12 ms·

Would you rather the market or the government make that choice for you?

by creaghpatr 9y ago

8note 9y ago
I want somebody who benefits from me being healthy on a long term to choose for me.
cycrutchfield 9y ago
False dichotomy. Please try to avoid logical fallacies when posting.
- creaghpatr 9y ago
  People seem awfully confused about who pays for healthcare in the US so let's be clear: either the government or the market (consumers) pays for healthcare, or they do it in tandem. I don't have a view on who should pay for it, but there are only 3 categories of payers in healthcare: 1 government and 2 private (insurance and self-pay). The compensation is funded by one of those sources.
  - pessimizer 9y ago
    People also seem awfully confused about how much the government currently spends on healthcare: the US government currently spends roughly as much per-capita on healthcare as socialized systems that cover the entire cost of healthcare for their citizens, and have better measured outcomes. The crippling healthcare costs borne by individuals entirely consist of rent-seeking. It's also important to say that a lot of that money comes back out in salaries for the massive workforce required for the unnecessary administrative overhead, adding to the economy, and of course in non-imported luxury goods purchased by the rent-seekers themselves.
  - cycrutchfield 9y ago
    So, to summarize, the person you replied to above asked what is the reasonable alternative to socialized healthcare that does not include people dying in the streets of treatable maladies. And through your explanation it appears as though you replied with a tautological statement that had no bearing on the question being asked. So, what is it that you are actually trying to say?
    - creaghpatr 9y ago
      They did not ask 'what', they asked 'if' an alternative exists, invoking the classic 'dying in the streets' motif. >Is there a reasonable alternative? I'm not trolling, but letting people die of treatable maladies doesn't seem like the right move. I answered a tautological statement with a tautological question based on the logic the poster omitted. Can you tell me who besides the government or the market (ie consumers) will prevent people from 'dying in the streets'? Perhaps by kidnapping another country's doctors and compelling them to provide care... >I'm not trolling
      - darkerside 9y ago
        I'm a little offended that you'd assume my question to be tautological, by which I in turn assume you mean rhetorical. Seems to have generated some good discussion.
  - Consultant32452 9y ago
    I feel like even that confuses the issue. The government can only pay for something with money it takes from consumers.
softawre 9y ago
Would I rather this market decide if I die from a treatable illness? No way.
boxy310 9y ago
We have lots of examples of governments doing this with ranges from poor to fair to good results. To my knowledge, the US is the only widescale attempt at market-based health care, with results of 2x the OECD average of health care cost per capita [1]. [1] https://read.oecd-ilibrary.org/social-issues-migration-health/health-at-a-glance-2017/health-expenditure-per-capita-2016-or-nearest-year_health_glance-2017-graph110-en#page1 https://read.oecd-ilibrary.org/social-issues-migration-healt...
- creaghpatr 9y ago
  The US is required to treat all critical condition patients under EMTALA since 1986. So the market does not currently decide in the current setting.
  - boxy310 9y ago
    What would you propose as being a "market-decides" approach to health care, beyond abolishing any-party insurers and revert to a 19th-century model?
    - creaghpatr 9y ago
      19th century healthcare was relatively affordable, or at least the costs were streamlined and transparent. Perhaps keep 3rd party insurance but ban it as an employment perk, that would incentivize the market to play to the greater public instead of just white collar salaried employees.
- aksss 9y ago
  But it’s hardly a market-based system with the third party payers. Consumers aren’t making informed decisions about what they buy, have little ability to comparison shop, and state-level regulations intentionally limit the number of providers in a market. With those attributes, the poor outcome of the “market” system is entirely predictable. We need to go in one direction or the other, but having the worst elements of centrally managed care and the worst elements of a market solution makes for rotten outcomes.
ceejayoz 9y ago
Definitely the government. People with severe disabilities may not be profitable, but I'd still like them to have the option to live.
- awat 9y ago
  This. What good is advanced technology if profitability calculations stop it from being used for all but those that can pay full price.
- ConceptJunkie 9y ago
  When cost-cutting needs to happen... and it's inevitable, the people with severe disabilities will be the first ones to get cut. Government-funded health care suffers from all the same economic problems that privately financed health care suffers from, and the government is just as corrupt as any private organization, plus there tends to be little incentive for efficiency, so government programs tend to be extremely inefficient and wasteful. I appreciate (and agree with) your concern for the disabled, but letting the government be in charge is a recipe for making everything worse.
  - ceejayoz 9y ago
    > I appreciate (and agree with) your concern for the disabled, but letting the government be in charge is a recipe for making everything worse. Except we have pretty much the entire developed world's healthcare systems to debunk that claim. They have similar life expectancies, medical outcomes, infant mortality, access to care, wait times, etc. for half the cost.
    - gregmac 9y ago
      Similar, sure, but US is ranked: * 31st for Life Expectancy [1] * 32nd in infant mortality [2] * 5th for colorectal cancer survival [3] * 1st for breast cancer survival [3] * 19th for cervical cancer survival [3] * 7th for heart attack mortality [3] The actual numbers are reasonably close, but the cost is also about 25% more per captia [4] than the second highest-spending country. [1] https://en.wikipedia.org/wiki/List_of_countries_by_life_expectancy https://en.wikipedia.org/wiki/List_of_countries_by_life_expe... [2] https://en.wikipedia.org/wiki/List_of_countries_by_infant_and_under-five_mortality_rates https://en.wikipedia.org/wiki/List_of_countries_by_infant_an... [3] https://en.wikipedia.org/wiki/List_of_countries_by_quality_of_healthcare https://en.wikipedia.org/wiki/List_of_countries_by_quality_o... [4] 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...
charonn0 9y ago
The market would just let them die, so if those are the only two options then I'd go with the government.
darkerside 9y ago
That's inappropriately anthropomorphizing the market. The market doesn't choose anything. I choose, and the market determines my constraints in choice. Since I'm well employed and not poor, my constraints are to my liking. My question regarding those who don't share that set of constraints. For some people, they go to the emergency room in cardiac arrest, having no insurance or ability to pay for critical treatment. Currently, they are treated, and costs are passed on to other consumers. Under single payer, those cost distributions would be made explicit. So besides doubling down on socialism, it accepting the status quo, are there reasonable alternative?
- creaghpatr 9y ago
  My half-baked opinion is that there should be a two tier system like US education. Free primary and preventative care along with dental and vision, and have a government subsidized insurance program for hospital/long term illness coverage akin to the public university system (along with the in-state discounts). And allow for a parallel private system to exist for those who want to pay more and get allegedly better treatment.
  - ceejayoz 9y ago
    Australia works on this model.
  - monocasa 9y ago
    So how NHS works in the UK?
    - pessimizer 9y ago
      No. If you have a private system, the public system gets abandoned; it's the first thing to be cut when budgets are constrained because no one making the decisions knows anyone who uses it. See US public schools.
      - zaroth 9y ago
        Public school funding per child increased 33% from 1995-2015. EDIT: This does appear to be inflation adjusted. Here’s a federal source which is definitely inflation adjusted showing funding increasing in real terms by 27% from 1995-2013. [2] [1] - http://apps.urban.org/features/education-funding-trends/ http://apps.urban.org/features/education-funding-trends/ [2] - https://nces.ed.gov/programs/digest/d16/tables/dt16_235.10.asp https://nces.ed.gov/programs/digest/d16/tables/dt16_235.10.a...
deciplex 9y ago
The government. Thanks for asking.
dbingham 9y ago
The evidence overwhelmingly suggests that the market fails to make this choice, and governments - for the most part - have done a good job.
- aksss 9y ago
  It it’s erroneous to call the American system a market-based system. It commonly is referred to as that - I know - but it doesn’t operate as such. Gov. regulation artificially and intentionally limits supply, supply shortage limits competition, limited competition inflates cost. Third party payer systems abstract the consumer from the supplier. Their buying decision is based on proximity of service center, not cost, because they often just see a $10 co-pay. So they aren’t making informed comparisons. If there’s a market there, it’s certainly not a free market, or anything close.
matte_black 9y ago
As long as markets decide who dies there is still hope. When a government decides who does it is absolutely final.
- ceejayoz 9y ago
  I've attempted to fight insurance denials. They're pretty final, too.
  - matte_black 9y ago
    It’s a matter of finding a way to raise the funds, insurance is only one way. If the government will not allow treatment and there’s no way to pay and you can’t leave the country, you’re finished.
    - DanBC 9y ago
      There is no treatment for Alfie Evans. All the doctors (even the Italian doctors) agree: Alfie Evans is going to die, and soon. What they're offering in Italy is exactly the same palliative end-of-life care that he'd get in the UK, but with the addition of a long painful trip. Alfie Evans has had the benefit of world class medical treatment - in the US he'd have been killed by the insurance company a long time ago. He's also had the benefit of free legal representation to make sure his best interests (because in the UK and Europe the best interests of the child are what's important) are looked after.
    - ceejayoz 9y ago
      > If the government will not allow treatment and there’s no way to pay and you can’t leave the country, you’re finished. If insurance will not allow treatment and there’s no way to pay and you can’t leave the country, you’re finished. Side note: private health insurance, private healthcare facilities, and paying out of your own pocket are all possible in countries with socialized healthcare.
      - DanBC 9y ago
Frondo 9y ago
The government. I don't trust the market to create a humane, compassionate system. I don't even trust the market to create an efficient system. I trust the market to be adjusted by the wealthy to further enrich themselves. I also trust the government to be the one organized group of people that can restrain that market, to give the rest of us a chance.
s73v3r_ 9y ago
The choice on whether or not people should die because they can't afford healthcare?

Would you rather the market or the government make that choice for you?

8note 9y ago

I want somebody who benefits from me being healthy on a long term to choose for me.

cycrutchfield 9y ago

False dichotomy. Please try to avoid logical fallacies when posting.

creaghpatr 9y ago
People seem awfully confused about who pays for healthcare in the US so let's be clear: either the government or the market (consumers) pays for healthcare, or they do it in tandem. I don't have a view on who should pay for it, but there are only 3 categories of payers in healthcare: 1 government and 2 private (insurance and self-pay). The compensation is funded by one of those sources.
- pessimizer 9y ago
  People also seem awfully confused about how much the government currently spends on healthcare: the US government currently spends roughly as much per-capita on healthcare as socialized systems that cover the entire cost of healthcare for their citizens, and have better measured outcomes. The crippling healthcare costs borne by individuals entirely consist of rent-seeking. It's also important to say that a lot of that money comes back out in salaries for the massive workforce required for the unnecessary administrative overhead, adding to the economy, and of course in non-imported luxury goods purchased by the rent-seekers themselves.
- cycrutchfield 9y ago
  So, to summarize, the person you replied to above asked what is the reasonable alternative to socialized healthcare that does not include people dying in the streets of treatable maladies. And through your explanation it appears as though you replied with a tautological statement that had no bearing on the question being asked. So, what is it that you are actually trying to say?
  - creaghpatr 9y ago
    They did not ask 'what', they asked 'if' an alternative exists, invoking the classic 'dying in the streets' motif. >Is there a reasonable alternative? I'm not trolling, but letting people die of treatable maladies doesn't seem like the right move. I answered a tautological statement with a tautological question based on the logic the poster omitted. Can you tell me who besides the government or the market (ie consumers) will prevent people from 'dying in the streets'? Perhaps by kidnapping another country's doctors and compelling them to provide care... >I'm not trolling
    - darkerside 9y ago
      I'm a little offended that you'd assume my question to be tautological, by which I in turn assume you mean rhetorical. Seems to have generated some good discussion.
- Consultant32452 9y ago
  I feel like even that confuses the issue. The government can only pay for something with money it takes from consumers.

softawre 9y ago

Would I rather this market decide if I die from a treatable illness? No way.

boxy310 9y ago

We have lots of examples of governments doing this with ranges from poor to fair to good results. To my knowledge, the US is the only widescale attempt at market-based health care, with results of 2x the OECD average of health care cost per capita [1]. [1] https://read.oecd-ilibrary.org/social-issues-migration-health/health-at-a-glance-2017/health-expenditure-per-capita-2016-or-nearest-year_health_glance-2017-graph110-en#page1 https://read.oecd-ilibrary.org/social-issues-migration-healt...

creaghpatr 9y ago
The US is required to treat all critical condition patients under EMTALA since 1986. So the market does not currently decide in the current setting.
- boxy310 9y ago
  What would you propose as being a "market-decides" approach to health care, beyond abolishing any-party insurers and revert to a 19th-century model?
  - creaghpatr 9y ago
    19th century healthcare was relatively affordable, or at least the costs were streamlined and transparent. Perhaps keep 3rd party insurance but ban it as an employment perk, that would incentivize the market to play to the greater public instead of just white collar salaried employees.
aksss 9y ago
But it’s hardly a market-based system with the third party payers. Consumers aren’t making informed decisions about what they buy, have little ability to comparison shop, and state-level regulations intentionally limit the number of providers in a market. With those attributes, the poor outcome of the “market” system is entirely predictable. We need to go in one direction or the other, but having the worst elements of centrally managed care and the worst elements of a market solution makes for rotten outcomes.

ceejayoz 9y ago

Definitely the government. People with severe disabilities may not be profitable, but I'd still like them to have the option to live.

awat 9y ago
This. What good is advanced technology if profitability calculations stop it from being used for all but those that can pay full price.
ConceptJunkie 9y ago
When cost-cutting needs to happen... and it's inevitable, the people with severe disabilities will be the first ones to get cut. Government-funded health care suffers from all the same economic problems that privately financed health care suffers from, and the government is just as corrupt as any private organization, plus there tends to be little incentive for efficiency, so government programs tend to be extremely inefficient and wasteful. I appreciate (and agree with) your concern for the disabled, but letting the government be in charge is a recipe for making everything worse.
- ceejayoz 9y ago
  > I appreciate (and agree with) your concern for the disabled, but letting the government be in charge is a recipe for making everything worse. Except we have pretty much the entire developed world's healthcare systems to debunk that claim. They have similar life expectancies, medical outcomes, infant mortality, access to care, wait times, etc. for half the cost.
  - gregmac 9y ago
    Similar, sure, but US is ranked: * 31st for Life Expectancy [1] * 32nd in infant mortality [2] * 5th for colorectal cancer survival [3] * 1st for breast cancer survival [3] * 19th for cervical cancer survival [3] * 7th for heart attack mortality [3] The actual numbers are reasonably close, but the cost is also about 25% more per captia [4] than the second highest-spending country. [1] https://en.wikipedia.org/wiki/List_of_countries_by_life_expectancy https://en.wikipedia.org/wiki/List_of_countries_by_life_expe... [2] https://en.wikipedia.org/wiki/List_of_countries_by_infant_and_under-five_mortality_rates https://en.wikipedia.org/wiki/List_of_countries_by_infant_an... [3] https://en.wikipedia.org/wiki/List_of_countries_by_quality_of_healthcare https://en.wikipedia.org/wiki/List_of_countries_by_quality_o... [4] 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...

charonn0 9y ago

The market would just let them die, so if those are the only two options then I'd go with the government.

darkerside 9y ago

That's inappropriately anthropomorphizing the market. The market doesn't choose anything. I choose, and the market determines my constraints in choice. Since I'm well employed and not poor, my constraints are to my liking. My question regarding those who don't share that set of constraints. For some people, they go to the emergency room in cardiac arrest, having no insurance or ability to pay for critical treatment. Currently, they are treated, and costs are passed on to other consumers. Under single payer, those cost distributions would be made explicit. So besides doubling down on socialism, it accepting the status quo, are there reasonable alternative?

creaghpatr 9y ago
My half-baked opinion is that there should be a two tier system like US education. Free primary and preventative care along with dental and vision, and have a government subsidized insurance program for hospital/long term illness coverage akin to the public university system (along with the in-state discounts). And allow for a parallel private system to exist for those who want to pay more and get allegedly better treatment.
- ceejayoz 9y ago
  Australia works on this model.
- monocasa 9y ago
  So how NHS works in the UK?
  - pessimizer 9y ago
    No. If you have a private system, the public system gets abandoned; it's the first thing to be cut when budgets are constrained because no one making the decisions knows anyone who uses it. See US public schools.
    - zaroth 9y ago
      Public school funding per child increased 33% from 1995-2015. EDIT: This does appear to be inflation adjusted. Here’s a federal source which is definitely inflation adjusted showing funding increasing in real terms by 27% from 1995-2013. [2] [1] - http://apps.urban.org/features/education-funding-trends/ http://apps.urban.org/features/education-funding-trends/ [2] - https://nces.ed.gov/programs/digest/d16/tables/dt16_235.10.asp https://nces.ed.gov/programs/digest/d16/tables/dt16_235.10.a...

deciplex 9y ago

The government. Thanks for asking.

dbingham 9y ago

The evidence overwhelmingly suggests that the market fails to make this choice, and governments - for the most part - have done a good job.

aksss 9y ago
It it’s erroneous to call the American system a market-based system. It commonly is referred to as that - I know - but it doesn’t operate as such. Gov. regulation artificially and intentionally limits supply, supply shortage limits competition, limited competition inflates cost. Third party payer systems abstract the consumer from the supplier. Their buying decision is based on proximity of service center, not cost, because they often just see a $10 co-pay. So they aren’t making informed comparisons. If there’s a market there, it’s certainly not a free market, or anything close.

matte_black 9y ago

As long as markets decide who dies there is still hope. When a government decides who does it is absolutely final.

ceejayoz 9y ago
I've attempted to fight insurance denials. They're pretty final, too.
- matte_black 9y ago
  It’s a matter of finding a way to raise the funds, insurance is only one way. If the government will not allow treatment and there’s no way to pay and you can’t leave the country, you’re finished.
  - DanBC 9y ago
    There is no treatment for Alfie Evans. All the doctors (even the Italian doctors) agree: Alfie Evans is going to die, and soon. What they're offering in Italy is exactly the same palliative end-of-life care that he'd get in the UK, but with the addition of a long painful trip. Alfie Evans has had the benefit of world class medical treatment - in the US he'd have been killed by the insurance company a long time ago. He's also had the benefit of free legal representation to make sure his best interests (because in the UK and Europe the best interests of the child are what's important) are looked after.
  - ceejayoz 9y ago
    > If the government will not allow treatment and there’s no way to pay and you can’t leave the country, you’re finished. If insurance will not allow treatment and there’s no way to pay and you can’t leave the country, you’re finished. Side note: private health insurance, private healthcare facilities, and paying out of your own pocket are all possible in countries with socialized healthcare.
    - DanBC 9y ago

Frondo 9y ago

The government. I don't trust the market to create a humane, compassionate system. I don't even trust the market to create an efficient system. I trust the market to be adjusted by the wealthy to further enrich themselves. I also trust the government to be the one organized group of people that can restrain that market, to give the rest of us a chance.

s73v3r_ 9y ago

The choice on whether or not people should die because they can't afford healthcare?