4 ms·

I'm not so sure that is a sensible inference to draw. Government "interference" in healthcare in many countries where citizens both have greater access and repo

I'm not so sure that is a sensible inference to draw. Government "interference" in healthcare in many countries where citizens both have greater access and report more satisfaction with the healthcare service they receive. Also, free markets really don't have much to say for people who don't have the money to trade in that market, and in the healthcare space, denying treatment to people just because they can't afford treatment can cause some massive negative externalities. Just imagine how bad it would be if there was a massive pandemic and only the rich could afford vaccines; there would be so many unvaccinated hosts for that virus that new variants would keep emerging and significantly harm the quality of life for everyone. Also, market efficiencies are largely a product of the ability of the consumer to compare the price and quality of different services. When the government is the consumer, it A) can afford to allocate this task to a few experts (rather than demand the entire population learn how to evaluate the cost and efficacy of medical treatments), B) can use its monopsony power to negotiate prices, and C) can use its treatment and outcome data to identify opportunities to do preventative maintenance rather than the more expensive (in both life and money) emergency care. I'm more sympathetic to free markets than most, but healthcare is arguably the sector where free markets would produce the worst outcomes.

WalterBright 4y ago
The US had a free market in health care in 1968, and there's simply no evidence to support your suspicions.
- modriano 4y ago
  First off, the US healthcare market wasn't a free market in 1968. State licensing boards regulated the supply of doctors and as Milton Friedman argued in his book "Free to Choose", powerful interest groups used the US court system to impose massive costs on unlicensed healthcare practitioners; "The AMA has engaged in extensive litigation charging chiropractors and osteopathic physicians with the unlicensed practice of medicine, in an attempt to restrict them to as narrow an area as possible." [0]. So no, even before Medicare and Medicaid, there wasn't a free market for healthcare in the US. Still, in that time, there was much less government involvement in healthcare and the stats show significant improvement after the implementation of the SSA of 1965 Act. Infant mortality fell from over 2.5% in the early 1960s to just over half a percent now [1], with the decrease accelerating in the late 1960's before tapering in the 1980's. Life expectancy also jolted upward in the late 1960's [1]. Healthcare has increased in cost significantly since the time before Medicare and Medicaid, when the treatment for a heart attack was to lay in a hospital bed and wait to die, whereas now, we have much better treatments that can add decades on to people's lives. [2] And regarding the pandemic hypothesis, there's so much evidence to support my claims. If vaccine shots hadn't been made free to individuals, uptake would have been far slower and life would be far worse as the death rate would be much higher than the (still horrifying) ~500 people per day. [0] https://en.m.wikipedia.org/wiki/American_Medical_Association#Criticism https://en.m.wikipedia.org/wiki/American_Medical_Association... [1] https://datacommons.org/place/country/USA?category=Health#Infant-mortality-rate https://datacommons.org/place/country/USA?category=Health#In... [2] https://www.politifact.com/article/2012/jan/20/was-early-1960s-golden-age-health-care/ https://www.politifact.com/article/2012/jan/20/was-early-196...
  - WalterBright 4y ago
    > First off, the US healthcare market wasn't a free market in 1968 Yes, there was still some government interference that made it less of a free market. The beauty of the free market, however, is the closer it is to a free market the better it works. It's pointless to nitpick over just where the line is. Healthcare outcomes in the US improved throughout the 20th century. There wasn't a magical change in the 1960s. The major government interference started in 1968, and your reference shows things improving throughout the 1960s. > If vaccine shots hadn't been made free to individuals, uptake would have been far slower An assumption without evidence. People don't appreciate things they get for free. In fact, the free vaccines seems to have engendered suspicion of the vaccine and lots of resistance to it. I've often suspected that charging for it would have increased vaccination rates. Besides, in a free market, nothing whatsoever impedes any charity from giving out free stuff. That said, I'd argue that vaccination against highly infectious diseases is a special case that suggests government involvement as a public good.

WalterBright 4y ago

The US had a free market in health care in 1968, and there's simply no evidence to support your suspicions.

modriano 4y ago
First off, the US healthcare market wasn't a free market in 1968. State licensing boards regulated the supply of doctors and as Milton Friedman argued in his book "Free to Choose", powerful interest groups used the US court system to impose massive costs on unlicensed healthcare practitioners; "The AMA has engaged in extensive litigation charging chiropractors and osteopathic physicians with the unlicensed practice of medicine, in an attempt to restrict them to as narrow an area as possible." [0]. So no, even before Medicare and Medicaid, there wasn't a free market for healthcare in the US. Still, in that time, there was much less government involvement in healthcare and the stats show significant improvement after the implementation of the SSA of 1965 Act. Infant mortality fell from over 2.5% in the early 1960s to just over half a percent now [1], with the decrease accelerating in the late 1960's before tapering in the 1980's. Life expectancy also jolted upward in the late 1960's [1]. Healthcare has increased in cost significantly since the time before Medicare and Medicaid, when the treatment for a heart attack was to lay in a hospital bed and wait to die, whereas now, we have much better treatments that can add decades on to people's lives. [2] And regarding the pandemic hypothesis, there's so much evidence to support my claims. If vaccine shots hadn't been made free to individuals, uptake would have been far slower and life would be far worse as the death rate would be much higher than the (still horrifying) ~500 people per day. [0] https://en.m.wikipedia.org/wiki/American_Medical_Association#Criticism https://en.m.wikipedia.org/wiki/American_Medical_Association... [1] https://datacommons.org/place/country/USA?category=Health#Infant-mortality-rate https://datacommons.org/place/country/USA?category=Health#In... [2] https://www.politifact.com/article/2012/jan/20/was-early-1960s-golden-age-health-care/ https://www.politifact.com/article/2012/jan/20/was-early-196...
- WalterBright 4y ago
  > First off, the US healthcare market wasn't a free market in 1968 Yes, there was still some government interference that made it less of a free market. The beauty of the free market, however, is the closer it is to a free market the better it works. It's pointless to nitpick over just where the line is. Healthcare outcomes in the US improved throughout the 20th century. There wasn't a magical change in the 1960s. The major government interference started in 1968, and your reference shows things improving throughout the 1960s. > If vaccine shots hadn't been made free to individuals, uptake would have been far slower An assumption without evidence. People don't appreciate things they get for free. In fact, the free vaccines seems to have engendered suspicion of the vaccine and lots of resistance to it. I've often suspected that charging for it would have increased vaccination rates. Besides, in a free market, nothing whatsoever impedes any charity from giving out free stuff. That said, I'd argue that vaccination against highly infectious diseases is a special case that suggests government involvement as a public good.