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The cruel reality appears to be that you ration health care without reducing spending, because medical administration and bureaucratic costs eat the savings and

The cruel reality appears to be that you ration health care without reducing spending, because medical administration and bureaucratic costs eat the savings and more. Untying insurance from employment is a great idea, but it won't solve this. With HDHPs being so common the 'disconnect' between providers and patients is already not a real thing. Neither will single payer fix the underlying problem, although at least individuals will be better off. At any rate, entrusting laymen to understand when they should and should not seek emergency medical attention means that people will die through entirely preventable causes in an attempt to ration their health care spending. Your cure sounds worse than the disease. There are no effective market forces you can 'unleash' in the case of health care. It wouldn't matter if you removed all government regulation and subsidies tomorrow. Even in a world where it all somehow works out, do you want medical providers in a race to the bottom? In the absence of meaningful quality of care information (impossible), consumers are incredibly sensitive to one thing: price. What you will end up with is cheap(ish) providers providing incredibly substandard care by cutting corners and killing people.

ultrarunner 7y ago
I seem to remember a comment on here complaining about $30 pacifiers. Why do pacifiers cost $30 when they’re post paid from a hospital and not when they’re bought literally anywhere else if not for the presence of market forces? I can assure you this effect is not just limited to pacifiers.
0815test 7y ago
> In the absence of meaningful quality of care information Except that quality information gets provided quite satisfactorily in plenty of industries, even ones that might appear otherwise quite opaque. Sure, sometimes it is done in distorted and counterintuitive ways (many marketing practices, including many kinds of advertising, are ultimately reputational games that are designed to signal quality), but meaningful info is far from "absent"!
conanbatt 7y ago
> With HDHPs being so common the 'disconnect' between providers and patients is already not a real thing. Long way to go for HDHP to take over the market. But its definitely the way to go. It will however attack mostly the primary care market, not the hospitals which are 40% of the national health spending. > At any rate, entrusting laymen to understand when they should and should not seek emergency medical attention means that people will die through entirely preventable causes in an attempt to ration their health care spending. Your cure sounds worse than the disease. Not my "cure" thats the economic reality. Unfettered access to healthcare will give you skyrocketing costs. You cant complain about both at the same time, they are a trade-off. I do think that cost is the single most important thing to attack, and the policies to do so are very easy to enact. They are just very unpopular, because the democratic party wants to increase the state, not make healthcare cheaper, and because republicas have their head up their ass on this topic for reasons I dont understand.
- Amezarak 7y ago
  According to Kaiser, HDHPs are the second most common health insurance plan and account for 28% of all insurance plans. > Not my "cure" thats the economic reality. Unfettered access to healthcare will give you skyrocketing costs. You cant complain about both at the same time, they are a trade-off. Yes, if the problem is skyrocketing demand. But it isn't. Yes, if we waved a magic wand and provided unlimited free access to medical care, demand would rise somewhat. But demand is not the reason for the current high prices, and it's not the reason costs are outpacing inflation. Medical care in the US is much more expensive than in comparable countries, but demand is not appreciably different. As long as people keep looking at this through a "market" lens, or through a "just make it single payer" lens, the problem will never be solved. The fundamental problem isn't that demand is too high. The problem is cost disease, the root of which consists of dozens of different factors. This is a decent article, albeit one that barely scratches the surface. https://slatestarcodex.com/2017/02/09/considerations-on-cost-disease/ https://slatestarcodex.com/2017/02/09/considerations-on-cost... Look at those graphs! It's mindblowing! Medical costs have increased ten times more than inflation, while doctor and nurse salaries were flat (actually worse, since now their salary goes to paying off educational debt) over the same time period. If there's a demand problem, why aren't salaries of medical professionals rising faster than inflation? Lastly, I think most people would disagree that cutting costs is the most important thing. Going bankrupt is better than dying of pneumonia because you were worried about wasting money on a doctor visit.

ultrarunner 7y ago

I seem to remember a comment on here complaining about $30 pacifiers. Why do pacifiers cost $30 when they’re post paid from a hospital and not when they’re bought literally anywhere else if not for the presence of market forces? I can assure you this effect is not just limited to pacifiers.

0815test 7y ago

> In the absence of meaningful quality of care information Except that quality information gets provided quite satisfactorily in plenty of industries, even ones that might appear otherwise quite opaque. Sure, sometimes it is done in distorted and counterintuitive ways (many marketing practices, including many kinds of advertising, are ultimately reputational games that are designed to signal quality), but meaningful info is far from "absent"!

conanbatt 7y ago

> With HDHPs being so common the 'disconnect' between providers and patients is already not a real thing. Long way to go for HDHP to take over the market. But its definitely the way to go. It will however attack mostly the primary care market, not the hospitals which are 40% of the national health spending. > At any rate, entrusting laymen to understand when they should and should not seek emergency medical attention means that people will die through entirely preventable causes in an attempt to ration their health care spending. Your cure sounds worse than the disease. Not my "cure" thats the economic reality. Unfettered access to healthcare will give you skyrocketing costs. You cant complain about both at the same time, they are a trade-off. I do think that cost is the single most important thing to attack, and the policies to do so are very easy to enact. They are just very unpopular, because the democratic party wants to increase the state, not make healthcare cheaper, and because republicas have their head up their ass on this topic for reasons I dont understand.

Amezarak 7y ago
According to Kaiser, HDHPs are the second most common health insurance plan and account for 28% of all insurance plans. > Not my "cure" thats the economic reality. Unfettered access to healthcare will give you skyrocketing costs. You cant complain about both at the same time, they are a trade-off. Yes, if the problem is skyrocketing demand. But it isn't. Yes, if we waved a magic wand and provided unlimited free access to medical care, demand would rise somewhat. But demand is not the reason for the current high prices, and it's not the reason costs are outpacing inflation. Medical care in the US is much more expensive than in comparable countries, but demand is not appreciably different. As long as people keep looking at this through a "market" lens, or through a "just make it single payer" lens, the problem will never be solved. The fundamental problem isn't that demand is too high. The problem is cost disease, the root of which consists of dozens of different factors. This is a decent article, albeit one that barely scratches the surface. https://slatestarcodex.com/2017/02/09/considerations-on-cost-disease/ https://slatestarcodex.com/2017/02/09/considerations-on-cost... Look at those graphs! It's mindblowing! Medical costs have increased ten times more than inflation, while doctor and nurse salaries were flat (actually worse, since now their salary goes to paying off educational debt) over the same time period. If there's a demand problem, why aren't salaries of medical professionals rising faster than inflation? Lastly, I think most people would disagree that cutting costs is the most important thing. Going bankrupt is better than dying of pneumonia because you were worried about wasting money on a doctor visit.