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I imagine both single-payer and a truly free market health care system would be substantially cheaper than the current system -- which has none of the benefits

I imagine both single-payer and a truly free market health care system would be substantially cheaper than the current system -- which has none of the benefits of either approach. With the federal government unable to act, turning healthcare back to the states to test a number of different solutions seems entirely reasonable. Let California try single-payer and Texas try something different -- after a few years see if we've found a solution that could work for the whole country.

ravitation 9y ago
> a truly free market health care system would be substantially cheaper Why would you imagine that? Regardless... You must also then ask the question, whether a "truly free market health care system" would be ethical.
- warcher 9y ago
  It's a fun thought experiment, but we'd never do it. A free market would look something like this: 1) everybody buys their own insurance in a genuinely free marketplace (this is ENTIRELY not the case now and would probably require significant gov intervention to defeat cartel-seeking behavior from insurance co's. There are good reasons insurance is so highly regulated, only the first of which is that insurance companies are highly incentivized to not pay out since they already have your money, and you can't go elsewhere with your claim.) 2) if you can't pay, you die in the gutter.
  - warcher 9y ago
    Point two would be a hell of an incentive to get insurance, by the by. Beats the hell out of some candy-ass tax penalty. "Young invincible bet wrong, got caught in some freak skateboarding accident? Sucks to be you. You an organ donor by any chance?"
    - magicalist 9y ago
      > Point two would be a hell of an incentive to get insurance, by the by. Beats the hell out of some candy-ass tax penalty. "Young invincible bet wrong, got caught in some freak skateboarding accident? Sucks to be you. You an organ donor by any chance?" It wasn't before, so it probably wouldn't serve as one in the future. The issue is that people aren't very good at estimating risk. I'm young, healthy, and no one in my family has been in a serious car accident/gotten cancer/had a heart attack in the last 15 years. Obviously that happening is a low risk compared to the financial penalty of maintaining insurance today, so why should I worry? Besides, I'm sure I can get some kind of plan from an insurance company if something bad does happen[1] [1] I'll be sure to look into the feasibility of this statement as soon as I finish all the other important things on my todo list...
      - warcher 9y ago
        Oh yeah, I don't mean it'd work, I think healthcare neatly falls in the category of collective action problems that are poor fits for the capitalistic profit motive. A lot of people would suffer and die unnecessarily. And in a democracy, enough people would be incentivized to vote for exception after exception to destroy any semblance of market competition. Old people are very very good at two things: getting sick and voting. The pathological dysfunction of American healthcare is pretty much inevitable if you try to stuff for-profit healthcare into a democracy. I'm really not a socialist, I promise. I just don't see how you'd do it any other better, and it's pretty clear to me that the results are definitively in for our free market experiment. It's funny how we all pretty much agree the govt should be in charge of stuff like roads, schools, military, police, fire dept, courts, quite a long list of stuff, but adding anything to that is marketed as creeping socialism.
    - xname2 9y ago
      In that case, why would the person choose to do skateboarding? Also, does the individual has any family / friend / church support? If you have no family, no friend, not involved in any community, why do you risk yourself for fun? Because "the society" have to pay for your stupidity?
  - xname2 9y ago
    "2) if you can't pay, you die in the gutter." No. It is simply false. Even a 100% free market does not exclude charity.
    - ravitation 9y ago
      So, the people too poor to pay but not poor enough for charity die slowly in their hovels?
    - warcher 9y ago
      Somebody pays, or you die in the gutter. Lotta people talk about charity as a replacement for government services, but folks give around 3% of their income to charity (tax deductible) in the US. That ain't gonna get it done. Not even close. People would have you believe they would give more if they didn't pay as much in taxes, but there is not one shred of evidence that is the case based on variations in local tax rates. And that's a hell of a gap to bridge based on a such a dubious promise. Occam's razor, and the available evidence, suggests that people would just pocket the difference and the poor can go to hell. They're happy to argue the point until they're blue in the face, but if the past year has taught us nothing at all, it's that people are more than capable of crafting any number of passionate arguments around their self-interest, truth be damned.
      - krupan 9y ago
        And so we should put government in control of health care. But who runs government? Oh, it's people, who you just argued are all hopelessly greedy and self-centered.
        warcher 9y ago
        It's not as if we don't have experimental data on both the ability to run a government that is more or less functional with a bunch of self-interested actors in general, or the relative merits of the free market vs socialized healthcare in specific. We ran the numbers. It isn't working. The arguments around doubling down on the free market I find intellectually spurious, and the most convenient explanation from my perspective is the fact that we are thus far wealthy and powerful enough to afford the application of a one-size-fits-all ideology to avoid the emotional strain of admitting we were wrong all these years.
  - coredog64 9y ago
    States or the feds could offer re-insurance for your primary insurance provider. That removes the incentive to not pay out, since astronomical risk moves into a larger pool (either the entire state or the entire US).
  - seanmcdirmid 9y ago
    Point two is already true in developing countries.
- kansface 9y ago
  > Why would you imagine that? Why do you imagine it wouldn't!? The portions of health care universally not covered by insurance are not subject to the same cost disease of the industry as a whole. Lo and behold, the real cost of eg. breast augmentation is declining (total cost of about 4K)! The cost of lasik has decreased ~50% over the last 15 years, current results are better, and the surgery has the highest rating of patient satisfaction in the entire industry! A similar result anywhere else in medicine in the US is completely unimaginable. > Regardless... You must also then ask the question, whether a "truly free market health care system" would be ethical. Nonsense. The important question is: 'would a "truly free market health care system" be more ethical than the current system'.
  - learc83 9y ago
    >Why do you imagine it wouldn't!? The portions of health care universally not covered by insurance are not subject to the same cost disease of the industry as a whole. Lo and behold, the real cost of eg. breast augmentation is declining (total cost of about 4K)! The cost of lasik has decreased ~50% over the last 15 years, current results are better, and the surgery has the highest rating of patient satisfaction in the entire industry! A similar result anywhere else in medicine in the US is completely unimaginable. In addition to not being covered by insurance those procedures are all elective. For elective procedures a free market is more likely to produce better results. There is no way to make money insuring or treating poor, sick patients. The free market just can't do it. The inherent problem here is that the math behind traditional free market economics breaks down when it comes to life saving goods and services. There is no equilibrium to be had, because of a combination of issues. First the answer to how much will you pay to access this live saving drug is "anything" for 99% of the population. Second, life saving services are time sensitive--customers often can't choose a different supplier except the closest one. Third patent law ensures that there often isn't an alternative supplier.
  - ravitation 9y ago
    Elective procedures work well in a free market system. That is not surprising at all, nor is it incredibly meaningful when trying to look at the health care industry as a whole. > Nonsense. The important question is: 'would a "truly free market health care system" be more ethical than the current system'. If you want to be overly semantic, which you clearly do, that's actually not "the important question" since it actually tells you less than my original question. You care about "a truly free market health care system's" relative ethicality not just in relation to the current system, but also in relation to (all) other potential alternative health care system (like a single payer system)...
typomatic 9y ago
In the meantime, Americans will die needless deaths from not receiving basic healthcare, but the market will win, so their sacrifice will be worth it.
- buckbova 9y ago
  > Americans will die needless deaths First off everyone dies. Who's not receiving healthcare right now that would be ultimately saved by the government? Secondly let's cut the hyperbole and have a rational conversation about this.
  - ravitation 9y ago
    But not everyone dies a needless death, which was his point. It is not irrational to point out the cost of ongoing debate.
    - buckbova 9y ago
      > In the meantime, Americans will die needless deaths from not receiving basic healthcare No, it's the typical appeal to emotion nonsense that got the ACA passed to begin with. Now that's going to fail before it's even completely applied.
      - ravitation 9y ago
        Making an emotional appeal is not inherently nonsense, so you will have to provide a little more of an argument as to why it's not a valid point to make.
  - magicalist 9y ago
    > Who's not receiving healthcare right now that would be ultimately saved by the government? People not receiving basic preventative care with problems that are only going to snowball until emergency services can try to treat a much more complex situation in the future? > Secondly let's cut the hyperbole and have a rational conversation about this. You could have maybe had a point by quoting "but the market will win", but "Americans will die needless deaths from not receiving basic healthcare" is literally what's at stake. What exactly do you think the downsides of people not being able to afford healthcare are?
rhcom2 9y ago
That would require both ideological sides to agree on objectives, agree on what counts as successful, agree on metrics. Something I doubt will ever happen at this point.
- krath94 9y ago
  Isn't the objective for both sides to provide affordable healthcare? I think they agree on the objectives, the means of getting there are where the disagreement comes from.
cortesoft 9y ago
The problem with a 'each state do their own thing' solution is the very problem with health care in this country in general - the freeloader problem. If California implements a single payer system, it would make people in other states more likely to choose not to get healthcare; if they get sick, they can just move to California. This is the reason the ACA has the 'individual mandate' to go along with preventing the denial of care because of pre-existing conditions - without some coercive force, there is no reason to buy health care until you get sick. This is why a national single payer system is the solution.
- flavor8 9y ago
  I'm not convinced this is insurmountable. How do countries with single payer handle this? Surely you could require an newly established resident who wants treatment to pay a portion since they hadn't been funding it directly via taxes, and then add a further penalty if they move back out of state within a certain period of time (to discourage moving in-state just for treatment).
  - Analemma_ 9y ago
    > I'm not convinced this is insurmountable. How do countries with single payer handle this? I'm confused by your question. Countries with single-payer have the same policy everywhere in the country, so there is no freeloading involved. Unless you're talking about people coming from other countries, in which case it's handled by their immigration policy.
  - cortesoft 9y ago
    It isn't insurmountable, it basically comes down to having to choose to deny care to someone. However, it is really hard to do it in a fair and humane way; to deny care to people trying to freeload but not deny care to people who aren't. The whole point of universal, single payer, healthcare is to avoid having to make this determination. This isn't an issue for a country because the number of new residents (immigrants) is not a large percentage of the total number of citizens. If it was a state, though, that ratio might not work out; there is a VERY large pool of possible 'freeloaders' who are legally allowed to move to the state whenever they want.
verelo 9y ago
Which would mark the second time in 241 years those states agreed upon something... In all seriousness, state run healthcare is a great idea, but the government is just such a big stakeholder in having a healthy population that I do not see a good reason for it [at some level] to stay out of that line of business. Single payer works, so much better than the current setup...why not start there and try iterate?
- dsfyu404ed 9y ago
  That would all be fine and dandy if it weren't for that pesky 200yr old document that explicitly denies the federal government the right to micromanage except in very specific circumstances.
  - verelo 9y ago
    sure, so like i said...use the state government. The point i was trying to make is basically this: as a government [local, state, fed...you pick] my interest would be in having a productive and happy workforce. One of the best tools i have to influnce that would be healthcare...hence, i see no outcome where the government [again - local, state, fed...whatever] should probably be involved in that. ORRRRR....you do what you've done 27 times before, and you amend the 200 yr old document :) We all make mistakes, sometimes the best option is to own up to them and do something different.
  - magicalist 9y ago
    > 200yr old document that explicitly denies the federal government the right to micromanage except in very specific circumstances. right, as long as you ignore 200 years of legal precedent in which it has...
anotherfounder 9y ago
Also, healthcare isn't truly a free market since there are no free agent buyers. So, you'd have to define that phrase 'truly free market health care'.
rednerrus 9y ago
You can't have a truly free market health care system: https://krugman.blogs.nytimes.com/2009/07/25/why-markets-cant-cure-healthcare/ https://krugman.blogs.nytimes.com/2009/07/25/why-markets-can... http://www.who.int/bulletin/volumes/82/2/PHCBP.pdf http://www.who.int/bulletin/volumes/82/2/PHCBP.pdf The federal government already pays for 64.3% of healthcare costs http://www.pnhp.org/news/2016/january/government-funds-nearly-two-thirds-of-us-health-care-costs-american-journal-of-pub http://www.pnhp.org/news/2016/january/government-funds-nearl.... In a centralized managed system this would likely cover the cost of all healthcare. It's roughly what other industrialized nations pay, per person, for single-payer.
- coredog64 9y ago
  This is what I don't understand. The feds are paying a bunch of money via Medicare/Medicaid/VA but clearly aren't covering everyone. What is the mechanism whereby more people are covered but no additional funds are required? Yes, there's some profit in private insurance companies, but it's not _that_ much.
  - rednerrus 9y ago
    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... Our current system is seriously inefficient. Look at how much we spend compared to similar industrialized countries that have single-payer systems. These numbers include the ~13% of the population that didn't have health insurance at the time this chart was created. So we currently pay roughly twice as much to cover 87% of our population. If we had a system similar to Germany we could do it with $600/capita/year in private money added. I would gladly split an additional $50/month in healthcare costs with my employer.
  - quadrangle 9y ago
    PROFIT is not the only economic factor. Let's say I'm in the business of selling normal goods (say, backpacks). Now, instead of just people going to my website or looking at crowdsourced backpack reviews, there's some cartel that has figured out how to dominate search engines and other sources so that almost all the customers see their middle-man stuff and buy through them instead of directly (even more extreme, maybe they spend massively on lobbying to achieve real rent-seeking via outlawing direct purchases by consumers, although that's not necessary for my argument). These middle-men charge much higher prices than we'd see if everyone bought directly. But dominating the search-engines while the algorithms constantly change is ENORMOUS work, so these cartel companies pay almost all their revenue to a huge number of employees who work constantly to update their systems and maintain their middle-man dominance. You could say they "barely make a profit!" So, in that scenario above, it's painfully obvious that the system is horribly wasteful and all-around negative for the economy aside from all the bullshit work of the cartel employees directly providing them income. The room for efficiency improvements are, in this case, nearly the entire REVENUE of the middle-men, minus only the costs of the goods themselves, not just their profits!! Insurance companies do TONS of bullshit economic waste that is both necessary to the system as it is today yet unnecessary in a single-payer system. All of that waste is NOT profit but IS available margin for efficiency improvements. But really, insurers are just one aspect. There's also total craziness in the core pricing that providers set and lots of other complete insanity in the status quo. P.S. the middle-man issues described above are potential market-failures for any market system and just one of many reasons that dogmatic "free market" ideology is bullshit. That said, there's cases where actions to fix market failures only make things worse. Recognizing that free-market dogma is bullshit does NOT mean the opposing dogma is correct.
donmatito 9y ago
If by "truly free market" you mean that healthy people can opt out of being insured, no, that would drive the costs up. Risk selection is a very driver of prices in health insurance. If you can spread the risk between healthy and sick people, the price goes down. If you can't, the price goes up. Secondly, having a population that has no health insurance means less prevention, i.e. worse health problems down the road, again driving the costs up
- krath94 9y ago
  No the point of free market is that insurance is cheap enough that even healthy people buy it. Or even better, that healthcare costs are low enough that you don't even need insurance (that won't happen though because of the healthcare monopolies).
  - nolepointer 9y ago
    >Or even better, that healthcare costs are low enough that you don't even need insurance See, this is what I don't get. I'm fairly inexperienced with this stuff, but it's starting to become relevant in my life. Despite my new employer offering insurance, I'm staying on my parents' until I'm 26 (this was part of their policy even before Obamacare). However, this is the question I've been asking ... why do I even need health insurance? Why can't the money I pay in the form of premiums just be used to pay for my health care? The answer: well, it can be really expensive, so this way the cost is shared. But why is it expensive? Why don't I ask how much something is versus whether my insurance will cover it? Again, like I said, I don't have a lot of experience, so go easy on me. But I think my questions are valid.
    - harryh 9y ago
      Part of health insurance is a bit like fire insurance on your house. There is a really small chance that your house will burn down next year (say 1 in 10,000) but if it does you'll lose a ton of money (say $500,000). So you pay $55 to get a year of fire insurance (500,000 / 10,000 = 50 + 5 in profit for the insurance company). This is a great deal for you. $55 is no big deal and now if your house burns down you don't suffer a tremendous financial loss. Similarly there is a really low chance you'll get cancer next year. But if you do it could cost a ton (millions of dollars possibly) to treat. So insurance is a good deal for this too. Now, in the US 2 other things get lopped on to health insurance that make things a bit more complicated: 1) For a lot of people health insurance covers cheap and predictable expenses like an annual checkup. There are a lot of people that think using insurance for this is a bad idea. But some people think it's a good idea. It's complicated. 2) Health insurance (especially after Obamacare) can be a form of social insurance where healthy and/or rich people pay more than they otherwise would so that unhealthy and/or poor people pay less. This reduces economic inequality. There is a lot of political disagreement about whether this is a good idea. Did this help? I've glossed over a ton of details but maybe it's enough to get started.

ravitation 9y ago

> a truly free market health care system would be substantially cheaper Why would you imagine that? Regardless... You must also then ask the question, whether a "truly free market health care system" would be ethical.

warcher 9y ago
It's a fun thought experiment, but we'd never do it. A free market would look something like this: 1) everybody buys their own insurance in a genuinely free marketplace (this is ENTIRELY not the case now and would probably require significant gov intervention to defeat cartel-seeking behavior from insurance co's. There are good reasons insurance is so highly regulated, only the first of which is that insurance companies are highly incentivized to not pay out since they already have your money, and you can't go elsewhere with your claim.) 2) if you can't pay, you die in the gutter.
- warcher 9y ago
  Point two would be a hell of an incentive to get insurance, by the by. Beats the hell out of some candy-ass tax penalty. "Young invincible bet wrong, got caught in some freak skateboarding accident? Sucks to be you. You an organ donor by any chance?"
  - magicalist 9y ago
    > Point two would be a hell of an incentive to get insurance, by the by. Beats the hell out of some candy-ass tax penalty. "Young invincible bet wrong, got caught in some freak skateboarding accident? Sucks to be you. You an organ donor by any chance?" It wasn't before, so it probably wouldn't serve as one in the future. The issue is that people aren't very good at estimating risk. I'm young, healthy, and no one in my family has been in a serious car accident/gotten cancer/had a heart attack in the last 15 years. Obviously that happening is a low risk compared to the financial penalty of maintaining insurance today, so why should I worry? Besides, I'm sure I can get some kind of plan from an insurance company if something bad does happen[1] [1] I'll be sure to look into the feasibility of this statement as soon as I finish all the other important things on my todo list...
    - warcher 9y ago
      Oh yeah, I don't mean it'd work, I think healthcare neatly falls in the category of collective action problems that are poor fits for the capitalistic profit motive. A lot of people would suffer and die unnecessarily. And in a democracy, enough people would be incentivized to vote for exception after exception to destroy any semblance of market competition. Old people are very very good at two things: getting sick and voting. The pathological dysfunction of American healthcare is pretty much inevitable if you try to stuff for-profit healthcare into a democracy. I'm really not a socialist, I promise. I just don't see how you'd do it any other better, and it's pretty clear to me that the results are definitively in for our free market experiment. It's funny how we all pretty much agree the govt should be in charge of stuff like roads, schools, military, police, fire dept, courts, quite a long list of stuff, but adding anything to that is marketed as creeping socialism.
  - xname2 9y ago
    In that case, why would the person choose to do skateboarding? Also, does the individual has any family / friend / church support? If you have no family, no friend, not involved in any community, why do you risk yourself for fun? Because "the society" have to pay for your stupidity?
- xname2 9y ago
  "2) if you can't pay, you die in the gutter." No. It is simply false. Even a 100% free market does not exclude charity.
  - ravitation 9y ago
    So, the people too poor to pay but not poor enough for charity die slowly in their hovels?
  - warcher 9y ago
    Somebody pays, or you die in the gutter. Lotta people talk about charity as a replacement for government services, but folks give around 3% of their income to charity (tax deductible) in the US. That ain't gonna get it done. Not even close. People would have you believe they would give more if they didn't pay as much in taxes, but there is not one shred of evidence that is the case based on variations in local tax rates. And that's a hell of a gap to bridge based on a such a dubious promise. Occam's razor, and the available evidence, suggests that people would just pocket the difference and the poor can go to hell. They're happy to argue the point until they're blue in the face, but if the past year has taught us nothing at all, it's that people are more than capable of crafting any number of passionate arguments around their self-interest, truth be damned.
    - krupan 9y ago
      And so we should put government in control of health care. But who runs government? Oh, it's people, who you just argued are all hopelessly greedy and self-centered.
      - warcher 9y ago
        It's not as if we don't have experimental data on both the ability to run a government that is more or less functional with a bunch of self-interested actors in general, or the relative merits of the free market vs socialized healthcare in specific. We ran the numbers. It isn't working. The arguments around doubling down on the free market I find intellectually spurious, and the most convenient explanation from my perspective is the fact that we are thus far wealthy and powerful enough to afford the application of a one-size-fits-all ideology to avoid the emotional strain of admitting we were wrong all these years.
- coredog64 9y ago
  States or the feds could offer re-insurance for your primary insurance provider. That removes the incentive to not pay out, since astronomical risk moves into a larger pool (either the entire state or the entire US).
- seanmcdirmid 9y ago
  Point two is already true in developing countries.
kansface 9y ago
> Why would you imagine that? Why do you imagine it wouldn't!? The portions of health care universally not covered by insurance are not subject to the same cost disease of the industry as a whole. Lo and behold, the real cost of eg. breast augmentation is declining (total cost of about 4K)! The cost of lasik has decreased ~50% over the last 15 years, current results are better, and the surgery has the highest rating of patient satisfaction in the entire industry! A similar result anywhere else in medicine in the US is completely unimaginable. > Regardless... You must also then ask the question, whether a "truly free market health care system" would be ethical. Nonsense. The important question is: 'would a "truly free market health care system" be more ethical than the current system'.
- learc83 9y ago
  >Why do you imagine it wouldn't!? The portions of health care universally not covered by insurance are not subject to the same cost disease of the industry as a whole. Lo and behold, the real cost of eg. breast augmentation is declining (total cost of about 4K)! The cost of lasik has decreased ~50% over the last 15 years, current results are better, and the surgery has the highest rating of patient satisfaction in the entire industry! A similar result anywhere else in medicine in the US is completely unimaginable. In addition to not being covered by insurance those procedures are all elective. For elective procedures a free market is more likely to produce better results. There is no way to make money insuring or treating poor, sick patients. The free market just can't do it. The inherent problem here is that the math behind traditional free market economics breaks down when it comes to life saving goods and services. There is no equilibrium to be had, because of a combination of issues. First the answer to how much will you pay to access this live saving drug is "anything" for 99% of the population. Second, life saving services are time sensitive--customers often can't choose a different supplier except the closest one. Third patent law ensures that there often isn't an alternative supplier.
- ravitation 9y ago
  Elective procedures work well in a free market system. That is not surprising at all, nor is it incredibly meaningful when trying to look at the health care industry as a whole. > Nonsense. The important question is: 'would a "truly free market health care system" be more ethical than the current system'. If you want to be overly semantic, which you clearly do, that's actually not "the important question" since it actually tells you less than my original question. You care about "a truly free market health care system's" relative ethicality not just in relation to the current system, but also in relation to (all) other potential alternative health care system (like a single payer system)...

typomatic 9y ago

In the meantime, Americans will die needless deaths from not receiving basic healthcare, but the market will win, so their sacrifice will be worth it.

buckbova 9y ago
> Americans will die needless deaths First off everyone dies. Who's not receiving healthcare right now that would be ultimately saved by the government? Secondly let's cut the hyperbole and have a rational conversation about this.
- ravitation 9y ago
  But not everyone dies a needless death, which was his point. It is not irrational to point out the cost of ongoing debate.
  - buckbova 9y ago
    > In the meantime, Americans will die needless deaths from not receiving basic healthcare No, it's the typical appeal to emotion nonsense that got the ACA passed to begin with. Now that's going to fail before it's even completely applied.
    - ravitation 9y ago
      Making an emotional appeal is not inherently nonsense, so you will have to provide a little more of an argument as to why it's not a valid point to make.
- magicalist 9y ago
  > Who's not receiving healthcare right now that would be ultimately saved by the government? People not receiving basic preventative care with problems that are only going to snowball until emergency services can try to treat a much more complex situation in the future? > Secondly let's cut the hyperbole and have a rational conversation about this. You could have maybe had a point by quoting "but the market will win", but "Americans will die needless deaths from not receiving basic healthcare" is literally what's at stake. What exactly do you think the downsides of people not being able to afford healthcare are?

rhcom2 9y ago

That would require both ideological sides to agree on objectives, agree on what counts as successful, agree on metrics. Something I doubt will ever happen at this point.

krath94 9y ago
Isn't the objective for both sides to provide affordable healthcare? I think they agree on the objectives, the means of getting there are where the disagreement comes from.

cortesoft 9y ago

The problem with a 'each state do their own thing' solution is the very problem with health care in this country in general - the freeloader problem. If California implements a single payer system, it would make people in other states more likely to choose not to get healthcare; if they get sick, they can just move to California. This is the reason the ACA has the 'individual mandate' to go along with preventing the denial of care because of pre-existing conditions - without some coercive force, there is no reason to buy health care until you get sick. This is why a national single payer system is the solution.

flavor8 9y ago
I'm not convinced this is insurmountable. How do countries with single payer handle this? Surely you could require an newly established resident who wants treatment to pay a portion since they hadn't been funding it directly via taxes, and then add a further penalty if they move back out of state within a certain period of time (to discourage moving in-state just for treatment).
- Analemma_ 9y ago
  > I'm not convinced this is insurmountable. How do countries with single payer handle this? I'm confused by your question. Countries with single-payer have the same policy everywhere in the country, so there is no freeloading involved. Unless you're talking about people coming from other countries, in which case it's handled by their immigration policy.
- cortesoft 9y ago
  It isn't insurmountable, it basically comes down to having to choose to deny care to someone. However, it is really hard to do it in a fair and humane way; to deny care to people trying to freeload but not deny care to people who aren't. The whole point of universal, single payer, healthcare is to avoid having to make this determination. This isn't an issue for a country because the number of new residents (immigrants) is not a large percentage of the total number of citizens. If it was a state, though, that ratio might not work out; there is a VERY large pool of possible 'freeloaders' who are legally allowed to move to the state whenever they want.

verelo 9y ago

Which would mark the second time in 241 years those states agreed upon something... In all seriousness, state run healthcare is a great idea, but the government is just such a big stakeholder in having a healthy population that I do not see a good reason for it [at some level] to stay out of that line of business. Single payer works, so much better than the current setup...why not start there and try iterate?

dsfyu404ed 9y ago
That would all be fine and dandy if it weren't for that pesky 200yr old document that explicitly denies the federal government the right to micromanage except in very specific circumstances.
- verelo 9y ago
  sure, so like i said...use the state government. The point i was trying to make is basically this: as a government [local, state, fed...you pick] my interest would be in having a productive and happy workforce. One of the best tools i have to influnce that would be healthcare...hence, i see no outcome where the government [again - local, state, fed...whatever] should probably be involved in that. ORRRRR....you do what you've done 27 times before, and you amend the 200 yr old document :) We all make mistakes, sometimes the best option is to own up to them and do something different.
- magicalist 9y ago
  > 200yr old document that explicitly denies the federal government the right to micromanage except in very specific circumstances. right, as long as you ignore 200 years of legal precedent in which it has...

anotherfounder 9y ago

Also, healthcare isn't truly a free market since there are no free agent buyers. So, you'd have to define that phrase 'truly free market health care'.

rednerrus 9y ago

You can't have a truly free market health care system: https://krugman.blogs.nytimes.com/2009/07/25/why-markets-cant-cure-healthcare/ https://krugman.blogs.nytimes.com/2009/07/25/why-markets-can... http://www.who.int/bulletin/volumes/82/2/PHCBP.pdf http://www.who.int/bulletin/volumes/82/2/PHCBP.pdf The federal government already pays for 64.3% of healthcare costs http://www.pnhp.org/news/2016/january/government-funds-nearly-two-thirds-of-us-health-care-costs-american-journal-of-pub http://www.pnhp.org/news/2016/january/government-funds-nearl.... In a centralized managed system this would likely cover the cost of all healthcare. It's roughly what other industrialized nations pay, per person, for single-payer.

coredog64 9y ago
This is what I don't understand. The feds are paying a bunch of money via Medicare/Medicaid/VA but clearly aren't covering everyone. What is the mechanism whereby more people are covered but no additional funds are required? Yes, there's some profit in private insurance companies, but it's not _that_ much.
- rednerrus 9y ago
  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... Our current system is seriously inefficient. Look at how much we spend compared to similar industrialized countries that have single-payer systems. These numbers include the ~13% of the population that didn't have health insurance at the time this chart was created. So we currently pay roughly twice as much to cover 87% of our population. If we had a system similar to Germany we could do it with $600/capita/year in private money added. I would gladly split an additional $50/month in healthcare costs with my employer.
- quadrangle 9y ago
  PROFIT is not the only economic factor. Let's say I'm in the business of selling normal goods (say, backpacks). Now, instead of just people going to my website or looking at crowdsourced backpack reviews, there's some cartel that has figured out how to dominate search engines and other sources so that almost all the customers see their middle-man stuff and buy through them instead of directly (even more extreme, maybe they spend massively on lobbying to achieve real rent-seeking via outlawing direct purchases by consumers, although that's not necessary for my argument). These middle-men charge much higher prices than we'd see if everyone bought directly. But dominating the search-engines while the algorithms constantly change is ENORMOUS work, so these cartel companies pay almost all their revenue to a huge number of employees who work constantly to update their systems and maintain their middle-man dominance. You could say they "barely make a profit!" So, in that scenario above, it's painfully obvious that the system is horribly wasteful and all-around negative for the economy aside from all the bullshit work of the cartel employees directly providing them income. The room for efficiency improvements are, in this case, nearly the entire REVENUE of the middle-men, minus only the costs of the goods themselves, not just their profits!! Insurance companies do TONS of bullshit economic waste that is both necessary to the system as it is today yet unnecessary in a single-payer system. All of that waste is NOT profit but IS available margin for efficiency improvements. But really, insurers are just one aspect. There's also total craziness in the core pricing that providers set and lots of other complete insanity in the status quo. P.S. the middle-man issues described above are potential market-failures for any market system and just one of many reasons that dogmatic "free market" ideology is bullshit. That said, there's cases where actions to fix market failures only make things worse. Recognizing that free-market dogma is bullshit does NOT mean the opposing dogma is correct.

donmatito 9y ago

If by "truly free market" you mean that healthy people can opt out of being insured, no, that would drive the costs up. Risk selection is a very driver of prices in health insurance. If you can spread the risk between healthy and sick people, the price goes down. If you can't, the price goes up. Secondly, having a population that has no health insurance means less prevention, i.e. worse health problems down the road, again driving the costs up

krath94 9y ago
No the point of free market is that insurance is cheap enough that even healthy people buy it. Or even better, that healthcare costs are low enough that you don't even need insurance (that won't happen though because of the healthcare monopolies).
- nolepointer 9y ago
  >Or even better, that healthcare costs are low enough that you don't even need insurance See, this is what I don't get. I'm fairly inexperienced with this stuff, but it's starting to become relevant in my life. Despite my new employer offering insurance, I'm staying on my parents' until I'm 26 (this was part of their policy even before Obamacare). However, this is the question I've been asking ... why do I even need health insurance? Why can't the money I pay in the form of premiums just be used to pay for my health care? The answer: well, it can be really expensive, so this way the cost is shared. But why is it expensive? Why don't I ask how much something is versus whether my insurance will cover it? Again, like I said, I don't have a lot of experience, so go easy on me. But I think my questions are valid.
  - harryh 9y ago
    Part of health insurance is a bit like fire insurance on your house. There is a really small chance that your house will burn down next year (say 1 in 10,000) but if it does you'll lose a ton of money (say $500,000). So you pay $55 to get a year of fire insurance (500,000 / 10,000 = 50 + 5 in profit for the insurance company). This is a great deal for you. $55 is no big deal and now if your house burns down you don't suffer a tremendous financial loss. Similarly there is a really low chance you'll get cancer next year. But if you do it could cost a ton (millions of dollars possibly) to treat. So insurance is a good deal for this too. Now, in the US 2 other things get lopped on to health insurance that make things a bit more complicated: 1) For a lot of people health insurance covers cheap and predictable expenses like an annual checkup. There are a lot of people that think using insurance for this is a bad idea. But some people think it's a good idea. It's complicated. 2) Health insurance (especially after Obamacare) can be a form of social insurance where healthy and/or rich people pay more than they otherwise would so that unhealthy and/or poor people pay less. This reduces economic inequality. There is a lot of political disagreement about whether this is a good idea. Did this help? I've glossed over a ton of details but maybe it's enough to get started.