose political leanings tend toward things like publicly-funded healthcare coverage, it should be possible to come up with a few of them without blatant misrepresentation
Both Medicare for all and Medicare buy in plans wouldn't eliminate private health insurance.
Private health insurance would still exist under both plans as supplemental coverage that people could buy that would cover things that were not covered by medicare.
The markets would be potentially reduced (drastically with medicare for all, moderately with a generally available medicare buy-in), but it's totally false to say they would be eliminated under those plans.
Family networks are probably the number one reason. Child/elder care, food/housing/etc. sharing and a lot more are all major factors that by definition do not show up in economic reports.
And that's before people's "psychological conditioning" (which some people refer to as "being part of a family") is considered.
I, too, have moved around a lot - across the US three times, overseas and back once, with smaller cross-state moves in between. And it has worked out for me. I am also not married, have no kids, am not very close to my family, have a high degree of risk tolerance and high attraction to novelty, and seem to need a smaller community of folks in my life than many others.
I'm also well aware that I am an abnormally-unattached person. Most people have significantly more difficulty uprooting and moving somewhere else. Writing that off as conditioning that interferes with economic concerns not only fails to recognize very real economic aspects that don't show up a bank account, but also fails to recognize that humans value things other than money.