2 ms·

It’s disturbing to see multiple comments that “capitalism” is to blame for the costs in healthcare. The US healthcare market is the least free market in the US.

by mchusma 7mo ago

It’s disturbing to see multiple comments that “capitalism” is to blame for the costs in healthcare. The US healthcare market is the least free market in the US. Capitalism (when there is true competition) brings down costs pretty universally. Those parts of the market that are market oriented tend to get better and cheaper over time (for example, generic over the counter meds, needles, and even health care panels, AI health advice) all getting better and cheaper. You can get pretty cheap panels of blood drawn, for $200 or less with tons of data. It’s only when you hit the regulatory wall and you exit the market do you see costs explode. Our imperfect system pays for the worlds medical R&D, so I would actually love to see per capita spending remain similar BUT have the market opened up, with a nice safety net at reasonable cost, and money pouring into curing aging and all disease.

estearum 7mo ago
> Capitalism (when there is true competition) brings down costs pretty universally. "True competition" is doing a lot of heavy lifting here. There are many conditions that must be true for prices to go down.
Dumblydorr 7mo ago
Capitalism =\= free-market We have crony capitalism in the US, healthcare is one of the easiest areas to see it. Free-market is the illusive perfect sphere. Most markets are oval or amoeba shaped. Rarely can the US achieve a true free market in any industry, since money pours into politics and corrupts the laws and regulations.
rexroad 7mo ago
Agreed on the diagnosis: the inpatient hospital market does not function as a competitive market. Patients arriving by ambulance do not shop on price. Insurance insulates consumers from marginal cost. Regulatory and capital barriers prevent new entrants. The HCRIS FY2023 data for 3,193 hospitals shows what this produces: a 2.6x median markup to actual cost, with the highest-markup hospitals rarely losing patients to lower-cost alternatives nearby. Your examples of what works are instructive. Generic OTC, needles, blood panels all share the same conditions: price-visible, consumer-controlled, no third-party payment insulation. The RAND hospital data shows the identical procedure (hip replacement) costing $29K commercially in the US versus $14.7K in Germany and $8.7K in Spain. Same implant, same surgeon training requirements. The patient's insurance status varies; the procedure does not. Montana's commercial reference pricing is not deregulation, but it creates the price-visibility function you are describing: a known floor price that makes it possible for a purchaser to act on price information. Employers have adopted it nationally with documented savings.

by mchusma 7mo ago

estearum 7mo ago

> Capitalism (when there is true competition) brings down costs pretty universally. "True competition" is doing a lot of heavy lifting here. There are many conditions that must be true for prices to go down.

Dumblydorr 7mo ago

Capitalism =\= free-market We have crony capitalism in the US, healthcare is one of the easiest areas to see it. Free-market is the illusive perfect sphere. Most markets are oval or amoeba shaped. Rarely can the US achieve a true free market in any industry, since money pours into politics and corrupts the laws and regulations.

rexroad 7mo ago

Agreed on the diagnosis: the inpatient hospital market does not function as a competitive market. Patients arriving by ambulance do not shop on price. Insurance insulates consumers from marginal cost. Regulatory and capital barriers prevent new entrants. The HCRIS FY2023 data for 3,193 hospitals shows what this produces: a 2.6x median markup to actual cost, with the highest-markup hospitals rarely losing patients to lower-cost alternatives nearby. Your examples of what works are instructive. Generic OTC, needles, blood panels all share the same conditions: price-visible, consumer-controlled, no third-party payment insulation. The RAND hospital data shows the identical procedure (hip replacement) costing $29K commercially in the US versus $14.7K in Germany and $8.7K in Spain. Same implant, same surgeon training requirements. The patient's insurance status varies; the procedure does not. Montana's commercial reference pricing is not deregulation, but it creates the price-visibility function you are describing: a known floor price that makes it possible for a purchaser to act on price information. Employers have adopted it nationally with documented savings.