@Brodehouse said:
@Suicrat I understand your points, and absolutely, private has the incentive to challenge each other on price and that could keep prices low. But that's not the nature of publicly traded corporations, they demand growth by their very nature and a health corporation only has two options; higher prices or more sick people. By nature they have a captive audience; anyone who needs health care to prevent crippling pain will pay their last dollar for it, and private health has no incentive to charge them any less. Public health has a democratic incentive to keep people pleased with their care (same as any service). I think it mostly comes down to the central stumbling block of whether one considers health a luxury, or a public necessity. I consider it the latter, as I said, it's a moral obligation of a sovereign. I'm not for private health care the same way I'm not for private police or military; I expect those to be my right based on citizenship, just as paying my taxes is my responsibility. Maybe I can understand the other viewpoint, but that's just not how I was raised, and that's not the culture I'd like to live in (Luckily for everyone involved, all western democracies practice freedom of movement, Libertarians are free to emigrate to Rapture if it so pleases them).
What you call a democratic incentive is a pretty fancy euphemism for public choice. But what happens is, the most effective planners and builders are not who win elections, it's the most effective orators who win elections. And their ability to make promises on other people's dime represents the moral hazard of spending the money of people whom he is not administrating. He is not administrating future generations, so he sees no harm in taxing them. The future taxpayers of a jurisdiction aren't disenfranchised, they never got to be enfranchised in the first place.
On the other hand, in a market more free than that found in either the U.S. or Canada, providers that choose one of the two options you lay out are choosing a lower marketshare, lower revenues, lower profits, lower shareholder return, fewer investors, and therefore, failure.
Listen to the arguments Steve Jobs makes for privatizing education and see how he equates it to the automobile industry at the time in North America (which, as he suggested, was enormously competitive, enormously lucrative, and enormously beneficial to people who otherwise would not have been able to afford automobiles.)
Now, admittedly, in this video, the system he suggests would not be that different from the libertarian mainstay "voucher system", but the process of competition driving down the cost of education and driving up the quality of service is reflective in other industries that are far more unfettered than education is, for example, the technology industry. Where faster, more user-friendly products are constantly being outmatched by new products and services, and prices are continually falling.
This notion that it's the "moral obligation of a sovereign" imbues coercive power with far too much responsibility to be managed effectively. The "sovereign", as you put it, may be "obligated" to be the nominal provider of the services you deem "public necessities", but the way he goes about producing that "public necessity" is from the coercively taken fund of current (and in the modern age, mostly future) taxpayers. This moral obligation is merely being passed on to other people, not embraced by the so-called sovereign.
When theory mismatches practice, you get the state our world is in. It's a nice idea that some overarching paternal figure provides our most essential needs, but that fantasy is betrayed by the reality that all values require economic and intellectual input, and those elements have to come from somewhere.
The difference between healthcare and the services offered by police and military forces is they are not in the realm of coercion. Police forces and Militaries are forces, their product is the application of force. Their practices need to be adjudicated by objective law, and met with thorough oversight and scrutiny, but they are part of the core functions of a government, which is in the loosest sense of the word, a coercive institution. The notion that things like healthcare and education need to be woven into the role played by coercive institutions is utterly bizarre, when closely examined.
The give and take you describe of cause: I pay my taxes, and effect: and in return I get an ever-eroding quality of healthcare is on its face corrupt. You are obligated to uphold your end of the social contract (lest you go to jail for tax evasion), but the service provider is not obligated to do anything more than write laws and spend your money. Your opportunity to sue for breach of contract only comes during election years, but even then your rights to publicly petition are severely curtailed, leading to the inevitable high success rate of incumbent candidates, who can stack the jury in their favour by buying votes with the voters' money promising ever greater, unaffordable services.
If conscientious people like yourself could see that the rhetoric of social contract theory is simply not matched, simply not upheld by the other side of the bargaining table, we'd have a louder and more unified class with which to sue for the continual breach of said social contract. Instead we have an ever-increasing number of voices trying to add to the list of proposed obligations (childcare, broadband internet, food, a guaranteed income) without regard for what is expected of them.
Ugh, not the Bioshock fallacy again. Even a cursory observation of the social and political institutions in Rapture would render a decidedly illiberal verdict against that imaginary place. There was no freedom of movement, there was no free market, there was no freedom of thought; there was just a crazy man who valued his own contributions to industry. Just because you're an electrical engineer doesn't mean you're a capitalist.
(And by the way, that's what I am, a capitalist, not a libertarian.)
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