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> has turned me from a pure free market thinking into a believer in single payer healthcare The current trend in 'free-market economics' is to call captured ma

by iaw 6y ago

> has turned me from a pure free market thinking into a believer in single payer healthcare The current trend in 'free-market economics' is to call captured markets free and then argue for the relatively lax regulation. Most markets are not free markets and the healthcare definitely isn't. There's very little true choice, participants are typically under duress when seeking expensive services, and prices are hidden. If there was ala-carte transparent pricing and no insurer lockouts things may be a bit better. My suspicion is that Private Equity has been funneled in healthcare for two decades intentionally distorting the market behaviors for increased profitability which is why the US has such excessive healthcare costs without any apparent justification.

annexrichmond 6y ago
> and prices are hidden I believe the Trump administration is addressing this: https://www.hhs.gov/about/news/2019/11/15/trump-administration-announces-historic-price-transparency-and-lower-healthcare-costs-for-all-americans.html https://www.hhs.gov/about/news/2019/11/15/trump-administrati... https://www.hhs.gov/about/news/2020/10/29/trump-administration-finalizes-rule-requiring-health-insurers-disclose-price-and-cost-sharing.html https://www.hhs.gov/about/news/2020/10/29/trump-administrati... > The rule requires that most health plans and health insurers not only provide easy-to-understand personalized information on enrollee cost-sharing for healthcare services, but must also publicly disclose the rates they actually pay healthcare providers for specific services. > Through a shopping tool available through their plan or insurance company, consumers will be able to see the negotiated rate between their doctor and their plan or insurer, as well as the most accurate out-of-pocket cost estimate possible based on their health plan for procedures, drugs, durable medical equipment, and any other item or service they may need. > Consumers will also have access to accurate price and plan information that allows them to shop and compare costs between individual doctors before receiving care, so they can choose a healthcare provider that offers the most value and best suits their medical needs. But it'll be another couple years before it's all implemented it seems
- zbrozek 6y ago
  We still need up-front transparency on what codes will be billed to whom, from whom, and for how much. I want a comprehensible restaurant-like menu. And we need to break up regional monopolies so that there's actually a choice of provider. Further, agreements to pay whatever, whenever, before any diagnosis need to be banned as contracts under duress. If we want the free market approach to work, we need to make it possible, easy even, to make informed decisions among competitors. But fixing this is increasingly feeling intractable, and this pushes me further and further towards believing a single-payer (maybe not exactly, but that's the buzzword) system is the better fix.
  - Karunamon 6y ago
    I want a comprehensible restaurant-like menu. Likely not going to happen purely out of complexity if nothing else. Look at the list of ICD procedure codes[1] and imagine all of these with a price attached. Comprehensive, sure, but comprehensible? Ehhh.. pushing it. [1]: https://www.icd10data.com/ICD10PCS/Codes https://www.icd10data.com/ICD10PCS/Codes
    - cogman10 6y ago
      Yup! And what will you do about it anyways? Like "Oh, you need xyz, it will cost $1000" Ok. Now that I know that, what am I supposed to do? Shop around? What if I'm in the emergency room, what then? Are they supposed to give me a price menu for every single drug or treatment they need to perform against me? "Hey, we'll do CPR, but that'll will be $100, please sign here so we can save your life". The ala cart method seems like it might work until you start thinking about the logistics. If someone goes to a doctor complaining about chest pain, do we really want them to leave because an EKG and blood test are going to cost $200. No matter how much the doctor explains to them "You might be dying" plenty of people will walk out of the hospital once the bill is presented. In some of those situations, that's going to be deadly.
      - newen 6y ago
        For some perspective, I’m pretty sure there are a lot of non-Americans reading this thread amazed at just how comical current US thinking around healthcare has become.
ashtonkem 6y ago
Price transparency would help, but it wouldn’t solve the duress problem. After a car crash we all want to go to the nearest hospital rather than the most price efficient one.
- calvinmorrison 6y ago
  That's probably true but a lot of medical cost is scheduled like follow up or specialist visits, surgery and things of the less urgent nature.
  - thowawayyy 6y ago
    How is that solving the car crash situation?
    - octopoc 6y ago
      It's not, but if 50% of your business cares about prices and 50% doesn't, that's still a lot of pressure to have competitive prices.
      - t-writescode 6y ago
        It sounds like this conversation needs a usage breakdown to see where most bills come from from a total price experienced perspective. It seems like most people's greatest fear around hospitals is a surprise ER visit that blows through their savings.
    - mindslight 6y ago
      The same way you don't get super gouged when choosing a restaurant while hangry - non-urgent shoppers keep prices down across the board, even for urgent participants. I'm not saying this makes for some total solution - just reacting to rejection of the market dynamic having any worth. It's foolish to cast aside entire paradigms of approaches because they don't fully solve every corner case. (The dual would be to ask how single payer healthcare solves purely elective procedures like cosmetic surgery. It doesn't.) Obviously any market dynamic for urgent care needs to recognize that no contract has been formed, and so hospitals can't unilaterally set charges under a fallacious idea of contract. For instance when your car gets towed under duress (accident on the highway, expired papers, etc), the state sets the rates they're allowed to charge. They're still inflated, but at least within a factor of 2-3x the usual market. (FWIW I think single payer is a good pragmatic way forward)
harperlee 6y ago
> Private Equity has been funneled in healthcare for two decades intentionally distorting the market behaviors for increased profitability But that is precisely a market effect of PE being able to do this due to lack of effective regulation, isnt it?
- mikem170 6y ago
  Ok, there could be multiple problems. One problem with health care in the U.S. is that prices are hidden from the customers. That interferes with a free market. Tax regulations incentivized tying health care to employment and Obamacare making it difficult to get catastrophic care both interfere with a free market, etc. Another set of problems, as you describe, is the ability for private equity funds to collude and impeded free markets. Especially lobbyists getting laws passed in their favor, medical associations limiting the supply of doctors, doctors incentivized to prescribe opioids, etc. The original post in this thread referred to our current health care system as a free market, and that is not accurate. That's probably just as wrong as saying that we currently have socialized medicine, and its not working. I would say that our current health care system is a not a free market and is not socialized, it is broken mix of the two. It won't be reformed any time soon because millions of insurance industry jobs would need to be eliminated to save any money. Good luck with that.
kstrauser 6y ago
I've that this before, but I like my markets free as in GPL, not free as in BSD. That is, I want the markets themselves to be free, even if that means that participants in the market have limitations put on them to keep them from capturing the market, forming monopolies, etc.
- gregario 6y ago
  It's the regulations / limitations you are proposing that make it possible/likely that a monopoly will form. See Milton Friedman on this. There's basically no example of a monopoly forming outside of government regulation.
  - lvs 6y ago
    That is a completely bizarre claim. What is Google? A highly regulated search monopoly? I think not.
    - curtainsforus 6y ago
      DMCA
      - Brian_K_White 6y ago
        DMCA? Let's see... Does this example of a bad government regulation come from the government? Or the people voting and demanding it from the government? No, it comes from business. DMCA is an example of the badness of private business if allowed to do what it wants. That was a purchased law. The failure on the governments part was in allowing itself to be for sale. So you are right, even though I bet this is just about the opposite of the conclusion you thought citing the DMCA resolves out to, we should definitely stop allowing the government to be influenced by the private sector.
        curtainsforus 6y ago
        Look, it's government power behind it. I don't fundamentally care how it's gotten rid of as long as it is. Weaken businesses, weaken the government, weaken the links between the two, whichever way is fastest/most effective- in principle. I just don't particularly trust your prescription, as you don't mine. This situation is, of course, exactly as the government-business complex wills it.
deleted 6y ago
[deleted]
phkahler 6y ago
>> If there was ala-carte transparent pricing and no insurer lockouts things may be a bit better. Posted prices, and provider always charges that price weather its paid by insurance or not. Then insurance companies can compete on how much they cover at what premiums.
- vkou 6y ago
  That leaves too much patient money on the table, and will lead to patients doing comparison shopping, which is not something the healthcare industry wants.
  - bpt3 6y ago
    You've described every service provider on Earth, and that's not a justification for them to avoid transparency in pricing or billing.
javajosh 6y ago
Yes, it should be "free markets...until the wolves take over the whole system". It's impressive how quickly those profit maximization ideas have caught on, driven by technology (I blame Excel more than anything), and throughout the entire system. The healthcare cash-cow benefits a LOT of people, workers, suppliers, and (especially) administrators at both hospitals and doctors offices. A poor healthcare system is a great way to create BS jobs, and have a de facto welfare system while not actually legislating for it. It is remarkable how quickly and completely the noble ideals of the professions (medicine and law) have totally fallen to the profit motive. Now, you are a fool if you show self-restraint, because no one will notice, and your unscrupulous competitors will eat your lunch. It's the kind of pervasive corruption that can only happen when literally everyone in the system, including the victims, have given up.
- npmaile 6y ago
  I think the argument you are responding to is not the one the previous user presented. This issue isn't that people are trying to maximize profit leading to issues. The problem is that there is undue government interference in the market leading to all of the negatives that come from people selfishly trying to maximize profit in a cynical way with none of the benefits of people trying to maximize profits by providing a product that people will prefer over the competition.
  - arcticbull 6y ago
    Free markets generally work better the less leverage one party has over another. When the negotiation is "pay up or die" then it's de facto not a free market [1] and the government has a responsibility to step in and address it. The minimum viable remediation is a two-tier system in which the government takes the "or die" out of the conversation. The best approach IMO is single-payer where the government takes the "pay up" part out too, as it allows the system to be globally optimized. At the end of the day health insurance isn't insurance, it's at best a structured payments plan. You buy insurance against things that may or may not happen. You will get sick and you will die. That's not insurance. [1] https://corporatefinanceinstitute.com/resources/knowledge/economics/free-market/ https://corporatefinanceinstitute.com/resources/knowledge/ec...
treeman79 6y ago
For actual free market, you would need to get ride of most regulations. Basically like going to the vet. Or dentist or cosmetic surgery. Fairly cheap, fine “most” of the time. Sometimes it’s not.
- mattnewton 6y ago
  Even then it would not be truly free because you would need to make decisions in a medical emergency with limited options. It would be like shopping for a dentist with an abscess that could kill you tomorrow.
  - AnthonyMouse 6y ago
    That would only apply to the 10% of medical costs spent on emergency care. It makes little sense to operate the other 90% based on requirements that don't exist in those cases. Emergency care is also inherently local. You could operate emergency rooms under the same framework as you do fire departments. Which doesn't require a national fire department to manufacture the fire extinguishers you buy for your house or repair the damage to your car a week after a car accident.
    - mattnewton 6y ago
      But also doesn't require fire insurance for someone to try pulling you out of a burning building. I think diseases that take longer but are still affecting your quality of life are just as important to consider, but also think they distort decision making and fail to work like a free market as a result. The "free market" has failed to provide affordable dental care outside large insurance policies, which are inaccessible to almost a quarter of americans, for example. https://www.coloniallife.com/employer-resource-center/2018/april/the-surprising-truth-about-dental-insurance https://www.coloniallife.com/employer-resource-center/2018/a...
      - AnthonyMouse 6y ago
        > But also doesn't require fire insurance for someone to try pulling you out of a burning building. Right, so your city should operate an emergency room funded mostly by taxpayers, and then just charge a fixed deductible (e.g. $1000) for emergency care, which isn't enough to induce bankruptcy in general but is enough to deter people from using it in place of primary care. > The "free market" has failed to provide affordable dental care outside large insurance policies, which are inaccessible to almost a quarter of americans, for example. Your link is to the promotional material of a dental insurance company. Dental isn't generally a market that requires insurance. You need health insurance because heart surgery or chemotherapy is a six figure expense that would bankrupt nearly everyone. Paying $1500 for dental work doesn't require insurance, it requires a payment plan. It isn't an expense large enough to require insuring against.
btilly 6y ago
My suspicion is that Private Equity has been funneled in healthcare for two decades intentionally distorting the market behaviors for increased profitability which is why the US has such excessive healthcare costs without any apparent justification. I do not believe that is the primary driver of costs, but it definitely does not help. For those who don't know what we're talking about, private equity looks for companies with stable revenue streams such that if you find days to make lots of cuts, the revenue stream will continue for a long time. They then strike an agreement with the current owner to buy the company by having the company take a large loan (actually issue bonds, but it comes to the same thing) to pay off the current owners. That's called a "leveraged buyout" (in finance debt is often called leverage). They then make those cuts and use the difference between revenue and costs to pay off the debt. They then try to juice up the corpse in various ways to find someone to sell the company to before the long-term impact of the cuts becomes obvious. This happens in any industry with stable revenue streams. And healthcare has exactly that characteristic. See https://ourfuture.org/20120913/sick-money-how-mitt-romneys-bain-investments-are-exploding-the-deficit-and-harming-our-health https://ourfuture.org/20120913/sick-money-how-mitt-romneys-b... for an article on this exact phenomena.
- jacobolus 6y ago
  Has anyone tried to figure out meaningful changes to to laws/regulations to make such private equity raiding unprofitable or attach financial/legal liability for the negative consequences to the people responsible? It has completely ruined hundreds of industries: driving out all of the experts, wrecking product quality, making companies unresponsive to customers, eliminating good jobs, ....
- ineedasername 6y ago
  For notable examples, Sears & Toys R Us make for interesting reading.
mbesto 6y ago
If they do actually exist - free markets only work when there is a clear distinction between the buyers and sellers of the good and services. This just doesn't exist in healthcare in the US. IMHO, healthcare should either be full retail or single payer - nothing in between. Even if you are a "free market advocate", the current system doesn't reward the customer (unless you rightfully deem Carrier's as the customers).
kristopolous 6y ago
In practice, "free market" as a historically implemented policy has meant "remove all oversight and revoke any protections or governing laws and thus legalize all business practices (such as scams, collusion, price fixing, market manipulations) regardless of ethics and hand the legislative pen to the business leaders to write their own laws. Ban all forms of community governance, municipal ownership, or a people doing something for their community without using a for profit private company middleman. Defund and gut any form of a social safety net. Disallow people to challenge a company polluting their drinking water and shut down the agencies tasked to inspect it. Forbid places from passing clean air laws or having the power to say no to any predatory company that wants to come to town Allow companies to sue entire countries in secret tribunals if a country decides to not eviscerate their health and safety standards. Disallow countries from preferring local industry or keeping out vulture capital doing pump and dump schemes on their water and food supply. Protect these companies by international private militias that have an authority which overrides the country's own military. Enshrine this right in treaty law so no sovereign people can possibly override it or fight back without severe consequences. Embargo, tariff and boycott them if they don't join in. Permit companies to hide how their products are produced, lie about abusive and child labor and hide their profits in tax shelters without any consequences whatsoever. Allow banks to defraud customers with phony accounts, car companies to lie about emissions, energy companies to crash entire state economies, insiders to manipulate the libor rates, and create shell companies using tobashi schemes to hide losses and reverse tobashi schemes to hide profits, and then bail them out with public money when it doesn't work out. And finally destroy public education and replace it with whatever influence peddler with deep pockets wants to pass off as curriculum so that the public doesn't ever catch on to how much they're getting robbed." Then there's this slight of hand where the advocates talk about the theoretically heady version of free market and then do mental acrobatics to bridge the policy and theories together. It's a distraction so that all the effort to combat the chicanery is instead exhausted on debates and theory discussions so obtuse intellectualism instead of meaningful directed focussed political action occupies all the time of thought leaders. It's just coercion exploitation and oppression based on raw capital wrapped with the union busting techniques that keep the con game going without any consequences. It's a giant hustle to snatch and grab profit while turning our back on centuries of progress all under a fraudulent banner labeled "freedom". Even the right wingers on gab and parler are seeing this now. It's so clear. Such a scam.
conanbatt 6y ago
A handy guide to check if healthcare is a free market: 1) Can you buy medicine from whoever sells it cheapest? 2) Can you hire the healthcare provider you want? 3) Are you financially punished for choosing your own health insurance? 4) Can you opt-out of government health services? 5) Can you waiver or partially waiver your right to sue the medical professional in exchange for cheaper services?
- 8note 6y ago
  6) can you pay any odd person off the street to open you up and take out your appendix?
  - conanbatt 6y ago
    What a nice world that would be, wouldn't it.
- nickpp 6y ago
  Also don’t forget the supply side: Can you open a healthcare service? Hospital? Medicine factory? If you actually have the required knowledge, how fast can you get the certifications to work as a healthcare provider?
sershe 6y ago
The reason healthcare is not a free market in the US are not market's fault etc. The govt restricts supply, subsidizes demand directly, and also created the system where insurance is tied to work so the major consumers are completely price insensitive... that is why healthcare is expensive.
golergka 6y ago
> participants are typically under duress when seeking expensive services I'm not from US and don't have personal experience with american health system, but that would only be true if you start shopping for medical insurance when you already have broken your leg. If you behave as a responsible adult and choose a hospital to register to, or an insurance provider to take care of you, beforehand, how are you under any kind of duress?

by iaw 6y ago

annexrichmond 6y ago

> and prices are hidden I believe the Trump administration is addressing this: https://www.hhs.gov/about/news/2019/11/15/trump-administration-announces-historic-price-transparency-and-lower-healthcare-costs-for-all-americans.html https://www.hhs.gov/about/news/2019/11/15/trump-administrati... https://www.hhs.gov/about/news/2020/10/29/trump-administration-finalizes-rule-requiring-health-insurers-disclose-price-and-cost-sharing.html https://www.hhs.gov/about/news/2020/10/29/trump-administrati... > The rule requires that most health plans and health insurers not only provide easy-to-understand personalized information on enrollee cost-sharing for healthcare services, but must also publicly disclose the rates they actually pay healthcare providers for specific services. > Through a shopping tool available through their plan or insurance company, consumers will be able to see the negotiated rate between their doctor and their plan or insurer, as well as the most accurate out-of-pocket cost estimate possible based on their health plan for procedures, drugs, durable medical equipment, and any other item or service they may need. > Consumers will also have access to accurate price and plan information that allows them to shop and compare costs between individual doctors before receiving care, so they can choose a healthcare provider that offers the most value and best suits their medical needs. But it'll be another couple years before it's all implemented it seems

zbrozek 6y ago
We still need up-front transparency on what codes will be billed to whom, from whom, and for how much. I want a comprehensible restaurant-like menu. And we need to break up regional monopolies so that there's actually a choice of provider. Further, agreements to pay whatever, whenever, before any diagnosis need to be banned as contracts under duress. If we want the free market approach to work, we need to make it possible, easy even, to make informed decisions among competitors. But fixing this is increasingly feeling intractable, and this pushes me further and further towards believing a single-payer (maybe not exactly, but that's the buzzword) system is the better fix.
- Karunamon 6y ago
  I want a comprehensible restaurant-like menu. Likely not going to happen purely out of complexity if nothing else. Look at the list of ICD procedure codes[1] and imagine all of these with a price attached. Comprehensive, sure, but comprehensible? Ehhh.. pushing it. [1]: https://www.icd10data.com/ICD10PCS/Codes https://www.icd10data.com/ICD10PCS/Codes
  - cogman10 6y ago
    Yup! And what will you do about it anyways? Like "Oh, you need xyz, it will cost $1000" Ok. Now that I know that, what am I supposed to do? Shop around? What if I'm in the emergency room, what then? Are they supposed to give me a price menu for every single drug or treatment they need to perform against me? "Hey, we'll do CPR, but that'll will be $100, please sign here so we can save your life". The ala cart method seems like it might work until you start thinking about the logistics. If someone goes to a doctor complaining about chest pain, do we really want them to leave because an EKG and blood test are going to cost $200. No matter how much the doctor explains to them "You might be dying" plenty of people will walk out of the hospital once the bill is presented. In some of those situations, that's going to be deadly.
    - newen 6y ago
      For some perspective, I’m pretty sure there are a lot of non-Americans reading this thread amazed at just how comical current US thinking around healthcare has become.

ashtonkem 6y ago

Price transparency would help, but it wouldn’t solve the duress problem. After a car crash we all want to go to the nearest hospital rather than the most price efficient one.

calvinmorrison 6y ago
That's probably true but a lot of medical cost is scheduled like follow up or specialist visits, surgery and things of the less urgent nature.
- thowawayyy 6y ago
  How is that solving the car crash situation?
  - octopoc 6y ago
    It's not, but if 50% of your business cares about prices and 50% doesn't, that's still a lot of pressure to have competitive prices.
    - t-writescode 6y ago
      It sounds like this conversation needs a usage breakdown to see where most bills come from from a total price experienced perspective. It seems like most people's greatest fear around hospitals is a surprise ER visit that blows through their savings.
  - mindslight 6y ago
    The same way you don't get super gouged when choosing a restaurant while hangry - non-urgent shoppers keep prices down across the board, even for urgent participants. I'm not saying this makes for some total solution - just reacting to rejection of the market dynamic having any worth. It's foolish to cast aside entire paradigms of approaches because they don't fully solve every corner case. (The dual would be to ask how single payer healthcare solves purely elective procedures like cosmetic surgery. It doesn't.) Obviously any market dynamic for urgent care needs to recognize that no contract has been formed, and so hospitals can't unilaterally set charges under a fallacious idea of contract. For instance when your car gets towed under duress (accident on the highway, expired papers, etc), the state sets the rates they're allowed to charge. They're still inflated, but at least within a factor of 2-3x the usual market. (FWIW I think single payer is a good pragmatic way forward)

harperlee 6y ago

> Private Equity has been funneled in healthcare for two decades intentionally distorting the market behaviors for increased profitability But that is precisely a market effect of PE being able to do this due to lack of effective regulation, isnt it?

mikem170 6y ago
Ok, there could be multiple problems. One problem with health care in the U.S. is that prices are hidden from the customers. That interferes with a free market. Tax regulations incentivized tying health care to employment and Obamacare making it difficult to get catastrophic care both interfere with a free market, etc. Another set of problems, as you describe, is the ability for private equity funds to collude and impeded free markets. Especially lobbyists getting laws passed in their favor, medical associations limiting the supply of doctors, doctors incentivized to prescribe opioids, etc. The original post in this thread referred to our current health care system as a free market, and that is not accurate. That's probably just as wrong as saying that we currently have socialized medicine, and its not working. I would say that our current health care system is a not a free market and is not socialized, it is broken mix of the two. It won't be reformed any time soon because millions of insurance industry jobs would need to be eliminated to save any money. Good luck with that.

kstrauser 6y ago

I've that this before, but I like my markets free as in GPL, not free as in BSD. That is, I want the markets themselves to be free, even if that means that participants in the market have limitations put on them to keep them from capturing the market, forming monopolies, etc.

gregario 6y ago
It's the regulations / limitations you are proposing that make it possible/likely that a monopoly will form. See Milton Friedman on this. There's basically no example of a monopoly forming outside of government regulation.
- lvs 6y ago
  That is a completely bizarre claim. What is Google? A highly regulated search monopoly? I think not.
  - curtainsforus 6y ago
    DMCA
    - Brian_K_White 6y ago
      DMCA? Let's see... Does this example of a bad government regulation come from the government? Or the people voting and demanding it from the government? No, it comes from business. DMCA is an example of the badness of private business if allowed to do what it wants. That was a purchased law. The failure on the governments part was in allowing itself to be for sale. So you are right, even though I bet this is just about the opposite of the conclusion you thought citing the DMCA resolves out to, we should definitely stop allowing the government to be influenced by the private sector.
      - curtainsforus 6y ago
        Look, it's government power behind it. I don't fundamentally care how it's gotten rid of as long as it is. Weaken businesses, weaken the government, weaken the links between the two, whichever way is fastest/most effective- in principle. I just don't particularly trust your prescription, as you don't mine. This situation is, of course, exactly as the government-business complex wills it.

deleted 6y ago

[deleted]

phkahler 6y ago

>> If there was ala-carte transparent pricing and no insurer lockouts things may be a bit better. Posted prices, and provider always charges that price weather its paid by insurance or not. Then insurance companies can compete on how much they cover at what premiums.

vkou 6y ago
That leaves too much patient money on the table, and will lead to patients doing comparison shopping, which is not something the healthcare industry wants.
- bpt3 6y ago
  You've described every service provider on Earth, and that's not a justification for them to avoid transparency in pricing or billing.

javajosh 6y ago

Yes, it should be "free markets...until the wolves take over the whole system". It's impressive how quickly those profit maximization ideas have caught on, driven by technology (I blame Excel more than anything), and throughout the entire system. The healthcare cash-cow benefits a LOT of people, workers, suppliers, and (especially) administrators at both hospitals and doctors offices. A poor healthcare system is a great way to create BS jobs, and have a de facto welfare system while not actually legislating for it. It is remarkable how quickly and completely the noble ideals of the professions (medicine and law) have totally fallen to the profit motive. Now, you are a fool if you show self-restraint, because no one will notice, and your unscrupulous competitors will eat your lunch. It's the kind of pervasive corruption that can only happen when literally everyone in the system, including the victims, have given up.

npmaile 6y ago
I think the argument you are responding to is not the one the previous user presented. This issue isn't that people are trying to maximize profit leading to issues. The problem is that there is undue government interference in the market leading to all of the negatives that come from people selfishly trying to maximize profit in a cynical way with none of the benefits of people trying to maximize profits by providing a product that people will prefer over the competition.
- arcticbull 6y ago
  Free markets generally work better the less leverage one party has over another. When the negotiation is "pay up or die" then it's de facto not a free market [1] and the government has a responsibility to step in and address it. The minimum viable remediation is a two-tier system in which the government takes the "or die" out of the conversation. The best approach IMO is single-payer where the government takes the "pay up" part out too, as it allows the system to be globally optimized. At the end of the day health insurance isn't insurance, it's at best a structured payments plan. You buy insurance against things that may or may not happen. You will get sick and you will die. That's not insurance. [1] https://corporatefinanceinstitute.com/resources/knowledge/economics/free-market/ https://corporatefinanceinstitute.com/resources/knowledge/ec...

treeman79 6y ago

For actual free market, you would need to get ride of most regulations. Basically like going to the vet. Or dentist or cosmetic surgery. Fairly cheap, fine “most” of the time. Sometimes it’s not.

mattnewton 6y ago
Even then it would not be truly free because you would need to make decisions in a medical emergency with limited options. It would be like shopping for a dentist with an abscess that could kill you tomorrow.
- AnthonyMouse 6y ago
  That would only apply to the 10% of medical costs spent on emergency care. It makes little sense to operate the other 90% based on requirements that don't exist in those cases. Emergency care is also inherently local. You could operate emergency rooms under the same framework as you do fire departments. Which doesn't require a national fire department to manufacture the fire extinguishers you buy for your house or repair the damage to your car a week after a car accident.
  - mattnewton 6y ago
    But also doesn't require fire insurance for someone to try pulling you out of a burning building. I think diseases that take longer but are still affecting your quality of life are just as important to consider, but also think they distort decision making and fail to work like a free market as a result. The "free market" has failed to provide affordable dental care outside large insurance policies, which are inaccessible to almost a quarter of americans, for example. https://www.coloniallife.com/employer-resource-center/2018/april/the-surprising-truth-about-dental-insurance https://www.coloniallife.com/employer-resource-center/2018/a...
    - AnthonyMouse 6y ago
      > But also doesn't require fire insurance for someone to try pulling you out of a burning building. Right, so your city should operate an emergency room funded mostly by taxpayers, and then just charge a fixed deductible (e.g. $1000) for emergency care, which isn't enough to induce bankruptcy in general but is enough to deter people from using it in place of primary care. > The "free market" has failed to provide affordable dental care outside large insurance policies, which are inaccessible to almost a quarter of americans, for example. Your link is to the promotional material of a dental insurance company. Dental isn't generally a market that requires insurance. You need health insurance because heart surgery or chemotherapy is a six figure expense that would bankrupt nearly everyone. Paying $1500 for dental work doesn't require insurance, it requires a payment plan. It isn't an expense large enough to require insuring against.

btilly 6y ago

My suspicion is that Private Equity has been funneled in healthcare for two decades intentionally distorting the market behaviors for increased profitability which is why the US has such excessive healthcare costs without any apparent justification. I do not believe that is the primary driver of costs, but it definitely does not help. For those who don't know what we're talking about, private equity looks for companies with stable revenue streams such that if you find days to make lots of cuts, the revenue stream will continue for a long time. They then strike an agreement with the current owner to buy the company by having the company take a large loan (actually issue bonds, but it comes to the same thing) to pay off the current owners. That's called a "leveraged buyout" (in finance debt is often called leverage). They then make those cuts and use the difference between revenue and costs to pay off the debt. They then try to juice up the corpse in various ways to find someone to sell the company to before the long-term impact of the cuts becomes obvious. This happens in any industry with stable revenue streams. And healthcare has exactly that characteristic. See https://ourfuture.org/20120913/sick-money-how-mitt-romneys-bain-investments-are-exploding-the-deficit-and-harming-our-health https://ourfuture.org/20120913/sick-money-how-mitt-romneys-b... for an article on this exact phenomena.

jacobolus 6y ago
Has anyone tried to figure out meaningful changes to to laws/regulations to make such private equity raiding unprofitable or attach financial/legal liability for the negative consequences to the people responsible? It has completely ruined hundreds of industries: driving out all of the experts, wrecking product quality, making companies unresponsive to customers, eliminating good jobs, ....
ineedasername 6y ago
For notable examples, Sears & Toys R Us make for interesting reading.

mbesto 6y ago

If they do actually exist - free markets only work when there is a clear distinction between the buyers and sellers of the good and services. This just doesn't exist in healthcare in the US. IMHO, healthcare should either be full retail or single payer - nothing in between. Even if you are a "free market advocate", the current system doesn't reward the customer (unless you rightfully deem Carrier's as the customers).

kristopolous 6y ago

In practice, "free market" as a historically implemented policy has meant "remove all oversight and revoke any protections or governing laws and thus legalize all business practices (such as scams, collusion, price fixing, market manipulations) regardless of ethics and hand the legislative pen to the business leaders to write their own laws. Ban all forms of community governance, municipal ownership, or a people doing something for their community without using a for profit private company middleman. Defund and gut any form of a social safety net. Disallow people to challenge a company polluting their drinking water and shut down the agencies tasked to inspect it. Forbid places from passing clean air laws or having the power to say no to any predatory company that wants to come to town Allow companies to sue entire countries in secret tribunals if a country decides to not eviscerate their health and safety standards. Disallow countries from preferring local industry or keeping out vulture capital doing pump and dump schemes on their water and food supply. Protect these companies by international private militias that have an authority which overrides the country's own military. Enshrine this right in treaty law so no sovereign people can possibly override it or fight back without severe consequences. Embargo, tariff and boycott them if they don't join in. Permit companies to hide how their products are produced, lie about abusive and child labor and hide their profits in tax shelters without any consequences whatsoever. Allow banks to defraud customers with phony accounts, car companies to lie about emissions, energy companies to crash entire state economies, insiders to manipulate the libor rates, and create shell companies using tobashi schemes to hide losses and reverse tobashi schemes to hide profits, and then bail them out with public money when it doesn't work out. And finally destroy public education and replace it with whatever influence peddler with deep pockets wants to pass off as curriculum so that the public doesn't ever catch on to how much they're getting robbed." Then there's this slight of hand where the advocates talk about the theoretically heady version of free market and then do mental acrobatics to bridge the policy and theories together. It's a distraction so that all the effort to combat the chicanery is instead exhausted on debates and theory discussions so obtuse intellectualism instead of meaningful directed focussed political action occupies all the time of thought leaders. It's just coercion exploitation and oppression based on raw capital wrapped with the union busting techniques that keep the con game going without any consequences. It's a giant hustle to snatch and grab profit while turning our back on centuries of progress all under a fraudulent banner labeled "freedom". Even the right wingers on gab and parler are seeing this now. It's so clear. Such a scam.

conanbatt 6y ago

A handy guide to check if healthcare is a free market: 1) Can you buy medicine from whoever sells it cheapest? 2) Can you hire the healthcare provider you want? 3) Are you financially punished for choosing your own health insurance? 4) Can you opt-out of government health services? 5) Can you waiver or partially waiver your right to sue the medical professional in exchange for cheaper services?

8note 6y ago
6) can you pay any odd person off the street to open you up and take out your appendix?
- conanbatt 6y ago
  What a nice world that would be, wouldn't it.
nickpp 6y ago
Also don’t forget the supply side: Can you open a healthcare service? Hospital? Medicine factory? If you actually have the required knowledge, how fast can you get the certifications to work as a healthcare provider?

sershe 6y ago

The reason healthcare is not a free market in the US are not market's fault etc. The govt restricts supply, subsidizes demand directly, and also created the system where insurance is tied to work so the major consumers are completely price insensitive... that is why healthcare is expensive.

golergka 6y ago

> participants are typically under duress when seeking expensive services I'm not from US and don't have personal experience with american health system, but that would only be true if you start shopping for medical insurance when you already have broken your leg. If you behave as a responsible adult and choose a hospital to register to, or an insurance provider to take care of you, beforehand, how are you under any kind of duress?