6 ms·

The free market offers no incentive to give health services to people who cannot pay for it, or don't know that these services will reduce hospitalization by 33

by pekk 14y ago

The free market offers no incentive to give health services to people who cannot pay for it, or don't know that these services will reduce hospitalization by 33% and costs by 22%. Basic health care is not McDonald's because your mother does not die prematurely (and miserably, and expensively) for the lack of McDonald's. The core issue is not about some private business being 'customer-responsive' in the vein of Starbucks. You can, today, start private clinics which are more "customer-responsive" (leave a mint on your pillow, etc.) but how are you going to recoup the costs and in particular, how does that benefit the populace in aggregate?

HarryHirsch 14y ago
> The free market offers no incentive to give health services to people who cannot pay for it, or don't know that these services will reduce hospitalization by 33% and costs by 22% Amen to that. The major killers at the turn of the last century were tuberculosis and waterborne diseases, and the free market did nothing to improve living conditions or supply clean water to the urban population then. I am in Portugal right now, where Dr Sousa Martins, a physician who spearheaded the fight against tuberculosis, is considered a saint. Public health is always political issue. It is as true 100 years ago as it is now.
- tosseraccount 14y ago
  Free market didn't improve living conditions? The supply and demand for more spacious housing and fuel to boil water didn't help things?
  - lukeschlather 14y ago
    For the upper 50%, sure, but the free market failed and generally fails to give the lower 50% of earners access to sufficient resources to do proper sanitation. Treating clean water as a commodity rather than a public utility is a public health disaster. Each household needing expertise and equipment for water purification does not scale.
    - tomjen3 14y ago
      Define failure in this case. Yes the poor have less than the rich, but so what? What is the cost of clean water today? How much for a fridge? As it turns out, 99.9% of us households have a fridge (http://www.eia.gov/emeu/recs/appliances/appliances.html http://www.eia.gov/emeu/recs/appliances/appliances.html). Those weren't really available in 1900, yet I don't remember any huge government subsidy for those (and by keeping your food fresh they prevent diarrhea and improve hygine). I do remember huge, private, factories making them, however. But even then soap is likely also one of those things that really help prevent deceases through proper sanitation -- yet how poor do you have to be to not be able to afford soap?
      - lukeschlather 14y ago
        > What is the cost of clean water today? How much for a fridge? A fridge is much more expensive, but it's also much more a luxury. You don't need to refrigerator to avoid diarrhea, it just helps. Pure running water on the other hand is extraordinarily cheap and makes avoiding waterborne illness easy. (Due to the fact that running water is provided by public utilities, not free markets.) I'm not saying the free market doesn't have a part to play in good hygiene, but trying to rely on the free market for a water supply and food handling regulations has been an unmitigated disaster everywhere it's been tried.
        tosseraccount 14y ago
        "unmitigated disaster everywhere it's been tried". England is served by private water companies. Is this a disaster?
        lukeschlather 14y ago
        Public utilities aren't necessarily public companies. Private companies own and manage the lines, yes, but prices are fixed by the government, and companies are required to supply water to residents, often even in cases of non-payment. Hardly a free market, and definitely what I would call regulated public utilities.
  - ahoyhere 14y ago
    No, the free market didn't. People like Sara Josephine Baker did: http://en.wikipedia.org/wiki/Sara_Josephine_Baker http://en.wikipedia.org/wiki/Sara_Josephine_Baker The free market creates slums. "People are willing to pay for it!" is the phrase that defines the free market. And yes, people are willing to pay to live in slums… when there are no laws, or no enforcement of laws, to protect their interests, because they are powerless, ignorant, undocumented, poor.
tklovett 14y ago
> The free market offers no incentive to give health services to people who cannot pay for it I'm not sure that's strictly true. For one, if the government is paying for those who cannot afford it (through medicare/medicaid, etc.) then there is money to be made, and thus some incentive. Even if its a relatively small amount, some model could be devised to capture the market as a sort of long tail. Much like Amazon has some incentive to sell even the cheapest, niche items.
randall 14y ago
Did you read the article? HQP sounds like a great way to start.
skue 14y ago
> The free market offers no incentive to give health services to people who cannot pay for it. That's why we balanced the market with limited regulations, such as requiring Emergency Departments to treat all patients regardless of their ability to pay. It's also why we established Medicare, Medicaid, and the VHA so providers can get paid for treating patients with limited means. With the new health reform, it's why we are providing insurance pools so people who do not have benefits through work can benefit by shared risk and still buy health insurance on their own. Health reform also includes an individual mandate to incentivize everyone who can afford it to purchase health insurance. > these services will reduce hospitalization by 33% and costs by 22%. > how are you going to recoup the costs and in particular, how does that benefit the populace in aggregate? You seem to be making contradictory points.
tomjen3 14y ago
While my mother wouldn't die for lack of McDonalds, she would die, prematurely, painfully (and cheap) for lack of food. So I don't see how your argument stand.
SilasX 14y ago
>Basic health care is not McDonald's because your mother does not die prematurely (and miserably, and expensively) for the lack of McDonald's It is indeed important to recognize where health care deviates from known "[market-]solved problems". But you haven't shown an important difference there. While mom doesn't die from lack of McDonald's, she does die from lack of food, and yet no one uses that a reason to make trite remarks about how we can't possibly allow a free market in food. Rather, they would recognize that we should leave food production to the market, and simply have the government buy from producers, like we do with food stamps, and then concentrate on making sure that such a system doesn't have bizarre implications for the incentive structure. >You can, today, start private clinics which are more "customer-responsive" (leave a mint on your pillow, etc.) but how are you going to recoup the costs and in particular, how does that benefit the populace in aggregate? The problem is that you're not going to get reimbursed by the government, no matter how much better your service is per dollar than the existing recipients of the money. So no, it's not really anything like a fair competition where market incentives bring in new entrants where existing providers suck. The things is, we are already using a market to provide health care to people unavailable to afford it; it's just that the payer is someone else. So it's import to examine the process by which that money is given out, and whether it's encouraging waste, or if it has an incentive to economize on care to get the best outcome per dollar. And you don't answer that question by saying "this ain't the market" (because it largely is) or dismiss it by asking how they're going to get paid (because someone is already paying for these services).
- ahoyhere 14y ago
  > and yet no one uses that a reason to make trite remarks about how we can't possibly allow a free market in food We do not have a free market in food. Even if you ignore subsidies entirely… Have you not heard of the FDA? Upton Sinclair? Health inspections for restaurants? Requirements to enrich certain food products, pasteurize others? How about the pet food and baby formula from China (free market!) that was found to have melamine and other poisons in it? A free market in food results in low quality, unsafe, non-nutritious food. Or things that masquerade as food but aren't. On that note… History will look back at many of our legal "foodstuffs" of today and call them as awful as Radon Water: http://www.periodictable.com/PopularScience/2004/08/2/index.html http://www.periodictable.com/PopularScience/2004/08/2/index.... Like slums (see my other comment) -- people will pay to live in slums, you know, the free market creates them --- a free market for food provides for a few and poisons the rest. Not unlike the healthcare situation in the US.
glenra 14y ago
> The free market offers no incentive to give health services to people who [...] don't know that these services will reduce hospitalization by 33% and costs by 22%. Your argument proves too much. You might want to think through the logic in some other area of life. Maybe gas prices at the pump, or candy prices at the supermarket counter. Cheaper and better comparable products DO tend to win over time, do they not? If X is 22% cheaper (while being better as well) than Y, the people who buy a LOT of this good, whatever it is, have a HUGE incentive to switch. In the case of health care, the big movers would be (a) health insurance companies, (b) other companies that offer health coverage to their employees. Additionally, of those who buy health coverage or health care directly as individuals there are bound to be some customers who are unusually price sensitive or unusually anal about doing price comparisons. On the margin, THOSE people will switch, and their friends who look to them for guidance will also switch. Just that movement alone might put a company out of business and thereby protect everyone else too, but you also have to think about natural churn. Even if existing customers and existing big companies and existing insurers are all too lazy to switch, as NEW companies and individuals look for their FIRST contract, they'll do a comparison and see that 22% savings. Last but not least, ignorance is somewhat curable. When X is 22% cheaper to provide (while also better) than Y, X can sell the service for less AND have a higher profit margin...and will use some of those profits (or expected profits) to ADVERTISE. They can TELL the people who "don't know" the stuff that they need to know. I recommend putting up billboards near the competing hospitals. :-)
bjhoops1 14y ago
> The free market offers no incentive to give health services to people who cannot pay for it Yes, thank you. I've said it many times before - the Free Market cares about your problems to the exact extent that you can Pay for them. Any benefits that happen to flow to the impecunious are incidental (though still nice when they do occur).

by pekk 14y ago

HarryHirsch 14y ago

> The free market offers no incentive to give health services to people who cannot pay for it, or don't know that these services will reduce hospitalization by 33% and costs by 22% Amen to that. The major killers at the turn of the last century were tuberculosis and waterborne diseases, and the free market did nothing to improve living conditions or supply clean water to the urban population then. I am in Portugal right now, where Dr Sousa Martins, a physician who spearheaded the fight against tuberculosis, is considered a saint. Public health is always political issue. It is as true 100 years ago as it is now.

tosseraccount 14y ago
Free market didn't improve living conditions? The supply and demand for more spacious housing and fuel to boil water didn't help things?
- lukeschlather 14y ago
  For the upper 50%, sure, but the free market failed and generally fails to give the lower 50% of earners access to sufficient resources to do proper sanitation. Treating clean water as a commodity rather than a public utility is a public health disaster. Each household needing expertise and equipment for water purification does not scale.
  - tomjen3 14y ago
    Define failure in this case. Yes the poor have less than the rich, but so what? What is the cost of clean water today? How much for a fridge? As it turns out, 99.9% of us households have a fridge (http://www.eia.gov/emeu/recs/appliances/appliances.html http://www.eia.gov/emeu/recs/appliances/appliances.html). Those weren't really available in 1900, yet I don't remember any huge government subsidy for those (and by keeping your food fresh they prevent diarrhea and improve hygine). I do remember huge, private, factories making them, however. But even then soap is likely also one of those things that really help prevent deceases through proper sanitation -- yet how poor do you have to be to not be able to afford soap?
    - lukeschlather 14y ago
      > What is the cost of clean water today? How much for a fridge? A fridge is much more expensive, but it's also much more a luxury. You don't need to refrigerator to avoid diarrhea, it just helps. Pure running water on the other hand is extraordinarily cheap and makes avoiding waterborne illness easy. (Due to the fact that running water is provided by public utilities, not free markets.) I'm not saying the free market doesn't have a part to play in good hygiene, but trying to rely on the free market for a water supply and food handling regulations has been an unmitigated disaster everywhere it's been tried.
      - tosseraccount 14y ago
        "unmitigated disaster everywhere it's been tried". England is served by private water companies. Is this a disaster?
        lukeschlather 14y ago
        Public utilities aren't necessarily public companies. Private companies own and manage the lines, yes, but prices are fixed by the government, and companies are required to supply water to residents, often even in cases of non-payment. Hardly a free market, and definitely what I would call regulated public utilities.
- ahoyhere 14y ago
  No, the free market didn't. People like Sara Josephine Baker did: http://en.wikipedia.org/wiki/Sara_Josephine_Baker http://en.wikipedia.org/wiki/Sara_Josephine_Baker The free market creates slums. "People are willing to pay for it!" is the phrase that defines the free market. And yes, people are willing to pay to live in slums… when there are no laws, or no enforcement of laws, to protect their interests, because they are powerless, ignorant, undocumented, poor.

tklovett 14y ago

> The free market offers no incentive to give health services to people who cannot pay for it I'm not sure that's strictly true. For one, if the government is paying for those who cannot afford it (through medicare/medicaid, etc.) then there is money to be made, and thus some incentive. Even if its a relatively small amount, some model could be devised to capture the market as a sort of long tail. Much like Amazon has some incentive to sell even the cheapest, niche items.

randall 14y ago

Did you read the article? HQP sounds like a great way to start.

skue 14y ago

> The free market offers no incentive to give health services to people who cannot pay for it. That's why we balanced the market with limited regulations, such as requiring Emergency Departments to treat all patients regardless of their ability to pay. It's also why we established Medicare, Medicaid, and the VHA so providers can get paid for treating patients with limited means. With the new health reform, it's why we are providing insurance pools so people who do not have benefits through work can benefit by shared risk and still buy health insurance on their own. Health reform also includes an individual mandate to incentivize everyone who can afford it to purchase health insurance. > these services will reduce hospitalization by 33% and costs by 22%. > how are you going to recoup the costs and in particular, how does that benefit the populace in aggregate? You seem to be making contradictory points.

tomjen3 14y ago

While my mother wouldn't die for lack of McDonalds, she would die, prematurely, painfully (and cheap) for lack of food. So I don't see how your argument stand.

SilasX 14y ago

>Basic health care is not McDonald's because your mother does not die prematurely (and miserably, and expensively) for the lack of McDonald's It is indeed important to recognize where health care deviates from known "[market-]solved problems". But you haven't shown an important difference there. While mom doesn't die from lack of McDonald's, she does die from lack of food, and yet no one uses that a reason to make trite remarks about how we can't possibly allow a free market in food. Rather, they would recognize that we should leave food production to the market, and simply have the government buy from producers, like we do with food stamps, and then concentrate on making sure that such a system doesn't have bizarre implications for the incentive structure. >You can, today, start private clinics which are more "customer-responsive" (leave a mint on your pillow, etc.) but how are you going to recoup the costs and in particular, how does that benefit the populace in aggregate? The problem is that you're not going to get reimbursed by the government, no matter how much better your service is per dollar than the existing recipients of the money. So no, it's not really anything like a fair competition where market incentives bring in new entrants where existing providers suck. The things is, we are already using a market to provide health care to people unavailable to afford it; it's just that the payer is someone else. So it's import to examine the process by which that money is given out, and whether it's encouraging waste, or if it has an incentive to economize on care to get the best outcome per dollar. And you don't answer that question by saying "this ain't the market" (because it largely is) or dismiss it by asking how they're going to get paid (because someone is already paying for these services).

ahoyhere 14y ago
> and yet no one uses that a reason to make trite remarks about how we can't possibly allow a free market in food We do not have a free market in food. Even if you ignore subsidies entirely… Have you not heard of the FDA? Upton Sinclair? Health inspections for restaurants? Requirements to enrich certain food products, pasteurize others? How about the pet food and baby formula from China (free market!) that was found to have melamine and other poisons in it? A free market in food results in low quality, unsafe, non-nutritious food. Or things that masquerade as food but aren't. On that note… History will look back at many of our legal "foodstuffs" of today and call them as awful as Radon Water: http://www.periodictable.com/PopularScience/2004/08/2/index.html http://www.periodictable.com/PopularScience/2004/08/2/index.... Like slums (see my other comment) -- people will pay to live in slums, you know, the free market creates them --- a free market for food provides for a few and poisons the rest. Not unlike the healthcare situation in the US.

glenra 14y ago

> The free market offers no incentive to give health services to people who [...] don't know that these services will reduce hospitalization by 33% and costs by 22%. Your argument proves too much. You might want to think through the logic in some other area of life. Maybe gas prices at the pump, or candy prices at the supermarket counter. Cheaper and better comparable products DO tend to win over time, do they not? If X is 22% cheaper (while being better as well) than Y, the people who buy a LOT of this good, whatever it is, have a HUGE incentive to switch. In the case of health care, the big movers would be (a) health insurance companies, (b) other companies that offer health coverage to their employees. Additionally, of those who buy health coverage or health care directly as individuals there are bound to be some customers who are unusually price sensitive or unusually anal about doing price comparisons. On the margin, THOSE people will switch, and their friends who look to them for guidance will also switch. Just that movement alone might put a company out of business and thereby protect everyone else too, but you also have to think about natural churn. Even if existing customers and existing big companies and existing insurers are all too lazy to switch, as NEW companies and individuals look for their FIRST contract, they'll do a comparison and see that 22% savings. Last but not least, ignorance is somewhat curable. When X is 22% cheaper to provide (while also better) than Y, X can sell the service for less AND have a higher profit margin...and will use some of those profits (or expected profits) to ADVERTISE. They can TELL the people who "don't know" the stuff that they need to know. I recommend putting up billboards near the competing hospitals. :-)

bjhoops1 14y ago

> The free market offers no incentive to give health services to people who cannot pay for it Yes, thank you. I've said it many times before - the Free Market cares about your problems to the exact extent that you can Pay for them. Any benefits that happen to flow to the impecunious are incidental (though still nice when they do occur).