4 ms·

There's a benefit to having a service tied to the individual receiving the service. For starters it put price pressure and competition on providing the service.

by bko 10mo ago

There's a benefit to having a service tied to the individual receiving the service. For starters it put price pressure and competition on providing the service. When someone else is paying for something you don't have a signal of efficacy, in terms of pricing or quality. To put another way, if I were facing some terminal illness I would want to have full control of picking the service even if it costs money. Sure, I would want "the best" specific to me and have someone else pick up the tab, but that's a fantasy, because no system or third party has as much skin in the game as me. That's why things like elective surgery are so cheap and competitive. The problem is why do these treatments cost so much? What prevents competition and innovation. And my argument it's largely due to regulation and third party payer system

k1musab1 10mo ago
Time and time again large competing forces in the market are found to have colluded instead of directly competing with each other to drive price/cost down. What is it that still makes you believe that two (or n-number) of providers won't collude to charge an astronomical amount for a life-saving treatment?
- nickpp 10mo ago
  > Time and time again large competing forces in the market are found to have colluded instead of directly competing with each other to drive price/cost down. Collusion and cartels never work on the long run. It's an unstable equilibrium, the incentive to reduce prices to capture more market is too great. > What is it that still makes you believe Competition. It's the only force keeping humans honest. That's why we must treat any barriers of entry in a market with extreme care. The only "failed" or "captured" market is a strongly regulated one.
  - jgeada 10mo ago
    Markets can remain irrational, or colluding, far longer than you can stay solvent (or even alive). For example, while the Phoebus cartel only really lasted from 1925 through to 1939, 1000hr incandescent light bulbs remain the standard offering till present day. Profitable market manipulations are sticky. The whole notion that markets are efficient is just a mathematical construct that has become very dogmatic for people. But if you look into the details, markets are efficient under the assumptions of perfect information and infinite time. Neither of those conditions are present in the real world: we neither have perfect information nor infinite time.
    - nickpp 10mo ago
      > the Phoebus cartel > 1000hr incandescent light bulbs remain the standard offering till present day This proves in fact that all the cartel did was establish a standard, an optimal average between various tradeoffs when building an incandescent lightbulb: brightness, cost, efficiency and life span. Yes, the cartel behaved anti-competitively. The effect on the market? Nil. > perfect information and infinite time There is absolutely no requirement for this for markets to work. Markets work just fine with partial information and just-in time. When new information and new market participants appear, markets will self-correct. The only way to prevent markets from working is through government intervention. In facts, free markets are the only system we have that works with incomplete info and reacts in real-time. Central planning will happily decide on incomplete info then never adapt. We saw that during communism when the Party decided allocate X resources for production of Y and it always resulted in a glut or shortages. Central planning doesn't work.
  - jittles 10mo ago
    > Competition. It's the only force keeping humans honest. Pure misanthropic fantasy pretending to be sophisticated economics.
    - nickpp 10mo ago
      > misanthropic fantasy It's the obvious reality around me here in Eastern Europe. We were starving under communism before 1990 but are now enjoying the amazing wealth capitalism brought.
  - lenkite 10mo ago
    > Collusion and cartels never work on the long run. Define "long run" - they have been already proven to have worked for years and in some cases even decades.
- bko 10mo ago
  Because if something sucks, someone comes up with something better and sells it for a profit. This is the history of pretty much every other good or service that is not heavily influenced by regulation and artificial barriers to entry
  - ryandrake 10mo ago
    > Because if something sucks, someone comes up with something better and sells it for a profit. This is basically a religious belief at this point. It's how a perfectly ideal free market might work, but we don't have any of these, especially in healthcare.
    - bko 10mo ago
      Do you not use private businesses or something? Do you not shop at a private grocer or order things from Amazon or use a private search engine? Probably 99% of what I consume comes from private companies and the services generally get better over time, with some exceptions. Compare that to an experience with the TSA.
  - ThrowMeAway1618 10mo ago
    [flagged]
    - nickpp 10mo ago
      No need for blind belief, you can always visit Venezuela, North Korea or Cuba to see how a country without free markets fares. Or come here in Eastern Europe where we had the "pleasure" of trying both systems and see how free markets pulled us out of utter poverty.
deleted 10mo ago
[deleted]
Retric 10mo ago
You’re confusing ideology with the way the world actually operates. The general public doesn’t have enough information to make informed decisions when it comes to healthcare. This alone completely removes the usual market forces from providing any benefit when it comes to healthcare. Cancer treatments don’t inherently cost that much money, the systems to ensure people are actually getting useful treatments are expensive. You can’t trust companies selling cures. You can’t trust every doctor when they have financial incentives to offer treatments. Insurance companies are in an adversarial relationship with providing treatments, which doesn’t result in efficient supervision here. Lawsuits offer some protection, but at extreme cost to everyone involved. Etc etc. The net result of all these poor incentives is single payer systems end up being way more efficient, resulting in people living longer and spending less on healthcare.
- bko 10mo ago
  > The general public doesn’t have enough information to make informed decisions when it comes to healthcare. This alone completely removes the usual market forces from providing any benefit when it comes to healthcare. Why is it always "the general public" and not "I". Do you have enough information about decisions? Can I take away some of your rights? No, of course not. Everyone else is dumb except me. I'm sorry but I refuse to believe some unelected, anonymous bureaucrat has my best interests in mind or can even know me anything about me such that I want to allow them to make health decisions for me.
  - Retric 10mo ago
    > Do you have enough information about decisions? Me personally, No. I don’t have enough information to make informed decisions here and you don’t either. Off the top of your head, how well educated is your dentist? You after all made an informed decision picking them. So how well did their background compare to others in your area. What where your concerns about their dental programs weaknesses and how was that offset by… Except no let me guess that never entered your mind did it.
    - bko 10mo ago
charles_f 10mo ago
> it put price pressure and competition on providing the service This is simply not true. Healthcare in the US is comparatively much more expensive than countries offering subsidized healthcare with comparable or better outcomes(1). > it's largely due to regulation and third party payer system Capitalism can't work in a market that's completely consolidated, and where people can't offer to not buy your service. Healthcare in publicly subsidized countries is much less expensive because it's regulated. Compare the price of simple drugs like insulin or asthma medicine if you need an easy example. Pharma companies still happily sell there, which is to say that the difference is pure profit on the back of sick people who don't have a choice. My biggest grief against this individual payment system is moral though. I don't see the virtue in a system where kids have to put on a show to receive care. Or anyone for that matter, you'll give to a kid because they're cute and generate empathy, does it make someone ugly with no family less deserving of getting cured from cancer? 1: https://www.healthsystemtracker.org/chart-collection/health-spending-u-s-compare-countries/#Health%20expenditures%20per%20capita,%20U.S.%20dollars,%202023%20(current%20prices%20and%20PPP%20adjusted) https://www.healthsystemtracker.org/chart-collection/health-...
ruszki 10mo ago
When you have to choose a provider or you die, there won’t be a real downward pressure on price because there is no need to form a cartel to feed on this. You can see this in every single market of utility or de facto utility segments.
jgeada 10mo ago
Because when you're dying you have no bargaining position. You can't just wait it out. And you're just a single client, whether you personally die or not does not meaningfully change their bottom line. So it is a highly asymmetric bargaining situation where all the incentives are poorly aligned. Of course it is exploitative.
- bko 10mo ago
  Okay, you have no bargaining decision when you have N providers, so we should get rid of all providers with a single provider because only then you'll be in better bargaining position. And now your death will have a meaningful change to the career bureaucrat or politician that made the decision that led to your death. Because power of an individual vote is much more powerful than the power to take your business elsewhere. That's if you can find out the responsible party that makes these decisions and they're not appointed but elected, otherwise you'd have to mount an influence campaign on the politicians with 90% re-election rate to change said bureaucratic leader. Makes a lot of sense.
  - jgeada 10mo ago
    All empirical evidence shows that single payer systems work better, producing far better outcomes at lower cost, than the US system. In fact, so much better that a single payer system is what Congress has chosen for itself! But seems some prefer to believe a theoretical argument with no evidence to back it up. “The Party told you to reject the evidence of your eyes and ears. It was their final, most essential command.”
    - nickpp 10mo ago
      > All empirical evidence shows that single payer systems work better, producing far better outcomes at lower cost, than the US system. Agreed. Also, all empirical evidence shows that free-markets work better, producing far better outcomes at lower cost than either. Just look around at any less-regulated and thus free-er markets. Or just "reject the evidence" - your choice. > die I am middle-aged so I used plenty of health services in my life. I always had choices when in came to price and level of care and treatment. None of them were for the "dying" case. But I do have an insurance specifically for that case. I am a rational being so I plan in advance. No need for a government bureaucrat to decide my health care for me just in case some day I may be incapacitated.

by bko 10mo ago

k1musab1 10mo ago

Time and time again large competing forces in the market are found to have colluded instead of directly competing with each other to drive price/cost down. What is it that still makes you believe that two (or n-number) of providers won't collude to charge an astronomical amount for a life-saving treatment?

nickpp 10mo ago
> Time and time again large competing forces in the market are found to have colluded instead of directly competing with each other to drive price/cost down. Collusion and cartels never work on the long run. It's an unstable equilibrium, the incentive to reduce prices to capture more market is too great. > What is it that still makes you believe Competition. It's the only force keeping humans honest. That's why we must treat any barriers of entry in a market with extreme care. The only "failed" or "captured" market is a strongly regulated one.
- jgeada 10mo ago
  Markets can remain irrational, or colluding, far longer than you can stay solvent (or even alive). For example, while the Phoebus cartel only really lasted from 1925 through to 1939, 1000hr incandescent light bulbs remain the standard offering till present day. Profitable market manipulations are sticky. The whole notion that markets are efficient is just a mathematical construct that has become very dogmatic for people. But if you look into the details, markets are efficient under the assumptions of perfect information and infinite time. Neither of those conditions are present in the real world: we neither have perfect information nor infinite time.
  - nickpp 10mo ago
    > the Phoebus cartel > 1000hr incandescent light bulbs remain the standard offering till present day This proves in fact that all the cartel did was establish a standard, an optimal average between various tradeoffs when building an incandescent lightbulb: brightness, cost, efficiency and life span. Yes, the cartel behaved anti-competitively. The effect on the market? Nil. > perfect information and infinite time There is absolutely no requirement for this for markets to work. Markets work just fine with partial information and just-in time. When new information and new market participants appear, markets will self-correct. The only way to prevent markets from working is through government intervention. In facts, free markets are the only system we have that works with incomplete info and reacts in real-time. Central planning will happily decide on incomplete info then never adapt. We saw that during communism when the Party decided allocate X resources for production of Y and it always resulted in a glut or shortages. Central planning doesn't work.
- jittles 10mo ago
  > Competition. It's the only force keeping humans honest. Pure misanthropic fantasy pretending to be sophisticated economics.
  - nickpp 10mo ago
    > misanthropic fantasy It's the obvious reality around me here in Eastern Europe. We were starving under communism before 1990 but are now enjoying the amazing wealth capitalism brought.
- lenkite 10mo ago
  > Collusion and cartels never work on the long run. Define "long run" - they have been already proven to have worked for years and in some cases even decades.
bko 10mo ago
Because if something sucks, someone comes up with something better and sells it for a profit. This is the history of pretty much every other good or service that is not heavily influenced by regulation and artificial barriers to entry
- ryandrake 10mo ago
  > Because if something sucks, someone comes up with something better and sells it for a profit. This is basically a religious belief at this point. It's how a perfectly ideal free market might work, but we don't have any of these, especially in healthcare.
  - bko 10mo ago
    Do you not use private businesses or something? Do you not shop at a private grocer or order things from Amazon or use a private search engine? Probably 99% of what I consume comes from private companies and the services generally get better over time, with some exceptions. Compare that to an experience with the TSA.
- ThrowMeAway1618 10mo ago
  [flagged]
  - nickpp 10mo ago
    No need for blind belief, you can always visit Venezuela, North Korea or Cuba to see how a country without free markets fares. Or come here in Eastern Europe where we had the "pleasure" of trying both systems and see how free markets pulled us out of utter poverty.

deleted 10mo ago

[deleted]

Retric 10mo ago

You’re confusing ideology with the way the world actually operates. The general public doesn’t have enough information to make informed decisions when it comes to healthcare. This alone completely removes the usual market forces from providing any benefit when it comes to healthcare. Cancer treatments don’t inherently cost that much money, the systems to ensure people are actually getting useful treatments are expensive. You can’t trust companies selling cures. You can’t trust every doctor when they have financial incentives to offer treatments. Insurance companies are in an adversarial relationship with providing treatments, which doesn’t result in efficient supervision here. Lawsuits offer some protection, but at extreme cost to everyone involved. Etc etc. The net result of all these poor incentives is single payer systems end up being way more efficient, resulting in people living longer and spending less on healthcare.

bko 10mo ago
> The general public doesn’t have enough information to make informed decisions when it comes to healthcare. This alone completely removes the usual market forces from providing any benefit when it comes to healthcare. Why is it always "the general public" and not "I". Do you have enough information about decisions? Can I take away some of your rights? No, of course not. Everyone else is dumb except me. I'm sorry but I refuse to believe some unelected, anonymous bureaucrat has my best interests in mind or can even know me anything about me such that I want to allow them to make health decisions for me.
- Retric 10mo ago
  > Do you have enough information about decisions? Me personally, No. I don’t have enough information to make informed decisions here and you don’t either. Off the top of your head, how well educated is your dentist? You after all made an informed decision picking them. So how well did their background compare to others in your area. What where your concerns about their dental programs weaknesses and how was that offset by… Except no let me guess that never entered your mind did it.
  - bko 10mo ago

charles_f 10mo ago

> it put price pressure and competition on providing the service This is simply not true. Healthcare in the US is comparatively much more expensive than countries offering subsidized healthcare with comparable or better outcomes(1). > it's largely due to regulation and third party payer system Capitalism can't work in a market that's completely consolidated, and where people can't offer to not buy your service. Healthcare in publicly subsidized countries is much less expensive because it's regulated. Compare the price of simple drugs like insulin or asthma medicine if you need an easy example. Pharma companies still happily sell there, which is to say that the difference is pure profit on the back of sick people who don't have a choice. My biggest grief against this individual payment system is moral though. I don't see the virtue in a system where kids have to put on a show to receive care. Or anyone for that matter, you'll give to a kid because they're cute and generate empathy, does it make someone ugly with no family less deserving of getting cured from cancer? 1: https://www.healthsystemtracker.org/chart-collection/health-spending-u-s-compare-countries/#Health%20expenditures%20per%20capita,%20U.S.%20dollars,%202023%20(current%20prices%20and%20PPP%20adjusted) https://www.healthsystemtracker.org/chart-collection/health-...

ruszki 10mo ago

When you have to choose a provider or you die, there won’t be a real downward pressure on price because there is no need to form a cartel to feed on this. You can see this in every single market of utility or de facto utility segments.

jgeada 10mo ago

Because when you're dying you have no bargaining position. You can't just wait it out. And you're just a single client, whether you personally die or not does not meaningfully change their bottom line. So it is a highly asymmetric bargaining situation where all the incentives are poorly aligned. Of course it is exploitative.

bko 10mo ago
Okay, you have no bargaining decision when you have N providers, so we should get rid of all providers with a single provider because only then you'll be in better bargaining position. And now your death will have a meaningful change to the career bureaucrat or politician that made the decision that led to your death. Because power of an individual vote is much more powerful than the power to take your business elsewhere. That's if you can find out the responsible party that makes these decisions and they're not appointed but elected, otherwise you'd have to mount an influence campaign on the politicians with 90% re-election rate to change said bureaucratic leader. Makes a lot of sense.
- jgeada 10mo ago
  All empirical evidence shows that single payer systems work better, producing far better outcomes at lower cost, than the US system. In fact, so much better that a single payer system is what Congress has chosen for itself! But seems some prefer to believe a theoretical argument with no evidence to back it up. “The Party told you to reject the evidence of your eyes and ears. It was their final, most essential command.”
  - nickpp 10mo ago
    > All empirical evidence shows that single payer systems work better, producing far better outcomes at lower cost, than the US system. Agreed. Also, all empirical evidence shows that free-markets work better, producing far better outcomes at lower cost than either. Just look around at any less-regulated and thus free-er markets. Or just "reject the evidence" - your choice. > die I am middle-aged so I used plenty of health services in my life. I always had choices when in came to price and level of care and treatment. None of them were for the "dying" case. But I do have an insurance specifically for that case. I am a rational being so I plan in advance. No need for a government bureaucrat to decide my health care for me just in case some day I may be incapacitated.