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So for life or death decisions, the ambulance driver would first go on some price comparison website or ask the insurance and see "ok, this person wants a docto
by teh64 4y ago
So for life or death decisions, the ambulance driver would first go on some price comparison website or ask the insurance and see "ok, this person wants a doctor in the $10,000-15,000 range, the closest of which is 30m away. The hospital next door costs at least $50,000 minimum, so we will not send them there for life saving medical care." And what incentive would insurance have to send me to a reasonably priced doctor, when they can send me to one in their network which is more expensive but means they keep more money? Also, they could send me to an expensive hospital and then just not pay out. These are both things Obamacare tried to fix [0]. Insurances want to maximize profits, which means paying as little as possible themselves and extracting as much as possible from customers. Your system would only work if insurances had to always pay 100% of medical costs and could never deny care, which is similar to how it works in Germany (at least for some baseline level of care).
Again, what incentive would there be to lower prices? New doctors could just be bought out and the prices jacked up. There are a lot of industries where there is little barrier to entry (for example tech), where the big companies just buy anyone trying to "get in on their territory".
Also, why would the "unreasonable prices" (what would that even look like?) doctors go out of business? They could just provide some kind of "luxury deluxe" ("no poor people here") state of the art care for people who can afford it.
[0] https://www.healthcare.gov/health-care-law-protections/doctor-choice-emergency-room-access/#:~:text=Access%20to%20out%2Dof%2Dnetwork,of%2Dnetwork%20provider%20or%20hospital https://www.healthcare.gov/health-care-law-protections/docto....
- bombcar 4y agoNo, very quickly everyone would know the hospitals that charge way more than the others, and not patronize them. Emergency services are only like 5% of costs, anyway [367]: > The percentage of U.S. health spending attributable to the ED has increased from 3.9% (CI, 3.9%-3.9%) in 2006 to 5.0% (CI, 5.0%-5.0%) in 2016. So the other 95% is more flexible. I know when looking at birthing costs they could vary wildly but it didn't really matter because who cares, they're all in-network anyway. [367] https://journals.plos.org/plosone/article?id=10.1371/journal.pone.0258182 https://journals.plos.org/plosone/article?id=10.1371/journal...
- olalonde 4y agoIt feels like you don't understand or don't believe in free enterprise in general, not just when it comes to medicine. All the theoretical issues you mention do not actually occur in industries that are closer to a free market. There is no cost problem in "tech". In fact, many services are literally free of charge. Despite Google having a near-monopoly on search, it is unable to charge users for it. Demand for software developers has grown massively in the past decades and yet, wages have only slightly gone up. Anyways, I didn't mean to start a debate on the merits of free enterprise. I was hoping that we could at least agree that artificial limiting the supply of doctors causes medicine to be more costly, regardless of the economic system.
- teh64 4y agoI understand just fine, I just don't share the naive "invisible hand" narrative. I think there are a lot of places where free markets make for better products and services, but not all products and markets are fundamentally the same, so I believe the same prescription of "just remove all limits to a free market -> all problems solved" does not work everywhere. But Google can charge their "actual" users, i.e. advertisers quite a bit, and it is much harder to do any advertising without also advertising on Google Platforms, such as Search, Maps, Youtube, Adwords, etc. The wages may have only slightly gone up, but the profits definitely have gone up quite a bit, which shows that amount of workers and their pay has little to do with how much money can be made (which I believe is perfectly fine, because tech is not a place where I think free markets create a detriment to society). I don't want to start a debate on free enterprise in general, just to show that free enterprise is not a once size fits all solution. My argument was just that the supply of doctors has very little to do with the price of medicine, because the market forces that determine price and can lead to lower prices in some markets do not work correctly in this market.