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You are assuming that healthcare is a free market. There is tremendous regulation, encouraged by incumbants, to keep away the competition. You should look at h

You are assuming that healthcare is a free market. There is tremendous regulation, encouraged by incumbants, to keep away the competition. You should look at historical healthcare expenditure by the US. The problem isn't providing healthcare for all... it is the method and the cost. Universal payer is one way. It is not the best way and in fact Medicare is one reason costs are currently high. It is a bit like a car that used to get 30MPG and now gets 15MPG, and getting worse, and the solution being offered is for all of us to collectively chip in and buy gas for those who can't -- which is not tenable in the longterm because you're spending more and more of the GDP on transportation. There are other ways of giving everyone coverage. One scheme, would be giving people money. Enough to cover average cost of healthcare plans and say education plans. The individual is then responsible for their own healthcare and has the funds to purchase health insurance. Then you have a healthy market and have mechanisms for the costs to come down.

luma 6y ago
A free market involves a customer that has the option to simply not buy what is on offer. Healthcare can never be a free market in this sense, because the customer is faced with a choice of "buy service and/or product" or "be dead". That is entirely unlike the choice involved in buying something like a refrigerator and seriously skews the applicability of traditional free market thinking to the problem.
- bravo22 6y ago
  That's not entirely accurate and that's not even the meaning of free market. Water is also a necessity as is food and you can have a free market for those. The questions are: 1. Does the buyer have enough choices or alternatives to choose from when it comes to healthcare? 2. Do those who offer services have a monopoly on the service? When you look at the US market you'll find that it doesn't meet those criterias. Market forces are prevented from acting and being able to reduce costs. The fact that there is a captive audience, as you suggest, means that we cannot just shovel money into it. You end up exactly where you are. Costs go up because it is a necessity. Same reason food prices go up when there is a shortage. It is not a luxury.
  - mizay7 6y ago
    I think you are making a more articulate defense of private/market based health care than i usually hear. but i think fundamentally health care has too many forces that make it untenable for a market. there is no real satiation point in care, people are price inelastic, many services cannot be priced before delivery, there is little opportunity to do repeated business for most of the costliest services, comparison between providers is very difficult, most of the choice happens under incredible duress when you are your weakest point. health care is just not a consumer good that responds well to market mechanisms.
    - bravo22 6y ago
      I suppose it all depends on how you define market mechanisms. What I've found -- after personally studying the subject -- is what a lot of people consider free market is the opposite of what the literature considers it to be. To answer your point: Most/all of the issues you raised are met by "pooling" aka insurance. The need arises at random and when it does there is a massive cost and you urgently need the service. This is what insurance is for. What I was suggesting isn't that people go and pay the doctor out of pocket -- although they can. Rather that they purchase insurance. Those who can't get $$ indexed to some national average or whatever scheme you prefer. The point is everyone gets to purchase insurance if they so prefer. The problem is that choice of insurance providers is artifically limited right now and the choice of healthcare providers is as well. So you have a system where you are captive to the need and those who provide the service have a monpoly. Naturally costs will rise. Putting political preassure on government to increase spending is easy way out but that will only shovel more money from the pockets of the many into the pockets of the few. In fact this was predicted when Medicare was first introduced, and here we are. It is not like doctors and providers magically became greedy capitalists in the last 40 years. Also to be very clear this isn't an issue of "profits". Insurance companies don't have huge profit margins. They make their "wealth" by being a monopoly. The execs make their money on the rise in stock prices which isn't sensitive to their 3-5% profit margin.
      - mizay7 6y ago
        so you are arguing that many small insurers, with insurance not bound to employment, would create a healthy price-quality structure in us health care? akin to the german model? i think that has some merit, but its hard for me to imagine that having the payer, be disconnected from the consumer can really create a stable market without heavy handed regulation. i dont think insurance can really get you to an efficient market. health care is simply not a good where price and substitution apply as in many other markets. and rather than jumping through hoops to invent such a market lets agree that this an ethical part of social contract and manage it with the best technocratic solutions that our society can offer. E.G. NHS and NICE
- bhupy 6y ago
  > Healthcare can never be a free market in this sense, because the customer is faced with a choice of "buy service and/or product" or "be dead". What you're referring to here is a high "price elasticity of demand", and markets are used to provision all sorts of goods for which this is true. Food, for example, is predominately provisioned by the market, and consumers are constantly faced with a choice of "buy food" or "starve to death".
  - dogsgobork 6y ago
    Different types of food are fungible goods. If broccoli is expensive I can instead purchase carrots and still survive. If I think chemotherapy is too pricey, I can't take an aspirin instead to treat the cancer (at least not with the same prognosis).
    - bravo22 6y ago
      This is very true, and not at all what I mean when I say "choice". In free market choice means alternative vendors. Do you have other choices for getting chemo besides the one hospital? You may be surprised to know that 80% of hospitals in the US are non-profit. The evil profit motive isn't the reason their bills are so outrages. In the 60's US healthcare expenditure was 5% of the economy and it is close to 20% right now.
      - dwohnitmok 6y ago
        I'm curious (you don't come out one way or the other on this from your comment, but this will help me make sense of where you're coming from) do you think there are any domains where a free market doesn't work? Or is your position that free markets work universally (or less absolutely, that free markets work for almost all practical purposes and fail only in very artificial environments).
        bravo22 6y ago
        Free markets don't work when the cost of the transaction isn't paid by the two sides of the transaction but by a third party. For example the environment where I can buy a gas guzzler from you and drive away polluting the environment. There you need intervention but the framework of intervention and has to meet some specific criteria. I don't want to digress. Other than that I have yet to see a problem that isn't solved by this scheme: increase the set of choices available to the person, and in some corner cases give them money so they are free to choose. You have to bear in mind that the alternative to the free market approach is for someone else to come in an constrain either the buyer and seller in some way. Ths may work for a limited time and for a specific set of buyers and sellers but it won't work beyond that. Given that people have diverse and evolving needs the forced solution causes long term harm. Then you'll need some kind of propoganda machine to either exagerate the good or down play the harm. To be clear I do not believe that we have a free market in the US in a lot of areas and what people conceive of as free market -- or rather what has been shoved down their throat as free market is anything but that.
- trboyden 6y ago
  Not accurate and the car insurance market provides the model health insurance should be based on. In car insurance you have multiple providers you are free to choose from with different coverage levels and service options. If your bad driving history prevents you from getting standard insurance, government programs provide a backstop alternative way to get coverage. Yes the alternative costs more, as it should, because you are responsible for your driving habits. But there are also government programs on top of that for low income drivers. The point is, the free market should be plan A, and government programs should only exist to cover the gaps. Ultimately, people should be responsible for their own health, but in special cases, for no fault of their own issues, government should provide a backstop because it is the right thing to do. Most taxpayers would agree with that. What they don't want is to be forced into something that is inferior and on top of that be penalized to subsidize someone else's premium.
eloff 6y ago
I'm not assuming anything. I'm starting that even in theory healthcare isn't very amenable to a market solution. I think you disagree with that. It's possible to have a reasonable position on both sides, I don't think it's a solved problem. Where I think we both agree is that the current disastrous mix of regulation and free markets in the present US system is a terrible solution.
- bravo22 6y ago
  I entirely agree with you on the above!

luma 6y ago

A free market involves a customer that has the option to simply not buy what is on offer. Healthcare can never be a free market in this sense, because the customer is faced with a choice of "buy service and/or product" or "be dead". That is entirely unlike the choice involved in buying something like a refrigerator and seriously skews the applicability of traditional free market thinking to the problem.

bravo22 6y ago
That's not entirely accurate and that's not even the meaning of free market. Water is also a necessity as is food and you can have a free market for those. The questions are: 1. Does the buyer have enough choices or alternatives to choose from when it comes to healthcare? 2. Do those who offer services have a monopoly on the service? When you look at the US market you'll find that it doesn't meet those criterias. Market forces are prevented from acting and being able to reduce costs. The fact that there is a captive audience, as you suggest, means that we cannot just shovel money into it. You end up exactly where you are. Costs go up because it is a necessity. Same reason food prices go up when there is a shortage. It is not a luxury.
- mizay7 6y ago
  I think you are making a more articulate defense of private/market based health care than i usually hear. but i think fundamentally health care has too many forces that make it untenable for a market. there is no real satiation point in care, people are price inelastic, many services cannot be priced before delivery, there is little opportunity to do repeated business for most of the costliest services, comparison between providers is very difficult, most of the choice happens under incredible duress when you are your weakest point. health care is just not a consumer good that responds well to market mechanisms.
  - bravo22 6y ago
    I suppose it all depends on how you define market mechanisms. What I've found -- after personally studying the subject -- is what a lot of people consider free market is the opposite of what the literature considers it to be. To answer your point: Most/all of the issues you raised are met by "pooling" aka insurance. The need arises at random and when it does there is a massive cost and you urgently need the service. This is what insurance is for. What I was suggesting isn't that people go and pay the doctor out of pocket -- although they can. Rather that they purchase insurance. Those who can't get $$ indexed to some national average or whatever scheme you prefer. The point is everyone gets to purchase insurance if they so prefer. The problem is that choice of insurance providers is artifically limited right now and the choice of healthcare providers is as well. So you have a system where you are captive to the need and those who provide the service have a monpoly. Naturally costs will rise. Putting political preassure on government to increase spending is easy way out but that will only shovel more money from the pockets of the many into the pockets of the few. In fact this was predicted when Medicare was first introduced, and here we are. It is not like doctors and providers magically became greedy capitalists in the last 40 years. Also to be very clear this isn't an issue of "profits". Insurance companies don't have huge profit margins. They make their "wealth" by being a monopoly. The execs make their money on the rise in stock prices which isn't sensitive to their 3-5% profit margin.
    - mizay7 6y ago
      so you are arguing that many small insurers, with insurance not bound to employment, would create a healthy price-quality structure in us health care? akin to the german model? i think that has some merit, but its hard for me to imagine that having the payer, be disconnected from the consumer can really create a stable market without heavy handed regulation. i dont think insurance can really get you to an efficient market. health care is simply not a good where price and substitution apply as in many other markets. and rather than jumping through hoops to invent such a market lets agree that this an ethical part of social contract and manage it with the best technocratic solutions that our society can offer. E.G. NHS and NICE
bhupy 6y ago
> Healthcare can never be a free market in this sense, because the customer is faced with a choice of "buy service and/or product" or "be dead". What you're referring to here is a high "price elasticity of demand", and markets are used to provision all sorts of goods for which this is true. Food, for example, is predominately provisioned by the market, and consumers are constantly faced with a choice of "buy food" or "starve to death".
- dogsgobork 6y ago
  Different types of food are fungible goods. If broccoli is expensive I can instead purchase carrots and still survive. If I think chemotherapy is too pricey, I can't take an aspirin instead to treat the cancer (at least not with the same prognosis).
  - bravo22 6y ago
    This is very true, and not at all what I mean when I say "choice". In free market choice means alternative vendors. Do you have other choices for getting chemo besides the one hospital? You may be surprised to know that 80% of hospitals in the US are non-profit. The evil profit motive isn't the reason their bills are so outrages. In the 60's US healthcare expenditure was 5% of the economy and it is close to 20% right now.
    - dwohnitmok 6y ago
      I'm curious (you don't come out one way or the other on this from your comment, but this will help me make sense of where you're coming from) do you think there are any domains where a free market doesn't work? Or is your position that free markets work universally (or less absolutely, that free markets work for almost all practical purposes and fail only in very artificial environments).
      - bravo22 6y ago
        Free markets don't work when the cost of the transaction isn't paid by the two sides of the transaction but by a third party. For example the environment where I can buy a gas guzzler from you and drive away polluting the environment. There you need intervention but the framework of intervention and has to meet some specific criteria. I don't want to digress. Other than that I have yet to see a problem that isn't solved by this scheme: increase the set of choices available to the person, and in some corner cases give them money so they are free to choose. You have to bear in mind that the alternative to the free market approach is for someone else to come in an constrain either the buyer and seller in some way. Ths may work for a limited time and for a specific set of buyers and sellers but it won't work beyond that. Given that people have diverse and evolving needs the forced solution causes long term harm. Then you'll need some kind of propoganda machine to either exagerate the good or down play the harm. To be clear I do not believe that we have a free market in the US in a lot of areas and what people conceive of as free market -- or rather what has been shoved down their throat as free market is anything but that.
trboyden 6y ago
Not accurate and the car insurance market provides the model health insurance should be based on. In car insurance you have multiple providers you are free to choose from with different coverage levels and service options. If your bad driving history prevents you from getting standard insurance, government programs provide a backstop alternative way to get coverage. Yes the alternative costs more, as it should, because you are responsible for your driving habits. But there are also government programs on top of that for low income drivers. The point is, the free market should be plan A, and government programs should only exist to cover the gaps. Ultimately, people should be responsible for their own health, but in special cases, for no fault of their own issues, government should provide a backstop because it is the right thing to do. Most taxpayers would agree with that. What they don't want is to be forced into something that is inferior and on top of that be penalized to subsidize someone else's premium.

eloff 6y ago

I'm not assuming anything. I'm starting that even in theory healthcare isn't very amenable to a market solution. I think you disagree with that. It's possible to have a reasonable position on both sides, I don't think it's a solved problem. Where I think we both agree is that the current disastrous mix of regulation and free markets in the present US system is a terrible solution.

bravo22 6y ago
I entirely agree with you on the above!