4 ms·

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 mech

by 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.

by dv_dt 5y ago

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.