I haven't given this much thought, as it was just a thought in passing while working on something. The biggest problem with any government solution is government employees. This is not an indictment of government employees, just an observation that people look out for themselves.

What do you mean by that? Is it that its that much harder to fire them? They're more expensive?

and the biggest reason why government solutions work better than private solutions (when they do) is that they use government employees instead of private employees and managers with their attendant incentives. This is not an indictment of private employees, just an observation that people look out for themselves.

When I go to work, if I did enough things to cut profits I would be replaced. How is the performance of a government employee measured?

Lol, that's what I figured you meant. How exactly do you measure the effect on profits for the vast majority of employees in the insurance industry? I had a friend that did claims processing and its a dead-end job full of people that don't try that hard. The only way to get fired is to be grossly incompetent - which is probably the same for a government employee.

I have little good to say about our current system. I was referring to government solutions to anything, not particularly health care.

My point was more that I think its silly to believe that Government workers are significantly less productive than Private workers in almost any setting.

In my (rather limited) experience of working in science labs, the labtechs in government funded labs were way more productive than those in private industry.

No and it's not even remotely close. I have no idea where you get this other than your own wall o posting.

So to summarize - MORE GOVERNMENT TOTAL REVENUE spent on health than those countries and HALF AS MUCH HEALTH CARE BY PERCENTAGE covered by the government.

I don't expect this to persuade RR, bk or jogs - to any normal human with an open mind this is case closed. US system blows compared to "socialized medicine".

Grunch: Libertarians, you at least support public healthcare when it comes to viruses and communicable diseases, right? Or does the government not have to defend the population against foreign invaders if those invaders are small enough?

Well I know ACists will tell you the market will take care of that and/or it's not possible, dangerous pandemics are overblown, govt plot, etc.

But I'm curious to hear some non-AC libertarians' responses.

Here you go RR: http://www.nytimes.com/2012/01/22/op...=1&ref=opinion

I'm assuming you're asking about government mandated / subsidized vaccinations.

Maybe I don't qualify as a libertarian, but I support them.

Being unvaccinated inflicts harm on other people. I think forcing vaccinations is a legitimate role of government.

I assume in ACtopia, there would be vaccination requirements as part of living in/entering many communities. If you don't want to meet those requirements, then you can move to an area where they're not enforced.

It has been brought up by a bunch of free-market people that the market is always going to bring the most efficient solutions, based mostly on the concept of opportunity cost. I.e., people don't get healthcare when it costs $500 because they would rather spend the $500 on something else, but if the public is spending $450 of that $500 for them, they will get the healthcare for $50.

I guess free-market peole want to say that this will be less efficient, but isn't it possible that people are naturally inclined to make poor decisions regarding healthcare? (due to liquidity problems or not understanding the risks of not getting preventative care, or whatever else) Maybe the healthcare that they are unwilling to spend $500 on is actually worth more than that, to both themselves and society. An obvious example is people not going to the doctor for preventative care, only to wind up going to the ER and having complications that could have been stopped cheaply.

Am I not understanding your basis for saying that government subsidies always lead to less efficient solutions?

Asking this question in response to posts such as this:

I am an ACist and imo US health care is just clearly inferior to fully socialized medicine. I don't buy the arguments that partial privatization is always better than a fully socialized system because the evidence to the contrary is too strong. That said, I believe a fully private system would be better still.

Why though? What leads you to that conclusion?

I am interested in the high pay to executives and profit for executives. I just skimmed that, but I think I see part of the problem. I want to look at resources consumed, while those without an interest in economics are more interested in where the money goes rather than the resources consumed in production.

Bingo.

In case anyone is curious what *most* anarchists think on this issue: They believe that the current "socialized medicine" model utilized in every single developed country except the US is better than a privatized/quasi-privatized model, not just because the empirical evidence clearly shows that the "socialized medicine" model is vastly more efficient and delivers better outcomes, but also for simple moral reasons: "Looking at health care, for example, the need for medical attention is not dependent on income and so a civilised society would recognise this fact." "They [social anarchists] would argue that a privatised system would only be able to meet the requirements of those who can afford to pay for it and so would be unjust and unfair."

The moral argument also points to another conclusion: EVEN IF socialized health care was shown to be more costly/less efficient than some privatized version, that alone should not persuade us to choose the privatized version. In fact, barring extreme examples, I believe most of humanity will still reject the privatized model for the simple reason that most people are simply too civilized to accept the idea that the care and attention one needs should be dependent on how much money is in one's wallet. (In this respect I think ACists/"Libertarians" drastically underestimate the capacity for empathy that most normal humans have.)

Back to socialized medicine: Where anarchists differ is that they prefer a bottom-up "socialized medicine" model based on the democratic principles of self-management instead of the top-down paternalistic "socialized medicine" model we see in the world today. But since, "what anarchists prefer" is clearly not in the cards right now, that subject is not really worth talking about. The fact remains, for efficiency reasons, and for moral reasons, decent reasonable people should prefer the current available "socialized medicine" model over any "privatized/quasi-privatized" model.

For furthering reading: I.5.12 Would an anarchist society provide health care and other public services?

Seems like the government did okay in WWII.

And other than belief, what sort of evidence do you have for that? Because based on all the evidence presented in this thread, the US system blows NOT because of the socialized aspects of it, but because of the market-based aspects.

I've used private hospitals in Mexico and the Philippines and received quality care at a fraction of the price that it costs in any US hospital. The problem in the US is an artificial restriction on the supply of health services. There are not enough doctors, not enough hospitals, etc. Because of this and the interaction with the insurance system, it is most profitable to offer the highest tier of medical services and those without insurance or money are left without because there are no lower tier services.The supply scarcity manifests in other developed countries as long wait times and restriction to services because insurance is provided by the government and not corporations. Government intervention is the cause of this scarcity. A simple example: Doctors from developing countries are not allowed to immigrate and practice here. These doctors are are willing to do house calls for a fraction of the cost of an office visit in the US. Allow them to immigrate and work here and the cost of medical services will plummet. Similar approaches to reducing standards for nurses, hospitals, etc will allow for the creation of lower tiers of medical services and in general drive down the costs of all medical services.

The other big problem in the US is the interaction of pharmaceutical corporations and the govt/insurance corporations. In a free market system, there would be no intellectual property law, so this problem would obviously disappear. This would mean that new drugs would be less likely to be developed, but this is an unfortunate side effect of reducing the abnormal profits that develop from government sponsored monopolies.

what is the free ride?

the va is far from perfect. im a vet get good care because our docs are all from duke. but there is tons of problems. lots of waiting. pills come in the mail so if u dont reorder in time its a wait. lots of waste. cant talk to your dr most of the time. appointments come in the mail. dealing with the gatekeepers is tough they remind me of dot employees.