As an American who has worked closely with the Federal government, I'm significantly more afraid of the idea that the government would be responsible for my medical care.
Medicare (single payer healthcare in the US for everyone over age 65) has a lower fraud rate than private insurance, serves millions of seniors and has for decades, and as an American there is a big discontinuity in actuarial data where your life expectancy literally goes up at 65 because you get access to it.
Maybe don't generalize from a few personal anecdotes to the functioning of the entire 4 million employee federal government?
A common right-wing criticism of Medicare that I was trying to pre-empt is that it is rife with waste, fraud, and abuse.
But to directly answer your question: if you want your dollars spent effectively, you should care about fraud rates in services you pay for (public or private).
Alright, well I guess I'll take your comment as an attempt at a real conversation. But fraud in the medical industry isn't really something that crosses my mind, nor is it part of my concern about the government dictating my healthcare.
Medicare not only covers the most at risk of our population, but is also by far the cheapest per capita beside medicaid. Yes, American health care is expensive, but medicare is the cheapest way to deliver it.
Most of the world does not have government run health care, what they have is government run health insurance. Hospitals, doctors, health care providers in general are privately operated and anyone with the right credentials can go ahead and start their own practice/clinic, but the government provides single payer and universal health insurance.
That's not what anyone in the US is proposing though. Even medicare for all would still have the same private companies responsible for your care, they would just be paid by the federal government.
It would transition away from employer-provided health insurance, to employer-subsidized insurance, having instead individuals choose their health care plan from state-approved private insurers. It sought to make the cost of health insurance more transparent to consumers, with the expectation being that this would increase market pressures to drive health insurance costs down.
Health insurance is one of the least concerning things for the government to get involved in with healthcare, really. Worst thing that happens is they don't insure you or the procedure, and you have to pay for it yourself somehow.
I would question the viability of government for handling many things, but collecting taxes and distributing funds is one of the things they usually are pretty good at. Some of the leanest health insurers in the US in terms of overhead are public enterprises, e.g. the VA and various state assistance programs.
In Germany, health insurance is also tied to your employer. If you're a freelancer in Germany you pay out of your own pocket every month (around 500 bucks).
It's a very similar system, the real difference is that it's illegal to not have insurance, so you are "forced" to always be insured, and unemployment support is more generous.
They are either included in your insurance (if you are employed and have public health insurance), or you'd have to add them to the insurance at extra cost, if you have private health insurance (for example freelancer).
I have no problem believing that other nations governments do a great job. I also do not live there nor am I a citizen of those countries.
American government is a uniquely incompetent form of government. Despite being one of the largest & most expensive governments it gets little to nothing done. Anything that is 'done' is often done far over the original projected budget.
> American government is a uniquely incompetent form of government.
Objectively untrue by any serious metric you'd like to go for, and in particular government-run health insurance programs (Medicare chief among them, but also the VA) are notably well-run and have low incidence of fraud while maintaining remarkably low overhead.
It's interesting to me that you're lumping together Medicare and the VA. Because while I here almost nothing but positive things about Medicare, I hear lots of stories of people not getting the care they need from the VA (and "slipping through the cracks"). Granted, those seem to be mostly older anecdotes, have things changed in the past decade or so?
You're conflating things like physical infrastructure and defense contracts with welfare. The welfare that we do give, for the most part, is exceptionally well run and effective.
Because giving individuals money, targeted or otherwise, is given/spent to enhance an individual or families life in some way. It is a direct benefit to them.
And yes, SS is absolutely welfare and it is extremely effective. It reduces the poverty rate of the elderly by nearly 30%. It also reduces, directly and indirectly, child and young adult poverty by meaningful amounts as well, 1.5% and 3% respectively.
Regarding your first point, I disagree. I think the intention is clearly to provide a direct benefit, but that isn’t always the effect. One example which seems to be entering the zeitgeist now is student aid. The presence of additional student aid has a high correlation with the rise in tuition over time, but I think we’d all struggle to say it was commensurate with to the cost.
Addressing your second point re: social security and perhaps generalizing my first point slightly, I think the statistics you cite are reductions in poverty vs simply abolishing the benefit. I don’t think they measure the counterfactual scenario of there never having been social security to begin with, and those current seniors having had their take home pay increase by some portion of the 15% of their gross pay which otherwise went to SS. Additionally, it doesn’t take into account the future debt servicing cost of current SS recipients on future generations.
As to your point about SS, you are right, but the counterfactuals have been measured. We didn't have SS in this country for the majority of its history and elder poverty was terrible prior to its existence, reaching well over 40% in the 1920's.
SS also has always been a Pay Go system and doesn't have any debt servicing, actually the reverse is true, SS is owed money from the US government. That is, SS lent the US government money. That government debt would exist with or without SS as federal government spending is not constrained in any way by tax receipts, so SS's impact here is moot.
To your point about student aid, that is far more complicated. While it is likely true that the existence of the aid has resulted in some upward pressure on tuition, it is not the only factor. Increased demand both in quantity and quality of services, reduction in direct public aid to institutions, and increasing administrative costs among other things all play a part. Without student aid, it is likely true that prices would be lower, but probably not nearly as much as one would assume, and we would have a far less educated populace. The latter being a substantial negative in a world where the best paying work is and continues to be more knowledge based.
doctors would be responsible for your medical care; taxes would foot the bill. The primary involvement of the government is the logistics involved in getting from A to B.
