Why people are afraid of universal health care

[Loren Pechtel]

Why would anyone assume that a YHC would not have some form of outside rsgulation?

Who? It's the government setting the standard of care. It's the government providing the care. That's a fox guarding the henhouse.

That's no less absurd than saying of any system "It's humans setting the standard of care. It's humans providing the care. That's a fox guarding the henhouse".

"The government" is not a monolithic entity. It is a society in its own right, and is divided into competing departments and divisions.

Would you suggest that an officer from the airforce could not fairly referee an army vs navy football game, on the basis that it's all "The Military"?

No wonder American politics is so fucked up; The people can't seem to grasp that they don't live in a dictatorship. Shit, even one of the two candidates for this year's presidential election can't seem to grasp that the US government is not the power apparatus by which the President rules as an autocrat.

No. The problem comes with any organization that self-regulates. Look what has happened recently with Boeing--the FAA was permitting them to do a lot of their own inspections. Oops. You need as much of a separation as can reasonably be accomplished.

Let me get this straight. The FAA -an independent regulator - screwing up is your reason for wanting an independent regulator.

It appears you are letting the perfect get in the way of the good.

No--the Republicans crippled the FAA to the point that they allowed Boeing to do their own inspections because the FAA wasn't able to.

But the FAA was an independent regulator.

The obvious point that eludes you is that an effective overseer is necessary for accountable, not its affliation.

I didn't say an independent overseer is inherently sufficient to ensure proper oversight. I only claimed it was necessary.

 

[Loren Pechtel]

Boeing can't self regulate because it's primary motive is profit, and it is accountable to the Boeing board for both profitability and regulatory actions. Internal regulators are under the control of the same board of directors who want corners to be cut.

The GAO has no such motive; It's job is to audit government departments, and it won't cut them any slack 'because they are government too'. The Comptroller General has no motive to let other federal agencies get away with anything; The GAO is as independent as it is possible for any regulator to be.

Government auditors have as much separation from those they regulate as can reasonably be accomplished. Your belief that they are not separate because they both have the label "government" is a failure to grasp how governments work.

The problem runs deeper--it's not just the auditors, but the rules themselves. That's what I'm worried about--defining down the standards. That's Congress, not the GAO.

 

[Loren Pechtel]

Well… we have the raw numbers from COVID.
While enduring an estimated one million “excess deaths” we (Trump) ran up a 7 trillion $ debt. So with inflation, the number has to be around $7m/citizen.
If I knew I was worth that much I’d have sold out long ago!

There are no lives saved here to be making the comparison.

WTF are you comparing/talking about?

That $7T is basically the cleanup cost, not the lifesaving cost. We didn't do a lot of life saving.

 

[Loren Pechtel]

I think that was LP's point, and I see some merit in it. "Regulators are all going to be captured anyway so let's just design the capture in from the get-go and treat it as a feature, not a bug." seems unnecessarily defeatist to me. Moving along the spectrum toward the independent end is of course swimming against the current, but if a regulatory agency turns out to be unreformable the government always has the option of creating a brand new regulatory agency to replace it. That's probably easier than creating a brand new industry for the government to operate itself.

I want the regulators to be as independent as is feasible, both in enforcement and in rule-making. It's the rule-making part I'm really worried about.

 

[Elixir]

That $7T is basically the cleanup cost, not the lifesaving cost.

Sorry - that’s another 7t$
The 7t$ I’m talking about mostly went into the pockets of major trump donors and onto the national debt balance sheet.

 

[Loren Pechtel]

And in any event, if we decide cost and efficiency don't matter and what we want is for the system to be popular amongst patients, forecasting whether a proposed system will be popular with patients is a hard technical problem of economics. You can't just postulate the system of your dreams and expect it to necessarily work out in practice the way you envision. Patient experience will depend on myriad decisions by doctors, nurses, researchers, manufacturers and so forth, and all those people's decisions will depend on the incentives the system gives them. Economics is pretty much just the science of incentive.

And note that medical costs are very disproportionately distributed. Remember that we are a democracy. Consider a policy of silently screwing the most expensive x% of patients. Of course they'll see what's happening and vote against you. Probably their families will also. But others will not see the problem and vote for you because you lowered the cost. Think about it--x can be a few percent and yet the voters will favor it. In time some will learn, but there will always be a new crop of voters. So long as the failures aren't too widespread or too obvious it's what the system will do. And note that x can be a substantial percent of those with serious medical issues that are not things that must be done right now. Like the woman whose blog I linked.

 

[bilby]

Boeing can't self regulate because it's primary motive is profit, and it is accountable to the Boeing board for both profitability and regulatory actions. Internal regulators are under the control of the same board of directors who want corners to be cut.

The GAO has no such motive; It's job is to audit government departments, and it won't cut them any slack 'because they are government too'. The Comptroller General has no motive to let other federal agencies get away with anything; The GAO is as independent as it is possible for any regulator to be.

Government auditors have as much separation from those they regulate as can reasonably be accomplished. Your belief that they are not separate because they both have the label "government" is a failure to grasp how governments work.

The problem runs deeper--it's not just the auditors, but the rules themselves. That's what I'm worried about--defining down the standards. That's Congress, not the GAO.

So vote for better congressmen.

Or better still, give the job of making the rules to an independent agency. Or agencies.