4 ms·

> This also stops the subsidy from ratcheting up the cost of the thing, because if you can drive 30 minutes out of your way to save a thousand dollars you do it

> This also stops the subsidy from ratcheting up the cost of the thing, because if you can drive 30 minutes out of your way to save a thousand dollars you do it, but if the government is paying either way then you don't. If the government is paying, why would it be cheaper 30 minutes away? One of the main features of single payer systems is that the single payer can impose a price list, and control any “ratcheting of prices” as you put it

AnthonyMouse 3y ago
A price list is a price control. Then no one has any incentive to lower the price beyond that so there is no price competition. If they set the price too low, you get shortages or long queues or sacrifice quality and no one can do better because that would require charging more, which isn't allowed. If they set the price too high they're overpaying, which is what happens in any system where the providers have political influence, as is manifestly the case in the US. Then new competitors can't lower the price because it's set by corrupt politicians and more efficient providers aren't allowed to return the difference to patients who choose them. And you can screw up in both directions at once. The list price is too low for a high cost of living area so you can't have a provider in a convenient location for people willing to pay more, but is too high for a provider in a less expensive area who then has no incentive to pass on their lower costs to price sensitive consumers. If the government tries to pay them each a different amount then patients have no reason to avoid the higher cost one which increases healthcare spending.
- namdnay 3y ago
  We're not talking about a controlled economy trying to set prices on an open market. We're talking about a single purchaser using its power to impose prices on suppliers. It's hardly unique - how do you think Walmart keeps its prices as low as possible? By leveraging their power. And all your aguments seem a bit moot when you look at countries with single-payer systems - they just work, at a per-person cost that is far lower than the US
  - AnthonyMouse 3y ago
    > It's hardly unique - how do you think Walmart keeps its prices as low as possible? By leveraging their power. Walmart is subject to competitive pressure. If they squeeze suppliers too hard and quality suffers or some suppliers refuse to meet their demands, consumers can go buy products from a different retailer. In cases where you actually do have a private monopolist, is is terrible. > And all your aguments seem a bit moot when you look at countries with single-payer systems - they just work, at a per-person cost that is far lower than the US In the US the medical providers have significant political influence which results in a regulatory environment that favors high prices and there is no reason to expect a single payer system in the same environment to change that. In some systems the providers have less political influence, but many of those systems have long queues or refuse care on the basis of cost or have other deficiencies with no recourse. It's also entirely possible to have a socialized system which is more efficient than the status quo in the US but less efficient than a system that actually exposed providers to competitive pressure. The cost efficiency of the existing US healthcare system is a bar level with the ground.

AnthonyMouse 3y ago

A price list is a price control. Then no one has any incentive to lower the price beyond that so there is no price competition. If they set the price too low, you get shortages or long queues or sacrifice quality and no one can do better because that would require charging more, which isn't allowed. If they set the price too high they're overpaying, which is what happens in any system where the providers have political influence, as is manifestly the case in the US. Then new competitors can't lower the price because it's set by corrupt politicians and more efficient providers aren't allowed to return the difference to patients who choose them. And you can screw up in both directions at once. The list price is too low for a high cost of living area so you can't have a provider in a convenient location for people willing to pay more, but is too high for a provider in a less expensive area who then has no incentive to pass on their lower costs to price sensitive consumers. If the government tries to pay them each a different amount then patients have no reason to avoid the higher cost one which increases healthcare spending.

namdnay 3y ago
We're not talking about a controlled economy trying to set prices on an open market. We're talking about a single purchaser using its power to impose prices on suppliers. It's hardly unique - how do you think Walmart keeps its prices as low as possible? By leveraging their power. And all your aguments seem a bit moot when you look at countries with single-payer systems - they just work, at a per-person cost that is far lower than the US
- AnthonyMouse 3y ago
  > It's hardly unique - how do you think Walmart keeps its prices as low as possible? By leveraging their power. Walmart is subject to competitive pressure. If they squeeze suppliers too hard and quality suffers or some suppliers refuse to meet their demands, consumers can go buy products from a different retailer. In cases where you actually do have a private monopolist, is is terrible. > And all your aguments seem a bit moot when you look at countries with single-payer systems - they just work, at a per-person cost that is far lower than the US In the US the medical providers have significant political influence which results in a regulatory environment that favors high prices and there is no reason to expect a single payer system in the same environment to change that. In some systems the providers have less political influence, but many of those systems have long queues or refuse care on the basis of cost or have other deficiencies with no recourse. It's also entirely possible to have a socialized system which is more efficient than the status quo in the US but less efficient than a system that actually exposed providers to competitive pressure. The cost efficiency of the existing US healthcare system is a bar level with the ground.