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Ah, the old "American exceptionalism" argument. Don't make that one, it's a bad argument. How about this? Would you rather be in the US, or Japan, for such an
by beat 8y ago
Ah, the old "American exceptionalism" argument. Don't make that one, it's a bad argument.
How about this? Would you rather be in the US, or Japan, for such an emergency? Japan costs half as much as the US per capita (with even lower out of pocket costs), and beats us by every other measure. I'd rather be in the Japanese system than the American one for anything.
edit: The Japanese system, structurally, is very similar to the American system. It's not socialized, by and large. Private insurance through employers to private providers. Yet it costs half as much and works better. This points to something broken in the US system at a deeper level. Expanding on this, every civilized nation in the world has health care more or less on par with the US (fuck exceptionalism), for more or less half our cost. To the chagrin of liberals, "socialized medicine" isn't the obvious solution, because a lot of systems no more socialist than ours work well. And to the chagrin of conservatives, a lot of highly socialized systems also work better. The American system is uniquely fucked up.
Back to Japan. The key difference I can see between the two systems is that Japan has strict price controls. A government commission sets the prices for all medical products and services covered by insurance, with an eye to controlling costs while maintaining profitability. Insurers and providers have to control their costs internally, rather than jacking prices or doing many-to-many negotiations. Is this the key?
- mjevans 8y agoCentralized planning and standards sound like a non-free market to me; and also exactly what an inflexible demand market for critical utility services needs.
- beat 8y agoAs Peter Thiel pointed out in Zero to One, in an idealized free market, profit is impossible. Pure competition drives profit margins to zero. This can be easily observed in highly competitive industries, like groceries or gas stations. They operate on razor-thin margins. The only way to make big money in competitive markets is huge scale, which explains consolidation and the drive of money to the top. All substantial profitability comes from friction or monopoly (including localized monopoly, like not having a full range of choices for your employee-based insurance). But I digress. At any rate, the Japanese system clearly works, while the American system is clearly broken. One is selling the same product for half the price of the other. Assuming I'm right about the key differentiator being the Japanese price controls (I could be wrong), then it really makes me wonder why we aren't trying that. Seems like a great way to get costs under control (even shrinking), while preserving much of the complex market and avoiding radical change to almost 20% of the economy. I think "critical utility services" touches on the importance, but doesn't go far enough. I believe a health care system that denies care purely out of poverty is immoral. A health care system that is the primary cause of bankruptcy for the middle class is immoral. A system that traps employees in jobs they hate, for fear of losing (or even changing) their insurance is both immoral and un-American - what's more American than quitting your job to get a better one, or start your own business? So our system is not just an economic failure, it's a moral failure. It's a stain on our honor and an insult to our values. In conclusion, I do not give a fuck about "free market" here. I am not putting economic ideology ahead of moral imperatives, and I'm not choosing ideology over observable facts. If I wanted to choose ideology over economic reality, I'd be a communist.