[BobbyTables2]

The two aren’t quite identical.

The municipality could service all the homes and pay for it with taxes, probably using their own people or a negotiated contract.

The private (and usually no -savvy) individual has much less negotiating power and is going to get taken to the cleaners by a plumber. Three houses in a street are likely to have 3 different plumbers on 3 different dates.

It’s just like that the cost per square foot to pave a single driveway vs the entire sidewalk or foundations for a whole neighborhood.

[AnthonyMouse]

The other side of that coin is that the homeowner is paying their own money and is therefore going to actually negotiate or shop around for the best price. Whereas the government is spending someone else's money and then the way the person choosing who to award the contract to gets to have more money in their own pocket is under the table.

[cucumber3732842]

The buyer has next to no negotiating leverage on a small (to the seller) job they're being compelled to purchase by the government.

[AnthonyMouse]

When there are multiple providers their leverage is the ability to choose a different one. Consider food: You have to buy it or you die, yet everything from farmers to cafes operate on razor-thin margins, why? Because it's a commodity and the customer can go across the street.

The prerequisite here, however, is that it's actually a competitive market. Two suppliers colluding or mirroring each other doesn't count.

[cucumber3732842]

That's the magic of it. You can't just conjure plumbers out of thin air, have some handyman do it, threaten to have your uncle from another state do it, etc, etc, because in order to get your magic piece of paper that says you've done the work the person doing it needs to be licensed by (an agency deputized by) the government and that intentionally takes time to constrain supply.

If this were the government telling everyone to buy landscaping services or something else that's not intentionally supply constrained by the government to benefit incumbent you'd have an argument.

[AnthonyMouse]

Obviously the argument is that they shouldn't constrain the supply.

[bebe83939]

Plus homeowner may decide to skip electric utility completely, and go with isolated home solar.

Extreme case is south africa, blackout 30% of time, and people are not allowed local solars (it makes goverment look bad).

[mistrial9]

other extreme case, California, where electricity costs are a large multiple of US averages, and the utility company owns military equipment. PG&E + minions monitor every connection, and charge to connect to the grid. High quality solar cannot be connected to the grid by regulation, not law, unless supervised by PG&E and minions. Naturally the regulations de facto equate to a monthly bill in a certain non-free range, no matter how much effort the client site makes.

[bebe83939]

> High quality solar

> no matter how much effort the client site makes

I doubt solar provides stable predictable current 24/7 with warranty amd penalties. That is the hard part, and what it takes to be "high quality".

State sized grid is not a joke.

[mistrial9]

checkout "batteries" for new info

agree, state grid is no joke

[thrance]

Now apply that logic to healthcare. Single payers are able to get much better deals.

[tptacek]

Not really, no. Medicare wildly overpays for everything compared to the rest of the world.

[skinfaxi]

Wouldn't a more apt comparison be between Medicare and non-government insurers in the US?

[AnthonyMouse]

There isn't really any way to make that comparison because Medicare provides a different type of benefits to a different subset of the population. Private insurers don't offer policies to the elderly that cover the things Medicare covers because those things are already covered by Medicare.

People sometimes try to measure things like "overhead" but that also doesn't really work. If one entity pays $10M in claims but half of them are unknowingly fraudulent and another spends $1M to prevent the fraud, the first one is paying $10M with 0% overhead for fraud detection while the other is paying $5M with 20% overhead for fraud detection. Comparing the percentages implies the second one has "higher overhead" but it's also the one paying $6M instead of $10M.

And the same thing bleeds into the prices for specific services. A provider will happily give you a "20% discount" on the price if you don't bother to check that half their claims are fake. Then you're actually paying them 60% more while the books show them charging you 20% less per procedure.

On top of that, the market for many medical services in the US is extremely captured. The majority of states still have Certificate of Need laws, which are literally laws prohibiting new providers from entering the market if the local government (i.e. the incumbents) think the result would be "too much" competition. The AMA consistently lobbies to limit the number of medical residency slots and sustain a doctor shortage, and doctors who immigrate from other countries, even licensed physicians in countries with first rate healthcare and medical education systems, can't practice in the US without doing a US residency, which in turn consumes one of the residency slots and prevents immigration from alleviating the shortage whatsoever.

The premise is that competitive markets result in lower prices, not that uncompetitive markets do.

[hn_acker]

Medicare covers only a minority of the population but (and?) relies heavily on the general US private healthcare system. At minimum, Medicare cost is affected by high drug prices (perpetuated by lobbying-influenced government avoidance of price controls), relatively high coverage denials (which Congress and the executive branch refuse to regulate), and lack of vision or dental coverage unless people use "Medicare" Advantage (which currently gives private insurers too much leeway to raise costs for the government without a corresponding healthcare benefit [1]).

Anyway, I think parent comment to yours is using single-payer in the sense that implies universal healthcare [2].

[1] https://www.kff.org/medicare/how-medicare-pays-medicare-adva...

[2] https://en.wikipedia.org/wiki/Single-payer_healthcare

[tptacek]

Drug prices are less than 10% of all US health care spending. Drive all drug prices to zero dollars and we get a grocery store circular discount on total health costs.

[nativeit]

I see this kind of argument a lot, but I have to assume the very noticeable ignorance of collective bargaining power in this framing is intentional?

[AnthonyMouse]

"Collective bargaining" is essentially a strategy for contending with a monopolist by getting your own. There are three major problems with it.

The first is that it doesn't actually get you out of the monopoly. If there is an uncompetitive market and you're required by law (or otherwise compelled) to purchase their services, making the buyer a monopsony still doesn't give them any leverage because they have to contract for the services even if the provider won't lower the price, and the provider knows that.

The second is that the purchasing bureaucracy then becomes a target for capture and has all the wrong incentives to resist it. They control a trillion dollars in purchasing power but it's really about a million providers getting an average of a million dollars each. That's the recipe for doing something inefficient a million times over because every provider wants to get $2M instead of $500k and will lobby for regulations or offer kickbacks or commit fraud to get it, and the public doesn't have the bandwidth to apprehend a million individual cases of things going crooked when each one is only 0.0001% of the total. And meanwhile "a million providers" still doesn't imply there is real competition to get you out of (1), because a radiology lab in Philadelphia isn't a substitute for a neurologist in Denver or vice versa.

The third is that you still don't have any sensible pricing mechanism. Even if you have a monopsony, how do they come up with a price to offer? Dart board? Demanding to look at the supplier's accounts, thereby giving the supplier an incentive to waste money because they're getting cost plus? The only real way to give them the incentive to do it for less if they can is to have alternate suppliers so that they each lose the contract if they don't offer the best price, but not having that was the original problem that "collective bargaining" was supposed to address.

Whereas if you instead focus on sustaining a competitive market then "collective bargaining" is just wasteful overhead, because the competition is already keeping margins thin so there is little more to extract from the supplier and you're only unnecessarily subjecting yourself to a layer of indirection and the principal-agent problem.

[nativeit]

The reason a vendor can fleece public services in the first place is, somewhat ironically, the limited access to free public records by independent journalists. I’d reckon we need more freedom of information, more regulatory oversight, and more participation by the public. The cynicism that governments are inherently dishonest and feckless (rather than being designed as-such by the self-interested lobbies pushing this cynicism) is one big reason such corruption has become so prevalent.

[lesuorac]

I've always thought the reason a vendor can fleece the public is a mixture of 2 things.

1) You get elected by convincing voters to vote for you. Which is not the same as actually getting the lowest prices.

2) Core competency has been stamped out of a lot of government agencies and so if you're a skill negotiator you want to be collecting the commission from the sales contract to the government as opposed to a low salary from being the government agent.

So at the end of the day, making all these contracts public wouldn't fix future ones from being issued. Although I'm still for more sunshine.

[ozozozd]

Exactly what I was going to say. And exactly what’s intended: for someone to make money.