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Does it need to involve the government? How about any aspect of human behaviour that involves people with a difference in economic, health, or educational lev

Does it need to involve the government? How about any aspect of human behaviour that involves people with a difference in economic, health, or educational levels will lead to an exploitative marketplace? (Edit: ^ that looks like a slippery slope to Marxism which isn't intentional so please be gentle with your feedback)

feet 4y ago
Marxism is not necessarily a bad thing
pclmulqdq 4y ago
Yes, it does. The government is the only entity here that has effectively an unlimited wallet. Every time the government is involved in these markets (without taking them over completely), prices explode because the government purse completely crushes the demand curve. Education and healthcare are prime examples. If you want a counterexample to the idea that healthcare prices are high solely because the demand for healthcare is inelastic, look at dental care. There isn't a lot of government funding for dental care, although it is very much necessary for your overall health. As a result, dental care is comparatively cheap - a full routine cleaning plus a check-up from your dentist (handled by private insurance) costs about the same as a single lab test (handled by medicare/medicaid and private insurance). Serious interventions, like wisdom tooth removal, crowns, or braces, cost only thousands of dollars. By contrast, routine surgeries are often in the tens of thousands. Similarly, in education, private trade schools tend to cost $10,000/year or so, while private colleges are $50,000-70,000. The economic benefits of a private trade school are actually similar to the benefits of several majors.
- PaulHoule 4y ago
  To be fair though, a shocking number of people don't see a dentist regularly for cleanings and go for years with problems that could be fixed with a $2000 dental surgery because they can't scrape together $2000.
- taeric 4y ago
  For profit education was a clear sham, though. Such that it is a giant elephant in the room when claiming that private schools are better than public. Dentistry is also similarly... not as strong as you'd hope. "Do something" behavior is strong in that field with relatively little evidence that the amount of interventions we do is necessary.
  - pclmulqdq 4y ago
    Dental cleaning and some oral surgeries (eg wisdom tooth removal) are both very clearly good for your overall health. I agree that a lot of dentistry is quackery, though. A lot of it is also pretty much cosmetic. Also, we should add that private != for-profit. This applies to both trade schools and colleges - don't go to a for-profit school.
    - taeric 4y ago
      Wisdom teeth removal is actually one of the things they default to, that it is less clear they should default. Though, I don't know how to square your thoughts here. Prime example of how private enterprises control costs? Or a lot of quackery and cosmetic only? These seem at odds. I'm not sure what the distinction between private and for-profit is. Can you elaborate?
      - pclmulqdq 4y ago
        Examples of necessary things. If the wisdom teeth are coming in straight, they can stay (although most dentists will remove them anyway), but they usually come in at an angle, and need to come out so that they don't cause problems. I agree with you that dentists overdo this one, but for many people it is actually necessary. In the US, we have 3 kinds of schools: * Public/state schools: The school is run by a state government. Some of these have good quality, but some are not good. All of them give a huge discount to students from the local state. * Private for-profit: These usually all suck, and are scams. ITT tech, University of Phoenix, and others are in this boat. These make their money by providing an education for less money than they charge in tuition. * Private non-profit: The school is organized and run as a non-profit institution, but is not connected to the government. Harvard, MIT, Stanford, and most other top colleges are private non-profits. Outside the US, I think Oxford and Cambridge are also like this. Private non-profit trade schools also exist, and they are usually the best ones. An example I can think of is the North Bennet Street School (again in Boston, MA). The high-end schools in this category tend to get more of their money from donations and endowments than from tuition.
- downut 4y ago
  In the US dental implants, bridges, and root canals are not cheap, and hardly affordable for anyone who is not well off (enough). I.e., me. For example, a central incisor bridge I can't stand cost me $2300 a couple of months ago.
  - slaw 4y ago
    Dentistry is highly regulated market so it must be expensive.
    - vkou 4y ago
      The exact same dental work in Canada is a third of the price. But my dentist there operated out of his suburban basement, while my dentist here operates out of a swanky Main Street office that I get to pay for. Both countries use the same, non-socialized, out-of-pocket-or-private-insurance model of dental care.
  - pclmulqdq 4y ago
    I hear that dentistry in Mexico is often better for complex procedures at 1/4th the cost. Dentists in the US want to be paid like doctors.
    - FireBeyond 4y ago
      > Dentists in the US want to be paid like doctors. There are not many poor US dentists. Just a month or two ago here was someone talking about how, fresh out of dental school, they were able to secure a $4M loan to set up their practice. I am in the midst of having some complex dental work done. In the US, I got three competing quotes. The lowest was $49K, the highest $57K. I am getting it done in Mexico for $23K. With arguably better equipment used (all 'top shelf' implants, materials, etc.)
      - stoppingin 4y ago
        I'm an Australian with family in eastern-Europe. I get my dental work done there at a fraction of the cost of doing it here in Sydney. The quality is at least on par with Australia. I was unable to travel for a few years on account of work, and then COVID, and was seeing the local dentist recommended by my health insurer. They advised me that I needed my wisdom teeth removed. I was skeptical: My wisdom teeth came through in my teens with zero pain. I'm an adult with no tooth pain. When I asked why, the dentist was very vague, and told me it was for the best on account of the long-term likelihood of decay. I wasn't convinced. When I recently saw my extended family's local dentist, they showed me that my local Australian dentist had just left decay to flourish in my wisdom teeth, and not even let me know there were cavities there that were fixable. A quick filling would have saved me lots of hassle. Instead it seems they wanted to encourage me to take a much more costly course of action. In case anyone is wondering, this was an expensive clinic in Sydney's CBD. I'll never return!
- anigbrowl 4y ago
  No it doesn't. The market for concert tickets is a complete shitshow, even though they're not subsidized by government. QED.
- cool_dude85 4y ago
  Healthcare is explicitly an area where the government is provably more efficient, and I believe situations like those in the article are caused by the interface between the government and private corporations lacking appropriate oversight, investigatory powers, etc. That is to say, the issue here is not "government waste" but rather the private sector bilking the government, abetted at times by the government itself, of course. But compare Medicare reimbursement rates and private insurer rates, compare outcomes and satisfaction with care between private insurers and Medicare/Medicaid, even within the US: the government is the clear winner despite spending much less. Once you compare across countries this becomes even more obvious.
  - coredog64 4y ago
    In the US, if you accept Medicare patients, by law you must not charge anyone less than you charge Medicare. Private entities typically see Medicare patients as marginal demand: The bed/room is there, the nurses are already staffed, so might as well take Medicare dollars than nothing. So it’s not really much of a dunk to point out Medicare vs. private reimbursement rates.
    - pclmulqdq 4y ago
      Also note that Medicare pays 10 cents on the dollar for everything on the chargemaster. Hospitals are priced to make a tiny bit of money on that, so a lab test with $20 of reagents and $10 of lab tech time goes on the chargemaster for about $300. 1 hour of doctor time easily pushes you into the high thousands on the chargemaster.
- vagrantJin 4y ago
  > The government is the only entity here that has effectively an unlimited wallet To be clear, the US government has an infinite wallet.
- robbiep 4y ago
  Yes, healthcare demand is inelastic. Dental care is actually not inelastic. A huge percentage pass it up. Where the absurdity of healthcare costs come from, in the US, from my experience as a provider there and in Australia, is the huge information assymetry (ie most people cannot doctor themselves - this is true everywhere) along with, in the US, the need to practice hugely defensive medicine and a drive to add in and bill for as many things as possible. The country is totally fucked (on a healthcare basis at least) because the construction of so many perverse incentives has driven the whole mode of behaviour out of whack
  - dsfyu404ed 4y ago
    Yes, healthcare demand is inelastic. Dental care is actually not inelastic. A huge percentage pass it up. A huge fraction of medical care is just as elective as dental.
PaulHoule 4y ago
Try watching the evening news on broadcast TV sometimes. You occasionally see an ad for something buy out of their own pocket (particularly DTC startups) but it is almost all benefits you can get from medicare, prescription drugs, lawsuits you can join because your CPAP is trying to kill you, and personal injury lawyers that specialize in car crash victims. (I guess somebody has to advertise cars because if people didn't buy cars you couldn't get hit by a car and call William Matar but you don't see car ads until 8pm when prime time starts) What's scary is that these people vote... And they want to get the government out of their medicare.

feet 4y ago

Marxism is not necessarily a bad thing

pclmulqdq 4y ago

Yes, it does. The government is the only entity here that has effectively an unlimited wallet. Every time the government is involved in these markets (without taking them over completely), prices explode because the government purse completely crushes the demand curve. Education and healthcare are prime examples. If you want a counterexample to the idea that healthcare prices are high solely because the demand for healthcare is inelastic, look at dental care. There isn't a lot of government funding for dental care, although it is very much necessary for your overall health. As a result, dental care is comparatively cheap - a full routine cleaning plus a check-up from your dentist (handled by private insurance) costs about the same as a single lab test (handled by medicare/medicaid and private insurance). Serious interventions, like wisdom tooth removal, crowns, or braces, cost only thousands of dollars. By contrast, routine surgeries are often in the tens of thousands. Similarly, in education, private trade schools tend to cost $10,000/year or so, while private colleges are $50,000-70,000. The economic benefits of a private trade school are actually similar to the benefits of several majors.

PaulHoule 4y ago
To be fair though, a shocking number of people don't see a dentist regularly for cleanings and go for years with problems that could be fixed with a $2000 dental surgery because they can't scrape together $2000.
taeric 4y ago
For profit education was a clear sham, though. Such that it is a giant elephant in the room when claiming that private schools are better than public. Dentistry is also similarly... not as strong as you'd hope. "Do something" behavior is strong in that field with relatively little evidence that the amount of interventions we do is necessary.
- pclmulqdq 4y ago
  Dental cleaning and some oral surgeries (eg wisdom tooth removal) are both very clearly good for your overall health. I agree that a lot of dentistry is quackery, though. A lot of it is also pretty much cosmetic. Also, we should add that private != for-profit. This applies to both trade schools and colleges - don't go to a for-profit school.
  - taeric 4y ago
    Wisdom teeth removal is actually one of the things they default to, that it is less clear they should default. Though, I don't know how to square your thoughts here. Prime example of how private enterprises control costs? Or a lot of quackery and cosmetic only? These seem at odds. I'm not sure what the distinction between private and for-profit is. Can you elaborate?
    - pclmulqdq 4y ago
      Examples of necessary things. If the wisdom teeth are coming in straight, they can stay (although most dentists will remove them anyway), but they usually come in at an angle, and need to come out so that they don't cause problems. I agree with you that dentists overdo this one, but for many people it is actually necessary. In the US, we have 3 kinds of schools: * Public/state schools: The school is run by a state government. Some of these have good quality, but some are not good. All of them give a huge discount to students from the local state. * Private for-profit: These usually all suck, and are scams. ITT tech, University of Phoenix, and others are in this boat. These make their money by providing an education for less money than they charge in tuition. * Private non-profit: The school is organized and run as a non-profit institution, but is not connected to the government. Harvard, MIT, Stanford, and most other top colleges are private non-profits. Outside the US, I think Oxford and Cambridge are also like this. Private non-profit trade schools also exist, and they are usually the best ones. An example I can think of is the North Bennet Street School (again in Boston, MA). The high-end schools in this category tend to get more of their money from donations and endowments than from tuition.
downut 4y ago
In the US dental implants, bridges, and root canals are not cheap, and hardly affordable for anyone who is not well off (enough). I.e., me. For example, a central incisor bridge I can't stand cost me $2300 a couple of months ago.
- slaw 4y ago
  Dentistry is highly regulated market so it must be expensive.
  - vkou 4y ago
    The exact same dental work in Canada is a third of the price. But my dentist there operated out of his suburban basement, while my dentist here operates out of a swanky Main Street office that I get to pay for. Both countries use the same, non-socialized, out-of-pocket-or-private-insurance model of dental care.
- pclmulqdq 4y ago
  I hear that dentistry in Mexico is often better for complex procedures at 1/4th the cost. Dentists in the US want to be paid like doctors.
  - FireBeyond 4y ago
    > Dentists in the US want to be paid like doctors. There are not many poor US dentists. Just a month or two ago here was someone talking about how, fresh out of dental school, they were able to secure a $4M loan to set up their practice. I am in the midst of having some complex dental work done. In the US, I got three competing quotes. The lowest was $49K, the highest $57K. I am getting it done in Mexico for $23K. With arguably better equipment used (all 'top shelf' implants, materials, etc.)
    - stoppingin 4y ago
      I'm an Australian with family in eastern-Europe. I get my dental work done there at a fraction of the cost of doing it here in Sydney. The quality is at least on par with Australia. I was unable to travel for a few years on account of work, and then COVID, and was seeing the local dentist recommended by my health insurer. They advised me that I needed my wisdom teeth removed. I was skeptical: My wisdom teeth came through in my teens with zero pain. I'm an adult with no tooth pain. When I asked why, the dentist was very vague, and told me it was for the best on account of the long-term likelihood of decay. I wasn't convinced. When I recently saw my extended family's local dentist, they showed me that my local Australian dentist had just left decay to flourish in my wisdom teeth, and not even let me know there were cavities there that were fixable. A quick filling would have saved me lots of hassle. Instead it seems they wanted to encourage me to take a much more costly course of action. In case anyone is wondering, this was an expensive clinic in Sydney's CBD. I'll never return!
anigbrowl 4y ago
No it doesn't. The market for concert tickets is a complete shitshow, even though they're not subsidized by government. QED.
cool_dude85 4y ago
Healthcare is explicitly an area where the government is provably more efficient, and I believe situations like those in the article are caused by the interface between the government and private corporations lacking appropriate oversight, investigatory powers, etc. That is to say, the issue here is not "government waste" but rather the private sector bilking the government, abetted at times by the government itself, of course. But compare Medicare reimbursement rates and private insurer rates, compare outcomes and satisfaction with care between private insurers and Medicare/Medicaid, even within the US: the government is the clear winner despite spending much less. Once you compare across countries this becomes even more obvious.
- coredog64 4y ago
  In the US, if you accept Medicare patients, by law you must not charge anyone less than you charge Medicare. Private entities typically see Medicare patients as marginal demand: The bed/room is there, the nurses are already staffed, so might as well take Medicare dollars than nothing. So it’s not really much of a dunk to point out Medicare vs. private reimbursement rates.
  - pclmulqdq 4y ago
    Also note that Medicare pays 10 cents on the dollar for everything on the chargemaster. Hospitals are priced to make a tiny bit of money on that, so a lab test with $20 of reagents and $10 of lab tech time goes on the chargemaster for about $300. 1 hour of doctor time easily pushes you into the high thousands on the chargemaster.
vagrantJin 4y ago
> The government is the only entity here that has effectively an unlimited wallet To be clear, the US government has an infinite wallet.
robbiep 4y ago
Yes, healthcare demand is inelastic. Dental care is actually not inelastic. A huge percentage pass it up. Where the absurdity of healthcare costs come from, in the US, from my experience as a provider there and in Australia, is the huge information assymetry (ie most people cannot doctor themselves - this is true everywhere) along with, in the US, the need to practice hugely defensive medicine and a drive to add in and bill for as many things as possible. The country is totally fucked (on a healthcare basis at least) because the construction of so many perverse incentives has driven the whole mode of behaviour out of whack
- dsfyu404ed 4y ago
  Yes, healthcare demand is inelastic. Dental care is actually not inelastic. A huge percentage pass it up. A huge fraction of medical care is just as elective as dental.

PaulHoule 4y ago

Try watching the evening news on broadcast TV sometimes. You occasionally see an ad for something buy out of their own pocket (particularly DTC startups) but it is almost all benefits you can get from medicare, prescription drugs, lawsuits you can join because your CPAP is trying to kill you, and personal injury lawyers that specialize in car crash victims. (I guess somebody has to advertise cars because if people didn't buy cars you couldn't get hit by a car and call William Matar but you don't see car ads until 8pm when prime time starts) What's scary is that these people vote... And they want to get the government out of their medicare.