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> My personal bias is wanting to fix healthcare by fixing its price signals, so this surprised me. The problem is that we're very far from market signals, and

> My personal bias is wanting to fix healthcare by fixing its price signals, so this surprised me. The problem is that we're very far from market signals, and "quality of the healthcare system" is not a monotonic function of market-orientation. If we were to go all the way to a fully market-oriented system, a lot of the obscene inefficiencies and horrors of the healthcare system would be addressed. There may even be people by whose chosen measure, our healthcare system functions better than it does today. But we'd have new horrors around access that we as a society have chosen not to accept, which means we're in this grotesque inefficient middle-ground where we have neither the advantages of a centralized system nor the advantages of a system where market signals aren't choked off at every turn. It's completely plausible that we're at the part of the curve where more centralization moves us up the U-shaped curve instead of down

mindslight 6y ago
I tried to word that as nonargumentatively as I could, as single payer does seem like the best concrete plan for moving forward despite it not being my preferred style. I just think there's a lot of low hanging fruit that would reform the system bottom up, such as stopping providers from making up fictitious bills and prosecuting the ones that attempt to defraud customers with them. Requiring providers to set uniform prices across all payers and publish their price list would go a long way. And even moving towards a "single payer" system, this dynamic is still going to exist for many kinds of care. If by "new horrors around access" you just mean the poor not being able to pay for care, I see that as orthogonal and have no problem with subsidies. Of course I acknowledge the realpolitik would be different.
- wutbrodo 6y ago
  I think you might be misreading my comment as advocacy of one solution vs another; it absolutely wasn't, and in fact my views are roughly the same as yours (I think that a more market-oriented system would cause far less suffering than the current system, but that single-payer is a lot more feasible and that either solution would be preferable to the grotesque status quo). Where we disagree is that I don't think minor market-friendly improvements to the system would get us, given the mountain of regulation and other govt involvement that already exists. My thesis is basically: I'd prefer a more fully market-oriented solution, with the access problem explicitly handled through subsidies et al. But if we're going to have a healthcare economy that's planned in much more detail, let's actually plan it instead of the current nightmarish hodgepodge of inconsistent and mutually counter-productive one-off gov't interventions.

mindslight 6y ago

I tried to word that as nonargumentatively as I could, as single payer does seem like the best concrete plan for moving forward despite it not being my preferred style. I just think there's a lot of low hanging fruit that would reform the system bottom up, such as stopping providers from making up fictitious bills and prosecuting the ones that attempt to defraud customers with them. Requiring providers to set uniform prices across all payers and publish their price list would go a long way. And even moving towards a "single payer" system, this dynamic is still going to exist for many kinds of care. If by "new horrors around access" you just mean the poor not being able to pay for care, I see that as orthogonal and have no problem with subsidies. Of course I acknowledge the realpolitik would be different.

wutbrodo 6y ago
I think you might be misreading my comment as advocacy of one solution vs another; it absolutely wasn't, and in fact my views are roughly the same as yours (I think that a more market-oriented system would cause far less suffering than the current system, but that single-payer is a lot more feasible and that either solution would be preferable to the grotesque status quo). Where we disagree is that I don't think minor market-friendly improvements to the system would get us, given the mountain of regulation and other govt involvement that already exists. My thesis is basically: I'd prefer a more fully market-oriented solution, with the access problem explicitly handled through subsidies et al. But if we're going to have a healthcare economy that's planned in much more detail, let's actually plan it instead of the current nightmarish hodgepodge of inconsistent and mutually counter-productive one-off gov't interventions.