Has Western capitalism become too efficient and ruthless?

Iraq Bruin

Ad Honorem
Oct 2010
5,197
DC
Ok, let's clarify a bit (and make some history too).

To perceive the universal health care like a "no choice" imposition, coming from "governance and burocracy" it's rudimentary, unhistorical and unrealistic.

The social and medical coverage have their roots in early community regroupements, it goes back at least as far as guilds.

With the industrialization, it's the seeds of today's universal health care systems that were planted: workers started to organize into unions, and maybe the most important aspect was creating common funds to cover risks (illness, accident, death). In French is phenomenon is called "mutualiser" (aprox. "sharing"), there from the denomination still existing : "Mutualité".

Those unions extended and diversified (for example, Belgium had socialist, liberal, Catholic, neutral to name just the more important, I don't have the figure at hand, but I think France has more than 400 "Mutualités" these days, aso).

In time (with sometimes a lot of pressure, even violence in some cases) the system was imposed at national level, included in laws, in rights, in sum, at state level.

One have to understand that US had a totally different evolution from Europe from that point of view (therefrom also some radical differences in how things are saw in the two shores of the Atlantic).

In a blunt way, one could say that Americans choses to limit as much as possible state's interference, where European chooses to impose the state their solutions.

The states were imposed to adopt extensive (ultimately universal) health care. State's policy on the matter evolved, and evolved also because of the representatives are elected on a platform in healthcare. Indirectly, I do decide the orientation through my vote, and I do influence it more than a governmental burocracy as I am electing the representatives, thus deciding the evolution of the system.

On the other hand, inspite of what is said, the state itself is much much less involved than people might think.

I have to have a medical insurance, but nobody imposes me which one I take, and whom from. I have to be afiliated to a social security organism, but nobody imposes which one either.

I do have a choice, and it's a real one, as those organisations/organisms, be them profit or non profit, are in competition, and they try to attract me with their offer.

The main role of the state remains in regulating. Establishing limits, frames.

I know that some are against the regulator function of the state. I disagree: it's the role of the state. It's role is to regulate, to establish limits, to create a decent frame (juridical system isn't anything else than regulating, afterall).

Until now, implicating the state alongside the other actors was, pondering the pluses and the minuses, proves beneficial.


Bref, universal healthcare it's really not Ivan Ivanovich Ivanov, eURSSS Commissary for better health that ponded a law a Friday morning in his cabinet at Ljublianka.
I understand your post completely, I understand the grassroots and origins of the system(s) you mentioned, not to the details where I can explain to someone but I think I get the gist of it.

Your post highlight two intertwined issues at hand, Origin of system and role of the state:

I do not even how to begin with this but there is a large segment of the population who fail to see this issue as bottom-up originating the same way you described some European contexts, I tend to agree with their sentiments (but not necessarily their rationale) to an extent. I tend to see a lot of the health debate stemming not from "improving a bad system" but through an anti-corporatism, class envy, and society-slicing into victim-groups (for future bribing with other people's money).

Then the second part comes, I would trust my voice to reach Richmond (VA capital) in a more significant way than it reaches DC (Federal), if I were to accept any system similar to the ones I mentioned above (in an earlier reply) I would want to implement them in my state, I am not interested in funding other state's adventures and misadventures at the micro levels, yes I understand the national solidarity we need to have as a country but some states run their basic services better than others, using national averages will not serve the good ones nor will it incentivize the bad ones.

Case in point, my local county has a better public school system than most of California and I can foresee and hope a similar pattern in health as well.

I can go on and on but the basic premise is:
Without real origins and without local control and accommodation, the whole thing is not going to go well.
 

deaf tuner

Ad Honoris
Oct 2013
14,635
Europix
I understand your post completely, I understand the grassroots and origins of the system(s) you mentioned, not to the details where I can explain to someone but I think I get the gist of it.

Your post highlight two intertwined issues at hand, Origin of system and role of the state:

I do not even how to begin with this but there is a large segment of the population who fail to see this issue as bottom-up originating the same way you described some European contexts, I tend to agree with their sentiments (but not necessarily their rationale) to an extent. I tend to see a lot of the health debate stemming not from "improving a bad system" but through an anti-corporatism, class envy, and society-slicing into victim-groups (for future bribing with other people's money).

Then the second part comes, I would trust my voice to reach Richmond (VA capital) in a more significant way than it reaches DC (Federal), if I were to accept any system similar to the ones I mentioned above (in an earlier reply); I would want to implement them in my state, I am not interested in funding other state's adventures and misadventures at the micro levels, yes I understand the national solidarity we need to have as a country but some states run their basic services better than others, using national averages will not serve the good ones nor will it incentivize the bad ones.

Case in point, my local county has a better public school system than most of California and I can foresee and hope a similar pattern in health as well.

I can go on and on but the basic premise is:
Without real origins and without local control and accommodation, the whole thing is not going to go well.
Well, I'd say that You saying all that is going to reinforce some of my convictions.

First one would be about form and content: a good form, an appropriate form isn't the perfect form, but the form containing the best the content.

As good as I find the Belgian social and medical system, it will not work well in Sweden. And vice-versa.

The second one would be dogmatization.

If I look at the US healthcare system (be it from outside or from inside) there are things that I find better, others that I find worse.

But (and I repeat myself) there is a problem, as the American nation spends more than equivalent nations without getting significantly more. As US is in a front position in quality of medicine, of economical possibilities, there's only one explanation: the present form is inappropriate, is inefficient. Normally, US nation could (and should) have much better.

If we look at it like that, without sticking to (empty and emotional) political dogmas, I'm convinced that the system can be improved. And my impression is that even not that difficult, not that much to reform, to improve. Other systems can be used for comparison, can be used as "crush tests" (all have bad aspects, so it can be learned from that), can be used as inspiration.
I can go on and on but the basic premise is:
Without real origins and without local control and accommodation, the whole thing is not going to go well
Totally agreed.

Just transplanting things, it's a bad idea.


__________
btw, if You're interested (You or someone else) the following link is on French system. But this one is much more detailed, so it takes much longer to go through it: The French social security system (General Scheme)
 
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Iraq Bruin

Ad Honorem
Oct 2010
5,197
DC
I figured that much about the NHS.
I as an outsider seem to view it as one size fits all when compared to the other listed ones.
 
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Naomasa298

Forum Staff
Apr 2010
35,471
T'Republic of Yorkshire
The thing is, I think there's a distinction between universal healthcare systems where the provider of insurance and the provider of services are separate.

In the UK system (ignoring private insurance for a moment), the government effectively acts as both the provider of insurance and the provider of services.

This, in theory, should allow it to run the service more efficiently. While it does keep costs down, there have been attempts to introduce competition into the system, which, instead of making it more efficient, leads to multiple companies providing the same services at an increased cost. An example is the patient transport service, that takes patients to and from non-urgent hospital appointments. Several different companies provide transport to the same hospital. Instead of one ambulance picking up patients who live close to one another and taking them to the hospital, you might have one ambulance turning up to pick someone to go to oncology, another one picking someone else to go to radiology, etc. And because they're provided by a private company. or by a separate NHS unit, the hospital has no control over the service, and the ambulances are not accountable to the hospital or medical staff.

The latest scandal is that, due to the government's tax rules, doctors are being penalised if they work too much overtime, so any consultants are refusing to do so, making waiting lists in some parts of the country longer by up to 30%. But that's not a fault of the health system, but of of the tax system.