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The US health care system combines everything bad about government-run health care (slow progress due to heavy regulation, layers of bureaucracy, government-enf

by api 5y ago

The US health care system combines everything bad about government-run health care (slow progress due to heavy regulation, layers of bureaucracy, government-enforced drug monopolies) with everything bad about free-enterprise health care (inequality, market price fixing, uneven quality, lots of quackery at the edges of regulation). We need to pick something. If we're going the free enterprise way we need competition, price transparency, quality and outcome transparency, more open markets, and much lower taxes. If we're going the state-run or state-insured way then we need to whole-ass it and vertically integrate and drop the state-backed private insurance hybrid nightmare. The US does this pessimum thing all over the place. We are taxed almost like a more "socialist" country (unless you are rich enough to offshore and play tax loophole games) but do not get the benefits of one. Either cut my taxes down to Costa Rica levels or give me benefits at least as good as Canada please.

chiefalchemist 5y ago
What we need is a focus on prevention. A significant amount of the system is devoted to preventable conditions. Lower the demand and prices will naturally come down across the board as resouces get redistributed, etc. But as it is, insulin is high demand and increasing. Prices simply don't fall when demand increases.
dv_dt 5y ago
Every time I’ve dug into it, modern nations which enjoy a much lower cost per capita coverage (which the US is a major outlier) basically have a government mechanism to set prices for drugs and health services. There are no free market health systems in leading economic nations (unless maybe you take a very small niche corner of the systems)
- adventured 5y ago
  > There are no free market health systems in leading economic nations That also does not exist in the US and hasn't in more than half a century. The US could hardly be any further away from a free market in healthcare. It's hyper regulated, and hyper dominated by government programs (Medicare, Medicaid, and dozens of other programs and agencies). The US healthcare system is controlled top to bottom by rigid, strict government regulations and oversight. It's the way it is precisely because there is no free market at all. The corporatist interests like it just the way it is, and work with the politicians to constantly maintain that highly regulated environment: it's regulated in their favor, exclusionary of nearly all potential competition. And it's insanely expensive to try to start anything in healthcare, which favors the incumbent further. Try starting a hospital or opening a clinic. Try becoming a doctor. Try getting a drug to market. Try getting a medtech device to market. Hyper regulation every direction you look. Free market? Ha.
  - dv_dt 5y ago
    My point is that it's seems a little optimistic to think that a free market for healthcare is an adequate solution, given that no free market healthcare system exists anywhere at scale. I think some markets are simply inappropriate for free markets - particularly one where services are by definition specialized and market feedback involves failures in critical life risking situations.
    - api 5y ago
      The parent was fairly pointing out that healthcare in the US is not a free market. For one there is zero price transparency let alone competition. For another there is the insurance industry which is both heavily regulated and state backed. Health insurer market is similar to the wired ISP market. We don’t really know what a true free market would do with modern healthcare because as you say there is no such thing. Personally I think it could work for middle class and above but would leave a big coverage cliff down below because it’s not profitable to insure or treat the really poor. The question is whether real transparency with price competition and efficiency gains would make it cheaper to then add a safely net for the poor.
      - dv_dt 5y ago
        We already know the answer to this because free markets really don’t provide the poor with shelter or food or any other critical support.
KoftaBob 5y ago
Finally someone has put into words my frustration with this healthcare system.
- rrrrrrrrrrrryan 5y ago
  Obamacare was widely derided by many Democrats as a worst-of-both-worlds plan when the public option was scraped.
  - api 5y ago
    I've heard that Obama was reluctant to push harder for a public option because the health bureaucracy is such a massive employer. If true then we're basically dragging along a counter-productive boat anchor that eats a ton of our health care spending as a back-door jobs program.
    - rrrrrrrrrrrryan 5y ago
      They dropped it to woo one moderate Democratic senator (Lieberman), who was basically the Manchin of his day. Without his vote, it would've gotten filibustered to death. https://www.google.com/search?q=lieberman+public+option&oq=lieberman+public+option https://www.google.com/search?q=lieberman+public+option&oq=l...
sneak 5y ago
You're absolutely right that either would be better than the current situation. The issue, though, is not that it's half-assed and fucked up. It's working by design, to use legislative schemes to funnel money to incumbents and friends/donors, while still supporting the "free market" ideology, when really it's just regulatory capture. The system is designed for graft, and it's working as intended. Those with the power to "fix" it won't, because to them it's not broken at all. The US has the same problem in telecommunications, war/defense, and medicine. The largest vendors become integrated with the budget- and policy-makers, and the whole system exists to extract maximum value from the consumer class.

by api 5y ago

chiefalchemist 5y ago

What we need is a focus on prevention. A significant amount of the system is devoted to preventable conditions. Lower the demand and prices will naturally come down across the board as resouces get redistributed, etc. But as it is, insulin is high demand and increasing. Prices simply don't fall when demand increases.

dv_dt 5y ago

Every time I’ve dug into it, modern nations which enjoy a much lower cost per capita coverage (which the US is a major outlier) basically have a government mechanism to set prices for drugs and health services. There are no free market health systems in leading economic nations (unless maybe you take a very small niche corner of the systems)

adventured 5y ago
> There are no free market health systems in leading economic nations That also does not exist in the US and hasn't in more than half a century. The US could hardly be any further away from a free market in healthcare. It's hyper regulated, and hyper dominated by government programs (Medicare, Medicaid, and dozens of other programs and agencies). The US healthcare system is controlled top to bottom by rigid, strict government regulations and oversight. It's the way it is precisely because there is no free market at all. The corporatist interests like it just the way it is, and work with the politicians to constantly maintain that highly regulated environment: it's regulated in their favor, exclusionary of nearly all potential competition. And it's insanely expensive to try to start anything in healthcare, which favors the incumbent further. Try starting a hospital or opening a clinic. Try becoming a doctor. Try getting a drug to market. Try getting a medtech device to market. Hyper regulation every direction you look. Free market? Ha.
- dv_dt 5y ago
  My point is that it's seems a little optimistic to think that a free market for healthcare is an adequate solution, given that no free market healthcare system exists anywhere at scale. I think some markets are simply inappropriate for free markets - particularly one where services are by definition specialized and market feedback involves failures in critical life risking situations.
  - api 5y ago
    The parent was fairly pointing out that healthcare in the US is not a free market. For one there is zero price transparency let alone competition. For another there is the insurance industry which is both heavily regulated and state backed. Health insurer market is similar to the wired ISP market. We don’t really know what a true free market would do with modern healthcare because as you say there is no such thing. Personally I think it could work for middle class and above but would leave a big coverage cliff down below because it’s not profitable to insure or treat the really poor. The question is whether real transparency with price competition and efficiency gains would make it cheaper to then add a safely net for the poor.
    - dv_dt 5y ago
      We already know the answer to this because free markets really don’t provide the poor with shelter or food or any other critical support.

KoftaBob 5y ago

Finally someone has put into words my frustration with this healthcare system.

rrrrrrrrrrrryan 5y ago
Obamacare was widely derided by many Democrats as a worst-of-both-worlds plan when the public option was scraped.
- api 5y ago
  I've heard that Obama was reluctant to push harder for a public option because the health bureaucracy is such a massive employer. If true then we're basically dragging along a counter-productive boat anchor that eats a ton of our health care spending as a back-door jobs program.
  - rrrrrrrrrrrryan 5y ago
    They dropped it to woo one moderate Democratic senator (Lieberman), who was basically the Manchin of his day. Without his vote, it would've gotten filibustered to death. https://www.google.com/search?q=lieberman+public+option&oq=lieberman+public+option https://www.google.com/search?q=lieberman+public+option&oq=l...

sneak 5y ago

You're absolutely right that either would be better than the current situation. The issue, though, is not that it's half-assed and fucked up. It's working by design, to use legislative schemes to funnel money to incumbents and friends/donors, while still supporting the "free market" ideology, when really it's just regulatory capture. The system is designed for graft, and it's working as intended. Those with the power to "fix" it won't, because to them it's not broken at all. The US has the same problem in telecommunications, war/defense, and medicine. The largest vendors become integrated with the budget- and policy-makers, and the whole system exists to extract maximum value from the consumer class.