[Phi for All]

With privatization being such a big topic these days, and after reading many articles on both sides of the fence, it seems there are some sectors where profit and the need to grow as a business are actually detrimental to the goals of the sector. It's good market economics to see the need for toasters and manufacture some so everyone is happy, but what about those sectors where a cure is really the goal but maintenance makes better sense economically?

Healthcare is probably number one on this list. Is the goal of medicine to cure people or to make money? More effort seems to go into treating symptoms rather than root causes, and some treatments, once prescribed, will go on for the rest of a person's life. Part of this can be attributed to laziness, taking pills instead of doing the added diet control and exercise that would make the pill unnecessary, but in other cases a cure would seem to cut into the profits that maintenance provides. It makes one wonder, if someone came up with an inexpensive cure for cancer, what would the response be from those who see medicine primarily as a business?

Prisons are also an area where privatization seems to be gaining a foothold. If this becomes a big enough private business sector, will lobbyists be able to affect legislation which will change laws to create more business for prisons? Drug-related incarceration is huge business, mostly because the inmates are non-violent and fairly docile, their sentences are abnormally long, even for first-time offenses compared to the rest of the world, and they require much less overhead to house them in private prison facilities.

From Wikipedia: http://en.wikipedia....arceration_rate

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As of 2006, 49.3% of state prisoners, or 656,000 individuals, were incarcerated for non-violent crimes. As of 2008, 90.7% of federal prisoners, or 165,457 individuals, were incarcerated for non-violent offenses.[21] Drug offenses account for two-thirds of the federal inmate population; approximately half a million people are in prison for a drug offense today compared to 40,000 in 1981—an increase of 1,100 percent.

If rehabilitation is one of the goals of imprisonment, how hard is a private prison going to work at it if it will eventually mean fewer inmates and less profit? It seems to me that public funding is one of the best ways to make sure that we actually work harder to try to fix problems rather than trying to make a buck from them. Perhaps this is the lesson we need to learn about some of our public funding, that it must be aimed at cures and not at symptoms.

[Brainteaserfan]

Phi for All, on 9 December 2011 - 04:33 PM, said:

If rehabilitation is one of the goals of imprisonment, how hard is a private prison going to work at it if it will eventually mean fewer inmates and less profit? It seems to me that public funding is one of the best ways to make sure that we actually work harder to try to fix problems rather than trying to make a buck from them. Perhaps this is the lesson we need to learn about some of our public funding, that it must be aimed at cures and not at symptoms.

If you let the prisoners choose what private (but regulated) prison they would like to serve their sentence at, I think that the prisoners will be well taken care of.

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will lobbyists be able to affect legislation which will change laws to create more business for prisons?

What if we let prisoners vote?

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Healthcare is probably number one on this list. Is the goal of medicine to cure people or to make money? More effort seems to go into treating symptoms rather than root causes, and some treatments, once prescribed, will go on for the rest of a person's life. Part of this can be attributed to laziness, taking pills instead of doing the added diet control and exercise that would make the pill unnecessary, but in other cases a cure would seem to cut into the profits that maintenance provides.

So people need to get second opinions from people who are paid JUST to give their opinion, but who are told that they won't be being given the patient's business (other than the opinion fee). I would think that this would lead to the second opinion doctors giving their best opinion, and eliminating the risk of not-so-great treatments given to the patients.

This post has been edited by Brainteaserfan: 9 December 2011 - 05:29 PM

[michel123456]

Brainteaserfan, on 9 December 2011 - 05:28 PM, said:

So people need to get second opinions from people who are paid JUST to give their opinion, but who are told that they won't be being given the patient's business (other than the opinion fee). I would think that this would lead to the second opinion doctors giving their best opinion, and eliminating the risk of not-so-great treatments given to the patients.

That was too complicated for my poor mind. Could you rephrase it otherwise?

[insane_alien]

Phi for All, on 9 December 2011 - 04:33 PM, said:

If rehabilitation is one of the goals of imprisonment, how hard is a private prison going to work at it if it will eventually mean fewer inmates and less profit? It seems to me that public funding is one of the best ways to make sure that we actually work harder to try to fix problems rather than trying to make a buck from them. Perhaps this is the lesson we need to learn about some of our public funding, that it must be aimed at cures and not at symptoms.

From the little I know about the US prison system, the government pays the prison some amount per prisoner and then the privately run prison tries its best to keep operating costs down to maximise profit.(a horrible way for a business to run and a horrible way for a prison to run).

Perhaps if they applied a sliding scale or penalty system based upon reoffence rates. A bonus for having a low re-offence rate and a penalty for having a high reoffence rate. Therefore encouraging and making financial sense of rehabilitation.

Now, I can already hear people saying 'but that means poorly performing prisons get less money and are less able to deal with the prisoners' etc.

well, to that I say 'GOOD!' That's a competitive market! The companies that have crap product go out of business and those companies that are good at it become dominant and we end up with good prisons all round. Just because the service rendered is rehabilitating prisoners doesn't change that.

I believe that all the services outsourced to private companies can be made as good or better than if they were publicly run by rewarding the right goals. Don't just pay per prisoner, pay by how well the people leaving the prison re-integrate into society and become productive law-abiding members of society. We already measure re-offence rates so they even have market data to work on. This is more info than other companies have without spending a lot of money.

We can do similar things anywhere a government has privatised a sector but still pays for its services.

If however the sector has been privatised and is now nothing to do with the government then the government will have very little it can do. The only influence it would be able to exhert would be through trade regulators and so on. In this case it could be argues that splitting is a bad idea. Take public transport for example.

In the UK public transport is a bit of a joke, high prices, crap service and it all smells like urine (no really). Before privatisation (i'm told, i wasn't around then) the prices and service were better. Some things don't change but hey.

Anyway, TL;DR version, as long as the goals of the privatised business can be set externally (and there is no reasons why this should not be an option as business should be serving its customers) then those goals should be capable of being met.

If we just privatise things and forget about them (a not my problem field) then of course it's going to become crap. Chances are they only reason it was a public service was because nobody wanted to do it because there was no profit to be made.

[Brainteaserfan]

michel123456, on 9 December 2011 - 05:33 PM, said:

That was too complicated for my poor mind. Could you rephrase it otherwise?

Sorry, I was a little confusing.
If you have an ailment, you go to a doctor and get it diagnosed and a treatment described. Then you go to another doctor and tell him that you are only here to pay the "opinion fee" and that you want to know how he or she would treat you. You can even go to a third or fourth doctor. Does that help?

[michel123456]

Phi is right: there are conflicts.
There is a tendency nowadays to privatize almost everything, but IMHO it is very dangerous. The private sector does not function on the basis of democracy. The goal of profit-only is not the same as the goal of wealth-for-all. Profit-only conducts to slavery. And profit-only may drive to war. These are very sad perspectives. Our generation should act more wisely.

This post has been edited by michel123456: 9 December 2011 - 06:33 PM

[swansont]

Insurance is another example. You have conflicting obligations of maximizing shareholder profit and paying claims.

[Phi for All]

Brainteaserfan, on 9 December 2011 - 05:28 PM, said:

If you let the prisoners choose what private (but regulated) prison they would like to serve their sentence at, I think that the prisoners will be well taken care of.

And when the most popular are full, what then? And do you really see businesses allowing their commodities to dictate who they get sold to?

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What if we let prisoners vote?

First, good luck getting that approved by current voters. Second, lobbyists have been affecting legislation more than voters for a long time. What difference would letting prisoners vote make on legislation that affects private prisons?

insane_alien, on 9 December 2011 - 05:34 PM, said:

From the little I know about the US prison system, the government pays the prison some amount per prisoner and then the privately run prison tries its best to keep operating costs down to maximise profit.(a horrible way for a business to run and a horrible way for a prison to run).

Agreed. As I said, I also think there is a conflict of interest when prisons are supposed to discourage crime but private prisons would wither if that happened. It makes more sense for them to encourage crime and more arrests, just like arms dealers profit more from war than peace.

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Perhaps if they applied a sliding scale or penalty system based upon reoffence rates. A bonus for having a low re-offence rate and a penalty for having a high reoffence rate. Therefore encouraging and making financial sense of rehabilitation.

It would be interesting to crunch some numbers on this to see how much economic sense it made. Would it cost more than current private prisons, which cost more than state or federally funded prisons?

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I believe that all the services outsourced to private companies can be made as good or better than if they were publicly run by rewarding the right goals. Don't just pay per prisoner, pay by how well the people leaving the prison re-integrate into society and become productive law-abiding members of society. We already measure re-offence rates so they even have market data to work on. This is more info than other companies have without spending a lot of money.

While I agree that such services can be made as good as publicly funded ones, there is still the matter of the profit any business is entitled to. Unless they can somehow take this profit from greater efficiency or some more economical process than the government uses, privatized services will ALWAYS cost more than those purchased with tax dollars on a not-for-profit basis.

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In the UK public transport is a bit of a joke, high prices, crap service and it all smells like urine (no really). Before privatisation (i'm told, i wasn't around then) the prices and service were better. Some things don't change but hey.

Most of the US sold their publicly owned utilities to private businesses with the promise that they would be better run at a greater savings. We get the same power and water, but it now costs us 25-40% more in most markets. It used to be all about supplying power and water, and that's what we got, people who worked to do just that; now it's about making a profit by supplying power and water, and that's what we're getting. Big difference, I think (about 25-40%).

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Anyway, TL;DR version, as long as the goals of the privatised business can be set externally (and there is no reasons why this should not be an option as business should be serving its customers) then those goals should be capable of being met.

If we just privatise things and forget about them (a not my problem field) then of course it's going to become crap. Chances are they only reason it was a public service was because nobody wanted to do it because there was no profit to be made.

Beyond just privatization, I'm particularly interested in those types of businesses where the goal is in conflict with the business model. I mentioned arms dealers before, and that's kind of an example as well. If the goal of modern warfare is to bring peace, what would arms dealers do if that goal was actually realized? How would medicine survive as a business if suddenly researchers started finding actual cures for diseases? And if prisons actually became the effective deterrent to crime they're supposed to be, what kind of crimes would privately owned prisons want punished so they can continue to profit?

Brainteaserfan, on 9 December 2011 - 05:48 PM, said:

Sorry, I was a little confusing.
If you have an ailment, you go to a doctor and get it diagnosed and a treatment described. Then you go to another doctor and tell him that you are only here to pay the "opinion fee" and that you want to know how he or she would treat you. You can even go to a third or fourth doctor. Does that help?

Even the clarification didn't help me see how this relates to the seeming conflict of interest that arises from medicine being treated as a for-profit business when it's goal should be to make people healthy but it's success is measured by how often it can treat sick people.

swansont, on 9 December 2011 - 06:40 PM, said:

Insurance is another example. You have conflicting obligations of maximizing shareholder profit and paying claims.

Absolutely. I can think of no better first step than to have the government assume a not-for-profit risk pool to insure healthcare in this country. It's intensely stupid to divert the profit portion of our limited healthcare resources to middle men who's job includes denying us the services we count on.

[Brainteaserfan]

Phi for All, on 9 December 2011 - 06:48 PM, said:

Even the clarification didn't help me see how this relates to the seeming conflict of interest that arises from medicine being treated as a for-profit business when it's goal should be to make people healthy but it's success is measured by how often it can treat sick people.

I saw it as relating because you go to another doctor who has no conflict of interest. Problem solved.

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Absolutely. I can think of no better first step than to have the government assume a not-for-profit risk pool to insure healthcare in this country. It's intensely stupid to divert the profit portion of our limited healthcare resources to middle men who's job includes denying us the services we count on.

IIRC, a hospital has a legal requirement to treat you if you are hurt.

[Phi for All]

Brainteaserfan, on 9 December 2011 - 06:56 PM, said:

I saw it as relating because you go to another doctor who has no conflict of interest. Problem solved.

If they're all practicing medicine as a business, how long do you think they would retain that business by giving conflicting opinions? How would their malpractice insurance provider view that kind of liability? Where are you going to find all these other doctors who are willing to risk liability with an opinion that doesn't include a full diagnosis?

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IIRC, a hospital has a legal requirement to treat you if you are hurt.

I have no idea how that relates to why a not-for-profit government health insurance program would be better than for-profit private health insurance providers. It's simple math, really. It would have no impact on who treated you, just on who paid the doctors. And many doctors and hospitals have said they wouldn't have to charge as much if it weren't for all the delayed payments and red-tape hassles private insurance put them through. We'd have more funds available and less costs.

[Appolinaria]

I don't think medical care should ever cost the person who is sick... there are so many problems with how it's run I don't know where to begin and it's absolutely terrifying.

[iNow]

Appolinaria, on 9 December 2011 - 07:36 PM, said:

I don't think medical care should ever cost the person who is sick... there are so many problems with how it's run I don't know where to begin and it's absolutely terrifying.

Cover everyone equally from a collective risk pool which is governed closely with clear treatment guidelines themselves based on proven efficacy and efficiency, and continue offering the option of private insurance to those who wish to supplement this single payer approach. What is terrifying is that our politics don't even allow an intelligent discourse on the question anymore. Answering the question about where to begin is not itself very terrifying at all. We begin with education, and follow it up with consensus building.

[Brainteaserfan]

Phi for All, on 9 December 2011 - 07:09 PM, said:

If they're all practicing medicine as a business, how long do you think they would retain that business by giving conflicting opinions? How would their malpractice insurance provider view that kind of liability? Where are you going to find all these other doctors who are willing to risk liability with an opinion that doesn't include a full diagnosis?

There's an underlying problem with this paragraph.

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...by giving conflicting opinions?

You assume that they would give conflicting opinions. What I'm saying is that they WOULDN'T give conflicting opinions, not because the second doctor gives a faulty opinion, but because the first doctor realizes that it is in his best interest to give you what is best for you and not what might seem to be best for his wallet.

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How would their malpractice insurance provider view that kind of liability?

Yup, because of this, the first opinion doctor would realize that he must give you his best opinion.

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Where are you going to find all these other doctors who are willing to risk liability with an opinion that doesn't include a full diagnosis?

Maybe I was misinterpreted (or maybe I mistyped earlier on). The second doctor would do everything that the first doctor did except for giving the actual treatment.

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I have no idea how that relates to why a not-for-profit government health insurance program would be better than for-profit private health insurance providers. It's simple math, really. It would have no impact on who treated you, just on who paid the doctors. And many doctors and hospitals have said they wouldn't have to charge as much if it weren't for all the delayed payments and red-tape hassles private insurance put them through. We'd have more funds available and less costs.

I could be wrong, but I think there are quite a few severe regulations imposed on insurance companies now. I think that if some of them were removed, it might allow for more competition to the current companies, resulting in better service.

Back to prisons:

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First, good luck getting that approved by current voters. Second, lobbyists have been affecting legislation more than voters for a long time. What difference would letting prisoners vote make on legislation that affects private prisons?

Your first point is valid; although I am more talking ideologically than reality. To the second one though; lobbyists aren't any more than inspired voters (although sometimes they are inspired voters who have a good deal of cash). Prisoners would be quite an inspired group of citizens, and so I think that they WOULD have an impact (they can write letters, get family and friends to carry out lobby-type projects, etc.

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And when the most popular are full, what then?

Those companies would build more prisons, or prisoners would stop choosing them because of overcrowding.

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And do you really see businesses allowing their commodities to dictate who they get sold to?

???? The prisoner would be the customer, the prison offered would be the commodity. Does it not make sense that the customer should choose the best available commodity.

I think that private prisons are (a) cheaper because they are more efficiently run since the private company has to run more efficiently than their competition, and (b) provide a better/more humane atmosphere for the prisoners since the prisoners will choose the most humane and "luxurious" prison.

I think what insane_alien said was interesting, especially with regards to:

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Perhaps if they applied a sliding scale or penalty system based upon reoffence rates. A bonus for having a low re-offence rate and a penalty for having a high reoffence rate. Therefore encouraging and making financial sense of rehabilitation.

so, +1 and thank you insane_alien

[Phi for All]

Brainteaserfan, on 10 December 2011 - 06:09 AM, said:

There's an underlying problem with this paragraph.


You assume that they would give conflicting opinions. What I'm saying is that they WOULDN'T give conflicting opinions, not because the second doctor gives a faulty opinion, but because the first doctor realizes that it is in his best interest to give you what is best for you and not what might seem to be best for his wallet.


Yup, because of this, the first opinion doctor would realize that he must give you his best opinion.


Maybe I was misinterpreted (or maybe I mistyped earlier on). The second doctor would do everything that the first doctor did except for giving the actual treatment.

I originally stated that there seems to be a conflict with regards to medical practice as a business; people look to doctors to cure illnesses but doctors make more money by fixing symptoms. You responded with this stuff about getting multiple opinions, which you now confess would be based on the original doctor's diagnosis to avoid conflict. Obviously these opinions are being gathered to determine the efficacy of the original treatment, prior to the actual treatment. Multiple opinions would be equal in cost to the original, because no doctor is going to give an opinion without a full diagnosis.

So I have to ask you. How is this, in any way, shape or form, an answer to the conflict I mentioned regarding medicine's goals as a practice and as a business? Why did you bring this up?

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I could be wrong, but I think there are quite a few severe regulations imposed on insurance companies now. I think that if some of them were removed, it might allow for more competition to the current companies, resulting in better service.

Interesting. What kinds of regulations do you think there might be that, if removed, would increase competition and allow the kind of service that would help doctors get paid faster? All the regulations I've read about with regard to health insurance protect the patient's and healthcare provider's rights. Are these the types of regulations you want removed in order to give better service?

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Your first point is valid; although I am more talking ideologically than reality. To the second one though; lobbyists aren't any more than inspired voters (although sometimes they are inspired voters who have a good deal of cash). Prisoners would be quite an inspired group of citizens, and so I think that they WOULD have an impact (they can write letters, get family and friends to carry out lobby-type projects, etc.

First of all, the inspiration lobbyists have is paid for by businesses who want certain legislation carried out. Lobbyists aren't "voters" in any sense of the word, even though most would probably be registered. Lobbyists are affecting the votes in Congress, where the laws are being made. A prisoner, even if you could successfully lobby to give them back a right such as voting (which, I can practically guarantee you, is never, never, NEVER going to happen), would only be able to vote for a representative. Second, the point is moot because no politician is going to campaign on the point of giving convicted felons the right to vote. There would be no one for the convicts to vote for to help them.

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Those companies would build more prisons, or prisoners would stop choosing them because of overcrowding.

This is probably a fair point. It still makes me laugh to think that convicts would EVER be allowed to choose where they want to spend their incarceration, but I could see this kind of pressure on the market being successful if they ever were.

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???? The prisoner would be the customer, the prison offered would be the commodity. Does it not make sense that the customer should choose the best available commodity.

Careful, you're sounding a bit liberal with respect to the treatment of prisoners!

The customer is the federal or state government who wants the prisoner housed, they are the ones paying for the service (it could be argued that the taxpayers are the customers, since we still have to pay the government for the now more expensive private prisons). In that sense, the prisoner is like a pallet, the prison is like a warehouse. In business terms, the pallet doesn't get to choose where it is stored.

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I think that private prisons are (a) cheaper because they are more efficiently run since the private company has to run more efficiently than their competition, and (b) provide a better/more humane atmosphere for the prisoners since the prisoners will choose the most humane and "luxurious" prison.

Your thinking doesn't reflect reality. I guess you didn't read my link in the Privatization thread that proves private prisons are more expensive to run than publicly funded ones, so here it is again. When the competition (aka publicly funded government prisons) doesn't have to make a profit, how could private prisons be cheaper?

[Appolinaria]

iNow, on 10 December 2011 - 03:55 AM, said:

Cover everyone equally from a collective risk pool which is governed closely with clear treatment guidelines themselves based on proven efficacy and efficiency, and continue offering the option of private insurance to those who wish to supplement this single payer approach. What is terrifying is that our politics don't even allow an intelligent discourse on the question anymore. Answering the question about where to begin is not itself very terrifying at all. We begin with education, and follow it up with consensus building.

Truth.

I guess I'm quite uninformed on this, but based on experience, I'm left disheartened and scared. I've seen things happen that shouldn't, IMO.

[Phi for All]

iNow, on 10 December 2011 - 03:55 AM, said:

Cover everyone equally from a collective risk pool which is governed closely with clear treatment guidelines themselves based on proven efficacy and efficiency, and continue offering the option of private insurance to those who wish to supplement this single payer approach. What is terrifying is that our politics don't even allow an intelligent discourse on the question anymore. Answering the question about where to begin is not itself very terrifying at all. We begin with education, and follow it up with consensus building.

This is such a simple fix and it disgusts me that there is even a debate on the subject. I can't help but think that if everyone were presented with this proposition and shown how effectively it would solve so many problems with healthcare, public opinion in favor would be overwhelming.





iNow, I have a question for you (of course others can answer as well). Imagine that the researchers in this study (related article here) come up with an inexpensive treatment for diabetes that completely cures it. The patient's pancreas begins producing insulin normally and the cure seems permanent with a single treatment. The research also provides evidence for possible cures for other diseases. In your opinion, what would be the impact on medicine as a business?

[CharonY]

I think one question is the complexity of the treatment and whether there are any kind of risks involved. If it is easy (i.e. one does not need any highly specialized equipment/drugs) to do the treatments and it is safe, I would think that it would be relatively quickly adopted by hospitals. If there are any risks, I would imagine that companies that have specialized in selling and producing insulin would lobby heavily to at least delay the approval of this treatment (so that they can re-orient themselves). If it requires specialized drugs, but the profit margin is low, then it may take a while until a company sells it, unless, of course, the aim is to hurt a competitor who is heavily invested in diabetes control.

[Phi for All]

CharonY, on 10 December 2011 - 08:46 PM, said:

I think one question is the complexity of the treatment and whether there are any kind of risks involved. If it is easy (i.e. one does not need any highly specialized equipment/drugs) to do the treatments and it is safe, I would think that it would be relatively quickly adopted by hospitals. If there are any risks, I would imagine that companies that have specialized in selling and producing insulin would lobby heavily to at least delay the approval of this treatment (so that they can re-orient themselves). If it requires specialized drugs, but the profit margin is low, then it may take a while until a company sells it, unless, of course, the aim is to hurt a competitor who is heavily invested in diabetes control.

So here's the conflict of interest I'm talking about. Let's say the treatment is easy, a special injection of capsaicin directly into the pancreas, something that could be done with minimal preparation in just about any doctor's office. There are no risks but don't you think there would be companies that would lobby to delay implementation anyway, just to give themselves time to "re-orient themselves"? Is it fairer to give these companies time to re-orient, or is it fairer to start curing diabetics?

[iNow]

Phi for All, on 10 December 2011 - 07:43 PM, said:

In your opinion, what would be the impact on medicine as a business?

I'm rather biased on this question. I don't think medicine should ever be a profit driven business. In fact, I think profit should be removed from medicine entirely, and that any rewards given are based solely on efficacy. Profit AFAIC is anathema to patient wellness.

My hope would be that medicine is obliterated as a business, and instead used for what it ought to be... A way to improve the well-being of humans and their families, and available even to those who are not wealthy or suffering from desperate poverty.

Now, I recognize there are some issues in materials up front, and shipping costs, and education to know when to administer and when not to treat with certain items. I know there is work and research into learning about these solutions and huge investments needed to make them available. But I also know we could do it better if we weren't so purely profit focused and approaching the issue like nothing is ever better than a free market.

I fear, though, that until drastic changes are made to the system as a whole that cures and treatments like those you reference above will likely be available only to the wealthy, or those with high quality healthcare, and that those without money will not have access. I fear that we'd essentially prioritize the profit of the few over the wellness of the many... Because profits drive the world of medicine, not always outcomes.

[CharonY]

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There are no risks but don't you think there would be companies that would lobby to delay implementation anyway, just to give themselves time to "re-orient themselves"?

Based on current behavior of a number of the big pharmas, my bet is that they would leverage their lobbyists. Unless there is such media hype regarding that treatment that it would be hard for them to succeed. I am not sure regarding fairness, since this is not what corporations are there for. This is generally a bit of an issue in overall health care. Of course, patient outcome should be paramount, but much of the infrastructure requires corporations and those are obviously profit-driven. This is not always a bad thing, as they can leverage their capital to e.g. conduct clinical trials.

What I think that is more important is to cut ties between regulators and the corporations, so that that kind of lobbying cannot happen. But considering how humans work, I assume it is a pipe dream.