In my book, the problems begin as soon as the healthcare system is required to be lucrative. And don't tell me not-for-profit hospitals are not lucrative. It would be even worse without regulations. Care providers would illegally organize into cartels (which is of course already happening) and going to see the doc would then really just be like bringing your car to the garage, with all the 'niceties' that go with that. I don't expect to convince any free market proponent, since to really grasp what I mean by all that those people would have to experience the private system from the inside (as I do). Private interests are very much the problem. Healthcare should be a public service.

Yet plenty of countries have well functioning private healthcare. Singapore is a good example. Hell, even in Canada most primary care doctors run private clinics.

Small private clinics run by a small bunch or even a single practitioner have almost nothing in common with huge healthcare companies. This is precisely what I mean when I say that docs have control over their own turf but no further. Such small private structures are perfectly acceptable since they're much less toxic to the system at large. Independent practitioners will never have the lobbying weight that whole companies have, and therefore are IMO the only form of private healthcare provider that can work. Hospitals should be public.

I've seen first hand the opposite in my country, where free market private health care is working almost near perfection. All it takes is minimal regulation and then watching the healthy patient incentives aligning with the profit motive without government meddling.

And I've been watching in real time as the government is actively blocking and preventing this same functioning private healthcare system from acquiring covid vaccines. Right now, this "evil" private healthcare provider has all the money and willingness to vaccinate us all for free, but the government is denying it because they want a slice of the potential Profit to pay for the vaccines for the rest of the country.

So you tell me who is evil because of money.

Curious, which country are you referring to?

South Africa...I looked on the wiki page for it now, and it doesn't do the state of healthcare here justice.

Ok, so we must have very different views of public health if you consider the south african system to work near perfection. I mean, can you really say that given south african HIV prevalence? And that's just an example among many others.

I think it's very fair (and as you know as an epidemiologist, correct) to differentiate between a country's public health system and medical system. And between a country's primary, secondary, and tertiary medical care systems.

It's true that SA has quite good tertiary and secondary care, while they struggle with public health and primary care.

I do think the pricing mechanism of almost any other country outside the US is more reasonable than ours. Insurance, big hospital chains, and yes, to a lesser extent the AMA, have ripped pricing from its market mooring.

There are many other countries that have well-functioning market-based medical systems (even as they sometimes struggle with public health system due to poverty): Mexico and India spring to mind. Even catastrophic medical care (eg, cancer treatment, or major trauma) is affordable to the middle class in both of those countries, unlike in the US, where those events can ruin a middle class family even with insurance (I've lived it myself, to some extent).

Regulation can play a positive role here, but not by creating more bureaucracies. Rather, we need more transparent pricing. We need enforcement of anti-trust legislation against big hospital chains. With some hesitation, I'd say we also need to resume of significant prior support of basic medical research to push big pharma beyond their current biosimilars business model. And we need to "encourage" the AMA to put out more physicians (the student loan issue can be mostly solved by getting the government out of the student loan game).

If by public health you are referring to the government's provision of health-care, then yes, you are right. It's absolutely abysmal and very unfortunate for those unable to afford a private medical aid here.

So in the grand-scheme of things, public-health in SA is a failure, with the majority of the public being very poor and unable to afford medical aid. However, the model of the private sector on it's own is something that we've seen works and can probably be scaled up if government stayed out of meddling and "tweaking" it to their social value system. So if all they did was give people money to spend on their preferred medical aid (similar to the proposed "school credits" in the USA), then I think it'd work and the poor would have great access to healthcare despite not being able to afford it on their own.

Unfortunately, the 11% of tax-expenditure being spent on healthcare is not enough to cover such a thing, and they'd have to scale that up. Other things to keep in mind is that they have a ridiculously tiny tax-base here due to the inequality (I.e. something like only 10% of people pay income tax). The other thing to keep in mind is that a lot of the money that tax-payers here pay for, they don't actually use at all. E.g. Police, ambulance, fire services. They might as well be non-existant and defunded because the private sector has picked up the slack. As an example, just the other day I found out their largest city has less than 10 working fire trucks.

So you're telling me that your private sector wants to vaccinate everyone for free? Sure, yeah! So, call me Red but I feel something between "free for everyone" and "private sector" doesn't align...

Free as in out of our collective insurance pool, yeah. So free just like in a country with socialized medicine ;)