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> The free market does not work in all situations. Sure, but you did not enumerate a single free market. I'd wager the US healthcare industry is far and away

> The free market does not work in all situations. Sure, but you did not enumerate a single free market. I'd wager the US healthcare industry is far and away the most regulated market in the entire world. We know that regulation protects the big players at the expense of their would be competition and drives up profits. Colleges are hardly any better, and ISPs are nearly all monopolies granted by municipalities in exchange for kick backs of various sorts. The government has interfered with every industry in this list via direct/indirect regulation, grants, guaranteed loans, or tax incentives. Lets go ahead and throw in housing in our list, too.

fzeroracer 8y ago
Can you prove that the US healthcare industry is more regulated than countries like say, Germany or Canada? Because it would be incredibly hard to believe that somehow America is more regulated than countries that have more direct control over their healthcare.
- kryogen1c 8y ago
  I think that's exactly the point: direct control and heavy regulation are two different things. This in-between fairyland with artificial barriers to entry on the frontend but no control on the back end is what's creating these captive markets where old companies to do almost anything because new companies can't join the market.
  - chillacy 8y ago
    To add to that point, because the government guarantees things that it has no control over, it means the businesses in these industries have the best risk/reward ratio possible: no risk for unlimited upside, because the risk is taken care of by taxpayers.
mcguire 8y ago
An unregulated healthcare market, complete with all the benefits of the free market, was the rule in the US until the Pure Good and Drug Act of 1906. It's history is... entertaining.
- telchar 8y ago
  An act which incidentally is credited as the most beneficial piece of US legislation to date in terms of addiction reduction and prevention.
sam0x17 8y ago
I still think the way to go is to have a price index where if procedure X is available in (list of countries with good healthcare system) for $Y, then it should be illegal to charge more than $Y in the U.S. Have a central authority that manages the price index and the list of countries that we survey prices from. Then doctors and hospitals and pharmaceuticals couldn't all take advantage of the system by charging $500 for a fucking IV drip.
- barrow-rider 8y ago
  I believe Australia uses something similar, at least that's what I noticed while living & working there. Ex: https://www.health.nsw.gov.au/Hospitals/Going_To_hospital/cost-of-care/Pages/default.aspx https://www.health.nsw.gov.au/Hospitals/Going_To_hospital/co... In the US there is the Surgery Center of Oklahoma which does something similar; I believe there are doctors in Oregon who do the same as well. https://surgerycenterok.com/pricing/ https://surgerycenterok.com/pricing/
etiennemarcel 8y ago
From a European point of view I have a hard time understanding your opinion. In other countries, regulated/public healthcare works better and is more efficient than your system, it's hard to deny it... I don't see how doubling down on cutting regulations would solve anything. In a way it reminds me of the gun control issue: the idea that deregulating gun ownership and carrying will make everybody safer seems so absurd from abroad... I guess it's cultural.
- closeparen 8y ago
  Regulating a service and providing it at public expense are completely separate concepts. Europeans do not have cheap healthcare as a result of price controls on private medical practices (regulation), but as a result of redistribution and subsidy (spending).
  - etiennemarcel 8y ago
    At least in France, it's both. The cost for the patient is usually low thanks to the health insurance, but also because of price control. A GP visit is 25 euros by law, covered from 70 to 100% depending on your insurance. Doctors can choose to charge more but then patients need better private insurances to be reimbursed. You can find the price lists here: * https://www.ameli.fr/paris/medecin/exercice-liberal/facturation-remuneration/tarifs-generalistes/tarifs-metropole https://www.ameli.fr/paris/medecin/exercice-liberal/facturat... * https://www.ameli.fr/paris/medecin/exercice-liberal/facturation-remuneration/tarifs-specialistes/metropole https://www.ameli.fr/paris/medecin/exercice-liberal/facturat...
    - madmulita 8y ago
      How many visits does it take to get a simple prescription? We have something similar, I've been appointed consultations only to be asked how I felt.
      - daleco 8y ago
        You can get a simple prescription at the first consultation. For what I remember 10yrs ago, to see a specialist, you need to go to you general practitioner first. Then he will decide if you need a referral. Edit: you can go directly to a specialist or not follow the « health path », you will just get less reimbursed. Some specialist can be seen without referral (gyn, psy...)
ionised 8y ago
> We know that regulation protects the big players at the expense of their would be competition and drives up profits. You're describing poorly thought out or outright captured regulation. Regulation is not defacto bad. There are plenty of regulations from the last 100 years all over the world that are demonstrably positive.
afpx 8y ago
Three honest questions: 1. Is there a place that is deregulated enough that it can be used as an example? 2. If so, does that place significantly outperform all others? 3. If so, what holds back the people in more regulated areas from adopting that type of system?

fzeroracer 8y ago

Can you prove that the US healthcare industry is more regulated than countries like say, Germany or Canada? Because it would be incredibly hard to believe that somehow America is more regulated than countries that have more direct control over their healthcare.

kryogen1c 8y ago
I think that's exactly the point: direct control and heavy regulation are two different things. This in-between fairyland with artificial barriers to entry on the frontend but no control on the back end is what's creating these captive markets where old companies to do almost anything because new companies can't join the market.
- chillacy 8y ago
  To add to that point, because the government guarantees things that it has no control over, it means the businesses in these industries have the best risk/reward ratio possible: no risk for unlimited upside, because the risk is taken care of by taxpayers.

mcguire 8y ago

An unregulated healthcare market, complete with all the benefits of the free market, was the rule in the US until the Pure Good and Drug Act of 1906. It's history is... entertaining.

telchar 8y ago
An act which incidentally is credited as the most beneficial piece of US legislation to date in terms of addiction reduction and prevention.

sam0x17 8y ago

I still think the way to go is to have a price index where if procedure X is available in (list of countries with good healthcare system) for $Y, then it should be illegal to charge more than $Y in the U.S. Have a central authority that manages the price index and the list of countries that we survey prices from. Then doctors and hospitals and pharmaceuticals couldn't all take advantage of the system by charging $500 for a fucking IV drip.

barrow-rider 8y ago
I believe Australia uses something similar, at least that's what I noticed while living & working there. Ex: https://www.health.nsw.gov.au/Hospitals/Going_To_hospital/cost-of-care/Pages/default.aspx https://www.health.nsw.gov.au/Hospitals/Going_To_hospital/co... In the US there is the Surgery Center of Oklahoma which does something similar; I believe there are doctors in Oregon who do the same as well. https://surgerycenterok.com/pricing/ https://surgerycenterok.com/pricing/

etiennemarcel 8y ago

From a European point of view I have a hard time understanding your opinion. In other countries, regulated/public healthcare works better and is more efficient than your system, it's hard to deny it... I don't see how doubling down on cutting regulations would solve anything. In a way it reminds me of the gun control issue: the idea that deregulating gun ownership and carrying will make everybody safer seems so absurd from abroad... I guess it's cultural.

closeparen 8y ago
Regulating a service and providing it at public expense are completely separate concepts. Europeans do not have cheap healthcare as a result of price controls on private medical practices (regulation), but as a result of redistribution and subsidy (spending).
- etiennemarcel 8y ago
  At least in France, it's both. The cost for the patient is usually low thanks to the health insurance, but also because of price control. A GP visit is 25 euros by law, covered from 70 to 100% depending on your insurance. Doctors can choose to charge more but then patients need better private insurances to be reimbursed. You can find the price lists here: * https://www.ameli.fr/paris/medecin/exercice-liberal/facturation-remuneration/tarifs-generalistes/tarifs-metropole https://www.ameli.fr/paris/medecin/exercice-liberal/facturat... * https://www.ameli.fr/paris/medecin/exercice-liberal/facturation-remuneration/tarifs-specialistes/metropole https://www.ameli.fr/paris/medecin/exercice-liberal/facturat...
  - madmulita 8y ago
    How many visits does it take to get a simple prescription? We have something similar, I've been appointed consultations only to be asked how I felt.
    - daleco 8y ago
      You can get a simple prescription at the first consultation. For what I remember 10yrs ago, to see a specialist, you need to go to you general practitioner first. Then he will decide if you need a referral. Edit: you can go directly to a specialist or not follow the « health path », you will just get less reimbursed. Some specialist can be seen without referral (gyn, psy...)

ionised 8y ago

> We know that regulation protects the big players at the expense of their would be competition and drives up profits. You're describing poorly thought out or outright captured regulation. Regulation is not defacto bad. There are plenty of regulations from the last 100 years all over the world that are demonstrably positive.

afpx 8y ago

Three honest questions: 1. Is there a place that is deregulated enough that it can be used as an example? 2. If so, does that place significantly outperform all others? 3. If so, what holds back the people in more regulated areas from adopting that type of system?