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I'm glad to see someone else shares this view. I've been saying for years that both a single payer health system and an actual free market system would be prefe

I'm glad to see someone else shares this view. I've been saying for years that both a single payer health system and an actual free market system would be preferable to the heavily-yet-poorly-regulated mess of a "market" we have now. If we don't go the single payer route, it seems one of the #1 things we could do is to help move "insurance" back to being actual insurance (i.e., we'll keep you from being bankrupted by your medical bills) rather than a system that highly subsidizes your regular medical care but then may not actually be there for you when the bills really pile up... If consumers had to actually shop for procedures (as opposed to knowing the out-of-pocket is $250 and who knows what happens beyond that), I think you'd start to see people screaming for transparency, and medical providers would have to get their acts together. Only one of many problems, I know.

acidtrucks 8y ago
I agree with this, and I would also like to see more welfare programs separate from the insurance role. Insurance companies like to trick you into thinking you're getting a better deal because of them. That's not what insurance means. Keep those roles separate and straightforward.
cookiecaper 8y ago
Yes! Political chicanery and tribalism is exploited to make sure that the leeches stay in place, with neither side realizing that what we have now is just the worst of all worlds for everyone else. I'm pretty conservative and I'd love to see a solution to the healthcare marketplace that doesn't amount to nationalization, but at this point, the market is so distorted and fundamentally unworkable that even a nationalized healthcare industry would be preferable. There is no definition that fits better than "FUBAR" [0]. The only solution is going to be tear down the industry that we have and build something more sustainable in its place, whether that new thing is a nationalized health system or just very serious regulations to ensure healthy and functioning competition and free-market ideals (Obamacare does the opposite of this, literally making it illegal to not pay a health insurer; good policy would make non-catastrophic medical coverage illegal). Whatever the answer is, there's going to be a lot of people who are unhappy about it, but we have to fix this. That other conservatives are just slamming their heads into the sand and saying "free market" when it's impossible to know how much a given medical procedure will actually cost until 3-6 months after the fact is just utterly and fundamentally embarrassing for everyone. Pricing is the most fundamental element in a functioning market. You can't pretend to be making rational choices if you can't even find out the cost. The whole thing shows how very little anyone is paying attention to anything other than virtue signaling. The government is a big bad powerful thing, but it exists for a reason, and reducing every argument down to "just let those nice men in the Hamptons handle it, they wouldn't be rich if they weren't real smart" gets really tiresome. [0] https://www.urbandictionary.com/define.php?term=fubar https://www.urbandictionary.com/define.php?term=fubar
- maxerickson 8y ago
  Bronze ACA plans are pretty much catastrophic coverage. $7300 individual, $14,500 family deductibles. There's plenty of people that could afford higher deductibles than that (and would prefer the accompanying lower premiums), but not really the majority of people. Cutting the basic benefits out of them wouldn't even really save that much money (because insurance negotiates reasonable prices for basic office visits...).
  - cookiecaper 8y ago
    Insurance certainly costs far too much money, but that's missing the forest for the trees. Insurance is the reason that the market is non-functional and broken. The misdirection inherent in an insurance-centric pricing regime is what's made it impossible for anyone to ever know the actual out-of-pocket cost of anything, and getting that is the first part of getting a functioning market established. We need to stop looking at the individual level and "What can we eek out of people who don't qualify for Medicaid?", and look to the macro-scale effects. Insurance is the wrong model for routine services (indeed, insurance usually functions as a discount program rather than true insurance) and people shouldn't be able to sell it for that purpose due to the debilitating effects it has on the marketplace. Docs and pharamacies should be up front about their real prices. Today, even people who are "posting prices" can't be up front about it because posted prices function as high anchors for insurance negotiations. This is why you can often get a massive "cash discount" if you call about a bill that you're going to self-pay. That's what they'd really like to charge you, but if they don't start out charging the sticker price they quoted the insurer, they're in big trouble. For a market to work, there must be a real pricing dynamic where the consumer can be reasonably well informed about the actual total cost and vote with their feet. Hyperinflated 300% prices, necessitated by insurer demands for large discounts, don't count, they're still not real numbers. Markets simply cannot work without meaningful and accessible pricing information. The medical system will remain a disaster until we can break this dynamic around pricing, and the only way to do that is to fundamentally change the way that medical insurance works, either by nationalizing insurance and/or medicine so that the government writes all the checks and price becomes only indirectly relevant to the public anyway, or by imposing law that mandates price transparency and seriously limits what "medical insurance" and "discount programs" can do, so that we don't immediately descend back into this. IMO this is a textbook case of a market screaming for good regulation. Ideally we would identify the malicious actors (primarily insurers), develop rules and systems that minimize their ability to operate, and allow the free flow of commerce to handle everything else. "Nationalize it" is a clear power grab, but lacking any willingness to do anything else about such a breathtakingly large economic and humanitarian issue, even that would be better than "let's just keep crossing our fingers". It's so sad that the level of conservative dialogue is not "let's find a good minimalist intervention that will get this market working again" but rather "Did someone say 'MURICA wasn't the best at something?!"
custos 8y ago
If it worked like normal insurance, people with chronic illnesses would still go bankrupt.
- salawat 8y ago
  I want to tell you not to waste your breath. Frankly, no one wants to talk about chronic ailments. ADHD (the so-called fake disease) for example. Nevermind that they are a real part of why premiums are likely as high as they are. Nevermind that it is essentially a life-long tax for the patient. Nevermind that the law deprives those who suffer from a case for which narcotic therapies work and CBT doesn't into profit slaves to drug manufacturer's and their 'attending' prescription writer. They have a solution to the problem (that generally works out better for the supply chain than the patient)! How dare you suggest it isn't the best approach! What are you, some communist? /s But alas, if we don't say it no one will listen. So... As the parent said... "If it worked like normal insurance, people with chronic illnesses would still go bankrupt."
patrickmay 8y ago
Resetting the expectation that insurance is for unusual procedures, not for yearly checkups and the common cold would be a great start. It's also necessary to focus on the supply side. Just two examples: the AMA limits the number of doctors and new hospitals can't be opened without the approval of the existing hospitals in the area. There is far from a free market in health care in the US. http://reason.com/archives/2017/10/25/this-one-weird-trick-could-improve-medic http://reason.com/archives/2017/10/25/this-one-weird-trick-c...
- ejstronge 8y ago
  I understand your sentiment, but it is absolutely incorrect that the AMA limits the number of doctors. I presume you really mean 'residency slots' when you say doctors. In this case, the relevant administrative body is the ACGME... who sets the limits based on appropriations from Congress. The trope of doctors restricting entry to enrich themselves does not explain reported physician shortages.
  - lr4444lr 8y ago
    Practicing medicine without a license is illegal in all 50 states. The AMA is a major gatekeeper of this process. It's one thing to prosecute people for falsely passing themselves off as being licensed, quite another not letting them perform procedures on consenting patients.
    - nradov 8y ago
      That was tried before and resulted in horrible levels of death and suffering. Which is exactly why we now have the AMA and laws against the unlicensed practice of medicine. No one who understands the history of medicine wants to go back.
      - fragmede 8y ago
        That's a false dichotomy, no one said anything about going back. Never mind that Josef Mengele was a licensed physicians, or that the AMA was well established before the Tuskegee syphilis experiments occurred, also with work performed by licensed physicians. Just that the bureaucracy has resulted in an industry that fails patients. Heart surgeons refuse difficult surgeries to juke the stats. Good for their mortality ratings (not that anybody could blame individuals doctors)[1], not so great for patients. Even just the notion of specialties hurts the patient - it makes perfect sense that the deep knowledge involved means that an orthopedic doctor can't (and shouldn't!) treat issues that should be seen by a podiatrist. But at the end of the day, the patient is in chronic pain, and has such a low quality of life, that to them, the risks of street heroin are acceptable. This isn't a moral failing by the patient's, nor is it a lack of intelligence, this life being too much to bear otherwise, and if you've never considered suicide as an option, be grateful. Dr. David Casarett's talk[2] takes a closer look at an alternate, but accepted medical practice, and gives some thoughts about how our medical bureaucrats have resulted in worse patient care. [1] https://www.telegraph.co.uk/science/2016/06/03/one-in-three-heart-surgeons-refuse-difficult-operations-to-avoid/ https://www.telegraph.co.uk/science/2016/06/03/one-in-three-... [2] https://www.ted.com/talks/david_casarett_a_doctor_s_case_for_medical_marijuana https://www.ted.com/talks/david_casarett_a_doctor_s_case_for...
tstrimple 8y ago
> If consumers had to actually shop for procedures You'd have even more people avoiding easily treatable conditions due to cost.

acidtrucks 8y ago

I agree with this, and I would also like to see more welfare programs separate from the insurance role. Insurance companies like to trick you into thinking you're getting a better deal because of them. That's not what insurance means. Keep those roles separate and straightforward.

cookiecaper 8y ago

Yes! Political chicanery and tribalism is exploited to make sure that the leeches stay in place, with neither side realizing that what we have now is just the worst of all worlds for everyone else. I'm pretty conservative and I'd love to see a solution to the healthcare marketplace that doesn't amount to nationalization, but at this point, the market is so distorted and fundamentally unworkable that even a nationalized healthcare industry would be preferable. There is no definition that fits better than "FUBAR" [0]. The only solution is going to be tear down the industry that we have and build something more sustainable in its place, whether that new thing is a nationalized health system or just very serious regulations to ensure healthy and functioning competition and free-market ideals (Obamacare does the opposite of this, literally making it illegal to not pay a health insurer; good policy would make non-catastrophic medical coverage illegal). Whatever the answer is, there's going to be a lot of people who are unhappy about it, but we have to fix this. That other conservatives are just slamming their heads into the sand and saying "free market" when it's impossible to know how much a given medical procedure will actually cost until 3-6 months after the fact is just utterly and fundamentally embarrassing for everyone. Pricing is the most fundamental element in a functioning market. You can't pretend to be making rational choices if you can't even find out the cost. The whole thing shows how very little anyone is paying attention to anything other than virtue signaling. The government is a big bad powerful thing, but it exists for a reason, and reducing every argument down to "just let those nice men in the Hamptons handle it, they wouldn't be rich if they weren't real smart" gets really tiresome. [0] https://www.urbandictionary.com/define.php?term=fubar https://www.urbandictionary.com/define.php?term=fubar

maxerickson 8y ago
Bronze ACA plans are pretty much catastrophic coverage. $7300 individual, $14,500 family deductibles. There's plenty of people that could afford higher deductibles than that (and would prefer the accompanying lower premiums), but not really the majority of people. Cutting the basic benefits out of them wouldn't even really save that much money (because insurance negotiates reasonable prices for basic office visits...).
- cookiecaper 8y ago
  Insurance certainly costs far too much money, but that's missing the forest for the trees. Insurance is the reason that the market is non-functional and broken. The misdirection inherent in an insurance-centric pricing regime is what's made it impossible for anyone to ever know the actual out-of-pocket cost of anything, and getting that is the first part of getting a functioning market established. We need to stop looking at the individual level and "What can we eek out of people who don't qualify for Medicaid?", and look to the macro-scale effects. Insurance is the wrong model for routine services (indeed, insurance usually functions as a discount program rather than true insurance) and people shouldn't be able to sell it for that purpose due to the debilitating effects it has on the marketplace. Docs and pharamacies should be up front about their real prices. Today, even people who are "posting prices" can't be up front about it because posted prices function as high anchors for insurance negotiations. This is why you can often get a massive "cash discount" if you call about a bill that you're going to self-pay. That's what they'd really like to charge you, but if they don't start out charging the sticker price they quoted the insurer, they're in big trouble. For a market to work, there must be a real pricing dynamic where the consumer can be reasonably well informed about the actual total cost and vote with their feet. Hyperinflated 300% prices, necessitated by insurer demands for large discounts, don't count, they're still not real numbers. Markets simply cannot work without meaningful and accessible pricing information. The medical system will remain a disaster until we can break this dynamic around pricing, and the only way to do that is to fundamentally change the way that medical insurance works, either by nationalizing insurance and/or medicine so that the government writes all the checks and price becomes only indirectly relevant to the public anyway, or by imposing law that mandates price transparency and seriously limits what "medical insurance" and "discount programs" can do, so that we don't immediately descend back into this. IMO this is a textbook case of a market screaming for good regulation. Ideally we would identify the malicious actors (primarily insurers), develop rules and systems that minimize their ability to operate, and allow the free flow of commerce to handle everything else. "Nationalize it" is a clear power grab, but lacking any willingness to do anything else about such a breathtakingly large economic and humanitarian issue, even that would be better than "let's just keep crossing our fingers". It's so sad that the level of conservative dialogue is not "let's find a good minimalist intervention that will get this market working again" but rather "Did someone say 'MURICA wasn't the best at something?!"

custos 8y ago

If it worked like normal insurance, people with chronic illnesses would still go bankrupt.

salawat 8y ago
I want to tell you not to waste your breath. Frankly, no one wants to talk about chronic ailments. ADHD (the so-called fake disease) for example. Nevermind that they are a real part of why premiums are likely as high as they are. Nevermind that it is essentially a life-long tax for the patient. Nevermind that the law deprives those who suffer from a case for which narcotic therapies work and CBT doesn't into profit slaves to drug manufacturer's and their 'attending' prescription writer. They have a solution to the problem (that generally works out better for the supply chain than the patient)! How dare you suggest it isn't the best approach! What are you, some communist? /s But alas, if we don't say it no one will listen. So... As the parent said... "If it worked like normal insurance, people with chronic illnesses would still go bankrupt."

patrickmay 8y ago

Resetting the expectation that insurance is for unusual procedures, not for yearly checkups and the common cold would be a great start. It's also necessary to focus on the supply side. Just two examples: the AMA limits the number of doctors and new hospitals can't be opened without the approval of the existing hospitals in the area. There is far from a free market in health care in the US. http://reason.com/archives/2017/10/25/this-one-weird-trick-could-improve-medic http://reason.com/archives/2017/10/25/this-one-weird-trick-c...

ejstronge 8y ago
I understand your sentiment, but it is absolutely incorrect that the AMA limits the number of doctors. I presume you really mean 'residency slots' when you say doctors. In this case, the relevant administrative body is the ACGME... who sets the limits based on appropriations from Congress. The trope of doctors restricting entry to enrich themselves does not explain reported physician shortages.
- lr4444lr 8y ago
  Practicing medicine without a license is illegal in all 50 states. The AMA is a major gatekeeper of this process. It's one thing to prosecute people for falsely passing themselves off as being licensed, quite another not letting them perform procedures on consenting patients.
  - nradov 8y ago
    That was tried before and resulted in horrible levels of death and suffering. Which is exactly why we now have the AMA and laws against the unlicensed practice of medicine. No one who understands the history of medicine wants to go back.
    - fragmede 8y ago
      That's a false dichotomy, no one said anything about going back. Never mind that Josef Mengele was a licensed physicians, or that the AMA was well established before the Tuskegee syphilis experiments occurred, also with work performed by licensed physicians. Just that the bureaucracy has resulted in an industry that fails patients. Heart surgeons refuse difficult surgeries to juke the stats. Good for their mortality ratings (not that anybody could blame individuals doctors)[1], not so great for patients. Even just the notion of specialties hurts the patient - it makes perfect sense that the deep knowledge involved means that an orthopedic doctor can't (and shouldn't!) treat issues that should be seen by a podiatrist. But at the end of the day, the patient is in chronic pain, and has such a low quality of life, that to them, the risks of street heroin are acceptable. This isn't a moral failing by the patient's, nor is it a lack of intelligence, this life being too much to bear otherwise, and if you've never considered suicide as an option, be grateful. Dr. David Casarett's talk[2] takes a closer look at an alternate, but accepted medical practice, and gives some thoughts about how our medical bureaucrats have resulted in worse patient care. [1] https://www.telegraph.co.uk/science/2016/06/03/one-in-three-heart-surgeons-refuse-difficult-operations-to-avoid/ https://www.telegraph.co.uk/science/2016/06/03/one-in-three-... [2] https://www.ted.com/talks/david_casarett_a_doctor_s_case_for_medical_marijuana https://www.ted.com/talks/david_casarett_a_doctor_s_case_for...

tstrimple 8y ago

> If consumers had to actually shop for procedures You'd have even more people avoiding easily treatable conditions due to cost.