From: Stathis Papaioannou (stathisp@gmail.com)
Date: Sun Apr 20 2008 - 05:32:47 MDT
On 20/04/2008, J. Andrew Rogers <andrew@ceruleansystems.com> wrote:
> > Across the world, capitalists provide the cars while government
> > provides the schools and the healthcare. It's not as if there is less
> > money and less opportunity for corruption and a large bureaucracy in
> > cars. Could it be that, um, empirically, it has been found that
> > government is better at some things and private enterprise is better
> > at others?
>
> Not really. There is no evidence to support this assertion, just the
> assertion itself.
I would have thought that the fact some things are consistently paid
for by governments and others not does constitute evidence. Even an
ideologically pro-business, anti-tax country like Singapore has an
extensive public health and education system. How do you explain this?
> The United States did not have universal public education until well into
> the 20th century, yet for most of its history it had the highest literacy
> rate in the world by a remarkable margin. Its robust private education
> system was destroyed for purely political reasons, and the consequence is
> that we pay orders of magnitude more per student today for an arguably
> inferior education. At least the US still has its universities.
>
> As for healthcare, I would make the observation while the last major
> industrialized country with a quasi-private system standing is the United
> States, the United States also enjoys significantly better diagnostic
> accuracy and disease survival rates than any other industrialized country.
> As was highlighted in a recent Lancet Oncology Journal study, the average
> cancer survival rate in the United States is 20-40% higher (depending on the
> type of cancer) than in Europe and the best in the world by any absolute
> measure. Those are results that matter, since we are paying for healthcare
> results and not feel-good platitudes.
This study is often raised as evidence that the US is getting some
value for its at least 50% more expensive than anywhere else health
system. But against this is the fact that life expectancy in the US is
near the bottom for the developed world. Lower overall life
expectancy, more expensive overall health care, better cancer survival
rates... does that mean all the health professionals other than the
oncologists are ripping off everyone big time?
> Add to that the fact that the vast
> majority of medical research happens in the US disproportionate to either
> its population or GDP and everyone benefits from its marginally private
> status.
And this despite the poor general standards of basic education?
> An interesting fact is that a half century ago government funded R&D was
> about the same as privately funded R&D in the United States. Today, private
> R&D dwarfs government funded R&D, and the gap has been growing steadily for
> decades.
How much of this is basic science? How much is funded by charity
rather than business seeking to make a profit?
> There may be good arguments that the government is better at some things,
> but you will have to pick your examples more carefully than education and
> healthcare. You simply assumed your conclusion without being cognizant of
> the available evidence.
In just about every field of human endeavour the US is, rightly or
wrongly, studied and copied around the world. Certainly this is so
with medical science. But in the *delivery* of health care, most
countries see the situation in the US as a warning of how not to do
it. This fact requires an explanation.
-- Stathis Papaioannou
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