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> Only non-profit healthcare services allowed Honestly, this isn't necessary, as long as you have single payer (or close to it). When the government is the one

> Only non-profit healthcare services allowed Honestly, this isn't necessary, as long as you have single payer (or close to it). When the government is the one paying for 99% of healthcare, they have huge clout enforcing razor-thin margins and high efficiency on the provider side. Just look at how the massive supermarket chains are able to keep the margins of the upstream supply chain at a minimum.

AnthonyMouse 8y ago
> Honestly, this isn't necessary, as long as you have single payer (or close to it). When the government is the one paying for 99% of healthcare, they have huge clout enforcing razor-thin margins and high efficiency on the provider side. Just look at how the massive supermarket chains are able to keep the margins of the upstream supply chain at a minimum. The problem is that governments don't work that way. When a purchasing officer at a business negotiates a lower price he gets a large bonus. What does a Congressman get when he negotiates a lower price, compared to what he gets (from the people he's negotiating with) if he "negotiates" a higher price? What about the government bureaucrat who will be working in that industry soon? That is the problem. Meanwhile who is more knowledgeable about produce if you have a question, the staff at Walmart or the farmers at the local farmer's market? It's easy to order cost cutting from the top of the tower, but if you don't know what's happening on the ground, you don't know what you're actually cutting. What you need is for people -- the people who are actually consuming services and can choose to go somewhere else if the price is wrong -- to be able to choose based on published price information. The argument people sometimes make about this is that you don't get to choose which hospital an ambulance takes you to when you're unconscious, but the majority of healthcare spending isn't that, and that doesn't explain why we have no price transparency for non-emergency surgical procedures or diabetes or cancer treatment.
- namdnay 8y ago
  > The problem is that governments don't work that way Well, they can... Just look at France. Amazing healthcare, a lot of it private, relatively cheap > What does a Congressman get Nothing, they don't negotiate > What about the government bureaucrat A performance bonus, a raise, a promotion? Just like any other organisation? > What you need is for people to be able to choose based on published price information OK, go and buy a pound of ground meat. Or an LCD screen. Are you seriously telling me you can get a better deal than McDonalds or Apple?
  - coolwhhip 8y ago
    Doesn’t the French government have some leverage via pharmaceutical intellectual property rights? I’m no expert, but I don’t think it’s as simple as “everyone should just buy in bulk like we do.”
  - toasterlovin 8y ago
    > What you need is for people to be able to choose based on published price information What they're saying is that a large amount of healthcare spending is driven by patients and providers, but paid for by insurance companies. Neither patients nor doctors have an immediate, short-term incentive to make sure they utilize insurance company resources judiciously. On the contrary, the both have an incentive to consume as many insurance company resources as possible (the patient wants to make sure they get every possible treatment, even if that means consuming 10x resources to prevent a 1/10th as likely outcome, and the provider wants to bill as much as possible to increase revenue). I can tell you, as somebody whose family has catastrophic coverage only, that we think long and hard before we blow $200 so that a doctor can tell us to take some ibuprofen and drink plenty of fluids. And we also ask lots of questions about how much various recommended treatments will cost vs. what they will do for us.
  - AnthonyMouse 8y ago
    > Well, they can... Just look at France. Amazing healthcare, a lot of it private, relatively cheap In a place with a different political system, population, demographics, culture, economy, etc... and France has a price transparency law. > Nothing, they don't negotiate They pass laws dictating how others can negotiate (or not). > A performance bonus, a raise, a promotion? Just like any other organisation? But not like any other organization, because if you gave a government employee a million dollar bonus for doing their job there would be a riot. Meanwhile they can get million dollar private sector employment for not doing their job. > OK, go and buy a pound of ground meat. Or an LCD screen. Are you seriously telling me you can get a better deal than McDonalds or Apple? I'm telling you I can get a better deal than the Department of Defense.
- craftyguy 8y ago
  > What does a Congressman get when he negotiates a lower price, compared to what he gets (from the people he's negotiating with) if he "negotiates" a higher price? What about the government bureaucrat who will be working in that industry soon? Ideally there would be some sort of accountability for elected officials, where they would have to answer to their electorate, and where conflicts of interest would be against the law (and prosecuted), but who am I kidding?
  - AnthonyMouse 8y ago
    > Ideally there would be some sort of accountability for elected officials, where they would have to answer to their electorate, and where conflicts of interest would be against the law (and prosecuted), but who am I kidding? Right, exactly. It's like the claim that Communism would work great once automation eliminates the need for all human labor. It's a nice theory, might even be true, but until we can satisfy the precondition what practical relevance does it have? Go work on the precondition and come back after you accomplish that. In the meantime we need something else.

AnthonyMouse 8y ago

> Honestly, this isn't necessary, as long as you have single payer (or close to it). When the government is the one paying for 99% of healthcare, they have huge clout enforcing razor-thin margins and high efficiency on the provider side. Just look at how the massive supermarket chains are able to keep the margins of the upstream supply chain at a minimum. The problem is that governments don't work that way. When a purchasing officer at a business negotiates a lower price he gets a large bonus. What does a Congressman get when he negotiates a lower price, compared to what he gets (from the people he's negotiating with) if he "negotiates" a higher price? What about the government bureaucrat who will be working in that industry soon? That is the problem. Meanwhile who is more knowledgeable about produce if you have a question, the staff at Walmart or the farmers at the local farmer's market? It's easy to order cost cutting from the top of the tower, but if you don't know what's happening on the ground, you don't know what you're actually cutting. What you need is for people -- the people who are actually consuming services and can choose to go somewhere else if the price is wrong -- to be able to choose based on published price information. The argument people sometimes make about this is that you don't get to choose which hospital an ambulance takes you to when you're unconscious, but the majority of healthcare spending isn't that, and that doesn't explain why we have no price transparency for non-emergency surgical procedures or diabetes or cancer treatment.

namdnay 8y ago
> The problem is that governments don't work that way Well, they can... Just look at France. Amazing healthcare, a lot of it private, relatively cheap > What does a Congressman get Nothing, they don't negotiate > What about the government bureaucrat A performance bonus, a raise, a promotion? Just like any other organisation? > What you need is for people to be able to choose based on published price information OK, go and buy a pound of ground meat. Or an LCD screen. Are you seriously telling me you can get a better deal than McDonalds or Apple?
- coolwhhip 8y ago
  Doesn’t the French government have some leverage via pharmaceutical intellectual property rights? I’m no expert, but I don’t think it’s as simple as “everyone should just buy in bulk like we do.”
- toasterlovin 8y ago
  > What you need is for people to be able to choose based on published price information What they're saying is that a large amount of healthcare spending is driven by patients and providers, but paid for by insurance companies. Neither patients nor doctors have an immediate, short-term incentive to make sure they utilize insurance company resources judiciously. On the contrary, the both have an incentive to consume as many insurance company resources as possible (the patient wants to make sure they get every possible treatment, even if that means consuming 10x resources to prevent a 1/10th as likely outcome, and the provider wants to bill as much as possible to increase revenue). I can tell you, as somebody whose family has catastrophic coverage only, that we think long and hard before we blow $200 so that a doctor can tell us to take some ibuprofen and drink plenty of fluids. And we also ask lots of questions about how much various recommended treatments will cost vs. what they will do for us.
- AnthonyMouse 8y ago
  > Well, they can... Just look at France. Amazing healthcare, a lot of it private, relatively cheap In a place with a different political system, population, demographics, culture, economy, etc... and France has a price transparency law. > Nothing, they don't negotiate They pass laws dictating how others can negotiate (or not). > A performance bonus, a raise, a promotion? Just like any other organisation? But not like any other organization, because if you gave a government employee a million dollar bonus for doing their job there would be a riot. Meanwhile they can get million dollar private sector employment for not doing their job. > OK, go and buy a pound of ground meat. Or an LCD screen. Are you seriously telling me you can get a better deal than McDonalds or Apple? I'm telling you I can get a better deal than the Department of Defense.
craftyguy 8y ago
> What does a Congressman get when he negotiates a lower price, compared to what he gets (from the people he's negotiating with) if he "negotiates" a higher price? What about the government bureaucrat who will be working in that industry soon? Ideally there would be some sort of accountability for elected officials, where they would have to answer to their electorate, and where conflicts of interest would be against the law (and prosecuted), but who am I kidding?
- AnthonyMouse 8y ago
  > Ideally there would be some sort of accountability for elected officials, where they would have to answer to their electorate, and where conflicts of interest would be against the law (and prosecuted), but who am I kidding? Right, exactly. It's like the claim that Communism would work great once automation eliminates the need for all human labor. It's a nice theory, might even be true, but until we can satisfy the precondition what practical relevance does it have? Go work on the precondition and come back after you accomplish that. In the meantime we need something else.