[Drlee]

There are two givens. One is that the American people will not accept hospitals turning away sick people. The other is that their care costs money that they can't pay themselves

So the cluster fuck that we have now requires that we the taxpayer pay the money. There is no way in hell short of forcing them to do it at a financial loss to make the insurance companies accept the expensive patients without also giving them the cheap ones.

So the private sector is stuck. The best that they can do is stall. The nationalization of the industry is inevitable.

[Rothbardian]

There are two givens. One is that the American people will not accept hospitals turning away sick people. The other is that their care costs money that they can't pay themselves

So the cluster fuck that we have now requires that we the taxpayer pay the money. There is no way in hell short of forcing them to do it at a financial loss to make the insurance companies accept the expensive patients without also giving them the cheap ones.

So the private sector is stuck. The best that they can do is stall. The nationalization of the industry is inevitable.

You're right, Americans would not accept having sick people turned away and thrown into the street. That is why this universal health care scam is so ridiculous. Before government involvement in health care people were not left to die in the streets, in fact it happened less often per capita than it does today in, say, a place like Canada.

[Drlee]

Now Rothbardian I have to call bullshit on you. Show me a single statistic to support that. You can't. Why? Because there is not a shred of truth in it.

I am not going to waste time posting for the thousandth time the statistics that support the lifesaving effects of universal health care.

Really Man. You just can't post nonsense and expect us to believe it. So where is it? Where is your proof for an outrageous and obviously untrue statement like that?

[Eran]

One is that the American people will not accept hospitals turning away sick people.

The other is that their care costs money that they can't pay themselves

Americans would not accept people staving in the streets either. Does that mean we need to nationalise the food production and delivery system?

Wouldn't it make more sense to consider system reforms that would lower the cost of care, such that more people can care for themselves - e.g. by allowing more competition, removing artificial barriers to entry?

[Pants-of-dog]

Americans would not accept people staving in the streets either. Does that mean we need to nationalise the food production and delivery system?

Fortunately, food and health care are such different markets that a lightly regulated market does work well for most food resource allocations. Thus, there is no need to repeat the failures of previous "communist" regimes.

Wouldn't it make more sense to consider system reforms that would lower the cost of care, such that more people can care for themselves - e.g. by allowing more competition, removing artificial barriers to entry?

Maybe, but you would still have to deal with knowledge problems. You know what food you will need and when. You do not know when you will need medical care or what treatment you will need at that time.

[Eran]

I agree that health-care and food are different markets. In fact, health-care isn't a single market.

Health-care needs associated with:
1. Routine treatments like well-baby care, flu shots or minor accidents
2. Major emergency care
3. Diagnosis of major medical issues
4. Treatment of major, chronic conditions

are all different. If you want to get specific, they shouldn't all be lumped together.

Thus one shouldn't use arguments based on the cost and uncertainty associated with the diagnosis and treatment of major chronic conditions (like cancer) to justify public provision, funding, or tight regulation of other categories of health-care.

It is wrong to suggest a completely different categorical treatment of, say, food and health-care. Rather, any system that helps consumers in their decision-making (whether through government regulation or voluntary certification) should be tailored to the specific product rather than to the broad category to which it belongs.



There is nothing inherent about the knowledge problem that requires (or even recommends) its solution through a coercive and monopolistic provider. All the advantages of a competitive, voluntary market apply to the issue of knowledge, just as much as to any other product attribute.

Attributes of a solution to the knowledge problem include:
1. Existence of credibly objective, independent and professional providers of information
2. Sufficient resources available for examination of products
3. Effective means of conveying relevant information to consumers

All of those can be "produced" by the market.


And solutions to the knowledge problem are, of course, not exempt from the benefits of competition.

[Drlee]

Americans would not accept people staving in the streets either. Does that mean we need to nationalise the food production and delivery system?

Lousy analogy. Try again. The market is failing WRT healthy food too. It is aligning itself to industry groups that are reducing the quality and nutritional value of food. And this same free market system is failing with price and distribution of food. And has the price of food mirrored wages? Nope. Bad example.

Wouldn't it make more sense to consider system reforms that would lower the cost of care, such that more people can care for themselves - e.g. by allowing more competition, removing artificial barriers to entry?

No it wouldn't. These are not the issues driving up the cost of health care. The interstate commerce bullshit is just a sham anyway. While I have no essential problem with allowing insurance companies to compete nationwide. (Most do anyway) the industry has absolutely proved that it will not reduce costs.

Eran you opt for theory and NEVER provide examples. Here is one I will provide. The eighth largest economy in the world allows competition among insurance companies. The result? Prices are skyrocketing and access is falling. Outcomes are failing as well. In this minimally controlled market the insurance company profits are up and the dumping of unprofitable patients on the roles of the state increasing.

Now you tell me Eran. You maintain that your system can reduce prices so that everyone can afford effective insurance. Tell me what a family of four that earns less than $20K per year can afford. 20% of households do you know. Tell us exactly where the money will come from to pay for their care and make it profitable for an insurance company to insure them. I can do this. I can do this easily. I am certain you can't consistent with your theory of economics. And it must be possible for you to articulate this without refusing adaquate services and making it profitable for insurance companies or your argument collapses. I can name 34 countries that solved this problem. Now you do it.

Every developed country in the world but us has realized what we keep running our mouths about. That there are some functions (healthcare among them) that government just does better. (Or some hybrid of government controlled private health care.)

Go for it. If you have something that the best experts in the country don't know tell me. I will get it published. What you just posted above is simple evasion. Nonsense really. Time for the specifics. We are ready.

[nucklepunche]

Interesting thread. I think the chances of going to a free market in medicine are next to none. The older voters are holding onto Medicare too much. It makes sense to go universal single payer then the government can negotiate prices. We may pay slightly higher taxes but so what? We already pay some of the lowest taxes in the industrial world. Finally it will create a positive liberty which will encourage entrepreneurs. Do you know how many entrepreneurs are discouraged to start businesses because of worries about health care? As far as I see we would have national health care if only Republican ideology was not standing in the way.

[Drlee]

You are right. And consider this:

Interesting thread. I think the chances of going to a free market in medicine are next to none. The older voters are holding onto Medicare too much.

While it is true that Medicare is dear to older voters, you should also consider that there is not an insurer in the world who wants medicare (and medicaid for that matter) to go away. They do not want the expensive patients. They also know that by pawning the most expensive patients and those who can't pay off on the government that they are free to make tons of money with the cheaper ones. The whole key to insurance is shared risk. The cheap ones pay for the expensive ones. The insurance companies have fucked us royally by making the taxpayer cover the ones who can't pay high premiums for service or who they don't want to cover at all.

If anyone for a moment thinks that the insurance companies stand ready to insure everyone for a reasonable price if the government gets out of the way, they should seek help. I recommend econ 101 for them.

ON EDIT: And here is how skanky the insurance companies are. In the PPACA, they were required to cap out of poket expenses at roughly $6K for singles and $11K for families. But the insurance companies howeled at this WRT medicare suppliments. So the caps do not apply to those over 65. That is these dirt bag free marketers at work.

[nucklepunche]

The big insurance companies complain that Obama is stealing their freedom while demanding handouts. It's typical. Just goes to show how slavish the average Republican is. In a sense they are like unpaid lobbyists and they don't even know it.

[Eran]

Lousy analogy.

If you think this is a bad analogy, you would have to refine your argument.

Your argument for public provision of health are went:
1. The American people will not accept hospitals turning away sick people.
2. Their care costs money that they can't pay themselves
3. Therefore, government ought to fund medical care.

Clearly, you don't believe the same logic applies to food provision. What is the relevant difference?

The market is failing WRT healthy food too.

How do you know? The market gives people what they are willing to pay for. If most people prefer tasty and convenient to healthy, a market providing those goods isn't failing.

Eran you opt for theory and NEVER provide examples. Here is one I will provide. The eighth largest economy in the world allows competition among insurance companies. The result? Prices are skyrocketing and access is falling. Outcomes are failing as well. In this minimally controlled market the insurance company profits are up and the dumping of unprofitable patients on the roles of the state increasing.

Competition between insurance companies is just one component (btw, don't believe political headlines; more often than not, such "competition" is still expected to take place in a highly-restricted marketplace).

We also need competition at the provision level, i.e. relaxation (ideally, complete removal) of the thicket of regulations and restrictions around provision of medical care.

Finally, we need to allow people to pay for their own cost, or, at least, care about that cost. A good idea would be to remove the silly rule that employer-provided health-insurance (but not privately-purchased health-insurance) are tax deductible. This rule creates endless distortions in the market, such as preference for very broad "insurance" that actually is pre-paid medical services.

What would happen to food prices if people were incentivized to only consume foods through programs that allow, for a fixed monthly fee, unlimited access to a range of restaurants?

Now you tell me Eran. You maintain that your system can reduce prices so that everyone can afford effective insurance. Tell me what a family of four that earns less than $20K per year can afford. 20% of households do you know. Tell us exactly where the money will come from to pay for their care and make it profitable for an insurance company to insure them.

Who knows? If we relaxed medical licensing laws, and allowed most minor medical diagnosis and procedures to be performed by experienced nurses and pharmacists, created high deductible insurance policy that only covered catastrophic health-care (e.g. being diagnosed with cancer), as opposed to covering every doctor visit to diagnose and treat an ear infection, if we allowed qualified medical professionals from other countries to offer services in the US, if Wal-mart offered a quick consultation with their own trained employees, covering routine health-care issues, relying on advanced computer-driven expert systems and outsourcing diagnosis to Doctors living and working in India...

I repeat - who knows what innovations might come if you unshackle entrepreneurs and allow them to think?

Go for it. If you have something that the best experts in the country don't know tell me.

This is not how innovation and progress works. You don't condition allowing innovations on a specific roadmap of where those innovations might take you. You unleash entrepreneurs and see what they come up with.

[Drlee]

Eran that is a complete fail.

We already have mid-levels doing what you said they ought to do.

But prices go up.

You want to relax the licensing standards for doctors?



Outsource medical care to India?



Good luck with that prostate exam.

Your entire premise is aburd on the face of it.

There is one issue, and one issue only that you mentioned with which I completely agree.

There must be some incentive for patients to seek less expensive alternatives.

IF EVERYONE HAS ACCESS TO ROUTINE AND PREVENTIVE HEALTH CARE. AND ONLY THEN.

I am in favor of incentivizing patients to use mid-levels and perhaps even dial-a-doc. If, for example, the co-pay for seeing a nurse was $10.00 and a doctor $25.00 I would have no problem with that. I also support a basic care system with people allowed to purchase "Cadillac" provisions if they like.

But all under the aegis of a single-payer system. Once that system is in place, if the insurance companies want to compete for add-ons then they are welcome to do that.

Yet again Eran, you just don't have a reasonable solution. All of the other developed countries in the world have rejected our system and to make our system even worse for many would be inconceiveable.

We are going to get a single payer system. It is not a matter of if. Just when.

[Eran]

We already have mid-levels doing what you said they ought to do.

What makes you think so?

Your entire premise is absurd on the face of it.

Not at all. I wouldn't outsource my prostate exam, but I could easily outsource my X-ray interpretation, something that is already being done.

You want to relax the licensing standards for doctors?

Why is that absurd? Do you agree that licensing standards could (in theory) be made too strict (for example by requiring that all Doctors complete a 15 year apprenticeship before being allowed to prescribe antibiotics)?

If so, how can you tell whether the current licensing standards are "just right", and not too strict? Even if you are right, and the current standards happen to be correct, why is the suggestion that they might be too strict laughable on its face?

[mikema63]

That could be a usefull idea for other systems too, a nurse can do a great many things that doctors now do, freeing doctors to work on more important issues. Could lower wait times in a universal healthcare system as well, no reason any system should consider this at some level.

[Eran]

Except, of course, that a universal healthcare system, like any other monopoly, faces much weaker pressures to economise and become more efficient than would competitive players in a field in which innovation is possible (i.e. not hampered by excessive regulations) and consumers are cost-sensitive.

[ThereBeDragons]

consumers are cost-sensitive.

Demand for healthcare is extremely inelastic, and it is actually quite rare for people to shop hospitals for the best prices.

[Eran]

That's true in today's market, but isn't a fact of nature.

Most people wouldn't need to shop around - it is enough that the marginal consumer would, for hospitals to moderate their prices. Most people don't comparison-shop for food either - they go to their local supermarket, motivate primarily by convenience and quality. But some people do care about prices, and that's enough for supermarkets to keep their prices in check.

We should also distinguish between deciding whether or not to undergo diagnosis / treatment, and deciding where or by whom to undergo the same. Most people will get their injuries treated even at a high cost, but will still prefer getting them treated at a low-cost facility.

[ThereBeDragons]

Most people wouldn't need to shop around - it is enough that the marginal consumer would, for hospitals to moderate their prices.

Only if the difference of the marginal consumers is enough to make up for the lost profit. Very often it is not.

TIME has an article "Bitter Pill: Why Medical Bills Are Killing Us" that investigates why people pay far more than they should for medical care.

[Kman]

Only if the difference of the marginal consumers is enough to make up for the lost profit. Very often it is not.

What a load of bullshit, supermarkets are extremely efficient, they have mindblowingly low costs compared to the work they have to do and why is this? Because any supermarket chain that starts raising its prices by lets say 10% more than its hyperefficient competitors will simply lose a shitload of customers, we have various types of supermarkets in Denmark, some of them are low cost Walmart type things, others are more high end with like 15% higher prices, I dont attend the high end stores because I dont want to pay more for food than I have to. The same would work for healthcare, you would have different clinics offering services and if any clinic raised its prices too much it would simply go bankrupt just like supermarkets go bankrupt if they raise prices too much compared to their competitors. This doesnt happen in american healthcare ofc because the US government have regulated it in such a way that free market cost control no longer works like it does with supermarkets.

[ThereBeDragons]

What a load of bullshit, supermarkets

I was talking about hospitals in particular. I agree that supermarkets tend to charge reasonable prices.

This doesnt happen in american healthcare ofc because the US government have regulated it in such a way that free market cost control no longer works like it does with supermarkets.

It doesn't tend to happen in American healthcare, but how does US government regulation prevent people from hospital shopping?