[giantrobot]

No one wants to learn the lesson that while government administration of some things might be "inefficient", any efficiencies brought about by privatization will be turned into margins by the private entity rather than savings to the end customers. Private entities need to maintain margins and will cut service to maintain them.

[Frost1x]

Yea the argument that efficiency gains are passed to consumers is a tired old and often false argument. The only time efficiencies are passed to consumers are when there is real healthy competition and consumers are supporting that diversity. That's when in order to remain competitive, efficiency needs to be passed to the consumer.

Even in those situations it's not guaranteed. Markets seem to arise at or duplicate similar solutions and even if it's inefficient it's not worth he risk to find better alternatives for consumers because the competitive edge vs risk vs reward just isn't a winning mix worth pursing.

I'm increasingly convinced that most forms of free market systems work best once we have commoditization of a solution and it's just a matter of reproducing that solution, and doing so isn't too capital intensive. As you start to move away from these parameters, markets get more and more consumer hostile and self focused making the argument for them increasingly weak.

[rqtwteye]

There needs to be a focus on competitive markets instead of free markets. Competition is mostly good for customers but competition needs to be created by regulating the market to some degree. Otherwise markets will almost always be taken over slowly by the biggest players that don’t like competition.

[brayhite]

It’ll never happen in the US. Neither political party with power will break away from the corporate interests that determine what laws and regulations will pass.

The last candidate who ran on small donors and wore a proud badge of being anti-corporate interests lost twice. Politicians are figuring out how much money can be made by both acquiring legislative influence and power and accepting donations to steer their platforms, as well as passing legislation and policy that helps siphon public funds into private companies that said politicians have a financial stake in.

Changing private equity power requires benevolence, and there’s very little of that left amongst those with political power in the US.

[lelandfe]

Not to mention that the private companies will work to avoid said competition. Little wonder why ISPs refer to creating networks where one already exists as “overbuilding”

[lotsofpulp]

When I look around, there are multiple businesses usually near each other that compete. Home Depot and Lowes, Walmart and Target, Burger King and McDonald’s. ATT/Verizon/Tmobile.

But it is possible that if you pay to build out an entirely new network to a place where Comcast has a monopoly, and the customers would rather pay Comcast $5 less than whatever the lowest price you can charge is, then you would see negative returns by paying to build that network (since the cost of building out a network like that is so astronomical, and Comcast obviously does not have to pay it so their COGS is much lower).

[JumpCrisscross]

> most forms of free market systems work best once we have commoditization

It’s almost the opposite. Free markets didn’t work in the pre-industrial era because everything was commoditised. That made returns on capital paltry, which in turn made it more “profitable” to conquer capital than build it.

After industrialisation, we repeatedly saw innovation—though not necessarily creativity—in market economies outperform that in centralised ones.

[JumpCrisscross]

> Private entities need to maintain margins and will cut service to maintain them

This is a false dichotomy. Public v private is so often framed as a political agency versus free-market bonanza. In reality, we have independent agencies and public-private partnerships. But on the private side, we also co-operatives, a model which seems well-suited for community hospitals.

[Arn_Thor]

PPPs are often a mirage. As long as there's a private actor involved, some of the input (money) will be siphoned off as profits. That's the height of inefficiency. Where the alternative is a competent, responsive and accountable government, the government will allocate the resources more effectively, and all "inefficiency" goes into working people's pockets. This is not always practical, for example in situations where only private businesses have highly specialized knowledge, but for basic infrastructure the private sector offers nothing the government couldn't do just as well.

[phkahler]

Or how about just non-profit? Regardless of the options, private equity seems like the worst one and should probably be illegal.

Taking "profit" from keeping people "not dead" seems as close to extortion as you can get without actually being so.

[JumpCrisscross]

> how about just non-profit?

“If the public health goal is to improve hospital care, then focusing on things like for-profit or nonprofit status is a distraction” [1].

> Taking "profit" from keeping people "not dead" seems as close to extortion

Modern medicine is expensive. For profit or not, expenses must be covered.

We’re better off incentivising people to become doctors and nurses and pharmaceutical researchers. The problem is all the nonsense being eaten up in administration, administration largely paid for by price obfuscation.

[1] https://www.hsph.harvard.edu/news/press-releases/hospitals-c...

[phkahler]

>> “If the public health goal is to improve hospital care, then focusing on things like for-profit or nonprofit status is a distraction”

Fair enough. So let's just ban for-profit healthcare so we can stop being distracted by that whole thing.

[albert180]

Still you manage to waste 10% on Administrative Expenses and have the worst health outcomes in G7 but the highest expenses. Maybe learn a thing or two from northern Europe which has 100% public healthcare delivery

[giantrobot]

> Modern medicine is expensive. For profit or not, expenses must be covered.

There's a ton of bullshit that goes into "medical expenses" in the US. Not the least of which is the inability for people to pay for care and end up in the ER for urgent non-emergency services because ER services are required to be provided. Hospitals need to foot the costs of those people that literally can't pay. Those costs get amortized over every other service (plus plain old margin and gauging) increasing the overall costs.

Besides eliminating unpaid emergency service public health coverage would let people get regular medical care without plunging into debt so they'd go sooner before conditions become acute. Private insurance could even still exist, but as a premium add-on to statutory coverage.

More doctors and nurses is just supply side economics applied to healthcare. Those jobs will appear naturally with the entire population completely covered. Rural hospitals could even open back up since they'd be serving people with actual coverage.