6 ms·

I’m a big free-market person, and generally skeptical of regulation and government programs. That being said, I think there are conditions when a free market c

I’m a big free-market person, and generally skeptical of regulation and government programs. That being said, I think there are conditions when a free market can fail, and one of those conditions is when you don’t have supply and demand working rationally for one reason or another. I’ve come to see healthcare as one of those cases. If a doctor says the cost of your life, or your child’s life, is X... who is going to shrug that off and refuse to pay? Thus in an unregulated market, medical practitioners can very nearly charge whatever a patient is capable of paying, and in my experience that’s exactly what they do. Simple reforms that I think could help: 1) Published prices for all medical services offered. You should be able to get an exact price quote and comparison shop. 2) A ban on drug advertisements. Only the US and New Zealand allow this in the first place. 3) A cap on drug prices based on their age and manufacturing cost. I understand that the actual cost of a new drug is much more R&D than manufacturing, but that doesn’t justify pharma company. Given a reasonable and predictable price cap formula, pharma will adapt. There are a lot of other interesting and more radical ideas out there, but these seem to me like relatively straightforward starting points that would help remove some of the worst opacity in the US healthcare system, which should in turn create more accountability.

Apocryphon 7y ago
Universal healthcare would be a great boon for employers, as then they would no longer have to worry about providing and paying for it as part of employee compensation.
- burlesona 7y ago
  I get that now. I didn’t understand it for a long time. While a government-run universal care program doesn’t thrill me, I find the current employer-based system to be borderline immoral. The more I deal with the system the more it strikes me as a corrupt, crony deal to make workers more dependent on their employer, depress wages, and drive up medical industry profits.
  - TomMckenny 7y ago
    It will also benefit lower income employees and consumers who will see good wage/price changes relative to taxes. Another possibility is a cap on drug profits declining with drug age. This will allow enough market to avoid having to guess production costs in advance and set them in stone. The drawback is incentives to efficiency. Perhaps a mixture of price cap and profit cap would hit the sweet spot.
  - aplummer 7y ago
    “Borderline” immoral? Unemployed people doing gofundme’s for insulin...
  - sdenton4 7y ago
    My partner and I have, for the last couple months, been going through the medical system hoops over a broken elbow and resulting surgery. We've fiiiiinally started getting the bills in, along with the 'Explanation of Benefits', and so far 100% of the bills have included a patient-oriented error. And then spent many many hours on the phone getting them corrected. It's goddamn criminal. [edit: it's also 'fun' to think how much harder it would have been to identify the bad charges prior to the ACA's explanation of benefits requirements.]
- d--b 7y ago
  If universal healthcare were to be implemented, they'd probably copy what most other countries do: financing it through taxes paid by employers for each employee. In France, if you want to spend 120k euros on an employee, you'd pay about 40k towards healthcare and the national retirement plan (and a few other things). The employee gets paid 80k, and then pays income tax on that. Income tax is quite lower than in the US though. All in all, my experience has been that the taxation levels in France are comparable to what you'd pay if you lived in New York City.
  - tehlike 7y ago
    What is the income tax rate in france roughly? In us, federal reaches to 36% or so on highest bracket, and about 10% on states like california. I dont know how much is average, however.
    - jkh1 7y ago
      From years ago when I lived in CA, taxes for mid-range income were comparable with France (and Western Europe in general), just itemized differently. The main difference in my opinion was in the quality/quantity of public services one got.
    - zokier 7y ago
      I can give some information from Finland, which I imagine is relatively similar to France. For a hypothetical 100k EUR/year salary you'd pay total 40% income tax. I think the top bracket is somewhere north of 50%. To more accurately compare the taxation, I think it is prudent to mention that we pay usually 24% VAT for most goods we purchase, which iirc is bit higher than typical sales taxes in US.
  - pitaj 7y ago
    Taxes on employers are taxes on employees. Employers have set compensations that include the payroll taxes and insurance plans and everything. Why have an extra layer of obscurity when you could just tax income directly? Unnecessary complication that makes doing business harder just so the taxes are hidden from the working class.
- golemiprague 7y ago
  Why paying is a worry? it is just a deduction from the total salary no? Also in universal healthcare they have to pay it, as a tax to the government or directly to the person insurer, depends on the system.
refurb 7y ago
If a doctor says the cost of your life, or your child’s life, is X... who is going to shrug that off and refuse to pay? Of all healthcare dollars spent, what percentage are these kind? 20%?
- karlp 7y ago
  Well, there is a reason why infant mortality is so low in western countries, so you can imagine pretty big.
  - refurb 7y ago
    Lowering of infant mortality was mostly driven by preventative measures.
pitaj 7y ago
The current American system is heavily regulated and nowhere close to a free market. > Thus in an unregulated market, medical practitioners can very nearly charge whatever a patient is capable of paying, and in my experience that’s exactly what they do. Emergency situations are exactly what insurance is for. Free market advocates don't expect patients to shop around in that kind of situation, but they do expect them to shop around for insurance, general practitioners, specialists for non-emergency treatments, etc. Right now, none of those things are realistic for the vast majority of Americans because the government has incentivized and now mandates employers to provide comprehensive insurance, which introduces a layer of opacity between consumers and prices. You make some okay suggestions but even more can be done without resorting to mandates: 1. Remove the requirements and incentives for employer-provided insurance, introduce a program for transitioning employer insurance into private individual/family coverage. 2. Reduce or eliminate medical patents. You suggest price controls, which are a bad idea, commonly leading to shortages. Pharmas can't charge such outrageous prices when faced with competition. 3. Reduce or eliminate minimum coverage requirements, introducing a new type of medical plan that covers only catastrophic unpreventable emergencies. 4. Reduce the onerous nature of the FDA to a level on par with such agencies in other countries. Make it cheaper to develop drugs. The FDA should have two branches: safety and efficacy, with separate certifications. A drug can be released whenever it is safe, but they can't directly advertise until it's proven effective.

Apocryphon 7y ago

Universal healthcare would be a great boon for employers, as then they would no longer have to worry about providing and paying for it as part of employee compensation.

burlesona 7y ago
I get that now. I didn’t understand it for a long time. While a government-run universal care program doesn’t thrill me, I find the current employer-based system to be borderline immoral. The more I deal with the system the more it strikes me as a corrupt, crony deal to make workers more dependent on their employer, depress wages, and drive up medical industry profits.
- TomMckenny 7y ago
  It will also benefit lower income employees and consumers who will see good wage/price changes relative to taxes. Another possibility is a cap on drug profits declining with drug age. This will allow enough market to avoid having to guess production costs in advance and set them in stone. The drawback is incentives to efficiency. Perhaps a mixture of price cap and profit cap would hit the sweet spot.
- aplummer 7y ago
  “Borderline” immoral? Unemployed people doing gofundme’s for insulin...
- sdenton4 7y ago
  My partner and I have, for the last couple months, been going through the medical system hoops over a broken elbow and resulting surgery. We've fiiiiinally started getting the bills in, along with the 'Explanation of Benefits', and so far 100% of the bills have included a patient-oriented error. And then spent many many hours on the phone getting them corrected. It's goddamn criminal. [edit: it's also 'fun' to think how much harder it would have been to identify the bad charges prior to the ACA's explanation of benefits requirements.]
d--b 7y ago
If universal healthcare were to be implemented, they'd probably copy what most other countries do: financing it through taxes paid by employers for each employee. In France, if you want to spend 120k euros on an employee, you'd pay about 40k towards healthcare and the national retirement plan (and a few other things). The employee gets paid 80k, and then pays income tax on that. Income tax is quite lower than in the US though. All in all, my experience has been that the taxation levels in France are comparable to what you'd pay if you lived in New York City.
- tehlike 7y ago
  What is the income tax rate in france roughly? In us, federal reaches to 36% or so on highest bracket, and about 10% on states like california. I dont know how much is average, however.
  - jkh1 7y ago
    From years ago when I lived in CA, taxes for mid-range income were comparable with France (and Western Europe in general), just itemized differently. The main difference in my opinion was in the quality/quantity of public services one got.
  - zokier 7y ago
    I can give some information from Finland, which I imagine is relatively similar to France. For a hypothetical 100k EUR/year salary you'd pay total 40% income tax. I think the top bracket is somewhere north of 50%. To more accurately compare the taxation, I think it is prudent to mention that we pay usually 24% VAT for most goods we purchase, which iirc is bit higher than typical sales taxes in US.
- pitaj 7y ago
  Taxes on employers are taxes on employees. Employers have set compensations that include the payroll taxes and insurance plans and everything. Why have an extra layer of obscurity when you could just tax income directly? Unnecessary complication that makes doing business harder just so the taxes are hidden from the working class.
golemiprague 7y ago
Why paying is a worry? it is just a deduction from the total salary no? Also in universal healthcare they have to pay it, as a tax to the government or directly to the person insurer, depends on the system.

refurb 7y ago

If a doctor says the cost of your life, or your child’s life, is X... who is going to shrug that off and refuse to pay? Of all healthcare dollars spent, what percentage are these kind? 20%?

karlp 7y ago
Well, there is a reason why infant mortality is so low in western countries, so you can imagine pretty big.
- refurb 7y ago
  Lowering of infant mortality was mostly driven by preventative measures.

pitaj 7y ago

The current American system is heavily regulated and nowhere close to a free market. > Thus in an unregulated market, medical practitioners can very nearly charge whatever a patient is capable of paying, and in my experience that’s exactly what they do. Emergency situations are exactly what insurance is for. Free market advocates don't expect patients to shop around in that kind of situation, but they do expect them to shop around for insurance, general practitioners, specialists for non-emergency treatments, etc. Right now, none of those things are realistic for the vast majority of Americans because the government has incentivized and now mandates employers to provide comprehensive insurance, which introduces a layer of opacity between consumers and prices. You make some okay suggestions but even more can be done without resorting to mandates: 1. Remove the requirements and incentives for employer-provided insurance, introduce a program for transitioning employer insurance into private individual/family coverage. 2. Reduce or eliminate medical patents. You suggest price controls, which are a bad idea, commonly leading to shortages. Pharmas can't charge such outrageous prices when faced with competition. 3. Reduce or eliminate minimum coverage requirements, introducing a new type of medical plan that covers only catastrophic unpreventable emergencies. 4. Reduce the onerous nature of the FDA to a level on par with such agencies in other countries. Make it cheaper to develop drugs. The FDA should have two branches: safety and efficacy, with separate certifications. A drug can be released whenever it is safe, but they can't directly advertise until it's proven effective.