SB 107-02: Hospitals Act (Rejected)

[Southern Senator North Carolina Yankee]

The main problem with the American health care system (IRL) is that the incentives all point towards and inflationary posture.

1. Everyone gets emergency care but not preventative care.
2. Yes it is overwhelmingly private sector, but with many multitude of competing programs that subsidize the industry as a side effect of helping a targetted group.
3. Alongside of this subsidization, there is no attempt at leveraging lower prices because of the disparate nature of the government programs and the fractional nature of the health care system, means no one is in a position to sort of level the playing field
4. Massive amounts of special interest money flows into Congress and the allure of the potential lobbying careers for Congress, staff and executive personnel means they are literally greasing the wheels of post public office careers where millions of dollars will be made in the future by selling out the public interest now.

However, in game:
1. Atlascare covers preventative care and the subsidies and such work to reduce this mal-incentive.
2. The government programs have been consolidated into Atlascare, giving it massively more leverage than the Medicare program in real life.
3. The equivalent of "Medicare negotiating lower drug prices" not only exists for the larger Atlascare and has for going on five years now, but such has also been cross applied to hospitals, producers of medical supplies/equipment and etc.
4. We don't have that kind of corruption here.

The end result is that most of the incentives here point away from health care inflation while not leaving people to die in the streets and ensuring greater access to health care, in part because so much work has been done to reign in the costs.

I credit President Scott for his work as such on ensuring the application and enhancement of these provisions in the area of drugs beyond what the original bill even had.

[Southern Senator North Carolina Yankee]

Beyond the practical effects of the Atlascare program as detailed in my previous post, I would draw attention to this issue from an area of game mechanics as this is a policy area, where within certain limits, regional agency has been preserved for the sake of game play, including a number of market place regulations as well as to regulate the kind of delivery modes available.

Atlascare deals primarily with paying for health care, as in you go to someone and pay them to cover your expenses aspect of health care. The space occupied IRL by insurers, medicare, etc. The regulations within the larger bill deal with setting up how that relationship works, helping people who need it to afford it and as stated previously, the presence of various structures, and policies whereby "coverage" aspect of health care can have a substantial impact on the "delivery", ie the realm of hospitals, clinics, etc etc.

The presumption being that if the regions wanted to experiment with different models would thus have a degree of freedom in terms of how they could structure their regulations and thus allow them to structure a different setup. It gets back to a concern that pertains to centralist approaches, that if you completely "resolve" a situation without no room for maneuver down the line, you have shut down that as a "playable" option for those lower entities and that is a consequence here that needs to be considered.

[Southern Senator North Carolina Yankee]

The point about profit, we have a number of areas where profit is not only allowed but expected in terms of the production of necessities of life. Food, clothing, entertainment (I would consider it a necessity), alcohol for some. Anyway the point being is we don't feel the need for the government to start manufacturing canned beans because of how much money Pepsi Co makes.

We even decided a long time ago that the most efficient way to help fight hunger was to give people aid on a card (yes this was done through a more complex process some time ago), that they then take and use to buy groceries from a privately owned supermarket or big box store, where they buy food products manufactured by private industry. In fact it is the right, during the Trump administration IRL, that made the argument in favor of a "socialist scheme" distributing beans and rice to people Soviet Style as a way to remove the ability to "waste" food stamps on "luxury foods" or whatever the hell they claimed. As some will recall, I spoke out about this ridiculous proposal at the time.

So process that, we give people food stamps on a card, which are then used to buy goods in a privately owned super market, which is selling privately produced food items, most all of which (baring a few co-ops) is operating on the for profit model.

If it works for food, why does health care have to be nationalized "because people shouldn't profit off a persons health". The whole reason why health care is different and it is regarded as different is because of the inflationary mal incentives IRL, the resulting insane prices that it produces and get this "the corruption induced" government policies that allow it to happen.

That is the only reason why there is such an appetite for nationalization and single payer in the United States IRL today because of the influence of the anglosphere and the fact that industry induced gov't corruption makes any alternative unfeasible. However, if the past year has served as any guide in such matters, those same dynamics will stop the anglosphere centralist approach from happening just as much as it stands in the way of a German or Swiss model. I have long contended that the latter is a better fit for America IRL based on its history and traditions etc, etc. I have never bought into the argument that the Anglosphere approach is "more practical" because of the corruption, which obviously isn't any less induced to bribe away the possibility of then it would be such a regulated multi-payer system.

I don't support monopolies, be they government or private and I think the creation of a government monopoly here in the quest to solve an IRL problem or appease certain ideological sensibilities, is only going to create more problems then it fixes, especially when failing to account for the differences in game, relative to the situation IRL.

 

[Southern Senator North Carolina Yankee]

Nay