4 ms·

The quality of care must go down for some, right? It's not possible to a) keep the same existing standard of care for all, b) maintain prices, or c) keep the sa

The quality of care must go down for some, right? It's not possible to a) keep the same existing standard of care for all, b) maintain prices, or c) keep the same level of profit for the industry. Something has to give. If [a] and [b] are true, then profits will be lower, and therefore quality will suffer next.

lallysingh 9y ago
I think the parent is taking about a third party, insurers who is taking money from a,b, and c.
ACow_Adonis 9y ago
Without debating around the edges (because yes,in practice there is almost always someone winning and someone losing), a market model only works if profit is a function of a sufficiently competitive market, and not other structural, cultural, or political factors and barriers working against that outcome. And your implied equivalency largely ignores those factors present in the US. Indeed, the theory that a competitive market can actually deliver socially efficient outcomes could almost be said to be predicated on the idea that yes, you can push down profits substantially without quality deteriorating, because market outcomes are not driven just by profit making motives on the producers' side, but also competitive and structural considerations that determine the nature of competition and consumer demand, competition, and substitutions in that market. So if the US healthcare system generally delivers worse outcomes and costs more (and that's something I generally take to be true), I think it would be a mistake to come at it from a simplistic point of view of an efficient market already operating and saying that any cut would worsen outcomes, because your opponents position is not predicated on the US health care system being a competitive market. Indeed, we need to take into consideration all the other structural qualities driving healthcare delivery and outcomes in the US market. And compared to most other countries, these differences are usually quite substantial: everything from your political process, to where and how health care is typically purchased and received, how your insurance market works, to your social security and labour laws. There is nothing, in even basic neoclassical economic theory, that implies a market is optimal, in either supply quantity or quality, by maximising producer profits or surplus.
emiliobumachar 9y ago
Yes, it's possible, in principle, to have all of [a], [b], and [c], by increasing productivity. If doctors are spending a large time doing billing paperwork, that looks like a thing that could be cut.
astrodust 9y ago
> ... then profits will be lower. Ah, you see, when you remove profit as the primary motivator a lot of problems go away. Here (Canada) the insurance is public, but the hospitals are private, the doctors are self-employed. The insurance companies (plural since each province has their own singular insurer) regulate prices so costs are predictable. If a knee replacement is $X and they expect to do Y of them per year based on statistics, then it's no surprise what the final tab will be. Hospitals and doctors are free to innovate in terms of how they provide care provided they can meet all applicable standards and regulations. If they make money, great. If they lose money that's their problem. On the whole there's no serious problem with providing the care at the regulated prices. So yeah, it is possible to maintain the same level of care for all if you're willing to reign in profit.
- banned1 9y ago
  But the question then would be: what If I want to pay more for even better care? Why wouldn't I be allowed to? Assuming I would be allowed to (unless there is a law against paying more), then providers should be allowed to deliver it (unless there is a law against better). At that point, some will get worse care than others, and because the line is qualitative (since politicians mostly know nothing about care), then this creates worse care for those who can't pay. It is those who we need to solve for.
  - astrodust 9y ago
    Here (Canada) you have some options, but are limited. You can't pay to get to the head of the queue for some operation, you can't skip your place in line for replacement organs. Sure, if your name is literally on the hospital building because you've made a gigantic donation to it they might grease the wheels a bit in your favour, but generally you're just like everyone else. You can go internationally for treatment but it's on your own dime. Some people, irate at wait times, will hop across the border for treatment at US hospitals. These stories show up in the paper from time to time, but the "intolerable" wait these people endure is more often than not pretty minor. Waiting six months for a hip replacement, which is not a life-threatening procedure, is not uncommon. You'll survive. Meanwhile if you're feeling really ill and step in to the emergency wing, then they realize you're suffering from a massive cardiac problem and need to get you into the operating room immediately, you won't be stuck in line, you may not even fill out any paperwork, you'll be given all the attention they can spare until you're stabilized. "Two-tier" health care, where you can pay to get better service than everyone else, is something politicians of the conservative bent flirt with from time to time as a way of "fixing" our health-care system. It's always shouted down because people know they're just looking for ways that their billionaire buddies can jump the queue. It's disruptive, it creates a rift between the rich and poor and puts a lot of stress on people who may not have the money but believe they need the superior treatment. Consider: When the Canadian medical system fails someone, when they fall through the cracks, it is front page news and the media has a field day. This happens so frequently in the US that it doesn't even surface as a story. "Old lady didn't get hip replacement, insurance wouldn't pay, stuck in old-age home forever" is not news in the US, but it would be here because people would be pissed off she didn't get fair treatment.

lallysingh 9y ago

I think the parent is taking about a third party, insurers who is taking money from a,b, and c.

ACow_Adonis 9y ago

Without debating around the edges (because yes,in practice there is almost always someone winning and someone losing), a market model only works if profit is a function of a sufficiently competitive market, and not other structural, cultural, or political factors and barriers working against that outcome. And your implied equivalency largely ignores those factors present in the US. Indeed, the theory that a competitive market can actually deliver socially efficient outcomes could almost be said to be predicated on the idea that yes, you can push down profits substantially without quality deteriorating, because market outcomes are not driven just by profit making motives on the producers' side, but also competitive and structural considerations that determine the nature of competition and consumer demand, competition, and substitutions in that market. So if the US healthcare system generally delivers worse outcomes and costs more (and that's something I generally take to be true), I think it would be a mistake to come at it from a simplistic point of view of an efficient market already operating and saying that any cut would worsen outcomes, because your opponents position is not predicated on the US health care system being a competitive market. Indeed, we need to take into consideration all the other structural qualities driving healthcare delivery and outcomes in the US market. And compared to most other countries, these differences are usually quite substantial: everything from your political process, to where and how health care is typically purchased and received, how your insurance market works, to your social security and labour laws. There is nothing, in even basic neoclassical economic theory, that implies a market is optimal, in either supply quantity or quality, by maximising producer profits or surplus.

emiliobumachar 9y ago

Yes, it's possible, in principle, to have all of [a], [b], and [c], by increasing productivity. If doctors are spending a large time doing billing paperwork, that looks like a thing that could be cut.

astrodust 9y ago

> ... then profits will be lower. Ah, you see, when you remove profit as the primary motivator a lot of problems go away. Here (Canada) the insurance is public, but the hospitals are private, the doctors are self-employed. The insurance companies (plural since each province has their own singular insurer) regulate prices so costs are predictable. If a knee replacement is $X and they expect to do Y of them per year based on statistics, then it's no surprise what the final tab will be. Hospitals and doctors are free to innovate in terms of how they provide care provided they can meet all applicable standards and regulations. If they make money, great. If they lose money that's their problem. On the whole there's no serious problem with providing the care at the regulated prices. So yeah, it is possible to maintain the same level of care for all if you're willing to reign in profit.

banned1 9y ago
But the question then would be: what If I want to pay more for even better care? Why wouldn't I be allowed to? Assuming I would be allowed to (unless there is a law against paying more), then providers should be allowed to deliver it (unless there is a law against better). At that point, some will get worse care than others, and because the line is qualitative (since politicians mostly know nothing about care), then this creates worse care for those who can't pay. It is those who we need to solve for.
- astrodust 9y ago
  Here (Canada) you have some options, but are limited. You can't pay to get to the head of the queue for some operation, you can't skip your place in line for replacement organs. Sure, if your name is literally on the hospital building because you've made a gigantic donation to it they might grease the wheels a bit in your favour, but generally you're just like everyone else. You can go internationally for treatment but it's on your own dime. Some people, irate at wait times, will hop across the border for treatment at US hospitals. These stories show up in the paper from time to time, but the "intolerable" wait these people endure is more often than not pretty minor. Waiting six months for a hip replacement, which is not a life-threatening procedure, is not uncommon. You'll survive. Meanwhile if you're feeling really ill and step in to the emergency wing, then they realize you're suffering from a massive cardiac problem and need to get you into the operating room immediately, you won't be stuck in line, you may not even fill out any paperwork, you'll be given all the attention they can spare until you're stabilized. "Two-tier" health care, where you can pay to get better service than everyone else, is something politicians of the conservative bent flirt with from time to time as a way of "fixing" our health-care system. It's always shouted down because people know they're just looking for ways that their billionaire buddies can jump the queue. It's disruptive, it creates a rift between the rich and poor and puts a lot of stress on people who may not have the money but believe they need the superior treatment. Consider: When the Canadian medical system fails someone, when they fall through the cracks, it is front page news and the media has a field day. This happens so frequently in the US that it doesn't even surface as a story. "Old lady didn't get hip replacement, insurance wouldn't pay, stuck in old-age home forever" is not news in the US, but it would be here because people would be pissed off she didn't get fair treatment.