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After seeing Youtube's "Healthcare Triage" on USA and Canadian healthcare, it seems a public single-payer system (or some state based combination of the two) seems to be a far more efficient system and better for our overall health. IMPORTANT: I understand we have a heavily regulated private system now which may not be up to snuff against public systems, but we have a choice between something which works well enough (public) and something which no country has done and we have no solid evidence works better than other options (unregulated private). Also I'm not saying the federal government should run the thing but maybe states can...

Any evidence to convince me private and unregulated brings better outcomes and lowers cost?

asked Apr 24 '14 at 12:57

TheBucket's gravatar image


edited Apr 26 '14 at 18:03

Any evidence to convince me private and unregulated brings better outcomes and lowers cost?

Doubtful. But how are you defining "better outcomes" and "lower costs"? Are these two even necessarily compatible?

(Apr 24 '14 at 21:36) anthony anthony's gravatar image

I am defining better outcomes as things like higher life expediencies, less disease, better access etc and lower cost as a lower percent of GDP so we can spend it on other things. I know there isn't a magical formula for healthcare but, for example, Canada spends less on healthcare and gets better outcomes for more people.

Any evidence I'm wrong and should consider private as a better alternative?

(Apr 24 '14 at 23:18) TheBucket TheBucket's gravatar image

I am defining better outcomes as things like higher life expediencies, less disease, better access etc and lower cost as a lower percent of GDP so we can spend it on other things.

This doesn't seem like a very objective definition.

I know there isn't a magical formula for healthcare but, for example, Canada spends less on healthcare and gets better outcomes for more people.

How many people does Canada get better outcomes for? How many people does the US get better outcomes for?

(Apr 25 '14 at 08:35) anthony anthony's gravatar image

Any evidence I'm wrong and should consider private as a better alternative?

You're wrong in that you're trying to consider what is "better" without factoring in individual rights.

I mean, we could get a lot better outcomes (under your definition) for the average person, at a much lower cost, if we just took all the sickest people, with the most expensive medical problems, and killed them.

You probably don't advocate direct killing of people, but stealing from people and preventing people from engaging in consensual commercial transactions does make people's lives worse.

(Apr 25 '14 at 08:37) anthony anthony's gravatar image
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I'm not very familiar with the Canadian healthcare system, but I found two informative articles about it on Wikipedia:

  • "Health care in Canada"
  • "Single-payer health care"

As I understand it, the Canadian system is basically a mixed-economy program, i.e., a mixture of freedom (of individuals and enterprises) and government controls. As Objectivism points out, all forms of government controls involve violations of individual rights. That's what government control means -- compulsion. In the case of single-payer healthcare, the victims include taxpayers (forced to pay for programs they may not need or want or agree with); doctors (restricted in where they can work, how much they can be paid, what services they can provide, what possible treatment therapies they are allowed to discuss with patients, which patients they can accept, on what terms, etc.; and countless other victims associated with the healthcare industry in various other capacities.

Objectivism, in contrast, opposes all forms of government controls on an economy or society, and advocates complete separation of state and economics, with no role for government other than upholding individual rights. And there is no such thing as a "right" to healthcare or any other man-made goods or services produced by others, except what one is able to persuade them to give in return for payment of some kind, i.e., voluntary and mutually beneficial trade (including the right to form contracts, again mutually voluntarily).

The principle of individual rights is exactly that -- a principle. The questioner wonders whether consistent adherence to principles is necessarily good. Objectivism holds that it depends on which principles, and how they are derived and validated. The questioner observes:

... we have a choice between something which works well enough (public [single-payer]) and something which no country has done and we have no solid evidence works better than other options (unregulated private).

This formulation amounts to outright rejection of principles as such, in favor of some criterion of "good" based on trial and error, with some loosely defined (or completely undefined) view of what constitutes "working." Indeed, this same questioner previously posted the following question on this very website:

Refer to that earlier discussion for a detailed answer on why man needs principles. And for another principled discussion specifically about healthcare, refer to the following question posted recently by another questioner:

One of the key points to remember about principles is that they don't stand still. Insofar as there is an identifiable principle behind any public policy, the same principle is open to others (over time) to point out and refer to in justifying further applications of it. It acts as a precedent. The fundamental ethical principle behind all forms of government controls on the economy is that everyone has a moral duty to serve others, and the others have a moral "right" to sacrifice anyone to everyone as the "society" might wish. It takes time for a principle of that kind to grow in its domination of entire society, but such a principle can never be stopped and reversed except by a better principle -- which is what Objectivism offers. Objectivism also explains why the principle of individual rights is "better" than alternatives, and by what criteria (and why the criteria are valid). The science of economics today also explains in great detail why the operation of division-of-labor markets is most effective and efficient when property rights and economic freedom (freedom of production and trade) are consistently upheld. (Refer to the best, most consistent aspects of the long-standing, extensive Classical and Austrian schools of economics, as integrated by Objectivism's broad philosophical principles.)

Update: Coercion is anti-life

Comments by the questioner continue to express an unprincipled, narrowly concrete-bound view of the issues.

If one believes that a "single-payer" system can work (i.e., provide quality healthcare at economical prices) without government coercion forcing some (perhaps most) of its citizens to act against their own will, why not do away with the government coercion entirely and make the whole system voluntary (including its financial support)? I wonder if the questioner believes that people generally need to be told (commanded) what to do and can't be left free to decide the best course of action for themselves. If people supposedly like government coercion so much, why is there allegedly an ongoing need to force anyone who would prefer to opt out (and not have to pay taxes for a healthcare system they don't want to be part of)? Wherever there is government coercion, those who are being coerced are its victims. A system of government coercion necessarily depends on the sacrifice of some to benefit others. Such a system can endure only as long as there continue to be new victims to sacrifice. How can any such system be said to be "good" for the victims, by the standard of man's life qua man? Objectivism identifies physical force as inherently destructive of man's life.

Some advocates of government-mandated "single-payer" healthcare may prefer to evade any concern for underlying principles in issues such as reason versus mysticism, egoism versus altruism, individualism versus collectivism, and capitalism versus statism. But Objectivism teaches that such issues are matters of life or death for man. Objectivism thereby equips the victims to understand what the system depends on and how to fight back when needed. Atlas Shrugged, in particular, very dramatically concretizes the principle of "the sanction of the victims" and how the victims can withdraw their sanction. To repeat: the fact that a majority may choose to support a system of government coercion does not make it a just system, nor a "good" system for the victims, however allegedly small the number of victims may be. The number inevitably grows, since a coercive system cannot endure unless it can keep finding more victims to sacrifice. Coercion consumes its victims.

Update: Mode of Cognitive Integration

The same questioner has now posted at least nine separate questions that are all of the form, "Why shouldn't government regulate and/or provide 'X'?" -- where 'X' can be just about anything, including:

  • Central banking
  • Climate change
  • Healthcare
  • Education
  • General infrastructure
  • Monopolies
  • Foreign aid
  • Scientific research (posted Oct. 2013)
  • Emergency services (posted Oct. 2013)

All but the last two of these questions were posted just within the past three days.

To repeat: the main answer in every case is the same, namely, government control involves initiation of physical force against some for the alleged benefit of others; it expresses and reinforces the precedent that anyone can be sacrificed to anyone at any time if it's the alleged will of "society"; and government coercion is thereby thoroughly destructive of both the immediate victims and (as a consequence) the whole society.

Yet the questioner continues to dismiss these identifications as "mere logic" or "a priori logic." (The former expression appears in the questioner's posting on infrastructure; the latter appears in the questioner's comments on the present question about healthcare.) Rejecting principles, the questioner demands instead that readers provide concrete facts and examples to support opposition to government controls. The questioner even knows full well that examples of free markets will not be found in modern history in many cases such as healthcare, which the questioner describes as "something which no country has done and we have no solid evidence works better than other options (unregulated private)."

But the principled answer given above isn't "mere logic" or "a priori logic." It's a broad integration of facts of reality. Objectivism is a highly integrated philosophy grounded in demonstrable concretes of man's fundamental nature and the kind of conditionally benevolent universe in which man exists. The questioner's basic psycho-epistemological approach, demonstrated over and over in concrete after concrete, is disintegration -- rejection of all appeal to broad abstractions as nothing but "mere logic" and/or "a priori logic." Leonard Peikoff's book, The DIM Hypothesis, explains the processes of disintegration (D), integration (I), and misintegration (M) in great detail, step by step. The questioner himself even asked about it on this website not long ago (link) and received an answer that he found interesting.

In the 'D' perspective, any approach that isn't 'D' is automatically assumed to be 'M.' In contrast, Objectivism opposes both 'M' and 'D', and upholds the 'I' methodology as most consonant with man's life and its reality-imposed requirements. For additional perspective on cognitive integration, refer to the topic of "Objectivity" in The Ayn Rand Lexicon.

For those who may be interested in an integrated approach to healthcare issues, I highly recommend Free Market Revolution by Yaron Brook and Don Watkins, Chapter 13, "You Are not your Brother's Health Care Provider." Regarding the problems of modern healthcare, the chapter explains "The Cause: How Government Made Health Care Inefficient and Expensive." That section discusses specifically "Government-Provided Health Coverage," "Perverse Tax Incentives," "Licensing," and "Insurance Regulation." The next major section describes "The Cure: Toward a Free Market in Health Care," which discusses specifically "Patient Protection and Affordable Care Act" (immediate repeal thereof); "Medicare"; "Licensing"; "Health Insurance"; and "Medicaid." The chapter concludes with a section titled, "Freeing the Unfree Health Care Market."

On p. 202, early in the "Cure" section, the book emphasizes:

There is a unique difficulty in discussing free market medicine: Medicine as we know it arose at the tail end of America's freer days. Although it was the scientific and technological discoveries made possible by freedom that gave birth to modern medicine, modern medicine did not come into its own in an era of freedom....

History can't give us a full sense of what the American health care system would look like absent today's dense web of controls, regulations, and government redistribution programs. And given that unchained markets are centers of innovation, trying to project today's system minus its chains can only approximate a truly free market in medicine.

The chapter goes on to itemize the main features that a free market would not have, followed by further discussion of the specific topics listed in the "Cure" section.

Still more discussion of healthcare issues and remedies can be found in the references listed in a previous question that was cited in my original Answer above:

I've also very recently started reading an 1100-page textbook on economics that was published in 1996 and is available for free downloading in PDF form from the website of the Ludwig von Mises Institute (link). The file is about 14 MB in size. For efficient downloading using a slow DSL link, it may be faster to right-click the link, select "Save Target As," and then open the downloaded file only after the downloading is completed. The author of this book was closely affiliated with The Ayn Rand Institute for many years but went through a policy disagreement and separation in 1993. I am nevertheless finding the book highly informative in economic principles and issues, including the subsection titled, "Egalitarianism and the Abolition of Cost: The Example of Socialized Medicine" (pp. 148-150) in Chapter 5. "Socialized Medicine" is the older term for what is described today as government-mandated single-payer healthcare financing. Yaron Brook's book, cited above, also discusses "the perverse idea that health care should be free...." (p. 194)

Again, the kind of unprincipled, concrete-bound 'D' approach demanded by the questioner is not an accurate identification of how man acquires knowledge. Man comprehends reality by means of reason, which Objectivism identifies as "the faculty that identifies and integrates the material provided by man's senses." An integrated ('I') approach is essential.

answered Apr 26 '14 at 00:13

Ideas%20for%20Life's gravatar image

Ideas for Life ♦

edited Apr 27 '14 at 19:31

With your first paragraph I notice you assume government healthcare is opposed by consumers and medical professionals alike but there's no evidence that is the case. There are no strong movements against state healthcare in countries that have it and there exist high satisfaction with both medical personnel and tax-payers (I'll refer you to the YouTube video I mentioned)

(Apr 26 '14 at 17:34) TheBucket TheBucket's gravatar image

Finally I'm concerned you are getting around answering the question of "is there any solid empirical evidence for private and unregulated healthcare being better than current alternatives".

You copped out of the question by pretending criterion such as "good" and "working" don't make sense and instead we must use principles to derivative the best healthcare system.

Please answer my question, I used to be a part of this community but my opinion of it is very low right now.

(Apr 26 '14 at 17:40) TheBucket TheBucket's gravatar image

For example, there is a net influx of doctors and medical professional moving to Canada rather than the other way around (showing medical professionals are okay with such a system) and very very few Canadians go to the US to get better or faster healthcare (most of them are tourist in the US needing basic emergency care).

You have opinions, you must back them up with more than propaganda and a priori logic.

(Apr 27 '14 at 09:27) TheBucket TheBucket's gravatar image
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Asked: Apr 24 '14 at 12:57

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Last updated: Apr 27 '14 at 19:31