What Do Socialism and Capitalism Mean to You

[Loren Pechtel]

Scarcity of health care services, for one thing. Sure, it's nationalized and free to all... which isn't helpful when you can't get in to a doctor.

Which is a problem for all healthcare systems. The number of doctors is necessary limited by the very high and very necessary barriers to people who want to become doctors.

The question is, should you resolve this unavoidable shortage by having all patients go through a triage process which leaves the non-urgent patients waiting for long periods; Or use a wealth based process that leaves the poor untreated regardless of how urgently they need attention, while the wealthy need not wait to have even their trivial needs met?

Your triage systems leave urgent patients waiting.

And the fundamental issue is that your system makes it very hard to increase spending to improve the situation.

 

[Loren Pechtel]

jut off of a casual google, I pulled up this:

17% of adults with health care debt declared bankruptcy or lost their home because of it. 66.5% of bankruptcies are caused directly by medical expenses, making it the leading cause for bankruptcy. As of April 2022, 14% of Americans with medical debt planned to declare bankruptcy later in the year because of it.Aug 30, 2022

This garbage "research" needs to be nuked from orbit.

It doesn't say what you think it says, it was done in a very deceptive way to make reporters think it said this.

Rather, what it really said was that most bankruptcies include medical debt, not that they were caused by medical debt.

The real number is more like 5%--and even there half of those are retirees overspending their assets, the bankruptcy was inevitable and the medical stuff was simply the straw that broke the camel's back.

 

[Loren Pechtel]

And people don't want to be in the street watching their houses burn down, they don't choose to be, and the cost of their loss is determined by the severity of the fire rather than by anything they have control over. And yet in spite of those shared characteristics, fire insurance is an excellent example of a product for which capitalism is spectacularly well fitted -- so much so that when Adam Smith was going on and on about the general deficiencies of corporations, insurance was a service he singled out as one of the exceptions; it's something the early corporations of his era were actually good at.

Except that it's absolutely not good at it at all.

The only good fire department is the one that extinguishes all fires, regardless of the insurance status of the owner or resident of the property where the fire is currently occurring, because fires spread, and big fires are FAR harder to control than little fires.

I note that fire departments are almost never privately owned in modern times, and that this strongly hints that private fire insurance wasn't found to be fit for purpose.

Actually, private fire insurance worked better than many think. The private fire companies would fight any insured fire and then bill the insurance company that insured the building.

It's a good that is better handled publicly but what came before wasn't actually that bad.

 

[Loren Pechtel]

Employer coverage, on the other hand, very often has point of service costs that are, in my opinion, absurd. Hell, I'm well compensated, and even for me the fact that I have a $10K deductible for my family is frightening. I'm lucky enough to have a health savings account that has amassed a fair bit over the last 15 years... but still. It's a terrifying amount. For all intents, I have no insurance, I just have a savings account that gets funded from pre-tax dollars, and access to a slight discount from billed prices when I see a doctor.

You save a lot compared to the rack rate. And the insurance stops them from billing for garbage.

 

[Loren Pechtel]

1) Customers have options because they shop around for insurance

Most people in the US do NOT shop around for insurance - they get whatever their employer gives them. The premiums for employer sponsored care are usually very heavily subsidized. Most people in the US have no idea at all how much health insurance would actually cost if it weren't subsidized - either by their employer or by the government. The average cost of medical care for people under 65 in the us is around $700 per month. For some people, it's a whole lot higher than that. For someone with employer coverage, they usually contribute $50 per month (give or take, some industries are better some are worse). For ACA coverage, that's more like $130 per month.

The employers do the shopping, but you still have the shopping.

2) Customers don't have material cost at the point of service

Sometime in the early 00's there was a push to "Consumer Driven Health Plans" under the misguided notion that patients would shop around for the most cost effective doctors. This wasn't driven by insurers, btw, it was driven by the government, paired with Health Savings Accounts (HSAs). The problem is that people don't shop around. Maybe, to a small degree, people might shop around for a Primary Care Doctor... but even then, most people are more interested in finding one that is conveniently located, or with whom they feel comfortable than the actual cost. And since PCPs have some of the lowest costs, the impact is really small. When it comes to big things, customers don't have the knowledge to be able to determine which specialist, or which imaging facility, or which physical therapist is the "best value". Most customers wouldn't even know how to begin defining value in that context. And realistically, most people don't want the cheapest care either. And that's only touching on situations where there customer has a reasonable degree of squish in timing. For things that involve surgeries, or are time sensitive, people aren't going to shop around - they're going to go wherever a doctor tells them to go.

This is even true for those of us who work within the health industry. I know a lot more than the average person when it comes to health care (not nearly as much as a doctor or nurse though). I definitely know more about the costs than the average person. And when I needed surgery... I went to the surgeon my doctor told me to go to.

Anyway, the point is that a really large number of health insurance plans have deductibles that can be a material barrier to accessing care. Even a $500 deductible is nothing to sneeze at, and that's on the lower end of the Deductible spectrum.

I think there is some deterrent to might-as-well-as-it's-free but I think it deters more care that is needed. Thus it's a bad thing.

3) People can pick the right plan for themselves before they get sick

This is technically true... and realistically false. Even if we set aside the entirety of my first point above, this is like saying "people can shop around for the right automobile before their sister dies and they end up with three unexpected kids". The right plan for a healthy person is generally going to be one that has a relatively low premium with moderate fixed-dollar copays for PCP visits and generic drugs. Because a healthy person doesn't really use medical services much - an annual check up, maybe a cold or a bout of strep throat, some basic antibiotics, maybe some stitches and a pain killer. Basics. The problem is that when something unexpected goes wrong... that plan is no longer the right plan for them. People shop based on what their expected costs are going to be, with some mind to something going wrong.

Maybe people should shop for things that might happen. But after 25 years in this field, I still haven't figured out how to convince them to do that - and that's for people who actually have an opportunity to shop in the first place.

The reality is that the mandated coverage means that anyone who chooses the low-deductible plan is expecting to use a lot of medical care and thus low deductible plans have a major adverse selection that pretty much drives them from the market other than when subsidized. A few years back I compared the various ACA options here and I could find no spending level where anything but bronze made any sense--the higher plans all charged more in premiums than you could recoup from lower bills.

 

[Playball40]

Socialism - an economic system wherein decisions about what ought to be done, where, for whom, and to what extent, is determined by a authoritarian process, usually predicated on minimisation of inequalities, and ideally managed by democracy or representative democracy.

Capitalism - an economic system wherein decisions about what ought to be done, where, for whom, and to what extent, is determined by the holders of large numbers of transferable tokens, usually predicated on the maximisation of inequalities in the distribution of those tokens (and therefore the power that they grant), and managed by the wealthiest individuals (ie those holding the most tokens) in society at any given time.

A well ordered and effective community will use a combination of these systems, as socialism is far superior to capitalism in decisions about infrastructure (in its broadest sense) and the distribution of resources that tend towards natural monopolies; While capitalism is far superior in decisions about consumable and luxury goods.

Socialism in the provision of such things as electricity, education, healthcare, water, and transportation infrastructure (roads, railways, ports, airports, etc.), coupled with capitalism in the provision of pretty much everything else, seems to be the best option.

Wherever capitalism is applied to infrastructure or natural monopolies, people suffer; Likewise whenever socialism is applied to consumables and luxuries.

Having capitalist healthcare, roads or utilities sucks.

Having socialist food, clothing, and entertainment also sucks.

There are always people who want to push their preferred system into areas where it's not appropriate. Usually they're folks who have benefited greatly from one of the two systems, and leapt to the conclusion that it's therefore got to be the best possible strategy in absolutely all circumstances.

In the modern world, socialists making this error are generally shouted down by capitalists making this error, because society in the OECD currently gives a lot of power to capitalists - particularly those in the branch of the entertainment industry that is pretending to provide information infrastructure, and that has largely overwhelmed the socialist information infrastructure that used to be in place.

There's a reason why the BBC and PBS are more respectable and trustworthy than MSNBC or CNN, and it's simply that actual news is more respectable and trustworthy than entertainment pretending to be news can ever be. It's not as much fun, though.

Don't forget prison system. That should NOT be a for-profit model.

 

[Emily Lake]

The circumstance that some of the fire insurance companies happened to also try to reduce their payout expenses by putting out fires was immaterial to Smith's point and he didn't talk about it.

Well, health insurance is a lot more like the fire fighting element of the fire insurance of Smith's day than it is like fire insurance as we know it today.

Meh. It's actually a lot more like an extended vehicle warranty paired with a pre-paid service agreement for routine maintenance.

 

[Emily Lake]

You save a lot compared to the rack rate. And the insurance stops them from billing for garbage.

That depends entirely on how powerful the provider group is, how close to a monopoly it is, and how effective negotiations are.

In rural areas where there is only one hospital and very few doctors, the discount from billed is almost nonexistent.

 

[Emily Lake]

1) Customers have options because they shop around for insurance

Most people in the US do NOT shop around for insurance - they get whatever their employer gives them. The premiums for employer sponsored care are usually very heavily subsidized. Most people in the US have no idea at all how much health insurance would actually cost if it weren't subsidized - either by their employer or by the government. The average cost of medical care for people under 65 in the us is around $700 per month. For some people, it's a whole lot higher than that. For someone with employer coverage, they usually contribute $50 per month (give or take, some industries are better some are worse). For ACA coverage, that's more like $130 per month.

The employers do the shopping, but you still have the shopping.

2) Customers don't have material cost at the point of service

Sometime in the early 00's there was a push to "Consumer Driven Health Plans" under the misguided notion that patients would shop around for the most cost effective doctors. This wasn't driven by insurers, btw, it was driven by the government, paired with Health Savings Accounts (HSAs). The problem is that people don't shop around. Maybe, to a small degree, people might shop around for a Primary Care Doctor... but even then, most people are more interested in finding one that is conveniently located, or with whom they feel comfortable than the actual cost. And since PCPs have some of the lowest costs, the impact is really small. When it comes to big things, customers don't have the knowledge to be able to determine which specialist, or which imaging facility, or which physical therapist is the "best value". Most customers wouldn't even know how to begin defining value in that context. And realistically, most people don't want the cheapest care either. And that's only touching on situations where there customer has a reasonable degree of squish in timing. For things that involve surgeries, or are time sensitive, people aren't going to shop around - they're going to go wherever a doctor tells them to go.

This is even true for those of us who work within the health industry. I know a lot more than the average person when it comes to health care (not nearly as much as a doctor or nurse though). I definitely know more about the costs than the average person. And when I needed surgery... I went to the surgeon my doctor told me to go to.

Anyway, the point is that a really large number of health insurance plans have deductibles that can be a material barrier to accessing care. Even a $500 deductible is nothing to sneeze at, and that's on the lower end of the Deductible spectrum.

I think there is some deterrent to might-as-well-as-it's-free but I think it deters more care that is needed. Thus it's a bad thing.

3) People can pick the right plan for themselves before they get sick

This is technically true... and realistically false. Even if we set aside the entirety of my first point above, this is like saying "people can shop around for the right automobile before their sister dies and they end up with three unexpected kids". The right plan for a healthy person is generally going to be one that has a relatively low premium with moderate fixed-dollar copays for PCP visits and generic drugs. Because a healthy person doesn't really use medical services much - an annual check up, maybe a cold or a bout of strep throat, some basic antibiotics, maybe some stitches and a pain killer. Basics. The problem is that when something unexpected goes wrong... that plan is no longer the right plan for them. People shop based on what their expected costs are going to be, with some mind to something going wrong.

Maybe people should shop for things that might happen. But after 25 years in this field, I still haven't figured out how to convince them to do that - and that's for people who actually have an opportunity to shop in the first place.

The reality is that the mandated coverage means that anyone who chooses the low-deductible plan is expecting to use a lot of medical care and thus low deductible plans have a major adverse selection that pretty much drives them from the market other than when subsidized. A few years back I compared the various ACA options here and I could find no spending level where anything but bronze made any sense--the higher plans all charged more in premiums than you could recoup from lower bills.

Thank you Loren, for manspaining my area of expertise to me.

 

[George S]

Socialism is veneration of a tribal ideal. Go back to the time we were evolving, the time when we were separate groups struggling with competing groups for places to live and harvest and hunt. The surviving tribes did what evolution demands and survived better when tribal identity was strong. Within the true tribe it is a matter of course that resources are distributed according to need and each does what they're best at: child rearing, leading, hunting, harvesting and such.
Capitalism takes advantage of economies between different tribes. An agreeable exchange where, ideally, both say "Thank you!" -- happier for the exchange. Capitalism is the building of a means of making a product your tribe doesn't need but others do. Socialism arises naturally most easily in small tribes which practice capitalism with outsiders. It is also the investment in service industries. (Service industries sell the same action over and over.)
Socialism preaches "Family First -- Favor people who look and act like me, my Tribe -- Neighbors Next -- Strangers we bargain with."
Socialism and Capitalism are comfortable together.
________________
Political systems are another matter.
Pure Tribal rule? Empires and Kings?
Pure Democracy? Everyone votes on everything?
Representative democracy in which the equivalent of temporary kings are voted in and not inherited?
Some other system which recognizes certain facts about human beings being human? Accounts for and recognizes the power of wealth so large they are only judged by their equally wealthy peers, their privileged tribe. Accounts for the fact that might makes right -- their is ownership by right of conquest. Accounts for the fact that even leaders, being human, make mistakes. Not sure what that system is, though.

 

[Jimmy Higgins]

3) People can pick the right plan for themselves before they get sick

This is technically true... and realistically false. Even if we set aside the entirety of my first point above, this is like saying "people can shop around for the right automobile before their sister dies and they end up with three unexpected kids". The right plan for a healthy person is generally going to be one that has a relatively low premium with moderate fixed-dollar copays for PCP visits and generic drugs. Because a healthy person doesn't really use medical services much - an annual check up, maybe a cold or a bout of strep throat, some basic antibiotics, maybe some stitches and a pain killer. Basics. The problem is that when something unexpected goes wrong... that plan is no longer the right plan for them. People shop based on what their expected costs are going to be, with some mind to something going wrong.

Maybe people should shop for things that might happen. But after 25 years in this field, I still haven't figured out how to convince them to do that - and that's for people who actually have an opportunity to shop in the first place.

The reality is that the mandated coverage means that anyone who chooses the low-deductible plan is expecting to use a lot of medical care and thus low deductible plans have a major adverse selection that pretty much drives them from the market other than when subsidized. A few years back I compared the various ACA options here and I could find no spending level where anything but bronze made any sense--the higher plans all charged more in premiums than you could recoup from lower bills.

I think the reality is that almost no one can afford to get really sick in America. Jebus, my daughter had some scans done, and the final bill was $800. We could afford it... but only because we have money saved, and it sure stung. How many people in America can afford a $1,000 medical bill? Forget something that is terribly serious?

How fucked up is it that it is difficult to afford health care when you HAVE insurance?! Low deductible, high deductible. I'd hate to be the person who has to choose the low deductible. They aren't gaming the system, they (or someone in their family) are sick.

 

[AthenaAwakened]

I'm kind of wondering if @AthenaAwakened is planning to come back to her thread... ?

I'm here

 

[AthenaAwakened]

What do socialism and capitalism mean to you and has your understanding of these words changed since you first encountered them?

I'll answer the latter question first: Yes, my understanding has changed.

My earliest exposure was based on Germany and the Soviet Union both incorporating "socialist" into their parties, in ways that seemed pretty anti-social to me. Also, totally wrong, of course. Then for a long time I thought of it as "communism light" based on the technical definition of socialism as being social control of the means of production - which I did (and still do) think is an abysmal idea.

As I've gotten older, I've kind of scrapped all the academic jargon and the politically charged views. Both are ways of organizing an economy. Capitalism refers to a system where the consumer drives the bus - whatever sells is what gets made, whatever sells better gets made more. Socialism refers to a system where the government drives the bus - whatever is needed gets made, and whatever is needed more gets made more. Neither is a perfect view, but in practice that seems to be the core of it.

In terms of reality... neither is perfect, and they both have their role. I tend to favor a largely capitalist structure for most trade. I think that the concepts behind it are best suited to human nature, and they provide a reasonable means to provide options and choice to the greatest number of people. But left completely unfettered, there's opportunity for exploitation in all sorts of ways. There are a lot of potential pitfalls, but to me the largest fall into a few categories.

There's the risk of very large companies taking a monopoly role in the market, which then gobbles up all the surplus value that makes the whole thing work. This is particularly problematic when those monopolies are associated with services that most people would consider necessary - water, power, sanitation, etc.

Then there's the risk of what I'll call "silent collusion" between large players within a particular industry, where the companies involved all realize that they can collectively push the price of something up and they all win as long as nobody rocks the boat. It's not direct collusion, there's no meetings about it. It's just sort of something that happens. This happens a lot when there's a bit of a middle man involved, and it tends to more often be the primary suppliers upping the costs to the middle men, who then pass it on to the end customer. I see this a lot in the health care industry, with pharmaceuticals and medical devices. The primary manufacturers know that there's a middle-man who spreads the cost risk, and they take full advantage of it. Customer end up angry at the insurers for the high price of health care, even though it is being driven by the profit margins at the provider end of the deal.

There are others, but I think this captures the problem - there's a risk of bad actors exploiting loopholes and basically profiteering.

When it comes to socialism, it has the opposite problem - lack of choice. This can lead to quality-related pitfalls, as well as sometimes the government thinking it knows what is important to people and being wrong about it. In many parts of the US, water and power are effectively socialized industries. We usually only have one choice for those services... and if they suck then you're just screwed.

Socialism can also lead to resource constraints that aren't always necessary. I end up going back to my area of expertise, because it's where I have the most concrete knowledge... so health care again. One common refrain we hear from UK and Canada is excessively long wait times, sometimes not being able to get access to a doctor, sometimes being denied care that is quality of life but not directly life saving (like knee surgeries and similar things that reduce pain and increase mobility, but they don't actually make you dead if they're not fixed).

By themselves, both of those can lead to problems. So over the years, I've ended up favoring a hybrid. I tend to want essential services to be socialized, but with civilian oversight committees with term limits so you don't end up with entrenched interests playing games. I think the oversight is necessary so that quality and resources can be addressed by representatives of the people actually using those services. I think it would also be a good idea to have multiple committees that vary by geography - not all parts of the country are going to have the same needs at the same times.

On the other hand, I'd like to see most non-essential businesses continue to be privately owned (also employee owned if a company wants to be). It increases competition and innovation. I also think that the "capital" element of capitalism - the investment in new ideas and in young companies - is something that is unlikely to come from a highly socialized system. You've got to have at least some people with enough extra cash that they're willing to take bets on something that might not work out - and that's something that the government shouldn't do with taxpayer money in my opinion.

So circling back to my sphere of knowledge, I'd love to see providers of health care socialized. I'd like to see the doctors, nurses, and other professional practitioners be government employees, paid a salary. Same with facilities - hospitals, urgent care centers, imaging centers, etc. would be government owned and government run. Medical supplies and pharmaceuticals should be negotiated at the federal level. This would help control primary costs. I think there's still a need for consumer oversight to make sure that government wages and payment levels aren't making it impossible to stay in business.

I would pair this with a subsidized health insurance system - something more akin to Medicare than current ACA is. A core set of reasonable benefits, with reasonable cost sharing for customers (helps to manage over utilization). But also allow private insurance to wrap around or to replace it, same as we do with Medicare Supplement and Medicare Advantage today. There would still be a lot of available choice, so that those who need more care can manage their financial investment in it, and those who don't use care aren't being charged so much that it risks bankruptcy. This would then also have government oversight - to make sure that insurance companies aren't exploiting customers or lining their pockets in an abusive way.

So yeah, really long answer. That's essentially how I perceive socialism and capitalism to be in the real world, outside of academic notions.

Do consumers drive the bus, or marketers?

 

[Loren Pechtel]

You save a lot compared to the rack rate. And the insurance stops them from billing for garbage.

That depends entirely on how powerful the provider group is, how close to a monopoly it is, and how effective negotiations are.

In rural areas where there is only one hospital and very few doctors, the discount from billed is almost nonexistent.

Yeah, that's probably a very different market than what I've seen.

 

[Loren Pechtel]

The reality is that the mandated coverage means that anyone who chooses the low-deductible plan is expecting to use a lot of medical care and thus low deductible plans have a major adverse selection that pretty much drives them from the market other than when subsidized. A few years back I compared the various ACA options here and I could find no spending level where anything but bronze made any sense--the higher plans all charged more in premiums than you could recoup from lower bills.

Thank you Loren, for manspaining my area of expertise to me.

You stated what the situation was with no explanation.

 

[Jimmy Higgins]

Do consumers drive the bus, or marketers?

You misspelled "large corporations that can influence the market by reducing competition both by organizing with other large corporations or by buying up smaller competing companies or by employing economic gimmicks that inhibit new competition from forming". Should check your spell checker.

Anyone that thinks consumers drive capitalism hasn't read a damn thing about economics in the US in the 19th and early 20th centuries.

 

[Cheerful Charlie]

We tried raw laisse fair capitalism at the beginning of the indutrial revolution. It was a horror. That does not work. We tried strict communism in the USSR and Mao era China.more horrors.

Things that mankind has tried and found to be evils. Slave societies. Feudalism. Oligarchies. Kleptocracies. Crony capitalism. Neo-liberalism.

Social Democracies work tolerably well. Scandinavian models seem to work tolerably well. Progressive nations will be the way of future workable nations. No nation is perfect. But we can look at the best and try to avoid their mistakes, and learn from their failings.

What a concept! Can I have my Nobel Prize for smartness now?

 

[Alcoholic Actuary]

Do consumers drive the bus, or marketers?

You misspelled "large corporations that can influence the market by reducing competition both by organizing with other large corporations or by buying up smaller competing companies or by employing economic gimmicks that inhibit new competition from forming". Should check your spell checker.

Anyone that thinks consumers drive capitalism hasn't read a damn thing about economics in the US in the 19th and early 20th centuries.

"I can't wait until Apple starts making a phone"
-nobody, 2005

aa

 

[Bomb#20]

Healthcare is an excellent example of a product for which capitalism is poorly fitted - "customers" buy healthcare mostly because they have absolutely no option. They don't want to be in hospital having triple bypass surgery, they don't choose to be, and the cost of their operation is determined by their medical needs, rather than by anything they have control over.

Stuff and nonsense. There are a variety of reasons capitalism is poorly fitted for some fraction of healthcare, but those aren't them. Customers mostly do have options, because customers mostly pay for healthcare with insurance premiums instead of at point of service and customers can shop around for the best insurance policy for their needs before they get sick.

Well actchooalleee....

First off, health care in the US is NOT a free market system at all. Insurance makes it not a free market, it doesn't follow the patterns of supply and demand... like at all.

Who said it was? I pointed out that bilby's claims weren't correct. He wasn't even talking about the US; he was making claims about healthcare in general.

Instead, let's address some of your other items from this first couple of sentences.

1) Customers have options because they shop around for insurance

Not what I said. They have options because they --> can <-- shop around. If they choose not to shop around, that doesn't change the fact that they have options.

Most people in the US do NOT shop around for insurance - they get whatever their employer gives them.

My employer gave me a choice of four plans from two companies, with or without coverage for my wife, who could have gotten her own plan. And the employers shop around on behalf of their employees. And people can shop around for a new job if their current employers' offerings are inadequate. And non-employer-based health insurance is available from any number of companies.

The premiums for employer sponsored care are usually very heavily subsidized.

Well, sure -- that's why most people go with what their employers offer -- but offering somebody a cheaper option doesn't make his other options go away. This all happened because back in WWII, US wages were controlled, so employers had to find some other way to compete, so the US went down this whole tie-healthcare-to-jobs blind alley. That's a consequence of our wartime socialism, not a consequence of capitalism.

2) Customers don't have material cost at the point of service

Not what I said -- I said "mostly". The premiums are usually a good deal more than the point-of-service bills, at least in my experience.

Sometime in the early 00's there was a push to "Consumer Driven Health Plans" under the misguided notion that patients would shop around for the most cost effective doctors. This wasn't driven by insurers, btw, it was driven by the government, paired with Health Savings Accounts (HSAs). ...Anyway, the point is that a really large number of health insurance plans have deductibles that can be a material barrier to accessing care. Even a $500 deductible is nothing to sneeze at, and that's on the lower end of the Deductible spectrum.

Which was the whole purpose. If you want a system whose costs don't tend toward infinity there has to be either a drop in quality or some mechanism in place to disincentivize consumption. The government made a political calculation that the latter would be more acceptable to the public.

When it comes to big things, customers don't have the knowledge to be able to determine which specialist, or which imaging facility, or which physical therapist is the "best value". Most customers wouldn't even know how to begin defining value in that context. And realistically, most people don't want the cheapest care either.

Most people don't want the cheapest anything; what's different about healthcare is that the political will isn't there to deny people expensive care when they can only afford the cheapest. As I said, there are a variety of reasons capitalism is poorly fitted for some fraction of healthcare, and you're bringing some of them up. My point was never that healthcare should be capitalist; it was that bilby's argument for socializing it was wrong. It's important to get that right. When people are mistaken about what characteristics of a service make socializing it a good idea, they're going to reapply their same bad arguments to other services and then they're going to socialize the wrong parts of the economy.

3) People can pick the right plan for themselves before they get sick

This is technically true... and realistically false. Even if we set aside the entirety of my first point above, this is like saying "people can shop around for the right automobile before their sister dies and they end up with three unexpected kids". The right plan for a healthy person is generally going to be one that has a relatively low premium with moderate fixed-dollar copays for PCP visits and generic drugs. Because a healthy person doesn't really use medical services much - an annual check up, maybe a cold or a bout of strep throat, some basic antibiotics, maybe some stitches and a pain killer. Basics. The problem is that when something unexpected goes wrong... that plan is no longer the right plan for them. People shop based on what their expected costs are going to be, with some mind to something going wrong.

Maybe people should shop for things that might happen. But after 25 years in this field, I still haven't figured out how to convince them to do that - and that's for people who actually have an opportunity to shop in the first place.

And yet, nobody says the possibility of their sister dying and leaving them with three unexpected kids is a good reason for cars to be issued to people by the government based on what car experts decide they need. In most areas of life people are expected to decide how much risk they can stand to bear, make their own decisions of how much to pay to mitigate it, and eat the costs themselves if it turns out they didn't take enough precautions. But people generally feel differently about healthcare -- medical bankruptcy is regarded as a failure of the system rather than as what you get for skimping on insurance. Which is probably as it should be. The main reason healthcare is an example of a product for which capitalism is poorly fitted can be summarized in two words: "preexisting condition".

 

[rousseau]

Socialism is veneration of a tribal ideal. Go back to the time we were evolving, the time when we were separate groups struggling with competing groups for places to live and harvest and hunt. The surviving tribes did what evolution demands and survived better when tribal identity was strong. Within the true tribe it is a matter of course that resources are distributed according to need and each does what they're best at: child rearing, leading, hunting, harvesting and such.
Capitalism takes advantage of economies between different tribes. An agreeable exchange where, ideally, both say "Thank you!" -- happier for the exchange. Capitalism is the building of a means of making a product your tribe doesn't need but others do. Socialism arises naturally most easily in small tribes which practice capitalism with outsiders. It is also the investment in service industries. (Service industries sell the same action over and over.)
Socialism preaches "Family First -- Favor people who look and act like me, my Tribe -- Neighbors Next -- Strangers we bargain with."
Socialism and Capitalism are comfortable together.
________________
Political systems are another matter.
Pure Tribal rule? Empires and Kings?
Pure Democracy? Everyone votes on everything?
Representative democracy in which the equivalent of temporary kings are voted in and not inherited?
Some other system which recognizes certain facts about human beings being human? Accounts for and recognizes the power of wealth so large they are only judged by their equally wealthy peers, their privileged tribe. Accounts for the fact that might makes right -- their is ownership by right of conquest. Accounts for the fact that even leaders, being human, make mistakes. Not sure what that system is, though.

It can get lost that the whole point of socialism is to promote a 'collective', but also that nations as we know them today are actually full of collectives. A corporation is a collective where everyone works together and shares in the profit. Families. Unions. etc

Socialist theory wants to apply collectivity to the supra-structure, or at least equalize the sharing of profits within sub-groups. But that raises the question of, what exactly does that equalization look like? I'd argue that what we have now, in many parts of the world, is already pretty close to that system.

What we're missing is environmental impact.