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> 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 hea

> 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.

minikites 8y ago
Are you saying that the richest country in the world can't accomplish something that already exists in plain view in some of the poorest countries in the world?
- TheCoelacanth 8y ago
  There is no country on earth that gives people all the healthcare they might want with no limits and that is not what we should be aiming for. There are many that give people enough healthcare and that is what we should be aiming for.
- geezerjay 8y ago
  You really should get the facts on how those systems actually operate. I'm currently living in an european country that has a national health service that supposedly ticks all the socialist talking points, including free (in theory) access to emergency care, but not only is the service largely inoperational with year-long waiting periods for surgeries, including cancer treatments, but also has a disgruntle workforce who systematically complains they are underpaid and overworked. The situation is so appalingly bad that the national health service even routes patients to private hospitals and clinics, ending up paying a hefty bill for the services they were supposed to provide in-house but are largely unable to provide.
  - gambiting 8y ago
    While I also come from a country like the one you described, there is a very simple fact that cannot be ignored - when my dad got cancer 8 years ago, every single one of his operations and all the drugs(including incredibly expensive Glivec) were 100% free. He was even reimbursed for the cost of travelling to the hospital for his monthly check-up. If he had the same disease in US, he would die much earlier than he did, I'm 100% certain of it, because quite simply there is no way he could afford the treatment or the premiums that americans are paying for their healthcare. Even when he was sick enough that he couldn't work anymore, he was still 100% covered and didn't have to pay anything for anything ever. My point is - there are people in our countries who are probably dying because they have to wait months to be seen by someone. True. But there are also people in US who are dying because they cannot afford the treatment they need. I feel like this is far worse than the first situation - after all, we only have a finite number of doctors, a finite amount of hospitals, and limited capacity to add more(for reasons other than financial too). But US is the richest country in the world - and its citizens die because they cannot afford cancer drugs? That's abhorrent.
    - ams6110 8y ago
      You have gone from a hypothetical to concluding that people in the US die because they can't afford cancer drugs. If your dad was over 65, he would be on Medicare. If he was younger than 65 and impoverished (income between 0 - ~150% of poverty level) he would be on Medicaid or another state plan for low income people. If he's above 150% of poverty level he probably has health insurance available at work or thru ACA. In fact is legally obligated to.
      - normal_man 8y ago
        It's entirely possible to have health coverage and still be financially ruined by a health emergency due to deductibles and pre-existing condition loopholes.
        taysic 8y ago
cogman10 8y ago
"Don't let The Perfect be the enemy of The Good." We are overspending on the quality of health care we get today. Further there is a lot of fear mongering about socialized medicine. I've experienced medicine in both the UK and the US. I can tell you, there isn't a difference in quality. Further, when I got a cold and went in, wait time wasn't 6 hours or whatever other BS people claim. Wait time was ~10 minutes. In fact, the time to see a doctor in the US is almost always longer. Why? Because half the time you have to fill out forms and provide proof of insurance and a whole host of other information for them before they will put you on the waiting list. What did I have to fill out to see a doc in the UK? A card that had my name and current address. Even that, they told me, was optional. Cheaper medicine for less money is a reality. The only people that lose with socialized medicine are admin and insurance. Everyone else in the nation wins.
- conanbatt 8y ago
  Insurance is complicated in the US in no small part because of government intervention. Starting with the fact that employers pick insurance plans for their employees, eliminating enormous market power: and this happens because the government doesn't tax the money that is spent on insurance plans.
- bko 8y ago
  Why did you go to a doctor for a cold? That seems to be a problem. You send someone to school for 10 years and they spend their time talking to patients about a runny nose due to a common cold. And for what? To write a prescription?
  - tdsamardzhiev 8y ago
    To get an absence note for school/work? To make sure it's a common cold?
    - bogle 8y ago
      For a cold, just wait a week or two. There's nothing medicine can do for you anyway. If it's still there, then it's worth checking. Also, you shouldn't need a sick note unless you are off for more than a week (your legislative framework may vary).
lumost 8y ago
That assumes that the desire for health care is unbounded like other consumables. In reality most healthy individuals want a limited amount of care, sick individuals want the least amount of care required to return them to health - and there are fundamental limits on the amount of care that can be provided to those who are beyond the help of current technology. As such you would expect a finite level of demand from the economy as a whole if everyone was allowed as much healthcare as they desired. Any attempt at rationing care will both reduce efficiency, and constrain supply - driving up prices. The most market oriented system would leave supply unconstrained and provide universal and automatic coverage allowing more suppliers to enter the market until supply outstrips demand and "prices" naturally fall.
- conanbatt 8y ago
  All demand is always infinite: you can always get more. (i.e. I want my cold to be checked out by a panel of CDC experts
- sonnyblarney 8y ago
  No, the demand for healthcare is basically infinite. I got a cold yesterday with a crazy bad sore throat, I thought of maybe popping into the doctor. But it turns out to be just a regular cold. My mother would have 100% gone to the doctor. The clinics here in Canada are chock full of kids with the flu and people coming in 'because'. Maybe that's beneficial due to the risk 'it could be something bad'. Or maybe the economics don't make sense i.e. for really mundane things it's better to just stay home and take Tylenol. But the demand is super high. Once people cross 50, there are always problems. Always something. And it's all expensive.
  - cortesoft 8y ago
    Even if people go to the doctor for every minor cold, it is still not INFINITE demand.
  - crottypeter 8y ago
    > Maybe that's beneficial due to the risk 'it could be something bad'. I would assume it's detrimental because it results in doctors' waiting rooms full of people with colds (making it a dangerous place for anyone who is immunosupressed and really needs to see the doctor).
dredmorbius 8y ago
But does it make sense to exclude coverage based on ability-to-pay or some other criteria? Say, medical necessity and probable benefit? We're a long way from those particular decision criteria, presently.

minikites 8y ago

Are you saying that the richest country in the world can't accomplish something that already exists in plain view in some of the poorest countries in the world?

TheCoelacanth 8y ago
There is no country on earth that gives people all the healthcare they might want with no limits and that is not what we should be aiming for. There are many that give people enough healthcare and that is what we should be aiming for.
geezerjay 8y ago
You really should get the facts on how those systems actually operate. I'm currently living in an european country that has a national health service that supposedly ticks all the socialist talking points, including free (in theory) access to emergency care, but not only is the service largely inoperational with year-long waiting periods for surgeries, including cancer treatments, but also has a disgruntle workforce who systematically complains they are underpaid and overworked. The situation is so appalingly bad that the national health service even routes patients to private hospitals and clinics, ending up paying a hefty bill for the services they were supposed to provide in-house but are largely unable to provide.
- gambiting 8y ago
  While I also come from a country like the one you described, there is a very simple fact that cannot be ignored - when my dad got cancer 8 years ago, every single one of his operations and all the drugs(including incredibly expensive Glivec) were 100% free. He was even reimbursed for the cost of travelling to the hospital for his monthly check-up. If he had the same disease in US, he would die much earlier than he did, I'm 100% certain of it, because quite simply there is no way he could afford the treatment or the premiums that americans are paying for their healthcare. Even when he was sick enough that he couldn't work anymore, he was still 100% covered and didn't have to pay anything for anything ever. My point is - there are people in our countries who are probably dying because they have to wait months to be seen by someone. True. But there are also people in US who are dying because they cannot afford the treatment they need. I feel like this is far worse than the first situation - after all, we only have a finite number of doctors, a finite amount of hospitals, and limited capacity to add more(for reasons other than financial too). But US is the richest country in the world - and its citizens die because they cannot afford cancer drugs? That's abhorrent.
  - ams6110 8y ago
    You have gone from a hypothetical to concluding that people in the US die because they can't afford cancer drugs. If your dad was over 65, he would be on Medicare. If he was younger than 65 and impoverished (income between 0 - ~150% of poverty level) he would be on Medicaid or another state plan for low income people. If he's above 150% of poverty level he probably has health insurance available at work or thru ACA. In fact is legally obligated to.
    - normal_man 8y ago
      It's entirely possible to have health coverage and still be financially ruined by a health emergency due to deductibles and pre-existing condition loopholes.
      - taysic 8y ago

cogman10 8y ago

"Don't let The Perfect be the enemy of The Good." We are overspending on the quality of health care we get today. Further there is a lot of fear mongering about socialized medicine. I've experienced medicine in both the UK and the US. I can tell you, there isn't a difference in quality. Further, when I got a cold and went in, wait time wasn't 6 hours or whatever other BS people claim. Wait time was ~10 minutes. In fact, the time to see a doctor in the US is almost always longer. Why? Because half the time you have to fill out forms and provide proof of insurance and a whole host of other information for them before they will put you on the waiting list. What did I have to fill out to see a doc in the UK? A card that had my name and current address. Even that, they told me, was optional. Cheaper medicine for less money is a reality. The only people that lose with socialized medicine are admin and insurance. Everyone else in the nation wins.

conanbatt 8y ago
Insurance is complicated in the US in no small part because of government intervention. Starting with the fact that employers pick insurance plans for their employees, eliminating enormous market power: and this happens because the government doesn't tax the money that is spent on insurance plans.
bko 8y ago
Why did you go to a doctor for a cold? That seems to be a problem. You send someone to school for 10 years and they spend their time talking to patients about a runny nose due to a common cold. And for what? To write a prescription?
- tdsamardzhiev 8y ago
  To get an absence note for school/work? To make sure it's a common cold?
  - bogle 8y ago
    For a cold, just wait a week or two. There's nothing medicine can do for you anyway. If it's still there, then it's worth checking. Also, you shouldn't need a sick note unless you are off for more than a week (your legislative framework may vary).

lumost 8y ago

That assumes that the desire for health care is unbounded like other consumables. In reality most healthy individuals want a limited amount of care, sick individuals want the least amount of care required to return them to health - and there are fundamental limits on the amount of care that can be provided to those who are beyond the help of current technology. As such you would expect a finite level of demand from the economy as a whole if everyone was allowed as much healthcare as they desired. Any attempt at rationing care will both reduce efficiency, and constrain supply - driving up prices. The most market oriented system would leave supply unconstrained and provide universal and automatic coverage allowing more suppliers to enter the market until supply outstrips demand and "prices" naturally fall.

conanbatt 8y ago
All demand is always infinite: you can always get more. (i.e. I want my cold to be checked out by a panel of CDC experts
sonnyblarney 8y ago
No, the demand for healthcare is basically infinite. I got a cold yesterday with a crazy bad sore throat, I thought of maybe popping into the doctor. But it turns out to be just a regular cold. My mother would have 100% gone to the doctor. The clinics here in Canada are chock full of kids with the flu and people coming in 'because'. Maybe that's beneficial due to the risk 'it could be something bad'. Or maybe the economics don't make sense i.e. for really mundane things it's better to just stay home and take Tylenol. But the demand is super high. Once people cross 50, there are always problems. Always something. And it's all expensive.
- cortesoft 8y ago
  Even if people go to the doctor for every minor cold, it is still not INFINITE demand.
- crottypeter 8y ago
  > Maybe that's beneficial due to the risk 'it could be something bad'. I would assume it's detrimental because it results in doctors' waiting rooms full of people with colds (making it a dangerous place for anyone who is immunosupressed and really needs to see the doctor).

dredmorbius 8y ago

But does it make sense to exclude coverage based on ability-to-pay or some other criteria? Say, medical necessity and probable benefit? We're a long way from those particular decision criteria, presently.