7 ms·

I have a hard time believing that the "free market" can solve healthcare given that the demand for it is more inelastic than pretty much any other product.

vacri 9y ago
The free market rewards people with money. The problems in healthcare aren't really being felt by people with money.
pdonis 9y ago
The demand for food is also pretty inelastic, yet the free market seems to handle that fine.
- wfo 9y ago
  No actually it does not. The government subsidizes food production and food for the poor HEAVILY. Also food is cheap and plentiful to create. And most importantly, food is easy to steal; the one important factor in a functioning free market libertarians tend to forget about is the natural control at the bottom, for the poor: if the poor need something in order to survive and can't afford it, they act as a check on greed and neoliberalism run amok by ignoring the fake magic pieces of paper that the wealthy wave around as tokens of power and take what they need. It's a lot harder to steal health care so there's no incentive for the rich to modify the system to help the poor like there is with food.
  - JoeAltmaier 9y ago
    Maybe its similar. My last 30-day dose of blood pressure medicine cost be 54 cents. And the store had shelves full of medicine all around me, thousands of them, all easily pocketable.
  - maxerickson 9y ago
    One of the motivations for Medicaid expansion in the ACA was to reduce the number of no-pay emergency room visits.
  - pdonis 9y ago
    > The government subsidizes food production Yes, and this is a bug, not a feature. Food would be cheaper if this were not done. The "subsidies" are to the food producers, to artifically keep prices up. The equivalent for health care would be subsidies to health care providers. > and food for the poor Yes, with food stamps. But nobody tells the poor what they have to spend the food stamps on, and nobody regulates grocery stores up one side and down the other telling them what food items they have to provide if they accept food stamps and what they have to charge for every single item. So this regulation is nothing at all like US health care regulation. The equivalent of food stamps for health care would be to give poor people a flat sum of money per month on a "health care spending card" that they could use at any health care provider they wanted, for any service they wanted. And then no other regulation of health care providers--no rules about what services they have to provide, no regulation of prices, etc. I personally think this would be a significant improvement over the current US system. > food is cheap and plentiful to create Yes, and it would be cheaper if the government did not subsidize producers, as above. The reason for this is, of course, that there is a free market in food (or at least much closer to one than the market in health care) and so producers are competing on price, therefore driving them to make food production more and more efficient. A century ago in the US, food was not cheap and plentiful to create. Technology and production processes improve over time if they are forced to by competition. I see no reason why the same would not apply to health care, if it were competitive the way food production is. > food is easy to steal This is an interesting point, but I'm not sure how much difference it makes in itself, because even the richest person in the world can only consume a limited quantity of food. So it makes no difference to rich people whether the poor can steal food or not; even if they do, the rich won't be the one to suffer, someone much further down the income ladder will (if anyone does). A more interesting aspect is this: > It's a lot harder to steal health care I would rephrase this as: health care is much less fungible than food is. You and I can trade lunches, but we can't trade, say, gallbladder operations or physical exams. I agree that this is potentially a valid reason to treat health care different from food. What might be helpful is to look at other goods or services that are not fungible and see how they are handled in comparison with health care.
    - wfo 9y ago
      Government subsidies are also responsible for a large part of the food production infrastructure -- not only is one of the biggest problems behind food transporting it from production to market, which is completely government subsidized (if food producers had to pay for the highways their trucks use/erode they would go out of business and not serve half the country) food not only is subsidized now, but HAS BEEN subsidized for every moment the industry has existed because it is a necessity. It is impossible to separate the food industry from government interference, they are permanently symbiotically joined. If food production can even now survive now without the government (it cannot in anything near its current form), this does not mean the progress we have today could have been made without it; it just means the government has done a good job of fostering and supporting the industry. Food is heavily regulated, including the food bought by stamps. The government decides what can be purchased by the stamps, and every item of food sold in any store across the country is approved for safety and health. Without these regulations we would have massive constant food related deaths as producers compete on price and compromise safety to the detriment and possibly death of any customer who cannot afford the high quality "market regulated" product which is exactly what has happened in every unregulated industry in the history of the world. And for higher end products: the calculus of a PR cover up operation and possible civil suit vs. actually safely creating food is done by companies, and currently federal regulators weigh in on the side of 'you had better make this safe or else'. You are proposing pushing the balance here towards "well, if we can save a buck, screw it, we can tie the victims up in court until they go bankrupt and die anyway or blame it on the supply chain and promise we will do better" which makes safety much less important. A health care spending card is perhaps a natural suggestion but is made all the more insidious because it is so. It is, in reality, an atrocious and murderous idea; the entire crux of health care is not only that it is essential to living and therefore has an infinite price and that quality is almost impossible for consumers to accurately assess but that needs for different people are drastically different, usually for reasons that have very little to do with their choices or desires, which is why it is generally taken care of by insurance while people do not buy "food insurance". Health care spending cards (or HSAs) are essentially a euphemism for condemning any poor person who gets sick to death. And of course it makes a difference whether poor people can steal the food. Remember that unfettered free market capitalism is the system where a rich man's dog eats 5 course gourmet meals while his poor neighbor's child dies of hunger. Putting something necessary for survival behind an arbitrary chalked in line and saying "sorry, you don't get to have that because you weren't born rich and the neoliberal market economy has transitioned and has no room for your skillset, enjoy your one free death, maybe when you are reincarnated your father will be named Koch" is a very fast way to start riots and anarchy. The only reason the rich are rich is because the poor believe they are and act accordingly, we call this belief structure market society and government; shattering that necessary illusion will likely hurt everyone, but it most definitely hurts the rich. The point is that if food is available but inaccessible to the poor the free market and governmental structure in place will cease to exist -- the market and government have evolved in a very careful way to prevent this from happening.
- VLM 9y ago
  Food is extremely predictable. Expensive medical care is not. Unfortunately the emergency / end of life care is by far the most expensive. You can get maybe a thousand flight physicals for the cost of one really good heart attack. Also once "the system" has its claws in you, you can't leave in practice even if its theoretically legally possible. My MiL goes in with stomach upset vomiting urgent care, next thing you know she's getting admitted something to do with gallbladder removal. In theory she legally could have vomited her way out of the hospital with an IV attached into the parking lot to another, cheaper hospital to have her gallbladder removed (or whatever it was) but in practice this isn't happening.
  - pdonis 9y ago
    > emergency / end of life care Emergency care, yes, that's unpredictable, and that's the sort of thing that health insurance should cover. End of life care is not always unpredictable. In fact it rarely is in terms of the general need. Yes, you can't predict the exact point in time at which an 80-year-old person, say, will have an event that makes them require assisted living or a nursing home, but you can certainly foresee well in advance that such a need will arise at some point around that age. So this is not an unexpected need in the sense that emergency care is. And there's no reason why the same health plan should have to cover both needs, yet that is what the US health system does. > you can't leave in practice even if its theoretically legally possible Yes, this example of yours is an case of an unexpected need that health insurance should cover. However, I don't know of any "health insurance" in the US that only covers cases of unexpected need like this, and does not also cover everything else that is in any way involved with health care.
    - VLM 9y ago
      People like to think competition results in variety, like the difference between Walmart and Nordstrom. The reality is the unified vocational training and the court system and malpractice insurance system and fluidity of employee transfers and government licensing standards mean the variety in care available is more like the difference between McDonalds and Burger King and this aspect is extremely carefully avoided in the debates. Price competition simply will not happen in medical care, theres a lot more required to initiate it than merely messing with the insurance system, it goes very deep. I think you miss the difficulty of walking out in mid treatment. Yes sure in theory its possible for people to get reservations at three restaurants and eat appetizers and drinks at one, the main meal at the second, and desert at the third. In practice roughly zero people do this even though in the restaurant marketplace they're hopefully not in pain or dying or semi-senile or some other medical distress, and their family isn't panicking. To get the restaurant marketplace analogy correct above, you'd have to use McDonalds, Burger King, and Wendys as your examples, so even if you wandered back and forth between restaurants, the bill would be about the same in the end if not higher on a system perspective from all the paperwork and increased transactional costs. The main, possibly only, effect of playing patient "hot potatoe" would be increasing suffering of sick people.
stale2002 9y ago
It is absolutely NOT as inelastic as everyone assumes. Most health issues are not emergencies. I as a consumer would be perfectly happy to shop around the market, and find the best deal on healthcare, if my efforts were rewards. Unfortunately, prices are not transparent, and the costs are not payed directly by me. They are paid by my insurance provider, so why would I bother trying to reduce my bill by thousands of dollars, if someone else is paying for it anyway?
- xherberta 9y ago
  I agree. The incentives are out of whack. Being a self-pay patient over the last several years has been enlightening. The health care people I've dealt with are generally ready to go well out of their way to help make care more affordable. Once I was given an unasked-for 55% discount on an ER visit. (They're happy they don't have to deal with an insurance company!) I've heard that people with high-deductible plans are now finding it advantageous to just say they are self-pay to get the discounts. For comparison shopping, healthcarebluebook.com can give an average price for a certain procedure in your area.
micahbright 9y ago
That's not hard to believe, it only requires an ignorance of economics. Cheers

vacri 9y ago

The free market rewards people with money. The problems in healthcare aren't really being felt by people with money.

pdonis 9y ago

The demand for food is also pretty inelastic, yet the free market seems to handle that fine.

wfo 9y ago
No actually it does not. The government subsidizes food production and food for the poor HEAVILY. Also food is cheap and plentiful to create. And most importantly, food is easy to steal; the one important factor in a functioning free market libertarians tend to forget about is the natural control at the bottom, for the poor: if the poor need something in order to survive and can't afford it, they act as a check on greed and neoliberalism run amok by ignoring the fake magic pieces of paper that the wealthy wave around as tokens of power and take what they need. It's a lot harder to steal health care so there's no incentive for the rich to modify the system to help the poor like there is with food.
- JoeAltmaier 9y ago
  Maybe its similar. My last 30-day dose of blood pressure medicine cost be 54 cents. And the store had shelves full of medicine all around me, thousands of them, all easily pocketable.
- maxerickson 9y ago
  One of the motivations for Medicaid expansion in the ACA was to reduce the number of no-pay emergency room visits.
- pdonis 9y ago
  > The government subsidizes food production Yes, and this is a bug, not a feature. Food would be cheaper if this were not done. The "subsidies" are to the food producers, to artifically keep prices up. The equivalent for health care would be subsidies to health care providers. > and food for the poor Yes, with food stamps. But nobody tells the poor what they have to spend the food stamps on, and nobody regulates grocery stores up one side and down the other telling them what food items they have to provide if they accept food stamps and what they have to charge for every single item. So this regulation is nothing at all like US health care regulation. The equivalent of food stamps for health care would be to give poor people a flat sum of money per month on a "health care spending card" that they could use at any health care provider they wanted, for any service they wanted. And then no other regulation of health care providers--no rules about what services they have to provide, no regulation of prices, etc. I personally think this would be a significant improvement over the current US system. > food is cheap and plentiful to create Yes, and it would be cheaper if the government did not subsidize producers, as above. The reason for this is, of course, that there is a free market in food (or at least much closer to one than the market in health care) and so producers are competing on price, therefore driving them to make food production more and more efficient. A century ago in the US, food was not cheap and plentiful to create. Technology and production processes improve over time if they are forced to by competition. I see no reason why the same would not apply to health care, if it were competitive the way food production is. > food is easy to steal This is an interesting point, but I'm not sure how much difference it makes in itself, because even the richest person in the world can only consume a limited quantity of food. So it makes no difference to rich people whether the poor can steal food or not; even if they do, the rich won't be the one to suffer, someone much further down the income ladder will (if anyone does). A more interesting aspect is this: > It's a lot harder to steal health care I would rephrase this as: health care is much less fungible than food is. You and I can trade lunches, but we can't trade, say, gallbladder operations or physical exams. I agree that this is potentially a valid reason to treat health care different from food. What might be helpful is to look at other goods or services that are not fungible and see how they are handled in comparison with health care.
  - wfo 9y ago
    Government subsidies are also responsible for a large part of the food production infrastructure -- not only is one of the biggest problems behind food transporting it from production to market, which is completely government subsidized (if food producers had to pay for the highways their trucks use/erode they would go out of business and not serve half the country) food not only is subsidized now, but HAS BEEN subsidized for every moment the industry has existed because it is a necessity. It is impossible to separate the food industry from government interference, they are permanently symbiotically joined. If food production can even now survive now without the government (it cannot in anything near its current form), this does not mean the progress we have today could have been made without it; it just means the government has done a good job of fostering and supporting the industry. Food is heavily regulated, including the food bought by stamps. The government decides what can be purchased by the stamps, and every item of food sold in any store across the country is approved for safety and health. Without these regulations we would have massive constant food related deaths as producers compete on price and compromise safety to the detriment and possibly death of any customer who cannot afford the high quality "market regulated" product which is exactly what has happened in every unregulated industry in the history of the world. And for higher end products: the calculus of a PR cover up operation and possible civil suit vs. actually safely creating food is done by companies, and currently federal regulators weigh in on the side of 'you had better make this safe or else'. You are proposing pushing the balance here towards "well, if we can save a buck, screw it, we can tie the victims up in court until they go bankrupt and die anyway or blame it on the supply chain and promise we will do better" which makes safety much less important. A health care spending card is perhaps a natural suggestion but is made all the more insidious because it is so. It is, in reality, an atrocious and murderous idea; the entire crux of health care is not only that it is essential to living and therefore has an infinite price and that quality is almost impossible for consumers to accurately assess but that needs for different people are drastically different, usually for reasons that have very little to do with their choices or desires, which is why it is generally taken care of by insurance while people do not buy "food insurance". Health care spending cards (or HSAs) are essentially a euphemism for condemning any poor person who gets sick to death. And of course it makes a difference whether poor people can steal the food. Remember that unfettered free market capitalism is the system where a rich man's dog eats 5 course gourmet meals while his poor neighbor's child dies of hunger. Putting something necessary for survival behind an arbitrary chalked in line and saying "sorry, you don't get to have that because you weren't born rich and the neoliberal market economy has transitioned and has no room for your skillset, enjoy your one free death, maybe when you are reincarnated your father will be named Koch" is a very fast way to start riots and anarchy. The only reason the rich are rich is because the poor believe they are and act accordingly, we call this belief structure market society and government; shattering that necessary illusion will likely hurt everyone, but it most definitely hurts the rich. The point is that if food is available but inaccessible to the poor the free market and governmental structure in place will cease to exist -- the market and government have evolved in a very careful way to prevent this from happening.
VLM 9y ago
Food is extremely predictable. Expensive medical care is not. Unfortunately the emergency / end of life care is by far the most expensive. You can get maybe a thousand flight physicals for the cost of one really good heart attack. Also once "the system" has its claws in you, you can't leave in practice even if its theoretically legally possible. My MiL goes in with stomach upset vomiting urgent care, next thing you know she's getting admitted something to do with gallbladder removal. In theory she legally could have vomited her way out of the hospital with an IV attached into the parking lot to another, cheaper hospital to have her gallbladder removed (or whatever it was) but in practice this isn't happening.
- pdonis 9y ago
  > emergency / end of life care Emergency care, yes, that's unpredictable, and that's the sort of thing that health insurance should cover. End of life care is not always unpredictable. In fact it rarely is in terms of the general need. Yes, you can't predict the exact point in time at which an 80-year-old person, say, will have an event that makes them require assisted living or a nursing home, but you can certainly foresee well in advance that such a need will arise at some point around that age. So this is not an unexpected need in the sense that emergency care is. And there's no reason why the same health plan should have to cover both needs, yet that is what the US health system does. > you can't leave in practice even if its theoretically legally possible Yes, this example of yours is an case of an unexpected need that health insurance should cover. However, I don't know of any "health insurance" in the US that only covers cases of unexpected need like this, and does not also cover everything else that is in any way involved with health care.
  - VLM 9y ago
    People like to think competition results in variety, like the difference between Walmart and Nordstrom. The reality is the unified vocational training and the court system and malpractice insurance system and fluidity of employee transfers and government licensing standards mean the variety in care available is more like the difference between McDonalds and Burger King and this aspect is extremely carefully avoided in the debates. Price competition simply will not happen in medical care, theres a lot more required to initiate it than merely messing with the insurance system, it goes very deep. I think you miss the difficulty of walking out in mid treatment. Yes sure in theory its possible for people to get reservations at three restaurants and eat appetizers and drinks at one, the main meal at the second, and desert at the third. In practice roughly zero people do this even though in the restaurant marketplace they're hopefully not in pain or dying or semi-senile or some other medical distress, and their family isn't panicking. To get the restaurant marketplace analogy correct above, you'd have to use McDonalds, Burger King, and Wendys as your examples, so even if you wandered back and forth between restaurants, the bill would be about the same in the end if not higher on a system perspective from all the paperwork and increased transactional costs. The main, possibly only, effect of playing patient "hot potatoe" would be increasing suffering of sick people.

stale2002 9y ago

It is absolutely NOT as inelastic as everyone assumes. Most health issues are not emergencies. I as a consumer would be perfectly happy to shop around the market, and find the best deal on healthcare, if my efforts were rewards. Unfortunately, prices are not transparent, and the costs are not payed directly by me. They are paid by my insurance provider, so why would I bother trying to reduce my bill by thousands of dollars, if someone else is paying for it anyway?

xherberta 9y ago
I agree. The incentives are out of whack. Being a self-pay patient over the last several years has been enlightening. The health care people I've dealt with are generally ready to go well out of their way to help make care more affordable. Once I was given an unasked-for 55% discount on an ER visit. (They're happy they don't have to deal with an insurance company!) I've heard that people with high-deductible plans are now finding it advantageous to just say they are self-pay to get the discounts. For comparison shopping, healthcarebluebook.com can give an average price for a certain procedure in your area.

micahbright 9y ago

That's not hard to believe, it only requires an ignorance of economics. Cheers