4 ms·

This is a bit of a false narrative. 99% of healthcare is not emergency room, imminent bleeding out. Fine, it is a "dramatic illustration" but for even ordinar

This is a bit of a false narrative. 99% of healthcare is not emergency room, imminent bleeding out. Fine, it is a "dramatic illustration" but for even ordinary, ongoing medicine, the average consumer isn't in a position to evaluate the choices involved, there a natural advantage whatever health care provider is in the area, necessary regulation create severe barriers to entry and so-forth.

krupan 8y ago
Yes, the situation we have now sucks. But that's where we should start questioning. Is all the regulation we have necessary? Why aren't average consumers in a position to evaluate the choices, just like we do for food (admittedly, we aren't doing the best job at choosing the best foods, but we like our freedom of choice, and the information and options are there)?
- joe_the_user 8y ago
  Why aren't average consumers in a position to evaluate the choices How could a consumer be in a position to evaluate their physician (and the entire health care process)? The knowledge required is huge. Moreover, once you have an adversarial market situation where the competitors use any means available to present themselves well, the ability of the consumer to do these evaluations will further decline - after twenty years of ecommerce, determining if a random thing I buy on Amazon actually has value is still hard, still a crapshoot (I don't mind having to be careful buying a random thing on Amazon, that's reason tradeoff. For something that could threaten my life, it's not a reasonable tradeoff). But bad health care products and services can kill you. The usual answer is "we'll find a third party to do the evaluating" but unless that's actually the state, at which point things pointless, you will still have all the corruption of today - insurance companies are the evaluators and aggregators of health care services but they ultimately can't control prices (they can limit services provided but aren't really limiting the price for the services - they don't have an incentive to do so since they take a cut of the services).
  - krupan 8y ago
    Sounds like fear-based decision making there. If things are that bad, that difficult to get right, then the government isn't going to save you. Sorry. The good news, whether you choose to believe it or not, is that things are not that bad. We can do this.
    - joe_the_user 8y ago
      Sounds like fear-based decision making there. If things are that bad, that difficult to get right, then the government isn't going to save you. Most advanced industrialized nations have a state-run health care system and pay on average half of what the US pays. Health is naturally quite complicated but it isn't impossible to get right. The fundamental problem is that an adversarial system, where every provider has an incentive to wrangle their presentation and to wrangle their position in the regulator system, means, in the specific case of health care, pseudo-competition plus regulation as we have now, doesn't lower costs or increase productivity, it just produces a tide of dubious opportunism as one can see from current conditions. And a look at present US health would show things are pretty bad - costs are approaching 20% of GDP and given that this is double that of equivalent advanced industrialized nation, that means we're spending 10% of the entire GDP on some combination of waste and inefficiency.
      - lliamander 8y ago
        > Most advanced industrialized nations have a state-run health care system and pay on average half of what the US pays. The U.S. is not an outlier with regard to healthcare consumption when you factor in household income[1]. GDP is the wrong metric to measure against. [1]https://randomcriticalanalysis.com/2018/11/19/why-everything-you-know-about-healthcare-is-wrong-in-one-million-charts-a-response-to-noah-smith/ https://randomcriticalanalysis.com/2018/11/19/why-everything...
        joe_the_user 8y ago
        This argument uses average income as proxy for what health care spending in the US should be. That seems clearly wrong given that with US now having a GINI coefficient, high level of income inequality, median household income would be a better thing to measure health care spending, since every individual has to spend money on staying healthy. The argument generally seems wrong too. The need for health care isn't elastic - if someone need care, they need care and people going without needed health care is a humanitarian crisis (a situation that the US is arguable in - see the people giving free dental in a stadium a few years back).
wuliwong 8y ago
I still totally disagree with your narrative. There is no natural monopoly in health care. New hospitals continue to be built all the time. You can goto your CVS and see a doctor if you want. There are tons and tons of choices and competition. >the average consumer isn't in a position to evaluate the choices involved Why? Once again I completely disagree with this narrative as well.
- pwinnski 8y ago
  The narrative is accurate. There are many, many, many examples of people who go to a hospital and ask at every point whether the services being provided are "in-network" for their insurance company, and yet still find themselves being billed for "out-of-network" services because of some assistant to a doctor or someone who was consulted outside the patient's presence. It's a minefield, even for people with patience and a clear head, which doesn't describe the majority of people seeking medical care. A quick search turns up a few examples: - http://www.news-gazette.com/news/local/2019-01-20/wondering-why-you-got-unexpected-out-network-medical-bill.html http://www.news-gazette.com/news/local/2019-01-20/wondering-... - https://www.consumerreports.org/health-insurance/states-work-to-limit-out-of-network-medical-bills/ https://www.consumerreports.org/health-insurance/states-work... - https://www.prlog.org/12766040-hbma-adopts-policy-framework-for-unexpected-out-of-network-medical-bills.html https://www.prlog.org/12766040-hbma-adopts-policy-framework-... This is a very common issue, so common it is receiving legislative attention.
  - krupan 8y ago
    Everyone agrees that this is a problem. The debate is about how to solve the problem. One side says, "the government should just make our decisions for us." The other side says, "the government should intervene enough so that consumers have the information they need to make informed decisions on their own."
    - pwinnski 8y ago
      Everyone agrees that this is a problem... apparently excepting the commenter to whom I was responding. Oversimplifications don't serve anyone, and mischaracterizations are unhelpful and unwelcome.

krupan 8y ago

Yes, the situation we have now sucks. But that's where we should start questioning. Is all the regulation we have necessary? Why aren't average consumers in a position to evaluate the choices, just like we do for food (admittedly, we aren't doing the best job at choosing the best foods, but we like our freedom of choice, and the information and options are there)?

joe_the_user 8y ago
Why aren't average consumers in a position to evaluate the choices How could a consumer be in a position to evaluate their physician (and the entire health care process)? The knowledge required is huge. Moreover, once you have an adversarial market situation where the competitors use any means available to present themselves well, the ability of the consumer to do these evaluations will further decline - after twenty years of ecommerce, determining if a random thing I buy on Amazon actually has value is still hard, still a crapshoot (I don't mind having to be careful buying a random thing on Amazon, that's reason tradeoff. For something that could threaten my life, it's not a reasonable tradeoff). But bad health care products and services can kill you. The usual answer is "we'll find a third party to do the evaluating" but unless that's actually the state, at which point things pointless, you will still have all the corruption of today - insurance companies are the evaluators and aggregators of health care services but they ultimately can't control prices (they can limit services provided but aren't really limiting the price for the services - they don't have an incentive to do so since they take a cut of the services).
- krupan 8y ago
  Sounds like fear-based decision making there. If things are that bad, that difficult to get right, then the government isn't going to save you. Sorry. The good news, whether you choose to believe it or not, is that things are not that bad. We can do this.
  - joe_the_user 8y ago
    Sounds like fear-based decision making there. If things are that bad, that difficult to get right, then the government isn't going to save you. Most advanced industrialized nations have a state-run health care system and pay on average half of what the US pays. Health is naturally quite complicated but it isn't impossible to get right. The fundamental problem is that an adversarial system, where every provider has an incentive to wrangle their presentation and to wrangle their position in the regulator system, means, in the specific case of health care, pseudo-competition plus regulation as we have now, doesn't lower costs or increase productivity, it just produces a tide of dubious opportunism as one can see from current conditions. And a look at present US health would show things are pretty bad - costs are approaching 20% of GDP and given that this is double that of equivalent advanced industrialized nation, that means we're spending 10% of the entire GDP on some combination of waste and inefficiency.
    - lliamander 8y ago
      > Most advanced industrialized nations have a state-run health care system and pay on average half of what the US pays. The U.S. is not an outlier with regard to healthcare consumption when you factor in household income[1]. GDP is the wrong metric to measure against. [1]https://randomcriticalanalysis.com/2018/11/19/why-everything-you-know-about-healthcare-is-wrong-in-one-million-charts-a-response-to-noah-smith/ https://randomcriticalanalysis.com/2018/11/19/why-everything...
      - joe_the_user 8y ago
        This argument uses average income as proxy for what health care spending in the US should be. That seems clearly wrong given that with US now having a GINI coefficient, high level of income inequality, median household income would be a better thing to measure health care spending, since every individual has to spend money on staying healthy. The argument generally seems wrong too. The need for health care isn't elastic - if someone need care, they need care and people going without needed health care is a humanitarian crisis (a situation that the US is arguable in - see the people giving free dental in a stadium a few years back).

wuliwong 8y ago

I still totally disagree with your narrative. There is no natural monopoly in health care. New hospitals continue to be built all the time. You can goto your CVS and see a doctor if you want. There are tons and tons of choices and competition. >the average consumer isn't in a position to evaluate the choices involved Why? Once again I completely disagree with this narrative as well.

pwinnski 8y ago
The narrative is accurate. There are many, many, many examples of people who go to a hospital and ask at every point whether the services being provided are "in-network" for their insurance company, and yet still find themselves being billed for "out-of-network" services because of some assistant to a doctor or someone who was consulted outside the patient's presence. It's a minefield, even for people with patience and a clear head, which doesn't describe the majority of people seeking medical care. A quick search turns up a few examples: - http://www.news-gazette.com/news/local/2019-01-20/wondering-why-you-got-unexpected-out-network-medical-bill.html http://www.news-gazette.com/news/local/2019-01-20/wondering-... - https://www.consumerreports.org/health-insurance/states-work-to-limit-out-of-network-medical-bills/ https://www.consumerreports.org/health-insurance/states-work... - https://www.prlog.org/12766040-hbma-adopts-policy-framework-for-unexpected-out-of-network-medical-bills.html https://www.prlog.org/12766040-hbma-adopts-policy-framework-... This is a very common issue, so common it is receiving legislative attention.
- krupan 8y ago
  Everyone agrees that this is a problem. The debate is about how to solve the problem. One side says, "the government should just make our decisions for us." The other side says, "the government should intervene enough so that consumers have the information they need to make informed decisions on their own."
  - pwinnski 8y ago
    Everyone agrees that this is a problem... apparently excepting the commenter to whom I was responding. Oversimplifications don't serve anyone, and mischaracterizations are unhelpful and unwelcome.