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> the free market-based US healthcare system market, maybe, "free" market? I doubt it. It's not a very free market when there is such a large power differenti

> the free market-based US healthcare system market, maybe, "free" market? I doubt it. It's not a very free market when there is such a large power differential between the buyer and the seller. You can't exactly shop around for the ambulance or the hospital when you need it, nor can you realistically circumvent the artificially constrained supply [1] of doctors to get cheaper healthcare (unless you live next to the border). When the alternative is a one-sided market like this, government becomes rather more appealing. 1. https://en.wikipedia.org/wiki/American_Medical_Association#Restrictions_on_physician_supply https://en.wikipedia.org/wiki/American_Medical_Association#R...

WalterBright 2y ago
> You can't exactly shop around The vast bulk of health care is by appointment, not a dash in the ambulance.
- globular-toast 2y ago
  Even so, when was the last time someone needed cancer treatment but said "ooh, that's pricey, nah, I'd rather buy a new car instead". This is my main argument against private healthcare: there's no real choice involved. Without even getting into what a free market is and perfect information etc, the main advantage of a capitalist society is you get to choose what you like. Nobody chooses healthcare (at least, not the super expensive part).
  - tastyfreeze 2y ago
    A large portion of healthcare could be free market. Insurance should be for unlikely events not every single thing deemed "medical". My home and auto insurance don't cover regular costs for maintenance. Why must health insurance cover a checkup with the doctor?
  - SoftTalker 2y ago
    > This is my main argument against private healthcare: there's no real choice involved. Is your argument that there is choice involved in public healthcare? Or simply that it's not even a question?
  - WalterBright 2y ago
    There are many options for cancer treatment, with different prices, efficacy, misery, etc. > Nobody chooses healthcare Yeah, they do. Root canal vs implant vs dentures, for example. Ozempic vs diet+exercise, for another.
- davkan 2y ago
  You’re still significantly limited by your insurance carrier’s network and also the consolidation of the healthcare industry. I used to live in a city of 1 million that had essentially two hospital networks that bought everything. You could not find a specialist not associated with those two companies. Pre-natal, allergy, cardiac, two choices. When my seventy year old doctor who ran a practice out of his house retired he sold the practice to one of the two. It’s not shopping for a tv. You can’t choose not to buy. It’s often time sensitive even if by appointment. Pricing is incredibly complex as are the details of the product. Your average person does not have the information necessary to navigate the market.
  - Pikamander2 2y ago
    Even more fun is when your doctor refers you to a specialist that's in-network, but your insurance comes up with a bunch of reasons to deny it. How did we collectively decide that it's okay for insurance companies to overrule medical professionals?
    - gruez 2y ago
      AFAIK the overruling is done by a "medical professional" as well, albeit one that's on the insurance company's payroll.
      - jandrese 2y ago
        That "medical professional" has literally 90 seconds to review your case and say yes/no. They've never met you. They don't know your doctor. All they have are some notes on the case, a billing code, and a quota to reach every day. They get bonuses based on how much money they save the insurance company. All of that cost savings makes US healthcare cost double what it does anywhere else in the world.
        nradov 2y ago
        I think you're a little confused about causality. All healthcare systems, including fully socialized ones, perform similar types of case review to ration care and hold down costs. US healthcare costs might be high now but would be even higher if the payers (including the Medicare / Medicaid government payers) paid every claim that came in without denying those that fail to mean plan coverage rules. If we want to hold down costs then we'll have to put a greater focus on preventative care, stop expensive treatments for terminal patients, impose price controls on providers, and stop subsidizing drug development for the rest of the world. None of those measures are politically popular.
- ddfs123 2y ago
  Even for non-emergency, the short amount of time before a health issue turn serious means that it's already hard for you to take second opinion.
- yellottyellott 2y ago
  other than normal doctor’s office visits, i have no idea what i’m going to pay when i get a small procedure done. a basic heart ultrasound cost me over $1k while my vasectomy cost me a $60 copay. i was expecting those prices to be flipped. and don’t get me started on labs. i’ve gotten bills for basic screens years later for thousands of dollars. you can’t shop around if you don’t know what you’ll pay until months after it happens. if you call the insurance company beforehand you wait on a static filled line with a call center in india, and even with the CPT code they can’t give you a straight answer.
  - WalterBright 2y ago
    > i have no idea what i’m going to pay when i get a small procedure done. All you gotta do is ask.
    - jandrese 2y ago
      They don't know. Nobody does until the bill is processed. There are a thousand factors that might affect your coverage. This is the nightmare I'm living through right now. Even if you have the code and doctor and patient the help desk at the insurance company can't say for sure if they will cover it or not. That comes down to the discretion of the claims adjuster. You won't know if something is going to cost $100 or $10,000 until after it is done.
      - WalterBright 2y ago
        > They don't know It works every time I asked.
        jandrese 2y ago
        The provider or the insurance company? The provider can give you the cash price, but that's a made up number with no relation to reality. The Insurance company can give you what the standard discount would be on that procedure, but they can't say if they'll cover it, give only that discount, give nothing, or anything in between.
xbmcuser 2y ago
To me that is the funny thing today if you look at markets Chinese markets under it's communist system are actually freer than US. China is not interested any 1 company getting a monopoly and becoming more powerful than the government so they promote finance multiple companies resulting in a truer capitalist market than the US.
- HPsquared 2y ago
  It's so ironic. Market competition is definitely intense over there.
- corimaith 2y ago
  Not really. Chinese SOEs comprise around 60% of market capitalization and around 23% of GDP, far higher than USA or other developed economies. While they do have a competitive market, the government very much does pick and choose winners and loosers here like Huawei, resulting in consolidation into a few large conglomerates like every other country. Their (software) tech scene certainly dosen't like more particularly "capitalist" than Big Tech, nor is the Fed pumping subsidies to Tesla like BYD, if anything they're sidelining Elon Musk.
- lolinder 2y ago
  > Chinese markets under it's communist system are actually freer than US Right up until the moment that the CCP decides to purge your entire sector, sure. I don't know if it counts as "free" if the government stands ready to nuke the sandbox they so generously let you play in. https://www.reuters.com/technology/beijings-regulatory-crackdown-wipes-11-trln-off-chinese-big-tech-2023-07-12/ https://www.reuters.com/technology/beijings-regulatory-crack...
  - adam_arthur 2y ago
    You would expect market cap of the largest players to decline if the market becomes more competitive... which was China's primary goal with their recent crackdown. They proactively forced interconnectivity and limited the ability for companies to make "walled-garden peudo-monopolies", as we have in the US with Apple and Google. If the same happens here (through act of congress, or legal outcomes), you can expect their market caps to decline as well. A decline in market cap doesn't speak at all to whether it's beneficial to the industry or consumers
wisty 2y ago
There's also a lot of regulation and lots of subsidies (the US has similar per capita public spending to Canada - old people on Medicare are not cheap). If something is so heavily regulated and subsidised that the private sector is only there to outsmart the government to line their pockets, it's inferior to even a public system.
froh 2y ago
"free" is newspeak for "rules only apply to the poor, ie.e the lower 99.9%"
drdec 2y ago
>>the free market-based US healthcare system >market, maybe, "free" market? I doubt it. The consumer of healthcare is doubly removed from the price of healthcare. This is the opposite of a free market. The patient did not pay the doctor, the insurance company does. In most cases the patient does not pay for insurance their employer does. So the normal pricing forces of a free market are removed. Then we need to talk about certificate of need laws which restrict the supply...
- Spooky23 2y ago
  The free market aspect is the insurance marketplace. If you’re poor, you’re fucked. If you’re old you’re ok. If you work for the government or certain companies, you have access to world class care. Everyone else is on a spectrum from high quality PPO to the shittiest Cigna plan.
  - pclmulqdq 2y ago
    There is nothing free about the health insurance market. It is regulated to hell to the point where a common complaint of actuaries I know is that they are not allowed to price your health risk.
    - caseysoftware 2y ago
      ^ When the grossly overweight 60yo smoker pays the same amount as a health-conscious 30yo, we have a problem.
      - FirmwareBurner 2y ago
        [flagged]
        caseysoftware 2y ago
        Maybe but I'm more concerned about a) easily demonstrable and measurable risks not being addressed and b) separating people from the consequences of their own choices. Ignoring risk and consequences doesn't make them go away.
FollowingTheDao 2y ago
There is no free market when pain and distress is involved, that is for sure. When I am psychotic I cannot exactly choose which psychiatric hospital I want to check into and ponder about the price to put it off for another day. And this is what the free market did to psychiatric hospitals: https://www.wral.com/holly-hill-hospital/21507953/ https://www.wral.com/holly-hill-hospital/21507953/
mattmaroon 2y ago
The American health care system is also highly regulated. There’s nothing free about it in any sense if the word.

WalterBright 2y ago

> You can't exactly shop around The vast bulk of health care is by appointment, not a dash in the ambulance.

globular-toast 2y ago
Even so, when was the last time someone needed cancer treatment but said "ooh, that's pricey, nah, I'd rather buy a new car instead". This is my main argument against private healthcare: there's no real choice involved. Without even getting into what a free market is and perfect information etc, the main advantage of a capitalist society is you get to choose what you like. Nobody chooses healthcare (at least, not the super expensive part).
- tastyfreeze 2y ago
  A large portion of healthcare could be free market. Insurance should be for unlikely events not every single thing deemed "medical". My home and auto insurance don't cover regular costs for maintenance. Why must health insurance cover a checkup with the doctor?
- SoftTalker 2y ago
  > This is my main argument against private healthcare: there's no real choice involved. Is your argument that there is choice involved in public healthcare? Or simply that it's not even a question?
- WalterBright 2y ago
  There are many options for cancer treatment, with different prices, efficacy, misery, etc. > Nobody chooses healthcare Yeah, they do. Root canal vs implant vs dentures, for example. Ozempic vs diet+exercise, for another.
davkan 2y ago
You’re still significantly limited by your insurance carrier’s network and also the consolidation of the healthcare industry. I used to live in a city of 1 million that had essentially two hospital networks that bought everything. You could not find a specialist not associated with those two companies. Pre-natal, allergy, cardiac, two choices. When my seventy year old doctor who ran a practice out of his house retired he sold the practice to one of the two. It’s not shopping for a tv. You can’t choose not to buy. It’s often time sensitive even if by appointment. Pricing is incredibly complex as are the details of the product. Your average person does not have the information necessary to navigate the market.
- Pikamander2 2y ago
  Even more fun is when your doctor refers you to a specialist that's in-network, but your insurance comes up with a bunch of reasons to deny it. How did we collectively decide that it's okay for insurance companies to overrule medical professionals?
  - gruez 2y ago
    AFAIK the overruling is done by a "medical professional" as well, albeit one that's on the insurance company's payroll.
    - jandrese 2y ago
      That "medical professional" has literally 90 seconds to review your case and say yes/no. They've never met you. They don't know your doctor. All they have are some notes on the case, a billing code, and a quota to reach every day. They get bonuses based on how much money they save the insurance company. All of that cost savings makes US healthcare cost double what it does anywhere else in the world.
      - nradov 2y ago
        I think you're a little confused about causality. All healthcare systems, including fully socialized ones, perform similar types of case review to ration care and hold down costs. US healthcare costs might be high now but would be even higher if the payers (including the Medicare / Medicaid government payers) paid every claim that came in without denying those that fail to mean plan coverage rules. If we want to hold down costs then we'll have to put a greater focus on preventative care, stop expensive treatments for terminal patients, impose price controls on providers, and stop subsidizing drug development for the rest of the world. None of those measures are politically popular.
ddfs123 2y ago
Even for non-emergency, the short amount of time before a health issue turn serious means that it's already hard for you to take second opinion.
yellottyellott 2y ago
other than normal doctor’s office visits, i have no idea what i’m going to pay when i get a small procedure done. a basic heart ultrasound cost me over $1k while my vasectomy cost me a $60 copay. i was expecting those prices to be flipped. and don’t get me started on labs. i’ve gotten bills for basic screens years later for thousands of dollars. you can’t shop around if you don’t know what you’ll pay until months after it happens. if you call the insurance company beforehand you wait on a static filled line with a call center in india, and even with the CPT code they can’t give you a straight answer.
- WalterBright 2y ago
  > i have no idea what i’m going to pay when i get a small procedure done. All you gotta do is ask.
  - jandrese 2y ago
    They don't know. Nobody does until the bill is processed. There are a thousand factors that might affect your coverage. This is the nightmare I'm living through right now. Even if you have the code and doctor and patient the help desk at the insurance company can't say for sure if they will cover it or not. That comes down to the discretion of the claims adjuster. You won't know if something is going to cost $100 or $10,000 until after it is done.
    - WalterBright 2y ago
      > They don't know It works every time I asked.
      - jandrese 2y ago
        The provider or the insurance company? The provider can give you the cash price, but that's a made up number with no relation to reality. The Insurance company can give you what the standard discount would be on that procedure, but they can't say if they'll cover it, give only that discount, give nothing, or anything in between.

xbmcuser 2y ago

To me that is the funny thing today if you look at markets Chinese markets under it's communist system are actually freer than US. China is not interested any 1 company getting a monopoly and becoming more powerful than the government so they promote finance multiple companies resulting in a truer capitalist market than the US.

HPsquared 2y ago
It's so ironic. Market competition is definitely intense over there.
corimaith 2y ago
Not really. Chinese SOEs comprise around 60% of market capitalization and around 23% of GDP, far higher than USA or other developed economies. While they do have a competitive market, the government very much does pick and choose winners and loosers here like Huawei, resulting in consolidation into a few large conglomerates like every other country. Their (software) tech scene certainly dosen't like more particularly "capitalist" than Big Tech, nor is the Fed pumping subsidies to Tesla like BYD, if anything they're sidelining Elon Musk.
lolinder 2y ago
> Chinese markets under it's communist system are actually freer than US Right up until the moment that the CCP decides to purge your entire sector, sure. I don't know if it counts as "free" if the government stands ready to nuke the sandbox they so generously let you play in. https://www.reuters.com/technology/beijings-regulatory-crackdown-wipes-11-trln-off-chinese-big-tech-2023-07-12/ https://www.reuters.com/technology/beijings-regulatory-crack...
- adam_arthur 2y ago
  You would expect market cap of the largest players to decline if the market becomes more competitive... which was China's primary goal with their recent crackdown. They proactively forced interconnectivity and limited the ability for companies to make "walled-garden peudo-monopolies", as we have in the US with Apple and Google. If the same happens here (through act of congress, or legal outcomes), you can expect their market caps to decline as well. A decline in market cap doesn't speak at all to whether it's beneficial to the industry or consumers

wisty 2y ago

There's also a lot of regulation and lots of subsidies (the US has similar per capita public spending to Canada - old people on Medicare are not cheap). If something is so heavily regulated and subsidised that the private sector is only there to outsmart the government to line their pockets, it's inferior to even a public system.

froh 2y ago

"free" is newspeak for "rules only apply to the poor, ie.e the lower 99.9%"

drdec 2y ago

>>the free market-based US healthcare system >market, maybe, "free" market? I doubt it. The consumer of healthcare is doubly removed from the price of healthcare. This is the opposite of a free market. The patient did not pay the doctor, the insurance company does. In most cases the patient does not pay for insurance their employer does. So the normal pricing forces of a free market are removed. Then we need to talk about certificate of need laws which restrict the supply...

Spooky23 2y ago
The free market aspect is the insurance marketplace. If you’re poor, you’re fucked. If you’re old you’re ok. If you work for the government or certain companies, you have access to world class care. Everyone else is on a spectrum from high quality PPO to the shittiest Cigna plan.
- pclmulqdq 2y ago
  There is nothing free about the health insurance market. It is regulated to hell to the point where a common complaint of actuaries I know is that they are not allowed to price your health risk.
  - caseysoftware 2y ago
    ^ When the grossly overweight 60yo smoker pays the same amount as a health-conscious 30yo, we have a problem.
    - FirmwareBurner 2y ago
      [flagged]
      - caseysoftware 2y ago
        Maybe but I'm more concerned about a) easily demonstrable and measurable risks not being addressed and b) separating people from the consequences of their own choices. Ignoring risk and consequences doesn't make them go away.

FollowingTheDao 2y ago

There is no free market when pain and distress is involved, that is for sure. When I am psychotic I cannot exactly choose which psychiatric hospital I want to check into and ponder about the price to put it off for another day. And this is what the free market did to psychiatric hospitals: https://www.wral.com/holly-hill-hospital/21507953/ https://www.wral.com/holly-hill-hospital/21507953/

mattmaroon 2y ago

The American health care system is also highly regulated. There’s nothing free about it in any sense if the word.