Comments by "Xyz Same" (@xyzsame4081) on "Yang Drops M4A, Discussed ‘VP’ For Biden" video.

@pietersteenkamp5241 the "free market" on principle cannot work for healthcare because the patients / insured are by far the weakest players in the "market". (huge information disadvantage, medicine is complex, and billing can be intentionally made very complex, the service is critical for well-being or staying alive, everyone needs it and it can get very, very expensive). For profit companies will exploit customers if they can. With healthcare the customers cannot simply abstain from buying (which restorses some power to the consumers)- so they (and the taxpayers if the overpriced services are subsidized) will be taken advantage of. Even if the hospitals are not as predatory as in the U.S. there are inefficiencies and incentives to milk the patients with good coverage if the profit motive plays a role in a hospital. And IF an entity is for-profit - profit is the most important thing (no, big companies do not first and foremost serve the consumers even though good service may be a necessary condition IF the serice is a good fit for the free market. So not healthcare). Especially large entities are quite ruthless about maximizing profit - and in medicine many players are large. profit is the reward for entrepreneurial acting, product diversification (which makes no sense at all in healthcare), finding out the needs of the potential buyers, creating a demand for the product, innovation, creativity, using marketing to entice customers to buy, or to buy more etc. Nothing of that makes sense and a lot of it would pose a toxic incentive. Insurance is about ADMINISTRATION. Insurers are paper shufflers and middle men (collecting the money, negotiating contracts and paying the bills). The public non-profit insurance agencies are much more cost-efficient in doing that standardized routine work. providing care (doctors, nurses) is also very standardized - much more than the work in other professions. A hospital does not need to be managed in a creative manner (on the contrary), again it is: systems, routines, protocols. having reserves and paying the staff well and getting them the equipment they need. Again: non-profits do a good job with that. Innovation often comes from universities and research center - and doctors employed by non-profit hospitals also improve surgery techniques. The ONLY way to avoid extortion of the customers is to take the profit motive out of all situations where the consumers are in the much weaker position - like with natural monopolies - or healthcare (regulators and law makers cannot protect the patients either, they would have to monitor every medical decision regarding merit and price). That is impossible. Complexity and providing an indispensable service that usually does not even allow a delay favors for-profit players. Especially when they are large enough to employ hordes of lawyers, bean counters, lobbyists and advertisers. They will always be 2 steps ahead of the regulators and 3 steps ahead of the insured / patients. In a well set-up single payer system the only large and powerful for-profit player is big pharma (non profit insurers and non-profit hospitals). Since medical drugs are internationally standardized the national non-profit public insurance agencies can contain the drug companies in price negotiations. (Even small countries can find out what discounts on the list prices much larger nations get).
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@pietersteenkamp5241 a private option is not single payer and should not be called M4A which is a specific bill. A private option squanders a lot of potential for cost savings (streamlined admin for instance, wrong incentives because the profit motive plays a role, the private packages still need a sales team, marketing, etc.) If the public offer is sufficiently ! funded it is comprehenisve and then you need no or little private extra (and then it is usually cheaper to pay out of pocket for the better dental care or accupuncture etc.). And WHY should the public offer not be sufficient (which is the only scenario where "private options" make sense because then they are needed to complement an insufficient public package. In ZA there is a two class society so of course the medical care mirrors that. I live in a country (Austria) where private insurers play a small role in healthcare and that is a good thing. Hospitals are non-profits run by cities or the states (the church-run co-exist with them and are allowed a small profit - well that is one of the inefficiencies of the historcally grown system, the church run facilities were the first to provide care to low-income people and were grandfathered in).
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The oligarchs that produce something (as opposed to those that speculate in the Great Casino) are worried about declining purchasing power - and about the pitchforks. They are also more impacted by strikes. Big finance can make its bets w/o workers demanding 15 USD minimum wage. An UBI can be implemented to paper over the cracks that start showing and be used to placate the masses (bread and circus). Or an UBI could be used to help transform the system - in a few years when Climate change and the overhaul of the medical system and getting OFF the oil and military industry were tackled. These are the difficult projects. An UBI can be implemented easily, provided there is a database to identify them. That could be prepared when a central voter register is implemented - to make sure everyone CAN vote (births and naturalizations would be entered so people are automatically registered, resp. invited to vote approx. 18 years after they were born). M4A is much more difficult. UBI is NOT the most pressing issue. the automation of trucks is not yet there ! and for an infrastructure and green energy program blue collar workers are needed. But the banks and credit card companies and the manufacturers would like it - especially when it is financed with VAT for the most part and eliminates welfare administration costs. Now an UBI could help to make people move into more rural areas with lower costs of living. They do not have the jobs there, but with an UBI a part time job could suffice especially if there are 2 adults (AND they stay together). On the other hand it is a subsidy for low paying jobs. That is why Joe Biden might go along with it. UBI is the only progressive sounding program that can be used to prop up the neoliberal status quo. Nixon and Friedman were not out to change the status quo or free up the citizens in the 1970s. Nixon wanted to make himself a name by lifting people out of poverty, the plan was initially well received by public, media and many politicians - but then some Ayn Rand fans / libertarians hit back and presented him with a historic example that had allegedly gone wrong in the U.K. (which was not true, the historic reports were heresay and slander from the British clergy and upper class, not a set of data suited for an scientific evaluation. Thorough test runs in Canada on the other hand were ignored. One could see that Nixon backed it for ego reasons and not because he wanted the best for the most people. So he did not oppose the narrative that the poor would just get lazy, and that narrative was of course stroked by some (who feared they could not exert pressure on the workers, if they got too independent financially).
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