6 ms·

I agree. The "everything is a market" ideology had a good run of almost half a century, but it should be heavily criticized in hindsight. Institutions like hea

by dgb23 5y ago

I agree. The "everything is a market" ideology had a good run of almost half a century, but it should be heavily criticized in hindsight. Institutions like healthcare, education, public transport, prisons(!) and so on are more efficient, less corrupt and of higher quality when they are in large parts collectively and democratically organized and funded. The "in large parts" is important here: A community should agree on what that means and let the market play out on the edges, or the bureaucratic costs become too heavy _and_ unfair. Decentralization is key here.

dqpb 5y ago
> The "everything is a market" ideology had a good run of almost half a century But that never actually happened. Externalities were never part of the market.
- howdydoo 5y ago
  Are you suggesting that healthcare-as-a-market would start working if externalities were priced in? How would that help?
  - donatj 5y ago
    I suspect the argument is "Healthcare has never been allowed to be a market" Given how many legal restrictions are placed on it, I tend to agree.
    - tablespoon 5y ago
      > I suspect the argument is "Healthcare has never been allowed to be a market" Given how many legal restrictions are placed on it, I tend to agree. Emergency services aren't a good fit for markets. For markets to work, people really need the luxury to shop around with some leisure. Wasn't there some Roman oligarch that ran a private fire department, and basically just used it to extort property owners when they had a fire? Truly market based emergency medical care without legal restrictions would likely frequently resemble that with some frequency. Edit: Yep: https://en.wikipedia.org/wiki/History_of_firefighting#Rome https://en.wikipedia.org/wiki/History_of_firefighting#Rome > The first ever Roman fire brigade was created by Marcus Licinius Crassus. He took advantage of the fact that Rome had no fire department, by creating his own brigade—500 men strong—which rushed to burning buildings at the first cry of alarm. Upon arriving at the scene, however, the firefighters did nothing while Crassus offered to buy the burning building from the distressed property owner, at a miserable price. If the owner agreed to sell the property, his men would put out the fire, if the owner refused, then they would simply let the structure burn to the ground.
      - lostcolony 5y ago
        I will also comment that when we talk about "healthcare being a market", we need to separate out providers of healthcare, with insurers of healthcare. Insurers of healthcare are much closer to a market (in that I can generally find out what the cost of the insurance is, and what it covers), but providers aren't (in that prices lists are hidden, it's not clear what is covered vs what isn't, etc). We talk about the cost of the insurance, but that's artificially high because of the practices of the providers (themselves incentivized to behave that way because of the insurers). And that's the open market; it gets even more cloudy when we talk about employers being involved, so we have an agency problem as well. It's a system unlike any other, and I don't think general theories really apply very well as such.
        swagasaurus-rex 5y ago
        Here's a theory: Insurance companies argue and refuse to pay out to hospitals because it's an adversarial relationship. Hospitals increase rates to cover the overhead of dealing with hostile insurance companies. Insurance companies raise rates to match increased hospital billing. Ironically both industries are incentivized to raise rates on customers while trying to gouge each other. Is it any wonder healthcare is a scam?
- tablespoon 5y ago
  >> The "everything is a market" ideology had a good run of almost half a century > But that never actually happened. Externalities were never part of the market. But isn't the essence of an externality that it's a social cost not factored into the market price?
  - dqpb 5y ago
    It becomes a social cost because it was not accounted for as a market cost. It may be that some of these cannot in principle be accounted for, and even more which cannot in practice be accounted for. But I imagine the majority of externalities could be accounted for if we tried.
    - tablespoon 5y ago
      > But I imagine the majority of externalities could be accounted for if we tried. The irony is if you actually came close to achieving that (e.g. accounting for all externalities in the market price), you'd have something like central planning. That's why externalities are usually managed through other mechanisms. Also, externalities are only one kind of market failure.
  - deleted 5y ago
    [deleted]
- nopenopenopeno 5y ago
  Employer-based healthcare was won by an alliance of corporate and healthcare industry lobbies against a state healthcare plan in the 1950s when the so-called “free market” healthcare system was failing the public. Prices were increasing and the New Deal corporate powers pacified the public with social security and employer-based healthcare. Edit: updated 1960s to 1950s per info in replies
  - ch4s3 5y ago
    In the US healthcare was intentionally tied to employment as a means of controlling wage inflation during the 1950s by Eisenhower. He had pushed for the "middle way" of private nonprofit health insurance that could be purchased individually or by employers. As inflation began to spike, the administration added new tax benefits to encourage employers to compete on providing benefits rather than higher base salaries. Roosevelt also tried to institute a national scheme in the 30s but labor unions were split on notional vs. employer provided and it became a wedge issue that scuttled the plan. Truman's push for that same national health insurance plan was shot down in ~1949, partially killed by AMA lobbying.
    - nopenopenopeno 5y ago
      You’re right. It was earlier than I thought. I updated my comment per your reply. Heaven forbid “wage inflation!” Was the AFL pushing for employer-based and the CIO pushing for national? I don’t even know where to find history like this. It’s virtually impossible for an average person to learn about the history of the American labor movement.
      - ch4s3 5y ago
        > Heaven forbid “wage inflation!” I realized after double checking that it was actually a 1942 Roosevelt bill, and they were trying to figure out how to keep a lid on rising prices during the war. It's also not uniformly good if prices also rise quickly. Inflationary spirals are real, and very bad for regular people. > Was the AFL pushing for employer-based and the CIO pushing for national? I'd have to double check. > It’s virtually impossible for an average person to learn about the history of the American labor movement. A bunch of this stuff is available in more popular history and online now. "The Devil Is Here in These Hills" is supposed to be good, but I haven't read it.
omosubi 5y ago
Re: prisons - This isn't necessarily the case. Florida's private prisons have air conditioning and the public ones don't in part because of democratic control and the private ones have fewer deaths from heat stroke as a result.
- stremrn8 5y ago
  [dead]
- nopenopenopeno 5y ago
  - tablespoon 5y ago
    >>> Institutions like healthcare, education, public transport, prisons(!) and so on are more efficient, less corrupt and of higher quality when they are in large parts collectively and democratically organized and funded. >> Re: prisons - This isn't necessarily the case. Florida's private prisons have air conditioning and the public ones don't in part because of democratic control and the private ones have fewer deaths from heat stroke as a result. > Extremely suspicious comment. Please elaborate on “democratic control.” Yeah. Also the GP weirdly collapses "more efficient, less corrupt and of higher quality" into "has air conditioning: Y/N." You have to evaluate those things holistically, and it's quite possible that he holistically-better solution is actually worse in some specific areas. Also I don't have any specific knowledge about Florida prisons, but private prisons are a new(ish) phenomena [1], and "hav[ing] air conditioning" might simply be an unintended consequence of that, because building standards have changed. [1] You know what I mean, don't nitpick with some ancient example.
mumblemumble 5y ago
One thing to note about US healthcare is that it seems almost deliberately engineered to not be a market. I've never received significant health care in another country, so I can't say how the US system differs from others with any expertise. But I can say how US health care differs from just about anything else I spend money on: 1. I don't really get to shop for health insurance providers. My employer picks one, maybe two plans, and I can take it or leave it. If I leave it, I am leaving at least $10,000/year on the table, so I generally take it. 2. Even when I am on the market, the phenomenon in #1 does weird things. Once upon a time, when I was choosing my own health insurance, I started a new job with health insurance benefits that I did choose to take. But my start date was toward the beginning of the month, my old insurance wouldn't let me do a partial month, and the new employer wouldn't let me delay opting for coverage. So I was essentially forced to own two health insurance plans simultaneously for a period of time. 3. Nobody knows what care will cost ahead of time, which makes it impossible for me to make any informed economic decisions. I need to see a physical therapist. I called a few places to shop for prices. They all know what the rate for uninsured people is, but the only way we can find out what it will cost with my insurance is if I receive care, they submit a claim, and then we all find out together what the price was, after the fact. 4. #3 creates a situation where they can hide all sorts of excessive charges. When my first child was born, I got lessons on how to give him a bath and change his diaper. Both of which I already knew; I was really just going along with the lessons to be polite. I certainly wouldn't have said yes if the hospital had been transparent and up-front about the price tag on this lesson: about $2,000. 5. And sure, insurance covered most of it... but that didn't make it free; it just means the price was amortized over a large number of health insurance premiums. Unfortunately, I think that this setup makes it all too easy for us to think of these things as free, which, in turn, reduces public scrutiny over where the money comes from or where it goes. And it just keeps going like that. Compare with signing up for cell phone service. It's a famously sleazy business, but, even with all the hidden fees they like to tack on, at least they're up-front about the basic price of service. With US health care, every fee is a hidden fee. That makes it impossible for consumers to make free, informed decisions, which is the most fundamental precondition that must be satisfied in order for a capitalist market to form.
- fatnoah 5y ago

by dgb23 5y ago

dqpb 5y ago

> The "everything is a market" ideology had a good run of almost half a century But that never actually happened. Externalities were never part of the market.

howdydoo 5y ago
Are you suggesting that healthcare-as-a-market would start working if externalities were priced in? How would that help?
- donatj 5y ago
  I suspect the argument is "Healthcare has never been allowed to be a market" Given how many legal restrictions are placed on it, I tend to agree.
  - tablespoon 5y ago
    > I suspect the argument is "Healthcare has never been allowed to be a market" Given how many legal restrictions are placed on it, I tend to agree. Emergency services aren't a good fit for markets. For markets to work, people really need the luxury to shop around with some leisure. Wasn't there some Roman oligarch that ran a private fire department, and basically just used it to extort property owners when they had a fire? Truly market based emergency medical care without legal restrictions would likely frequently resemble that with some frequency. Edit: Yep: https://en.wikipedia.org/wiki/History_of_firefighting#Rome https://en.wikipedia.org/wiki/History_of_firefighting#Rome > The first ever Roman fire brigade was created by Marcus Licinius Crassus. He took advantage of the fact that Rome had no fire department, by creating his own brigade—500 men strong—which rushed to burning buildings at the first cry of alarm. Upon arriving at the scene, however, the firefighters did nothing while Crassus offered to buy the burning building from the distressed property owner, at a miserable price. If the owner agreed to sell the property, his men would put out the fire, if the owner refused, then they would simply let the structure burn to the ground.
    - lostcolony 5y ago
      I will also comment that when we talk about "healthcare being a market", we need to separate out providers of healthcare, with insurers of healthcare. Insurers of healthcare are much closer to a market (in that I can generally find out what the cost of the insurance is, and what it covers), but providers aren't (in that prices lists are hidden, it's not clear what is covered vs what isn't, etc). We talk about the cost of the insurance, but that's artificially high because of the practices of the providers (themselves incentivized to behave that way because of the insurers). And that's the open market; it gets even more cloudy when we talk about employers being involved, so we have an agency problem as well. It's a system unlike any other, and I don't think general theories really apply very well as such.
      - swagasaurus-rex 5y ago
        Here's a theory: Insurance companies argue and refuse to pay out to hospitals because it's an adversarial relationship. Hospitals increase rates to cover the overhead of dealing with hostile insurance companies. Insurance companies raise rates to match increased hospital billing. Ironically both industries are incentivized to raise rates on customers while trying to gouge each other. Is it any wonder healthcare is a scam?
tablespoon 5y ago
>> The "everything is a market" ideology had a good run of almost half a century > But that never actually happened. Externalities were never part of the market. But isn't the essence of an externality that it's a social cost not factored into the market price?
- dqpb 5y ago
  It becomes a social cost because it was not accounted for as a market cost. It may be that some of these cannot in principle be accounted for, and even more which cannot in practice be accounted for. But I imagine the majority of externalities could be accounted for if we tried.
  - tablespoon 5y ago
    > But I imagine the majority of externalities could be accounted for if we tried. The irony is if you actually came close to achieving that (e.g. accounting for all externalities in the market price), you'd have something like central planning. That's why externalities are usually managed through other mechanisms. Also, externalities are only one kind of market failure.
- deleted 5y ago
  [deleted]
nopenopenopeno 5y ago
Employer-based healthcare was won by an alliance of corporate and healthcare industry lobbies against a state healthcare plan in the 1950s when the so-called “free market” healthcare system was failing the public. Prices were increasing and the New Deal corporate powers pacified the public with social security and employer-based healthcare. Edit: updated 1960s to 1950s per info in replies
- ch4s3 5y ago
  In the US healthcare was intentionally tied to employment as a means of controlling wage inflation during the 1950s by Eisenhower. He had pushed for the "middle way" of private nonprofit health insurance that could be purchased individually or by employers. As inflation began to spike, the administration added new tax benefits to encourage employers to compete on providing benefits rather than higher base salaries. Roosevelt also tried to institute a national scheme in the 30s but labor unions were split on notional vs. employer provided and it became a wedge issue that scuttled the plan. Truman's push for that same national health insurance plan was shot down in ~1949, partially killed by AMA lobbying.
  - nopenopenopeno 5y ago
    You’re right. It was earlier than I thought. I updated my comment per your reply. Heaven forbid “wage inflation!” Was the AFL pushing for employer-based and the CIO pushing for national? I don’t even know where to find history like this. It’s virtually impossible for an average person to learn about the history of the American labor movement.
    - ch4s3 5y ago
      > Heaven forbid “wage inflation!” I realized after double checking that it was actually a 1942 Roosevelt bill, and they were trying to figure out how to keep a lid on rising prices during the war. It's also not uniformly good if prices also rise quickly. Inflationary spirals are real, and very bad for regular people. > Was the AFL pushing for employer-based and the CIO pushing for national? I'd have to double check. > It’s virtually impossible for an average person to learn about the history of the American labor movement. A bunch of this stuff is available in more popular history and online now. "The Devil Is Here in These Hills" is supposed to be good, but I haven't read it.

omosubi 5y ago

Re: prisons - This isn't necessarily the case. Florida's private prisons have air conditioning and the public ones don't in part because of democratic control and the private ones have fewer deaths from heat stroke as a result.

stremrn8 5y ago
[dead]
nopenopenopeno 5y ago
- tablespoon 5y ago
  >>> Institutions like healthcare, education, public transport, prisons(!) and so on are more efficient, less corrupt and of higher quality when they are in large parts collectively and democratically organized and funded. >> Re: prisons - This isn't necessarily the case. Florida's private prisons have air conditioning and the public ones don't in part because of democratic control and the private ones have fewer deaths from heat stroke as a result. > Extremely suspicious comment. Please elaborate on “democratic control.” Yeah. Also the GP weirdly collapses "more efficient, less corrupt and of higher quality" into "has air conditioning: Y/N." You have to evaluate those things holistically, and it's quite possible that he holistically-better solution is actually worse in some specific areas. Also I don't have any specific knowledge about Florida prisons, but private prisons are a new(ish) phenomena [1], and "hav[ing] air conditioning" might simply be an unintended consequence of that, because building standards have changed. [1] You know what I mean, don't nitpick with some ancient example.

mumblemumble 5y ago

One thing to note about US healthcare is that it seems almost deliberately engineered to not be a market. I've never received significant health care in another country, so I can't say how the US system differs from others with any expertise. But I can say how US health care differs from just about anything else I spend money on: 1. I don't really get to shop for health insurance providers. My employer picks one, maybe two plans, and I can take it or leave it. If I leave it, I am leaving at least $10,000/year on the table, so I generally take it. 2. Even when I am on the market, the phenomenon in #1 does weird things. Once upon a time, when I was choosing my own health insurance, I started a new job with health insurance benefits that I did choose to take. But my start date was toward the beginning of the month, my old insurance wouldn't let me do a partial month, and the new employer wouldn't let me delay opting for coverage. So I was essentially forced to own two health insurance plans simultaneously for a period of time. 3. Nobody knows what care will cost ahead of time, which makes it impossible for me to make any informed economic decisions. I need to see a physical therapist. I called a few places to shop for prices. They all know what the rate for uninsured people is, but the only way we can find out what it will cost with my insurance is if I receive care, they submit a claim, and then we all find out together what the price was, after the fact. 4. #3 creates a situation where they can hide all sorts of excessive charges. When my first child was born, I got lessons on how to give him a bath and change his diaper. Both of which I already knew; I was really just going along with the lessons to be polite. I certainly wouldn't have said yes if the hospital had been transparent and up-front about the price tag on this lesson: about $2,000. 5. And sure, insurance covered most of it... but that didn't make it free; it just means the price was amortized over a large number of health insurance premiums. Unfortunately, I think that this setup makes it all too easy for us to think of these things as free, which, in turn, reduces public scrutiny over where the money comes from or where it goes. And it just keeps going like that. Compare with signing up for cell phone service. It's a famously sleazy business, but, even with all the hidden fees they like to tack on, at least they're up-front about the basic price of service. With US health care, every fee is a hidden fee. That makes it impossible for consumers to make free, informed decisions, which is the most fundamental precondition that must be satisfied in order for a capitalist market to form.

fatnoah 5y ago