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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 w

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?!"
bambataa 8y ago
Isn’t choice also a fundamental part of a free market? I can choose to buy a certain product and decide not to buy if the market prices are above what I’m willing to spend. How does that apply to medical procedures?
- michaelmrose 8y ago
  Every medical procedure I've ever seen anyone forgo has been to their gross detriment. People really don't choose not to by like its a new car or chinese food. They suffer or die because they can't afford to do otherwise.
- cookiecaper 8y ago
  Most medical issues are not emergencies. For most problems, there is plenty of time to comparison shop, consider the urgency and/or optionality of specific care, and so forth. We do this just fine with other usually-non-emergent necessities of life like food, clothing, and housing. We didn't need to nationalize land ownership or food distribution to create vibrant economies for these, despite the fact that people can't really just "choose not to buy them". Things are that way in part because there is a controlled regulatory regime in there, not trying to nationalize everything but also acknowledging the duty to protect the market from bad actors. Food, clothing, and housing aren't perfect analogs because medicine is a professional service, but this suffices to show that necessities aren't necessarily exempt from market forces just by virtue of their non-optionality. Medicine needs a middle ground between "nationalize it" and "ignore it", but in this case, if those are the only two options, "ignore it" is clearly the worse one. My wife and kids had 0 medical emergencies last year and we still paid over $10k in doctor and dentist bills just from deductibles, copays, and coinsurance. That's after having nearly $1k per month deducted from my paychecks for insurance premiums, not to mention the part that my employer contributed on top of that. It makes me sick to add those figures up, so I'll just leave that as an exercise. You can bet that if there were any actual optionality here, we'd spend a few days trying to sort out the most efficient way to handle this stuff. Let's also not forget that insurance imposes a significant amount of rationing too. Our policy only covered up to 40 "habilitative care" visits per year, despite the fact that every therapist and doctor we saw recommended about 3x that. These are relatively mild speech and occupational therapy visits -- 40 visits is combined, every speech and pt/ot visit counts against it. "You need insurance because you'll have to buy medical care or you'll die" doesn't always play out that way.

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?!"

bambataa 8y ago

Isn’t choice also a fundamental part of a free market? I can choose to buy a certain product and decide not to buy if the market prices are above what I’m willing to spend. How does that apply to medical procedures?

michaelmrose 8y ago
Every medical procedure I've ever seen anyone forgo has been to their gross detriment. People really don't choose not to by like its a new car or chinese food. They suffer or die because they can't afford to do otherwise.
cookiecaper 8y ago
Most medical issues are not emergencies. For most problems, there is plenty of time to comparison shop, consider the urgency and/or optionality of specific care, and so forth. We do this just fine with other usually-non-emergent necessities of life like food, clothing, and housing. We didn't need to nationalize land ownership or food distribution to create vibrant economies for these, despite the fact that people can't really just "choose not to buy them". Things are that way in part because there is a controlled regulatory regime in there, not trying to nationalize everything but also acknowledging the duty to protect the market from bad actors. Food, clothing, and housing aren't perfect analogs because medicine is a professional service, but this suffices to show that necessities aren't necessarily exempt from market forces just by virtue of their non-optionality. Medicine needs a middle ground between "nationalize it" and "ignore it", but in this case, if those are the only two options, "ignore it" is clearly the worse one. My wife and kids had 0 medical emergencies last year and we still paid over $10k in doctor and dentist bills just from deductibles, copays, and coinsurance. That's after having nearly $1k per month deducted from my paychecks for insurance premiums, not to mention the part that my employer contributed on top of that. It makes me sick to add those figures up, so I'll just leave that as an exercise. You can bet that if there were any actual optionality here, we'd spend a few days trying to sort out the most efficient way to handle this stuff. Let's also not forget that insurance imposes a significant amount of rationing too. Our policy only covered up to 40 "habilitative care" visits per year, despite the fact that every therapist and doctor we saw recommended about 3x that. These are relatively mild speech and occupational therapy visits -- 40 visits is combined, every speech and pt/ot visit counts against it. "You need insurance because you'll have to buy medical care or you'll die" doesn't always play out that way.