Whether or not non-productive individuals who don't do any work can own the means of production and reap the majority of the economic surplus from it is somewhat tangential to the question of who pays for whose healthcare.
There are plenty of capitalist nations that provide public healthcare on a large spectrum of coverage and quality.
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.
The boy with cancer who is a main subject of the article and was scammed out of desperation to raise funds to cover his healthcare is in The Philippines.
"Aljin says treatment at their local hospital in the city of Cebu was slow, and she had messaged everyone she could think of for help."
The Philippines' constitution says access to healthcare is a human right. They have universal healthcare insurance, and public hospitals and medical centers.
The next one is the girl from Colombia. Colombia has a mostly public (with regulated private) healthcare system with universal health insurance.
The next one is from Ukraine. Ukraine has a government run universal healthcare system. Wikipedia tells me "Ukrainian healthcare should be free to citizens according to law," fantastic, but then it goes on, "but in practice patients contribute to the cost of most aspects of healthcare."
In first world countries with social healthcare systems like Canada and Germany and Australia, people with complex illnesses do not get coverage for unlimited treatments either, or general costs of being sick (travel, family carers, etc). There are many cases of fundraisers for, and charities which try to help, sick people in need in these countries.
Capitalism is not the reason not everyone with cancer is being cured and not chasing expensive treatments. Healthcare is something that you can throw unlimited money into. You'll get diminishing returns, but there will always be more machines and scans and tests and drugs and surgical teams and devices you can pay for. It doesn't matter the economic system, at some point more people will get more good from spending money on other things, and those unfortunate and desperate ones who fall through the cracks might have to resort to raising money themselves.
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.
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.
When I'm unconscious in an ambulance, I'm definitely in a position to appreciate all that price transparency the free market has provided, so I can rationally weigh up all my options calmly and objectively while my organs are shutting down.
The great majority of health care is not emergency health care. Actually, the fact that emergency health is so expensive is quite the incentive for preventive medicine. And for the rest, insurance is necessary. Like for house fires or floods: I get the insurance but I also check my wires and pipes regularly.
> 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.
Evidence: the vast majority of European countries who have socialized medicine and seem to be doing fine.
> the vast majority of European countries who have socialized medicine and seem to be doing fine
You do realize that the "vast majority" of European countries doesn't mean highly developed Western Europe, right?
Here in Central and Eastern Europe (where I live) socialized medicine is not "fine". You should visit some hospitals in Bulgaria or Romanian to get a more complete picture. We pay the state outrageous insurance costs every month then go and pay out-of-pocket in private hospitals when we actually need them.
>>In socialism it's much more random: black markets, lists, lotteries
>Evidence: the vast majority of European countries who have socialized medicine and seem to be doing fine.
That evidence of socialism working well, only works as long as there are enough resources to cover the needs of most people, basically some of the wealthier European countries.
But when those resources become scarce due to poor economic conditions and/or mismanagement, then you'll see the endless queues, black margets and nepotism running the system.
Evidence: former European communist countries who experienced both systems and where in some, nepotism to bypass lists still work to this day.
I think the 2024 Economics Nobel disproves this. It showed that nations with strong institutions create wealth - and it was a causative link they proved, not simply correlation.
How does that disprove what I said about abundance or lack thereof in socialized systems? Feels like an orthogonal issue.
Socialized systems don't work without abundance. How you generate that abundance is orthogonal to socialism since even countries that are wealthy on paper suffer from shortages and long waiting times in public healthcare leading to a gray-market of using connections to get ahead or more private use.
Both are true. Because when the abundance runs out, people start using nepotism to get what they need. You can see it in the tech job market now. More and more good jobs are only through networking. Meritocracy alone was enough during the times of abundance.
That's the difference between a corrupt and non-corrupt system rather than a capitalist vs socialist one. Nearly all European countries have an at least somewhat socialist healthcare system but in most you don't have to resort to those tactics.
the market / capitalism won’t correct itself, much people want to call it God/ perfect
Regulation, anti-trust laws try to correct somethings but many politicians are against those things because they limit the profit that can be made, profit first, that’s the corruption
Can't think of a socialist country, but invite you to visit the German system. Significantly less costly for society and objectively better for the people falling ill (or just having a baby born).
And no, no lists, no lotteries or any of that other lies the conservative US media is spewing out to keep the masses pacified.
I strongly believe, that if US citizens were to experience German healthcare for a year and having to go back to the US system, that there would be riots. Because I don’t think anyone with first hand experience of both systems would ever want to return to the US system.
Yep, loving my gesetzliche Krankenkasse (public health insurance, which is more like "highly regulated insurance"), even more than I liked the Privatkrankenversicherung (less highly regulated, but still with better guardrails than a lot of things I've seen in the States) I was on my first decade in the system here. Sure, there are some specialists who won't accept it, or who will give you a sooner appointment if you're private pay, but in that situation, you have the option of declaring that you're a self-payer that quarter, and your public insurance will reimburse in the amount they normally would have for that procedure or exam. For things like an MRI, the full retail cost in Germany is still much lower than in the US (it was about 600 EUR for my back a few years ago, while I was still privately insured, and I still had to wait for reimbursment).
Even once I do hit the income threshold to switch back to private (switching back to fulltime work), I'm pretty sure I won't.
As far as doctor choice goes, I feel like I have more on the public insurance here (like 90% of the population) than I did with UHC in the early 2000's back in the US. I certainly have fewer financial surprises.
Healthcare in the US seems to cost about double per capita what it does in other developed countries with universial/social healthcare. Public spending in US is on-par with others, and then private spending is that much again. Standard of healthcare I've heard (and would hope) is world class if you can pay, but still something seems broken there to be sure.
But you have lists, queues, lotteries, whatever you call it. That's not a lie. The fact you think lists are a vast right wing conspiracy demonstrates your government is not really forthcoming about your healthcare system. There are lists everywhere. There are ambulance wait times, hospital emergency wait times, various levels of urgent and elective treatment wait times. There are procedures and medicines and tests that are simply not covered at all.
Now, obviously USA has queues and lists too. And I could be wrong but I'm sure I've heard that US private insurance companies are notorious for not covering certain treatments and drugs as well. I don't know what it is exactly these right wing people are saying about healthcare, I thought they did not like the American "Obamacare" though.
There definitely are lists. You don't just get the surgery or therapy you need the next day. You get the next free slot in the list of people queuing at the hospital/practice that still has free slots.
For example the first appointment you can get at my state funded therapist if you call today, will be in june. How is that "not a list"?
Or like, if you call most public GPs in my neighbourhood, they'll all tell you they're full and don't have slots to take on any new patients and you should "try somewhere else". How is that "not a list"?
There are multiple lists here in the NL. I called for a surgery and got put on the fast list (she said that if it weren’t urgent, it would be over a year wait). Your doc has a lot of influence on how urgent things are and how far you are willing to travel. I got in to see a therapist in a matter of weeks, because I was willing to travel out of the city; otherwise it will be months. The doc can see the lines and give you recommendations; all you have to do is ask to be seen sooner.
Doesn't work like that in Austria. Or my doctor's were unwilling to fake urgency to bypass the waiting system for me.
Anyway, do you not realize the fault with the system in your logic? Because if everything becomes urgent in order to bypass queues, then nothing is urgent anymore.
It doesn't fix the problem, you're just scamming the system to get ahead of the problem.
In my case, there was no faking urgency. I was pointing out that urgency puts you in a different line that gets priority (basically, cancellations from the longer line).
For some other things, you can travel further away to where there is less demand for what you need, and if you're willing, you don't have to wait as long. These are all different "lines" and they're the ones doing the schedule.
I wish I could have waited one year. 0/10, would not recommend that proceedure. FWIW, it's a very common, usually also scheduled long in advance (even in the US). Pretty much every man has to get one over 40; so it makes sense the wait list is long unless you've got something else going on.
>Ok but urgency is a different kettle of fish. Life threatening cases get urgency everywhere and immediate care everywhere.
Except it doesn't. At least not in the United States. I have Peripheral Artery Disease.
I had two completely occluded arteries in my left leg and a third that was mostly occluded and had an aneurysm to boot.
One day, that third artery collapsed and I was left with zero blood flow to my left foot.
The doctor had me go to the Emergency Room to get testing and imaging to have surgery the following week.
He did not simply schedule surgery, as that would have required pre-approval from my insurance company and, in fact, the insurance company denied the claim and did not approve the procedure (which saved my foot) until six weeks later -- at which time I'd have had to have my foot amputated without the angioplasty and arterial bypass.
In fact, after surgery the insurance company continued to deny my claims and refused to authorize pain meds (they sliced my left leg open from my hip to my ankle and rooted around to use an existing vein to bypass the blockage on one of my arteries) for those same six weeks.
Oh yeah, US healthcare is so much better. /rolls eyes. My insurer would have forced me to wait until I required amputation if I hadn't just gone ahead on an emergency basis as suggested (because it's not unusual for that to happen) by the surgeon.
And in case you were wondering, yes I have private insurance and pay nearly $1200/month just for me. In fact, my deductible for next year just went up 20% and my annual out of pocket doubled, yet I'm still paying essentially the same premium.
No. The US healthcare system is completely fucked and I hope you don't die or lose important body parts learning that.
They do? If they misdiagnose something, you can end up in the slow line instead of the fast one, or vice versa. Compared to them, you have no influence.
Rather, crony capitalism with no real competition (cartelisation in the absence of strong regulation). This invariably leads to Imperialism ... We see this with BiGTech today and the phenomena of "digital imperialism".
Capitalism is the reason those treatments exist in the first place. I don't see many cutting-edge cancer treatments coming out of Cuba, North Korea or Venezuela.
> you also need to tax it, to deliver benefits to your population
The benefits were already delivered by that strong and prosperous economy in form of products and services.
Taxation is of course necessary to fund government spending but we need to keep in mind its drawbacks: from discouraging productive activity and slowing economic growth to giving politicians funds to buy votes with populist social policies.
Strong and prosperous economy built by progressive tax rate that used to tax up to 70% of non-work income, and now tax most of it 27-29% (depending on the corporate taxe of the state). The people who can use loopholes to avoid income taxes also pay reduced consumption tax (they usually pay the 'Use tax' rather than sale tax in the US, and can basically ignore VAT in Europe).
That's a common misconception. Although the top tax rates were indeed high, they kicked in at such high income levels and included so many deductions and loopholes that the effective tax rate were much closer to 50%.
And it makes sense, considering human nature and motivation: how much would you work considering the taxation? Me:
0-20%: I work as hard, want to excel and advance; I will take risks and invest in entrepreneurial endeavors
20-40%: I will do my duty, 9-5 then hit the door to spend time with the family; actively seek low-responsibility low risk high stability and lots of benefits government jobs
>40%: f that s, I will take my welfare payments and do various cash jobs without declaring that income; stay in my parents basement playing Xbox, smoking weed and jerking off
Counting consumption and estate taxes, i'm pretty sure you're just above 40%, so i guess you're on benefits?
In the US, unless you or your family own a holding with a lot of companies, the country taxes you between 50 and 40% (well, 30 and 50%, but food stamps are a bit weird so i will exclude them here). If you manage to get rich enough to be able to optimize your taxation, you are only taxed on company profits (so 21% to federal, 27-29% depending on your state) and sometime use taxe (sales taxe doesn't really apply anymore).
I have benefited from VAT-free school furniture most of my life because my uncle owned a company that bought office furniture regularly, and VAT-free sport clothing/tools because of a similar scheme by his wife and her companies.
I assure you you pay more taxes overall than people holding a few companies, and the more you own, the easier it get to avoid VAT and taxes in general (the owner of the Yacht my sister used to cook for was hired by the Yachting company as the captain or something for his vacations: avoided VAT on buying the Yacht, avoid VAT on a personal cook, avoid VAT on food. And if this specific company loose a small amount of money every year, tax write-off baby!).
Zucman wrote The Triumph of Injustice: How the Rich Dodge Taxes and How to Make Them Pay.
It's an interesting read, and
Actually I've been lucky to practice what I preach all my life. Early in my career I realized that salaried employment is a rip-off: you pay through your nose for an illusion of safety and stability you don't want nor need. So I embraced risk and switched to contracting.
Having leftover income this way, I looked into investing. That's when I realized that being financially prudent, saving and investing was actually punished in the USA, taxwise, while borrowing and spending was encouraged. So I left the USA and returned to Eastern Europe.
Understanding that selling your time is much worse than selling a product drove me to entrepreneurship. Luck threw a little success my way and turned me financially independent.
Now I am semi-retired living from investments and small gigs and spending time with my family. My tax rate (income only, not consumption or VAT) is well under 20% on most of my income. I didn't do any effort to optimize it further, but I could if I must. I actually do not mind paying taxes, but I do respond to incentives and I am not afraid to relocate.
> If you manage to get rich enough to be able to optimize your taxation
Actually I did a little research and you don't need to be rich, you can do that with very little money. But then the gains for a few percent reduction aren't that great anyway so...
> you pay more taxes overall than people holding a few companies
I probably do, but I don't mind it. I think the rich are a net positive to our society because capitalism ensures they contribute to the society orders of magnitude more than they manage to keep. Also I lived under communism pre-1990 in a world without rich and I've seen how bad it is.
Sure, capitalism isn't perfect. No economic system is, mainly because they're all composed of us semi-evolved chimps. Every economic system has that problem. Getting rid of or severely constraining economic freedoms isn't a solution, it makes it worse.
Ok but if its taken you just three comments to get to "well... nothing is perfect I guess" where did that initial conviction come from?? Like why even play out this same argument if your heart isn't even in it? Is it a sense of obligation? If anything, you do your entire position a disservice by folding so quickly. It just goes to show noone deep down even believes these stories anymore, even we expect others to.
Like, yes, we are discussing an "imperfection" here! You are the one that asserting the greater perfection, not the lesser.
Market economy. Capitalism is a name for the bad thing-- "the accumulation of capital by some to the exclusion of others". Those who argue for a market economy usually claim that with their rule, it won't be accumulation of capital by some to the exclusion of others, with them assuring us that there will be free markets and competition.
Both actual capitalism, i.e. the bad thing, and this which can plausible be argued to be well-functioning market economies, are is often stabilized by adding elements of communism to the system-- publicly funded education, healthcare etc. This is one of the reasons why I as a vaguely socialism-influenced whatever I can reasonably be said to be see communism, i.e. a system characterized by the distribution principle "to each according to his need" as less revolutionary than the socialism distribution principle "to each according to his contribution". Communist distribution principles can coexist with ill-functioning market systems such as things which have degenerated into actual capitalism, whereas the socialist distribution principle can't.
Even in a pure unadulterated market economy that doesn't publicly fund healthcare you would expect to be able to protect yourself from high-impact low-likelihood events by means of an insurance. I find it hard to describe the US healthcare situation as anything other than a market failure
> 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.”
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.
> Communist distribution principles can coexist with ill-functioning market systems such as things which have degenerated into actual capitalism, whereas the socialist distribution principle can't.
You won't have to worry about distributing advanced cancer medications when they don't exist in the Communist version, because they weren't discovered. You can't fulfil a need with a drug you never risked a giant amount of funding and effort to discover.
It can be, but who decides what to work on? Capitalism puts risk and reward off to the side, to be done by experts. Why take the risk if you have no reward, and, conversely, why give someone a load of money to allocate if there's no risk for them if it fails?
the problem is your framing of the problem, not the questions you posed. it seems to me like you’re assuming that the only metrics for risk and reward are profit and cost. let me put it this way: do you find there to be any intrinsic value to the invention of antibiotics, or is such a development only worth the money that it can make for its inventor / discoverer? do you think that the cost of developing such technologies is worth it even if it does not gain any material income?
Let’s also imagine the other side of the equation. Can you not imagine any penalty or cost other than bankruptcy? Let’s say you are forced to allocate $1 million per year to research. is the only cost function you can imagine based on the risk of default?
I would say your problem is the framing :) You're assuming an outcome because you know antibiotics work. What is the incentive to spend $10m on research for a particular drug? It's not "because we know it ends up in a cure for X", because we haven't done the research yet. It's "because we think this will reach enough people to be useful and we'll commit a lot to this thing vs lots of other options."
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.
"the accumulation of capital by some to the exclusion of others"
This allows decentralised decision making for large grained resource allocation - for example should we build a factory for shoes, or for toothbrushes? - and is a good thing, as central planning has been demonstrated to not work if applied to the whole economy. (the converse, no central planning to any of the economy, has also been demonstrated to not work!)
However that accumulation can be (and nowadays usually is) orchestrated by a corporate entity, which in an ideal world would be almost entirely beneficially owned by retirees on an equitable basis.
What has gone wrong, is that the benefits of productivity enhancements (since 1970?) have flowed to capital more so than to workers - which not least prevents them from forming capital themselves (savings/pensions), hence rising wealth inequality.
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.
My point is that socially beneficial capital intensive projects require, well, a large lump of capital. This can be organised by the state (command economy), or through allowing private accumulation of capital - but here I do include corporations, and indeed financing through loans. It would be quite possible for individuals to have much the same wealth (perhaps modulo time to retirement?), and to be pooling it as share owners of said corporations. This would still be a capitalist system - but a fairer one maybe!
What are you suggesting is the alternative? Please don't reference small homogenous countries the size of Minnesota as something that will work for the US.
