4 ms·

The problem is the preservation of market mechanisms. Distributing healthcare through market mechanisms is ludicrous, has never worked and will never work.

mindslight 5y ago
> The problem is the preservation of market mechanisms. I don't know what you mean by this. Unless we're talking about a system in which all doctors and drug companies are bona fide government employees, then healthcare is indeed being distributed via market mechanisms. For an analog, take a look at the market for food (a vital necessity for life). The vast majority of people pay for food directly. Competition between grocery stores keeps the prices reasonable. Government programs provide funds to those unable to afford food, and those government dollars benefit from the consumer market mechanic. The idea that you could receive a bill in the mail a month later, for the cashier or counter worker being an unknown "outside vendor" is nowhere in sight. The only fundamental difference with healthcare is that you might suddenly need a lot of it and not be able to shop around - ie the necessity of insurance. But this still isn't a reason to throw away the overall market in favor of an obtuse cartel that controls access to what should be simple cases.
- LordDragonfang 5y ago
  >The only fundamental difference with healthcare is that you might suddenly need a lot of it and not be able to shop around. I mean, that's kind of a crucial difference, though, isn't it? To use your supermarket metaphor, if I'm starving, it doesn't matter if I buy a fresh-butchered sirloin or a jar of peanut butter. In contrast, a diabetic can't just decide to take aspirin instead of insulin - and that's not that's not even getting into more specialized disorders. The fundamental problem is that any market solution to drug pricing is going to end up with awful prices because: * Most drugs, by nature, have extremely small sets of potential clients relative to their cost of development * For those who need drugs, they have an inflexible demand for the drug (buy it of suffer/die), and the drug is essentially non-fungible with other drugs.
  - mindslight 5y ago
    > that's kind of a crucial difference, though, isn't it It's a crucial difference for emergency situations only, which does not include your insulin example. The sheer majority of insulin use is not from people going from not knowing they need insulin, to needing insulin on an emergency basis. Rather, there is plenty of time for a market dynamic of shopping between suppliers to do its work. The main reason this concept seems so foreign is that we're presently prevented shopping around by "insurance" cartels and opaque pricing, and then we're shown extortionary fake prices on bills. Right now we're essentially designing the whole system around people who cannot afford drugs, while making them directly unaffordable to most everyone. This is not a sustainable system! > For those who need drugs, they have an inflexible demand for the drug (buy it of suffer/die), and the drug is essentially non-fungible with other drugs. I'm not making the claim that restoring market mechanics will solve the whole problem. That's the kind of grandiose claim that proponents of governments feeding the cancer usually engage in. Rather, restoring market mechanics is a mere first step towards healthcare sanity, no matter who ends up paying. Drugs themselves are given government granted monopolies, both by patents and FDA approval. Maintaining these monopolies while allowing a free for all pricing dynamic is obviously a nonstarter. But keep in mind the dynamic is just as broken regardless whether individual users are paying or not! Perhaps my whole point would be better phrased in terms of choice. From what I know, there are several different types of insulin of varying effectiveness and convenience. Should people be forced to buy the best gold-plated "insurance" (aka cartel bundle), possibly only available through a specific employer, just to be able to get "approval" for the best kind of insulin for their own medical situation? Or rather should access to each type be openly available, and every individual able to choose to pay a little more to get a type that benefits them better? I think people reacting negatively to the idea of restoring some market mechanics envision some utopia where everyone easily gets the best version for free, but this is wildly unworkable especially taking into account yet-to-be-developed drugs. In the best case this system gets mediated by doctors and "medical need", which creates its own autonomy-denying paternalistic dynamic.

mindslight 5y ago

> The problem is the preservation of market mechanisms. I don't know what you mean by this. Unless we're talking about a system in which all doctors and drug companies are bona fide government employees, then healthcare is indeed being distributed via market mechanisms. For an analog, take a look at the market for food (a vital necessity for life). The vast majority of people pay for food directly. Competition between grocery stores keeps the prices reasonable. Government programs provide funds to those unable to afford food, and those government dollars benefit from the consumer market mechanic. The idea that you could receive a bill in the mail a month later, for the cashier or counter worker being an unknown "outside vendor" is nowhere in sight. The only fundamental difference with healthcare is that you might suddenly need a lot of it and not be able to shop around - ie the necessity of insurance. But this still isn't a reason to throw away the overall market in favor of an obtuse cartel that controls access to what should be simple cases.

LordDragonfang 5y ago
>The only fundamental difference with healthcare is that you might suddenly need a lot of it and not be able to shop around. I mean, that's kind of a crucial difference, though, isn't it? To use your supermarket metaphor, if I'm starving, it doesn't matter if I buy a fresh-butchered sirloin or a jar of peanut butter. In contrast, a diabetic can't just decide to take aspirin instead of insulin - and that's not that's not even getting into more specialized disorders. The fundamental problem is that any market solution to drug pricing is going to end up with awful prices because: * Most drugs, by nature, have extremely small sets of potential clients relative to their cost of development * For those who need drugs, they have an inflexible demand for the drug (buy it of suffer/die), and the drug is essentially non-fungible with other drugs.
- mindslight 5y ago
  > that's kind of a crucial difference, though, isn't it It's a crucial difference for emergency situations only, which does not include your insulin example. The sheer majority of insulin use is not from people going from not knowing they need insulin, to needing insulin on an emergency basis. Rather, there is plenty of time for a market dynamic of shopping between suppliers to do its work. The main reason this concept seems so foreign is that we're presently prevented shopping around by "insurance" cartels and opaque pricing, and then we're shown extortionary fake prices on bills. Right now we're essentially designing the whole system around people who cannot afford drugs, while making them directly unaffordable to most everyone. This is not a sustainable system! > For those who need drugs, they have an inflexible demand for the drug (buy it of suffer/die), and the drug is essentially non-fungible with other drugs. I'm not making the claim that restoring market mechanics will solve the whole problem. That's the kind of grandiose claim that proponents of governments feeding the cancer usually engage in. Rather, restoring market mechanics is a mere first step towards healthcare sanity, no matter who ends up paying. Drugs themselves are given government granted monopolies, both by patents and FDA approval. Maintaining these monopolies while allowing a free for all pricing dynamic is obviously a nonstarter. But keep in mind the dynamic is just as broken regardless whether individual users are paying or not! Perhaps my whole point would be better phrased in terms of choice. From what I know, there are several different types of insulin of varying effectiveness and convenience. Should people be forced to buy the best gold-plated "insurance" (aka cartel bundle), possibly only available through a specific employer, just to be able to get "approval" for the best kind of insulin for their own medical situation? Or rather should access to each type be openly available, and every individual able to choose to pay a little more to get a type that benefits them better? I think people reacting negatively to the idea of restoring some market mechanics envision some utopia where everyone easily gets the best version for free, but this is wildly unworkable especially taking into account yet-to-be-developed drugs. In the best case this system gets mediated by doctors and "medical need", which creates its own autonomy-denying paternalistic dynamic.