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Healthcare has been a political football for decades, with massive interventions by government up and down the stack of services. Think about the market's prov

Healthcare has been a political football for decades, with massive interventions by government up and down the stack of services. Think about the market's provision of grocery stores: plenty of competition. Most places they don't enjoy geographic monopolies like car dealerships do. They manage to get one of the most vital goods to a huge population spread across a huge area on time and at a great price, with local variations anticipating the specific desires of local consumers. There is no central coordinator or Department of Grocery Services. The market figures it out. How can someone look at healthcare, with its absolutely absurd outcomes, and not understand that it is precisely because of government interference that nothing makes any sense? Costs keep rising unsustainably, which is the opposite of the way markets work. Paperwork and administrative staff balloons in proportion to patient care. Once the state gets involved, now it becomes political. Do you think the current political climate in the US should be further embedded into healthcare? If the state controlled everything, then you'd get outcomes like red/blue states losing/gaining funding depending on the results of the most recent election. One could imagine more dystopian outcomes quite easily.

dahfizz 7y ago
> they don't enjoy geographic monopolies like car dealerships do This is a bit of a tangent, but do car dealerships have geographic monopolies in some places? I don't think I've even seen just one dealership. They always cluster around each other where I'm from - you could car shop on foot and see at least 3-4 different dealerships.
- mattzito 7y ago
  By brand/corporate representation they do. So you’ll see a cluster of different brands all around the same interchange - but that might be the only, say, Toyota dealership in the area.
  - dahfizz 7y ago
    Ah, that makes more sense. Thank you!
monetus 7y ago
The market only provisions grocery stores after massive subsidization, centralization, and exploitative labor. Can you usually purchase cheap local produce for less than that offered by a conglomerate? I'm certain there are useful parallels between healthcare and the grocery market, but I feel like you left them out of your comment. Take bananas for instance: ubiquitous, constantly in demand, sold mostly by two companies, and widely produced by slave labor. Disclaimer: I'm in favor of a preventative care system available to everyone, regardless of income.
- dahfizz 7y ago
  > Can you usually purchase cheap local produce for less than that offered by a conglomerate? You can never purchase local, small batch ____ than you can from large companies. That's why companies get large - they are more efficient the larger they get (to oversimplify). Your local farmer has much less land than factory farm, and he doesn't have the state of the art equipment to harvest or store his crops. He can't justify spending so much money on equipment when he runs such a small farm. There's also a good chance he uses "organic" as a selling feature, which means his yeild per area land is way lower than an efficient farm. He also has to work much harder to actually sell his crop. He doesn't have large commercial deals that put his product directly onto shelves at Aldi. He has to spend half his time driving all over the place to various farmers markets to try and get people to buy his stuff. You might think all of this is pedantic or obvious, but I think efficiency of food production is very important. Food production is a massive contributor to climate change and opting for methods than can save on land area and water usage can have big impacts.
  - deleted 7y ago
    [deleted]
persistent 7y ago
You don't seem very familiar with our system of production, distribution, and consumption of food. The government is _very_ involved in all aspects of this. They intervene on the supply side to guarantee prices for commodities. They intervene on the demand side by directly subsidizing 10% of consumers. The federal government inspects all meat, fish, and poultry packed in this country. There is a USDA agent filing a market report every morning from every produce terminal in America. The government maintains a detailed database on soil conditions across the nation. The USDA alone has over 100000 employees. The government also funds a nationwide system of agricultural universities, extensions, and bureaus through the land grant program. I think if you want to pick some aspect of American life that is free of government involvement, you started in the wrong place.
erentz 7y ago
I had to go to the ER yesterday. I was taken to the closest ER. You bring up geographic monopolies without any irony and yet healthcare has huge and very obvious geographical monopolies. At the ER I was made to sign something on the way in in a state in which I couldn’t really tell what I was signing. I was given various drugs and sent through a CT scan. I had no idea what was going on. I certainly was in no position, with symptoms of a life threatening condition on top of being incapacitated to say “hey hold up, I think the Safeway has cheaper CT scans can you guys transfer me there!” Healthcare is entirely different from buying groceries. It does not and will never operate like a typical market for typical commodity items.
- refurb 7y ago
  Emergency medicine is a small fraction of all medicinal needs. A lot of medicinal procedures allow time for determining what the most cost effective offering is.
  - lostlogin 7y ago
    But is the ideal system one with several hospitals per city, duplicating expensive resources or one big centre with centralised resources?
fzeroracer 7y ago
Or, you do the rational thing that many other nations have done and decide that healthcare is a human right, then stop playing hot potato with the ticking bomb of healthcare. America is the only one with this very unique problem and going further in the direction of a 'free market' won't work. Because healthcare can never be a free market. The insurers have an incentive to not give quality healthcare and give people the bare minimum while hiding details from customers and no amount of freedom would solve this. The end result is that you'd see something like ISP companies where they work together to enforce a regional monopoly and gouge people all the same.
- SamReidHughes 7y ago
  Veterinary services and dentistry aren't in the same situation though. And you can have both a public option alongside a free market.
rat87 7y ago
> How can someone look at healthcare, with its absolutely absurd outcomes, and not understand that it is precisely because of government interference that nothing makes any sense? Because they see how much of the mess is the markets fault. They also see how nearly every other first world country has a working system while spending less on healtchare. In some places its private non profits subsidized and regulated by the government, in some its the government providing insurance like in Canada, in some it's really socialistic and government employs most doctors like the NHS. In each case the system works much better then the US and the US system is rightly considered a bogeyman. I'm unaware of any place that works like you've described
- jfnixon 7y ago
  Please define "works much better." Thanks.
wefarrell 7y ago
Honest question - are there any successful healthcare systems that have more privatization than the US?

dahfizz 7y ago

> they don't enjoy geographic monopolies like car dealerships do This is a bit of a tangent, but do car dealerships have geographic monopolies in some places? I don't think I've even seen just one dealership. They always cluster around each other where I'm from - you could car shop on foot and see at least 3-4 different dealerships.

mattzito 7y ago
By brand/corporate representation they do. So you’ll see a cluster of different brands all around the same interchange - but that might be the only, say, Toyota dealership in the area.
- dahfizz 7y ago
  Ah, that makes more sense. Thank you!

monetus 7y ago

The market only provisions grocery stores after massive subsidization, centralization, and exploitative labor. Can you usually purchase cheap local produce for less than that offered by a conglomerate? I'm certain there are useful parallels between healthcare and the grocery market, but I feel like you left them out of your comment. Take bananas for instance: ubiquitous, constantly in demand, sold mostly by two companies, and widely produced by slave labor. Disclaimer: I'm in favor of a preventative care system available to everyone, regardless of income.

dahfizz 7y ago
> Can you usually purchase cheap local produce for less than that offered by a conglomerate? You can never purchase local, small batch ____ than you can from large companies. That's why companies get large - they are more efficient the larger they get (to oversimplify). Your local farmer has much less land than factory farm, and he doesn't have the state of the art equipment to harvest or store his crops. He can't justify spending so much money on equipment when he runs such a small farm. There's also a good chance he uses "organic" as a selling feature, which means his yeild per area land is way lower than an efficient farm. He also has to work much harder to actually sell his crop. He doesn't have large commercial deals that put his product directly onto shelves at Aldi. He has to spend half his time driving all over the place to various farmers markets to try and get people to buy his stuff. You might think all of this is pedantic or obvious, but I think efficiency of food production is very important. Food production is a massive contributor to climate change and opting for methods than can save on land area and water usage can have big impacts.
- deleted 7y ago
  [deleted]

persistent 7y ago

You don't seem very familiar with our system of production, distribution, and consumption of food. The government is _very_ involved in all aspects of this. They intervene on the supply side to guarantee prices for commodities. They intervene on the demand side by directly subsidizing 10% of consumers. The federal government inspects all meat, fish, and poultry packed in this country. There is a USDA agent filing a market report every morning from every produce terminal in America. The government maintains a detailed database on soil conditions across the nation. The USDA alone has over 100000 employees. The government also funds a nationwide system of agricultural universities, extensions, and bureaus through the land grant program. I think if you want to pick some aspect of American life that is free of government involvement, you started in the wrong place.

erentz 7y ago

I had to go to the ER yesterday. I was taken to the closest ER. You bring up geographic monopolies without any irony and yet healthcare has huge and very obvious geographical monopolies. At the ER I was made to sign something on the way in in a state in which I couldn’t really tell what I was signing. I was given various drugs and sent through a CT scan. I had no idea what was going on. I certainly was in no position, with symptoms of a life threatening condition on top of being incapacitated to say “hey hold up, I think the Safeway has cheaper CT scans can you guys transfer me there!” Healthcare is entirely different from buying groceries. It does not and will never operate like a typical market for typical commodity items.

refurb 7y ago
Emergency medicine is a small fraction of all medicinal needs. A lot of medicinal procedures allow time for determining what the most cost effective offering is.
- lostlogin 7y ago
  But is the ideal system one with several hospitals per city, duplicating expensive resources or one big centre with centralised resources?

fzeroracer 7y ago

Or, you do the rational thing that many other nations have done and decide that healthcare is a human right, then stop playing hot potato with the ticking bomb of healthcare. America is the only one with this very unique problem and going further in the direction of a 'free market' won't work. Because healthcare can never be a free market. The insurers have an incentive to not give quality healthcare and give people the bare minimum while hiding details from customers and no amount of freedom would solve this. The end result is that you'd see something like ISP companies where they work together to enforce a regional monopoly and gouge people all the same.

SamReidHughes 7y ago
Veterinary services and dentistry aren't in the same situation though. And you can have both a public option alongside a free market.

rat87 7y ago

> How can someone look at healthcare, with its absolutely absurd outcomes, and not understand that it is precisely because of government interference that nothing makes any sense? Because they see how much of the mess is the markets fault. They also see how nearly every other first world country has a working system while spending less on healtchare. In some places its private non profits subsidized and regulated by the government, in some its the government providing insurance like in Canada, in some it's really socialistic and government employs most doctors like the NHS. In each case the system works much better then the US and the US system is rightly considered a bogeyman. I'm unaware of any place that works like you've described

jfnixon 7y ago
Please define "works much better." Thanks.

wefarrell 7y ago

Honest question - are there any successful healthcare systems that have more privatization than the US?