5 ms·

1. A properly competitive marketplace 2. Socialized medicine 3. What we have now I would like to see #1 tried but at this point I’ll gladly accept #2

mattnewton 1y ago
I just don't think #1 is possible, how can you have a functioning marketplace for a good when the demand is hard to forecast for an individual, almost completely inelastic and often extremely time sensitive. I'd say the US really tried and the incentives just aren't there for a stable system.
- arwhatever 1y ago
  When did the U.S. really try?
  - mattnewton 1y ago
    Isn’t this just a no true Scotsman? The US claims at least to have built a free market solution, and if nobody else has been able to make it work at scale, why isn’t that enough.
    - eviks 1y ago
      > why isn’t that enough. Because why would you ever only rely on some vague "US claims" instead of looking at reality?
    - arwhatever 1y ago
      I don’t think so, although that seems like a fair question of you to ask. I’ve tried on numerous occasions to get pricing quotes for healthcare both paying fully out of pocket, and for getting an estimate for what I’ll be left covering after insurance negotiates ads pays their part. In every attempt I get absolutely nowhere price estimate-wise and wind get this or that procedure done just hoping and praying that the ultimate bill will be remotely reasonable We’re so far off the mark for having a healthy marketplace for healthcare pricing that I just can’t see considering it dysfunctional to itself be an appeal to some purity. Perhaps one might argue that a formerly functional healthcare pricing system will inevitably degenerate into this robber Baron situation that we’ve got currently, but otherwise I don’t see the no true Scotsman.
    - pdonis 1y ago
      > The US claims at least to have built a free market solution I don't know that "the US" has actually claimed this, but in any case any such claim is false. There are lots of reasons for that, but the key one is simple: the people getting care, patients, don't know how much it costs. You can't have a free market if the person receiving a good or service doesn't know the cost of what they're getting, and so can't judge whether what they're getting is worth what it costs.
- jaredklewis 1y ago
  I don’t think we tried. For a market to work, the buyers have to be exercising their discretion. But most health insurance in the US is provided through employers (whose interests are different from those of the employees). There are a thousand other ways that the US healthcare markets are not free or poorly designed, but this is the original sin that (I would argue) causes most of the issues: the insured don’t choose their insurer, so the insurers are not competing for members, they’re competing for employers. See Singapore for a place that actually tried. They have a public healthcare but also a well functioning private healthcare market.
- savanaly 1y ago
  >demand is hard to forecast for an individual, almost completely inelastic and often extremely time sensitive These don't preclude a free market working well. For instance, they're all apt descriptors of me when I find myself needing an Uber home. I'm not completely inelastic, since I could take a series of long bus rides to get home, or walk, but accepting for the sake of argument those aren't life-threatening, the cab companies more or less have me over a barrel. Or do they? We all know what keeps them from charging me more they do, even given the time sensitivity, lack of prediction, or inelasticity. It's competition. The USA system doesn't work well, and I'm not necessarily saying that free market is the right solution, just pushing back on the notion that just because a good meets those criterion we are forced to throw our hands up and say the free market could never provide that.
  - mattnewton 1y ago
    Taxi demand is actually usually quite easy to forecast for an individual, which makes planning alternative competition easier, although we often don’t try anymore because we’re used to good app competition. This is before even getting to how much lower the infrastructure and personnel barriers are to competing in the medical space versus the taxi space. I know that most nights I am going to want to sleep in my own bed, this is somewhat inelastic sure, but not a surprise. The apps can’t raise prices too much however because they are in competition with us making plans to use the bus or call a friend. There is not a good equivalent in the medical world, it’s webmd and herbal compresses versus licensed doctors and prescription only drugs, with your life on the line.
- pdonis 1y ago
  > how can you have a functioning marketplace for a good when the demand is hard to forecast for an individual, almost completely inelastic and often extremely time sensitive. Most health care is not like this. Most health care is fairly routine: periodic physical exams and checkups, or getting evaluated when you have cold or flu symptoms. These sorts of things are much better provided for in a free market. It's true that, if you have an emergency, it's probably not something that could have been forecast, and you don't have much of a choice about what care you need. That is indeed the sort of situation that insurance is intended for. But what we call "health insurance" isn't limited to those things. It also covers everything else--all the stuff above that isn't unpredictable or time sensitive. The result is a mess.
SamoyedFurFluff 1y ago
How can we have a competitive marketplace? I’m not a doctor (and therefore cannot informed evaluate the services) and even if I was I can’t search for my preferred cardiologist when I’m having a heart attack.
- arwhatever 1y ago
  Is all of your healthcare 100% heart attacks?
  - SamoyedFurFluff 1y ago
    But again I don’t have enough education to judge if my doctor is yanking my chain.
- eviks 1y ago
  You're not a mechanic, how can you evaluate the services be certain that they didn't oil your breaks instead of your engine? > can’t search for my preferred cardiologist when I’m having a heart attack. You can't search for your preferred mechanics when your breaks failed on a highway. Yet somehow that didn't kill the competitive marketplace.
  - mattnewton 1y ago
    I can call a cab or get a replacement car from my insurance to drive around in, and I understand my body a whole lot less than my car. Demand for a car mechanic is nowhere near as inelastic as most of healthcare, so I don’t think this analogy really fits. At most it suggests that private markets can handle ambulances as well as we handle roadside towing.
  - kstrauser 1y ago
    That’s a bad analogy. If my brakes fail, once I come to a stop there’s no urgency in getting them fixed. I can abandon the care if it’s a lemon. I can have it towed home. I can use Yelp to find a reasonable mechanic. I can rent another car until this one’s fixed. It’s the opposite of “every second counts”. Meanwhile, this is the only heart I have, and if it’s in danger of stopping, I have approximately seconds to call 911 to get someone to come take me to the repair shop of their choosing.
kstrauser 1y ago
I agree in theory, but I no longer believe #1 is possible in reality. #2 would make tens of millions of lives better than the dystopian nightmare #3 we have today.
_DeadFred_ 1y ago
In the USA we've been told that the market will sort itself out and give us item 1 any day now...since 1992.
- arwhatever 1y ago
  Pricing signals have been blocked from flowing from consumers to providers since LONG before that.
hippo22 1y ago
I think the outcome we're witnessing in the U.S. is simply an outcome of an insurance-backed industry. All the market forces conspire for prices to be higher. Insurance companies actually don't care how much healthcare costs because they earn a fixed percentage on premiums. If healthcare costs are higher, then premium costs are higher, so the insurance companies earn more money. Naturally, hospitals also wants prices to be higher so they can earn more money. I would expect this dynamic to play out whenever all the buyers in the marketplace are insurance companies.

mattnewton 1y ago

I just don't think #1 is possible, how can you have a functioning marketplace for a good when the demand is hard to forecast for an individual, almost completely inelastic and often extremely time sensitive. I'd say the US really tried and the incentives just aren't there for a stable system.

arwhatever 1y ago
When did the U.S. really try?
- mattnewton 1y ago
  Isn’t this just a no true Scotsman? The US claims at least to have built a free market solution, and if nobody else has been able to make it work at scale, why isn’t that enough.
  - eviks 1y ago
    > why isn’t that enough. Because why would you ever only rely on some vague "US claims" instead of looking at reality?
  - arwhatever 1y ago
    I don’t think so, although that seems like a fair question of you to ask. I’ve tried on numerous occasions to get pricing quotes for healthcare both paying fully out of pocket, and for getting an estimate for what I’ll be left covering after insurance negotiates ads pays their part. In every attempt I get absolutely nowhere price estimate-wise and wind get this or that procedure done just hoping and praying that the ultimate bill will be remotely reasonable We’re so far off the mark for having a healthy marketplace for healthcare pricing that I just can’t see considering it dysfunctional to itself be an appeal to some purity. Perhaps one might argue that a formerly functional healthcare pricing system will inevitably degenerate into this robber Baron situation that we’ve got currently, but otherwise I don’t see the no true Scotsman.
  - pdonis 1y ago
    > The US claims at least to have built a free market solution I don't know that "the US" has actually claimed this, but in any case any such claim is false. There are lots of reasons for that, but the key one is simple: the people getting care, patients, don't know how much it costs. You can't have a free market if the person receiving a good or service doesn't know the cost of what they're getting, and so can't judge whether what they're getting is worth what it costs.
jaredklewis 1y ago
I don’t think we tried. For a market to work, the buyers have to be exercising their discretion. But most health insurance in the US is provided through employers (whose interests are different from those of the employees). There are a thousand other ways that the US healthcare markets are not free or poorly designed, but this is the original sin that (I would argue) causes most of the issues: the insured don’t choose their insurer, so the insurers are not competing for members, they’re competing for employers. See Singapore for a place that actually tried. They have a public healthcare but also a well functioning private healthcare market.
savanaly 1y ago
>demand is hard to forecast for an individual, almost completely inelastic and often extremely time sensitive These don't preclude a free market working well. For instance, they're all apt descriptors of me when I find myself needing an Uber home. I'm not completely inelastic, since I could take a series of long bus rides to get home, or walk, but accepting for the sake of argument those aren't life-threatening, the cab companies more or less have me over a barrel. Or do they? We all know what keeps them from charging me more they do, even given the time sensitivity, lack of prediction, or inelasticity. It's competition. The USA system doesn't work well, and I'm not necessarily saying that free market is the right solution, just pushing back on the notion that just because a good meets those criterion we are forced to throw our hands up and say the free market could never provide that.
- mattnewton 1y ago
  Taxi demand is actually usually quite easy to forecast for an individual, which makes planning alternative competition easier, although we often don’t try anymore because we’re used to good app competition. This is before even getting to how much lower the infrastructure and personnel barriers are to competing in the medical space versus the taxi space. I know that most nights I am going to want to sleep in my own bed, this is somewhat inelastic sure, but not a surprise. The apps can’t raise prices too much however because they are in competition with us making plans to use the bus or call a friend. There is not a good equivalent in the medical world, it’s webmd and herbal compresses versus licensed doctors and prescription only drugs, with your life on the line.
pdonis 1y ago
> how can you have a functioning marketplace for a good when the demand is hard to forecast for an individual, almost completely inelastic and often extremely time sensitive. Most health care is not like this. Most health care is fairly routine: periodic physical exams and checkups, or getting evaluated when you have cold or flu symptoms. These sorts of things are much better provided for in a free market. It's true that, if you have an emergency, it's probably not something that could have been forecast, and you don't have much of a choice about what care you need. That is indeed the sort of situation that insurance is intended for. But what we call "health insurance" isn't limited to those things. It also covers everything else--all the stuff above that isn't unpredictable or time sensitive. The result is a mess.

SamoyedFurFluff 1y ago

How can we have a competitive marketplace? I’m not a doctor (and therefore cannot informed evaluate the services) and even if I was I can’t search for my preferred cardiologist when I’m having a heart attack.

arwhatever 1y ago
Is all of your healthcare 100% heart attacks?
- SamoyedFurFluff 1y ago
  But again I don’t have enough education to judge if my doctor is yanking my chain.
eviks 1y ago
You're not a mechanic, how can you evaluate the services be certain that they didn't oil your breaks instead of your engine? > can’t search for my preferred cardiologist when I’m having a heart attack. You can't search for your preferred mechanics when your breaks failed on a highway. Yet somehow that didn't kill the competitive marketplace.
- mattnewton 1y ago
  I can call a cab or get a replacement car from my insurance to drive around in, and I understand my body a whole lot less than my car. Demand for a car mechanic is nowhere near as inelastic as most of healthcare, so I don’t think this analogy really fits. At most it suggests that private markets can handle ambulances as well as we handle roadside towing.
- kstrauser 1y ago
  That’s a bad analogy. If my brakes fail, once I come to a stop there’s no urgency in getting them fixed. I can abandon the care if it’s a lemon. I can have it towed home. I can use Yelp to find a reasonable mechanic. I can rent another car until this one’s fixed. It’s the opposite of “every second counts”. Meanwhile, this is the only heart I have, and if it’s in danger of stopping, I have approximately seconds to call 911 to get someone to come take me to the repair shop of their choosing.

kstrauser 1y ago

I agree in theory, but I no longer believe #1 is possible in reality. #2 would make tens of millions of lives better than the dystopian nightmare #3 we have today.

_DeadFred_ 1y ago

In the USA we've been told that the market will sort itself out and give us item 1 any day now...since 1992.

arwhatever 1y ago
Pricing signals have been blocked from flowing from consumers to providers since LONG before that.

hippo22 1y ago

I think the outcome we're witnessing in the U.S. is simply an outcome of an insurance-backed industry. All the market forces conspire for prices to be higher. Insurance companies actually don't care how much healthcare costs because they earn a fixed percentage on premiums. If healthcare costs are higher, then premium costs are higher, so the insurance companies earn more money. Naturally, hospitals also wants prices to be higher so they can earn more money. I would expect this dynamic to play out whenever all the buyers in the marketplace are insurance companies.