Orphan crushing proponent: "Why should I pay for orphans not to be crushed??"

No but it provides a framework to begin thinking about ways we can protect the vulnerable from these contemptible but totally predictable bad actors.

For example, families forced to publicly beg for money to provide their sick children with treatment. What societal structures enable this situation to occur? Who is profiting off of this structure?

Well, that's a pretty bold stance. Scammers who steal from dying children are bad people? Geez...

The whole "anonymous bureaucrat" shtick doesn't land anymore. The purpose of having long-term non-political staff is so that operations don't change on a whim when some rogue director comes in and wants a second Ferrari. The reason government spends more AND is paradoxically more efficient is because most of the work of those bureaucrats is tracking, reporting, and reconciliation. That's the whole deal. Congress passes laws and in those laws is usually an obscene and near impossible amount of auditing.

I trust government staff far more than the decision of unregulated, greedy corporations who literally exist to extract the most money from whatever process they're trying to sell you.

> Do you have enough information about decisions?

Me personally, No.

I don’t have enough information to make informed decisions here and you don’t either. Off the top of your head, how well educated is your dentist? You after all made an informed decision picking them. So how well did their background compare to others in your area. What where your concerns about their dental programs weaknesses and how was that offset by… Except no let me guess that never entered your mind did it.

> I'm sorry but I refuse to believe some unelected, anonymous bureaucrat has my best interests in mind or can even know me anything about me such that I want to allow them to make health decisions for me.

I'm sorry to tell you that this is, but unelected bureaucrats are constantly making health decisions on your behalf. You may not want government bureaucrats, but bureaucrats already work in your employer's HR department, deciding on which insurer to partner with, and with what benefits. They are at your insurance company, doctors office, and hospital administration, negotiating and deciding which procedures and drugs are available to you without ever asking for your opinion. Bureaucrats you didn't vote for infest drug company's research and finance offices, determining the availability and cost of your present and future care. None of these even pretend to act in your interests.

I'd rather have some government bureaucrat preside over all the other predatory bureaucrats. I sure as hell wouldn't be make well-informed decisions in the ER, or after getting a cancer diagnosis. Further, it is impossible to compare provider quality and final costs for elective, cosmetic procedures when I'm under no time pressure or stress.

> Because if something sucks, someone comes up with something better and sells it for a profit.

This is basically a religious belief at this point. It's how a perfectly ideal free market might work, but we don't have any of these, especially in healthcare.

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Markets can remain irrational, or colluding, far longer than you can stay solvent (or even alive).

For example, while the Phoebus cartel only really lasted from 1925 through to 1939, 1000hr incandescent light bulbs remain the standard offering till present day. Profitable market manipulations are sticky.

The whole notion that markets are efficient is just a mathematical construct that has become very dogmatic for people. But if you look into the details, markets are efficient under the assumptions of perfect information and infinite time. Neither of those conditions are present in the real world: we neither have perfect information nor infinite time.

> Competition. It's the only force keeping humans honest.

Pure misanthropic fantasy pretending to be sophisticated economics.

> Collusion and cartels never work on the long run.

Define "long run" - they have been already proven to have worked for years and in some cases even decades.

All empirical evidence shows that single payer systems work better, producing far better outcomes at lower cost, than the US system. In fact, so much better that a single payer system is what Congress has chosen for itself!

But seems some prefer to believe a theoretical argument with no evidence to back it up.

“The Party told you to reject the evidence of your eyes and ears. It was their final, most essential command.”

There are both private and public health care systems. Private care is a complicated scam, the small print is tens of times the contract.

Public health systems vary with country. Private advocates say public sucks, until it is their turn to be scammed.

What's 'paid' to the median child in education is a pittance compared to what the payers suck back out of them in old age during social security.

Public education is largely a scam to put 'original sin' of debt of children to society so when they grow up there is some plausible explanation that "we're a society" and they must feed into the pyramid scheme.

This isn’t about free market vs single payer healthcare. These kids are from poor countries. Unless you’re arguing for rich countries to offer literal worldwide healthcare.

I wish this was still what we meant by "Greatness" in America

The IRS can audit the reporting, and if you lie on egregiously you can even go to jail. Granted that is very rare, and we currently have an anti-IRS administration, but that’s the basic enforcement mechanism.

> But who can audit the reporting?

The same people that audit your taxes, roughly with the same consequences for lying. Except the IRS is far more likely to send unannounced auditors to NGOs than they are to send them to for-profit companies or individuals. It's more of a hassle to get/retain tax-free status than it is to simply pay your taxes like everyone else (as it should be).

> Is that it?

Let me guess: you haven't clicked on "view filing", which leads to a roughly 20-pages-long document.

In terms of waiting times to see a doctor or specialist (the only cases where stats for the US seem to be available), the US looks a touch better than average in waiting times for healthcare within comparable countries: https://www.oecd.org/en/publications/health-at-a-glance-2025....

Ahead of Canada, sure (they come worst here in both scenarios) but behind countries like the UK, Germany & the Netherlands that do have universal health care.

I prefer that over people having to start a GoFundme whenever they get sick. My relatives in Germany get necessary treatment as needed. There is the myth of no wait times in the US but from my experience there are also of wait times here.

Still better than months long fundraisers that aren't even certain to raise enough to cover the cost.

If you think there aren't long waits for non-emergency treatment in the US, you are lucky or a moron.

I needed a sleep study. An inpatient sleep study is booked 3 years out here. Good insurance.

Seeing that sleep study doctor in the first place just to get sent a $150 gadget that listens to me sleep? I waited two months. The follow up appointment? 3 months.

Do you know why non-emergency care waits that long? Efficiency. Turns out, hospitals want to not spend extra money on doctors they don't need whether they get paid by the government or this weird industry called "insurance" we have developed.

Go head, tell me about how you can get any treatment or any scan in a week without fail in our wonderful overpriced system.

In the US, twenty day wait list for a broken toe, seven month wait list for a neurologist, five month wait list for a deviated septum surgery, and good luck finding a PCP taking new patients.

This quality of service costs me and my wife ~$23,000/year.

Sure, we can walk into urgent care and get seen. I've also never had a problem walking into a walk-in clinic in Canada, either. The clinic's lobby and the doctor's car in the parking lot isn't as nice over there, though.

Any system needs a resource allocation algorithm.

In capitalism it is easy and transparent: price, with the side effect of aligning society interests with those of the selfish individual.

Of course the strange and heavily regulated US health-care system is obviously far far away from a free market.

In socialism it's much more random: black markets, lists, lotteries, friends and network of connections. The side effect is that the most productive individuals are discouraged and punished, with the whole society lagging in effect.

Case in point: the EU that started lagging the USA so much in growth that ended up having to beg for basic defense when a blood-thirsty neighbor came hungry for land.

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> I find it hard to describe the US healthcare situation as anything other than a market failure

The market is just reacting to the regulatory environment and all the political patches and shortcuts of same done to appease voters over the last 100 years. Fix that and the market will sort itself out.

Basically the US has mixed the worst aspects of for profit healthcare with the worst aspects of socialized healthcare. It underperforms while still costing obscene amounts of money.

I was shooting heroin and reading “The Fountainhead” in the front seat of my privately owned police cruiser when a call came in. I put a quarter in the radio to activate it. It was the chief.

“Bad news, detective. We got a situation.”

“What? Is the mayor trying to ban trans fats again?”

“Worse. Somebody just stole four hundred and forty-seven million dollars’ worth of bitcoins.”

The heroin needle practically fell out of my arm.

Probably, but that isn't really something I say anything about in what I wrote. Instead, what I wrote is basically a terminology quibble with the use capitalism instead of market economy.

I don't think your statement is true absolutely, I think it's very possible to have pure market economies that are quite well-functioning, i.e. not monopolies etc., where many people are very rich but with some people being really poor, even to the point of not being able to afford healthcare or healthcare insurance, so I don't think it's guaranteed to be true, though I think it's mostly true.

You literally have the communist distribution principle for education at the primary level in the US, and it's a stabilizing element that allows you to stabilize your system despite having one of the harshest market economies in the world.

So I don't understand how your comment really relates to mine. My comment is basically me quibbling about terminology with the terms capitalism and market economy.

I’m the farthest thing from a communist, but what makes you think public funding cannot be given to drug research?

Maybe, and you really believe that, then you do believe in capitalism as Louis Blanc defined it, even though he invented it as a way to characterize something which he regarded as bad.

But this kind of thing, i.e. capital accumulation by some to the exclusion of others, is, I think, objectively problematic in that it's not really compatible with free markets since capital ownership will be barrier to entry once capital has in fact been accumulated by some to the exclusion of others.

I agree that it is decentralized though, but sort of like how feudalism is decentralized.

It's largely not up to people. 59% of Americans support Medicare for All[1], including over 1 in 3 Republicans, but how many politicians even talk about it?

[1]https://d3nkl3psvxxpe9.cloudfront.net/documents/econTabRepor... via https://truthout.org/articles/6-in-10-americans-back-medicar...

I would take my insurance over public German healthcare in an instant. I would not trade.

Now maybe when I stop working that may be a different comparison. And its not like there is a choice, voting for a D doesn't magically get German healthcare.

A Single-Payer-System would also be cheaper in the US. Nobody expenses as much on administrative cost, nobody pays so much as a % of GDP on Healthcare as you, still you have the worst health outcomes of all developed nations.

Taking into account both the costs of coverage expansion and the savings that would be achieved through the Medicare for All Act, we calculate that a single-payer, universal health-care system is likely to lead to a 13% savings in national health-care expenditure, equivalent to more than US$450 billion annually (based on the value of the US$ in 2017). The entire system could be funded with less financial outlay than is incurred by employers and households

https://www.thelancet.com/journals/lancet/article/PIIS0140-6...

If a treatment isn't approved yet, you can usually submit a request for getting it paid.

You need to show that it has a chance of working (literature etc...) and it will be reviewed by a doctor from the "Medical Service" which is independent from the Health Insurers.

If they decide it should be paid, it will be paid (which is most of the time the case).

Otherwise you can go through the social courts. (No court costs for the insured person. You can get a lawyer reimbursed if you're poor)

I know that's what you hear and read on Fox News and other "News Sources" daily. But here in Germany, there are no "death panels" or long waiting times for cancer treatment.

Also we don't need "pre-auth" and other Bullshit before we start standard treatments.

The real death panels are sitting in your Insurance Companies Offices as seen by the news coverage around United Healthcare et al lately

I am yet to see any western nations go bankrupt for universal healthcare.

I have three second-hand cancer experiences from family here in Australia (Dad, Mum and my half-sister - under 35/yo). All three were detected early thanks to regular checkups and screening (covered under Medicare), treated in major hospitals (Dad was in a rural hospital, Mum and half-sister in Metro major city hospitals) and are all alive and certainly not in debt. The biggest cost was parking at the hospital, drinks from the vending machine and the PBS medication (all PBS medicine costs $31.60 for adults, and $7.70 for concessions).

Any PBS medication has the full-cost price printed on the label for reference, more often than not the printed prices go from $300 - $2,000, but I remember that these aren't the full price anyway since our government collectively bargains for cheaper prices on OS medication).

I can't imagine having to pay for treatment AND the insane full price of medications, it must be so much more stressful for families going through cancer treatment.

Americans, don't let the media and your government tell you otherwise. Universal healthcare is cheaper [0] and more effective than whatever archaic system you have now.

I am so god damn proud of our system in Australia, it's not perfect, but damn it's so efficient for critical care, thank heavens for Medicare and the PBS.

Oh and for those that say "well doctors aren't paid very well"... they are. My brother-in-law is a surgeon and he's doing pretty well for himself, bought a new Audi last month for his wife, heading to Europe for a month-long holiday with his family and just moved into a new house.

[0] https://data.worldbank.org/indicator/SH.XPD.CHEX.PC.CD?most_...

> but thought delays and countless committees and bureaucracy until the patient expires...

So then you would expect life expectancy in the US to be higher than in Germany, France, UK?

It is not.

Private/public here in Japan works okayishly well. I have never heard of anyone getting bankrupted over medical bills, and have had loved ones going through surgeries and other complex issues.

As soon as you said "death panels" you invalidated your entire point, I'm sorry.

Did you make all of this up or just so credulous that you repeated what someone else made up?

Is there a legitimately good reason for all those treatments to be so expensive, or is that, to a large degree, capitalism extracting capital from the market? Why is American insulin so expensive when compared to that from other countries?

Theres a (now old) memo that specifically outlines which talking points carry most salience amongst the audience. Those terms are present here in your comment. (Luntz - The language of Healthcare 2009)

Even with waiting lists, people get healthcare. They get better health outcomes per $ spent. America can provide excellent cutting edge healthcare, which is especially great if you can afford it. At some point, you have to decide whether having most of the bell curve taken care of, is more / less important in terms of rhetoric and priority.

> waiting lists, death panels and very often saying no

As we all know, American insurance companies never deny coverage, nor do you ever have to wait in an American hospital. /s