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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 iss

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...
- unishark 6y ago
  Personally I've never been told to pay up before receiving treatment at a hospital. Especially when I arrive there unconscious. And Herb Cohen would say once you've received the service, you're actually in a great negotiating position. People actually negotiate hospital bills all the time. Especially in those crazy stories you hear about. And you need a citation for your claim about when free markets do and don't work.
  - arcticbull 6y ago
    > Personally I've never been told to pay up before receiving treatment at a hospital. Of course you have. The first thing you did when you walked in was hand them your ID and coverage info. You think hospitals operate on the honor system? As a Canadian I've never been asked to pay up before or after receiving treatment [edit: at the point of care]. And before you jump into taxation, Canadians pay less per capita in taxes than Americans ($13K vs $14K), and that's before you factor in the $600 per month in private tax you directly (or indirectly via employer) have to pay your insurers. > Especially when I arrive there unconscious. You either have insurance or you're driven into Chapter 11. Further I suspect this is not due to good will but rather government intervention. > And Herb Cohen would say once you've received the service, you're actually in a great negotiating position. The debt was incurred once the service was rendered, and you are now liable. 66.5% of all bankruptcies in the US are medical -- are they just bad negotiators? I'm not sure what point you're trying to make but it's not in good faith. > People actually negotiate hospital bills all the time. Especially in those crazy stories you hear about. That sounds the worst. > And you need a citation for your claim about when free markets do and don't work. Voluntary contractual exchange is one of the undisputed key pillars to a free market economy. If you're being told you will die without the service it is a coercive exchange and therefore violates one of the key tenets. [1] If I hold a gun to your head and tell you to buy my oranges for $1000 or I kill you, is the free market price of oranges $1000? If I tell you that you have cancer and you'll die unless you get $48,000 worth of chemotherapy, is that a free market? [2] A free market requires both the voluntary production and voluntary consumption of services. [1] https://en.wikipedia.org/wiki/Free_market https://en.wikipedia.org/wiki/Free_market [2] https://www.asbestos.com/featured-stories/high-cost-of-cancer-treatment https://www.asbestos.com/featured-stories/high-cost-of-cance...
    - winston_smith 6y ago
      As a Canadian you pay up every time you pay taxes, and you don't negotiate because you take what the government gives you. If they say your orthopedic surgery happens in six months, then that's what you get, or you start shopping south of the border.
      - arcticbull 6y ago
        Re taxes: I explicitly addressed that. The government negotiates with the drug companies and sets pricing for an efficiently functional health system. I don't have to and shouldn't have to negotiate. The system costs half per capita to operate and covers everyone. Re: waiting times, take it from the horses' mouth, you've been fed a crock [1]. Of course the system could be better, but on the whole you're just wrong. The insurance lobby has spent a lot of time, money and effort to convince you of that. The data backs that up. A small handful of Canadians go to the US to "shop for orthopedic surgery" out of millions of visits per year in Canada. After all a hip replacement in America costs one hundred thousand dollars. Just how many Canadians do you think there are with a spare $100K USD ($128,500 CAD) kicking around in the old piggy bank for a new hip that'd be free in a few months? [2] If you see 50-60,000 ish numbers they tend to be the 'snowbirds' - Canadians living in Florida for half the year who choose to seek care close to their winter homes. These are folks wealthy enough to have winter homes, and also maintain private insurance. [1] https://www.npr.org/2020/06/27/884307565/after-pushing-lies-former-cigna-executive-praises-canadas-health-care-system https://www.npr.org/2020/06/27/884307565/after-pushing-lies-... [2] https://www.vox.com/2016/10/9/13222798/canadians-seeking-medical-care-us-trump-debate https://www.vox.com/2016/10/9/13222798/canadians-seeking-med...
    - unishark 6y ago
      > You either have insurance or you're driven into Chapter 11. Further I suspect this is not due to good will but rather government intervention. You really are making a lot of bold assertions. If you declare bankruptcy, the hospital gets zero. Negotiation is a process by which both sides give something to meet in the middle. Yes they do it. https://www.cnbc.com/2020/10/28/you-can-negotiate-your-medical-bills-heres-how-to-lower-your-costs.html https://www.cnbc.com/2020/10/28/you-can-negotiate-your-medic...
  - amznthrwaway 6y ago
    If your argument was right, medical bankruptcies would not be a major problem in the United States. Folks would negotiate out without a hitch. However, they are a major problem, because you are absolutely fucking wrong. Please update your post to indicate that you were wrong, and to explain if you were wrong because you’re stupid, or if you knew you were wrong when you posted, but were hoping to trick people into supporting evil and sociopathic policies.
- winston_smith 6y ago
  Ironically the proposed solution is usually to put the government in charge, which is far larger and more violent than any private company.
  - arcticbull 6y ago
    Every medical insurance claim denied in bad faith is an assault if it leads to delay in care, and if it leads to death, is a murder. I suspect if you take that lens, you will see that the government insurance is not the violent one here. 45,000 people die each year in the US without care. Ending that would go a long way to reducing government violence. [1] [1] https://news.harvard.edu/gazette/story/2009/09/new-study-finds-45000-deaths-annually-linked-to-lack-of-health-coverage/ https://news.harvard.edu/gazette/story/2009/09/new-study-fin...
    - winston_smith 6y ago
      And if you define paper cuts as murder, then libraries are the real killers. Do you really want to put your insurance paperwork on the same level as innocents getting bombed?
      - arcticbull 6y ago
        If they're dead either way, then the same liability should exist. Does it really matter how?
      - 8note 6y ago
        Who's dying of paper cuts? It's easy to see who's dying of denied insurance
    - nradov 6y ago
      That's a non sequitur. Even single payer systems deny certain treatments or force patients to wait in order to control costs. Every healthcare system has some form of rationing.
      - 6y ago
- meheleventyone 6y ago
  It’s also a poverty of imagination that death is the worst thing that can happen. Further there is also a general societal argument that we all benefit more from having a more healthy population than dealing with the external costs of a less healthy one.
- conanbatt 6y ago
  Why doesn't the pay-up-or die model apply to food or shelter?
  - three14 6y ago
    If you found yourself in a situation where getting food or shelter now was a matter of life and death, and you effectively had only one supplier, it would. But you usually have time to find alternatives, and usually can skip the shelter altogether, and the markets are so large that it's usually hard for a supplier to form a monopoly or a few to form oligopoly. On top of that, even "pay-up-or-die" doesn't mean that the price will be a billion dollars. Instead, it means that it's the price that maximizes total profits. Suppose that no one could ever pay more than $30,000 for the medical helicopter. Then the helicopter people would set a price that prompts people to pay as close to $30,000 as they can. Perhaps if patients see a bill for $50,000 they negotiate down to $30,000, but if they see $500,000, they go to court and only at the end pay $30,000. Similar dynamics can limit food prices in areas that really only have one food supplier - there's only so much you can charge, and if you charge more than that, you won't succeed in squeezing more out of them, but you may attract all kinds of trouble - violence, or legislation, or competitors, etc.
    - conanbatt 6y ago
      So you think that farmers sell corn at the prices because they fear they will get robbed or plundered otherwise, but hospitals fear no plunder?
      - three14 6y ago
        No. I think I covered that with "the markets are so large that it's usually hard for a supplier to form a monopoly or a few to form oligopoly."
        conanbatt 6y ago
        Healthcare market is really big as well. Why is it easy to build a monopoly there?
whiddershins 6y ago
The thing is, government intervention is probably the biggest way the wolves take over. They distort the market to their benefit using governmental force (aka. regulation)
- Brian_K_White 6y ago
  I can't imagine why I am so unmoved by this tale of woe of the horrible government intervention.
- arcticbull 6y ago
  This article may change your mind [1]. It's an NPR interview with Cigna's former head of corporate comms, an executive in charge of pushing lies about socialized medicine. He has since come to terms with what he'd done and is working to undo the harm he has caused to the American people. "Canada has done a better job [re: COVID], I think, because of having the kind of health care system you have in making sure that everyone who needs to be treated is treated. And so that was what prompted that. And I felt that to provide some context, I needed to describe what I used to do for a living to try to scare people away from the Canadian health care system because insurance companies fear that. They know that if the U.S. moves to a system like that, it would certainly put a real crimp in their profits." "Our industry PR and lobbying group, AHIP, supplied my colleagues and me with cherry-picked data and anecdotes to make people think Canadians wait endlessly for their care. It's a lie. And I'll always regret the disservice I did to folks on both sides of the border." [1] https://www.npr.org/2020/06/27/884307565/after-pushing-lies-former-cigna-executive-praises-canadas-health-care-system https://www.npr.org/2020/06/27/884307565/after-pushing-lies-...
- deleted 6y ago
  [deleted]
- ineedasername 6y ago
  Who are wolves, the government? If so, I'd be open to suggestions on how the problems can be solved some other way. There's not much regulation related to healthcare pricing at the moment, and between bankruptcies related to medical debt & lack of coverage leading to preventable illness or death, it seems like the wolves are already in control of the system.
tomc1985 6y ago
> This issue isn't that people are trying to maximize profit leading to issues. This is exactly the issue. You cannot seriously think that the trainwreck that is US healthcare is what it is solely because of government intereference? Would Cigna fund and run the tiny little community clinics that serve with sliding-scale pricing? Would Kaiser willingly insure students with preexisting conditions at a fair price? (I know that in my case, they wouldn't) What "free market" incentive is there for these insurance companies to cover people that would clearly cost them more money than they receive? Those people need help and sickness/viruses do not have any concept of money, and they effect people indiscriminately. You are promoting a healthcare system for the wealthy and privileged, which is exactly what we have right now and what needs to be torn down.

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...

unishark 6y ago
Personally I've never been told to pay up before receiving treatment at a hospital. Especially when I arrive there unconscious. And Herb Cohen would say once you've received the service, you're actually in a great negotiating position. People actually negotiate hospital bills all the time. Especially in those crazy stories you hear about. And you need a citation for your claim about when free markets do and don't work.
- arcticbull 6y ago
  > Personally I've never been told to pay up before receiving treatment at a hospital. Of course you have. The first thing you did when you walked in was hand them your ID and coverage info. You think hospitals operate on the honor system? As a Canadian I've never been asked to pay up before or after receiving treatment [edit: at the point of care]. And before you jump into taxation, Canadians pay less per capita in taxes than Americans ($13K vs $14K), and that's before you factor in the $600 per month in private tax you directly (or indirectly via employer) have to pay your insurers. > Especially when I arrive there unconscious. You either have insurance or you're driven into Chapter 11. Further I suspect this is not due to good will but rather government intervention. > And Herb Cohen would say once you've received the service, you're actually in a great negotiating position. The debt was incurred once the service was rendered, and you are now liable. 66.5% of all bankruptcies in the US are medical -- are they just bad negotiators? I'm not sure what point you're trying to make but it's not in good faith. > People actually negotiate hospital bills all the time. Especially in those crazy stories you hear about. That sounds the worst. > And you need a citation for your claim about when free markets do and don't work. Voluntary contractual exchange is one of the undisputed key pillars to a free market economy. If you're being told you will die without the service it is a coercive exchange and therefore violates one of the key tenets. [1] If I hold a gun to your head and tell you to buy my oranges for $1000 or I kill you, is the free market price of oranges $1000? If I tell you that you have cancer and you'll die unless you get $48,000 worth of chemotherapy, is that a free market? [2] A free market requires both the voluntary production and voluntary consumption of services. [1] https://en.wikipedia.org/wiki/Free_market https://en.wikipedia.org/wiki/Free_market [2] https://www.asbestos.com/featured-stories/high-cost-of-cancer-treatment https://www.asbestos.com/featured-stories/high-cost-of-cance...
  - winston_smith 6y ago
    As a Canadian you pay up every time you pay taxes, and you don't negotiate because you take what the government gives you. If they say your orthopedic surgery happens in six months, then that's what you get, or you start shopping south of the border.
    - arcticbull 6y ago
      Re taxes: I explicitly addressed that. The government negotiates with the drug companies and sets pricing for an efficiently functional health system. I don't have to and shouldn't have to negotiate. The system costs half per capita to operate and covers everyone. Re: waiting times, take it from the horses' mouth, you've been fed a crock [1]. Of course the system could be better, but on the whole you're just wrong. The insurance lobby has spent a lot of time, money and effort to convince you of that. The data backs that up. A small handful of Canadians go to the US to "shop for orthopedic surgery" out of millions of visits per year in Canada. After all a hip replacement in America costs one hundred thousand dollars. Just how many Canadians do you think there are with a spare $100K USD ($128,500 CAD) kicking around in the old piggy bank for a new hip that'd be free in a few months? [2] If you see 50-60,000 ish numbers they tend to be the 'snowbirds' - Canadians living in Florida for half the year who choose to seek care close to their winter homes. These are folks wealthy enough to have winter homes, and also maintain private insurance. [1] https://www.npr.org/2020/06/27/884307565/after-pushing-lies-former-cigna-executive-praises-canadas-health-care-system https://www.npr.org/2020/06/27/884307565/after-pushing-lies-... [2] https://www.vox.com/2016/10/9/13222798/canadians-seeking-medical-care-us-trump-debate https://www.vox.com/2016/10/9/13222798/canadians-seeking-med...
  - unishark 6y ago
    > You either have insurance or you're driven into Chapter 11. Further I suspect this is not due to good will but rather government intervention. You really are making a lot of bold assertions. If you declare bankruptcy, the hospital gets zero. Negotiation is a process by which both sides give something to meet in the middle. Yes they do it. https://www.cnbc.com/2020/10/28/you-can-negotiate-your-medical-bills-heres-how-to-lower-your-costs.html https://www.cnbc.com/2020/10/28/you-can-negotiate-your-medic...
- amznthrwaway 6y ago
  If your argument was right, medical bankruptcies would not be a major problem in the United States. Folks would negotiate out without a hitch. However, they are a major problem, because you are absolutely fucking wrong. Please update your post to indicate that you were wrong, and to explain if you were wrong because you’re stupid, or if you knew you were wrong when you posted, but were hoping to trick people into supporting evil and sociopathic policies.
winston_smith 6y ago
Ironically the proposed solution is usually to put the government in charge, which is far larger and more violent than any private company.
- arcticbull 6y ago
  Every medical insurance claim denied in bad faith is an assault if it leads to delay in care, and if it leads to death, is a murder. I suspect if you take that lens, you will see that the government insurance is not the violent one here. 45,000 people die each year in the US without care. Ending that would go a long way to reducing government violence. [1] [1] https://news.harvard.edu/gazette/story/2009/09/new-study-finds-45000-deaths-annually-linked-to-lack-of-health-coverage/ https://news.harvard.edu/gazette/story/2009/09/new-study-fin...
  - winston_smith 6y ago
    And if you define paper cuts as murder, then libraries are the real killers. Do you really want to put your insurance paperwork on the same level as innocents getting bombed?
    - arcticbull 6y ago
      If they're dead either way, then the same liability should exist. Does it really matter how?
    - 8note 6y ago
      Who's dying of paper cuts? It's easy to see who's dying of denied insurance
  - nradov 6y ago
    That's a non sequitur. Even single payer systems deny certain treatments or force patients to wait in order to control costs. Every healthcare system has some form of rationing.
    - 6y ago
meheleventyone 6y ago
It’s also a poverty of imagination that death is the worst thing that can happen. Further there is also a general societal argument that we all benefit more from having a more healthy population than dealing with the external costs of a less healthy one.
conanbatt 6y ago
Why doesn't the pay-up-or die model apply to food or shelter?
- three14 6y ago
  If you found yourself in a situation where getting food or shelter now was a matter of life and death, and you effectively had only one supplier, it would. But you usually have time to find alternatives, and usually can skip the shelter altogether, and the markets are so large that it's usually hard for a supplier to form a monopoly or a few to form oligopoly. On top of that, even "pay-up-or-die" doesn't mean that the price will be a billion dollars. Instead, it means that it's the price that maximizes total profits. Suppose that no one could ever pay more than $30,000 for the medical helicopter. Then the helicopter people would set a price that prompts people to pay as close to $30,000 as they can. Perhaps if patients see a bill for $50,000 they negotiate down to $30,000, but if they see $500,000, they go to court and only at the end pay $30,000. Similar dynamics can limit food prices in areas that really only have one food supplier - there's only so much you can charge, and if you charge more than that, you won't succeed in squeezing more out of them, but you may attract all kinds of trouble - violence, or legislation, or competitors, etc.
  - conanbatt 6y ago
    So you think that farmers sell corn at the prices because they fear they will get robbed or plundered otherwise, but hospitals fear no plunder?
    - three14 6y ago
      No. I think I covered that with "the markets are so large that it's usually hard for a supplier to form a monopoly or a few to form oligopoly."
      - conanbatt 6y ago
        Healthcare market is really big as well. Why is it easy to build a monopoly there?

whiddershins 6y ago

The thing is, government intervention is probably the biggest way the wolves take over. They distort the market to their benefit using governmental force (aka. regulation)

Brian_K_White 6y ago
I can't imagine why I am so unmoved by this tale of woe of the horrible government intervention.
arcticbull 6y ago
This article may change your mind [1]. It's an NPR interview with Cigna's former head of corporate comms, an executive in charge of pushing lies about socialized medicine. He has since come to terms with what he'd done and is working to undo the harm he has caused to the American people. "Canada has done a better job [re: COVID], I think, because of having the kind of health care system you have in making sure that everyone who needs to be treated is treated. And so that was what prompted that. And I felt that to provide some context, I needed to describe what I used to do for a living to try to scare people away from the Canadian health care system because insurance companies fear that. They know that if the U.S. moves to a system like that, it would certainly put a real crimp in their profits." "Our industry PR and lobbying group, AHIP, supplied my colleagues and me with cherry-picked data and anecdotes to make people think Canadians wait endlessly for their care. It's a lie. And I'll always regret the disservice I did to folks on both sides of the border." [1] https://www.npr.org/2020/06/27/884307565/after-pushing-lies-former-cigna-executive-praises-canadas-health-care-system https://www.npr.org/2020/06/27/884307565/after-pushing-lies-...
deleted 6y ago
[deleted]
ineedasername 6y ago
Who are wolves, the government? If so, I'd be open to suggestions on how the problems can be solved some other way. There's not much regulation related to healthcare pricing at the moment, and between bankruptcies related to medical debt & lack of coverage leading to preventable illness or death, it seems like the wolves are already in control of the system.

tomc1985 6y ago

> This issue isn't that people are trying to maximize profit leading to issues. This is exactly the issue. You cannot seriously think that the trainwreck that is US healthcare is what it is solely because of government intereference? Would Cigna fund and run the tiny little community clinics that serve with sliding-scale pricing? Would Kaiser willingly insure students with preexisting conditions at a fair price? (I know that in my case, they wouldn't) What "free market" incentive is there for these insurance companies to cover people that would clearly cost them more money than they receive? Those people need help and sickness/viruses do not have any concept of money, and they effect people indiscriminately. You are promoting a healthcare system for the wealthy and privileged, which is exactly what we have right now and what needs to be torn down.