[avs733]

>Because it would not necessarily be cheaper. The government can be incredibly wasteful and inefficient, especially when corruption is involved - and the money still comes from you!

Personally, I've come to the following conclusion after dealing with the American health care system far to much in the last three years and several encounters with corporate America throughout my adult life:

There is no difference in the potential for waste, inefficiency, fraud, corruption, laziness, and outright stupidity between government and private systems. There is a difference in (1) my (and my fellow citizens) ability to influence between that two and (2) not having to pay for profit and the costs to me resulting from necessary profit on top of the rest of the shit sundae.

[IG_Semmelweiss]

there's no private healthcare system in the US, except for maybe the individual mom & pop doctor's offices.

Every other player is

- getting handouts from govt (hospital non-profit statuses from all taxes incl property taxes, payouts for invented"losses"; payor premium subsidies),

- protections from competition (PBM "discounts", Pharma IP evergreening rules, hospital requirements to approve new local competitors, payor lobbying for regs to prevent "lite" plans )

- and are very much flirting with antitrust action (payor & pharmacy vertical integration, cutting off contracts of any remaining independent doctor/vendor holdouts etc).

[2devnull]

Just think about it abstractly. Variation decreases as n count increases. Large organizations will tend to be similar. As you note most large private systems end up behaving similarly to large public systems in terms of corruption, inefficiency etc….

But notice that it’s driven by the n size. If you look across smaller systems, you’ll notice they are more diverse. Like startups. Smaller n means more variation. Occasionally a small variation or mutation will push evolution forward. Public systems are generally to large and risk averse for that sort of evolutionary adaptation. At least at present. Maybe we can make public sector more like startups by changing how tax dollars are spent, not necessarily changing the amount spent, but the way it’s spent? I don’t think we’re there yet.

[dylan48203]

As someone who has actually worked for both the US government and the private sector - this isn't true:

> There is no difference in the potential for waste, inefficiency, fraud, corruption, laziness, and outright stupidity between government and private systems.

The inefficiency that I saw in the government was far greater than that of the private sector.

To some extent, it had to be - the government has to be extremely reliable and accessible (while most companies content themselves with 99.99% website uptime, or only serving people with a mailing address, or whatever - the government has to serve everyone and be available as much as possible), and that's a good thing.

But beyond that, factors such as extreme risk aversion (which generally grows with the size of an organization), gross incompetence, and outright corruption made the government far less efficient than what I experienced in industry - to the point where it was an old-and-not-funny-anymore running joke among my government colleagues.

Moreover, the government also holds massive influence over your life that corporations do not and cannot: taxes, monopoly on violence, control of the legal system, ability to enact and enforce regulation, and many more.

It should be pretty clear that separation of powers is a good thing, and only an idiot would decide that it's better to consolidate as many things as possible into a single central entity that also uniquely holds all of those powers.

> There is a difference in (1) my (and my fellow citizens) ability to influence between that two

Ability to influence? Yes, you have ability - but the amount of actual influence exerted on government in the US is minimal. Public opinion in the US has almost zero correlation on the law[1]. The political process is overwhelmingly dominated by a small amount of wealthy and powerful individuals and special interest groups.

It's absolute insanity to take this mess and put more things in control of it.

> (2) not having to pay for profit and the costs to me resulting from necessary profit on top of the rest of the shit sundae

Well, as we've already established, the government is significantly less efficient than industry - and even if it wasn't, the extra margin that you have to pay is a trivial price to the utterly insane alternative of the government controlling all private industry.

[1] https://act.represent.us/sign/problempoll-fba