9 ms·

I'm always irritated when people blame capitalism and free markets for the high cost of healthcare in the USA. The reality is that healthcare is anything but a

I'm always irritated when people blame capitalism and free markets for the high cost of healthcare in the USA. The reality is that healthcare is anything but a free market, and costs aren't going to come down until it becomes one.

nostromo 13y ago
Or becomes not one. We have a worse system than both free-market and single-payer, either would be more cost-effective.
- notdrunkatall 13y ago
  I fully agree.
- venomsnake 13y ago
  Health care cannot be free market by one simple fact - you have total inflexibility of demand/constant production of goods/information asymmetry. No sane person will buy brain surgery if he has no problems even if it 1$ and he has no choice but to buy one at whatever cost if he has. We should work towards making healthcare cheap in absolute sense - if we could make healthcare cost on average 1000$ per person per year than the question who should foot the bill is moot - it will be such a small sum it won't matter.
  - brazzy 13y ago
    I suspect that's impossible unless you first reach a full post-scarcity economy of nanotech and robotic servants. For rare conditions, it's not overall cost-effective to spend the necessary money to make them cheap, and for everything else there is too much labor involved to ever be cheap.
  - eatitraw 13y ago
    I don't get your point. > No sane person will buy brain surgery if he has no problems even if it 1$ and he has no choice but to buy one at whatever cost if he has. So what? Also, if there are multiple methods to treat his conditions, he may choose more expensive(or more cheap) method. Also, he may choose not to have brain surgery -- and sadly suffer or die. Socialism is hardly a solution here, if state will fail to provide necessary amount of surgeons to fulfill demand for them, then people will die too(not mentioning that there always be better methods and better qualified surgeons, so you won't be able to achieve the same level of healthcare anyway).
    - venomsnake 13y ago
      First - if I cannot afford a treatment not getting it is not a choice. A choice is when I have insurance and refuse chemo because the side effects outweigh the benefits. I am not talking about socialism. I am talking that we should treat the healthcare system the same way that we treat power plants and energy distribution utilities. A system of grants and loans that ensures long term supply of goods. So you pay your bills each month but the government takes care of you not being price gouged (except in California) In the US (disclaimer - most I know for the healthcare is from the media, non US citizen) a good starting point will be forfeiting and subsidizing medical education so the graduates will be loan free. Also the government should not leave R&D to the private sector but create human health Manhattan project - this will have the benefits of everything that comes out of it entering public domain so no royalties patents and other shit to take care of. A good healthcare system should be like interstate etc. It is there it is low margin but enables the society to move faster towards the future.
      - eatitraw 13y ago
        > First - if I cannot afford a treatment not getting it is not a choice. The same is true in your system, substituting "afford" for whatever verb is better suited for your proposed system. > Also the government should not leave R&D Government leaving R&D to private sector(which is major source of funding even now, at least in the USA) would be the great decision. It will stop crowding out resources from private R&D, thus making R&D more effective and more beneficial to economy. Patents are the separate issue. There is the flaw in your logic. Patents are government granted. You view them as undesirable, but your solution is even more government. However, the logical solution would be abolishing patents.
        agent00f 13y ago
        > Government leaving R&D to private sector(which is major source of funding even now, at least in the USA) would be the great decision. The only people who claim this are those who have no idea what constitutes anything near blue skies research. Anything worth looking into for the mid to long term is going to have questionable profit potential and therefore not conducive to profit seeking. There's a reason why most research uni's are public and the results are dumped out for industry to exploit, and it's not because it steals the talent by paying so well. > You view them as undesirable, but your solution is even more government. However, the logical solution would be abolishing patents. So your plan is to incentivize private R&D by abolishing IP. Hahahahahaha.
  - yummyfajitas 13y ago
    ...total inflexibility of demand... False. The RAND experiment shows that people's consumption of medicine is dependent on it's marginal cost to them. Higher levels of cost sharing induce people to reduce consumption of medicine by 30% (with no adverse health effects). http://www.rand.org/health/projects/hie.html http://www.rand.org/health/projects/hie.html The Oregon health study got similar results, although it demonstrated one adverse health effect of consuming less medicine, namely increased rates of depression. http://oregonhealthstudy.org/for-participants/findings/ http://oregonhealthstudy.org/for-participants/findings/
    - XorNot 13y ago
      Which fails to translate into a meaningful result beyond what every other socialized healthcare system already knows and has addressed: you bill for stuff at the low end to keep people from going to the doctor for every tiny complaint, but it's utterly nonsensical to say that charging people for setting bones, or performing needed surgery is somehow going to encourage them to consume less.
    - venomsnake 13y ago
      I would love to see how someone gets 70% kidney or joint transplant. Like they put the stuff but don't sew you? Or you forfeit the anesthesia? Or if you have infection they give you antibiotics only 7 of the 10 days needed? They remove the bone cask a week before it is fully healed? Remove only 70% of tumor during surgery?
      - yummyfajitas 13y ago
        The fact that you can ridiculously misinterpret the two most important studies in a field does not make them invalid.
        venomsnake 13y ago
        No but it makes case about the fact that we are currently overtreating people in some cases. With defensive medicine and the fact that there is growing body of evidence that aggressive screening for cancer in a lot of cases does little good there is good chunk we could eliminate. By my friend that is on dialysis cannot use it 30% less in the long term without endangering her life or degrading her quality of life to the point of not worth living. Fracture a bone - you can go without professional help - risking all kinds of nasty stuff that will get you into ER or limping for the rest of your life. You can ignore the dermatitis but if a mole starts bleeding you MUST go to the dermatologist to check yourself for skin cancer. 30 percent less of the later checkups and you have a few corpses on your hand.
rdtsc 13y ago
Actually given healthcare's state either camp can raise an equally long list of complaints to blame the opposite camp. Socialists can say for example, if healthcare is left up to the market then monopolies would rise, the quality would become abysmal, the primary goal of hospitals, doctors and insurance companies is now profit as opposed to keeping people healthy. They might claim government is not doing enough. There should be a single payer option or price control options etc etc. Libertarians and those who like to extol the virtues of free markets and hate government intervention can blame all the brokenness on government bureaucracy and regulation. If only companies could just handle everything themselves it would all be very clear and easy, kind of like with car insurance. There would be competition etc etc. See, one can defend either position. So it is not 100% clear cut and obvious which is which.
- jivatmanx 13y ago
  I totally agree with this. Similarly, Socialists can point to most European countries that get superior service for much less cost, while Capitalists (I lean this way) point to amazing efficiency innovations that happen in countries with less regulated systems like India's[0] What's clear is that our system has somehow found a way to be the worst of both worlds, very expensive, bad service, not universal. [0]http://online.wsj.com/article/SB125875892887958111.html http://online.wsj.com/article/SB125875892887958111.html
  - vertex-four 13y ago
    Of course, from experience living in India for several years, the problem with "less regulated systems like India's" is simply that aside from basic reactive healthcare of the sort you'd get from your GP, the poor do not have access to healthcare there. While even being able to see a GP when necessary is admittedly slightly better than the US's system, it's still not good enough, from the point of view of someone who can now take NHS Scotland for granted.
    - ippisl 13y ago
      This is not a problem of regulation, but of general lack of money and/or agreement of social cost sharing. And some other low cost services are offered to some of the poor in India like heart surgeries, artificial ankles, ambulances, eyeglasses, psychiatric services. With some money and growth they could theoretically be offered to everyone in India.
tzs 13y ago
> The reality is that healthcare is anything but a free market, and costs aren't going to come down until it becomes one. So the solution to our costs being higher than every other first world country is to make our system less like any of them?
gohrt 13y ago
Not true (as you noted in your reply), unless you mean in some very limited sense that ignore the ratio of benefits to that cost. Health care will never be a free market, it is too complex a good (it is a whole set of complicated products that take a life time to consume), and is packed with externalities relating to insurance premiums and emergency care. There is no simple answer for high-quality health care.
crygin 13y ago
There's absolutely no good reason to think that it should be possible to make money propping up us bags of decaying organic matter for as long as possible. The idea of making money providing healthcare is absurd -- like being able to deliver a letter anywhere for a fixed cost or basic defense of our borders, it's the proper role of a minimal viable government.
SoftwareMaven 13y ago
Given the mess started when the government implemented wage freezes in WWII and has only gotten worse since then, it is staggering that anybody could believe the US healthcare system is remotely related to a free market. And it keeps getting worse.
coldtea 13y ago
>I'm always irritated when people blame capitalism and free markets for the high cost of healthcare in the USA. The reality is that healthcare is anything but a free market, and costs aren't going to come down until it becomes one. Capitalism ain't nothing like a free market either, that's the point of those people. Capitalism is large private interests, big corporations, elites, and government in bed together to milk the population. As for the "free market", that's an impossible unicorn and ponies fantasy, formulated in the 18th century and perpetuated as a myth by economists who should know better afterwards.
- venomsnake 13y ago
  Free market is possible - the problem is that it is tool and not ideology. For it to work you need several conditions: 1. Relatively low barrier of entry 2. Non essential goods 3. Comoditization/semi comoditization of the products 4. Price, demand and supply elasticity The android phone/ tablet marked in the developing world right now is perfect example. Cheap PCs in the 80s/90s. Sadly in the developed world the business models with carrier subsidization is quite evil and hostile towards the consumers. We should really make the wireless and wired assholes dumb pipes.
  - brazzy 13y ago
    You realize you've essentially state that a free market is not possible in health care, yes?
    - eatitraw 13y ago
      He explicitly states that in another thread: https://news.ycombinator.com/item?id=6040196 https://news.ycombinator.com/item?id=6040196
    - deleted 13y ago
      [deleted]
  - coldtea 13y ago
    >Free market is possible - the problem is that it is tool and not ideology. For it to work you need several conditions: 1. Relatively low barrier of entry 2. Non essential goods 3. Comoditization/semi comoditization of the products 4. Price, demand and supply elasticity I don't see how all those are possible. They presuposse a place where: 1) There is no government intervention. 2) Private interests play nice to each other and never take advantage of their position to skew the market. That might happen temporarily in some sub-market (e.g cheap PCs in the 80s/90s) but it absolutely cannot happen in the overall market. Even something like "patents" and "copyright" is enough to fuck this up. Not to mention the issues of raw materials, infrastructure (roads, etc), foreign dependencies, etc.
wavefunction 13y ago
Maybe it's time to realize that there is no such thing as a "free market," since unethical individuals will always attempt to maximize their positions through their established power bases and political connections. The complaints about how "free markets" unfairly get blamed for market failures sounds exactly like communists bemoaning the fact that "pure communism" has never been tried in the real world, just corrupted versions of it.
- Ygg2 13y ago
  Heck you don't need political connection; even if there is no state there would be no free market. Corporations would simply fight over who owns most force and media. If you have ability to wield force and control the media you have made it.
- forgottenpaswrd 13y ago
  Not really, "free markets" are real, they exist. You find them in small villages all around the world, someone needs something that someone else has in abundance, they make a deal. I buy quality lentils, rice, milk, cows, ... this way, as I live in Europe. In the US you can't even buy natural milk, they have germs paranoia, and lots of big corps's interests. Any person on the village could sell you anything, without any control, and that works, believe it or not. A free market is as simple as a market that meets certain criteria, like existence of competition. Regulated markets use to destroy competition. In the US competition in healthcare is not so good in this regard, but don't tell any American, they believe they live in the best country in the world, specially those that had never lived abroad. You could argue that perfect "free markets" do not exist, like a perfect "cube" or "rectangle" or "sphere" do not either. And that is true, because in the end atoms are just discrete approximations of a perfect shape, but cubes are very useful as a reference.
  - wavefunction 13y ago
    We can buy raw milk in the US, it's just a hassle. Sorry to burst your Euro-bubble.
    - 13y ago
Ygg2 13y ago
Problem is, free market is not a panacea. You can't say well if thing X is free market then it would exist. First free market is an illusion that probably never existed unless you count the really rudimentary communities. The laws that make a free market a non-free market aren't bad, like banning child labor or reducing work hours to 40, etc. Second even in free market you can get monopolies, once all players consolidate or make deals. Then you lose any benefits of free market if paying to hush your competitors is lower than R&D.
flexie 13y ago
Yeah well. Are there any free market industries in the US? Financial sector, energy, car manufacturing, IT, education, news, health care, law, home buying, defense - those are all in one or more ways deeply subsidized or maintain such close relationship with government that it's difficult to say whether they are part of the government. Take Google: A single company that somehow manages to sit on almost all searches, most of the online add market, a good chunk of the email market. Yet it avoids being split up in antitrust cases. Google started as a government sponsored research project that was spun out from a government subsidized institution (Stanford). Then it raised tax subsidized financing (venture capital). It has what seems to be a free flow of information with different government institutions such as the NSA. Google doesn't really pay tax on most of its world wide income and it has some 20,000 government granted monopolies (also known as "patents"). Is Google a private company in a free market? Exactly what US industry should health care emulate?
- rorrr2 13y ago
  > sit on almost all searches, most of the online add market At least they don't control subtraction and multiplication.
  - deleted 13y ago
    [deleted]
  - maw 13y ago
    Those are in an independent division.
- specialist 13y ago
  Exactly what US industry should health care emulate? The best available answer is capitation, where care providers are rewarded for keeping people healthy, not treating disease. http://en.wikipedia.org/wiki/Capitation_(healthcare) http://en.wikipedia.org/wiki/Capitation_(healthcare) In practice, people live longer and costs go down. Too many people confuse prices (set by a market) with incentives. In the mythical future perfect "free market", competition would drive prices down and all would be "good". Alas, there are no free markets. Further, the desired outcomes is healthy people, not cheap healthcare.
pjmorris 13y ago
Can someone give an example of a free market health care system in a developed nation? Or an undeveloped nation? Would it be wrong to settle for a system that covers everyone and is 1/2 to 2/3 the price of the current US system, like other developed nations have figured out?
ThomPete 13y ago
There is no such thing as a 100% free market og 100% capitalism. What people are complaining about is that US healthcare is subject to a free market logic. I.e. the hospitals are profit centers and the insurance agencies are profit centers. The opposite is also bad (like in Denmark) with the hospitals being 100% state owned and the insurer being the state. In my mind what we need is a combination where one part needs to take care of making a profit and the other needs to be frugal about how it spends it's money. Have no idea how that would work, but somethings gotta give.
ryanackley 13y ago
I get irritated when people claim that free markets are a silver bullet for the ills of society. Even if you ignore the cruelty of not providing healthcare to people who can't afford it. How does the free market deal with community impact of untreated health problems? For example, highly infectious diseases which are relatively easy to treat but people may not be able to afford treatment for (post-exposure treatment for rabies, scarlet fever, etc)? Do we just quarantine these people until they die or someone pays for treatment? If we treat these people for free, we're now subsidizing health care. Where do you draw the line? Why don't we apply free market principles to law enforcement, fire services, and utilities?
- deelowe 13y ago
  > Why don't we apply free market principles to law enforcement, fire services, and utilities? Some utilities are starting to do this actually. Where I live Gas is provided by multiple servicers who setup contracts with the gas provided(sort of like a commodities market). There's been some talk about doing something similar with water as there's been some serious corruption uncovered with water billing in my area. Some fire departments are a combination of private and volunteer efforts. There's not many issues with this AFAIK. I used to live in a town like this and no one ever complained. Regarding the police, for better or worse, they are more or less treated as part of the judicial branch of government. I don't think many people would argue the police(as it exists today) should be private. That said, the system as it exists today is corrupt and resembles more of a military than a group dedicated to "protecting and serving." There are private police types in Texas and AFAIK, it works fine. Same goes for private bounty hunters. That said, most of the above aren't for profit services, so it's hard to compare them with medical, which is an industry that must sustain a profit to progress. When governments become profit centers, you will have problems. Considering the problems we have now with medical, less regulation around competition would certainly be a good thing. For example, I should be able to call and get prices for common services so that I can compare doctors. Not my employer(nor the government) should be allowed to provide me with subsidized insurance(except in welfare cases). I should be able to buy insurance from a provider anywhere in the country. I should be able to negotiate rates on my own behalf instead of the insurance provider doing it for me. Insurance providers should not get preferential treatment from doctors and/or hospitals. Fix these and things will get better. There will still be issues, but at least the market would be more efficient and prices would start going down.
epo 13y ago
The American system of healthcare may not be free-market but it is as pure a form of capitalism as you can get. That people equate competition with capitalism is merely wishful thinking. Monopoly, lack of transparency and a stranglehold over supply is the way to maximise profits.
jellicle 13y ago
Libertarianism can't fail - it can only be failed.
readme 13y ago
Could you give an example of a country with an acceptable healthcare system that has lowered healthcare costs by using a free market approach? Why do you think the free market is the best device for getting me a fair price on my ambulance ride? After all, I might be unconscious, so I won't even be able to compare ambulance rates beforehand.
- FireBeyond 13y ago
  That's also the reason why in almost all places in the US, ambulance rates are regulated. If you have a concern with the price of your ambulance ride, contact your county or state - or the ambulance company. We (as paramedics and EMTs) are also required to document the medical necessity of transport, without which Medicare, and insurance providers will likely not cover the bill, and (at least in my company, and others) is a good way for you to waiver your bill. As a general aside, though, treatment of unconscious persons is done on the presumption that they would want the most expedient and appropriate emergent treatment.
  - readme 13y ago
    I did not know that but I am pleased to know this information, it gives me hope that sanity might one day prevail here.
dragonwriter 13y ago
> I'm always irritated when people blame capitalism and free markets for the high cost of healthcare in the USA. The reality is that healthcare is anything but a free market, and costs aren't going to come down until it becomes one. Every other OECD country except Mexico has similar or better outcomes than the US, at lower cost (per capita and per GDP) than the US, so its pretty ridiculous to claim that the only possible way for the US to reduce prices is to convert the healthcare market into an unregulated free market, which is far from what any of the countries that achieve equal or better results at lower than the US have. The US pays more in healthcare in its public healthcare systems -- as a share of GDP or in $/capita -- than many countries do in their public systems that provide virtually everything through those public systems, and then pays about the same amount again in nonpublic healthcare expenditures. From all evidence, the biggest problem with healthcare costs in the US is the high degree of privatization, not the lack of a free market.

nostromo 13y ago

Or becomes not one. We have a worse system than both free-market and single-payer, either would be more cost-effective.

notdrunkatall 13y ago
I fully agree.
venomsnake 13y ago
Health care cannot be free market by one simple fact - you have total inflexibility of demand/constant production of goods/information asymmetry. No sane person will buy brain surgery if he has no problems even if it 1$ and he has no choice but to buy one at whatever cost if he has. We should work towards making healthcare cheap in absolute sense - if we could make healthcare cost on average 1000$ per person per year than the question who should foot the bill is moot - it will be such a small sum it won't matter.
- brazzy 13y ago
  I suspect that's impossible unless you first reach a full post-scarcity economy of nanotech and robotic servants. For rare conditions, it's not overall cost-effective to spend the necessary money to make them cheap, and for everything else there is too much labor involved to ever be cheap.
- eatitraw 13y ago
  I don't get your point. > No sane person will buy brain surgery if he has no problems even if it 1$ and he has no choice but to buy one at whatever cost if he has. So what? Also, if there are multiple methods to treat his conditions, he may choose more expensive(or more cheap) method. Also, he may choose not to have brain surgery -- and sadly suffer or die. Socialism is hardly a solution here, if state will fail to provide necessary amount of surgeons to fulfill demand for them, then people will die too(not mentioning that there always be better methods and better qualified surgeons, so you won't be able to achieve the same level of healthcare anyway).
  - venomsnake 13y ago
    First - if I cannot afford a treatment not getting it is not a choice. A choice is when I have insurance and refuse chemo because the side effects outweigh the benefits. I am not talking about socialism. I am talking that we should treat the healthcare system the same way that we treat power plants and energy distribution utilities. A system of grants and loans that ensures long term supply of goods. So you pay your bills each month but the government takes care of you not being price gouged (except in California) In the US (disclaimer - most I know for the healthcare is from the media, non US citizen) a good starting point will be forfeiting and subsidizing medical education so the graduates will be loan free. Also the government should not leave R&D to the private sector but create human health Manhattan project - this will have the benefits of everything that comes out of it entering public domain so no royalties patents and other shit to take care of. A good healthcare system should be like interstate etc. It is there it is low margin but enables the society to move faster towards the future.
    - eatitraw 13y ago
      > First - if I cannot afford a treatment not getting it is not a choice. The same is true in your system, substituting "afford" for whatever verb is better suited for your proposed system. > Also the government should not leave R&D Government leaving R&D to private sector(which is major source of funding even now, at least in the USA) would be the great decision. It will stop crowding out resources from private R&D, thus making R&D more effective and more beneficial to economy. Patents are the separate issue. There is the flaw in your logic. Patents are government granted. You view them as undesirable, but your solution is even more government. However, the logical solution would be abolishing patents.
      - agent00f 13y ago
        > Government leaving R&D to private sector(which is major source of funding even now, at least in the USA) would be the great decision. The only people who claim this are those who have no idea what constitutes anything near blue skies research. Anything worth looking into for the mid to long term is going to have questionable profit potential and therefore not conducive to profit seeking. There's a reason why most research uni's are public and the results are dumped out for industry to exploit, and it's not because it steals the talent by paying so well. > You view them as undesirable, but your solution is even more government. However, the logical solution would be abolishing patents. So your plan is to incentivize private R&D by abolishing IP. Hahahahahaha.
- yummyfajitas 13y ago
  ...total inflexibility of demand... False. The RAND experiment shows that people's consumption of medicine is dependent on it's marginal cost to them. Higher levels of cost sharing induce people to reduce consumption of medicine by 30% (with no adverse health effects). http://www.rand.org/health/projects/hie.html http://www.rand.org/health/projects/hie.html The Oregon health study got similar results, although it demonstrated one adverse health effect of consuming less medicine, namely increased rates of depression. http://oregonhealthstudy.org/for-participants/findings/ http://oregonhealthstudy.org/for-participants/findings/
  - XorNot 13y ago
    Which fails to translate into a meaningful result beyond what every other socialized healthcare system already knows and has addressed: you bill for stuff at the low end to keep people from going to the doctor for every tiny complaint, but it's utterly nonsensical to say that charging people for setting bones, or performing needed surgery is somehow going to encourage them to consume less.
  - venomsnake 13y ago
    I would love to see how someone gets 70% kidney or joint transplant. Like they put the stuff but don't sew you? Or you forfeit the anesthesia? Or if you have infection they give you antibiotics only 7 of the 10 days needed? They remove the bone cask a week before it is fully healed? Remove only 70% of tumor during surgery?
    - yummyfajitas 13y ago
      The fact that you can ridiculously misinterpret the two most important studies in a field does not make them invalid.
      - venomsnake 13y ago
        No but it makes case about the fact that we are currently overtreating people in some cases. With defensive medicine and the fact that there is growing body of evidence that aggressive screening for cancer in a lot of cases does little good there is good chunk we could eliminate. By my friend that is on dialysis cannot use it 30% less in the long term without endangering her life or degrading her quality of life to the point of not worth living. Fracture a bone - you can go without professional help - risking all kinds of nasty stuff that will get you into ER or limping for the rest of your life. You can ignore the dermatitis but if a mole starts bleeding you MUST go to the dermatologist to check yourself for skin cancer. 30 percent less of the later checkups and you have a few corpses on your hand.

rdtsc 13y ago

Actually given healthcare's state either camp can raise an equally long list of complaints to blame the opposite camp. Socialists can say for example, if healthcare is left up to the market then monopolies would rise, the quality would become abysmal, the primary goal of hospitals, doctors and insurance companies is now profit as opposed to keeping people healthy. They might claim government is not doing enough. There should be a single payer option or price control options etc etc. Libertarians and those who like to extol the virtues of free markets and hate government intervention can blame all the brokenness on government bureaucracy and regulation. If only companies could just handle everything themselves it would all be very clear and easy, kind of like with car insurance. There would be competition etc etc. See, one can defend either position. So it is not 100% clear cut and obvious which is which.

jivatmanx 13y ago
I totally agree with this. Similarly, Socialists can point to most European countries that get superior service for much less cost, while Capitalists (I lean this way) point to amazing efficiency innovations that happen in countries with less regulated systems like India's[0] What's clear is that our system has somehow found a way to be the worst of both worlds, very expensive, bad service, not universal. [0]http://online.wsj.com/article/SB125875892887958111.html http://online.wsj.com/article/SB125875892887958111.html
- vertex-four 13y ago
  Of course, from experience living in India for several years, the problem with "less regulated systems like India's" is simply that aside from basic reactive healthcare of the sort you'd get from your GP, the poor do not have access to healthcare there. While even being able to see a GP when necessary is admittedly slightly better than the US's system, it's still not good enough, from the point of view of someone who can now take NHS Scotland for granted.
  - ippisl 13y ago
    This is not a problem of regulation, but of general lack of money and/or agreement of social cost sharing. And some other low cost services are offered to some of the poor in India like heart surgeries, artificial ankles, ambulances, eyeglasses, psychiatric services. With some money and growth they could theoretically be offered to everyone in India.

tzs 13y ago

> The reality is that healthcare is anything but a free market, and costs aren't going to come down until it becomes one. So the solution to our costs being higher than every other first world country is to make our system less like any of them?

gohrt 13y ago

Not true (as you noted in your reply), unless you mean in some very limited sense that ignore the ratio of benefits to that cost. Health care will never be a free market, it is too complex a good (it is a whole set of complicated products that take a life time to consume), and is packed with externalities relating to insurance premiums and emergency care. There is no simple answer for high-quality health care.

crygin 13y ago

There's absolutely no good reason to think that it should be possible to make money propping up us bags of decaying organic matter for as long as possible. The idea of making money providing healthcare is absurd -- like being able to deliver a letter anywhere for a fixed cost or basic defense of our borders, it's the proper role of a minimal viable government.

SoftwareMaven 13y ago

Given the mess started when the government implemented wage freezes in WWII and has only gotten worse since then, it is staggering that anybody could believe the US healthcare system is remotely related to a free market. And it keeps getting worse.

coldtea 13y ago

>I'm always irritated when people blame capitalism and free markets for the high cost of healthcare in the USA. The reality is that healthcare is anything but a free market, and costs aren't going to come down until it becomes one. Capitalism ain't nothing like a free market either, that's the point of those people. Capitalism is large private interests, big corporations, elites, and government in bed together to milk the population. As for the "free market", that's an impossible unicorn and ponies fantasy, formulated in the 18th century and perpetuated as a myth by economists who should know better afterwards.

venomsnake 13y ago
Free market is possible - the problem is that it is tool and not ideology. For it to work you need several conditions: 1. Relatively low barrier of entry 2. Non essential goods 3. Comoditization/semi comoditization of the products 4. Price, demand and supply elasticity The android phone/ tablet marked in the developing world right now is perfect example. Cheap PCs in the 80s/90s. Sadly in the developed world the business models with carrier subsidization is quite evil and hostile towards the consumers. We should really make the wireless and wired assholes dumb pipes.
- brazzy 13y ago
  You realize you've essentially state that a free market is not possible in health care, yes?
  - eatitraw 13y ago
    He explicitly states that in another thread: https://news.ycombinator.com/item?id=6040196 https://news.ycombinator.com/item?id=6040196
  - deleted 13y ago
    [deleted]
- coldtea 13y ago
  >Free market is possible - the problem is that it is tool and not ideology. For it to work you need several conditions: 1. Relatively low barrier of entry 2. Non essential goods 3. Comoditization/semi comoditization of the products 4. Price, demand and supply elasticity I don't see how all those are possible. They presuposse a place where: 1) There is no government intervention. 2) Private interests play nice to each other and never take advantage of their position to skew the market. That might happen temporarily in some sub-market (e.g cheap PCs in the 80s/90s) but it absolutely cannot happen in the overall market. Even something like "patents" and "copyright" is enough to fuck this up. Not to mention the issues of raw materials, infrastructure (roads, etc), foreign dependencies, etc.

wavefunction 13y ago

Maybe it's time to realize that there is no such thing as a "free market," since unethical individuals will always attempt to maximize their positions through their established power bases and political connections. The complaints about how "free markets" unfairly get blamed for market failures sounds exactly like communists bemoaning the fact that "pure communism" has never been tried in the real world, just corrupted versions of it.

Ygg2 13y ago
Heck you don't need political connection; even if there is no state there would be no free market. Corporations would simply fight over who owns most force and media. If you have ability to wield force and control the media you have made it.
forgottenpaswrd 13y ago
Not really, "free markets" are real, they exist. You find them in small villages all around the world, someone needs something that someone else has in abundance, they make a deal. I buy quality lentils, rice, milk, cows, ... this way, as I live in Europe. In the US you can't even buy natural milk, they have germs paranoia, and lots of big corps's interests. Any person on the village could sell you anything, without any control, and that works, believe it or not. A free market is as simple as a market that meets certain criteria, like existence of competition. Regulated markets use to destroy competition. In the US competition in healthcare is not so good in this regard, but don't tell any American, they believe they live in the best country in the world, specially those that had never lived abroad. You could argue that perfect "free markets" do not exist, like a perfect "cube" or "rectangle" or "sphere" do not either. And that is true, because in the end atoms are just discrete approximations of a perfect shape, but cubes are very useful as a reference.
- wavefunction 13y ago
  We can buy raw milk in the US, it's just a hassle. Sorry to burst your Euro-bubble.
  - 13y ago

Ygg2 13y ago

Problem is, free market is not a panacea. You can't say well if thing X is free market then it would exist. First free market is an illusion that probably never existed unless you count the really rudimentary communities. The laws that make a free market a non-free market aren't bad, like banning child labor or reducing work hours to 40, etc. Second even in free market you can get monopolies, once all players consolidate or make deals. Then you lose any benefits of free market if paying to hush your competitors is lower than R&D.

flexie 13y ago

Yeah well. Are there any free market industries in the US? Financial sector, energy, car manufacturing, IT, education, news, health care, law, home buying, defense - those are all in one or more ways deeply subsidized or maintain such close relationship with government that it's difficult to say whether they are part of the government. Take Google: A single company that somehow manages to sit on almost all searches, most of the online add market, a good chunk of the email market. Yet it avoids being split up in antitrust cases. Google started as a government sponsored research project that was spun out from a government subsidized institution (Stanford). Then it raised tax subsidized financing (venture capital). It has what seems to be a free flow of information with different government institutions such as the NSA. Google doesn't really pay tax on most of its world wide income and it has some 20,000 government granted monopolies (also known as "patents"). Is Google a private company in a free market? Exactly what US industry should health care emulate?

rorrr2 13y ago
> sit on almost all searches, most of the online add market At least they don't control subtraction and multiplication.
- deleted 13y ago
  [deleted]
- maw 13y ago
  Those are in an independent division.
specialist 13y ago
Exactly what US industry should health care emulate? The best available answer is capitation, where care providers are rewarded for keeping people healthy, not treating disease. http://en.wikipedia.org/wiki/Capitation_(healthcare) http://en.wikipedia.org/wiki/Capitation_(healthcare) In practice, people live longer and costs go down. Too many people confuse prices (set by a market) with incentives. In the mythical future perfect "free market", competition would drive prices down and all would be "good". Alas, there are no free markets. Further, the desired outcomes is healthy people, not cheap healthcare.

pjmorris 13y ago

Can someone give an example of a free market health care system in a developed nation? Or an undeveloped nation? Would it be wrong to settle for a system that covers everyone and is 1/2 to 2/3 the price of the current US system, like other developed nations have figured out?

ThomPete 13y ago

There is no such thing as a 100% free market og 100% capitalism. What people are complaining about is that US healthcare is subject to a free market logic. I.e. the hospitals are profit centers and the insurance agencies are profit centers. The opposite is also bad (like in Denmark) with the hospitals being 100% state owned and the insurer being the state. In my mind what we need is a combination where one part needs to take care of making a profit and the other needs to be frugal about how it spends it's money. Have no idea how that would work, but somethings gotta give.

ryanackley 13y ago

I get irritated when people claim that free markets are a silver bullet for the ills of society. Even if you ignore the cruelty of not providing healthcare to people who can't afford it. How does the free market deal with community impact of untreated health problems? For example, highly infectious diseases which are relatively easy to treat but people may not be able to afford treatment for (post-exposure treatment for rabies, scarlet fever, etc)? Do we just quarantine these people until they die or someone pays for treatment? If we treat these people for free, we're now subsidizing health care. Where do you draw the line? Why don't we apply free market principles to law enforcement, fire services, and utilities?

deelowe 13y ago
> Why don't we apply free market principles to law enforcement, fire services, and utilities? Some utilities are starting to do this actually. Where I live Gas is provided by multiple servicers who setup contracts with the gas provided(sort of like a commodities market). There's been some talk about doing something similar with water as there's been some serious corruption uncovered with water billing in my area. Some fire departments are a combination of private and volunteer efforts. There's not many issues with this AFAIK. I used to live in a town like this and no one ever complained. Regarding the police, for better or worse, they are more or less treated as part of the judicial branch of government. I don't think many people would argue the police(as it exists today) should be private. That said, the system as it exists today is corrupt and resembles more of a military than a group dedicated to "protecting and serving." There are private police types in Texas and AFAIK, it works fine. Same goes for private bounty hunters. That said, most of the above aren't for profit services, so it's hard to compare them with medical, which is an industry that must sustain a profit to progress. When governments become profit centers, you will have problems. Considering the problems we have now with medical, less regulation around competition would certainly be a good thing. For example, I should be able to call and get prices for common services so that I can compare doctors. Not my employer(nor the government) should be allowed to provide me with subsidized insurance(except in welfare cases). I should be able to buy insurance from a provider anywhere in the country. I should be able to negotiate rates on my own behalf instead of the insurance provider doing it for me. Insurance providers should not get preferential treatment from doctors and/or hospitals. Fix these and things will get better. There will still be issues, but at least the market would be more efficient and prices would start going down.

epo 13y ago

The American system of healthcare may not be free-market but it is as pure a form of capitalism as you can get. That people equate competition with capitalism is merely wishful thinking. Monopoly, lack of transparency and a stranglehold over supply is the way to maximise profits.

jellicle 13y ago

Libertarianism can't fail - it can only be failed.

readme 13y ago

Could you give an example of a country with an acceptable healthcare system that has lowered healthcare costs by using a free market approach? Why do you think the free market is the best device for getting me a fair price on my ambulance ride? After all, I might be unconscious, so I won't even be able to compare ambulance rates beforehand.

FireBeyond 13y ago
That's also the reason why in almost all places in the US, ambulance rates are regulated. If you have a concern with the price of your ambulance ride, contact your county or state - or the ambulance company. We (as paramedics and EMTs) are also required to document the medical necessity of transport, without which Medicare, and insurance providers will likely not cover the bill, and (at least in my company, and others) is a good way for you to waiver your bill. As a general aside, though, treatment of unconscious persons is done on the presumption that they would want the most expedient and appropriate emergent treatment.
- readme 13y ago
  I did not know that but I am pleased to know this information, it gives me hope that sanity might one day prevail here.

dragonwriter 13y ago

> I'm always irritated when people blame capitalism and free markets for the high cost of healthcare in the USA. The reality is that healthcare is anything but a free market, and costs aren't going to come down until it becomes one. Every other OECD country except Mexico has similar or better outcomes than the US, at lower cost (per capita and per GDP) than the US, so its pretty ridiculous to claim that the only possible way for the US to reduce prices is to convert the healthcare market into an unregulated free market, which is far from what any of the countries that achieve equal or better results at lower than the US have. The US pays more in healthcare in its public healthcare systems -- as a share of GDP or in $/capita -- than many countries do in their public systems that provide virtually everything through those public systems, and then pays about the same amount again in nonpublic healthcare expenditures. From all evidence, the biggest problem with healthcare costs in the US is the high degree of privatization, not the lack of a free market.