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> They have no idea what they are buying, and have no idea if the seller is scamming them or incompetent. It's worse than that, important healthcare decisions

> They have no idea what they are buying, and have no idea if the seller is scamming them or incompetent. It's worse than that, important healthcare decisions are often made while you are unconscious, and you just have to pay for whatever choice was made. Not only do you not know what you're buying, you don't even know a purchase is being made. I am convinced that it doesn't make sense to discuss healthcare as if it is a market. Patients are not "buyers". You pass out, some random person calls 911 and they send a private ambulance, you wake up at the hospital, and now you owe money to the ambulance company. In what sense have you "bought" anything? There has to be more to the definition than just "money is involved". We don't talk about the parking ticket market or the taxation market (just move to a different country if you aren't satisfied with your taxation provider!), and we shouldn't talk about the healthcare market.

lotsofpulp 3y ago
That is a good point, but unless people work for free, someone is selling and someone is buying. While you might not have explicitly bought anything, your agent (whether it be family or the government) did buy something. More broadly, anytime you are dealing with limited resources (including time), you have to be buying and selling (i.e. there are opportunity costs to making a decision). > We don't talk about the parking ticket market You cannot buy a parking ticket, so this is not comparable. However, people do often calculate the cost of legally parking versus the probability * cost of potential fines. >or the taxation market (just move to a different country if you aren't satisfied with your taxation provider!) This happens all the time, but everyone may not have the means to do it. It was one of the factors for my relocation within the US. Even businesses use it to determine where to expand or close operations. Warren Buffett mentioned it in his annual letter some years ago.
- burkaman 3y ago
  I agree that someone is buying and selling, what I mean is that it doesn't make sense to talk about healthcare recipients as participants in a market. Obviously firefighters purchase equipment and sell their labor to the government, but we don't refer to homeowners as buyers in a firefighting market. If we forced them to pay a fee after being saved from a fire, that wouldn't somehow constitute a market. The same is true for any other essential government service: we created socialized systems because they can't function as markets. > You cannot buy a parking ticket Exactly, just like you can't buy an unexpected medical bill. You still have to pay it though. The fact that rich people sometimes choose to accept a parking ticket or choose to purchase citizenship in a more favorable tax environment is not evidence of a market, in fact it's the opposite. If 99% of "buyers" are forced to participate but have 0 decision-making power, and a handful of rich people are able to (sometimes) shop around, you are not describing a market.
  - lotsofpulp 3y ago
    I think this conversation is going off track. For the purposes of determining prices for healthcare, there exists a market, even if the person receiving the healthcare is not paying.
orangecat 3y ago
important healthcare decisions are often made while you are unconscious, and you just have to pay for whatever choice was made This is a problem, but it's not a major driver of health care expenses. Emergency care is around 5% of total spending: https://www.healthaffairs.org/doi/10.1377/hlthaff.2022.01287 https://www.healthaffairs.org/doi/10.1377/hlthaff.2022.01287
- burkaman 3y ago
  It looks like that figure doesn't include ambulance charges, which is the example I had in mind when I wrote that sentence. It also doesn't include decisions made during non-emergency surgery, which still might be necessary to stay alive even though you aren't in the emergency department. It of course doesn't include medication and followup care resulting from whatever unconscious decisions were made. Regardless, I don't believe determining an exact percentage is relevant to this discussion. I'm not an economist, but every definition of "market" I can find says something like "a system where two parties can engage in a transaction". If there's a significant chance that one of the parties is unconscious and/or about to die, they are not engaging in a transaction any more than a mugging victim is. 5% is the chance of rolling a 1 on a d20, that is certainly significant.
  - MichaelZuo 3y ago
    Can you link one such definition?
    - burkaman 3y ago
      > In economics, a market is a composition of systems, institutions, procedures, social relations or infrastructures whereby parties engage in exchange. - https://en.m.wikipedia.org/wiki/Market_(economics) https://en.m.wikipedia.org/wiki/Market_(economics) > A market is a place where parties can gather to facilitate the exchange of goods and services. - https://www.investopedia.com/terms/m/market.asp https://www.investopedia.com/terms/m/market.asp
      - 3y ago

lotsofpulp 3y ago

That is a good point, but unless people work for free, someone is selling and someone is buying. While you might not have explicitly bought anything, your agent (whether it be family or the government) did buy something. More broadly, anytime you are dealing with limited resources (including time), you have to be buying and selling (i.e. there are opportunity costs to making a decision). > We don't talk about the parking ticket market You cannot buy a parking ticket, so this is not comparable. However, people do often calculate the cost of legally parking versus the probability * cost of potential fines. >or the taxation market (just move to a different country if you aren't satisfied with your taxation provider!) This happens all the time, but everyone may not have the means to do it. It was one of the factors for my relocation within the US. Even businesses use it to determine where to expand or close operations. Warren Buffett mentioned it in his annual letter some years ago.

burkaman 3y ago
I agree that someone is buying and selling, what I mean is that it doesn't make sense to talk about healthcare recipients as participants in a market. Obviously firefighters purchase equipment and sell their labor to the government, but we don't refer to homeowners as buyers in a firefighting market. If we forced them to pay a fee after being saved from a fire, that wouldn't somehow constitute a market. The same is true for any other essential government service: we created socialized systems because they can't function as markets. > You cannot buy a parking ticket Exactly, just like you can't buy an unexpected medical bill. You still have to pay it though. The fact that rich people sometimes choose to accept a parking ticket or choose to purchase citizenship in a more favorable tax environment is not evidence of a market, in fact it's the opposite. If 99% of "buyers" are forced to participate but have 0 decision-making power, and a handful of rich people are able to (sometimes) shop around, you are not describing a market.
- lotsofpulp 3y ago
  I think this conversation is going off track. For the purposes of determining prices for healthcare, there exists a market, even if the person receiving the healthcare is not paying.

orangecat 3y ago

important healthcare decisions are often made while you are unconscious, and you just have to pay for whatever choice was made This is a problem, but it's not a major driver of health care expenses. Emergency care is around 5% of total spending: https://www.healthaffairs.org/doi/10.1377/hlthaff.2022.01287 https://www.healthaffairs.org/doi/10.1377/hlthaff.2022.01287

burkaman 3y ago
It looks like that figure doesn't include ambulance charges, which is the example I had in mind when I wrote that sentence. It also doesn't include decisions made during non-emergency surgery, which still might be necessary to stay alive even though you aren't in the emergency department. It of course doesn't include medication and followup care resulting from whatever unconscious decisions were made. Regardless, I don't believe determining an exact percentage is relevant to this discussion. I'm not an economist, but every definition of "market" I can find says something like "a system where two parties can engage in a transaction". If there's a significant chance that one of the parties is unconscious and/or about to die, they are not engaging in a transaction any more than a mugging victim is. 5% is the chance of rolling a 1 on a d20, that is certainly significant.
- MichaelZuo 3y ago
  Can you link one such definition?
  - burkaman 3y ago
    > In economics, a market is a composition of systems, institutions, procedures, social relations or infrastructures whereby parties engage in exchange. - https://en.m.wikipedia.org/wiki/Market_(economics) https://en.m.wikipedia.org/wiki/Market_(economics) > A market is a place where parties can gather to facilitate the exchange of goods and services. - https://www.investopedia.com/terms/m/market.asp https://www.investopedia.com/terms/m/market.asp
    - 3y ago