6 ms·

Can this be a side effect of the "free healthcare" goal that the state is trying to achieve? When people don't have to pay for something straight from their po

Can this be a side effect of the "free healthcare" goal that the state is trying to achieve? When people don't have to pay for something straight from their pocket, they're not feeling the ripoff so strongly, so they don't revolt. That's why I personally think that the systems where people vote with their wallets are much more efficient.

bigchewy 10y ago
the challenge is that ~40% of healthcare spend is even plausibly directed by the patient. the majority is not elective, a result of an acute situation, etc. The concept of free market, unfortunately, doesn't work. It's easy to confuse this because most people on HN are (relatively) healthy. 15% of the population consumes 80% of total healthcare spend. These are the ones that we need to solve for Sources: lots of research I could link to but don't have handy and, with great dismay/frustration, I've spent a decade analyzing the root causes of US healthcare spend.
- nickff 10y ago
  How much does the government have to intervene in this market before it is at least partially culpable for the problems? Will government be blamed for any systemic problems even when there is a single-payer system, or will the problems then be attributed to underfunding?
- deleted 10y ago
  [deleted]
rickycook 10y ago
here in australia where social healthcare pays for plenty of things including medicine subsidies, i'd tend to disagree
willvarfar 10y ago
And yet in countries with universal health care, the cost of health care in real total terms is much lower: https://en.wikipedia.org/wiki/List_of_countries_by_total_health_expenditure_per_capita https://en.wikipedia.org/wiki/List_of_countries_by_total_hea... Monopolies can dictate terms, which is why monopolistic companies are regulated. But if that monopoly is the state, then it actually works in the citizens favour if the monopoly presses down costs.
- hueving 10y ago
  So the question that comes up with this, if there is no free market like the US medical system, would it kill the incentive for biomedical startups and pharmaceutical research in general (which is largely based on the US now).
  - vvvv 10y ago
    Is the R&D largely based in the US? Also, it's important to distinguish between true R&D aimed at developing actual cures and iterative R&D aimed at developing medicine that will get you hooked on long-term courses that maximise profits.
    - willvarfar 10y ago
      And R&D aimed at developing replacements for perfectly-fine drugs that are soon to go out of patent, or R&D that is put on a back burner until some other drug is about to go out of patent etc.
    - hueving 10y ago
      >Is the R&D largely based in the US? As far as I understand it, yes. http://www.xconomy.com/seattle/2014/09/02/which-countries-excel-in-creating-new-drugs-its-complicated/# http://www.xconomy.com/seattle/2014/09/02/which-countries-ex... As far as your claim about most drugs being a scam, I can't speak to that as I'm not familiar enough with the industry.
  - snewk 10y ago
    I think its clear that the US medical system is specifically not a free market. It has become (and is continuing to become) increasingly subjected to regulatory capture.
    - AstralStorm 10y ago
      Corporate capture, not regulatory. Plain old corruption. Regulation just increases the barrier to enter for competition, which is beneficial to the status quo who can afford it.
pikzen 10y ago
Unfortunately, voting with your wallet when it's a matter of life and death is not an option.
- nickff 10y ago
  People vote with their wallets (and their feet) on matters of life and death all the time. People choose what car they buy (with crash ratings and cost being significant factors), what dentist they go to (in places where they pay for dental), and many (but not all) Canadians choose to pay for medical care to avoid long waits. People also choose what neighborhood they live in (both safety and pollution are significant concerns), what job they do, how much to spend on food, what airplane to fly on (, the DC-10 was doomed by its safety record), and any number of other health-critical, financial decisions.
  - gambiting 10y ago
    I thought it was obvious, but I'm sure OP meant that if you have an accident, you can't shop for providers - an ambulance or a helicopter takes you to a hospital, and you wake up with a gigantic bill. Not exactly "voting with your wallet", is it?
    - nickff 10y ago
      Perhaps there is some misunderstanding, but that (parent to my comment) was responding to a comment which indicated that there is too much government intervention, which is not allowing people to feel the direct financial impact of their medical decisions. People using epipens are not buying them 'just-in-time', they are planning ahead. The great grandparent comment also seemed to be speaking to the way the government has incentivized employer-provided health insurance, which insulates people from making cost/benefit decisions. I think that if individuals had to pay $100 per juice box their insurer gets billed, they would likely find a way to cut costs.
colemickens 10y ago
Wait, how is the state trying to achieve "free healthcare" in the US? .... or is your comment not about the US? If it's in regards to Obamacare, that's pretty recent compared to the trend of the medical lobbying getting one over on Americans... and definitely not "free healthcare" by really any measure.
huuu 10y ago
Voting with your wallet is very short sighted. Some examples: A manager replaces free coffee in the office with a paid vending machine to save expenses. Moral goes down. Production goes down. A team member is fired because she has the worst production level of the team. What they did not know is that this team member was holding the team together. So there are a lot of side effects to every decision. And therefore I think voting with your wallet is a bad idea.
- armenarmen 10y ago
  alternatively: A manager sees that workers work better when well caffeinated, but that they are sucking up time with starbucks runs. So she installs a Keurig machine, an investment that saves money and time in the long run.
- nickff 10y ago
  Voting with your wallet is short-sighted if you are short-sighted. Alternatively, we might have a manager who buys a coffee machine to give the employees free coffee, as the former sees the latter will be happier and more productive for a low price; this the manager buys productivity cheaply.
- deleted 10y ago
  [deleted]
- hueving 10y ago
  That's not even what "voting with your wallet" means. It has nothing to do with saving costs. It's about depriving an organization/person of money to stop supporting them. For example, you might choose a higher airfare with a carrier that has better customer service than the cheapest. This is voting with your wallet and it has nothing to do with cutting costs.
- austinjp 10y ago
  In this situation, an example of the staff "voting with their wallets" might be that they buy coffee elsewhere. The manager hasn't "voted with their wallet" in your example.
deleted 10y ago
[deleted]

bigchewy 10y ago

the challenge is that ~40% of healthcare spend is even plausibly directed by the patient. the majority is not elective, a result of an acute situation, etc. The concept of free market, unfortunately, doesn't work. It's easy to confuse this because most people on HN are (relatively) healthy. 15% of the population consumes 80% of total healthcare spend. These are the ones that we need to solve for Sources: lots of research I could link to but don't have handy and, with great dismay/frustration, I've spent a decade analyzing the root causes of US healthcare spend.

nickff 10y ago
How much does the government have to intervene in this market before it is at least partially culpable for the problems? Will government be blamed for any systemic problems even when there is a single-payer system, or will the problems then be attributed to underfunding?
deleted 10y ago
[deleted]

rickycook 10y ago

here in australia where social healthcare pays for plenty of things including medicine subsidies, i'd tend to disagree

willvarfar 10y ago

And yet in countries with universal health care, the cost of health care in real total terms is much lower: https://en.wikipedia.org/wiki/List_of_countries_by_total_health_expenditure_per_capita https://en.wikipedia.org/wiki/List_of_countries_by_total_hea... Monopolies can dictate terms, which is why monopolistic companies are regulated. But if that monopoly is the state, then it actually works in the citizens favour if the monopoly presses down costs.

hueving 10y ago
So the question that comes up with this, if there is no free market like the US medical system, would it kill the incentive for biomedical startups and pharmaceutical research in general (which is largely based on the US now).
- vvvv 10y ago
  Is the R&D largely based in the US? Also, it's important to distinguish between true R&D aimed at developing actual cures and iterative R&D aimed at developing medicine that will get you hooked on long-term courses that maximise profits.
  - willvarfar 10y ago
    And R&D aimed at developing replacements for perfectly-fine drugs that are soon to go out of patent, or R&D that is put on a back burner until some other drug is about to go out of patent etc.
  - hueving 10y ago
    >Is the R&D largely based in the US? As far as I understand it, yes. http://www.xconomy.com/seattle/2014/09/02/which-countries-excel-in-creating-new-drugs-its-complicated/# http://www.xconomy.com/seattle/2014/09/02/which-countries-ex... As far as your claim about most drugs being a scam, I can't speak to that as I'm not familiar enough with the industry.
- snewk 10y ago
  I think its clear that the US medical system is specifically not a free market. It has become (and is continuing to become) increasingly subjected to regulatory capture.
  - AstralStorm 10y ago
    Corporate capture, not regulatory. Plain old corruption. Regulation just increases the barrier to enter for competition, which is beneficial to the status quo who can afford it.

pikzen 10y ago

Unfortunately, voting with your wallet when it's a matter of life and death is not an option.

nickff 10y ago
People vote with their wallets (and their feet) on matters of life and death all the time. People choose what car they buy (with crash ratings and cost being significant factors), what dentist they go to (in places where they pay for dental), and many (but not all) Canadians choose to pay for medical care to avoid long waits. People also choose what neighborhood they live in (both safety and pollution are significant concerns), what job they do, how much to spend on food, what airplane to fly on (, the DC-10 was doomed by its safety record), and any number of other health-critical, financial decisions.
- gambiting 10y ago
  I thought it was obvious, but I'm sure OP meant that if you have an accident, you can't shop for providers - an ambulance or a helicopter takes you to a hospital, and you wake up with a gigantic bill. Not exactly "voting with your wallet", is it?
  - nickff 10y ago
    Perhaps there is some misunderstanding, but that (parent to my comment) was responding to a comment which indicated that there is too much government intervention, which is not allowing people to feel the direct financial impact of their medical decisions. People using epipens are not buying them 'just-in-time', they are planning ahead. The great grandparent comment also seemed to be speaking to the way the government has incentivized employer-provided health insurance, which insulates people from making cost/benefit decisions. I think that if individuals had to pay $100 per juice box their insurer gets billed, they would likely find a way to cut costs.

colemickens 10y ago

Wait, how is the state trying to achieve "free healthcare" in the US? .... or is your comment not about the US? If it's in regards to Obamacare, that's pretty recent compared to the trend of the medical lobbying getting one over on Americans... and definitely not "free healthcare" by really any measure.

huuu 10y ago

Voting with your wallet is very short sighted. Some examples: A manager replaces free coffee in the office with a paid vending machine to save expenses. Moral goes down. Production goes down. A team member is fired because she has the worst production level of the team. What they did not know is that this team member was holding the team together. So there are a lot of side effects to every decision. And therefore I think voting with your wallet is a bad idea.

armenarmen 10y ago
alternatively: A manager sees that workers work better when well caffeinated, but that they are sucking up time with starbucks runs. So she installs a Keurig machine, an investment that saves money and time in the long run.
nickff 10y ago
Voting with your wallet is short-sighted if you are short-sighted. Alternatively, we might have a manager who buys a coffee machine to give the employees free coffee, as the former sees the latter will be happier and more productive for a low price; this the manager buys productivity cheaply.
deleted 10y ago
[deleted]
hueving 10y ago
That's not even what "voting with your wallet" means. It has nothing to do with saving costs. It's about depriving an organization/person of money to stop supporting them. For example, you might choose a higher airfare with a carrier that has better customer service than the cheapest. This is voting with your wallet and it has nothing to do with cutting costs.
austinjp 10y ago
In this situation, an example of the staff "voting with their wallets" might be that they buy coffee elsewhere. The manager hasn't "voted with their wallet" in your example.

deleted 10y ago

[deleted]