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the problem with healthcare in America is not “the market”

by whimsicalism 2y ago

lesuorac 2y ago
Do go on.
- novariation 2y ago
  My guess is they're talking about regional monopolies ? There's generally a misunderstanding from left wing voters — when people say "markets" they understand "crony capitalism and monopolies with regulatory capture" when most other people just mean "fair competition between suppliers". We'll all agree the second option isn't easy to get, but the disagreement often comes from the fact one team thinks it's impossible or even undesirable, and something more radical should be preferred.
- brightball 2y ago
  Your employer offers health insurance. You go to doctors who bill the insurance company for your services. You paying directly for your services is almost entirely removed from the equation. You even deciding on which insurance company you would like to use is removed from the equation as well because it’s more expensive for you to sign up directly than it is for your company to sign up as well. If you wanted to be a part of a private insurance group with diet and exercise requirements for membership, including annual physicals that could potentially get you a lower rate…but you don’t really get that option. The market doesn’t even get to attempt to provide that option because of how separated the producer and consumer of the service are from the people paying for it. The market is completely removed from the equation. The only person who proposed a plan that would have resolved this problem was Dr Ben Carson fwiw. It was by far the best solution to fixing healthcare in the US that I’ve heard in the last 20 years but instead we got ACA.
- whimsicalism 2y ago
  There are a number of related problems. 1. Doctor cartels (this one is sort of self-explanatory) and other provider coordination on pricing 2. Over expansion of insurance (insurance is not meant to cover things that are expected, we have expanded insurance to cover routine expected expenses) and the associated costly administrative structure 3. Lack of price transparency 4. Global free ridership on drug prices makes us think we could get new drugs for much cheaper than we could 5. Lack of neutrality in tax law between cadillac health insurance plans and income 6. Overutilization (partially due to fear of malpractice lawsuits, partially due to overexpansion of insurance) 7. Political failure to address any of these. Obama tried to resolve 5 and Trump tried to resolve 3. Both have essentially failed. Almost all of these are caused by bad policy more so than the market-based outcome. This is not a ranked list, if I had to find primary culprits it would be 2, 3, and 6.
deleted 2y ago
[deleted]
rambojohnson 2y ago
okay. that was insightful.
readyman 2y ago
I don't necessarily disagree. I would say the problem is capitalism, which is not to be confused with "the market." They are distinctly different things.
- whimsicalism 2y ago
  saying the problem is capitalism is basically a non-answer to me. anything that exists today can be called capitalism, nobody has a clear definition of what is constitutive and it is not a useful diagnosis for offering prescriptions on how to make it better
- novariation 2y ago
  I've got a weird relationship with market socialists because I generally think they're much more sensible and convincing than the average "destroy evil and create utopia" socialists, but ultimately it's hard to understand whether their efforts to rebuild society would yield much better outcomes compared to European style welfare capitalism with more taxation and welfare spending. I suppose they're trying to build a grand theory of social market economies / social democracy, which is nice.
mathgradthrow 2y ago
The primary beneficiary of treating productive young people is society itself, and they are also the most efficient to treat. The primary beneficiary of existing socially subsidized care is the elderly. Since this is the optimally bad outcome, it is reasonable to assert that every system of healthcare incentives is misaligned.

the problem with healthcare in America is not “the market”

lesuorac 2y ago

Do go on.

novariation 2y ago
My guess is they're talking about regional monopolies ? There's generally a misunderstanding from left wing voters — when people say "markets" they understand "crony capitalism and monopolies with regulatory capture" when most other people just mean "fair competition between suppliers". We'll all agree the second option isn't easy to get, but the disagreement often comes from the fact one team thinks it's impossible or even undesirable, and something more radical should be preferred.
brightball 2y ago
Your employer offers health insurance. You go to doctors who bill the insurance company for your services. You paying directly for your services is almost entirely removed from the equation. You even deciding on which insurance company you would like to use is removed from the equation as well because it’s more expensive for you to sign up directly than it is for your company to sign up as well. If you wanted to be a part of a private insurance group with diet and exercise requirements for membership, including annual physicals that could potentially get you a lower rate…but you don’t really get that option. The market doesn’t even get to attempt to provide that option because of how separated the producer and consumer of the service are from the people paying for it. The market is completely removed from the equation. The only person who proposed a plan that would have resolved this problem was Dr Ben Carson fwiw. It was by far the best solution to fixing healthcare in the US that I’ve heard in the last 20 years but instead we got ACA.
whimsicalism 2y ago
There are a number of related problems. 1. Doctor cartels (this one is sort of self-explanatory) and other provider coordination on pricing 2. Over expansion of insurance (insurance is not meant to cover things that are expected, we have expanded insurance to cover routine expected expenses) and the associated costly administrative structure 3. Lack of price transparency 4. Global free ridership on drug prices makes us think we could get new drugs for much cheaper than we could 5. Lack of neutrality in tax law between cadillac health insurance plans and income 6. Overutilization (partially due to fear of malpractice lawsuits, partially due to overexpansion of insurance) 7. Political failure to address any of these. Obama tried to resolve 5 and Trump tried to resolve 3. Both have essentially failed. Almost all of these are caused by bad policy more so than the market-based outcome. This is not a ranked list, if I had to find primary culprits it would be 2, 3, and 6.

deleted 2y ago

[deleted]

rambojohnson 2y ago

okay. that was insightful.

readyman 2y ago

I don't necessarily disagree. I would say the problem is capitalism, which is not to be confused with "the market." They are distinctly different things.

whimsicalism 2y ago
saying the problem is capitalism is basically a non-answer to me. anything that exists today can be called capitalism, nobody has a clear definition of what is constitutive and it is not a useful diagnosis for offering prescriptions on how to make it better
novariation 2y ago
I've got a weird relationship with market socialists because I generally think they're much more sensible and convincing than the average "destroy evil and create utopia" socialists, but ultimately it's hard to understand whether their efforts to rebuild society would yield much better outcomes compared to European style welfare capitalism with more taxation and welfare spending. I suppose they're trying to build a grand theory of social market economies / social democracy, which is nice.

mathgradthrow 2y ago

The primary beneficiary of treating productive young people is society itself, and they are also the most efficient to treat. The primary beneficiary of existing socially subsidized care is the elderly. Since this is the optimally bad outcome, it is reasonable to assert that every system of healthcare incentives is misaligned.