At least in the US we (try) and make donations public. The places where it’s “banned” are black holes.
That is definitely an interesting take. So, is your ideal society one where anybody is allowed to give and take bribes as long as it is public?
Given that influence and manipulation is impossible to stamp out, and then realizing that some of those that want to influence are some of the richest and most powerful entities on earth, I would personally rather allow lobbying and donations to be legal, but require all of it to be public. That way you can tell who is taking money from who.
Otherwise, it’s just the mafia and insiders games all the way up the chain.
There is a huge dufference between “subject matter expert advises lawmaker to vote some way” and “business tycoon hands a bag of money to lawmaker to vote some way.” Somehow, America has equated the two, and considers them equally acceptable.
1. In Europe and UK, bribery (Let's not sugercoat it as "lobbying". We all know what it is.) is illegal. So people will just do it secretly. In other words, legislation doesn't prevent bad things, in this case, bribery, from happening.
2. In the US, bribery is legal, but hiding the records is illegal. So people will make it public. In other words, legislation does prvent bad things, in this case, covert bribery, from happening.
I guess legislation is just so much more effective in the US.
I know somebody who owns a therapy business. Medicaid rates have not increased in 15 years and increasingly make it harder and harder to do your job. The level of stress and pressure it creates is intense.
What do you think is going to happen when private equity comes around and offers an exit?
I can't speak for the pressures on doctors as confidently, but I can assume there are similar issues.
So what you end up with is regulatory pressure that is forcing the market to a certain position, which makes private equity seem like the only realistic escape. In a true free market, this wouldn't happen or it would be significantly more expensive for the PE firms to make acquisitions. The businesses would either fail quickly or become successful enough to increase their rates and thus the compensation for their employees and owners, which removes incentives to sell.
I was at a sporting event earlier this year where I overheard an exec from an insurance company (I was a guest of somebody with pricey tickets). He was complaining about how a hospital was forcing them to increase rates after being willing to drop them as an insurance provider, because the insurance company would lose all business in the area of the hospital wasn't on board. It's a microcosm of the stuff happening behind the scenes.
If only there were a single payer. ;-)
Seriously, there should be single-payer health care. Also, there's the fundamental question of whether you view health care as a political right or as a personal privilege. The free market is very good at serving the privileged, not so great at serving everyone universally, equally. If you're ok with millions of people having little or no health care, that's definitely what you'll get with a totally free market for health care.
How good would you feel about your job, even if well-paid initially, after 15 years of no raise. Not even inflation or cost-of-living adjustments.
And would you sell if someone came and offered you money for your customers, knowing they'd get screwed sooner or later?
Excuse my ignorance as a non-American, but I don't understand how Medicare and Medicaid can be called "single-payer", even if we bunch both of them together for the sake of the argument. Are certain healthcare providers restricted so as to only accept Medicare and/or Medicaid patients, and cannot by law accept those who are privately insured or would like to pay out of pocket? That is the only context in which I can imagine Medicare/Medicaid being called "single payer".
Those aren't the same things.
The government paying for services in a private market is not single payer.
Things aren't called the same thing everywhere. For example, "single payer" is called "third payer" in Northwest Europe.
Expensive (e.g. expat) insurance tends to be single payer/third payer even though it is 100% private insurance. You just go to a doctor, they help, other than your insurance card, no questions asked.
No, that's not what it means.
> The doctor/hospital/... just gets the money for medical services rendered directly from insurance (and insurance collects things like a deductible from the patient, not the doctor. Essentially, insurance guarantees payment to the medical provider and deals with all patient financial matters).
You seem to be describing medical insurance in general, not single payer health care.
> Medicare and medicaid are single payer.
No, they're not. "Medicare for All" would be single payer. https://en.wikipedia.org/wiki/Single-payer_healthcare
From Wikipedia: Single-payer healthcare is a type of universal healthcare in which the costs of essential healthcare for all residents are covered by a single public system (hence "single-payer").
The difference here being the US has a fractured system, with several government systems (but from the same government). Medicare for All would be try single payer.
Of course, I don't actually think you believe this bit about the free market. I think you've been trained to rant here because this community rewards views like that.
"More like running many kinds of businesses has become more hassle than its worth. Medical malpractice premiums are very high"
"This is the kind of economic distortion that should be expected when onerous government-imposed regulation of practitioners, medication, and medical devices creates barriers to entry that reduce competition. While such regulation may have been imposed to try to increase safety, quality, and consistency, for example, it also ends up interfering with the incentives of the participants."
> Of course, I don't actually think you believe this bit about the free market.
I do believe it. What I said was "a significant portion of the population is vehemently opposed to any regulation of capital", which is not to say that the entire population is opposed. In fact, the population is very divided over this. There's more than one religion. :-)
In any case, the problem as I see it is that capital is very creative and inventive and coming up with new and terrible ways to extract profit, and regulation of these new terrible things comes far too slowly, if ever, precisely because the public is so divided, creating legal gridlock.
You're talking about old regulation. Of course long ago we've established regulations for the provision of medical care. Whereas private equity taking over everything is a relatively new phenomenon.
> I think you've been trained to rant here because this community rewards views like that.
Oh, I've been ranting for decades.
Blaming something for being practically a religion is about as empty a piece of reasoning as it's possible to make.
Why not actually suggest a solution rather than just throwing your hand up at the whole thing?
A solution to which problem?
The solution to the problem of private equity running the medical system is government-run health care, like in most other nations, who spend less on health care per person than the US but whose populations are nonetheless healthier.
Or are you talking about the problem of the severe ideological divide? Or some other problem?
A super majority of the medical R&D is funded by the US system. The gov run systems pay for a minimum of it. Of the U.S. adopts a system like other gov run countries where does the medical R&D get financed?
You can find the health R&D expenditure data here: https://www.oecd-ilibrary.org/sites/health_glance-2017-72-en...
It shows the U.S. spending 2.4x that of Europe on pharma expenditure as a % of GDP, and 3.2x that of Europe on government R&D health budgets as a % of GDP.
Edit: somewhat newer data is here https://www.oecd-ilibrary.org/sites/fc8b43f4-en/index.html?i...
It shows that the R&D pharma spending gap has actually increased even further to 3.5x.
You could pick the next most expensive country's plan, triple US R&D expenditures, and still spend way less. The GP's point about it not being outsized is correct.
I this your count misrepresent the reality.
In my mind, people who oppose free market capitalism usually don't understand how it works.
The good thing is that reality is what settles the debate. What happens is that people vote with their feet --- and millions of ambisious people from countries where there is less free market economy are desperately trying to come to US to realize their full potential, but not the other way around.
I'd like to see your statistics on immigration and emigration. Most people coming to America are coming from Mexico or the Caribbean, which I would consider to be free market capitalist societies, just poorer ones. How is the free market more restrained there than in the US?
(Note, for the purposes of the statistics I looked at, both Venezuela and Cuba are not generalized to "Caribbean" but have their own categories)
The next cartoon pane shows "The Free Market Reality", and it's a bunch of tired looking people standing in line for one of two automated computer terminals.
The truths portrayed would be: Those selling in the market have automated processes, there is no talking with the merchant, no haggling over prices, and there are not dozens of carts to choose from, in many markets there's 2 or maybe 3, or sometimes only 1.
For what it’s worth, I don’t like a lot of government meddling. Not because the free market is so great but because the meddling works out poorly and is subject to worse kinds of corruption and power games.
Political discourse too often talks about "capitalism", "socialism", or "communism", and half the people using those words don't know the difference, only that capitalism is the good American one. I'd like it if we instead focused on more understandable clichés, like "consumer choice is good", "market competition is good", etc. When considering a new regulation it's hard to discuss whether it's socialist or not; it's easier to discuss whether it will increase consumer choice, or make entering and competing in markets easier for new companies.
We get one group talking about capitalism and what they like about it is consumer choice and free market competition between several companies. The next group likes capitalism because of wealth concentration and their ability to warp society with their money. Both groups talk and agree capitalism is great, without realizing they have very different things in mind.
But then you also need to discuss the government power structures you need to put in place to create and implement that regulation. And when you look out ten, twenty years how that power structure will be twisted and abused.
Government always offers the same deal: grant government more power and they will solve problem X. But over time the people wielding that power change from people interested in problem X into people interested in the power. And the power is never contained to problem X.
After all, what could be more efficient for shareholders than having no competition?
According to the Heritage Foundation's Economic Freedom ranking, it ranks 25th, well below "socialist" states like Denmark (in 9th place) and Sweden (in 10th place).
"The Heritage Foundation (abbreviated to Heritage) is an American conservative think tank based in Washington, D.C. The foundation took a leading role in the conservative movement during the presidency of Ronald Reagan, whose policies were taken from Heritage's policy study Mandate for Leadership." https://en.wikipedia.org/wiki/The_Heritage_Foundation
In what way is it a political propaganda piece? From what I can tell it's a pretty transparent ranking of countries by factors that the organisation cares about.
While the Scandinavian countries have high taxes and regulated labour markets, they have deregulated markets, strong property protections and are very simple to do business in.
And they don't even define what their categories mean. I'm willing to bet that "labor freedom" to them means "right-to-work" and no minimum wage, for example. In any case, without proper measurable definitions, they can easily manipulate their index to say whatever they want.
But that's not my point. My point is only that there are aspects of a typical free market economy (by American right wing definitions) that are better represented in countries other than the US.
[0] https://www.heritage.org/index/pdf/2023/book/2023_IndexOfEco...
The fundamental loophole is that "the free market" is practically a religion in the United States (the so-called Invisible Hand taking the role of a god doling out rewards and punishments), and a significant portion of the population is vehemently opposed to any regulation of capital. You can even see this attitude in some of the comments here, where commenters are claiming that the problem is too much regulation rather than too little.
Moreover, political campaigns are financed by private "donations" (i.e., legal bribes), so the lawmakers themselves are practically indebted to wealthy interests who don't want to be regulated.