Net Neutrality is Live
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I completely agree with Scott on that, we've had this conversation before.
Though I'm not sure why you, @scottalanmiller, think healthcare is a last mile consideration? Is it because of Medicare/Medicaid?
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@Dashrender said:
Though I'm not sure why you, @scottalanmiller, think healthcare is a last mile consideration? Is it because of Medicare/Medicaid?
Because real healthcare, outside of well visits (who even does that) is a expensive, no options, generally emergency situation. When you are unconscious and need to be treated, there is no "open market." 911 gets you an ambulance and it takes you to the nearest facility. End of story.
When you are conscious, how often is there a real choice? You don't have any reasonable ability to switch facilities, negotiate prices up front, test or interview the facility first and likely only one is even within possible distance or reasonable distance. Almost nothing in healthcare is an open market. Pharmacies would be an exception, much of the time. But serious care cannot be openly competitive. You can't just turn down healthcare and do without it, it's not like a car. You can't do it yourself.
And doctors have powers that don't apply to an open market. In an open market, your life can't be threatened or put at risk. Everything about healthcare is naturally a utility and not an open market. In the US, like everything, we go to great expense and risk to fake this for political gain, but it doesn't change the reality that when it matters - you have no means of treating healthcare as an open market.
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If healthcare was an open market, the over charging and service problems would be fixed. There would also be no way to get services that you can't pay for.
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I think the life and death part is the sticking point.
Short of being unconscious though, you totally have choice, unless you live in a rural area. My town of 650K people has 9 hospitals. They all do most of the major things, like treating cancer.
The thing that kills competition in this situation is the insurance companies. They are the ones that make the deals, Not the patients.I have definitely taken a softer view on healthcare since you explained your position a few years ago, but if you talk to people in Canada or Europe they will all tell you when it comes to major ailments, there are waiting lists and budget constraints. I have personally done no research though to know how many people die while waiting on surgery for cancer treatments, etc because of the back log.
My German friends all have told me that they all purchase supplemental insurance because the government provided healthcare is not good enough to cover the bad stuff like a bad car accident, etc.
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@Dashrender said:
Short of being unconscious though, you totally have choice, unless you live in a rural area.
But that's like 49% of the population! It is a LOT of people. Even living around NYC, I only had one hospital choice within reason. One was five minutes away, another was over and hour and a big risk because traffic could be unpredictable.
There was truly only one local hospital there.
Sure, SOME people get choices. But even then, the choices are not how open markets work. Unless your entire hospital stay is in negotiated prices, up front, no surprises, you haven't even gone down a path to start talking capitalism. I know of no medical facility in the nation that will do this.
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@Dashrender said:
I have definitely taken a softer view on healthcare since you explained your position a few years ago, but if you talk to people in Canada or Europe they will all tell you when it comes to major ailments, there are waiting lists and budget constraints. I have personally done no research though to know how many people die while waiting on surgery for cancer treatments, etc because of the back log.
Talk to people in the US and you get the same thing. Everyone I know with major healthcare needs has these problems. I know of no one in Canada or Europe that has these and thinks that they are worse to what they are here.
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@Dashrender said:
The thing that kills competition in this situation is the insurance companies. They are the ones that make the deals, Not the patients.
That too, the forced insurance system is the opposite of capitalism as well. Not that I don't support insurance, I'm just saying that the way that it is doesn't support the pretense that there is some choice either.
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@scottalanmiller said:
@Dashrender said:
I have definitely taken a softer view on healthcare since you explained your position a few years ago, but if you talk to people in Canada or Europe they will all tell you when it comes to major ailments, there are waiting lists and budget constraints. I have personally done no research though to know how many people die while waiting on surgery for cancer treatments, etc because of the back log.
Talk to people in the US and you get the same thing. Everyone I know with major healthcare needs has these problems. I know of no one in Canada or Europe that has these and thinks that they are worse to what they are here.
Well sure, but those who are here (in the USA) only hear that Europe has free healthcare and really have no clue what that means.
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@scottalanmiller said:
@Dashrender said:
The thing that kills competition in this situation is the insurance companies. They are the ones that make the deals, Not the patients.
That too, the forced insurance system is the opposite of capitalism as well. Not that I don't support insurance, I'm just saying that the way that it is doesn't support the pretense that there is some choice either.
But these issues are made by us, the users, and them too. I don't see that the system couldn't change to be one of more openness, except for the fact that everyone believes they they are entitled to any and all medical technologies in their time of need. And our current system kinda gives that to them.
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@Dashrender said:
Well sure, but those who are here (in the USA) only hear that Europe has free healthcare and really have no clue what that means.
Actually almost the only thing that I hear here is things like "wait times" and " no services", which does not match up with the WHO's assessment of the reality.
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@scottalanmiller said:
@Dashrender said:
Well sure, but those who are here (in the USA) only hear that Europe has free healthcare and really have no clue what that means.
Actually almost the only thing that I hear here is things like "wait times" and " no services", which does not match up with the WHO's assessment of the reality.
As you noted when your child was sick while you were traveling in France, we're over doctored here in the US. This puts an even larger burden on the healthcare system.
There are fewer and fewer people becoming doctors because the regulation is making it harder for them to make an better than good living doing it. Instead those smart individuals are going into business or some other venture to find their successes.
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@Dashrender said:
In reading some comments on another page I realized another issue of internet based scheduled programming, DVRs. Currently there is no way to DVR content for you to consume on your own schedule. Sure, the content providers could leave copies of all of their programming online for X amount of time and embed fewer commercials for the non-primetime viewing of a show, much like what happens today with shows on demand from a cable and Hulu, but that services doesn't come close to the current abilities that consumers have and love of home DVRs that allow you to fast forward through commercials at your own pace.
I've considered cutting the cord for the past 6 months or so. I've looked into what it would take to get the programming I really want the way I want and keep coming back to the fact that the cost is negligibly better than what I'm doing today yet requires me to jump through a ton of hoops to get it.
With IPTV you can still use a standard DVR you just use a Network to Coax converter that logs into the service and provides the cable to you as normal.
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@scottalanmiller said:
@Dashrender said:
Well sure, but those who are here (in the USA) only hear that Europe has free healthcare and really have no clue what that means.
Actually almost the only thing that I hear here is things like "wait times" and " no services", which does not match up with the WHO's assessment of the reality.
I'll agree that wait times are outrageous, but what do they mean by no services? when I hear that it's mostly around how insurance companies are refusing to pay for the test/meds, etc that a doctor prescribes.
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@Dashrender said:
Yeah, That's the failing in my mind. The last mile should actually be provided by the municipality, like roads and water and power. The municipality charges the vendors enough rent to keep the system up, and do upgrades when needed (yeah I know, the whole upgrade thing becomes a political nightmare).
By having the last mile be municipality owned with laws saying they can't play favorites to vendors, the end user totally wins. The last mile is where there is little to no control for the vendor or the consumer.The government is generally bad at providing any services on time, on budget and doing it well. in fact if it were up to the manicipalities many places would not have anything as around here some collect tax dollars and then provide only emergency services and schools. Roads etc fall to the state if they aren't picked up by the locality.
Middle mile fiber is heavily funded by the gov't we have it all over hear. in fact comes near just about everyone's home (but, not to) so there is no one using this hundreds of miles which was like a 15 million dollar project.
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@Dashrender said:
There are fewer and fewer people becoming doctors because the regulation is making it harder for them to make an better than good living doing it. Instead those smart individuals are going into business or some other venture to find their successes.
It's less about not making enough money... it is easy to make money as a doctor, and less about it being rewarding. We have a pointless, horrible hazing process for people becoming doctors and way too low of an educational standard. We'd be (and regularly are) appalled by IT practitioners at the same education and creativity of most doctors. Shouldn't healthcare be a higher standard, not a really low one?
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@thecreativeone91 said:
The government is generally bad at providing any services on time, on budget and doing it well. in fact if it were up to the manicipalities many places would not have anything as around here some collect tax dollars and then provide only emergency services and schools. Roads etc fall to the state if they aren't picked up by the locality.
Is this really true? What local government providing fiber or electric have you seen not just rock? I don't know any private company doing roads better than governments do. Governments provide services taht are very hard.
I know lots of towns that do their own electric and they are way better than the utility companies. WAY better. Half the cost (actually like 1/10th the cost) and never outages.
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But the problem is, once you allow a monopoly, even a private company turns into a form of government. Where does the line go?
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Agreed, if the government is doing a service, those figures should be open for anyone to view. Yeah I know it's a hassle, but it's the only way to keep things above board.
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@thecreativeone91 said:
@Dashrender said:
Yeah, That's the failing in my mind. The last mile should actually be provided by the municipality, like roads and water and power. The municipality charges the vendors enough rent to keep the system up, and do upgrades when needed (yeah I know, the whole upgrade thing becomes a political nightmare).
By having the last mile be municipality owned with laws saying they can't play favorites to vendors, the end user totally wins. The last mile is where there is little to no control for the vendor or the consumer.The government is generally bad at providing any services on time, on budget and doing it well.
I keep hearing this... the only government institutions that this happens regularly with is the military, congress, and the fed. Local and state governments generally do a fairly good job with maintenance and new infrastructure. As I stated earlier in the thread municipal broadband has been able to increase customer service, speeds, and bandwidth, at a decrease of price. I don't see any ISP making the same claim.
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@Dashrender said:
Agreed, if the government is doing a service, those figures should be open for anyone to view. Yeah I know it's a hassle, but it's the only way to keep things above board.
Sure, I agree there. But where is this not the case with municipal services? And if it applies to government, it must apply to any monopoly equally, right?
