World, Writing, Wealth discussion
Wealth & Economics
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State vs Private
"A state is usually richer than any of its individuals and should be able to hire best executives, although due to salary limitations, this may not always work."A state is richer BECAUSE of the individuals, due to taxes and fees collected. And you would think that money would buy the best and the brightest, but the best and the brightest have no interest in ruling their fellow citizens. People that run for elected office are more often than not just power hungry egomaniacs with no desire to act in the best interest of the citizenry.
Anita wrote: "And you would think that money would buy the best and the brightest, but the best and the brightest have no interest in ruling their fellow citizens...."Sure, that may well be true.
My intent here is less about 'elected/ruling' positions, more about entities that provide services: like telecom, post service, and maybe even - army, jail and police, if somebody thinks they should be private -:)
In my opinion, things like the police or the army should be state run. The Res Publica allowed private armies, and naturally the General owning so many legions went out and conquered someone and kept the loot. Private ownership has one objective only - to make money. Everything else is subordinate, and is usually optimised only if that is needed to help make money. I also think utilities should be run publicly. Yes, the people pay, but that ALWAYS pay. If the state runs them, the people pay capital and operating costs; if the private sector runs them, the people pay capital and operating costs and profit.
My experience with privatized services have been dismal. For instance: Health Insurance. In my last years of work (I worked for US Army DoD). During that time government health insurance became privatized. Before privatization, it was efficient and no questions asked how much it would cost. As long as I stay in Germany, this is true. And I surmise because the cost in Germany isn't that high compared to the US (about 10 times higher). Services and quality isn't any different. The problem in Germany, Medicare doesn't pay. I pay the 20% out of pocket.
When I go to the States for medical services (Medicare is 80%, Insurance pays the balance, and I pay nothing out of pocket). But, I have to get permission from the Insurance Company for any services I want, even if my primary insurance in the States is Medicare.
I'm not sure if services should be privatized. Transportation in Germany was efficient and reliable. Since they became privatized, they are anything but. Cost went up, and on-time is not guaranteed. Telephone: Before they became Telekom, they were cheap and reliable. Now, they are expensive and charged for everything you don't want in a package. I don't need extra. I only need the specifics.
I say, keep public services out of the private sector. You get more for the buck!
In truth, which is more effective? Neither and both.
Privatized Business are in it for profit.
Government Services are not for profit, and for the public.
Insurances, education, protection, recreation, etc., should not be for profit, whether they are public or private. Anything for the welfare and benefit of the public as a whole, should be for the public, not as a means to make profit.
Interesting article I read in Medium. Headline: Large Insurers Left Obamacare, but Not Because It Was Broken. It turns out that small insurance companies did will with Obamacare--made money. It was the large companies that didn't do well. Their high expenses and the need for profits got in the way. They just weren't making money.
As I said in the blog above, some services are better handled by government than by private enterprises. Privatized services doesn't mean better service.
On the counter to public - they are frequently inefficient, lazy and corrupt. They can be just as self serving for the power level of whichever person is in charge. I want my budget and staff numbers higher because that increases my importance and gold plates my pension/honour/promotionHaving worked for many outsourcers and for public service the people doing the job are the same it's at management and executive level things change. Never ending bureaucracy and the feeling that the organisation was run for the benefit of the staff not the customers. As a specific example I negotiated a very large contract with the NHS - days of meetings and not once did any representative from the NHS mention patient care. The purpose of the deal. The fabulous doctors and nurses (None in the room) would have been horrified - I was.
The best I have seen are not for profit but then incentives to do better or continuously improve are harder to set up. Workers respond to reward - we all do whether its praise or a bonus.
Despite my dislike of many of the large former public sector organisations in the UK I do remember how appallingly run they were when they were publicly owned. If BT are bad now I remember them from before - they were considerably worse. Same with the railways. British Rail anyone. Is Jaguar a better car company now with better products than British Leyland.
The problem with state owned is management - they can get lazy and corrupt in the sense they try to optimize their own importance by hiring too many people, etc. The answer to that is not to privatize, but to sort out the incompetents. The problem with that is the state usually does not have a mechanism to do that because the state operates as a unit, and not, like private companies, a number of discrete units. The effect is staff can move between, and take the rot with them.On the other hand, the private service provider is there to make money. In NZ, since the electricity supply was privatised, the price to the ordinary consumer has jumped by several hundred per cent, but the price to certain large industrial users has only moved slightly. The reliability of supply to consumers has dropped as maintenance has been heavily reduced and equipment runs until it breaks down irreversibly. When the railways were privatised, all that happened was massive asset stripping. There are problems everywhere, but the state ownership is in principle the easiest to fix, but I suspect that in practice it is not.
I found private enterprise and public have the same problem: people. Do away with the problem, and you do away with the problem. Hence, androids and robots will solve the problem. I worked for Raytheon back in the 1960s. I found the same problem as in the public services, head-honchos laid back and played with the girls and us plebes did all the work.
Short answer, I would favor privatization with sufficient oversight. Problem is though, you never get reasonable oversight. Dems want to over regulate, Repubs want no regulations.
J.J. wrote: "Problem is though, you never get reasonable oversight. Dems want to over regulate, Repubs want no regulations."Harmony is something not that easy to achieve -:)
You need a rule to decide what should be regulated, and when the need kicks in :-)
This notion is largely American in nature, at least in its current form, and it's not exactly universal. The idea is a revamped version of 19th century laissez-faire economic theory that stated that the free market was the best means of accomplishing anything and that "artificial stimuli" or regulation was anathema. But history has shown - first in the early 20th century and again in the late 20th/early 21st - that an unregulated marketplace is a recipe for disaster.
Bravo, Matthew. I wish people would see that, but they don't. What they see is liberties for themselves, and that includes companies. As long as they have that philosophy, man will never leave its laissez-faire attitude.
I have seen private companies where regulations and fines are just the cot of doing business. I have seen public sector where all the officials are interested in is protecting their own jobs and budgets, not delivering efficient services for their employers the tax payer.Very strong regulation for private where fines (and prison ) hurt. Very strong policing of officialdom where accountability is assigned to the official that makes the mistake.
Philip wrote: "I have seen private companies where regulations and fines are just the cot of doing business. I have seen public sector where all the officials are interested in is protecting their own jobs and bu..."The usual problem with officialdom is backside covering - the tendency to do nothing rather than risk being criticized. Obviously you need to find bad behaviour, but the real problem in the state sector is to get people to take low level risks to get things done.
Ian wrote: "the real problem in the state sector is to get people to take low level risks to get things done.."That and also in some places it becomes virtually impossible to fire someone on state payroll, because of unions, labor protection stuff, etc.. - which renders close to impossible to motivate or replace non-motivated employees with more zealous ones
Complex question! Lots of different opinions here indicate that.I have nothing against private enterprise if there are controls. Government can take away initiative and creativity, as the Soviet Union showed. Run-away, uncontrolled capitalism like in China has many problems, including destruction of the environment.
On the other hand, some government services make sense. Single-payer healthcare in other countries, including the Third World, offers uniform care for all the country's citizens. Linking it to for-profit orgs like insurance companies and Big Pharma in the U.S. and not controlling costs is a disaster. Medical care and pharmaceutical products cost more here than anywhere else, and the system caters to the rich elites.
I realize that this is a hot topic. Discussing it openly is probably a good thing as long as it's sane and civilized.
r/Steve
PS. My novel Full Medical extrapolates the present situation to the future--a possible one, mind you, that we could change.
In my day job (which currently pays much more than my author job) I work in health. I'm a physiotherapist. We have universal health care here, but we also have both public and private systems.Medicare covers every Australian, and we pay a medicare levy as part of our tax. If you earn in a certain tax bracket (our taxes depend on our earnings) then if you don't take out private health cover, you incur an extra 1% Medicare levy.
The way it works in practice is that I could turn up to any public hospital facility in Australia and receive all necessary care - for free.
I can also have elective surgery in the public system, should I so wish. If it's non-urgent, then I'll have to wait. If I have private health insurance, I can have it straight away with my choice of specialist in the private system.
As rural residents, we use a combination of public/private services. Mainly because we can afford private health insurance. It provides us with provider choice, and takes those of us who can afford it out of the public system, so that those who can't have more timely treatment. (This is the whole point of the hybrid system of course.)
In practice, it does mean that we might pay a 'gap' between what our insurance pays and what the surgeon/anaesthetist charges, but it's not usually enormous compared to the whole cost.
As a physiotherapist, who has worked in the public system, and now works in the private system, I see both sides of the coin.
As a public physio, I was free for anyone, no matter their insurance status. I worked flat out, in order to maximise access, which sometimes meant shorter face to face consults.
As a private physio, my patients pay a 'gap' - which might be nothing or $30 a session, dependent on the type of health cover, or level of cover. But having said that, I can spend more time with them, dependent on their needs.
The good thing about our type of health system is universal access. No-one ever worries about turning up to the ED because the outcome might be something their insurance doesn't cover. If it's needed, it's done.
Leonie wrote: "In my day job (which currently pays much more than my author job) I work in health. I'm a physiotherapist. We have universal health care here, but we also have both public and private systems.Med..."
Sounds like a fair system. Similar to ours. The question whether private 'pushes' public out with constantly making the waiting for public longer. That's something we experience, for example..
Nik wrote: "Leonie wrote: "In my day job (which currently pays much more than my author job) I work in health. I'm a physiotherapist. We have universal health care here, but we also have both public and privat..."The waiting times can be pushed out for that very reason, Nik, which is somewhat frustrating, or people attending ED for things they should really have seen their local GP for also.
Some GPs 'bulk bill' - that is, charge only the Medicare rebate, but others (more often than not) charge above that, partly because the rebate hasn't kept pace with their costs, and that means people have to pay a gap, and some don't want to.
The vast majority make exceptions for those on centrelink (social security) benefits or the elderly.
I haven't seen any wait list here in Germany. As I had said before, Germany has two systems: private insurance and public. Most people have public, but some have both to offset extra costs. And private insurance is inexpensive here (about a 3rd of US, and it is full coverage). But, people do wait to see the doctor, the same as they do in the States. Seeing a doctor on emergency is always a wait, regardless where you are. I don't know anybody who has priority over anybody, except maybe the president, or some statesman. I did know a doctor in LA who catered to the movie industry, and yes, they did have priority over the regular patient.
But here in Germany, there is something called an appointment. And it applies to anyone wanting to see a doctor (regardless of insurance status).
But, my experience in the States, an appointment doesn't mean anything. You may have an appointment at 2:00, but you may have to wait an 1/2 hour so. That's not an appointment.
GR wrote: "But here in Germany, there is something called an appointment...."German punctuality is world renowned -:)
If there's a public and a private insurance system, as in Australia, doesn't that mean that the rich are provided with better health care? There's already a big divide between the rich and the middle class/poor in the US. Our health is our most valuable resource. In the interest of making life more fair in this most important aspect, shouldn't we all have the best health care possible, regardless of income? Shouldn't we all (government employees included) be required to be insured on the same plans, with government assistance for the less wealthy - and not two separate systems? What worries me is that the best doctors will be privatized, and those of us without the means to see them will be stuck with less competent doctors.
That is the problem with the US. As we say here in German about US health care: the US has the best medicine in the world, provided you can afford it. And it won't change. Here in Germany (I'm an American retired in Germany), medicine is for all, regardless of status. Most Germans have 2 insurances -- public and private. The 2 are for any unforeseen coverage. Or if they want a private room. The little extras that public insurance doesn't pay. In the US, insurance doesn't mean anything. What counts in the US is status. Not insurance. In the US if you have to go to the hospital on emergency because of dire illness, you wait in line -- regardless of insurance. It happened to my wife. If you have status, you are seen immediately -- even though you don't have insurance. Status Counts -- Not Insurance.
In Germany, if you have an emergency due to illness, your house doctor comes out to your house to see you. Every resident, regardless of status, has a house doctor. He diagnoses and determines treatment. I'm not talking about heart attacks, strokes, death emergencies, that is taken care of by emergency services.
What the US doesn't have, and probably never have, is a personal care service, which Germany has. It is their right to personal care.
Scout wrote: "Our health is our most valuable resource. In the interest of making life more fair in this most important aspect, shouldn't we all have the best health care possible, regardless of income?..."Yeah, I believe in basic package available to all citizens notwithstanding, healthcare (at least live-saving and life-supporting) being its part.
I don't think the US really cares. If we, the people are the most important asset of society, the US is not illustrating this. This is why there are so many brains brought to the State to work. India is the number one brain import to the US. Silicon Valley has the most. I've never heard that the US imports it's brains. I don't know if there're are any. What I see in Germany and Europe, English teachers are needed, and there are many. You are almost guaranteed a job if you teach English. I suppose French, Russian, Spanish, Chinese, and Japanese, too. They are part of the commerce world.
Scout wrote: "If there's a public and a private insurance system, as in Australia, doesn't that mean that the rich are provided with better health care? There's already a big divide between the rich and the midd..."There's not two types of insurance in Australia. We have Medicare (universal health care) available to everyone, which is the Public Health system. Then we have private health cover, which funds the use of the private health system.
Certainly private health cover does cost a significant amount, however the idea of the private system is that it's meant to take those who can afford it, out of the public system for elective procedures.
It can mean quite a difference in waiting times for those procedures, but our tertiary public hospitals often have cutting edge procedures and techniques.
There is a divide in terms of wealth, which has slowly increased, however every single Australian has access to all public services, without cost.
Leonie's description more or less applies to New Zealand as well, except that private insurance is highly desirable for elective surgery. For example, I recently had a hip replacement. By using private insurance I could choose where, when, and what surgeon. They do a lot in the public system, but the waiting lists are very long, and you can wait an awful long time. You also may get a surgeon who is in training. That would be supervised, but there is a big difference between the really skilled surgeon and someone else. As an example, with my surgeon, I could discard one crutch after three weeks, but the instructions were for any of the other ones, you should not try that until six weeks. So there are advantages in going private. However, if you don't want to pay the insurance, you will eventually get it. On the other hand, if you get something serious, you go to the public hospitals immediately.
All,I agree with Scout.
We talk about Medicare for all, but even Medicare (sure to be hit now with the current U.S. admin, Congress, and SCOTUS), isn't 100%. Most elders need some kind of supplement because Medicare only covers 80% of the contests and many doctors and hospitals charge beyond the allowed Medicare limits, so even the supplements limited to Medicare rates aren't good enough. Single-payer (like Canada, Europe, and other countries, including the ones named above and even many Third World countries) is the only way to go. Medical coverage is a right, not a privilege for the privileged few. We need to get that point!
r/Steve
PS. We also need to regulate and get the waste, graft, and fraud out of the current systems, which involves enforcing the regs.
Am I understanding this correctly? In Australia and NZ, everyone has basic coverage, but people with more income are afforded better health care? I'm impressed that in Germany doctors make home visits. That's unheard of here in the US.
Scout wrote: "Am I understanding this correctly? In Australia and NZ, everyone has basic coverage, but people with more income are afforded better health care? I'm impressed that in Germany doctors make home v..."
It's not necessarily better health care. In the majority of cases you'll simply be able to access elective procedures faster, and most of those procedures are surgical.
For example - if I was involved in a motor vehicle accident, I'd be transported to the nearest public hospital, and provided with all the care required, no matter my insurance status, and at no cost to me.
If I required a knee replacement, and have no private health insurance, I would still have the knee replacement, however, as it's not life threatening, I'd go on the waiting list. (The length differs in different areas.) I could also pay to have it done immediately in the private system. My surgery in the public system would still be done by a qualified orthopaedic surgeon, I would just not necessarily be able to choose exactly who.
If I have private health cover, I can have it immediately, in the private system, with the surgeon of my choice. There may also be some 'gap' to pay, dependent on whether the surgeon charges above and beyond the schedule fee. I can also choose to go via the public system if I wish. Some surgeons work in both systems.
As someone who has worked in both public and private health care in Australia, I can happily say that they systems generally work well and also work hand in hand. As a private practice physiotherapist, I treat people who've had surgery in both systems. As a public physiotherapist, I also saw people who had surgery in both systems.
I hope that makes it clearer.
As a general point, medical treatment in NZ, and probably many other countries, is a lot cheaper than the US, and without a loss of quality in most cases.
Steven wrote: "All,I agree with Scout.
We talk about Medicare for all, but even Medicare (sure to be hit now with the current U.S. admin, Congress, and SCOTUS), isn't 100%. Most elders need some kind of suppleme..."
The whole system is corrupt. I have cousin who was, at the time, a Prosthesis doctor. He prescribed a walker for my dad, and charged him $500, because of medicare. Dad blew and said, that was outrages. My cousin said, of course, but that's allowed under medicare. I only bill the minimum charge allowable by the system. The chair cost $30.
That whole system has to change. Doctors are billing and sucking the system for what its worth.
Have you ever seen a medical bill from the hospital? They charge you for everything under the sun, whether you use it or not--even the toilet paper in the john. It's all under obscure charges. It's padded to the hilt.
The only advantage I have using the medical system in the US, when in the US, I pay nothing, because of my medicare and private insurance. Here in Germany, medicare doesn't pay. So, I pay the 20% of my medical cost. Which isn't bad, because medical cost isn't that bad here. One can pay for it out of pocket. Not in the States.
Leonie wrote: "My surgery in the public system would still be done by a qualified orthopaedic surgeon, I would just not necessarily be able to choose exactly who.If I have private health cover, I can have it immediately, in the private system, with the surgeon of my choice...."
We have exactly same system as Leonie describes, although I'm a little worried that it looks like going 'private' is being encouraged, because the queue for 'public' not life-threatening procedures ever becomes longer. The 'private' insurance isn't expensive - but still. 'Public' is also paid through state regulated and relatively inexpensive levies. However, the hospitals are not allowed to refuse emergency treatment to anyone, doesn't matter if he/she has coverage, local or foreign..
And with public hospitals now allowed to have 'medical tourism' departments - open for patients coming from abroad and paying hard cash (mostly rich clients from former USSR), we often see (televised by reporters) how they get priority on expense of general public..
Now that Obama/Trump-care comes into service, they say it will make it more competitive and cost less. I say it will be a windfall profit for industry. Everything that is private will never go down. They will see a way to suck you of everything. Unless, there is a bill that state insurance companies can't go over a person affordability. Then you'll see quality go down. It's all about money, profits, and who's-who.
GR,Medicare wasn't as much a gift to insurance companies and Big Pharma as Obamacare. I'd still prefer to fix Obamacare and not create a whole new class of uninsured people to anything the GOP can invent. Voucher systems? Tax deductions? C'mon! Accessible is not affordable, to paraphrase Sanders. A $10 million house is accessible to everyone, but it's affordable to very few. For healthcare, not being affordable means that many people will suffer tremendously and die early deaths.
We spend the most for healthcare but cover the fewest than any other industrialized nation. Even some Third World countries have better coverage. This insanity has to stop. Healthcare is a right, not a privilege for the rich.
r/Steve
You are so right, Steven. The problem with the US, it lives under a punishment-reward system. It is archaic and medieval. And it will never get out of it. Look at our myths, legends, and folk heroes, and where they came from. It's all about do or die. If you know the children's story: The Little Red Hen, this is a good example. We punish the weak and reward the strong. The problem is, many weak ride on the shoulders of the strong--just look at the hierarchy of the rich.
GR,Sometimes numbers of the weak can stand up against the strong but tyrannical minority. That's what we need right now. The recent class-action suit against Kay/Jared shows what can be done when people come together. Maybe things will turn around in general?
r/Steve
In my view, private will never be a means of lowering costs. You are not going to have competition because it is in everyone's interest, except the patient, to keep costs high. In my opinion, part of the reason costs are lower in NZ than many other places is that the public hospitals act as a sort of base that helps keep costs down. Private can go higher, but not exceptionally, and of course the government is a stronger bargaining agent than the patient who badly needs something.
I agree with you, Ian. I see it here in Germany. Private insurance here in Germany is 1/3 the cost of US insurance, and it's 100% coverage. That's because it's in competition with the State. I wish I could get it, but I'm too old for it.
Ian and GR,I imagine drugs are a lot cheaper there too. I once spent nine weeks in Europe (work-related stuff) and was amazed at the low cost of drugs. I don't know what NZ and Germany do, but Canada negotiates with Big Pharma. I suspect everyone does...except here, which is why they gouge us here.
The U.S. has the best healthcare in the world, but only for the privileged few. I've been for a single-payer system here for years. That's not being a commie; it's being a compassionate and practical person.
r/Steve
A few years back I went home to see the kids, and I needed some medicine, went to doctor to get a Rx and then the drug store. A little prescription cost in Germany $18, cost $90 in the States. I couldn't believe it, and blew up at the pharmacist. Also, my wife had to get some antihistamine because she suffers from allergies. In the States a box of 18 cost $35. Here in Germany the same antihistamines cost 20 Euros for 100 tablets. The Pharms are just ripping people off. I can't believe people are putting up with such gouging.
BTW, from what I hear the parallel market of medicine is grey, but huge and counterfeit is probably even bigger. I heard that drugs allocated cheaply to some less prosperous countries are being brought and sold close to the price in a more expensive countries.As always for customers the prices may be a killer (sometimes literally), while for others - just a biz opportunity
All those US residents on the US border who pop across to Mexican pharmacies to fulfill their prescriptions may be in for a shock with a large wall blocking their access
A pharmacist armed with a sling or a slingshot might still make some decent money
Steven, what NZ does is have a drug buying agency and they ask for tenders for the various types of drugs, specifying performance, and buy from whichever big pharma offers the cheapest, and in return, usually that alone is used by the public sector. And, of course, they buy generics, provided the quality s sufficient. By purchasing in bulk, they get cheaper bids.
Should everything become private? What do you think?
Nik wrote: "Should everything become private? What do you think?"Absolutely not. That only leads to disaster for those on lower incomes.
If government services had a standard higher than mediocrity I would more satisfied. However, the only government programs I participate in are the ones I cannot avoid. Social security is a good example.....I don't plan on ever seeing any of that money ever again. I am pretty sure the US government will spend it foolishly, so I am providing for my own retirement.Our public schools are not very good and I would love a private school option, but we only have parochial schools as an alternative. So my daughter receives most of her education at home.
Most federal programs could be more effective and cost efficient if they were administrated at a local level.
A state is usually richer than any of its individuals and should be able to hire best executives, although due to salary limitations, this may not always work.
And we all know that 'more effective' may come at the expense of environment protection, employees conditions of employment and other quite important issues.
Also, can and should everything be private? Many functions over the years were privatized or initially planed as such: be it airlines, jails, roads, post service or federal reserve.
However do we want everything private and if not, why?
Wouldn't private army, police or foreign office be more effective?