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The US government did not invent insurance. If a company wanted to compete with an existing insurance company but do it differently, they can already do that; d

by borski 3y ago

The US government did not invent insurance. If a company wanted to compete with an existing insurance company but do it differently, they can already do that; direct primary care offerings exist right now. Healthcare, when coupled with a profit motive, offers misaligned incentives, period. Getting people healthier for cheaper doesn't make a healthcare company money. That is why I believe basic healthcare should be socialized. That doesn't mean we can't have private companies offering countless other medical services or additional insurance, but nobody should be getting denied a cochlear implant because they are deaf due to 'paperwork issues' for months or years until they die.

pdonis 3y ago
> The US government did not invent insurance. I never claimed it did. My claim is that what we call "health insurance" in the US is not just insurance; it is a bundle of insurance (coverage for high cost unforeseen events) with other things that aren't insurance, but have to be bundled with it because the government says so. > direct primary care offerings exist right now. Yes, they do, but they are hamstrung by the fact that the US health care system disincentivizes patients from using them. If all primary care in the US was provided by such places, and patients paid the costs directly, that would be a free market, at least in primary care. But that's nothing like what we have. It's certainly nothing like what Medicare Advantage, which is the subject of this discussion, provides. > Healthcare, when coupled with a profit motive, offers misaligned incentives, period. Not in a free market. Health care in the US before WW II was provided by private companies (or individuals like doctors with their own practices), for profit, and worked better, given the technology of the time, than what we have now. What ended that system was laws passed during WW II that fixed wages, which meant that companies could not compete for labor in a free market by offering higher wages. So companies looked around for other benefits they could offer to compete, and health care was an obvious one. And then after the war the government decided to regulate the company-provided health care instead of ending it and restoring a free market. What offers misaligned incentives is the bastardized system we have in the US, which combines the worst features of for-profit with the worst features of socialism. The for-profit part is not visible to the actual patients--as I have already pointed out upthread, patients have no idea what the services they are getting actually cost, so they have no idea whether they are worth what they cost. The socialized part is what patients see--the services available to them are determined by their health "insurance", not them--but decisions are made by third parties who have no skin in the game and suffer no consequences when they make bad decisions that cause harm to patients. > nobody should be getting denied a cochlear implant because they are deaf due to 'paperwork issues' for months or years until they die. Of course not. And this would not happen in a free market. It happens because we don't have a free market in cochlear implants, we have a non-free market system with misaligned incentives, as I described above.
- sulam 3y ago
  What would happen in a truly free market is that a large percentage of elderly people with fixed incomes would be priced out of the medical care they need to live healthy, fulfilling lives past their 60s. This is very simple math, and it is something our society has decided not to support. There's a variety of factors driving that decision, not least that the elderly is a large, active voting bloc and politicians want to court their good will. If you have a solution for this that doesn't just assume "the free market" will work it out, that would be interesting.
  - nickpp 3y ago
    Free markets tend to reduce prices making health care more affordable (including for people on fixed income). For an incredible success story see how the free markets made computing power so affordable despite last century’s “digital divide” worries.
    - ffgjgf1 3y ago
      “Free market” can only exist in specific sectors and rarely without extensive regulation. Comparing computer and healthcare industries makes almost no sense (besides extremely superficial ways) due to perfectly obvious reasons. > making health care more affordable Doubtful (since there is zero evidence of this working anywhere). Try to imagine how would this work for cancer and other serious diseases (hint: it wouldn’t at all for the majority of the population without some form of ins)
      - nickpp 3y ago
        Free markets have existed since the dawn of mankind. Their only prerequisite was the rule of law. They are responsible for the amazing wealth we are enjoying everyday, for the full shelves of products and the range of services offered to us. While regulations - brought for our own good and safety, of course - succeed in increasing costs and add delays. Just see healthcare, housing and education for some sad examples. I am curious why you think they wouldn't work for healthcare since: a) they worked just fine before government started intervening somewhere mid-last century and b) their mechanisms (price signals, competition, law of supply and demand, etc) apply just as well like for any other essential goods (food, water, fuel, etc).
ffgjgf1 3y ago
> That doesn't mean we can't have private companies offering countless other medical services or additional insurance You can have fully functional almost entirely private healthcare systems (more so than in the US) which are heavily regulated like in the Netherlands or Switzerland. Of course they are still ‘socialized’ system but so is the US by that definition.

by borski 3y ago

pdonis 3y ago

> The US government did not invent insurance. I never claimed it did. My claim is that what we call "health insurance" in the US is not just insurance; it is a bundle of insurance (coverage for high cost unforeseen events) with other things that aren't insurance, but have to be bundled with it because the government says so. > direct primary care offerings exist right now. Yes, they do, but they are hamstrung by the fact that the US health care system disincentivizes patients from using them. If all primary care in the US was provided by such places, and patients paid the costs directly, that would be a free market, at least in primary care. But that's nothing like what we have. It's certainly nothing like what Medicare Advantage, which is the subject of this discussion, provides. > Healthcare, when coupled with a profit motive, offers misaligned incentives, period. Not in a free market. Health care in the US before WW II was provided by private companies (or individuals like doctors with their own practices), for profit, and worked better, given the technology of the time, than what we have now. What ended that system was laws passed during WW II that fixed wages, which meant that companies could not compete for labor in a free market by offering higher wages. So companies looked around for other benefits they could offer to compete, and health care was an obvious one. And then after the war the government decided to regulate the company-provided health care instead of ending it and restoring a free market. What offers misaligned incentives is the bastardized system we have in the US, which combines the worst features of for-profit with the worst features of socialism. The for-profit part is not visible to the actual patients--as I have already pointed out upthread, patients have no idea what the services they are getting actually cost, so they have no idea whether they are worth what they cost. The socialized part is what patients see--the services available to them are determined by their health "insurance", not them--but decisions are made by third parties who have no skin in the game and suffer no consequences when they make bad decisions that cause harm to patients. > nobody should be getting denied a cochlear implant because they are deaf due to 'paperwork issues' for months or years until they die. Of course not. And this would not happen in a free market. It happens because we don't have a free market in cochlear implants, we have a non-free market system with misaligned incentives, as I described above.

sulam 3y ago
What would happen in a truly free market is that a large percentage of elderly people with fixed incomes would be priced out of the medical care they need to live healthy, fulfilling lives past their 60s. This is very simple math, and it is something our society has decided not to support. There's a variety of factors driving that decision, not least that the elderly is a large, active voting bloc and politicians want to court their good will. If you have a solution for this that doesn't just assume "the free market" will work it out, that would be interesting.
- nickpp 3y ago
  Free markets tend to reduce prices making health care more affordable (including for people on fixed income). For an incredible success story see how the free markets made computing power so affordable despite last century’s “digital divide” worries.
  - ffgjgf1 3y ago
    “Free market” can only exist in specific sectors and rarely without extensive regulation. Comparing computer and healthcare industries makes almost no sense (besides extremely superficial ways) due to perfectly obvious reasons. > making health care more affordable Doubtful (since there is zero evidence of this working anywhere). Try to imagine how would this work for cancer and other serious diseases (hint: it wouldn’t at all for the majority of the population without some form of ins)
    - nickpp 3y ago
      Free markets have existed since the dawn of mankind. Their only prerequisite was the rule of law. They are responsible for the amazing wealth we are enjoying everyday, for the full shelves of products and the range of services offered to us. While regulations - brought for our own good and safety, of course - succeed in increasing costs and add delays. Just see healthcare, housing and education for some sad examples. I am curious why you think they wouldn't work for healthcare since: a) they worked just fine before government started intervening somewhere mid-last century and b) their mechanisms (price signals, competition, law of supply and demand, etc) apply just as well like for any other essential goods (food, water, fuel, etc).

ffgjgf1 3y ago

> That doesn't mean we can't have private companies offering countless other medical services or additional insurance You can have fully functional almost entirely private healthcare systems (more so than in the US) which are heavily regulated like in the Netherlands or Switzerland. Of course they are still ‘socialized’ system but so is the US by that definition.