The following refers to, and elaborates on, parts of a comment a friend made on Facebook, to someone’s post. I didn’t want to post a ton of text there. So I’m making it a blog post, here.
I think there is a lot of validity to "Agustus’s" comment. Any less direct means of paying for your health services (vs. paying “out of pocket”) certainly can have the effect of a person losing track of the cost. When people have any kind of insurance, they can tend to think “It’s paid for.”, or at the very least reason that they pay the same amount, so why not take advantage of as many services as they think they might “need” to. One might see how these could have the effect of providers (i.e. “free-market” businesses) being able to get away with increasing costs and services. So I think it’s valid to propose that effect happens when going through a modern government, with all its administrative structures, etc. -i.e. It can be hard to SEE the true costs you’re paying, for any specific service. So an unchecked/un-revisited "subsidy" can surely have the effect of increasing costs. Realizing I was naive to the history of employer-provided health care, I did some quick research. Apparently it started with hospitals trying to market some of the then new health care advances, without shocking patients with large one-time costs. I guess it got one big boost during the WWII economy, when employers tried to attract reluctant workers, by offering health care insurance/benefits. Said another way, these businesses used this “benefit” to lure employees, rather than paying a (modestly) higher wage. One could argue who’s fault that was: Manipulative “free market” employers, or “stupid” employees. Another big boost to employer-”paid” health benefits came in 1943, when the government made these benefits tax-free (plus another boost, in 1954). I personally don’t see any rationale for government services to be directly tied to one’s income (income taxes). Those health benefits seemed to enjoy an advantage, given that the other forms of employee compensation were taxed.
But I reject the notion that any of these effects are simply due to the nature of “the government” or the government being simply “too big”. People that advocate free market, also seem to want some socialism. E.g. “(some regulation and contract law is of course necessary for a functioning economy)”. I have asked, and have yet to get an actionable answer, to questions like “Exactly how much is ‘some’?”, or a question which should be easier to answer than that: “What is the concrete, guiding, PRINCIPLE you’d use to QUANTITATE how much regulation, of what kind, where?” How much of this socialism, you are in favor of, is too much?
My view: Any group construct, call it “public”, “government”, “corporation”, “company”, --whatever-- can be vulnerable to third-party manipulation. You can get some things done faster by dividing and specializing, and also spread risk. But you also increase the “attack surface”, when you introduce administrative processes, and other structures. Corporations have this third-party manipulation built right in. -shareholders, vs. the producers/servicers and the customers. The U.S. government has it’s lobbyists, etc., etc. As is usual, in life, there are tradeoffs. The fact that large organizations persist, means that the balance must be in favor of the large group, vs. individuals, for certain applications. Walmart is a large group. It uses it’s “large group” bargaining power to purchase things for its stores at very low prices. So why are so many people opposed to a group of all the U.S. citizens forming a large, collective bargaining group to get better prices for health care? If large organizations like Walmart regularly bargain for goods/services, why do people want to believe it’s IMPOSSIBLE for the U.S. citizens to do it? --and what is the large group that the U.S. citizens have formed?! Oh. Yeah. The U.S. government! The “free market” many people think of would only exist if individuals traded amongst each other. As soon as you have some group forming on one side of any trade (e.g. a company, or corporation), the self-correcting benefits of that dynamic tend to fail. --until an equally powerful group can form on the other side of the trade (consumer/trade/labor union, etc.). In terms of increased health care expense, I believe part of it is just that progress has allowed more health interventions to be possible, and thus more “opportunities” to pay more money. But I also feel like a big reason things have/had gotten so expensive is that we have allowed employers, private insurance companies, and health care providers to keep their hands too much on the controls of OUR healthcare money. Too much “compromise” with private health insurance providers. I believe a person should be able to join any cooperative group, to pay (collectively bargain) for anything. Give people the option of joining a large insurance cooperative (U.S. government), to collectively bargain for health services. People should have the option of joining any other group, instead. But why would any logical person want to join a group where, on top of health care, they are paying for shareholder profit, and advertising costs (used to try and convince the subscribers they are getting a good deal).
I guess, in summary, I feel like the government needs to be more streamlined and held accountable (maybe completely rebuilt). I don’t think a growing of the large groups on the “other side” (private, “free market”) is an antidote for this. I have been focusing on health care, because it is a case example of a government program. I guess I see an OPTIONAL single-payer system as more market-like, than the alternative. We would effectively be allowing people to form a consumer-union-like group on one side of the market trade. The alternative to doing this would require increasing the amount of enforcement of “regulation and contract law”, so that corporations aren’t too powerful a force in this exchange with health care consumers (U.S. citizens). --more regulation and enforcement infrastructure, vs. just allowing the U.S. citizens to simply form their own trade group (effectively).
But I think you are right that many people agree on what we want, and we only tend to disagree on how to get it. When I attempt to look at things logically, and objectively, I feel like certain people who control many of our resources would have a huge interest in pushing a “free market” notion, along with a general distrust in government. They, themselves, utilize and benefit from large-group power, including the U.S. government. They like, and use, these “too big” structures, regularly.. They want you to distrust them, by promoting the so-called “free market”. If you do that, you reduce your engagement with, and thus your control over, your large, powerful group. --your U.S. government. I think the parts of the “free market” notion that resonate with many people are the concepts of fairness and accountability (fair price setting, no “stealing”, etc.). We want to be able to fairly trade, and share, our resources. We want people to be accountable for what they do or don’t contribute to a trade or sharing. But how could we ever really enforce people not joining together into large groups, to gain some advantage over our environment (other people/groups are a part of our environment). Our working together in large social groups is a huge part of how we have become such a successful species. So I don’t think we need to demonize one group (say, the U.S. government), in contrast with others (businesses which operate in the “free market”). I think we just need to try to engage with and within groups to make them more directly fair and accountable. Remember that these groups aren’t real things. They are just a set of interactions and intra-actions. So the more you try to be fair and accountable, when dealing with others, the more things will be that way. Technology can be used to shorten the interaction loop, so it is easier to see how your actions are affecting others, and to reduce the attack surface for potential third-party agents. I’m thinking about things like directly paying to “subscribe” to government services, as a way to keep government agents accountable, and directly “register” your “vote” for what you want, without having to rely on some elected official to hopefully advocate for your will.