4 ms·

> Sure for some things, like elective surgeries (lasik for example) or routine dental care, people can shop around, and prices will reach a sane level. But the

> Sure for some things, like elective surgeries (lasik for example) or routine dental care, people can shop around, and prices will reach a sane level. But the majority of healthcare does not work like that. This is precisely because there is no health "insurance" middlemen for purchasing those services. The market drives those costs down. If - like in pre-ww2 America - instead people saved up for the inevitable doctors visits and paid out of pocket directly to the doctors and hospitals, costs would be FAR lower both due to competition and price sensitivity. This is the fundamental problem with using health "insurance" for expected costs, rather than just unpredictable emergencies.

skohan 7y ago
Yes but it is also because those specific types of treatments respond well to market forces: they are common enough for there to be a lot of competing providers, and if the price is too high, people can elect not to receive those services. For a counterexample, look at dental surgery. This is also often not covered by insurance, but it's much more expensive, and low-income individuals often take on debt and risk their financial security to undergo these procedures because the alternative is often a severely degraded quality of life. The difference is that the demand is much less flexible, so providers can get away with higher prices. Many healthcare procedures fall into this category.
entee 7y ago
And what if you happened to not be able to save? Or if something was too expensive for your savings? Or if you chose the wrong savings vehicle and the stock market tanked just when you needed that new hip? How much should you save? How do you know? Pre-WW2 America isn't a place most people would want to return to in terms of healthcare. It was far far less advanced, people died much more easily and you may recall a certain Great Depression which made it so those savings weren't quite as reliable as people hoped. Oh and when you go to the ER after getting hit by a bus, are you going to call around for the best deal? You might argue that's what insurance is for, but now you end up back where we are today, with a middle-man paying for things. Things that are essentially guaranteed to happen but unpredictable in their magnitude. I'm not saying we shouldn't have more market information, but it's just incorrect to say the market will solve this. Serious medical problems are a, "your money or your life" situation, pure unregulated markets are going to really struggle in this area.
- scottlocklin 7y ago
  >Pre-WW2 America isn't a place most people would want to return to in terms of healthcare. I dunno, the differences weren't huge, and at least people didn't go bankrupt (data not from the US, but close). https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2625386/ https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2625386/ "Life expectancy of mature women taken from Hollingsworth8 and OPCS data for England and Wales Date Life expectancy of women at 15 years (years) 1480–1679 48.2 1680–1779 56.6 1780–1879 64.6 1891 61.6 1901 62.6 1911 66.4 1921 68.1 1951 73.4 1961 75.7 1971 76.8 1981 78.0" 1989 79.2
  - seandougall 7y ago
    That seems to indicate a 16% increase in life expectancy between the last pre-WW2 data point and the most recent data point. That's pretty huge, especially when you consider that those are averages, meaning that the disparity is made up not so much of old people dying older, but more of young people not dying from illnesses that are now preventable. As a specific and personal data point, I have chronic kidney disease, which developed rapidly when I was 25. With pre-WW2 medicine (no transplants, no dialysis), I might have lived to 26, maaaaybe, and even then only if I'd been able to control my blood pressure long enough for renal failure to set in instead of a stroke or heart attack. Thanks to modern medicine, I'm now nearing 40 with a good prognosis; there's no reason to believe it will impact my life expectancy, and the impact on my quality of life is relatively minimal. Compared to dying in my mid-20s, that's a vast world of difference. I will not willingly go back to pre-WW2 medicine, thank you very much.
    - AcerbicZero 7y ago
      Not to derail whatever point you're trying to make but its important to note if you use WW2 as the middle point, you're splitting the data between a pre-penicillin world and post-penicillin world. If anything I'm amazed that its only a 16% increase after such a massive change.
      - seandougall 7y ago
SolaceQuantum 7y ago
"If - like in pre-ww2 America - instead people saved up for the inevitable doctors visits and paid out of pocket directly to the doctors and hospitals, costs would be FAR lower both due to competition and price sensitivity." So like, real question here... How does would that work if you're poor, chronically ill, have cancer, need an organ replacement, have HIV, etc? How do I know if I'm getting my money's worth, given I do not have medical education? What happens if I can't make a choice of what services I consent to because I've been rendered incapacitated due to a medical emergency?

skohan 7y ago

Yes but it is also because those specific types of treatments respond well to market forces: they are common enough for there to be a lot of competing providers, and if the price is too high, people can elect not to receive those services. For a counterexample, look at dental surgery. This is also often not covered by insurance, but it's much more expensive, and low-income individuals often take on debt and risk their financial security to undergo these procedures because the alternative is often a severely degraded quality of life. The difference is that the demand is much less flexible, so providers can get away with higher prices. Many healthcare procedures fall into this category.

entee 7y ago

And what if you happened to not be able to save? Or if something was too expensive for your savings? Or if you chose the wrong savings vehicle and the stock market tanked just when you needed that new hip? How much should you save? How do you know? Pre-WW2 America isn't a place most people would want to return to in terms of healthcare. It was far far less advanced, people died much more easily and you may recall a certain Great Depression which made it so those savings weren't quite as reliable as people hoped. Oh and when you go to the ER after getting hit by a bus, are you going to call around for the best deal? You might argue that's what insurance is for, but now you end up back where we are today, with a middle-man paying for things. Things that are essentially guaranteed to happen but unpredictable in their magnitude. I'm not saying we shouldn't have more market information, but it's just incorrect to say the market will solve this. Serious medical problems are a, "your money or your life" situation, pure unregulated markets are going to really struggle in this area.

scottlocklin 7y ago
>Pre-WW2 America isn't a place most people would want to return to in terms of healthcare. I dunno, the differences weren't huge, and at least people didn't go bankrupt (data not from the US, but close). https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2625386/ https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2625386/ "Life expectancy of mature women taken from Hollingsworth8 and OPCS data for England and Wales Date Life expectancy of women at 15 years (years) 1480–1679 48.2 1680–1779 56.6 1780–1879 64.6 1891 61.6 1901 62.6 1911 66.4 1921 68.1 1951 73.4 1961 75.7 1971 76.8 1981 78.0" 1989 79.2
- seandougall 7y ago
  That seems to indicate a 16% increase in life expectancy between the last pre-WW2 data point and the most recent data point. That's pretty huge, especially when you consider that those are averages, meaning that the disparity is made up not so much of old people dying older, but more of young people not dying from illnesses that are now preventable. As a specific and personal data point, I have chronic kidney disease, which developed rapidly when I was 25. With pre-WW2 medicine (no transplants, no dialysis), I might have lived to 26, maaaaybe, and even then only if I'd been able to control my blood pressure long enough for renal failure to set in instead of a stroke or heart attack. Thanks to modern medicine, I'm now nearing 40 with a good prognosis; there's no reason to believe it will impact my life expectancy, and the impact on my quality of life is relatively minimal. Compared to dying in my mid-20s, that's a vast world of difference. I will not willingly go back to pre-WW2 medicine, thank you very much.
  - AcerbicZero 7y ago
    Not to derail whatever point you're trying to make but its important to note if you use WW2 as the middle point, you're splitting the data between a pre-penicillin world and post-penicillin world. If anything I'm amazed that its only a 16% increase after such a massive change.
    - seandougall 7y ago

SolaceQuantum 7y ago

"If - like in pre-ww2 America - instead people saved up for the inevitable doctors visits and paid out of pocket directly to the doctors and hospitals, costs would be FAR lower both due to competition and price sensitivity." So like, real question here... How does would that work if you're poor, chronically ill, have cancer, need an organ replacement, have HIV, etc? How do I know if I'm getting my money's worth, given I do not have medical education? What happens if I can't make a choice of what services I consent to because I've been rendered incapacitated due to a medical emergency?