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Imagine a world where one entity received all the peoples medical bills and was incentived to negotiate for the lowest possible rate from each provider. Imagine

Imagine a world where one entity received all the peoples medical bills and was incentived to negotiate for the lowest possible rate from each provider. Imagine the savings alone from reducing a massively overly bureaucratic and complicated system down to just one entity negotiating and paying the health service providers. Just imagine in that world this article would have never needed to have been written.

avidphantasm 4y ago
Bu…bu…but we can’t have “big government”!!! Imagine the horrors!
firstlink 4y ago
> was incentived to negotiate for the lowest possible rate from each provider So, not an entity which by its very nature spends other people's money and can never run out? I agree, sounds like a great idea, but someone will have to invent such an entity first. The ones we have would not meet the requirement.
- mlyle 4y ago
  Of course, the existing private entities are barred from doing something like this by antitrust law.
- yamtaddle 4y ago
  Thank god no-one's tried, I'm sure the population of any such country would riot to reform to something free-market-based instead in short order, because expenses would rapidly grow out of control, vastly in excess of, say, what the US spends per-capita, and service would be completely terrible, leading to plainly-worse-in-every-way outcomes than in countries that retained more-enlightened systems. ... what's that? The entire OECD has more centralized government control of healthcare than the US, ranging from extensive price controls, to de-facto or de-jure monopsony, to outright direct control of the healthcare system, and nowhere is there a strong populist movement to ditch that for a heavily free-market-based solution? And literally all of them are way cheaper per-capita than our system? And outcomes remain between pretty-good and great? And instead of the bureaucratic billing mess we have, that's all nice & simple and takes up almost none of the time of sick people and their families? This makes no sense, I read several columns on mises.org proving from first principles that this is impossible!
Alupis 4y ago
> Imagine a world where Yes, and let's also imagine all of the existing single-payer systems (de facto or otherwise) work as advertised and didn't have elites-with-means flee to other nations for quality care. Let's also imagine these systems provide stellar quality care and more importantly, timely care. We can daydream all we want - but the reality isn't so obvious or absolute. For those who are really in the know... the US already is a socialized medicine nation. Look at how much of the US annual budget is blown on medical care. Hint... it's larger than the military budget.
- nhinck2 4y ago
  There are plenty of countries which operate functioning public health systems with optional private care. There is no daydreaming required.
  - Alupis 4y ago
    > There are plenty of countries which operate functioning public health systems with optional private care. You mean the US...? It's a quaint idea... but nobody likes the reality once it's implemented. Evidenced by the fact that the US is already the largest public health system in the world, and people do not even realize it.
    - nhinck2 4y ago
      No, functioning, so not like the US, universal public health care with costs covered by the government. I'm not sure why you're ignoring a lot of Europe, Canada, Australia and New Zealand.
      - Alupis 4y ago
        > I'm not sure why you're ignoring a lot of Europe, Canada, Australia and New Zealand. These are exactly the ones I had in mind. > universal public health care with costs covered by the government. To be pedantic, this doesn't exist anywhere in the world. The taxpayers foot the bill universally. You may not personally care, but it matters when we're discussing spending other people's money. In the US, we already have universal public health care. If you cannot afford to pay a portion of your premium, you can be eligible for healthcare at zero expense to you. The US government spends more on healthcare than any other nation. The US is already socialized healthcare. It's just not the utopia people thought it would be so they continue to complain... It gets way more complicated than we can discuss here - things like private premiums are so expensive because the socialized system does not pay it's entire bill, etc. The entire thing is a massive C.F. but speeding further down that same tunnel is not going to suddenly magically make it better. It's very much-so the "but we can do it better" mentality, despite however many previous attempts there has been.
elzbardico 4y ago
The reality is that both systems suck, and I say this having lived in systems with universal public healthcare. They just suck in different manners, different countries have different degrees of "suckness" and so on. And then there's the big problem beyond the question of who is paying: How much is being paid. Healthcare costs in the US are absurdly high both on relative terms (things are way more expensive) and on absolute terms (more of the same things is needed because the American population is relatively too unhealthy for what you'd expect in a developed country with similar demographics). You need to ask why relatively inexpensive stuff like insulin is so much expensive in America than say, Germany or the UK. If you don't solve this issue, a single payer system would probably become more similar to the terrible situation in most Latin American countries, where you have terrible supposedly universal public healthcare systems, but where in practice if you can pay for private insurance, you will do it.
- relaxing 4y ago
  > Healthcare costs in the US are absurdly high both on relative terms (things are way more expensive) and on absolute terms (more of the same things is needed because the American population is relatively too unhealthy for what you'd expect in a developed country with similar demographics). You need to ask why relatively inexpensive stuff like insulin is so much expensive in America than say, Germany or the UK. Must be that law of economics that says the more you make of something the more expensive it gets.
  - vianneychevalie 4y ago
    I know you're joking here, however, increasing marginal costs products are well-know and studied in microeconomics. https://www.investopedia.com/terms/l/lawofdiminishingmarginalreturn.asp https://www.investopedia.com/terms/l/lawofdiminishingmargina...
deleted 4y ago
[deleted]
Nition 4y ago
https://pharmac.govt.nz/about/what-we-do/pharmac-history/ https://pharmac.govt.nz/about/what-we-do/pharmac-history/
ratboy666 4y ago
The provider of care gets paid "a reasonable amount". The care is provided. No bureaucratic nonsense. Sound ideal. Except... someone invents a novel care. They can choose to provide it "for a reasonable amount". But it can ONLY be provided by the entity paying "a reasonable amount". That entity has to make the call "novel care/old care". Old care is ALSO provided at a "reasonable amount" and has entrenched interests. There is no way that novel care wins. Without setting up an alternate system, or going OUTSIDE the system. Then, consumers of old care can see novel care and its benefits. They can then demand novel care. This happens within the American system, and the American system provides that "outsider status" to other systems (like the one we have in Canada). What does the Canadian system eventually go? Without sufficient external force, it is less expensive to provide MAID (medical assistance in dying) that actual healthcare. The current debate in Canada is whether mental illness is a sufficient trigger for MAID. Depressed? Best cure is death. And, yes, Canada has been mocked for that.

avidphantasm 4y ago

Bu…bu…but we can’t have “big government”!!! Imagine the horrors!

firstlink 4y ago

> was incentived to negotiate for the lowest possible rate from each provider So, not an entity which by its very nature spends other people's money and can never run out? I agree, sounds like a great idea, but someone will have to invent such an entity first. The ones we have would not meet the requirement.

mlyle 4y ago
Of course, the existing private entities are barred from doing something like this by antitrust law.
yamtaddle 4y ago
Thank god no-one's tried, I'm sure the population of any such country would riot to reform to something free-market-based instead in short order, because expenses would rapidly grow out of control, vastly in excess of, say, what the US spends per-capita, and service would be completely terrible, leading to plainly-worse-in-every-way outcomes than in countries that retained more-enlightened systems. ... what's that? The entire OECD has more centralized government control of healthcare than the US, ranging from extensive price controls, to de-facto or de-jure monopsony, to outright direct control of the healthcare system, and nowhere is there a strong populist movement to ditch that for a heavily free-market-based solution? And literally all of them are way cheaper per-capita than our system? And outcomes remain between pretty-good and great? And instead of the bureaucratic billing mess we have, that's all nice & simple and takes up almost none of the time of sick people and their families? This makes no sense, I read several columns on mises.org proving from first principles that this is impossible!

Alupis 4y ago

> Imagine a world where Yes, and let's also imagine all of the existing single-payer systems (de facto or otherwise) work as advertised and didn't have elites-with-means flee to other nations for quality care. Let's also imagine these systems provide stellar quality care and more importantly, timely care. We can daydream all we want - but the reality isn't so obvious or absolute. For those who are really in the know... the US already is a socialized medicine nation. Look at how much of the US annual budget is blown on medical care. Hint... it's larger than the military budget.

nhinck2 4y ago
There are plenty of countries which operate functioning public health systems with optional private care. There is no daydreaming required.
- Alupis 4y ago
  > There are plenty of countries which operate functioning public health systems with optional private care. You mean the US...? It's a quaint idea... but nobody likes the reality once it's implemented. Evidenced by the fact that the US is already the largest public health system in the world, and people do not even realize it.
  - nhinck2 4y ago
    No, functioning, so not like the US, universal public health care with costs covered by the government. I'm not sure why you're ignoring a lot of Europe, Canada, Australia and New Zealand.
    - Alupis 4y ago
      > I'm not sure why you're ignoring a lot of Europe, Canada, Australia and New Zealand. These are exactly the ones I had in mind. > universal public health care with costs covered by the government. To be pedantic, this doesn't exist anywhere in the world. The taxpayers foot the bill universally. You may not personally care, but it matters when we're discussing spending other people's money. In the US, we already have universal public health care. If you cannot afford to pay a portion of your premium, you can be eligible for healthcare at zero expense to you. The US government spends more on healthcare than any other nation. The US is already socialized healthcare. It's just not the utopia people thought it would be so they continue to complain... It gets way more complicated than we can discuss here - things like private premiums are so expensive because the socialized system does not pay it's entire bill, etc. The entire thing is a massive C.F. but speeding further down that same tunnel is not going to suddenly magically make it better. It's very much-so the "but we can do it better" mentality, despite however many previous attempts there has been.

elzbardico 4y ago

The reality is that both systems suck, and I say this having lived in systems with universal public healthcare. They just suck in different manners, different countries have different degrees of "suckness" and so on. And then there's the big problem beyond the question of who is paying: How much is being paid. Healthcare costs in the US are absurdly high both on relative terms (things are way more expensive) and on absolute terms (more of the same things is needed because the American population is relatively too unhealthy for what you'd expect in a developed country with similar demographics). You need to ask why relatively inexpensive stuff like insulin is so much expensive in America than say, Germany or the UK. If you don't solve this issue, a single payer system would probably become more similar to the terrible situation in most Latin American countries, where you have terrible supposedly universal public healthcare systems, but where in practice if you can pay for private insurance, you will do it.

relaxing 4y ago
> Healthcare costs in the US are absurdly high both on relative terms (things are way more expensive) and on absolute terms (more of the same things is needed because the American population is relatively too unhealthy for what you'd expect in a developed country with similar demographics). You need to ask why relatively inexpensive stuff like insulin is so much expensive in America than say, Germany or the UK. Must be that law of economics that says the more you make of something the more expensive it gets.
- vianneychevalie 4y ago
  I know you're joking here, however, increasing marginal costs products are well-know and studied in microeconomics. https://www.investopedia.com/terms/l/lawofdiminishingmarginalreturn.asp https://www.investopedia.com/terms/l/lawofdiminishingmargina...

deleted 4y ago

[deleted]

Nition 4y ago

https://pharmac.govt.nz/about/what-we-do/pharmac-history/ https://pharmac.govt.nz/about/what-we-do/pharmac-history/

ratboy666 4y ago

The provider of care gets paid "a reasonable amount". The care is provided. No bureaucratic nonsense. Sound ideal. Except... someone invents a novel care. They can choose to provide it "for a reasonable amount". But it can ONLY be provided by the entity paying "a reasonable amount". That entity has to make the call "novel care/old care". Old care is ALSO provided at a "reasonable amount" and has entrenched interests. There is no way that novel care wins. Without setting up an alternate system, or going OUTSIDE the system. Then, consumers of old care can see novel care and its benefits. They can then demand novel care. This happens within the American system, and the American system provides that "outsider status" to other systems (like the one we have in Canada). What does the Canadian system eventually go? Without sufficient external force, it is less expensive to provide MAID (medical assistance in dying) that actual healthcare. The current debate in Canada is whether mental illness is a sufficient trigger for MAID. Depressed? Best cure is death. And, yes, Canada has been mocked for that.