5 ms·

>> Cheaper, faster, better. All three. > [citation needed] Lookup the history of laser eye surgery over the last, say, ten years. Free markets work. That's

>> Cheaper, faster, better. All three. > [citation needed] Lookup the history of laser eye surgery over the last, say, ten years. Free markets work. That's irrefutable. The problem is we've never had a free market system when it comes to medicine.

jjoonathan 13y ago
You're cherry picking: laser eye surgery has effective competition, elastic demand, no information asymmetry, and it is priced well within the annual (even monthly) earning potential of most Americans. It's a service that I would expect the free market to be able to provide efficiently and it does not surprise me that it succeeds. The free market is very good at optimizing value creation under certain circumstances and it's great that laser eye surgery matches up with those requirements. Unfortunately, when it comes to policy we do not get to cherry-pick the conditions under which the rest of the system operates, and the other parts of the health care market run under conditions that demonstrably throw the free market for a loop (hence the system-level failures vs socialized systems I pointed out above). Cancer treatments cannot be paid for out of most people's savings. "Customers" do not always have the chance to shop around between providers (w/o insurance) and those that do use insurance experience a 99% deleveraging effect because only the 1% that have extraordinary costs are in a position to examine the value of what they bought. Do you have a proposed mechanism of breaking information asymmetries, re-leveraging disproportionately expensive consumers, and standardizing the coverage provided by free market plans? Do you have a way of pricing the 5 externalities I listed into the insurance providers' budgets? Has your proposal been implemented in a dozen other countries and proven to be comparatively cost effective for decades? What is your answer to the figures that show that our system in aggregate is 2-10x less efficient than comparable social systems? Anybody can cherry pick a counterexample. Anybody can speculatively extrapolate it out to a convenient conclusion. But the single-payer advocates can point to a mountain of directly relevant apples-to-apples evidence regarding the industry as a whole that does not require extrapolating across markets or cherry picking conditions / good years. To me, it appears to be a mountain of evidence vs a pebble. Do you really think the the implicit strength of extrapolation from the (very) special case of laser eye surgery carries weight against these empirical apples-to-apples comparisons?
- EdSharkey 13y ago
  In abstract terms, I would say single payer systems could (and should) work well. It sounds nice to me on paper. I think an issue is that America has a system of government that lacks a long-term focus. Every 4 to 8 years, we get a new 40-100 year agenda. This leads to tinkering with these social programs and the original goals can get lost, muddled. That, and our government is not structured very well to deliver services with a largely unaccountable bureaucracy overseen by a divided and paralyzed government. Our government in the process of failing to deliver a service right here (with the exchanges at healthcare.gov). I could see single payer systems working well elsewhere. In the states, I think it would be implemented badly at 10x the cost. Just my opinion, but I think we should try developing a competitive market for healthcare and reduce government regulation in it and see how that goes. Then, when that flops, we can try out socialized medicine.
  - deleted 13y ago
    [deleted]
- robomartin 13y ago
  > Anybody can cherry pick a counterexample. Anybody can speculatively extrapolate it out to a convenient conclusion. And anybody can do what you are doing. You have an obvious bias against free markets. That's fine. However, I will argue that, if you live in the US, almost everything around you is the product of free market forces to a large extent. Perfect free markets don't exist. That's a given. Please don't point out that this or that market isn't perfectly free. I get it. Here's the difference with our views. My view is centered around the idea that government should be limited to a very small area of responsibility and influence in our lives. I won't get into the details. Suffice it to say it would be a small fraction of what it is today, in rough strokes perhaps reducing it by 50 to 75% --gradually, over a period of 25 to 50 years. Your view, if I read between the lines, feels like it is almost diametrically opposite mine. You don't have anything in your HN profile so I can't even attempt to understand where you might be coming from. For all I know you work for the government and are actually being paid by the current ACA/Obamacare "machine" in some form. I don't know. I, well, I've been an entrepreneur since forever and fully understand what it means to live a life where you make sound fiscal, social, educational and personal decisions based on the idea that you --not the government-- should be responsible the well-being of your family and community. That's my frame of reference, not sure what yours might be. Going back to the size of government, I would, for example, push to de-militarize our country over, say, 25 to 50 years and encourage others to do the same. We could and should take the lead in making this a better world. The military alone accounted for 25% of our federal budget. We don't need them. I know many think we do. We don't. The world needs to make supporting massive military forces a thing of history. I would also eject government from most areas affecting our lives. Take the Department of Education as an example. The US keeps testing significantly sub-par when it compared to other less developed countries. Yet we spend more than almost anyone per pupil and we have a massive DoE. I don't think they are effective. Gone. Anyhow, you can continue along these lines and remove government from all of these areas. Gradually. Over twenty-five to fifty years. Are regulations required? Are they important? Yes. Of course. In certain areas and with moderation. That's a different topic. No, I am not advocating a wild-west guns-a-blazing free market. Controls are almost required in certain areas. This would be a very important function of a limited government. When it comes to healthcare the free market approach would create efficient markets quickly due to competition. If I could go to Nevada and get heart surgery for less, with excellent quality and even a free slot machine in my room during recovery, hey, that's fantastic. California would have to find ways to compete. And they would. Technologies would be developed in order to make the medical business more efficient at all levels. Within a span of ten to twenty-five years the medical industry would be transformed into an incredibly efficient machine providing above-par services for everyone. No tax dollars or government involvement would be required outside of putting in place sensible and limited regulation in order to help, not hinder, the development of a useful free market. Corner cases will exist. In other words, the good, the bad and the ugly exist in all markets. Free or government originated and controlled. That's human nature. Neither school of thought can guarantee that bad things will not happen. Stories abound about people in highly socialized medical systems having to wait months or years for treatment. The free market equivalent might be not having enough money or insurance to pay for something or horrible cases of medial malpractice. How do we deal with the cost of ownership situation? I'd say much like we do with auto insurance. You own it. It's yours. It does not live and die with your employer. You get to insure yourself for anything you want and for as much as you want. I barely saw the inside of a doctor's office during my 20's. My guess is I would have been receptive to the idea of a low cost catastrophic health insurance policy with a relatively high deductible. If my auto insurance guy had said something like "Martin, for another $50 per month we can offer you catastrophic health insurance with a $10,000 deductible" my guess is I would have gone for it without much thought. Should medical insurance be mandated? Yes and no. It would be really easy to setup a situation where, for example, if you want to drive a car you have to also have health insurance coverage. This is just an example I am pulling out of my hat and it is not well thought out. The intent here is to say that, yes, I understand that an idea market would benefit from wide-spread market participation. In this hypothetical nearly everyone 16 and over would purchase health insurance to some extent or another. That would take care of a huge percentage of the US population. You would personally be responsible for the cost of your health care. In other words, if you go to a hospital and don't have insurance you have to pay the bills yourself. This is no different from going to the dealer with a car that broke down and no extended service warranty. This would setup a situation whereby everyone in the US would buy medical insurance, just like they buy car, homeowners and renters insurance. You know how they offer you insurance for your new TV or refrigerator at the appliance store. Well, al lot of people buy it. If you were free to shop for health insurance from any provider I can easily see companies competing for your business everywhere. I could, for example, see State Farm and Alstate offering people various health insurance policies along with their homeowners or auto policies. What to do about the really poor who can't afford any of it. We help them, of course. The details are not important here. We help them. Period. If you can't possibly pay for your insurance we, as a society, have a mechanism through which you will have it. This is where the idea deviates from the auto insurance model. What to do about the whole pre-existing condition situation. Well, your insurance policy has an "uninsured motorists" element? Perhaps every insurance policy would have a nominal "pre-existing conditions" fee that we collectively contribute towards dealing with these costs. This would be the socially responsible way to deal with situations where you have someone who might require half a million dollars of annual healthcare bills per year due to their unique situation. Oh, yes, all healthcare insurance should be 100% tax deductible. All of this would work and evolve very well with minimal government intervention. Laws and regulations would be passed in order to serve the free market and reduce government involvement to a minimum, not hinder it. The beauty of taking such approaches is that --due to the lack of set-in-stone laws-- we can always let observe them for a while and THEN decide whether they are working or not. The problem with passing legislation like the ACA/Obamacare is that you have 40,000 pages of legislation and rules that is convoluted, unmanageable and incomprehensible to such an extent that no citizen can even begin to comprehend it. And, to make things worst, we don't have the freedom to move away from it and modify it in an evolutionary and dynamic way. It is set in stone and it takes a tremendous amount of work to change it's path. I mean, they can't even get a medium complexity website to work correctly on launch. That should tell the entire story. The most fundamental issue here is that it is nearly impossible to have dozens or hundreds of people to create legislation that is, for lack of a better term, perfect. It takes years, decades to painfully evolve these things. This is where free markets have an overwhelming advantage because they can evolve as fast as humanly possible. The power of entrepreneurship and free markets has been massively demonstrated by the explosion of this little thing we call the Internet. Anyhow, we'll probably disagree. And that's OK. To each his own.

jjoonathan 13y ago

You're cherry picking: laser eye surgery has effective competition, elastic demand, no information asymmetry, and it is priced well within the annual (even monthly) earning potential of most Americans. It's a service that I would expect the free market to be able to provide efficiently and it does not surprise me that it succeeds. The free market is very good at optimizing value creation under certain circumstances and it's great that laser eye surgery matches up with those requirements. Unfortunately, when it comes to policy we do not get to cherry-pick the conditions under which the rest of the system operates, and the other parts of the health care market run under conditions that demonstrably throw the free market for a loop (hence the system-level failures vs socialized systems I pointed out above). Cancer treatments cannot be paid for out of most people's savings. "Customers" do not always have the chance to shop around between providers (w/o insurance) and those that do use insurance experience a 99% deleveraging effect because only the 1% that have extraordinary costs are in a position to examine the value of what they bought. Do you have a proposed mechanism of breaking information asymmetries, re-leveraging disproportionately expensive consumers, and standardizing the coverage provided by free market plans? Do you have a way of pricing the 5 externalities I listed into the insurance providers' budgets? Has your proposal been implemented in a dozen other countries and proven to be comparatively cost effective for decades? What is your answer to the figures that show that our system in aggregate is 2-10x less efficient than comparable social systems? Anybody can cherry pick a counterexample. Anybody can speculatively extrapolate it out to a convenient conclusion. But the single-payer advocates can point to a mountain of directly relevant apples-to-apples evidence regarding the industry as a whole that does not require extrapolating across markets or cherry picking conditions / good years. To me, it appears to be a mountain of evidence vs a pebble. Do you really think the the implicit strength of extrapolation from the (very) special case of laser eye surgery carries weight against these empirical apples-to-apples comparisons?

EdSharkey 13y ago
In abstract terms, I would say single payer systems could (and should) work well. It sounds nice to me on paper. I think an issue is that America has a system of government that lacks a long-term focus. Every 4 to 8 years, we get a new 40-100 year agenda. This leads to tinkering with these social programs and the original goals can get lost, muddled. That, and our government is not structured very well to deliver services with a largely unaccountable bureaucracy overseen by a divided and paralyzed government. Our government in the process of failing to deliver a service right here (with the exchanges at healthcare.gov). I could see single payer systems working well elsewhere. In the states, I think it would be implemented badly at 10x the cost. Just my opinion, but I think we should try developing a competitive market for healthcare and reduce government regulation in it and see how that goes. Then, when that flops, we can try out socialized medicine.
- deleted 13y ago
  [deleted]
robomartin 13y ago
> Anybody can cherry pick a counterexample. Anybody can speculatively extrapolate it out to a convenient conclusion. And anybody can do what you are doing. You have an obvious bias against free markets. That's fine. However, I will argue that, if you live in the US, almost everything around you is the product of free market forces to a large extent. Perfect free markets don't exist. That's a given. Please don't point out that this or that market isn't perfectly free. I get it. Here's the difference with our views. My view is centered around the idea that government should be limited to a very small area of responsibility and influence in our lives. I won't get into the details. Suffice it to say it would be a small fraction of what it is today, in rough strokes perhaps reducing it by 50 to 75% --gradually, over a period of 25 to 50 years. Your view, if I read between the lines, feels like it is almost diametrically opposite mine. You don't have anything in your HN profile so I can't even attempt to understand where you might be coming from. For all I know you work for the government and are actually being paid by the current ACA/Obamacare "machine" in some form. I don't know. I, well, I've been an entrepreneur since forever and fully understand what it means to live a life where you make sound fiscal, social, educational and personal decisions based on the idea that you --not the government-- should be responsible the well-being of your family and community. That's my frame of reference, not sure what yours might be. Going back to the size of government, I would, for example, push to de-militarize our country over, say, 25 to 50 years and encourage others to do the same. We could and should take the lead in making this a better world. The military alone accounted for 25% of our federal budget. We don't need them. I know many think we do. We don't. The world needs to make supporting massive military forces a thing of history. I would also eject government from most areas affecting our lives. Take the Department of Education as an example. The US keeps testing significantly sub-par when it compared to other less developed countries. Yet we spend more than almost anyone per pupil and we have a massive DoE. I don't think they are effective. Gone. Anyhow, you can continue along these lines and remove government from all of these areas. Gradually. Over twenty-five to fifty years. Are regulations required? Are they important? Yes. Of course. In certain areas and with moderation. That's a different topic. No, I am not advocating a wild-west guns-a-blazing free market. Controls are almost required in certain areas. This would be a very important function of a limited government. When it comes to healthcare the free market approach would create efficient markets quickly due to competition. If I could go to Nevada and get heart surgery for less, with excellent quality and even a free slot machine in my room during recovery, hey, that's fantastic. California would have to find ways to compete. And they would. Technologies would be developed in order to make the medical business more efficient at all levels. Within a span of ten to twenty-five years the medical industry would be transformed into an incredibly efficient machine providing above-par services for everyone. No tax dollars or government involvement would be required outside of putting in place sensible and limited regulation in order to help, not hinder, the development of a useful free market. Corner cases will exist. In other words, the good, the bad and the ugly exist in all markets. Free or government originated and controlled. That's human nature. Neither school of thought can guarantee that bad things will not happen. Stories abound about people in highly socialized medical systems having to wait months or years for treatment. The free market equivalent might be not having enough money or insurance to pay for something or horrible cases of medial malpractice. How do we deal with the cost of ownership situation? I'd say much like we do with auto insurance. You own it. It's yours. It does not live and die with your employer. You get to insure yourself for anything you want and for as much as you want. I barely saw the inside of a doctor's office during my 20's. My guess is I would have been receptive to the idea of a low cost catastrophic health insurance policy with a relatively high deductible. If my auto insurance guy had said something like "Martin, for another $50 per month we can offer you catastrophic health insurance with a $10,000 deductible" my guess is I would have gone for it without much thought. Should medical insurance be mandated? Yes and no. It would be really easy to setup a situation where, for example, if you want to drive a car you have to also have health insurance coverage. This is just an example I am pulling out of my hat and it is not well thought out. The intent here is to say that, yes, I understand that an idea market would benefit from wide-spread market participation. In this hypothetical nearly everyone 16 and over would purchase health insurance to some extent or another. That would take care of a huge percentage of the US population. You would personally be responsible for the cost of your health care. In other words, if you go to a hospital and don't have insurance you have to pay the bills yourself. This is no different from going to the dealer with a car that broke down and no extended service warranty. This would setup a situation whereby everyone in the US would buy medical insurance, just like they buy car, homeowners and renters insurance. You know how they offer you insurance for your new TV or refrigerator at the appliance store. Well, al lot of people buy it. If you were free to shop for health insurance from any provider I can easily see companies competing for your business everywhere. I could, for example, see State Farm and Alstate offering people various health insurance policies along with their homeowners or auto policies. What to do about the really poor who can't afford any of it. We help them, of course. The details are not important here. We help them. Period. If you can't possibly pay for your insurance we, as a society, have a mechanism through which you will have it. This is where the idea deviates from the auto insurance model. What to do about the whole pre-existing condition situation. Well, your insurance policy has an "uninsured motorists" element? Perhaps every insurance policy would have a nominal "pre-existing conditions" fee that we collectively contribute towards dealing with these costs. This would be the socially responsible way to deal with situations where you have someone who might require half a million dollars of annual healthcare bills per year due to their unique situation. Oh, yes, all healthcare insurance should be 100% tax deductible. All of this would work and evolve very well with minimal government intervention. Laws and regulations would be passed in order to serve the free market and reduce government involvement to a minimum, not hinder it. The beauty of taking such approaches is that --due to the lack of set-in-stone laws-- we can always let observe them for a while and THEN decide whether they are working or not. The problem with passing legislation like the ACA/Obamacare is that you have 40,000 pages of legislation and rules that is convoluted, unmanageable and incomprehensible to such an extent that no citizen can even begin to comprehend it. And, to make things worst, we don't have the freedom to move away from it and modify it in an evolutionary and dynamic way. It is set in stone and it takes a tremendous amount of work to change it's path. I mean, they can't even get a medium complexity website to work correctly on launch. That should tell the entire story. The most fundamental issue here is that it is nearly impossible to have dozens or hundreds of people to create legislation that is, for lack of a better term, perfect. It takes years, decades to painfully evolve these things. This is where free markets have an overwhelming advantage because they can evolve as fast as humanly possible. The power of entrepreneurship and free markets has been massively demonstrated by the explosion of this little thing we call the Internet. Anyhow, we'll probably disagree. And that's OK. To each his own.