4 ms·

"there is(sic) got to be a better way!" There are two better ways - each at a different end of the spectrum. You can give up entirely on government interventi

by rsync 8y ago

"there is(sic) got to be a better way!" There are two better ways - each at a different end of the spectrum. You can give up entirely on government intervention in health insurance and social "goods" being pursued - everyone is on their own and "healthcare" is a private, personal matter. You can play these agency/incentive games with insurers for better or for worse and you're on your own. OR We declare "healthcare" to be a public, common good and completely socialize it. Like roads and fire departments. What these two different strategies have in common is that both of them are intelligible, reasonable and give people a framework for planning and making long term decisions. Anything between these two points on the spectrum is unintelligible and unsustainable. You would probably be better off with (the option above that you like the least) than any option between them.

bovine3dom 8y ago
> We declare "healthcare" to be a public, common good and completely socialize it. Like roads and fire departments. 1. Lots of places have private roads without much trouble. France's autoroutes are perhaps the most famous example. 2. Many of the world's most successful universal healthcare systems are run at least partially privately. The first point of contact one has with the NHS, for example, is through a general practitioner via medical practice, all of whom are private businesses (free at the point of use). I don't see why you think a hodgepodge of private and public, as exists in many places already, would be such a problem; I totally fail to see how making everything completely private would be a better solution than that. You'd end up with horrendous lemon-dropping.
mindslight 8y ago
> Anything between these two points on the spectrum is unintelligible and ... very fucking profitable. I mean, the most significant part of "health insurance reform" was to penalize people if they choose to opt out of patronizing these private companies. Some reform! I'd actually nitpick and say there are sane ways to combine the two regimes. For instance, a base level of common care, and then a functioning market for elective care, additional care, and upgrades.
- bovine3dom 8y ago
  > I mean, the most significant part of "health insurance reform" was to penalize people if they choose to opt out of patronizing these private companies. Citation needed for excess profits. As I understand it, now that that requirement has been removed, most companies have dropped out of the Obamacare-market. That seems to me like they were previously only making near the bare minimum that made it worth their while.
  - mindslight 8y ago
    Leaving the "Obamacare-market" doesn't imply a health "insurance" company is then operating as some bastion of the free market. The entire sector is rotten, easily demonstrated by providers not publishing a uniform list of prices for every single customer. In general, a lack of legibility to consumers means they are unable to choose efficiently, which implies that the other party is likely taking an outsized amount of profit. Much of that profit goes to paying the paper pushers who keep the system opaque, but from the consumer's perspective that's little consolation.
    - bovine3dom 8y ago
      > The entire sector is rotten, easily demonstrated by providers not publishing a uniform list of prices for every single customer. Why does that imply that the sector is rotten? Supermarkets don't publish the amount they pay for food, for example. It's a valid negotiating strategy; it means that offering a low price to one consumer doesn't mean that they have to offer it to another. I suspect that the care-providers and care-purchasers are too close, and that collusion is a source of the extra cost that Americans experience. (They also have far reduced waiting times, which is a genuine expense). In the UK, the NHS is funded from taxes. I don't get a choice whether I pay that or not. Mandatory insurance (or an equivalent) for all is a common factor in well-run healthcare systems worldwide. Without it, it's a bit like allowing car drivers to not purchase insurance until after they've crashed.
      - chimeracoder 8y ago
gbrown 8y ago
It's like when the government tries to address an oversupply of luxury apartments by renting them at full price and re-renting them at subsidized rates to consumers. I forget where this happened, but it was covered on Marketplace a few months ago. That "solution" is objectively worse than either the extreme libertarian position or the socialist position (though there are economically sensible positions between, this just doesn't happen to be one). It preserves artificially high demand for these luxury apartments, costs taxpayers a ton of money, and around the waste-cycle we go.
Gibbon1 8y ago
> You can give up entirely on government intervention in health insurance and social "goods" being pursued - everyone is on their own and "healthcare" is a private, personal matter. Except Kenneth Arrow showed market based health care doesn't work. That was in 1963. Since then the US has pursued market based heath insurance for ideological reasons and... that doesn't work without vast government subsidies. The government pays enough subsidies to cover a socialized system. http://www.who.int/bulletin/volumes/82/2/PHCBP.pdf http://www.who.int/bulletin/volumes/82/2/PHCBP.pdf
- mkirklions 8y ago
  > Since then the US has pursued market based heath insurance I wouldnt consider hundreds of millions of dollars of bribery 'market based' https://www.opensecrets.org/lobby/top.php?indexType=s https://www.opensecrets.org/lobby/top.php?indexType=s Physicians are one of the biggest reason healthcare is so expensive. Ive seen studies saying physicians account for 10-20% of all US healthcare spending. Physicians play that off like- Oh only 10%? But the reality is that the hospital parking lot, the IT, the nursing staff, the electricity, the software, landscaping etc.... all go into that. So 10% of spending being on Physicians is quite high. Its a cartel that they continue to regulate to make more difficult to be part of. I genuinely hope medical tourism becomes established because US physicians are corrupt.
  - Gibbon1 8y ago
    The point that I didn't really make is. Companies that are successful working inside an open market don't bribe the government to provide them subsidies and protection. The system we have is the result of 50 years of market failure and government intervention.
- chimeracoder 8y ago
  > Except Kenneth Arrow showed market based health care doesn't work. That is a really disingenuous reading of Arrow's work. Even if you ignore the myriad of ways in which the global heathcare market has changed in the last 55 years and how those affect the US (which is the largest player in the global system), that's still an unjustifiably broad interpretation of his research.

by rsync 8y ago

bovine3dom 8y ago

> We declare "healthcare" to be a public, common good and completely socialize it. Like roads and fire departments. 1. Lots of places have private roads without much trouble. France's autoroutes are perhaps the most famous example. 2. Many of the world's most successful universal healthcare systems are run at least partially privately. The first point of contact one has with the NHS, for example, is through a general practitioner via medical practice, all of whom are private businesses (free at the point of use). I don't see why you think a hodgepodge of private and public, as exists in many places already, would be such a problem; I totally fail to see how making everything completely private would be a better solution than that. You'd end up with horrendous lemon-dropping.

mindslight 8y ago

> Anything between these two points on the spectrum is unintelligible and ... very fucking profitable. I mean, the most significant part of "health insurance reform" was to penalize people if they choose to opt out of patronizing these private companies. Some reform! I'd actually nitpick and say there are sane ways to combine the two regimes. For instance, a base level of common care, and then a functioning market for elective care, additional care, and upgrades.

bovine3dom 8y ago
> I mean, the most significant part of "health insurance reform" was to penalize people if they choose to opt out of patronizing these private companies. Citation needed for excess profits. As I understand it, now that that requirement has been removed, most companies have dropped out of the Obamacare-market. That seems to me like they were previously only making near the bare minimum that made it worth their while.
- mindslight 8y ago
  Leaving the "Obamacare-market" doesn't imply a health "insurance" company is then operating as some bastion of the free market. The entire sector is rotten, easily demonstrated by providers not publishing a uniform list of prices for every single customer. In general, a lack of legibility to consumers means they are unable to choose efficiently, which implies that the other party is likely taking an outsized amount of profit. Much of that profit goes to paying the paper pushers who keep the system opaque, but from the consumer's perspective that's little consolation.
  - bovine3dom 8y ago
    > The entire sector is rotten, easily demonstrated by providers not publishing a uniform list of prices for every single customer. Why does that imply that the sector is rotten? Supermarkets don't publish the amount they pay for food, for example. It's a valid negotiating strategy; it means that offering a low price to one consumer doesn't mean that they have to offer it to another. I suspect that the care-providers and care-purchasers are too close, and that collusion is a source of the extra cost that Americans experience. (They also have far reduced waiting times, which is a genuine expense). In the UK, the NHS is funded from taxes. I don't get a choice whether I pay that or not. Mandatory insurance (or an equivalent) for all is a common factor in well-run healthcare systems worldwide. Without it, it's a bit like allowing car drivers to not purchase insurance until after they've crashed.
    - chimeracoder 8y ago

gbrown 8y ago

It's like when the government tries to address an oversupply of luxury apartments by renting them at full price and re-renting them at subsidized rates to consumers. I forget where this happened, but it was covered on Marketplace a few months ago. That "solution" is objectively worse than either the extreme libertarian position or the socialist position (though there are economically sensible positions between, this just doesn't happen to be one). It preserves artificially high demand for these luxury apartments, costs taxpayers a ton of money, and around the waste-cycle we go.

Gibbon1 8y ago

> You can give up entirely on government intervention in health insurance and social "goods" being pursued - everyone is on their own and "healthcare" is a private, personal matter. Except Kenneth Arrow showed market based health care doesn't work. That was in 1963. Since then the US has pursued market based heath insurance for ideological reasons and... that doesn't work without vast government subsidies. The government pays enough subsidies to cover a socialized system. http://www.who.int/bulletin/volumes/82/2/PHCBP.pdf http://www.who.int/bulletin/volumes/82/2/PHCBP.pdf

mkirklions 8y ago
> Since then the US has pursued market based heath insurance I wouldnt consider hundreds of millions of dollars of bribery 'market based' https://www.opensecrets.org/lobby/top.php?indexType=s https://www.opensecrets.org/lobby/top.php?indexType=s Physicians are one of the biggest reason healthcare is so expensive. Ive seen studies saying physicians account for 10-20% of all US healthcare spending. Physicians play that off like- Oh only 10%? But the reality is that the hospital parking lot, the IT, the nursing staff, the electricity, the software, landscaping etc.... all go into that. So 10% of spending being on Physicians is quite high. Its a cartel that they continue to regulate to make more difficult to be part of. I genuinely hope medical tourism becomes established because US physicians are corrupt.
- Gibbon1 8y ago
  The point that I didn't really make is. Companies that are successful working inside an open market don't bribe the government to provide them subsidies and protection. The system we have is the result of 50 years of market failure and government intervention.
chimeracoder 8y ago
> Except Kenneth Arrow showed market based health care doesn't work. That is a really disingenuous reading of Arrow's work. Even if you ignore the myriad of ways in which the global heathcare market has changed in the last 55 years and how those affect the US (which is the largest player in the global system), that's still an unjustifiably broad interpretation of his research.