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It's definitely a problem that pricing is opaque and disconnected, but have you considered that maybe healthcare isn't a good candidate for a market solution? E

It's definitely a problem that pricing is opaque and disconnected, but have you considered that maybe healthcare isn't a good candidate for a market solution? Even without this problem, customers have relatively little ability to choose providers or price shop, and they often don't really understand what they're being asked to buy. By extension, it seems like the key difference between "elective" and "non-elective" care is that one of them is elective... it's going to be a very different market when a consumer can choose to buy something or not buy it at all, vs. when they have to buy something and may not even understand what or why they're buying it. It's not necessarily that consumers are shopping prices more or being stronger negotiators, it's partially just that demand naturally falls if prices start to rise too much.

dawhizkid 9y ago
One of the bigger problems in healthcare is also over-utilization i.e. getting things are are technically covered under insurance but not objectively medically necessary or getting a more expensive brand name drug over a chemically equivalent generic drug. Agree that the patient-provider relationship today is usually "I'm a doctor and I'm going to tell you to do this, this, and this" regardless of cost, and we go with it because if we're insured under today's system it means marginally more out of pocket dollars for us. If you had an high deductible plan with an HSA (i.e. paying pre tax dollars out of a health savings account), I'd bet psychologically you'd be more choosey when shopping around for healthcare and/or ask more questions of your provider around "is this really necessary?" or "is there a cheaper option?"
- tomkarlo 9y ago
  I have a high-deductible plan, and have had one for ~7 years now. It doesn't really change my decision process that much, honestly. Especially when I'm considering a procedure that my doctor has told me I need, but I don't know / understand the technical details of... I will try to go in-network, but I don't really have the capability to go shop around and assess which providers will give me a better outcome per dollar spent. I especially don't usually have the necessary skill set to assess if some cheaper option that's not my doc's first choice would really be a good choice. With healthcare, it's not just about "what's the cheapest option", it's also "who will deliver the best service"... given the relatively limited ability to optimize the first, I generally will focus on the second, and I think that's what most folks do - they go with providers they trust. It all comes back to my original point: healthcare, particularly non-elective healthcare, is not well-suited to a free market solution.
  - Consultant32452 9y ago
    Assuming you are not an auto mechanic, how do you go about deciding which cars to purchase? If you're unable to discern whether your doctor's preferred solution is the best one, then what is the purpose of asking your doctor in the first place? Or how would it be beneficial if the "worst" provider was forced to charge you the same as the best provider?
    - tomkarlo 9y ago
      Cars have the nice property of being mass-produced goods, where there's an established mechanism for testing, rating, and regulating them. There's no such thing for healthcare (and it's a service, not a hard good.) If I was qualified to discern if my doc's preferred solution was the best one, I'd be a doctor. I ask my doctor because he's been specifically trained to make that determination. > Or how would it be beneficial if the "worst" provider was forced to charge you the same as the best provider? You've got that backwards. Right now, we basically allow the worst provider to charge as much as the best one, because we don't really have any way to differentiate the best from the worst. There's no need to force any business to charge more.
      - Consultant32452 9y ago
        >Cars have the nice property of being mass-produced goods, where there's an established mechanism for testing, rating, and regulating them. There's no such thing for healthcare (and it's a service, not a hard good.) TIL there's no testing, rating, or regulating in the medical industry. >I ask my doctor because he's been specifically trained to make that determination. I agree, so this concern of yours is alleviated. The market provided you an expensive option which is the one your trusted advisor recommends, and there's a cheaper one which may offer lower quality service. You are now empowered to make your own decision on the matter. >You've got that backwards. Right now, we basically allow the worst provider to charge as much as the best one, because we don't really have any way to differentiate the best from the worst. There's no need to force any business to charge more. Moving to single payer does not help you differentiate the best from the worst. All it does is force the good provider and the bad provider to charge the same. The current insurance regime is not better, because your provider can choose the worse provider for you if they're cheaper, leaving you no option at all.
- emodendroket 9y ago
  I mean, you're right that people get less medical care if their out-of-pocket costs are higher. The problem is they're really poor at judging for themselves whether procedures are necessary and so they end up sacrificing their health or sometimes outright dying because they didn't get care they needed. "Skin in the game" is one of those zombie ideas that just don't die.
  - pdonis 9y ago
    > "Skin in the game" is one of those zombie ideas that just don't die. No, the idea that people who have no skin in the game--regulators and bureaucrats--can make better decisions than the people directly involved, particularly about matters with as much at stake as health care--is one of those zombie ideas that just don't die. No regulator or bucreaucrat ever suffers any negative consequences because of bad decisions about other people's health care. As for people being poor at judging for themselves whether procedures are necessary, another comment upthread already addressed that: there are plenty of other areas (auto repair, for example) where most people don't have the technical knowledge to judge for themselves whether procedures are necessary, yet markets seem to function in those areas. Furthermore, under the current system in the US, people have little incentive to become more knowledgeable, because they are not going to be given a choice anyway; they're going to get whatever their health insurance provider says is the standard care. Under a market system, people would have much more of an incentive to actually learn about the various options. And there would also be much more of an incentive for independent third parties to provide information, particularly information that health care providers might not want people to know. More generally, the reason market advocates, like me, advocate markets is not that they always give optimal outcomes. They don't. But in cases where they don't, non-market alternatives give outcomes that are even worse.
    - tomkarlo 9y ago
      And yet the data shows that when you leave the decision to regulators and bureaucrats, you seem to get better value for the healthcare dollar than if you let individuals make their own decisions. The US, in particular, spends more and sees worse outcomes than other counties. This shouldn't be a surprise. An individual is going to not make very good decisions about how healthcare dollars are allocated over the course of their life. They're going to usually tend to underspend on preventative care (which has the highest ROI) and tend to overspend on end-of-life care (which has a lower ROI). You can see this played out in things like the US's infant mortality rate (3X other developed nations) and life expectancy (31st worldwide, declining).
- u801e 9y ago
  > One of the bigger problems in healthcare is also over-utilization i.e. getting things are are technically covered under insurance but not objectively medically necessary or getting a more expensive brand name drug over a chemically equivalent generic drug. Another problem is that procedures and appointments that could be considered routine maintenance in other areas are paid for by insurance. You don't use car insurance to pay for oil changes or new tires. Services such as annual physicals/check ups, vaccinations, etc should be cheap enough to pay for out of pocket. That would leave insurance to pay for the more expensive forms of care, just like one would use car insurance to pay for damage as a result of a collision.
  - maxerickson 9y ago
    Flu vaccines are reasonably cheap. $30-40. The flip side of that is that they aren't contributing much to insurance premiums. At a policy level it may be worth a slight increase in cost if building it into insurance significantly increases the number of people that actually get the shot.
    - u801e 9y ago
      > The flip side of that is that they aren't contributing much to insurance premiums. Can we be certain of that? That is, even if the vaccination costs $30 to $40, will the insurance be billed for that amount, or do they get billed something like $300 instead? I haven't tried to pay for a influenza vaccination out of pocket recently, so I don't know what most places would charge.
      - maxerickson 9y ago
        Insurance will usually pay less than the cash price. They have a better idea of the cost than individuals and more leverage.
      - tomkarlo 9y ago
        The price the insurance company pays is almost never going to be higher than what you would pay if you're uninsured. You're confusing your co-pay with the uninsured cost of a flu shot. If Sam's Club and Costco can offer flu shots for $15 [0], it's a safe bet that the cost to an insurance company is less than that. [0] https://www.bradsdeals.com/blog/where-to-get-a-cheap-flu-shot https://www.bradsdeals.com/blog/where-to-get-a-cheap-flu-sho...
- uberduber 9y ago
  The vast majority of dollars spent in over-utilization has to do with our culture and is in the last 6 months of life. I wish we as a society could have a moral/ethical discussion about whether we should try every last treatment trying to save 89 year old grandma for two months at the cost of $300k. Ask any doctor, and there's a reason they personally do not want to go anywhere near a hospital at the end of life. It's usually the children/grandchildren who live far away and never visit who insist that every last thing be done prolonging their grandparents' suffering in my opinion. The ones who live nearby and spend plenty of time are usually okay with letting them go.
tkahnoski 9y ago
A further complication in my mind of healthcare operating as a market is a hippocratic oath. The ability for a doctor (merchant) to refuse service in certain situations just doesn't exist without violating an ethical boundary.
- deleted 9y ago
  [deleted]
- humanrebar 9y ago
  I don't follow. A ornery mechanic can refuse business all she wants. And doctors often refuse to perform procedures they don't want to perform for financial or professional reasons.
- PeterisP 9y ago
  Hippocratic oath generally does not prevent arbitrary reasons (including payment) for refusing to take on a patient in most versions (I'm aware that some places, including some medical teaching institutions have it vice versa) including the earliest surviving original one. Hippocrates and his students would not treat everyone or require the students to treat everyone, the oath describes the ethical boundaries of the 'implied contract' between a doctor and their patient - and becoming a doctor's patient even back then was conditional on doctor choosing to treat you, most likely (but not necessarily) based on your agreement. Neither classic Hippocratic oath nor the commonly used Declaration of Geneva (https://en.wikipedia.org/wiki/Declaration_of_Geneva https://en.wikipedia.org/wiki/Declaration_of_Geneva) would go against a doctor saying "the recommended procedure to cure your ailment costs one million dollars; I'll be treating you if and only if you pay that", assuming that the treatment honestly is the best option health-wise. What the oath could prohibit is the recommendation of a treatment that's objectively worse (i.e. less effective, or more likely to have harmful or fatal complications) but is much cheaper; while a person can choose (or be recommended) bread, wine or car that's worse but cheap, the ethics frown upon recommending worse health outcomes.
  - tkahnoski 9y ago
    Thank you for the links, these were just vague concepts to me before where I understood the intent, but I shall read up on the specifics now. In planned events and traditional health care your argument makes sense. I was specifically thinking about emergency care or other situations where communication isn't always possible or made in a timely manner. If a someone comes into an ER and turns out needs say a stent put in, when do you get clear agreement? (caveat I am clearly not a medical professional and this might be a terrible example). My assumption is largely the hospital does not wait to validate someone's credit to execute what would otherwise be something done for normal retail transactions of similar size.
sol_remmy 9y ago
> It's definitely a problem that pricing is opaque and disconnected, but have you considered that maybe healthcare isn't a good candidate for a market solution? Do you really think all healthcare - supplements, eye drops, family doctor visits, LASIK eye surgery - should be centrally controlled instead of using free market principles? That's quite a claim to make. Cutting the entire healthcare industry off from the free market would only happen through government force.
- tomkarlo 9y ago
  Supplements are explicitly not considered "health care" in the US Countries with single payer also offer eye drops, family doctor visits, and LASIK... they just tend to pay less for them You don't need "government force" to change how health insurance works. See Germany, many other countries. All you do is create a government healthcare pool that's large enough to cover risk, fund it, and give folks the option of using it or using a private insurer that will cost a lot more.
  - humanrebar 9y ago
    The U.S. consumer loan industry is basically backed by the national government. Nobody was shut down or arrested. But it doesn't make it an appropriate action for the government to take. Especially since in the U.S., major changes are supposed to go through strict democratic processes that require broad consensus. Beyond good democracy, that's just human decency. That's why I think there should be a healthcare constitutional amendment before the U.S. government gets involved. If California wants single-payer, they should go for it though.
- TheOtherHobbes 9y ago
  And yet all Western countries - especially those with single-payer state managed care - provide better outcomes at lower cost to consumers. Are you sure you're not confusing the US insurance system with an oligopoly? Markets don't exist to magically generate low prices for consumers through competition, because businesses compete primarily for investor and shareholder cash, not to make end users happy. The most reliable way to generate shareholder value is to create an oligopoly, and then squeeze consumers as hard as they can be squeezed - which is exactly why the US system regularly bankrupts participants, while regulated single-payer systems don't.
Consultant32452 9y ago
Healthcare will ALWAYS be a market. All something like single payer does is distort the market incentives. It generally trades innovation for quantity of covered people. There's an argument to be made there, for sure, but you can't pretend like you're going to make something impervious to the drives and interests of consumers and potential providers. With regard to elective vs non-elective, only about 2% of all healthcare costs are categorized as emergency care. So there's plenty of wiggle room for people to shop around for a good price or wait for better market conditions. What I would love to see is taking Medicare/Medicaid and instead of paying for healthcare services we just cut a check for cold hard cash to everyone who would've been receiving government funded care. Then they can spend that money on whatever they want. I guarantee you prices will drop through the floor. Some of those people will choose quality of life over longevity by going on vacation instead of paying for healthcare. I say good for them, do whatever you want it's none of my business.
- tomkarlo 9y ago
  Have you ever actually tried to "shop around" for a serious, non-elective procedure like chemo or surgery? It's very difficult to get quotes, you can't easily compare providers (there's no obviously corpus of "ratings" from other prior customers) and you're often limited to the 1-3 providers who are close enough to your home. That's not exactly a recipe for an effective market. Re your medicare proposal, are you suggesting that people who are diagnosed with cancer should get a cash check for the estimated value of the treatment? The incentive for fraud and graft in that kind of system would be incredible - lots of diagnoses are relatively subjective, and you'd be rewarding people for reporting every possible ailment they might be eligible for. If you're saying just give them their dollar average benefits, that pretty much defeats the whole purpose of having a risk pool.
  - Consultant32452 9y ago
    >It's very difficult to get quotes It's very difficult to get quotes because no one is actually paying for it themselves. This would be solved immediately by empowering individual consumers. >you can't easily compare providers (there's no obviously corpus of "ratings" from other prior customers) This is because your insurance provider has chosen for you. Once again, this would be resolved by putting peoples' money back into their own hands. >If you're saying just give them their dollar average benefits, that pretty much defeats the whole purpose of having a risk pool. In my head I included still providing disaster coverage, but failed to type it. So that should alleviate your fears regarding things like getting cancer.
savanaly 9y ago
>customers have relatively little ability to choose providers or price shop, and they often don't really understand what they're being asked to buy. I don't agree that these are good reasons to make healthcare not a market. It's true that customers don't necessarily have a lot of ability to choose providers or price shop under our current system, but that's certainly not an inherent trait of healthcare. It could be otherwise. As for not understanding what they're being asked to buy, what I'll say about that argument is it proves too much. Why do the markets for computer repair, automobile repair, etc. not have the problems that you claim would be inherent to a free market in human body repair? Understanding of the subtleties in those areas is equally out of reach to understanding of healthcare.
- adamlett 9y ago
  As for not understanding what they're being asked to buy, what I'll say about that argument is it proves too much. Why do the markets for computer repair, automobile repair, etc. not have the problems that you claim would be inherent to a free market in human body repair? You are ignoring the part about not having a choice of whether to buy or not. If I buy a car or something else about which I know next to nothing, I can ultimately decide not to buy, if I feel like I'm being scammed. If I get injured or sick, I can't realistically choose not to get treated.
  - humanrebar 9y ago
    People are injured or killed by cars. People lose their life's work when their hard drives go bad (yeah, backups, but it still happens). I agree that they aren't perfect analogs, but we're talking tangerines and oranges, not apples and oranges. EDIT: Downvoters care to comment on where they disagree?
    - nothrabannosir 9y ago
      This is one of those comments that will later be quoted in some Buzzfeed article about why HN is a soulless libertarian shit hole. And, quite frankly, I’d have to agree. The only redeemable counter argument is: it never got taken seriously, just downvoted, so it’s not representative of the tone of discussion. Although it’s awfully close to some of the other threads here, I’m happy we collectively chose to draw the line at an argument honestly comparing computer repair to health care. (I can’t even believe I’m typing this; please don’t ever ask me to explain that again).

dawhizkid 9y ago

One of the bigger problems in healthcare is also over-utilization i.e. getting things are are technically covered under insurance but not objectively medically necessary or getting a more expensive brand name drug over a chemically equivalent generic drug. Agree that the patient-provider relationship today is usually "I'm a doctor and I'm going to tell you to do this, this, and this" regardless of cost, and we go with it because if we're insured under today's system it means marginally more out of pocket dollars for us. If you had an high deductible plan with an HSA (i.e. paying pre tax dollars out of a health savings account), I'd bet psychologically you'd be more choosey when shopping around for healthcare and/or ask more questions of your provider around "is this really necessary?" or "is there a cheaper option?"

tomkarlo 9y ago
I have a high-deductible plan, and have had one for ~7 years now. It doesn't really change my decision process that much, honestly. Especially when I'm considering a procedure that my doctor has told me I need, but I don't know / understand the technical details of... I will try to go in-network, but I don't really have the capability to go shop around and assess which providers will give me a better outcome per dollar spent. I especially don't usually have the necessary skill set to assess if some cheaper option that's not my doc's first choice would really be a good choice. With healthcare, it's not just about "what's the cheapest option", it's also "who will deliver the best service"... given the relatively limited ability to optimize the first, I generally will focus on the second, and I think that's what most folks do - they go with providers they trust. It all comes back to my original point: healthcare, particularly non-elective healthcare, is not well-suited to a free market solution.
- Consultant32452 9y ago
  Assuming you are not an auto mechanic, how do you go about deciding which cars to purchase? If you're unable to discern whether your doctor's preferred solution is the best one, then what is the purpose of asking your doctor in the first place? Or how would it be beneficial if the "worst" provider was forced to charge you the same as the best provider?
  - tomkarlo 9y ago
    Cars have the nice property of being mass-produced goods, where there's an established mechanism for testing, rating, and regulating them. There's no such thing for healthcare (and it's a service, not a hard good.) If I was qualified to discern if my doc's preferred solution was the best one, I'd be a doctor. I ask my doctor because he's been specifically trained to make that determination. > Or how would it be beneficial if the "worst" provider was forced to charge you the same as the best provider? You've got that backwards. Right now, we basically allow the worst provider to charge as much as the best one, because we don't really have any way to differentiate the best from the worst. There's no need to force any business to charge more.
    - Consultant32452 9y ago
      >Cars have the nice property of being mass-produced goods, where there's an established mechanism for testing, rating, and regulating them. There's no such thing for healthcare (and it's a service, not a hard good.) TIL there's no testing, rating, or regulating in the medical industry. >I ask my doctor because he's been specifically trained to make that determination. I agree, so this concern of yours is alleviated. The market provided you an expensive option which is the one your trusted advisor recommends, and there's a cheaper one which may offer lower quality service. You are now empowered to make your own decision on the matter. >You've got that backwards. Right now, we basically allow the worst provider to charge as much as the best one, because we don't really have any way to differentiate the best from the worst. There's no need to force any business to charge more. Moving to single payer does not help you differentiate the best from the worst. All it does is force the good provider and the bad provider to charge the same. The current insurance regime is not better, because your provider can choose the worse provider for you if they're cheaper, leaving you no option at all.
emodendroket 9y ago
I mean, you're right that people get less medical care if their out-of-pocket costs are higher. The problem is they're really poor at judging for themselves whether procedures are necessary and so they end up sacrificing their health or sometimes outright dying because they didn't get care they needed. "Skin in the game" is one of those zombie ideas that just don't die.
- pdonis 9y ago
  > "Skin in the game" is one of those zombie ideas that just don't die. No, the idea that people who have no skin in the game--regulators and bureaucrats--can make better decisions than the people directly involved, particularly about matters with as much at stake as health care--is one of those zombie ideas that just don't die. No regulator or bucreaucrat ever suffers any negative consequences because of bad decisions about other people's health care. As for people being poor at judging for themselves whether procedures are necessary, another comment upthread already addressed that: there are plenty of other areas (auto repair, for example) where most people don't have the technical knowledge to judge for themselves whether procedures are necessary, yet markets seem to function in those areas. Furthermore, under the current system in the US, people have little incentive to become more knowledgeable, because they are not going to be given a choice anyway; they're going to get whatever their health insurance provider says is the standard care. Under a market system, people would have much more of an incentive to actually learn about the various options. And there would also be much more of an incentive for independent third parties to provide information, particularly information that health care providers might not want people to know. More generally, the reason market advocates, like me, advocate markets is not that they always give optimal outcomes. They don't. But in cases where they don't, non-market alternatives give outcomes that are even worse.
  - tomkarlo 9y ago
    And yet the data shows that when you leave the decision to regulators and bureaucrats, you seem to get better value for the healthcare dollar than if you let individuals make their own decisions. The US, in particular, spends more and sees worse outcomes than other counties. This shouldn't be a surprise. An individual is going to not make very good decisions about how healthcare dollars are allocated over the course of their life. They're going to usually tend to underspend on preventative care (which has the highest ROI) and tend to overspend on end-of-life care (which has a lower ROI). You can see this played out in things like the US's infant mortality rate (3X other developed nations) and life expectancy (31st worldwide, declining).
u801e 9y ago
> One of the bigger problems in healthcare is also over-utilization i.e. getting things are are technically covered under insurance but not objectively medically necessary or getting a more expensive brand name drug over a chemically equivalent generic drug. Another problem is that procedures and appointments that could be considered routine maintenance in other areas are paid for by insurance. You don't use car insurance to pay for oil changes or new tires. Services such as annual physicals/check ups, vaccinations, etc should be cheap enough to pay for out of pocket. That would leave insurance to pay for the more expensive forms of care, just like one would use car insurance to pay for damage as a result of a collision.
- maxerickson 9y ago
  Flu vaccines are reasonably cheap. $30-40. The flip side of that is that they aren't contributing much to insurance premiums. At a policy level it may be worth a slight increase in cost if building it into insurance significantly increases the number of people that actually get the shot.
  - u801e 9y ago
    > The flip side of that is that they aren't contributing much to insurance premiums. Can we be certain of that? That is, even if the vaccination costs $30 to $40, will the insurance be billed for that amount, or do they get billed something like $300 instead? I haven't tried to pay for a influenza vaccination out of pocket recently, so I don't know what most places would charge.
    - maxerickson 9y ago
      Insurance will usually pay less than the cash price. They have a better idea of the cost than individuals and more leverage.
    - tomkarlo 9y ago
      The price the insurance company pays is almost never going to be higher than what you would pay if you're uninsured. You're confusing your co-pay with the uninsured cost of a flu shot. If Sam's Club and Costco can offer flu shots for $15 [0], it's a safe bet that the cost to an insurance company is less than that. [0] https://www.bradsdeals.com/blog/where-to-get-a-cheap-flu-shot https://www.bradsdeals.com/blog/where-to-get-a-cheap-flu-sho...
uberduber 9y ago
The vast majority of dollars spent in over-utilization has to do with our culture and is in the last 6 months of life. I wish we as a society could have a moral/ethical discussion about whether we should try every last treatment trying to save 89 year old grandma for two months at the cost of $300k. Ask any doctor, and there's a reason they personally do not want to go anywhere near a hospital at the end of life. It's usually the children/grandchildren who live far away and never visit who insist that every last thing be done prolonging their grandparents' suffering in my opinion. The ones who live nearby and spend plenty of time are usually okay with letting them go.

tkahnoski 9y ago

A further complication in my mind of healthcare operating as a market is a hippocratic oath. The ability for a doctor (merchant) to refuse service in certain situations just doesn't exist without violating an ethical boundary.

deleted 9y ago
[deleted]
humanrebar 9y ago
I don't follow. A ornery mechanic can refuse business all she wants. And doctors often refuse to perform procedures they don't want to perform for financial or professional reasons.
PeterisP 9y ago
Hippocratic oath generally does not prevent arbitrary reasons (including payment) for refusing to take on a patient in most versions (I'm aware that some places, including some medical teaching institutions have it vice versa) including the earliest surviving original one. Hippocrates and his students would not treat everyone or require the students to treat everyone, the oath describes the ethical boundaries of the 'implied contract' between a doctor and their patient - and becoming a doctor's patient even back then was conditional on doctor choosing to treat you, most likely (but not necessarily) based on your agreement. Neither classic Hippocratic oath nor the commonly used Declaration of Geneva (https://en.wikipedia.org/wiki/Declaration_of_Geneva https://en.wikipedia.org/wiki/Declaration_of_Geneva) would go against a doctor saying "the recommended procedure to cure your ailment costs one million dollars; I'll be treating you if and only if you pay that", assuming that the treatment honestly is the best option health-wise. What the oath could prohibit is the recommendation of a treatment that's objectively worse (i.e. less effective, or more likely to have harmful or fatal complications) but is much cheaper; while a person can choose (or be recommended) bread, wine or car that's worse but cheap, the ethics frown upon recommending worse health outcomes.
- tkahnoski 9y ago
  Thank you for the links, these were just vague concepts to me before where I understood the intent, but I shall read up on the specifics now. In planned events and traditional health care your argument makes sense. I was specifically thinking about emergency care or other situations where communication isn't always possible or made in a timely manner. If a someone comes into an ER and turns out needs say a stent put in, when do you get clear agreement? (caveat I am clearly not a medical professional and this might be a terrible example). My assumption is largely the hospital does not wait to validate someone's credit to execute what would otherwise be something done for normal retail transactions of similar size.

sol_remmy 9y ago

> It's definitely a problem that pricing is opaque and disconnected, but have you considered that maybe healthcare isn't a good candidate for a market solution? Do you really think all healthcare - supplements, eye drops, family doctor visits, LASIK eye surgery - should be centrally controlled instead of using free market principles? That's quite a claim to make. Cutting the entire healthcare industry off from the free market would only happen through government force.

tomkarlo 9y ago
Supplements are explicitly not considered "health care" in the US Countries with single payer also offer eye drops, family doctor visits, and LASIK... they just tend to pay less for them You don't need "government force" to change how health insurance works. See Germany, many other countries. All you do is create a government healthcare pool that's large enough to cover risk, fund it, and give folks the option of using it or using a private insurer that will cost a lot more.
- humanrebar 9y ago
  The U.S. consumer loan industry is basically backed by the national government. Nobody was shut down or arrested. But it doesn't make it an appropriate action for the government to take. Especially since in the U.S., major changes are supposed to go through strict democratic processes that require broad consensus. Beyond good democracy, that's just human decency. That's why I think there should be a healthcare constitutional amendment before the U.S. government gets involved. If California wants single-payer, they should go for it though.
TheOtherHobbes 9y ago
And yet all Western countries - especially those with single-payer state managed care - provide better outcomes at lower cost to consumers. Are you sure you're not confusing the US insurance system with an oligopoly? Markets don't exist to magically generate low prices for consumers through competition, because businesses compete primarily for investor and shareholder cash, not to make end users happy. The most reliable way to generate shareholder value is to create an oligopoly, and then squeeze consumers as hard as they can be squeezed - which is exactly why the US system regularly bankrupts participants, while regulated single-payer systems don't.

Consultant32452 9y ago

Healthcare will ALWAYS be a market. All something like single payer does is distort the market incentives. It generally trades innovation for quantity of covered people. There's an argument to be made there, for sure, but you can't pretend like you're going to make something impervious to the drives and interests of consumers and potential providers. With regard to elective vs non-elective, only about 2% of all healthcare costs are categorized as emergency care. So there's plenty of wiggle room for people to shop around for a good price or wait for better market conditions. What I would love to see is taking Medicare/Medicaid and instead of paying for healthcare services we just cut a check for cold hard cash to everyone who would've been receiving government funded care. Then they can spend that money on whatever they want. I guarantee you prices will drop through the floor. Some of those people will choose quality of life over longevity by going on vacation instead of paying for healthcare. I say good for them, do whatever you want it's none of my business.

tomkarlo 9y ago
Have you ever actually tried to "shop around" for a serious, non-elective procedure like chemo or surgery? It's very difficult to get quotes, you can't easily compare providers (there's no obviously corpus of "ratings" from other prior customers) and you're often limited to the 1-3 providers who are close enough to your home. That's not exactly a recipe for an effective market. Re your medicare proposal, are you suggesting that people who are diagnosed with cancer should get a cash check for the estimated value of the treatment? The incentive for fraud and graft in that kind of system would be incredible - lots of diagnoses are relatively subjective, and you'd be rewarding people for reporting every possible ailment they might be eligible for. If you're saying just give them their dollar average benefits, that pretty much defeats the whole purpose of having a risk pool.
- Consultant32452 9y ago
  >It's very difficult to get quotes It's very difficult to get quotes because no one is actually paying for it themselves. This would be solved immediately by empowering individual consumers. >you can't easily compare providers (there's no obviously corpus of "ratings" from other prior customers) This is because your insurance provider has chosen for you. Once again, this would be resolved by putting peoples' money back into their own hands. >If you're saying just give them their dollar average benefits, that pretty much defeats the whole purpose of having a risk pool. In my head I included still providing disaster coverage, but failed to type it. So that should alleviate your fears regarding things like getting cancer.

savanaly 9y ago

>customers have relatively little ability to choose providers or price shop, and they often don't really understand what they're being asked to buy. I don't agree that these are good reasons to make healthcare not a market. It's true that customers don't necessarily have a lot of ability to choose providers or price shop under our current system, but that's certainly not an inherent trait of healthcare. It could be otherwise. As for not understanding what they're being asked to buy, what I'll say about that argument is it proves too much. Why do the markets for computer repair, automobile repair, etc. not have the problems that you claim would be inherent to a free market in human body repair? Understanding of the subtleties in those areas is equally out of reach to understanding of healthcare.

adamlett 9y ago
As for not understanding what they're being asked to buy, what I'll say about that argument is it proves too much. Why do the markets for computer repair, automobile repair, etc. not have the problems that you claim would be inherent to a free market in human body repair? You are ignoring the part about not having a choice of whether to buy or not. If I buy a car or something else about which I know next to nothing, I can ultimately decide not to buy, if I feel like I'm being scammed. If I get injured or sick, I can't realistically choose not to get treated.
- humanrebar 9y ago
  People are injured or killed by cars. People lose their life's work when their hard drives go bad (yeah, backups, but it still happens). I agree that they aren't perfect analogs, but we're talking tangerines and oranges, not apples and oranges. EDIT: Downvoters care to comment on where they disagree?
  - nothrabannosir 9y ago
    This is one of those comments that will later be quoted in some Buzzfeed article about why HN is a soulless libertarian shit hole. And, quite frankly, I’d have to agree. The only redeemable counter argument is: it never got taken seriously, just downvoted, so it’s not representative of the tone of discussion. Although it’s awfully close to some of the other threads here, I’m happy we collectively chose to draw the line at an argument honestly comparing computer repair to health care. (I can’t even believe I’m typing this; please don’t ever ask me to explain that again).