If you are a Libertarian and hold liberty as your core value, why do you not believe in universal healthcare? Nothing impacts liberty more than sickness and death.
I consider myself a libertarian and I believe in free healthcare. I think certain industries should not be run for profit. It creates perverse incentives that harm the common man. For example healthcare.
If there's a profit incentive in bealthcare, there is incentive for drug companies or hospitals to raise their prices. This would mean less people getting treatment or more people in medical debt.
Another industry I think shouldn't be for profit is education. We want an educated population. It should be encouraged, so it should be free for anyone who wants it.
In my view, libertarianism is a perspective that the government should interfere with the personal liberties of the individual as little as possible.
Every single government action should be heavily scrutinized and challenged. Some actions are justified. For example regulating healthcare I think is justified. You are taking away the liberty of starting a hospital - but the benefits outweigh the costs.
I believe that cooperatives should be encouraged if not explicitly mandated for large companies.
I think to Chomsky's conception of anarchism. Look at all hierarchies of power and challenge them. Some are justified - the power a father has over his child. Some are not - the power a cash advance place has over their customer base.
I think governments often make mistakes and through heavy handed actions end up screwing the average person. By dramatically limiting government action, you help prevent this.
There's examples that swing both ways of a government being benevolent and self serving. The more likely outcome is the government being self serving. I personally anticipate every government to eventually go that route. For instance Agustus and a few following Roman emperor's had set a good example. But once corruption had set its teeth within the government it became incredibly difficult to be a "good" emperor. Not impossible but discouraged.
So yeah. Just because there's good examples doesn't mean you shouldn't be cautious even in their cases. Enjoy the prosperity and encourage it but do have a Killswitch of sorts just in case
There are benevolent kings every once in a while. Doesn't mean monarchy is a good system in the long term. Nordic countries have some of the highest wealth inequalities in the world. They keep the working class content with the programs and benefits. They have been able to afford it up to now, but the system is straining.
In the long term they cannot sustain this and we see it with their indicators slowly falling over time to match other Western European countries.
French & UK citizens are not fans of their government.
Less power the government has unnecessarily, the better. Doesn't mean the government shouldn't have power, just we need a mentality that we always need to be trimming the fat.
You just described a somewhat progressive leaning liberal.
You believe that the government should stay our of our homes, socially. Progressives have been leading that charge for decades, and moderates have been on board for a while now.
You believe in universal Healthcare and income. Those are very progressive ideals. Those are about as anti libertarian as it gets, because they take away a lot of "individual" freedom, because to fund that, roughly half of your income will need to go to taxes. Maybe more, I haven't looked at the numbers in a long time, but plenty of current examples to pick from.
You believe in industrial regulation to combat bad actors when necessary. That is a general liberal ideal.
Nothing besides keeping the government away from your personal life is even marginally libertarian. And that's pretty much the only overlap between libertarianism and liberalism.
Do not be deluded by the abstract word Freedom. Whose freedom? Not the freedom of one individual in relation to another, but freedom of Capital to crush the worker.
I believe in universal basic income, because it is simple and easy to define, and therefore doesn’t have these two problems
Universal healthcare is problematic because of two things:
How much is covered? Because healthcare isn’t fungible like money is, unlike UBI, UH has a problem where a ton of attention and discussion is required to determine what’s covered and what isn’t. It becomes a “to each according to his need” scenario where “his need” is being determined by the central committee
Once society is promising to take care of my body, I now have to promise to society to take care of my body. If I want to take risks with my own health or safety, there is now opposition to that from others on the basis that I’m ruining their investment. This means less self-ownership and less liberty.
Universal Healthcare doesnt have that problem, it's what universal means.
This idealized version of universal healthcare isn't possible because it'll require more resources than we have as a species. There's always more that you can do to improve health outcomes. A line had to be drawn somewhere.
Yes, but universal basic income instead of universal healthcare has two issues as well:
You may not be able to afford expensive healthcare procedures, which may result in all ranges of bad consequences, from lost productivity to death. In either case, there's a big chance society loses a productive worker for no good reason, and for the person who couldn't get healthcare it's obviously super bad, too. All while this expense would be returned in the economy many times over if the person got recovered and continued working, and the person in question could keep living a fulfilling life.
Relying on private healthcare institutions means falling victim to the price-inefficient businesses, as a lot of your money goes to cover profits of the healthcare organization. When there is no public alternative, prices go through the roof. Even in the US, where there is some government oversight but no full-scale universal healthcare system, the prices for healthcare are insane. Thereby, you either have to hand people a fat UBI check and constantly increase it as companies drive up their appetites, putting more strain on the system than universal healthcare ever could, or let people not have decent healthcare, or control the healthcare institutions (which is not super libertarian), all while living with a reality that many people will not think of their medical needs or will genuinely have other strong priorities and will put money to something else, ending up shooting themselves - and the economy - in the foot.
I often hear criticisms of some "committee" deciding whether you're gonna get healthcare or not, like here. In an alternative when it is ruled by money, it's how much you earn that decides it. Someone in a critical condition might not receive help simply because they are poor. Someone will always be cut off, and it'd better be someone who needs the help the least or requires too much resources to help that could be better spent saving more people.
This is constantly ommitted by the haters of planned systems, which I think is very unjust.
When you combine "Libertarian" with the greed that is typical in the ultra wealthy, their core value typically only includes liberty for themselves and no empathy for others. You can use any party label you want but without empathy, members of every party are nothing more than selfish pieces of shit. Just to be clear, I am not a "they're all the same" idiot, as Republicans clearly think empathy is a four letter word. But there are sociopaths without empathy everywhere in society, especially in the US.
As far as universal healthcare is concerned, we can't even agree as a society to provide clean water to our population by removing leaded pipes. Why would we expect something as reasonable as universal healthcare?
The reasoning is nonsensical and requires several baseless leaps of logic to even begin with, of course it will get downvoted. OP's kinda the confused one here, they should have expected bad faith arguments in response to this post if it wasn't just bait, but hopefully they've learned what American Libertarianism is actually like now.
There's a legal obligation to provide defense lawyers to defendants and it obviously isnt done by holding lawyers at gunpoint. The "force doctors to work under threat of violence" argument is so bad faith and imaginary you might as well have just posted "I will make up fake reasons to object to this"
real markets need choice and transparency to operate and there's no way to have those things in emergency care.
Realistically, universal healthcare doesn't intrude on doctors it intrudes on insurance companies.
The term "libertarian" has been hijacked in the anglophone-world (starting in the US, of course) to essentially just mean "fundamentalist capitalist" - they are right-wingers who have been immunized from reality and mindlessly support only "liberty" as it applies to private corporations and their interests. Therefore, it shouldn't surprise anyone that you can find these (so-called) "libertarians" anywhere you find neo-nazis and the KKK.
In the non-anglophone world, the term libertarian still holds it's original meaning - a socialist... or, more specifically, an anarchist.
"Libertarian" became popular in the US when it started being incorporated into various science fiction novels. Probably the most famous is "The Moon Is A Harsh Mistress." I love the book as science fiction, but the society the author creates depends on so many caveats that even the author has the old style 'free' system fall apart as soon as an actual government [as opposed to prison regulations] is formed.
“Libertarian” became popular in the US when it started being incorporated into various science fiction novels.
They got their que from right-wing economic grifters like Rothbard and Hayek - people whose beliefs wouldn't be out of place in Nazi Germany. That's why olden days US sci-fi writing was a festering hole of fascism - nothing else could have produced people like Heinlein.
Heinlein was a huge friend to Philip K. Dick, and any number of Jewish science fiction writers. He was one of the first writers to have an African woman as a hero, one of the first to have a transman character. Stop using the word 'fascist' for anyone on the Right. It dilutes the term.
No, really, liberal - where the fuck do you see anything that can be called left with a straight face contesting anything in the formal political establishment?
Or is it just that you got your cartoonish and Reagen-esque idea of what left and right even means from hysterical liberals and fascists on CNN and Fox news?
you just fabricated your idea of what the other dude thinks in that second paragraph.
No, I didn't. If you think there's anything "leftist" about the formal political establishment it indicates a very specific form of brain-rot that is childishly easy to trace to the mass misrepresentation of political concepts one can easily find simply by turning on a television. Both liberals and their fascist fellow-travellers suffer from this brain-rot... and it's symptoms are perfectly predictable.
I don't think they're fascist, just selfish in most cases. They take the "me" in "Don't tread on me" too literally, and only care about their own rights and their own needs, fuck everyone else's.
Their Venn diagram of "Things the government should provide/allow people to do" and "Things I personally need/want to do" is just a circle, and they won't lift a finger to try to shape the government to work well for anyone else.
One of the vilest messiahs of US "libertarianism," Murray Rothbard, associated with Holocaust deniers and argued for the pig to be allowed to torture suspects (not people convicted of anything - suspects).
If your roots are fascist, you are fascist. US "libertarianism" is about as fascist as Heinrich Himmler.
Probably 99% of self described libertarians don't know anything about that, or actual libertarian rhetoric in general, they just want to smoke weed and not pay taxes for stuff that doesn't personally benefit them and they think that's what libertarianism is
Now that lemmy is overflowing with liberals - people who get their ideas of what political concepts actually mean from CNN and "Law & Order" reruns - I am constantly having to deal with people who don't know where the ideologies they cling to come from. or even means in reality.
So I guess these (supposed) "libertarians" isn't alone in that regard.
Rothbard was one of the foremost proponents of the pseudo-psychology known as praxeology. Rothbard viewed property rights as paramount to freedom and so went even beyond von Mises, who was a minarchist, in advocating anarcho-capitalism. He was also known as a big critic of fractional reserve banking and the Federal Reserve. Because of his philosophy, he held many views that would be seen as progressive as well as ones that were misguided. For example, he voiced support for the civil rights movement,[note 1] but also defended the practice of child labor, "racialist science,"[2] and that "cops must be unleashed, and allowed to administer instant punishment."[3] Also, despite his initial vocal support for revolutionary black power politics, he later worked with Lew Rockwell, founder and then president of the Ludwig von Mises Institute, to run a campaign strategy to exploit racism in order to build a libertarian/paleoconservative coalition (dubbed Paleolibertarianism),[4] and praised the notorious work by Richard Herrnstein and Charles Murray, The Bell Curve.[5] He was known as the first anarcho-capitalist.
Benito later followed his mother into school-teaching and became politically active as a democratic socialist. He was a very prominent member of the Italian Socialist Party in the years prior to World War I.[18] He edited several socialist papers and also wrote a satirical novel, The Cardinal's Mistress, which was poorly written and mostly served as a vehicle for numerous anti-clerical rants.[19][20]
Apparently Rothbard wasn't as bad as Himmler, but he was bad enough.
You no more have to be a disciple of Rothbard, Rand, or Hoppe to be a libertarian, anymore than you have to be a tankie to be leftist, however tankies might say otherwise.
Of course not - the likes of Rothbard or Rand will never be caught dead close to the mass-graves their ideological grifting helped to dig.
anymore than you have to be a tankie to be leftist
I make a hard distinction between leftists and political racketeers masquerading as leftists right until they get the power they crave. I place everything spawned by the Bolsheviks in the latter category.
There is nothing unique or new about this distinction.
I don't think being downvoted for answering the question in good faith should happen, but I do see a few bad faith answers that absolutely should be downvoted
It seems like you have an interesting definition of liberty. Liberty (to me) is freedom from authority. Libertarians core value is not having government force individuals to do anything. If people want to opt into a universal healthcare private system they are free to do so (kind of like insurance). A big motivation for this is lack of trust in government to handle the job well. Libertarians see government as inherently prone to corruption and thus want to limit their power as much as possible. The extent to which a given libertarian wants to limit government varies. By appointing government authorities to the system the cost of everything rises as in addition to health care you also have to pay the government workers who oversee the system and it's not very efficient. Not to mention politicians get to decide how much money goes to these programs etc etc. do you really want politicians involved in your health? With all the inefficiency and corruption in politics why do you trust them to handle your health?
Damn, you'd have to be completely brain dead to still believe anything is more efficient than single payer healthcare. The US has the worst outcomes for the highest cost in terms of life expectancy. Same with roads, utilities, schools etc... the more you privatise the more expensive things get for a lower quality product.
A well regulated, competitive market is good for many things, but for others it's atrocious. An unregulated market has never produced good outcomes on any scale larger than the board of directors.
If you're seriously summarizing the libertarian agenda then I can't believe any one over 14 could hold these ideas unless they were VERY sheltered from reality.
If you want a healthy discussion, you need better arguments.
Competition is inherently meaningless in the context of healthcare. What are you going to do, shop around while you're having a heart attack? Also, with single payer, the government is not involved in your healthcare directly. Compare that with the current system where insurance companies often decide if you're worth the treatment or, if you're under or uninsured, you get to carry the debt until you die.
I think part of the problem is the blurred lines between routine healthcare and emergencies. You are right, if you are having a heart attack insurance should step in to help you front the unexpected large cost. But for expected care like dentist visits you can and absolutely should shop around.
I like your point about insurance getting to decide but I think it's important to note you can still get treated even if insurance doesn't pay. Or you can sue them if you feel they should pay. You make some good points though.
Preventative care. If you have insurance that covers checkups, screenings, etc. then you get that benefit. If you don't have the insurance and can't afford the out of pocket expense, you skip. The issue is that then people wait until they're in really bad shape before seeking treatment meaning that outcomes are worse and treatment is much more expensive than if the illness had been caught earlier. Who pays for that? We all do through increased premiums.
This doesn't happen in a well-run single payer system.
But for expected care like dentist visits you can and absolutely should shop around.
Why? I'm not seeing any benefit to your idea vs single payer dental. It's not like your mouth isn't a part of your body or that dental issues don't effect your overall wellbeing.
Or you can sue them if you feel they should pay.
If someone can't afford insurance, what makes you think they can afford a lawyer?
It's very frustrating seeing someone argue for disproven theories (like the government is less efficient than the free market in arenas most countries have socialised) using easily disprovable statements (like single payer healthcare would be more expensive to US citizens than the private system you have now). Especially when those ideologies can only hurt everyone.
I do apologize for the tone since you have been respectful and I have been less so. You don't deserve the rudeness but your ideas don't deserve the consideration they get in civilised society either.
If you listen to online libertarians they seem to believe everything is on the tables. Utilities have already been partially privatised and they've successfully impressed the classification of broadband as a utility which would have improved service, accessibility, and price at the cost of corporate profit.
To me, this reads like it implies that government and govt programs are bad because of the govt employees, but if you were to take those same "corrupt" politicians and put them to work at private companies that they would stop being "corrupt." Like it is a belief/reaction to one specific bad instance of a large government/program. "The government sucks at program X, so if we get rid of that program, the same general population will gain empathy, morals and efficiency if working for a company to run program X."
It's a about competition. I'm not saying business owners aren't corrupt. But if one company, say nestle, turns out to be rotten then you can buy your chocolate chips from another company. But with government I don't have a say. If I don't pay taxes I go to jail and if I don't like how my taxes are spent then too bad. There is no alternative.
There is often no alternative in private business either. Take Nestle for example. Go look up how many different brands they actually own. You may think you've boycotted them, but in fact you're just buying one of their hundreds of other brands. We're very late in the capitalist system now, and the power has been heavily consolidated. Many industries are completely dominated by 1-3 companies, and they all collude to eliminate competition.
How often do we see real competition? Even if a new company comes along with a great idea, it's more likely to be gobbled up by a bigger company than be left to flourish.
But with government I don't have a say. If I don't pay taxes I go to jail and if I don't like how my taxes are spent then too bad. There is no alternative.
It's called voting, really basic part of our world you seem to have forgotten about.
You happy with how that's been going so far? Do you honestly feel represented by trump/biden? We are presented two rotten options and told we get a say in politics. That's just one more option than dictatorships. If I don't want us tax dollars gifting missiles to Israel I have no option in either party. That's not a say in government. I don't get to tell the president to spend my portion of the taxes. I would rather keep those taxes and voluntarily give to homeless shelters and other charitable groups which do a much better job helping people then the government ever will.
Libertarians see government as inherently prone to corruption and thus want to limit their power as much as possible.
I prefer voluntary interaction to using force or violence. Personally I believe we're obligated to help each other and our community and would voluntarily be a collectivist - I'm just not willing to force everyone else to.
We still need to modify liability and IP law to disincentivize megacorps and not use violence to benefit the wealthy.
Government programs IS US HELPING EACHOTHER. Sure corporations have been undermining democracy, but the government is OUR corporation. It's the only one that we get the choose what it does. The fact we're obligated to pay taxes is EXACTLY the implementation of your statement "we're obligated to help eachother"
I don't understand how you can make statements like this. The threat of violence? The government's monopoly on violence is rephrased as the will of society to ban violence in public life by restricting violence only to the enforcement of democratically selected laws. There is no other way I can conceive. Should more people have the ability to use violence to enforce their views on others? Should corporations have that right? If no one has that right how can we stop someone who decides THEY have that right?
The whole "government monopoly on violence" is for me the most absurd librarian statement of them all. What's the alternative? Who should decide what deserves violence? Who should use violence? What do we do if someone breaks this compact? Because the current answers are at least ideally "the people, through democratically enacted, clear and transparent laws", and "the people, through the police they pay for accountable only to the people" and "apply fair and balanced justice through the judiciary system, run by the people and accountable only to them". I'm in no way saying that it's working perfectly as is clear in recent politics, but it's certainly trending in the right direction in social democracies. We're closer to that ideal now than we have ever been. As far as I've seen libertarian ideology has only come up with absolutely HORRIFYING answers to these questions, or wishy washy nonsense.
How do libertarians generally handle minority rights? Is it as bad as conservatives? A good example are all of these anti-trans and anti choice in abortion bills. What would a libertarian think of these?
Looking on the internet it kind of feels like libertarians are usually suburban people or people so out of the way that the messes in Washington don't affect them as hard as those in the cities. So I have only met one and he didn't seem to fond of our black coworkers, if you get what I mean.
Libertarians are just like other political parties. There are different groups that subscribe the the term libertarian each with slightly different beliefs. Whatever extremists people are out there in the Internet do not represent the whole. I really suggest watching some of the 2024 libertarian debates. They are educated smart people who are informed about the complex issues like those you mentioned. This whole thread has been really eye opening for me. I had no idea people had these conceptions about libertarians. I am guessing there are a bunch of far right groups that like to identify as anarchists and throw around the term libertarian while they do. But if you listen to the rhetoric of the political party and the representatives you will see that those ideas are not held by the party as a whole.
To answer your question, libertarians are, in general, pro personal liberties and pro economic liberties. They believe the individual should get to choose. A common line they use is government should not exert force one way or the other. This means they tend to agree with Democrats on issues like race, drugs, LGBTQ etc. The people who actually get a stage in the political party are absolutely against racism, sexism etc. There was a debate recently where the candidates (about 7 primary) were Asked their stance on abortion. Most of them said they were personally pro life BUT they would still veto any bill or cut funding to any program that forced that perspective on others. Any person who goes around saying they think this and they want the government to force and regulate that disagrees fundamentally with the libertarian perspective. I said most, because one of the candidates was unapologetically pro choice. Please don't think that whatever alt right edge lords are out there actually have any idea what libertarianism is.
The term for this is "negative liberty": the freedom from something; whereas, "positive liberty" is the freedom to do something. Libertarianism, generally, aligns with the idea of negative liberty.
If there is freedom from a governing authority then there is no one to take away my freedom to do what I like. Sounds like two ways of saying the same thing. Maybe I miss your point.
The distinction between positive and negative liberties is, indeed, a rather blurry one, but there is generally a difference in mindset between the two. That being said, libertarianism seeks to minimize the size and influence of the government, but they don't seek to abolish it — those that seek to abolish it are anarchists (I'm not sure if I am reading your comment correctly, but it seems that you are advocating for anarchism rather than libertarianism when you said "freedom from a governing authority"). It's important to note that negative liberty is a concept that distinguishes a certain class of liberties — it doesn't require the presence of a government.
Well said, I probably wasn't very clear, but I am not an anarchist. There are certain critical functions that the government must control. When I say freedom from authority I refer to specific government agencies that can exert force on individuals. Government roads don't force users to do anything but rather empower citizens.
Government roads don’t force users to do anything but rather empower citizens.
Another argument for why government roads are ethical is because they fight off monopolization — property ownership is at high risk for monopolization. I'm not sure if the Georgist idea of taxing the land value that a private road would be on is enough.
Right, government should provide oversight to public goods that, by their nature, require monopolies such as roads or utilities. Government also needs to have a judicial branch that mediates conflicts between individuals and entities.
I like the idea of universal healthcare. I have zero trust in the US federal government to implement it properly. I think it would be a clusterfuck and make things worse for everyone, especially with Republicans on the warpath doing everything they can to sabotage it.
I can't really understand the tradition of never trusting the government in the US. The government is designed in a way that enables, even requires public oversight, public opinion. If that is not the case, you are not living in a democracy. Many Americans trust private initiatives, charity more than taxes and a working public system. People have no say in what corporations do. If people don't trust the government the attitude should be towards fixing it and enabling trust, not to accept it as is. I am not judging, maybe a little bit but not really. I live in a middle eastern country. We really don't trust the government but we keep working on steering it in the right direction. We are many times smaller than the US but we have minimum income, universal healthcare, unions are the norm, etc.
I can't really understand the tradition of never trusting the government in the US
I used to trust them, before 9/11 when I was young and naive. Then the attack happened. We ended up with bipartisan legislation to strip our civil liberties, torture captives, spy on citizens in direct violation of the bill of rights, and invade 2 countries that had nothing to do with it. Never again.
People have no say in what corporations do
Shareholders do. They get a vote. The government is essentially a mutual fund you're legally obligated to buy into.
If people don't trust the government the attitude should be towards fixing it and enabling trust, not to accept it as is.
I agree. I also believe we should take care of that before we go granting them vast additional powers.
We are many times smaller than the US but we have minimum income, universal healthcare, unions are the norm, etc.
Thats a good example of why universal healthcare doesn't need to be at the federal level here. States like New York and California are larger than many countries which have universal healthcare. What's stopping them from passing it themselves?
But corporations hold each other accountable. They have to compete for your trust. If corporation A does something shady then it's im their competitors interest to call them out in order to raise people's trust in themselves. There are also countless charities and third party sites to grade them. I can choose which programs I fund. I don't get any say in what government gets my taxes or what the government does with my taxes. What if I don't want to fund war but want my money to go to charity to help the poor? How effective is universal healthcare where you are?
Wow, you seriously still believe that corporations compete with eachother in the healthcare sector despite the fact that most insurance companies have a "network" specifically so that they don't have to compete with eachother? How is healthcare a competitive market that drives towards efficiency exactly? The more you privatise healthcare the lower life expectancy you get and the higher you all pay!
93% of stocks are owned by just 10% of people... They own all the companies, and are diversified... They aren't really competing with each other in any meaningful way
Then don't shop at those companies? Go buy produce at your local farmers market etc etc. You get to choose what you spend money on. Or you can start your own business if you feel there is a market gap. You cant start your own government.
I should go to my local farmer's market to sign up for Internet service, or to buy a cell phone? The big industries are so heavily dominated by massive colluding corporations that "don't shop there" is not a tenable solution.
The reason the government is garbage is because most of them are working for the corporations. If we heavily regulated the corporations and made it so they couldn't interfere with politics, the government would be better... They'd actually be working for the people and our interests, like they're supposed to
The problem isn't government, it's corporate control of the government
Privatizing things will always cost more because then you need to account for profits as well. Publicly controlled=x cost, privately controlled=x costs+profit for the rich
Even the most corrupt government employee is only getting a pay check (no profits). They make their corruption money by colluding with corporations and rich people
They don't want to pay taxes because they don't like how government uses taxes and don't trust the government to do a good job. Plus, it's an additional layer of bureaucracy at the top which costs more money and is less efficient.
That graph is relating cost of healthcare to quality. Not necessarily comparing cost of countries with universal healthcare to America. Additonally, most of the healthcare spending in America is already by the government and look how that's going. America is also significantly larger than any of those countries listed. Overseeing healthcare for a country so large requires way more overhead.
Every graph of healthcare costs vs privatisation with the US in it is necessarily a comparison between private and public healthcare systems since most countries have single payer as most of their healthcare.
The US government healthcare programs are by far the most cost effective offering in the US but it's hampered by regulations such as not having the ability to negotiate prices (until the recent tiny concession on a handful of drugs that has paid off in spades).
Finally, other large countries including India and China may have lower life expectancy, but they're close and rising rapidly compared the stagnant US trends. Of course the bang for the buck they get is at least 5x what the US gets with its ridiculous system
As a socialist libertarian that access health care, yes I think is a great step forward, I see all this social services that benefit the proletariat given by a government as positive part of the transition, but it's also a double edge sword if people become too dependent or get use to it once stops been an urgent matter people stop demanding it because they forget that's even there and end up voting for politician that would take it away, I'm thinking about Sweden or the uk.
The correct way is demand these services to become more decentralized, f.e. having fully equipied clinics everywhere instead of just big hospitals