3 ms·

I think the point you’re missing is that many parts of pricing are government regulations. And the way that the myriad of regulations drive some of this behavi

by refurb 2y ago

I think the point you’re missing is that many parts of pricing are government regulations. And the way that the myriad of regulations drive some of this behavior. A great example is the 340B program. A government regulation requiring manufacturers to offer steep discounts to hospitals. It’s created all sorts of distortions including the purchasing of pharmacies by hospitals so they can access the discount but charge the full price for the insured. The US healthcare system is terrible in big part because of regulations.

kevingadd 2y ago
Is there a successful healthcare system you'd point to that was achieved via deregulation?
- shiroiushi 2y ago
  I'm not sure OP was implying any claim that removing regulation would lead to a great healthcare system, just that the US regulations are bad and causing many of the system's problems. In better-run nations, the healthcare systems are highly regulated, but the regulation is actually (mostly) intelligent and implemented to have a positive effect. For some reason, when the US tries to do regulation, it somehow manages to do a uniquely bad job at it, causing a negative effect.
  - soco 2y ago
    Maybe it depends who you want to benefit with your regulation - the patient or the provider? Because I'd argue providers seem to make good money within the US regulation.
    - shiroiushi 2y ago
      I'm not so sure about that actually. I think the real winner in the US system is the insurance companies.
ggm 2y ago
> The US healthcare system is terrible in big part because of regulations. The US regulatory landscape is crippled by lobbying and fear of "socialism" -This is completely fixable by a competent regulator.
- deleted 2y ago
  [deleted]
- specialist 2y ago
  True. Alas, SCOTUS just overturned The Chevron Doctrine. (Along with their other attacks on the administrative state.) Hard to predict the aftermath.
  - edm0nd 2y ago
    and that imo is a good thing. A recent example is the ATF's expansion of the NFA by redefining a dealer from "Someone who makes selling firearms their primary income" to "Makes a profit on a sale" They effectively made everyone who ever sells a gun privately a felon. And the ATF is headed by a guy who has zero firearm experience and couldn't even separate the slide off a glock. Its a perfect example of a bad faith action and we only barely blocked its enforcement. Agencies with chevron were able to railroad whatever politicians wanted with zero accountability.
    - specialist 2y ago
      Since the Bipartisan Safer Communities Act necessitated this rule change, shouldn't you be mad at Congress? Further (emphasis mine): "Despite that concern, there have been at least a few overreactions to this rule online, with some commentators making dire proclamations about the criminalization of all private gun sales coming from this rule. That is not exactly what this rule does. Many of these changes apply to administrative and civil actions by ATF, rather than criminal actions. Being sued by the ATF and facing civil or administrative fines would not be pleasant, but it would be less terrible than being in federal prison." New ATF "Engaged In The Business" Rule (Kinda) Blocked By Judge https://www.thefirearmblog.com/blog/2024/05/22/new-atf-engaged-in-the-business-rule-kinda-blocked-by-judge/ https://www.thefirearmblog.com/blog/2024/05/22/new-atf-engag... I don't have a dog in this fight, so I had no idea what you're upset about. This article was the third hit in my noob search. Apparently you oppose informing the state (CLEO) about private transactions. Okay. There are ~430m guns owned privately in the USA. With ~15.5m/year sold (new and used). The updated rule covers, what, ~30,000/year transactions, less than 0.2%. That's what this whole fight is about? Really? A decades long slap fight over 0.2% of sales? I'm struggling to think of a hill that I'd personally die on (rhetorically) where the stakes were less than a round-off error.
specialist 2y ago
Regulations is just a scary word for rules. There's always rules. The trick is to fashion a ruleset (game, marketplace) that maximizes for public good (long term).
lotsofpulp 2y ago
340B legislation is one of the clearest examples of corruption. I cannot believe anyone can be so stupid, much less two branches of government, to pass something that does nothing but allow for corruption. Goal: provide poorer people with more access to healthcare and medicine Step 1: require medicine manufacturers to sell medicines at low cost to medicine retailers if they want the government to buy the medicines via Medicare/Medicaid Step 2: there is no step 2. There is no requirement for medicine retailers to sell the medicine to end users at low cost. Result: Medicine retailers arbitrage this by obtaining medicine for cheap and selling it to high prices to insurance, paid for by premium payers. Meaning people with health insurance paying extra so that medicine retailers can earn money…to do nothing.
- refurb 2y ago
  Great summary. It’s the perfect example of good intentions and regulations that actually make the system worse, not better. It’s driven a bunch of community oncologists out of business because they can’t compete with 340B hospitals who can get drug much, much cheaper. But do patients see any of the savings? No.

by refurb 2y ago

kevingadd 2y ago

Is there a successful healthcare system you'd point to that was achieved via deregulation?

shiroiushi 2y ago
I'm not sure OP was implying any claim that removing regulation would lead to a great healthcare system, just that the US regulations are bad and causing many of the system's problems. In better-run nations, the healthcare systems are highly regulated, but the regulation is actually (mostly) intelligent and implemented to have a positive effect. For some reason, when the US tries to do regulation, it somehow manages to do a uniquely bad job at it, causing a negative effect.
- soco 2y ago
  Maybe it depends who you want to benefit with your regulation - the patient or the provider? Because I'd argue providers seem to make good money within the US regulation.
  - shiroiushi 2y ago
    I'm not so sure about that actually. I think the real winner in the US system is the insurance companies.

ggm 2y ago

> The US healthcare system is terrible in big part because of regulations. The US regulatory landscape is crippled by lobbying and fear of "socialism" -This is completely fixable by a competent regulator.

deleted 2y ago
[deleted]
specialist 2y ago
True. Alas, SCOTUS just overturned The Chevron Doctrine. (Along with their other attacks on the administrative state.) Hard to predict the aftermath.
- edm0nd 2y ago
  and that imo is a good thing. A recent example is the ATF's expansion of the NFA by redefining a dealer from "Someone who makes selling firearms their primary income" to "Makes a profit on a sale" They effectively made everyone who ever sells a gun privately a felon. And the ATF is headed by a guy who has zero firearm experience and couldn't even separate the slide off a glock. Its a perfect example of a bad faith action and we only barely blocked its enforcement. Agencies with chevron were able to railroad whatever politicians wanted with zero accountability.
  - specialist 2y ago
    Since the Bipartisan Safer Communities Act necessitated this rule change, shouldn't you be mad at Congress? Further (emphasis mine): "Despite that concern, there have been at least a few overreactions to this rule online, with some commentators making dire proclamations about the criminalization of all private gun sales coming from this rule. That is not exactly what this rule does. Many of these changes apply to administrative and civil actions by ATF, rather than criminal actions. Being sued by the ATF and facing civil or administrative fines would not be pleasant, but it would be less terrible than being in federal prison." New ATF "Engaged In The Business" Rule (Kinda) Blocked By Judge https://www.thefirearmblog.com/blog/2024/05/22/new-atf-engaged-in-the-business-rule-kinda-blocked-by-judge/ https://www.thefirearmblog.com/blog/2024/05/22/new-atf-engag... I don't have a dog in this fight, so I had no idea what you're upset about. This article was the third hit in my noob search. Apparently you oppose informing the state (CLEO) about private transactions. Okay. There are ~430m guns owned privately in the USA. With ~15.5m/year sold (new and used). The updated rule covers, what, ~30,000/year transactions, less than 0.2%. That's what this whole fight is about? Really? A decades long slap fight over 0.2% of sales? I'm struggling to think of a hill that I'd personally die on (rhetorically) where the stakes were less than a round-off error.

specialist 2y ago

Regulations is just a scary word for rules. There's always rules. The trick is to fashion a ruleset (game, marketplace) that maximizes for public good (long term).

lotsofpulp 2y ago

340B legislation is one of the clearest examples of corruption. I cannot believe anyone can be so stupid, much less two branches of government, to pass something that does nothing but allow for corruption. Goal: provide poorer people with more access to healthcare and medicine Step 1: require medicine manufacturers to sell medicines at low cost to medicine retailers if they want the government to buy the medicines via Medicare/Medicaid Step 2: there is no step 2. There is no requirement for medicine retailers to sell the medicine to end users at low cost. Result: Medicine retailers arbitrage this by obtaining medicine for cheap and selling it to high prices to insurance, paid for by premium payers. Meaning people with health insurance paying extra so that medicine retailers can earn money…to do nothing.

refurb 2y ago
Great summary. It’s the perfect example of good intentions and regulations that actually make the system worse, not better. It’s driven a bunch of community oncologists out of business because they can’t compete with 340B hospitals who can get drug much, much cheaper. But do patients see any of the savings? No.