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Exhibit A for why "free market healthcare" is an oxymoron. I have yet to hear a coherent explanation for how anyone can reasonably expect for price discovery t

• deleted 8y ago
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• UnpossibleJim 8y ago
  Exactly. It's the same reason we don't have free market police and fire services. You simply don't get to "shop around" for emergency services, which includes privatized ambulance services (which are outrageously expensive, on the order of $12,000 for the ride I took when I had to take one, and it was a relatively benign one... thank god I had insurance). EMS is covered, but that's the Fire Department. After that, it's all privatized. If it's cosmetic, then I could see the argument. But when it comes to emergency services, and for ambulances especially, the "free market" argument just doesn't hold water.
  • cabaalis 8y ago
    > You simply don't get to "shop around" for emergency services You do actually, by where you choose to live and also by the services as detailed in [1]. I think there's merit to investigating public health care. That line stops for me in eliminating private care. 1] https://www.theatlantic.com/technology/archive/2018/11/kim-kardashian-kanye-west-history-private-firefighting/575887/ https://www.theatlantic.com/technology/archive/2018/11/kim-k...
    • neurotrace 8y ago
      A lot of people don't get much choice in where they live.
      • justtopost 8y ago
        Are they on felony probation? I have moved a few times with little money for better opprotunities. It seems like most people are just psychologically conditioned to die near where they were born. Most people just think the hardship is worth it, which is very much a choice. It is literally cheaper to move to most of the USA than live another month in places like california or nyc.
        • msla 8y ago
          > Are they on felony probation? So that's what they call "Taking care of an elderly relative" these days!
        • __jal 8y ago
          This ignores a huge array of practical reasons why people stay where they are. Family networks are probably the number one reason. Child/elder care, food/housing/etc. sharing and a lot more are all major factors that by definition do not show up in economic reports. And that's before people's "psychological conditioning" (which some people refer to as "being part of a family") is considered. I, too, have moved around a lot - across the US three times, overseas and back once, with smaller cross-state moves in between. And it has worked out for me. I am also not married, have no kids, am not very close to my family, have a high degree of risk tolerance and high attraction to novelty, and seem to need a smaller community of folks in my life than many others. I'm also well aware that I am an abnormally-unattached person. Most people have significantly more difficulty uprooting and moving somewhere else. Writing that off as conditioning that interferes with economic concerns not only fails to recognize very real economic aspects that don't show up a bank account, but also fails to recognize that humans value things other than money.
    • ademup 8y ago
      Although most humans are perfectly ambulatory, there are innumerable reasons why they don't get to "choose where to live". Income levels, employment availability, schooling, racial pressure, and many more factors come in to play. Not everyone can physically fit into the best areas. The best areas for emergency services don't necessarily align with the best education (although very high income levels tends to align with both). This comment essentially amounts to "Well if you don't like being poor, then just obtain more money". While everyone cannot live in the best places, nearly everyone will need emergency services at some point in their lives. Also, OP didn't suggest getting rid of private care entirely. A public option does not preclude a private system. If the private system provides value, it will likely survive.
      • vec 8y ago
        > If the private system provides value, it will likely survive. And if it doesn't survive, good! Industries don't have an inherent right to keep existing if they don't fill some useful function. Refusing to implement an otherwise desirable social program because it might cause an existing industry to become obsolete is far and away the most anti-capitalist argument I see self avowed capitalists make.
        • nybble41 8y ago
          You haven't rendered private health care "obsolete", you've just forced people to join your public system. Obviously people aren't going to pay for two health providers (unless the public system is completely inadequate). That does not imply that the private service is uncompetitive. There can be no competition when one service must find willing customers while the other takes its funding by force. This is the same issue with toll roads vs. public roads. Imagine there are two similar roads leading from A to B, one a toll road and the other public. The toll road charges drivers $1 per 100 miles. The public road is free to use but costs every driver $5 per 100 miles in taxes. Which one do you think drivers will take? The more expensive public road, of course—because they're already paying for it, whereas the toll road would be an additional expense.
          • 8y ago
    • ncallaway 8y ago
      > I think there's merit to investigating public health care. That line stops for me in eliminating private care I haven't seen a proposal yet that would eliminate private care (or even supplementary private insurance).
      • phd514 8y ago
        Canada did. It's not that far-fetched.
        • bdamm 8y ago
          That's a stretch. There are still a lot of private clinics operating in Canada for various grey-area medical needs. Also, Canadian (really, provincial) healthcare doesn't typically cover dental, and there's a massive grey area in rehab and injury recovery where private clinics abound. Certainly it is true, I agree, that emergency hospitals and ambulances are public-option only.
          • ncallaway 8y ago
            That's fair, and this is I suppose more what I meant. My original statement might have been more accurate had I said "fully eliminate private care and private insurance". Certainly with medicare for all both of those would be drastically reduced. With the medicaid buy-in they would both be moderately reduced. I still think private care and private insurance will exist under both models, but like you said, they may be different in terms of what they cover.
          • refurb 8y ago
            Doctors in Canada have to choose to participate in either the public system or private system. They can’t straddle both. Hence there are VERY few private clinics in Canada except for services where the govt realized it was in their benefit to allow it (MRIs).
            • ceejayoz 8y ago
              That sounds like the market for private care isn't really as big as is often claimed, then.
    • PhasmaFelis 8y ago
      > I think there's merit to investigating public health care. That line stops for me in eliminating private care. Has anyone proposed that? If not, I'm not sure why you mentioned it. Anyway, I suppose I can see the benefit to private doctors, but if private emergency response services for individuals are popular, then something is fucked, as your link demonstrates. Not saying they should be banned, but they shouldn't have to exist in a properly-run society.
      • ams6110 8y ago
        Yes, many people who advocate for "single payer" intend that to mean eliminating any private-pay option.
        • pjc50 8y ago
          Do they? Are you sure? Who? The UK's single payer system coexsists OK with private care. It's not a necessary part of the process.
        • ncallaway 8y ago
          I don't believe that's true. What serious single payer proposals have been put forward that would eliminate private-pay, private insurance, or private care? I've never seen one. In fact, almost all "single payer" health systems that exist in other countries have private care and private insurance options. For example, such options are available in both the UK with the NHS and in Canada. I've never once spoken with an advocate of single payer who wants to eliminate private pay, private insurance, or private care. I am also an advocate of single payer, and I wouldn't advocate eliminating any of those things.
          • ams6110 8y ago
            Bernie Sanders, for one, has advocated for the elimination of private health insurance by essentially putting everyone on Medicare.
            • ncallaway 8y ago
    • mulmen 8y ago
      "Move to a better market" seems like an argument that some local marketplaces have failed. The whole value proposition of the free market is that it improves the available services and prices through competition. If I have to move somewhere else to find a market where this is true then the local market is clearly failing and the free market idea doesn't work. Said another way: Should I then also move when I want to find a better price on milk?
      • krupan 8y ago
        I mean, I know people that moved away from Hawaii precisely because they couldn't afford the milk there. Believe it or not there are people who move into cities because of better fire departments, police departments, etc.
        • mulmen 8y ago
          Did they leave Hawaii only because of the price of milk or because staple goods in general were more expensive than other places? In this case the market is working but it is a market where cities compete on cost of living, not milk. In that case moving makes sense.
      • munk-a 8y ago
        "Move to a better market" also fails with regards to the fact that you may need the services when not at home. If you were working in sales would you refuse to do an onsite meeting with a client because their office is near a terrible hospital?
    • tivert 8y ago
      >> You simply don't get to "shop around" for emergency services > You do actually, by where you choose to live That's wrong on so many different levels: 1) The emergency service provider is unlikely to tell you how much anything costs in reality ahead of time. 2) Not all emergency services providers offer the best price for all services, or are even equipped offer all services. 3) Many medical emergencies are completely unexpected, you have no idea what kinds of services you'll actually need in an emergency. 4) You're not really talking about "where you choose to live," but rather "where you choose to be at all times." Do you really have a choice of ER if you have to stay within a couple miles of it at all times to make sure you'd always be taken there in an emergency? 5) etc.
    • pjc50 8y ago
      I don't think there are many places outside repressive states where private healthcare is actually banned? Even the UK's extremely centralized NHS runs alongside a private system. It actually has the effect of making the private system cheaper since they don't have to cover everything or everyone.
  • heavyset_go 8y ago
    The history of private firefighting is a particularly dirty one. In the past, fire companies would show up and demand payment before putting out fires. If a payment couldn't be made, the company might negotiate the purchase of the burning property at a steep discount. Later, insurance companies hired brigades to only put out fires on insured properties. Fire companies might have fought or sabotaged one another in order to win the right to put out a fire and get paid for it. While it isn't perfect, and it's often underfunded, I definitely prefer the system we have now.
    • Arubis 8y ago
      Indeed, this is the origin of the term "fire sale".
      • btilly 8y ago
        I'm pretty sure not. The term "fire sale" refers to selling merchandise that survived a fire and therefore would have associated damage. However the policy of negotiating for property at bargain basement prices while there was a fire next door was very notably one of the ways that Marcus Licinius Crassus (a political ally of Julius Caesar) enriched his fortune.
      • kbutler 8y ago
        This appears to be incorrect, and the usual interpretation of "sale of goods damaged in a fire" is the original. https://www.merriam-webster.com/dictionary/fire-sale https://www.merriam-webster.com/dictionary/fire-sale
    • AmVess 8y ago
      I have a vintage fire plaque next to my front door. They were commonly issued long ago to show that insurance has been purchased. No plaque, no service.
    • TheOtherHobbes 8y ago
      These scams were happening at least as far back as Roman times. Supposedly Crassus, the richest Roman of his day, made rather a lot of money like this.
  • mondo9000 8y ago
    Meanwhile the EMTs make $12/hr :(
    • wymy 8y ago
      I'm one and make $11/hr.
    • vkou 8y ago
      Where is all the money going? Does the ambulance have a solid-gold steering wheel?
      • sneakernets 8y ago
        Profit?
      • eli 8y ago
        Most people don't/can't pay their hospital bills.
        • vkou 8y ago
          Most? Like, over 50%? If this is true, the system is completely broken. If it's not true, then the system is completely broken, but in a different way.
          • null000 8y ago
            But yeah, I assume it's a combination of: * Most people pay through their insurance, so they don't have to pay the sticker price or anything resembling it * Some people going on payment plans and getting stuck in debt basically forever * Some people bargaining their bill down, paying pennies on the dollar * Some people going into collection, paying pennies on the dollar Of course, it's absurd that all 3 out of 4 paths require you to take extra, often really painful steps (collection + bankruptcy, maintaining insurance, or long drawn-out negotiation) just to pay a reasonable price for something that is 100% non-optional and most countries provide for much-closer-to-free. But that's kinda what happens when the system is broken
  • kupiakos 8y ago
    > If it's cosmetic, then I could see the argument. Then there's another problem: who defines what is considered "cosmetic"? Most insurance companies currently don't cover e.g. facial feminization surgeries for transgender women, even though they're considered medically necessary by WPATH, a document drafted largely by insurance companies [0]. [0]: https://www.wpath.org/media/cms/Documents/SOC%20v7/SOC%20V7_English.pdf https://www.wpath.org/media/cms/Documents/SOC%20v7/SOC%20V7_..., p. 58
    • UnpossibleJim 8y ago
      I said I could see the argument, not necessarily agree with it. I mean, in this day and age insurance companies also consider a severe cleft palate a cosmetic surgery and not a necessity. I certainly would not leave it up to them. I think it should be left up to the consult doctor, to be honest. If you don't agree, consult another =/
  • shoguning 8y ago
    There is so much good that price transparency would do. Most treatments are not emergency and you can absolutely shop around even if it's not cosmetic. Ever hear of medical tourism? It's not a perfectly 'free market', but it could benefit so much from better information.
  • FireBeyond 8y ago
    > privatized ambulance services (which are outrageously expensive, on the order of $12,000 for the ride What state? In Washington (and many, though definitely not all), ambulance prices are regulated, for this reason. When I worked private ambulance a couple of years ago it was $680 + $8/mi.
    • UnpossibleJim 8y ago
      Seattle, but I guess I had some perks. I didn't itemize it. That was for everything. They did not take me to the closest hospital, either, for some reason.
  • WalterBright 8y ago
    A free market police system cannot work, because the police use force against people, which is not allowed by the free market. Worse, the police aren't going to arrest people who pay them.
    • nybble41 8y ago
      > A free market police system cannot work, because the police use force against people, which is not allowed by the free market. The "free market" (in a libertarian sense) does not permit the initiation of force against people who have not resorted to force themselves. If that is a significant restriction on your police department's activities then there is something seriously wrong with your police department. > Worse, the police aren't going to arrest people who pay them. If they aren't willing to arrest anyone who pays them then no one will bother to pay them. Resolving disputes between two paying customers is part of their job description, and they won't retain customers if they're seen as biased or corrupt.
      • WalterBright 8y ago
        Arresting someone suspected of a crime is not responding to initiation of force, because the suspect hasn't been convicted yet. There are private police forces, we call them the "mafia", and people pay them for "protection". Sure, they're corrupt, but with no government funded police, whatcha going to do about it?
        • nybble41 8y ago
          > Arresting someone suspected of a crime is not responding to initiation of force, because the suspect hasn't been convicted yet. If the suspect is eventually convicted (of something at least as serious as kidnapping) then that conviction retroactively justifies the arrest. If the suspect is never convicted then arresting them is little better than kidnapping. If the police at least had a reasonable belief that the person they arrested would be convicted then it falls under the heading of accidental harm rather than negligence or malicious intent, which shields them from retribution, but that doesn't avoid the need to pay restitution to make their victim whole. In short: Be sure you're arresting the right person, and don't do anything to them in the process which you'd find difficult to set right.
• stdplaceholder 8y ago
  Even if you ask for the price and even if you get it in writing up front you will still get a different bill later.
  • drak0n1c 8y ago
    Legislation requiring up-front presented costs to be honored and any additional procedures/costs to be cleared with patient consent as they happen (or a consent waiver obtained from the patient with a promised limit or incentive such as overall discount) might be an improvement. Or it may increase costs for the worse. Who knows.
    • bluGill 8y ago
      Careful there though. If a surgeon is operating on cancer and discovers that the tumor is much larger than expected the operation will take longer - be more expensive - or the surgeon does the operation as planned and then charges even more for the second surgery to remove the rest. Or maybe all operations are estimated as the worst case and so you end up with no more clue about what you will pay than today - in some imaginable worst case this could be a five million dollar operations, so even though 99% are only fifty thousand you get that high estimate. Which is to say don't propose something until you understand the unintended side effects. You can get your desired result but while making everything worse. (this paragraph applies to everything in politics)
      • vkou 8y ago
        > Which is to say don't propose something until you understand the unintended side effects. You can get your desired result but while making everything worse. I think the American experiment in trying to provide market health care has demonstrated that you can, in fact, have a 'free' market for healthcare, while making almost everything about that healthcare worse.
        • bluGill 8y ago
          The american way is not a free market. The employer tax break on health insurance is a significant manipulation.
• pitaj 8y ago
  Emergency situations are exactly what insurance is for. Emergencies account for a minority (<15% IIRC) of health care spending. Nobody advocating for free market healthcare is expecting people to shop around in emergencies. People are expected to shop around for good insurance plans which will cover emergency situations to their satisfaction. That is why many free market healthcare supporters also support removing the incentives for employer-provided insurance plans: - remove the tax exemption for employer-provided insurance - add a tax exemption for individual/family insurance, including a rebate for the amount of money payroll (social security and medicare) taxes would affect the amount of money available for that insurance This way, people don't lose their insurance when they lose their job, and people have more insurance options. This would also likely have a beneficial affect on insurance competition.
  • ncallaway 8y ago
    But, as described in the article that system does not function. Acquiring insurance does nothing to ensure that the facility you visit will accept that insurance. Further, even if the facility you visit does accept the insurance, that's no guarantee that all doctors within that facility accept that insurance. Even further, there's no guarantee you'll be conscious to validate that you go to a facility that accepts your insurance. The insurance system needs to be fundamentally repaired before it can be used to support a "free market" healthcare system.
    • krupan 8y ago
      "That system" as described by parent has not been tried, at least not in recent memory. What we see happening now are thousands of unintended consequences from government meddling with the free market.
      • TheOtherHobbes 8y ago
        I think you mean from the "free market" - which is neither free, nor genuinely a market - usurping the good-citizen responsibilities of mature and sane government.
      • 8y ago
• StreamBright 8y ago
  Not sure what you mean. The US does not have a free market healthcare system.
• deleted 8y ago
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• bluGill 8y ago
  We do not have a free market. Most people get their health insurance from their employer - you cannot reasonably get insurance elsewhere (the same plan I have now for $100/month would cost over $1000/month, but I can't take that $1000/month to anyone else if I don't like my insurance so I accept it). This keeps me from taking a long leave of absence to live off my savings - until I quality for retirement (medicare). In a true free market you would have more choices: most emergencies are close to home so you are likely to know which hospital is a good deal. Of course there are still the emergency while on vacation, and the sudden collapse where a bystander brings you somewhere which are harder to handle. Though if there really was a free market there is incentive to handle those well - if only because the system is designed for the majority of cases where they have to handle it well or you would have gone elsewhere.
  • vec 8y ago
    > We do not have a free market. Most people get their health insurance from their employer - you cannot reasonably get insurance elsewhere What you are describing are in fact the freest parts of the health insurance market. Employers, quite rationally and of their own free will, choose to offer health insurance as a benefit because it attracts and retains talent better than other similarly priced incentives. The fact that you're hesitant to take a leave reveals that it's working. Insurance companies, quite rationally and of their own free will, choose to offer steep discounts to purchasers who buy for a large group of people instead of just one or two. It reduces their marketing costs and gets them a better balance between sick and healthy clients. You, quite rationally and of your own free will, choose to both accept your employer's offer of discounted insurance and to remain at your position longer than you would otherwise prefer to maintain that insurance coverage. In fact, the only thing you foresee changing the status quo and allowing you to retire at all is when you become entitled to benefits from the state in the form of Medicare. Nothing in the phrase "free market" implies the resulting equilibrium won't conspire to limit an individual consumer's choices.
    • vkou 8y ago
      And the reason that healthcare costs $1,000/month, is because this system has caused prices to spiral completely out of control, beyond the level of lunacy. Due to multiple agents in the market behaving of their own free will. Every other developed country manages to provide equivalent care for a fraction of the price. So much for the free market optimizing for better outcomes, eh?
• ThomPete 8y ago
  The problem is that neither models work and both have shortcomings. In the US model healthcare is a profit center which allow those who can afford to get help and those who can't various sub-optimal variations of help. In the ex. Scandinavian model healthcare is a cost center and there is a set budget each year which the providers need to function within. This means that prioritization needs to happen and various illnesses and procedures are limited to x amount a year. Healthcare is a wicked problem cause it's a good thing that it's a profit center in the sense that it provides budgets to do more research and it's a a bad thing because it makes it unreasonable expensive to to not have healthcare. In the scandinavian model it's a good thing that everyone gets treated (more or less) the same but a bad thing that they don't have as much capital to work with invest in new machines and that there are budgets which limit how much the government will spend on various procedures. Personally I would like the system to be so that you pay to get normal check-ups, there is no limit to how many doctors are allowed in different parts of the healtcare sector and no one goes bankrupt from getting seriously ill. That would at least help with some sort of a balance I think. Of course the problem is that the US is such a big country with huge immigration and scandinavian countries arent so it's always hard to compare.
  • xixixao 8y ago
    Agreeable until the last sentence: > Of course the problem is that the US is such a big country with huge immigration and scandinavian countries arent so it's always hard to compare. US Population: 325 million US Immigration: 1.5 million (2016) EU Population: 512 million EU Immigration: 2 million (2016) (taken from top Google results) It's fairly accurate to say that, compared to the US, the whole of EU has a "Scandinavian" model of health-care (ie, states guarantee good health-care services to everyone).
    • krupan 8y ago
      There isn't a single EU health care system. Each country still does their own. Maybe each US state could do their own, but there are huge concerns about freeloader problems since we have unrestricted movement between states in the U.S. From what I've read the systems of European countries are being threatened by the freeloader problem that increase immigration as of late has caused.
• berberous 8y ago
  I think everyone acknowledges the current system is the worst of all worlds. _Both_ the left and the right are correct in my view: (1) single payer universal healthcare or (2) removing a ton of the existing government regulations and forcing healthcare to behave more like a free market, would each be better than the existing system. I don't think "free market healthcare" is oxymoronic though. It does not seem to me impossible (logically...maybe it's impossible politically) to remove the current incentives that prohibit price discovery and/or enact laws and regulations that incentivize it.
• stcredzero 8y ago
  frequently couldn't reasonably be expected to refuse service even if they did believe it was overpriced I wonder if private urgent care businesses could offer free rides from emergency rooms to other facilities? There might well be laws against this. However, the existence of such services might give people a degree of choice they don't currently have. A few years back, I was in the position of seeking emergency room/urgent care services for my girlfriend at the time in North San Jose. It was not a pleasant experience, to the point where we just decided to simply give up. On the other hand, I did the same for my girlfriend at the time in Houston, and found the whole experience to be relatively smooth.
• ip26 8y ago
  Forget about obtuse billing, how is anyone expected to perform price discovery while unconscious (& being rushed to the hospital)?
  • randyrand 8y ago
    you’re not. Emergency care requires regulation. Even free market folks know this.
  • taysic 8y ago
    You buy your insurance package ahead of time. Competition in the free market will cause ins providers to provide the best, most comprehensive plans.
• crasch4 8y ago
  Price discovery is indeed difficult in the current market. However, the current healthcare market is no where close to a free market. For example, suppose you wanted to start a hospital that offered price transparency, like the Surgery Center of Oklahoma does. (1) In thirty-five states and the District of Columbia, you'd first have to acquire a certificate-of-need (CON) from the state healthcare regulators. In order to get certificate of need, you must prove that the community “needs” the new or expanded service, and existing providers are invited to challenge your application. Existing hospitals typically don't want new competitors taking away their patients, so they vigorously fight to prevent new CON's from being issued. For example, Dr. Mark Monteferrante wanted to buy a second MRI machine for his radiology practice in 2003. But it took five years and more than $175,000 in fees to get the certificate. (2) And conlaws are just one example of perverse effects of state intervention into the healthcare market, from state laws restricting insurance competition, to severe restrictions on new entrants to the medical labor market, to drug monopolies. (1) https://surgerycenterok.com/pricing/ https://surgerycenterok.com/pricing/ (2) https://www.modernhealthcare.com/article/20160123/MAGAZINE/301239964 https://www.modernhealthcare.com/article/20160123/MAGAZINE/3...
  • xenadu02 8y ago
    Price discovery requires pricing some people out of the market. Period. There is no "free market" healthcare system that can or ever will deliver required health services to everyone. Furthermore when the alternative is death or debilitation, the price a "consumer" is willing to pay is effectively everything they possess and can borrow. That is both a massive distortion and non-optimal for the economy as a whole. There are certainly regulatory inefficiencies and other inefficiencies in healthcare markets, but a truly "free market" in healthcare not morally justifiable.
    • nordsieck 8y ago
      > Price discovery requires pricing some people out of the market. Period. There is no "free market" healthcare system that can or ever will deliver required health services to everyone. There is no economic system that can deliver all of the health care to everyone who wants it. Fundamentally, health care resources are limited: doctors, beds, MRI machines, etc. Desire for health care is much less limited. The question is not whether to give everyone what they want, but instead how to imperfectly ration what we have.
• debt 8y ago
  I’m reminded of airports which function very similarly to healthcare. There’s absolutely no choice of merchants I can be in an airport is decided by a very small group of people. It’s not like an open air market you’re finding some developing countries where people can just set up shop and start selling stuff. It is a tightly very tightly controlled market I have very very small number of entities and organizations.
• Novashi 8y ago
  Even if you could flip a switch and go to a free market, that doesn't reset where the current players are, so they will use that going in to insulate themselves and abuse the market. For pricing, Hospitals/Insurance Co.'s are unwilling to absorb the cost of the statistical chances that something goes wrong or extra labor/things are needed during healthcare. That's why the patient-facing price could be anything and you get an itemized bill. The only way to get slow-moving and predictable patient-facing prices is to get the hospitals/insurance to absorb these costs.
• randyrand 8y ago
  Emergency situations require regulation. But as others say, healthcare is the most regulated industry in the USA. It’s the opposite of a free market. It’s actually a great example why regulations often suck.
• isoskeles 8y ago
  If it's such a free market, I implore HNers to explain what it might take to start your own free market hospital in the United States. Let me know what regulations you'll need to meet. Compare to opening a cafe. And I'm not saying a hospital or a cafe ought to be at all similar. That's not the point. The point is how odd it is to pretend that health care is a "free market" in the current state as some rhetorical device to associate these surprise fees with free markets. At a cafe, you don't get charged for using a stirrer or spoon or napkins. A cafe doesn't charge you for sitting on a stool. Free market health care would operate in the same way, if it existed. You get charged for your operation, they don't add in fees for specific items that you needed that would reasonably be expected as part of the process (a Tylenol pill, using a tissue, the gloves your surgeon wore). And again, I'm not suggesting this is how it ought to be, but let's not be disingenuous and pretend that absurd, opaque prices are somehow a result of a free market.
  • mattkrause 8y ago
    > Free market health care would operate in the same way, if it existed. Any particular reason you think that? Cafes sell standardized products--if we order the same small latte, we get the same thing and pay the same price. If you "require" something different, you pay a different price. Almond milk, for example, is $0.50 extra, near me. Flavored syrups cost a quarter. Medicine is a lot less one-size-fits-all. Your fractured arm could be harder to repair than mine and thus takes longer or requires more supplies (and those aren't cheap--bone screws can run $40+/each). Maybe a diagnostic test is inconclusive and needs a more expensive follow-up. You can't really know how some of this is going to go beforehand. I suppose some places could offer a prix fixe option, based on their expected cost + a safety margin. I bet many wouldn't though, because the variance can be huge.
• nkrisc 8y ago
  The concept of free market healthcare basically expects consumers to bargain with their own lives. No rational person would do that. We agree to service and pay even if it would bankrupt us because at least we'd still be alive.
• gonational 8y ago
  What free market? When a person is mandated to purchase insurance that is not a free market. When insurance companies have monopolies in an entire state and it’s illegal to purchase insurance from another state, that is not a free market. When hospitals are partly state funded, tax-free organizations, that is not a free market. When hospitals are required to treat patients regardless of their ability to pay, that is not a free market. When medical bills are paid by Medicaid, that is not a free market. Healthcare in the United States is anything but a free market. Down vote me, if it makes you feel better, but it will not change this fact.
• douglaswlance 8y ago
  One big issue is that healthcare is something you can spend infinitely on.