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The book The Healing of America by T.R. Reid, 2010 was a phenomenal look at this subject and the conclusion was this: we are the only developed nation whose gov

• braythwayt 8y ago
  "Never confuse an unregulated market with a free market." --- (Yes, yes, I understand that to an economist, a "free market" is free of regulation, a product of laissez-faire economics. But to the lay person, a "free market" is one where prices are set by perfect competition, which requires a balance of power, the prevention of monopolization, and information symmetry.)
  • PakG1 8y ago
    Really? I thought it was the other way around.
  • minikites 8y ago
    Both are about as real in practice as the Easter Bunny, so it's a distinction without a difference.
  • james_s_tayler 8y ago
    Yeah lay peoples definition is the markets which they are used to living with which don't match the technical terms exactly but come close enough for them. I just use the term "free enough market" to describe it.
• DennisP 8y ago
  I read that book too, and agree it's phenomenal. It's not just about capping insurance profits. The countries doing the best also have price controls on the healthcare providers. Doctors make a lot less money. On the other hand they generally don't have to pay for medical school. France, Germany, and Japan all have similar systems, according to the book. They have private nonprofit insurance, some kind of mandate to purchase it, a government price list on services, guaranteed coverage of anything on the list, and digital medical records. A lot of German primary care doctors don't even hire office staff. They prescribe whatever they want, swipe your medical card, and they're guaranteed to be paid in a week, no questions asked. Japan has a clever way to handle the mandate. If you don't pay your premiums, nothing happens, but if you need healthcare you're not covered until you pay your back premiums. I wish all the Americans who think the rest of the developed world runs on single payer would read this book. None of the three countries I just mentioned use single payer. The book also covers Canada and the UK, both of which are single payer (and single provider in the UK), and while their results are pretty good, they're not as good as the other three.
  • mikeg8 8y ago
    Thanks for your great comment and I agree especially with your last paragraph. While reading the book, I was so frustrated with how poorly my county has handled such an important issue, probably the most important.
  • jellicle 8y ago
    Sufficiently advanced regulation is indistinguishable from single-payer - insurance is completely reliable, covers everything, and is completely fungible. Who cares what name is on the card? The easiest way to accomplish that is just to have a single government insurer. But you can finagle your way in the back door by regulating the shit out of insurance companies too. One-third of the US population is on a US single-payer system right now.
    • DennisP 8y ago
      If you define single payer that broadly, ok. I'll just mention that Japan gives you your choice of about 2,000 insurance providers, which advertise extensively.
• gerdesj 8y ago
  we are the only developed nation whose government allows for-profit health insurance companies to exist with ZERO regulation to cap healthcare prices. So what are you going to do about it?
• refurb 8y ago
  Why would you cap healthcare prices for insurers, they don’t set prices. You mean providers? Half of US healthcare spending is public payers - Medicare and Medicaid. They do set prices for providers and still spend far more than other countries. And if you’ve been involved in US healthcare you’d realize it’s drowning in regulations already. It’s not a free market by a stretch.
  • will_brown 8y ago
    It’s more complicated, the insurers essentially tell providers how to practice (ie prescribe this generic not the name brand, don’t prescribe 30 day Rx prescribe 90 day and don’t see/treat them in the meantime, etc...) and if the providers don’t listen the provider gets dropped from the network and either the patients are forced to new providers who the insurers control behind the scenes, or more and more the patients are forced to providers the insurers actually own.
    • refurb 8y ago
      Insurers control care to reduce costs. The upward pressure on prices is from providers. In terms of these insurers who control providers, can you give an example?
      • mikeg8 8y ago
        Kaiser
        • refurb 8y ago
          Yes, and Kaiser has some of the lowest cost healthcare out of all insurers.
      • monocasa 8y ago
        The upward pressure on prices is also from the insurers. Insurers have an "80/20 rule" from Obamacare that only 20% of their revenue can be spent on non-medical expenses (ie. profit, insurance administrative overhead, etc.). They pretty quickly hit the caps, and now only by increasing medical expenditures (the other 80%) can the pie slice that contains their profit grow year after year.
• nickchuck 8y ago
  From what I understand, the healthcare market isn't free at all. LOTS of regulation is what has caused this mess I believe.
  • zanny 8y ago
    Its impossible to do an apples to apples comparison but I would imagine by most standards EU health markets are less regulated than American ones, just because the organizational structure is so much simpler and oversight is so much less distributed. Instead of needing policy on every kind of machine you can use in what configuration or parameter codified in law or by an agency by formal declaration the NHS just buys the stuff they want doctors to have.
  • laurentoget 8y ago
    It is much less free in France or Germany, and they spend considerably less for much better outcomes. You would never get an MRI for a sprained ankle in France, but on the other hand people do not die because they cannot afford insulin.
    • RHSeeger 8y ago
      Ugh. I hate this story. In every popular story I've seen of "this person died because they couldn't afford insulin", it's really been a case of "this person died because they couldn't afford the most expensive insulin, and they weren't willing to switch to the DRASTICALLY cheaper insulins available". - The story I'm looking at now had someone complaining he couldn't afford his Lantus. - Lantus is pretty much the most expensive 24 hour insulin available. Last I checked it was something like $275 per bottle. - Walmart has cheaper insulins R, N(PH) for somewhere in the range of $20-25. They're older insulins and don't work as well, but they are an option for any diabetic that can't afford the newer insulins. (Note, I can't find it on Walmart's web site but, as I understand it, you can't but it online, so that may be why) For context: - My insurance doesn't cover Lantus either. I take a generic (to be fair, I don't believe that generic was available at the time of the story) version of it. - I used to take R and N insulin
  • fzeroracer 8y ago
• deleted 8y ago
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• tptacek 8y ago
  If health insurance companies are the problem, why are administrative expenses --- which we overspend on, to be sure --- not the dominant factor in our health care expenses? They aren't; they're not even in the top 3. If Medicare managed all of US health care and nothing else changed (that is, if we relied on Medicare for funding and kept the rest of the system we had intact), we'd reduce prices by something in the low teens percentage points. Families upset about the cost to insure their families on the ACA markets would not be mollified by that level of price relief.
• skookumchuck 8y ago
  > allows for-profit health insurance companies to exist with ZERO regulation to cap healthcare prices. There's zero regulation on the software industry, and prices have trended to zero. I suspect the problem with the health care industry is much deeper than not enough regulation.
  • hannasanarion 8y ago
    How often do you get rushed to your local software company in need of an immediate node.js webapp or you'll die within the hour?
    • CryptoPunk 8y ago
      The vast majority of healthcare costs are not related to emergency care. For that portion, there is indeed an argument for government-provisioned services being more efficient.
• cteague 8y ago
  American healthcare is nowhere close to a "free market". Have you noticed how there are next to no startups disrupting the health industry? Why can't you sign up for insurance like you can sign up for a stock account on RobinHood? There's no free market. Government licensing and regulations have created huge barriers to entry. I thought this would be more understood by those technically/entrepreneurially minded. When things are too expensive, you need to raise the supply to get the price down. Not create price controls and socialize markets. Read this article because it explains the problem better than I can. https://hbr.org/2004/06/redefining-competition-in-health-care https://hbr.org/2004/06/redefining-competition-in-health-car...
  • nabla9 8y ago
    Free market and well functioning market are not synonyms. Healthcare economy is naturally inefficient if free. Information asymmetries and other market failures emerge without good regulation and mechanism design.
    • cteague 8y ago
      Every market has information asymmetry. Software is probably the biggest one today. Yet software keeps getting better and better... I agree there are needs for regulations--more like proper norms though and a good tort system.
      • hannasanarion 8y ago
        No it doesn't. You can negotiate the price of software before you buy it, and you can shop around and choose between alternatives, or choose not to buy at all. If you need a piece of rebar removed from your chest, then you need a piece of rebar removed from your chest. The price doesn't matter, the choice of provider doesn't matter. The "consumer" is completely at the whim of whatever provider happens to be closest. That's not how free markets are supposed to work.
        • dsfyu404ed 8y ago
• wjnc 8y ago
  We run a health insurance company at my firm for some € 100 in cost per insured per year (the Netherlands). We do full bargaining with suppliers on our risk, give yearly premiums up front and have to accept everyone for a pretty much standardized premium. Dare say we even try to innovate in combination with other private insurances we offer like disability as well. Of course required for this to work is quite massive government intervention. They lay the backbone for proper risk equalisation and we try to work with that. 20% of total health spending would be about a 14-fold increase. (It gets a little murky since parts of health are outside of our market and the responsibility of local municipalities.)
• Shivetya 8y ago
  please don't foist the entirety of this issue on insurance companies, the states and federal government dictate the paper work to be done and the coverage provided. it is damn easy to mandate paying for procedures when you don't have to pay for them. California and Vermont found this out when both determined single payer options; read : the state; were not affordable without seriously curtailing care options. As in, when you tell people no it becomes affordable, when you bend over for every little thing it suddenly becomes what we have today.
• closeparen 8y ago
  There are mutual (policyholder-owned) life insurance companies; why not mutual health insurance companies? Healthcare is extremely regulated, but poorly. In addition to the much-talked-about “more vs. less” dimension of regulation there is the much more important “better vs. worse.”
• joelx 8y ago
  Americans spend more on healthcare but get less for one simple reason. We artificially restrict the number of new doctors each year through licensing and other government regulations, which reduces the supply of medical professionals. When you restrict the supply of anything and demand is inelastic, prices go up.
  • mikeg8 8y ago
    This is a totally inaccurate answer. The intricasies of healcare inflation are way more complex than simple supply and demand economics and I’d suggest you read the book I mentioned in the my original comment to be more educated on this subject