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> 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 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)...

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)...