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> They’re the same people. Government employees, belonging to the same unions, subject to the same incentives. Similarly, private equity is the same people wit

> They’re the same people. Government employees, belonging to the same unions, subject to the same incentives. Similarly, private equity is the same people with the same incentives as Enron, Toys R Us, Sears, and other major collapses. I'm not sure this is a good argument except as to say that nobody should run anything? Government is supposedly less efficient, I'm not sure this is a bad thing, and I'm not sure government is worse at health care than private industry when we are talking about care for the bottom X% (25%?) of society that can't do private payment.

danny_codes 4y ago
Government is supposedly less efficient than a perfect capitol market. Healthcare has inelastic demand, so the perfect market would drive the price to infinity (that is, demand as much money from patients as possible). Oh look, that's exactly s what's happening! For people who love capitolism, Americans are surprisingly uneducated on the concept.
- bhupy 4y ago
  Except food also has inelastic demand (without it you starve and die), and has a pretty close to perfect market, and prices are not driven to infinity. Healthcare in America is about as far away from "capitolism"(sic) as one could possibly get. Due to Federal mandates and tax incentives, health insurance is predominately provided by employers rather than the individual market (unlike Switzerland, Germany, or the Netherlands). What we're seeing in healthcare costs is analogous to what you might see happen to airline ticket costs if we all got our air tickets through our employers: the vast majority of us would fly business class, while the unemployed would be simply unable to pay for business class fares out of pocket. Employers (especially medium-to-large businesses) have a much higher purchasing power (and hence, willingness to pay) than individuals. If you take this behavior and combine it with the fact that health insurers' profit margins are capped by law, insurers pay more absolute dollars for treatments (which doctors happily accept), charge more to employers (who are generally less price conscious vs individuals), thus bring in more absolute revenue, and therefore more profit because a capped profit percentage of a higher revenue is higher than a capped percentage of lower revenue. It's somewhat counter-intuitive, but the policy combination of an employer mandate and insurance profit cap results in prices rising to infinity. The furthest thing possible from a "perfect capitol(sic) market".
  - ggrrhh_ta 4y ago
    Air also has inelastic demand. It is just that it is too cheap (that doesn't mean that the producers make a good profit) to produce an enormous quantity of it (even though fresh food is perishable), so much, that even the US and the EU agree on agricultural quotas and/or increasing tariffs over a certain quota of imported quantity. For Switzerland & Germany the way the incentives work are different than in the US, but the market for compulsory health insurance is very strictly regulated and the cost distribution for healthcare is distributed across public and private entities (particularly for very expensive treatments, rare diseases, treatments involving machines of great complexity/cost [like for proton therapy]).
bhupy 4y ago
> Similarly, private equity is the same people with the same incentives as Enron, Toys R Us, Sears, and other major collapses Right, and the key difference is that there are several other options for all of those things. When private enterprises become unsustainable, they go out of business. When government programs become unsustainable, we increase their budget. With private enterprises, it becomes possible for other alternatives to be introduced in parallel — neither Enron, Toys R Us, nor Sears are monopolies, and with their demise, we still have plenty of energy, toys, and retail. That's not the case for government endeavors. That said, many countries have solved this problem through the provision of competing state-owned enterprises (state capitalism), which are often traded on public stock markets. This is pretty common in the Scandinavian countries, as well as the East Asian Tigers. > I'm not sure government is worse at health care than private industry when we are talking about care for the bottom X% (25%?) of society that can't do private payment. As we all know, there are several countries that are able to pay for care in a way that the government is the monopoly payer (i.e. single-payer), but there are also countries that are able to pay for care in a way that there are multiple payers, with similar (if not better) outcomes. Switzerland and the Netherlands both have purely private health insurance systems, and there's no sign of that changing any time soon, and both enjoy excellent health outcomes with broad approval of their respective healthcare systems (https://www.forbes.com/sites/theapothecary/2011/04/29/why-switzerland-has-the-worlds-best-health-care-system/?sh=43dab83d7d74 https://www.forbes.com/sites/theapothecary/2011/04/29/why-sw...). Even in the US, we're essentially running this A/B test with Medicare (ironically). When you turn 65, you have the option to enroll either in "Original Medicare", which is what we usually think of when we talk about "single payer healthcare in America", or you can enroll in Medicare Advantage (aka Medicare "Part C"), where the premiums that would go to the CMS instead go to private insurers like Humana, United, Oscar Health, Aetna, Clover, etc. These plans replace Original Medicare. - 48% of Medicare beneficiaries are on private Medicare Advantage plans instead of the public "Original Medicare". Because everyone is entitled to "Original Medicare", this is purely voluntary. This number has been growing so rapidly that the CBO projects that by 2023, the majority of beneficiaries with choose the private over the public option. The CBO further projects this proportion to increase to 61%(!!) by 2032. (https://www.kff.org/medicare/issue-brief/medicare-advantage-in-2022-enrollment-update-and-key-trends/ https://www.kff.org/medicare/issue-brief/medicare-advantage-...) - For most beneficiaries, Medicare Advantage costs about 40% less than Original Medicare and are, on average, of higher quality than Original Medicare (https://healthpayerintelligence.com/news/medicare-advantage-costs-40-less-than-fee-for-service-medicare https://healthpayerintelligence.com/news/medicare-advantage-...) - In Urban areas, Medicare Advantage costs less per capita to administer than Medicare — and that's not including the extra Medicare Part D insurance that you would have to buy if you're on the Original Medicare plan (https://www.commonwealthfund.org/publications/issue-briefs/2016/jan/does-medicare-advantage-cost-less-traditional-medicare https://www.commonwealthfund.org/publications/issue-briefs/2...) I personally don't think one is necessarily better than the other (single payer can have good outcomes!), it's just that each have trade-offs that optimize for different things, and it's up to societies to decide which of those trade-offs they prefer. The US has, unfortunately, chosen the worst of both worlds, given that our health insurance market is heavily distorted by the government, and the welfare system that underpins it is inefficiently distributed.

danny_codes 4y ago

Government is supposedly less efficient than a perfect capitol market. Healthcare has inelastic demand, so the perfect market would drive the price to infinity (that is, demand as much money from patients as possible). Oh look, that's exactly s what's happening! For people who love capitolism, Americans are surprisingly uneducated on the concept.

bhupy 4y ago
Except food also has inelastic demand (without it you starve and die), and has a pretty close to perfect market, and prices are not driven to infinity. Healthcare in America is about as far away from "capitolism"(sic) as one could possibly get. Due to Federal mandates and tax incentives, health insurance is predominately provided by employers rather than the individual market (unlike Switzerland, Germany, or the Netherlands). What we're seeing in healthcare costs is analogous to what you might see happen to airline ticket costs if we all got our air tickets through our employers: the vast majority of us would fly business class, while the unemployed would be simply unable to pay for business class fares out of pocket. Employers (especially medium-to-large businesses) have a much higher purchasing power (and hence, willingness to pay) than individuals. If you take this behavior and combine it with the fact that health insurers' profit margins are capped by law, insurers pay more absolute dollars for treatments (which doctors happily accept), charge more to employers (who are generally less price conscious vs individuals), thus bring in more absolute revenue, and therefore more profit because a capped profit percentage of a higher revenue is higher than a capped percentage of lower revenue. It's somewhat counter-intuitive, but the policy combination of an employer mandate and insurance profit cap results in prices rising to infinity. The furthest thing possible from a "perfect capitol(sic) market".
- ggrrhh_ta 4y ago
  Air also has inelastic demand. It is just that it is too cheap (that doesn't mean that the producers make a good profit) to produce an enormous quantity of it (even though fresh food is perishable), so much, that even the US and the EU agree on agricultural quotas and/or increasing tariffs over a certain quota of imported quantity. For Switzerland & Germany the way the incentives work are different than in the US, but the market for compulsory health insurance is very strictly regulated and the cost distribution for healthcare is distributed across public and private entities (particularly for very expensive treatments, rare diseases, treatments involving machines of great complexity/cost [like for proton therapy]).

bhupy 4y ago

> Similarly, private equity is the same people with the same incentives as Enron, Toys R Us, Sears, and other major collapses Right, and the key difference is that there are several other options for all of those things. When private enterprises become unsustainable, they go out of business. When government programs become unsustainable, we increase their budget. With private enterprises, it becomes possible for other alternatives to be introduced in parallel — neither Enron, Toys R Us, nor Sears are monopolies, and with their demise, we still have plenty of energy, toys, and retail. That's not the case for government endeavors. That said, many countries have solved this problem through the provision of competing state-owned enterprises (state capitalism), which are often traded on public stock markets. This is pretty common in the Scandinavian countries, as well as the East Asian Tigers. > I'm not sure government is worse at health care than private industry when we are talking about care for the bottom X% (25%?) of society that can't do private payment. As we all know, there are several countries that are able to pay for care in a way that the government is the monopoly payer (i.e. single-payer), but there are also countries that are able to pay for care in a way that there are multiple payers, with similar (if not better) outcomes. Switzerland and the Netherlands both have purely private health insurance systems, and there's no sign of that changing any time soon, and both enjoy excellent health outcomes with broad approval of their respective healthcare systems (https://www.forbes.com/sites/theapothecary/2011/04/29/why-switzerland-has-the-worlds-best-health-care-system/?sh=43dab83d7d74 https://www.forbes.com/sites/theapothecary/2011/04/29/why-sw...). Even in the US, we're essentially running this A/B test with Medicare (ironically). When you turn 65, you have the option to enroll either in "Original Medicare", which is what we usually think of when we talk about "single payer healthcare in America", or you can enroll in Medicare Advantage (aka Medicare "Part C"), where the premiums that would go to the CMS instead go to private insurers like Humana, United, Oscar Health, Aetna, Clover, etc. These plans replace Original Medicare. - 48% of Medicare beneficiaries are on private Medicare Advantage plans instead of the public "Original Medicare". Because everyone is entitled to "Original Medicare", this is purely voluntary. This number has been growing so rapidly that the CBO projects that by 2023, the majority of beneficiaries with choose the private over the public option. The CBO further projects this proportion to increase to 61%(!!) by 2032. (https://www.kff.org/medicare/issue-brief/medicare-advantage-in-2022-enrollment-update-and-key-trends/ https://www.kff.org/medicare/issue-brief/medicare-advantage-...) - For most beneficiaries, Medicare Advantage costs about 40% less than Original Medicare and are, on average, of higher quality than Original Medicare (https://healthpayerintelligence.com/news/medicare-advantage-costs-40-less-than-fee-for-service-medicare https://healthpayerintelligence.com/news/medicare-advantage-...) - In Urban areas, Medicare Advantage costs less per capita to administer than Medicare — and that's not including the extra Medicare Part D insurance that you would have to buy if you're on the Original Medicare plan (https://www.commonwealthfund.org/publications/issue-briefs/2016/jan/does-medicare-advantage-cost-less-traditional-medicare https://www.commonwealthfund.org/publications/issue-briefs/2...) I personally don't think one is necessarily better than the other (single payer can have good outcomes!), it's just that each have trade-offs that optimize for different things, and it's up to societies to decide which of those trade-offs they prefer. The US has, unfortunately, chosen the worst of both worlds, given that our health insurance market is heavily distorted by the government, and the welfare system that underpins it is inefficiently distributed.