kravietz 🦇 @kravietz@social.privacytools.io

@dmk @nicksellen

> Demonstration sites can be visited in the Ukraine and in Japan

Please, do not use such cheap propaganda.

If you want the latter, demonstration site for renewable energy can be visited at Mountain Pass mine or hundreds of unregulated mines in Africa or China. Hydro power demo site can be visited in Banqiao where 230'000 people died. Thousands of hectares occupied by coal ash. Hundreds of km2 occupied by wind farms. Etc etc.

@dump_stack

Exactly, this is precisely why I do my teeth in Nalchik 😂

@dump_stack

> Then it's should be even cheaper.

You know, if you want cheap healthcare, you can always go to Bangkok, but not so much guarantees of survival 😉

Behind every regulation there's someone dead or disabled as result of someone's stupidity or mistake.

The art is in finding a reasonable balance between regulation and free market approach. US certainly cannot into reasonable balances.

@dump_stack

Oh no, they have their kingdoms even within the same government - so you've got tax office and you've got pension office, and they represent the same public administration of say Poland, but one of them in terms of technology and organisational culture is in 19th century and another in 21st.

Oh, and obviously they should adhere to the same law too :)

@dump_stack

But this is not true. If you look at even simple economic indicators like percentage of GDP spent on healthcare you see that countries with predominantly public system spend much less on healthcare.

At the same time - and this is quite shocking in the US - these "public healthcare" countries have much better life expectancy and lower infant mortality etc.

So US pays much more, and gets much worse outcome.

@dump_stack

> all public sector in Russia should be eliminated

Russia is indeed a special case and I was thinking 100% the same when I lived in Poland like 20 years ago... but then things changed to better significantly.

Main problem are the silos - so each administrative unit is like a separate fucking kingdom with their own rules and habits. You have offices that are 21st century, you have offices that are little USSR museums 🤦‍♂️

@dump_stack

> last stage cancer

And this is true as well, there's many scammers in Switzerland or Germany, offering all kind of alt-med crap like homeopathy or naturetherapy for huge money.

Polish singer Jacek Kaczmarski was scammed out of hundreds of thousands of euroes by such "clinics" when he had a terminal throat cancer.

@dump_stack

Sure, if you have $$$ then private clinics in Switzerland or US are faster and better, but that's like hundreds of thousands of dollars.

In the UK a simple 15 min visit at private doctors is 250 GBP minimum and they will charge you for every fucking napkin and needle separately.

I know that many US folks go to Canada to buy insulin and they actually smuggle it through the border because it's illegal.

@dump_stack

Innovation is done at universities and specially selected hospitals, usually in cooperation with private firms - because innovation is risky in financial terms and this is what public sector is not very good at on the other hand.

So a smart mix of public and private sector is what works best, and you have always monitor and fine tune the mix.

@dump_stack

Now, the innovation is *not* done in typical hospitals. Hospitals and general practices (поликлиника) purpose is to deliver totally standardized, routine services at largest scale possible.

This is precisely at which public sector is much more effective and private sector will always haggle for every penny.

@dump_stack

If you have a picture of public healthcare in Russia, well - you know better than me what are the main causes.

In Poland it's much better as there's no corruption but yes, you can wait for non-life-threatening procedures for a few weeks.

In the UK I'm absolutely in love with NHS because they got me and my sons absolutely top treatment at quite typical cases and I understand the value behind it even if I have to wait a few weeks.

@dump_stack

So private healthcare is excellent as it comes to dental services (I always do my teeth in Nalchik) and relatively simple cases, but forget about treating chronic illnesses like cancer in private clinics.

Costs are too huge and you need to pay them out of your pocket, so you need to be really wealthy person. But yes, you get the best therapy available for your $$$.

This is precisely why there's so many people collecting money for "therapy abroad" for their children.

@dump_stack

Same in Poland, but this is typical for Eastern Europe and temporary. Private healthcare is cheap for two reasons: low purchasing power of the population (prices need to be affordable) and widespread practice of parasiting on public hospital infrastructure.

So when you have a more complex case, a private hospital will usually send you to do some procedures and analyses in a public hospital, where the same doctor works in parallel. This way they cut costs.

@dump_stack

So healthcare is one of the areas of society where it makes the most economic sense (!) and 100% pragmatically to have a large public insurer that doesn't need to make profit.

And most countries in the world have it since like mid-20th century, but not US because "values".

Same for pensions, public infrastructure, education etc. In most cases obviously the system is not 100% public but a hybrid between public and private - whatever works.

@dump_stack

Probably the dumbest of US healthcare inventions is the "maternity insurance"... but people buy because you can get a bill like $30k for having a baby.

And because they need to make profit *and* because the market is highly regulated, they inflate the cost at any stage. So a tablet of paracetamol will cost $100 in the bill, and in theory patient shouldn't care because "it's paid by insurance".

@dump_stack

US still thinks they're in like 19th century and ideologically stick to a pseudo-free-market model of healthcare, where each patient is obliged to pay for their treatment.

They can buy a private insurance but any insurance with a potential of multi-million dollar liability is obviously going to be bloody expensive and limited and require you to co-pay, because they are have to make profit on it.

@dump_stack

Modern healthcare has extremely wide cost variability and long tail.

So any of us can have an accident or illness tomorrow that will require an operation that will cost €400k. Or €4k. Or €4m.

Most countries in the world, USSR among the first to be fair, introduced public healthcare, which is the only way to fund that really without effectively letting people die.

The cost is spread across the whole society, those who are young and healthy pay for those who aren't so lucky.

@dump_stack

Free market in healthcare did work to some extent when people lived like 30 years on average, surgical procedures were limited and performed usually by a single surgeon.

Since mid-20th century it drastically changed - life expectancy doubled, but the benefit comes at a cost: healthcare is now extremely advanced science, drug are complex and take years to develop and you have operations that involve dozens of highly trainer personnel.

@dump_stack

Well, that's very much like people in Russia blame free speech and democracy when they never really had it 😂

But with healthcare it's not so simple.

@dump_stack

In general anything in the US and UK that involves even a tiny chance of a lawsuit tends to be extremely expensive due to tort lawsuits, which are a thriving business. Drugs are obviously a popular target, just as mobile phones, glyphosate and recently... yes, children talcum 🤦‍♂️