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After working over thirty years in the prison system of the state with the highest per capita income outside of DC I have to say that of the thousands of individuals and their families I came to know- I read all their files- no one was there for having poor morals, and I actually recognized their ‘criminality’ was a testament to their survival skills in a society unable to see them as human beings worthy of even having a name or identity. The ‘poor choices’ view wasn’t as pronounced in the early eighties as it was in nineties, when it was the grease that sold the ‘privatization’ of social service systems advanced of course by the ‘tough on crime’ posturing of political hacks and their corporate friends.

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Thank you for your powerful testimony as someone who knows the situation personally. I wish everyone could read this.

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The first institution I worked at was established in 1965 as “a home for wayward and delinquent” boys, but it also functioned as the State orphanage into the twenties: the astonishing thing was that all the original handwritten ledger books , twelve large volumes,identifying who entered and who was released had been preserved as well as all the classification/court records, the

social worker correspondence with families and the released individuals had been about 80% successfully preserved. We had an active State Archives department I was working with in the early nineties to preserve the original ledgers (used until some time around WW I) and the best examples of all the other records that had accumulated) when the State Archivist office was eliminated, and I had no legal power to do do anything with them; and now I bet none of them exist.

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Note: the institution was created in 1865, not 1965- I don’t see any feature to let me edit these kinds of errors once they are posted. That was one of those fat fingers tiny buttons kind of a mistake….

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This is a great commentary,a clear articulation of my own world view. I see the heart of socialism and buddhism here. I’m sharing this with people who both hold similar and different views. Imagine if this were out on mainstream newspapers’ editorial pages. A better world is possible.

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i think we should not merely consider whether healthcare is for the elite few or the many but understand the matter of choice, freedom, and market.

government interference in healthcare has had, among other things, two effects: 1. controlling how healthcare can be adminstered (rand paul stated a hospital was forced to deny charity due to regulations when they otherwise would have been able to provide it) and 2. raising the price of healthcare - manipulating insurance regulation has caused high prices in medical care and artificially increased the price point of medicine so that uninsured cant afford care.

When parties can deal directly with each other, free choice, good cost to value ratio can be maintained.

it became personally evident to me how efficient urgent care clinics were and they fill a gap between hard to see doctors and expensive emergency rooms. I think market innovations like this make treatment more accessible and affordible.

it is true that at the beginning a state funded healthcare might work well in the short run (since many pay taxes anyway) but in the long run it tends to have the same problems as monopolizing and reduction of competition which raises cost while lowering quality of service.

some third world countries have great state healthcare (such as costa rica) but they are developing so they may have a lot of growth and tourism income and have younger economies. The real key to thier comparitive success is not that they are state funded but that they are so underregulated compared to the US that they can afford to offer services at a reasonable price.

Im not saying this necessarily disagrees with your article but food for thought.

As we age, healthcare is a human need and a community necessity so lets think about which direction we want to go in.

im for free market plus private charity plus less regulation plus removing or reducing occupational licensing and monopolies.

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I agree that healthcare is a human need and a community necessity. However, I do not agree that competition within a market would achieve prices lower than those in single-payer nationalised systems, which have been around as long as the American model, but are 50-70% cheaper in some cases. This is because they spread the liabilities more widely and are able to negotiate costs more aggressively, something individuals cannot do. Such nationalised systems can also proactively spend more on prevention knowing it will cut costs later, as well as benefitting from economies of scale, and also not having the overheads of having to provide profits for shareholders at many points along the healthcare providing process. Nor am I convinced that anti-monopoly practices can be enforced in a deregulated market, or that such deregulation won't lead to potential major health / pharmaceutical scandals worse than those that already occasionally slip through. You also have far belief in the potential of individual charity than I do to cover what a competitive paid-for health service would not, but I appreciate your optimism.

Having said all of that I am not in favour of markets for essential services at all on, or the commodification of medicines (or even food for that matter) on philosophical / moral grounds, and I'll be covering this in the next couple articles in this series.

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