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Sorry, I was talking about insurance companies. I forgot that you can actually pay cash in America for medical services. It's a totally alien idea to me. Insur

Sorry, I was talking about insurance companies. I forgot that you can actually pay cash in America for medical services. It's a totally alien idea to me. Insurance in America is supposed to be buyers of medical services clubbing together to get a better deal, similarly to people unionising for better conditions. Allowing people with no negotiating power to purchase services is a bit nuts, but I'd hope the high prices would put most people off. It's like letting people by food on trains. Of course it's overpriced, you're a captive market (sometimes literally in a hospital).

mindslight 8y ago
From a USian perspective I think it's worthwhile to think in terms of the "base case" of individuals paying cash - from the perspective of the median person, our "health insurance" system is primarily a way of getting upfront pricing. I don't focus on the market dynamics to argue against a single payer system (it does seem to tackle the problem better than we've currently got), but to point out the utter hypocrisy of labeling the current regime as anything remotely market-based. As I said above, I'm personally open to a fusion of the two different philosophies when they're sensible together - not the worst of both as we tend to get in the US. To go with the train analogy - it's like knowing snacks are $8/ea on the train, so you're encouraged to buy a $20 pass for "all you can eat". Then you get hungry and find out that the pass just means you can wait in line for an hour to get one small snack at a time. The pass wasn't actually a solution to the high prices, and making buying the pass mandatory certainly isn't going to help the overall situation. Barring an honest train operator, the only thing that will keep prices down is actual competition - in this analogy the people who plan ahead and pack their own snacks obtained from an outside vendor.

mindslight 8y ago

From a USian perspective I think it's worthwhile to think in terms of the "base case" of individuals paying cash - from the perspective of the median person, our "health insurance" system is primarily a way of getting upfront pricing. I don't focus on the market dynamics to argue against a single payer system (it does seem to tackle the problem better than we've currently got), but to point out the utter hypocrisy of labeling the current regime as anything remotely market-based. As I said above, I'm personally open to a fusion of the two different philosophies when they're sensible together - not the worst of both as we tend to get in the US. To go with the train analogy - it's like knowing snacks are $8/ea on the train, so you're encouraged to buy a $20 pass for "all you can eat". Then you get hungry and find out that the pass just means you can wait in line for an hour to get one small snack at a time. The pass wasn't actually a solution to the high prices, and making buying the pass mandatory certainly isn't going to help the overall situation. Barring an honest train operator, the only thing that will keep prices down is actual competition - in this analogy the people who plan ahead and pack their own snacks obtained from an outside vendor.