4 ms·

A very good article that reminds me of an understanding that I've come to a couple of years ago - that free market capitalism and health care just don't mix. H

by skore 14y ago

A very good article that reminds me of an understanding that I've come to a couple of years ago - that free market capitalism and health care just don't mix. Having the option to choose against a service, or being physically able to choose another service vendor if one is ripping you off are some of the core rules keeping the worst absurdities of capitalism in check. Without them, the result is that people are being held hostage - pay here or die here. People aren't usually inclined to choose the second.

jpadkins 14y ago
How is the US Healthcare system in anyway like a free market? It's by far the most heavily regulated industry, every aspect of it. I believe government pays ~ 1/3rd of all healthcare costs. Free market healthcare is veterinary, plastic surgery, lasik or maybe even dentists. Those sectors haven't seen skyrocketing costs.
- michaelochurch 14y ago
  Corporate capitalism exists to provide the best of socialism and capitalism for the well-connected, entitled corporate elite and the worst of both systems for everyone else.
  - Roboprog 14y ago
    Odd, I prefer the term "corporate communism" for monopoly/oligarchy: A central board plans some aspect of the economy, just like Soviet Russia, once you get to a monopoly, with similar efficiencies. Anyway, the US would probably benefit from a hybrid system: government provided baseline care with option to purchase private upgrades.
- hamburglar 14y ago
  You have apparently never been handed a $93k estimate for dental work, and are probably not aware that it is nearly impossible to find a dental plan that will pay for more than a couple thousand dollars of work (they all have caps that can easily be exceeded by getting work done on a single tooth).
  - jpadkins 14y ago
    $93k dental work sounds like an outlier. In a free market, $93k dental work should be as rare Bentley's on the road. There are very few people who can afford $93k procedures, so dentists/doctors will have to figure out how to do the procedure for a lot less or deal with the fact that their target market will be extremely small.
    - hamburglar 14y ago
      Absolutely true that $93k is an outlier. $10-20k, however, is not, and is enough to constitute a genuine hardship for a lot of families.
      - hamburglar 14y ago
        Besides, isn't the entire purpose of insurance to smooth out the outliers? $500k cancer treatment is an outlier, too, which is why I have medical insurance that covers it.
robbiep 14y ago
You may be interested to look at the Australian health system, with a dual system of free cover for all, and the option of private insurance and private treatment (option of staying in a hospital with nicer rooms and the ability to choose your own doctor) - Good care is incentivised for all (many of the expensive drugs mentioned in the article, for example rituximab and the breast cancer treatment drug Herceptin, and many other drugs that would cost >$50,000 for an individual, are bought by the government and made available for anyone who needs them for a maximum cost of $36.10) And doctors can still earn good money in private practice if they so desire As a side note I am currently an Australian medical student taking a surgical placement in a Boston hospital. A surgeon in Australia can easily make the same amount of money as an American surgeon; they will earn on average twice as much during their training years (base salary for a first year graduate in aus is ~$56,000 extending up to ~$80,000 with overtime (paid hourly) vs ~$45k for an intern in the states who is salaried and not paid overtime. First year attendings/consultants in Australia generally take home $200-250k, exactly on par with US doctors With the added advantage of not having 200-500k in student debt (I have been a student for 10 years by the time I graduate later his year and will have $45k in student debt)
- skore 14y ago
  I believe the system we have here in Germany is quite similar and yes, I think it's working rather well.
marknutter 14y ago
Very few medical expenses are related to life and death scenarios, so I think you're being a bit dramatic. When it comes to basic care, there's absolutely no reason why a capitalist approach wouldn't work, and work well. And insurance was supposed to be the way to protect against catastrophic life and death scenarios but it has become synonymous with basic health coverage.
- skore 14y ago
  True, but even if they're not life and death - the implication is that you don't cut costs on health care, because somewhere down the line, you might regret it. Also, of course, a lot of the things that may be minor in comparison to true life-and-death scenarios have very real consequences concerning the ability to take part it everyday life or being able to work. Having two fingers cut off might not kill me, but I'm quite sure how I would react - even if somebody offered me a hefty cost to reattach them, I'd choose that over spending the rest of my entire life with only eight fingers.
  - marknutter 14y ago
    Well you, as the consumer, have to decide what each service provided is worth. I would pay handsomely to have my fingers re-attached, but if I was on a tight budget I might think twice before going into the doctor for every sore throat (I do that now anyways despite having good coverage). It's up to the individual to decide how much care they want or require and are willing to pay for.
    - skore 14y ago
      I like the thought that was the other reply to your initial comment: But what if that sore throat isn't just a sore throat, but something that will either get very expensive to fix, or kill you outright, the longer you wait? There are plenty of stories around where people thought they were just putting on weight, had some minor pain and it turns out - yup, giant tumor. Universal health care that is either free or affordable without ruining your finances is absolutely possible today. Defending it behind some thin veil of "personal liberty" and the like is cute, but doesn't map to reality.

by skore 14y ago

jpadkins 14y ago

How is the US Healthcare system in anyway like a free market? It's by far the most heavily regulated industry, every aspect of it. I believe government pays ~ 1/3rd of all healthcare costs. Free market healthcare is veterinary, plastic surgery, lasik or maybe even dentists. Those sectors haven't seen skyrocketing costs.

michaelochurch 14y ago
Corporate capitalism exists to provide the best of socialism and capitalism for the well-connected, entitled corporate elite and the worst of both systems for everyone else.
- Roboprog 14y ago
  Odd, I prefer the term "corporate communism" for monopoly/oligarchy: A central board plans some aspect of the economy, just like Soviet Russia, once you get to a monopoly, with similar efficiencies. Anyway, the US would probably benefit from a hybrid system: government provided baseline care with option to purchase private upgrades.
hamburglar 14y ago
You have apparently never been handed a $93k estimate for dental work, and are probably not aware that it is nearly impossible to find a dental plan that will pay for more than a couple thousand dollars of work (they all have caps that can easily be exceeded by getting work done on a single tooth).
- jpadkins 14y ago
  $93k dental work sounds like an outlier. In a free market, $93k dental work should be as rare Bentley's on the road. There are very few people who can afford $93k procedures, so dentists/doctors will have to figure out how to do the procedure for a lot less or deal with the fact that their target market will be extremely small.
  - hamburglar 14y ago
    Absolutely true that $93k is an outlier. $10-20k, however, is not, and is enough to constitute a genuine hardship for a lot of families.
    - hamburglar 14y ago
      Besides, isn't the entire purpose of insurance to smooth out the outliers? $500k cancer treatment is an outlier, too, which is why I have medical insurance that covers it.

robbiep 14y ago

You may be interested to look at the Australian health system, with a dual system of free cover for all, and the option of private insurance and private treatment (option of staying in a hospital with nicer rooms and the ability to choose your own doctor) - Good care is incentivised for all (many of the expensive drugs mentioned in the article, for example rituximab and the breast cancer treatment drug Herceptin, and many other drugs that would cost >$50,000 for an individual, are bought by the government and made available for anyone who needs them for a maximum cost of $36.10) And doctors can still earn good money in private practice if they so desire As a side note I am currently an Australian medical student taking a surgical placement in a Boston hospital. A surgeon in Australia can easily make the same amount of money as an American surgeon; they will earn on average twice as much during their training years (base salary for a first year graduate in aus is ~$56,000 extending up to ~$80,000 with overtime (paid hourly) vs ~$45k for an intern in the states who is salaried and not paid overtime. First year attendings/consultants in Australia generally take home $200-250k, exactly on par with US doctors With the added advantage of not having 200-500k in student debt (I have been a student for 10 years by the time I graduate later his year and will have $45k in student debt)

skore 14y ago
I believe the system we have here in Germany is quite similar and yes, I think it's working rather well.

marknutter 14y ago

Very few medical expenses are related to life and death scenarios, so I think you're being a bit dramatic. When it comes to basic care, there's absolutely no reason why a capitalist approach wouldn't work, and work well. And insurance was supposed to be the way to protect against catastrophic life and death scenarios but it has become synonymous with basic health coverage.

skore 14y ago
True, but even if they're not life and death - the implication is that you don't cut costs on health care, because somewhere down the line, you might regret it. Also, of course, a lot of the things that may be minor in comparison to true life-and-death scenarios have very real consequences concerning the ability to take part it everyday life or being able to work. Having two fingers cut off might not kill me, but I'm quite sure how I would react - even if somebody offered me a hefty cost to reattach them, I'd choose that over spending the rest of my entire life with only eight fingers.
- marknutter 14y ago
  Well you, as the consumer, have to decide what each service provided is worth. I would pay handsomely to have my fingers re-attached, but if I was on a tight budget I might think twice before going into the doctor for every sore throat (I do that now anyways despite having good coverage). It's up to the individual to decide how much care they want or require and are willing to pay for.
  - skore 14y ago
    I like the thought that was the other reply to your initial comment: But what if that sore throat isn't just a sore throat, but something that will either get very expensive to fix, or kill you outright, the longer you wait? There are plenty of stories around where people thought they were just putting on weight, had some minor pain and it turns out - yup, giant tumor. Universal health care that is either free or affordable without ruining your finances is absolutely possible today. Defending it behind some thin veil of "personal liberty" and the like is cute, but doesn't map to reality.