Because between the 1970s and 1990s, Western nations decided that private operations should be the default for everything except where the law specifically requires state institutions, instead of the other way round.
In many countries, essential services like hospitals, drinking water supply, airport security, schools, even prisons are now partially or fully privatized. It seems insane when you think about it, but that’s what your grandparents voted for.
How would this work the other way around? The state provides cheeseburgers and fidget spinners until someone writes a law requiring private industry to provide these things? Isn't there a sort of lack of freedom inherent in forcing people to get all their cheeseburgers from a single place?
The other way around would be having public options except where explicitly forbidden. The existence of a public option does not forbid private options. For example the existence of the USPS does not forbid UPS or Fedex or Amazon from operating delivery services, which may be preferable for many customers. But the public option guarantees that a certain level of service is available to anyone and makes it impossible for any private entity to secure a monopoly. It also is very sensible in cases of natural monopoly (power plants, international airports, prisons, wastewater treatment centers) where there's never going to be any meaningful competition that the government should own and operate the monopoly.
Ukraine an interesting moment with the recent (as in less than 10 years ago) health reform. The change was not in the ownership regime, but in funding (preallicated fixed amount vs post payment for itemised coded services).
Once the incetives got changed, a lot of doctors opened up their own practices as PE. The government still foots the bill, but the corrupt middleman of the local variety got cut from the flow
The hospital has 100 beds, 30 in personnel and some amount of equipment to maintain, repairs to make, etc. They get funding from the ministry based on that. Then the head of the hospital pockets some of the allocated money on repairs and gets some percentage off bribes that doctors get from patients. If nobody ever visits the hospital, no surgeries are performed and no x-rays are done, they still have the same funding. People mostly can only go the hospital in the locality where they have their registered address (which you don't get if you live in the privat rental, but it's a different problem), unless they pay a bribe (see above).
After: the hospital is still government (or city) owned, but it has to generate revenue by proding actual services. Since health is a basic constitional right, the government still pays for most of the stuff, but only after they get the itemized bill of services and materials provided. Itimized services and materials have fixed prices set by the government too. Government or a city can still give the hospital a subsidy if they want for some capital heavy stuff, but they then see how good it's utilized.
Now the best part -- if you are a doctor and head of your hospital is a cunt, who still does the habitual stuff, you can get from your ass and open your own one-person practice, sign a contract with the government and they will pay the same amount to your directly. The patients can choose freely where they get the service and will not pay for it anyway. In practice it also means not having to pay bribes to actually have it provided.
You can think of it as a government operating an insurance company that is funded directly by the taxpayers and then dealing with health providers on a regulated, but open, market.
What is the appropriate level of safety? Safety is a spectrum, not a binary condition. Privately owned commercial airlines operating under strict government regulation seem to be pretty safe.
Private is the default solution for all problems. The state only provides a service when the government takes action to do so, and usually this is on top of whatever existing private infrastructure there is.
This seems like a pretty weird perspective to have?
> It seems insane when you think about it, but that’s what your grandparents voted for.
Our grandparents wanted a nice hospital and that's what they voted for. The people they elected needed funds to build the hospital, so they sought funding. The IMF and World Bank said "sure, we'll help you fund it. But in order to do so, you need to privatize your healthcare industry."
Our grandparents got a nice hospital for a while, the politicians got another 4 years in power, and a few years later we noticed that our free healthcare was gone.
This, multiplied across the entire developing world.
A mix of public and private can work with proper regulation (especially when combined with state owned private companies).
This article only refers to the US. This is the second time I've brought it up over the last week, but it'd be nice if the US and "the west" weren't constantly conflated.
Not all of us have fucked over their citizens and spiraled into borderline dictatorships that are well on their way to becoming international pariahs as much as the US have.
Everything suddenly makes a lot more sense once you realize the US is a developing country, one that happens to control the global money printer (due to a few accidents of history).
It's the only developing country that is also "first-world" or "western", and unfortunately, also the most powerful of those.
In many countries, essential services like hospitals, drinking water supply, airport security, schools, even prisons are now partially or fully privatized. It seems insane when you think about it, but that’s what your grandparents voted for.