GM, Public Transportation, and Karma

Dear Mr. Privatization,

Please give me a few examples where your "magic" privatization has either worked well, or perhaps more importantly,, served some greater public good.

If I hear you correctly,,private industry should do EVERYTHING, and if it can't turn a profit,,, it shouldn't exist?

"Got cancer,,, well we can't make any money on you,, sorry. But we can cure your ED for a few bucks! Wrinkles,, sign here for Botox, oh and think of the profit in bigger boobs"

Icarus

 

You might like this, it is very flexible, quick and it hasn't cost the earth since it was installed.
The buses run on the busway to get from city to points along the track where they leave the track and travel in suburban streets to drop and pick up people near their homes.

 

The whole public verses private thing is pretty simple. Private works well when the payoff is relatively short term and the costs moderate enough to encourage competition. Public works well when the scope is beyond private means, the payoff is long term or difficult to quantify, or in cases where competition is not realistic.

It gets tricky deciding where to draw the line, which is why we have arguments like those in this thread. It is naive to assume that either form works best for all situations. Take, for example, fire departments. They used to be private organizations to which a home owner had to subscribe to obtain protection. It was often unclear which organization provided protection to which buildings. In one particularly ugly case competing fire departments responded to the same fire. Instead of extinguishing the fire, a brawl ensued.

In many cases a hybrid scheme is used, where private organizations provide services under public direction and control. Utilities are a good example of this. Without public control, the the utility companies would never have run electricity and telephone to rural customers. It is simply not cost effective. The reason that rural areas have these services is that we made a public decision to subsidize the cost.

Medical research is another hybrid scheme. Most fundamental medical research is publicly funded. Basic research is too risky and long term to attract private funding. Once an idea is shown to have promise, private industry steps in and creates products.

I wish it were easy to say which form of control works best for any given situation, but it's not. This is why we need smart people to make these decisions. The optimum solution varies by item and by time. What's best today may not be optimal tomorrow. It all comes down to clever thinking, and allowing the clever people to think.

Tom

 

Well said Tom,,, but let's not forget that there should be (IMHO) the concept of public good. Except for a complete fringe freemarketeer, there are few people who would support "private police" for example. These are teh same people who have little trouble funding "private security" behind their gated "communities",, but don't want to levy taxes for the 'real police'!

Let's hope we are emerging from an era of "me" to an era that at least includes "we" in some fashion.

Icarus.

 

Absolutely. That's part of the equation that must be balanced for each case. For example, take Pet Rocks. When the private manufacturer stopped making them, it wasn't exactly a hardship. City water is another matter. City water can be privately owned and operated, but there must be public safeguards to ensure an uninterrupted supply of water. The military is way out on the public side. I can't imagine a situation where a private army would be a good idea. The only way to safeguard a private army is to have a much larger public army, which kind of defeats the purpose.

Tom

 

I've gotten some good belly laughs over the 180 the privatization folks are making in regards to health care. One of the govt. proposals floating around is a large govt. sponsored plan to compete directly with the private plans. So what do the "private industry is always cheaper & more efficient" folks have to say about it? They should be saying, "Bring it on!" Instead they've been claiming that there is no way they could compete with that and it would result in the government completely displacing them!!! :bump2: In other words, they know what they've been claiming forever is untrue. It also means that the lowest cost system for the U.S. is universal coverage with a single primary payer. (No surprise as there is tremendous administrative waste with the current insurance based system.)

The real question of govt's role in such things is matter of degree. What is the best balance of private/public to acheive the desired societal result for a given task? It's not one-size fits all.

Personally, I would like to see real competition and commoditization in health care: prices of service advertized up front for easy comparision shopping, with specified care levels established by tradition/trade policing, and regulation.

Having uniform pricing for the same services to different customers is also a must. It torques me off tremendously that I get a bill with X dollars on it that then drops considerably after the insurance looks at it (50% is not uncommon.) It's not a bill, it's a vacation wishlist. Everything between the original invoice and the final amount is pure profit gouging.

Same goes for dental and eye care. I remember very well when I graduated and attempted to call around for pricing on a few basic dental services. Over 75% refused to provide any pricing and were obviously offended that anyone would comparison shop. I eventually ended up with a good dentist who charged 1/4th the rate of the first one that was recommended to me, did a better job, and didn't try to do a bunch of extra, unneeded work like the first guy wanted to do. I wondered how my dentist could afford to work so cheaply compared to the other guy. I never did figure it out, the cheaper dentist made his money and retired while the other guy was still working!

 

Privatization, while not perfect, tends to work much better than government control. Why do you think people dying of cancer in Canada come to the U.S. for treatment?

Watch the video

This is what government control of healthcare gets you.

 

That actually makes a lot of sense. Use the "busway" to get through the most crowded, traffic jammed areas then get off on local streets. Sounds smart to me.

 

Agreed. 100%. I am not privatization at any cost. But I think we need to get "clever" as you say and look for ways that private companies can bear some of these costs.

 

I agree. It is a strange system we have in that the average person has no idea what things cost and has no incentive to even care. This will not change - but would only get worse under a single payer plan though. The further someone is removed from seeing the costs, the less they care.

I think the answer is high deductible health care plans. That way, the consumer will keep close scrutiny on costs and manage those costs just as they would any other expense in their budget. This will put pressure on providers to more fully disclose and not throw in everything but the kitchen sink when they bill.

The crux of the problem remains, what to do with people who still can't afford a high deductible plan. In that case, I still believe they need some "skin in the game" to incentivize them to control costs. But the taxpayer in all likelihood is still going to have to bear the bulk of insuring these folks. I'm not happy about that (in the case of those capable of providing their own), but accept that such a scenario is largely unavoidable. Either cover the costs on the insurance or cover it when they come into the emergency room.

 

Right-wing BS propaganda... we die just as nicely at home thank you very much.

 

I do not know, Tim might have a point. U.S. doctors have so botched the initial diagnoses/treatment of several of my relations and acquaintances over the past couple of years that most have been untreatable/terminal before the correct diagnosis was acheived. I think we have an edge in killing cancer patients here.

 

Sorry to hear that. In any case, is that the doctors, or the system? Regardless, I think we can all agree that the current system, as is, is not working optimally. But I wouldn't count on socialized medicine to do any better. As per the video I posted, at least here in the US you (still) have options for other treatments. In Canada, you cannot opt for anything but what the government offers.

 

Are you disputing the facts of the video and problems of Canada-care?

 

Tim, are you working for the healthcare industry now, too?

 

My guess is that TimBikes knows less about Canada than I know about Mars,,,
Speaking as a trans-border resident I have a fairly unique perspective on Health care across the border. I am a US citizen who has worked in Canada over the years. I am not currently eligible for OHP (The Ontario medical program) so I pay insurance in the US.

The serious con of the Canadian system is wait times,, especially for cutting edge treatment. Clearly,, if you have money, or are well insured you can get in for cutting edge treatment faster in the states. On the other hand if you are poor, under or uninsured you probably won't get cutting edge treatment no matter how long you wait.

The Pro of the Canadian system is than NO ONE goes bankrupt as a result of getting sick or injured! There is a standard of care that is,, on balance pretty darn good. I have friends who just had a very complicated pregnancy and neo natal issues. After 1 year,, Mom, Dad, and Daughter are doing great,,,pocket book is healthy as well.

On the other hand,, my wife and I,, in calendar year 2005 (the last year I remember the numbers for) spent,, between insurance, co-pays, deductables, prescriptions, dental, eye care etc,, we spent ~$16,000 USD. And this is for two 50+ year olds who are basically healthy. Now you can talk all you want about not paying taxes for health care,, but we are paying right now,, we just don't call it a tax!

In the US the well off, and those that are insured through their employment have reasonable care,, at reasonable personal cost.

Those that are poor get pretty good care from the ER dept. of public hospitals who can't turn them away, thereby driving up the cost to those that can pay. Those of us who are self employed/self insured pick up a hugely disproportional share of the cost. The large insurance people get a break due to volume discounts, the poor get "free" care,,, and I pay the difference for both!

It is a pretty simple equation. In Canada,, health care costs in an imperfect system about 1/2 what it does on a per capita basis compared to the US. This in a country that has a huge disadvantage in terms of geography,,, large land mass with lots of remote communities that have great health care. ( I worked near the community of Moose Factory on the shore of Hudson's Bay. This community has huge health care coast due to the vast geography the local hospital covers,,the endemic substance abuse issues that come in remote communities, and the climate. For much of the year patients on one side of the river need to be choppered across the river to the hospital due to unsafe river ice). If Canada can do as well as it does with the resources it spends with the built in handicaps the US should be able to do VERY well.

In the US,, if you were to get the private, for profit hospitals, for profit insurance companies, along with the overhead that goes along with them JUST for the billing departments,, I would guess you could wring 30% savings our of our health care system today!

So we would spend ~150% of the Canadians instead of 200%. Now if the Canadians were to spend 75% as much as the US they would have a health care system that would be the envy of the world.

One final point,,, Why is it that ""government run" or " Socialized medicine" is a terrible idea,,, until we turn 65 years old? Medicare has worked quite well IN SPITE of the right wings argument that it doesn't.


Icarus

 

It's based mostly on need, which can be good or bad, depending on your need. In the US, simplisitically put, the highest bidder goes to the front of the line. Which is great if you've got the cash, and why the right wingers are so dead-set against 'socialised' medicine. Can you imagine, poor people getting served first? Horrors.

Yup. I have family in the US who were pretty much bankrupted by a spider bite. My monthly premium is $108 for a family of four.

 

The O-Bahn (a german invention) is the major transport link from Adelaides North Eastern Suburbs into the city of Adelaide, this transportation is brilliant. Unfortunately it wasn't used in other parts of Adelaide. It is fun to ride on and when we have any visitors from interstate or Overseas, we always plan a day out, and make sure it involves a trip on the O-Bahn. As Pat said the unique quality of this transport system is that it runs on track and road. Making it possible to travel virtually from your doorstep to the city quickly.

 

Sure there are problems with Canada's system. But when you are talking health care that's to be expected. Costs are rising. Big pharma is bribing our docs too and we've got an aging population. Big whoop. Beats the hell out of your system that bankrupts or doesn't even cover millions...

 

I don't think either system is working particularly well. Clearly the wait times (effectively rationing) is a problem in Canada and government paid plans in general. Lack of full coverage is clearly a problem in the U.S. (resulting in a lot of unnecessary ER visits). I have worked in pharma and heard of numerous scams (primarily by docs but abetted by some pharma companies). And the pharma companies would love to see most of the population on numerous drugs. That is a problem.

In my opinion the solution starts with people taking responsibility for their own health and healthcare. With some sort of safety net, but not a single payer system.