Every social or economic theory we tried fails for the same reason: it fails to account sufficiently for some aspect of human nature

The central failings of capitalism are no different. It fails to account for power-seeking behaviors (like willingness to manipulate), and for immediacy biases (it rewards short-term thinking, in other words)

Incidentally, if your gut response to this is “exactly, but theory/system X solves all those problems”? Sorry, but you’re making the same error. There is no system we can plan that will work around human nature. The ultimate solution to bettering society is people and communities learning and growing together

You want more socialism or whatever, cool; if there are ideas or tools we can implement to make improvements I’m all for it! But understand that just switching to a different system doesn’t solve the underlying problems

"The devil is in the details."

This is always the answer to these broad ideological conflicts, as far as I'm concerned.

Want federal health insurance or health care? It can work. But it all depends on implementation. Want it private? Likewise.

Want to go from income tax to sales tax (or VAT?) Sure. If the details work out -- TX government is all sales/franchise tax funded, and it works. Exemptions avoid the main fault of regressive taxation that people worry about.


I do think that sometimes it's easier to make broad sweeping changes in one go than it is to keep chipping away at the system we have.

I see that as the main advantage to, say, "Medicare for All" for the US. It's harder for special interests to put a stick in the spokes, than it is if your approach is to reform the "ACA" approach instead.

But whether it's the ACA or Medicare, it'll still need a massive overhaul to actually work.


@TerryHancock I’m not even really opposed to changing the underlying system. What worries me is people thinking things like “if we just replaced capitalism with socialism/communism/whatever, we’d solve everything”

Nope. People will still exploit others. You still have a never-ending effort in front of you to work toward the asymptote of a just and equitable society. We’ll have many of the same problems, and some novel ones.

@TerryHancock Take single-payer health systems. Great idea, I’m behind certain versions of it. But single-payer systems don’t magically solve (and in some cases exacerbate) all the issues of care access, systemic bias, exploitation of care workers, etc.

And it introduces new problems like being able to deny politically unpopular treatments without banning them by simply refusing to establish payment criteria. Doesn’t mean don’t do it! But imagining any such solution to be a panacea leads to bad ideas and outcomes

@TerryHancock (side note, if we get more specific here, it’ll be politics and we should move under a CW)

USPol (a little bit) 


Yeah. Though I think the examples of single-payer health systems in other countries show that, in general, they succeed better than our privatized system -- better results for less cost.

We could still screw it up, of course. But I think it's a good strategic move. If we could make it happen.

But our biggest problem in the US is the dysfunction of Congress and election finance (=bribes). If you can't fix that, it's really hard to get anything else done.

USPol (a little bit) 

@TerryHancock agreed, decision making processes are really hard

With things like single-payer, one of the underlying issues with having the conversation in the US is this cultural thing that combines utopian fallacy (X is not ideal, so we shouldn’t do anything) with “for us or against us” social models

Like, in general people really struggle with positions like “single-payer health care would be an improvement, but it also has some significant problems I’d like to see at least somewhat addressed in plans to go that way”

It’s like people think pointing out problems with a complex plan means you’re opposed to the idea in general, and so much effort is wasted on “no, this idea is perfect and if you have any criticism, no matter how constructive, I need to punish you”. It’s maddening.

USPol (a little bit) 

In the US the best chance to get to a universal, federal healthcare system is probably "Medicare for All" (aka "M4A"). This would extend our existing federal healthcare for seniors to apply to everyone.

But Medicare itself has a lot of design problems and grift, as it is.

Making this really work will also require us to fix those things.

And the body that has to do this is the same one that can't overcome the filibuster to pass even basic things.

USPol (a little bit) 

@TerryHancock @markusl I agree that’s probably the most likely to succeed here; and that it has some pretty significant problems that would need addressing, largely around access and how hamstrung the program is to negotiate care costs (which is one major criteria for success in other countries’ single-payer systems)

I honestly think we’d be better served by a public insurance scheme similar in principle to the German model (it’s far from perfect but would improve a lot and would be resistant to certain kinds of political fuckery after implementation), but the complexity means people will reject it. We tend to go for simple solutions and damn the problems.

USPol (a little bit) 


I may be out of my depth here, but Medicare IS a public insurance system, right?

The UK's NHS, though, is a healthcare system run directly by the government, though, right?

It's definitely not my area of expertise. I'm just a poor citizen wanting health & dental care I can afford!


USPol (a little bit) 

@TerryHancock @markusl Medicare is nominally a public insurance program, in that it doesn’t operate the health facilities directly but pays private providers

It is not a true public insurance program in reality, since it is largely prevented from doing the things that make insurance function (such as negotiating prices for care)

And I favor aspects of the German model which is kind of a hybrid (public insurance plus a public-private care system where government clinics/hospitals coexist with private ones and private insurance options exist but must compete with the public option)

My worry with single-payer in the US is the “we’re not going to use federal funds to pay for abortion or contraception or gender-affirming care or whatever makes the fundies angry this year” folks using it as a weapon. They already are to an extent but single payer would be a big lever. Any system we go with has to address that problem IMO

USPol (a little bit) 

I can see that.

But I also can see that even a system which didn't cover those things would be an improvement.

I definitely think that M4A needs to include adding the bargaining power. Without it, costs would balloon. It's just asking for corporate grift without that.

USPol (a little bit) 

@TerryHancock @markusl yep, we definitely need to address the pain of how many people are unable to access healthcare. ACA was a significant step forward, and we need more. I just hope we don’t further harm marginalized folks in the name of expanding access.

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