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That's a fine bit of conservative nonsense you just regurgitated, coming to the conclusion that the problem the U.S. is suffering from is "too much health care"

That's a fine bit of conservative nonsense you just regurgitated, coming to the conclusion that the problem the U.S. is suffering from is "too much health care", and therefore the solution is to reduce access to healthcare and insurance. It rests on the assumption that patients get frivolous medical procedures (open heart surgery for you! and open heart surgery for you! and open heart surgery for you!) because they may not pay full price for them, a claim which, like the teapot orbiting the sun directly opposite the Earth, has never been observed in real life. In actuality, healthcare is a well known example of a market failure - there cannot be a normal market in healthcare ever, because definitionally, your health is worth an infinite amount of money to you (how much would you pay not to be a slave? how much would you pay not to have your hands and feet chopped off?). Further, healthcare prices are unpredictable. How much does a gall bladder surgery cost? Did I mention that the patient got a flesh-eating bacterial infection as a result of the surgery? That's true and will always be true even if prices were posted at the door, which they are not. The solution - which has been discovered by every advanced nation on Earth except the U.S. - is having the government strongly involved in paying for healthcare, insuring across the entire population to even out costs and making sure that, e.g., medical device manufacturers can't gouge the unknowing public. Monopsony powers nicely counteract the inherent power imbalance that healthcare providers normally have over the sick, and everything works just fine, costing each of those nations less to cover their entire nation than the U.S. currently spends to cover a small segment of its population.

derefr 13y ago
> definitionally, your health is worth an infinite amount of money to you (how much would you pay not to be a slave? how much would you pay not to have your hands and feet chopped off?). That is not how you measure preferences, at all. Try "what likelihood of having your hands and feet chopped off would you trade for not being a slave?" Probabilities are fungible in a way dollars aren't.
- michaelt 13y ago
  It depends on what part of healthcare you're thinking of, and what stage of the process you're at. If you're wheeled into ER with a knife in your chest, you don't have a fungible probability of needing healthcare. You're going to be buying the knife-removal service whether it costs $100 or $100,000. You may be unconscious. Obviously at the other extreme of choice is purely elective surgery, like breast enhancement. Lots of choice there - if you don't like one doctor's prices you can shop around or skip the surgery all together. In between are situations where treatment is required but isn't urgent, or where the problem is minor and you can live with it/use off the shelf treatments, or where there are various types of surgery available. A lot of the time when there are multiple options with complicated trade-offs, that's exactly where it would be nice to have a friendly, trustworthy doctor who can give you some unbiased guidance. How exactly to bring all the incentives into alignment and make them fair, over the entire continuum of choice and accepting that the people who need the healthcare aren't themselves experts - that's the hard part.
novalis78 13y ago
One thought: there are other industries which sell services and tools that fluctute in price or are so complex that it is amazing how they can price their products at all - but they do. Just the fact that I cannot get any reliable pricing information for most procedures from health care providers seems strange and might point to the fact that their processes and methods are under no self-regulating forces/pressure. The situation reminds of Florida, 10 years ago, when the parties could not agree on a way to fix schools and the only bipartisan solution possible was to issue grades for the schools. That little "market transparency" started a whole avalanche of changes most of which came as a surprise and all of which have moved Florida ahead ever since. It performs dramatically better now, than it did 10 years ago in almost all assessments (minorities, drop-out rate, avg. Math/Science). I think giving people a choice by posting transparent pricing information is crucial to improving the American health care situation.
- novalis78 13y ago
  ...and btw, to anyone here who is a ruby or php developer and feels very strongly about this topic and likes to help with our project that is trying to change this (pricepain.com/why) shoot me an email, we can need some help.
- jellicle 13y ago
  A few years ago, I had an agonizing emergent medical condition, for which I headed to the emergency room, and ended up having surgery later that evening. Of course, the cost to me was $0, since I live in Canada and we do it right here. But supposing I lived in your "transparent pricing information" ideal society. How exactly do you suppose I would flip through the ten-thousand page pricing book to determine what brand of surgical gauze I'd like to have used in my surgery, when I'm in 11/10 pain and going to die within a few hours if left untreated? And do you think the other local hospitals would send over their ten-thousand pricing books as well, so I can price-shop? Do you think Dr. Smithers is really worth a 12% price premium over Dr. Johnson, or not? Can you really have a meeting of minds when one of the minds is unconscious from an automobile accident? Please advise.
  - deleted 13y ago
bhauer 13y ago
> That's a fine bit of conservative nonsense you just regurgitated Conservative, libertarian, I guess they are more or less the same for this subject. Fine. > coming to the conclusion that the problem the U.S. is suffering from is "too much health care" I suppose you're saying that because higher prices suggest a glut of supply? Wait, no. I'm not sure why you say that is the conclusion of my argument. I certainly never said the US has too much healthcare, nor imply it. In fact, if anything the US is supply-constrained in healthcare thanks to the AMA, FDA, etc. There is plenty of demand for healthcare, but the supply is pretty well controlled through regulation. I certainly can't start selling healthcare. Even with a lot of studying, I still couldn't just sell healthcare. Making additional healthcare supply isn't like making more supply of furniture, food, or even cars (which is closer on the regulation spectrum to healthcare, meaning it requires a herculean effort to enter this industry—witness Tesla). > therefore the solution is to reduce access to healthcare and insurance What? No, I'd rather make these services more readily available to everyone by making them available in the same way nearly every other product is available to anyone. Is the iPad unavailable to me because my employer doesn't provide tablet insurance? Just sell me healthcare and health insurance on regular markets, please. Nothing could be more available in my opinion. As it is, the "availability" of healthcare in my life is extremely narrow (again thanks to what evolved from 1940s price controls). I have a small set of options from one vendor selected by my employer. With the ACA, I will now have that option (maybe, though it's an HSA and I've been told to kiss HSAs goodbye) and a few other ratified options that have been selected by a central planning committee. If I can't afford routine health care on a regular market, I'd rather work harder to get a better job. In a worst-case scenario, I'll plead with friends and family or charities. I genuinely would prefer this to the current model. I'd pick up insurance to handle catastrophic events. I'd donate more to charity to boot. > your health is worth an infinite amount of money to you Actually, not really. If I have a quality of life issue and I can improve my quality of life for $500, I will weigh the pros and cons and probably go for it. If it costs $500,000, I'll suck it up until someone innovates the cost down to something I can afford. Even if I have a catastrophic issue and I have no insurance, and the only resolution is something that costs $1M, this is something my family (friends, charities) should decide. Sell/refinance property or pull the plug? Bottom line, it's a local decision to pull the plug, not something for a central planning board. > Further, healthcare prices are unpredictable This is not a counter-argument to using regular price signals. Services that are unpredictable are usually billed at hourly rates or time and materials with an estimate. If I have the termite guy out to check my house, he's not going to be able to give me a quote until he assesses the situation. Even then, it may be worse than he thought. But he has a price sheet of hours and services and I can look at that and select a different termite guy if the price sheet seems out of line. Better yet, other people will have paid termite guys and give me a basic feel for what a termite guy charges. When he says his hourly rate is $5,000, I'll know he's a nutcase. Today, if I heard it cost $5,000/hr for some medical procedure, I wouldn't even know how to react. Is that a lot? Is it low? I don't even know who I could ask for a guess. > which has been discovered by every advanced nation on Earth except the U.S. I don't enjoy the argument that everyone else does something a given way, so why don't you get in line already. The way I see it, this country has been doing healthcare more similar to other countries (no true market, no price signals) than similar to what I want for decades. A free market can support a central-planning model inside of itself, but vice-versa is never possible. This is why those of us who support free markets are so sensitive to those who would shut them off. Central planners don't have to kill the free market to do their central planning exercise, but they always choose to. We don't ask them to kill central planning so we can have a free market. In fact, we don't even care how central planners want to arrange their centrally-planned plan inside the free market, as long as it's voluntary. Have fun! If I had my way, the ACA would make centrally-planned healthcare an entirely in or entirely out proposition. Voluntary. Don't want in? Fine, you're on your own. Entirely. I'd opt out. And soon enough, I'd find people ready to sell me health care. Then I'd give more to charity. I'd be so much happier.
Zak 13y ago
your health is worth an infinite amount of money to you No, it isn't. Avoiding certain very undesirable outcomes is worth an infinite amount of money to me, but suffering from strep throat symptoms for 3 days instead of 5 days is worth a finite amount of money. My upper bound on that is hundreds of dollars, but if I can pay less to get the result I want (if I'm certain I have strep, I want a course of amoxicillin, and I don't care if that involves seeing a doctor), I will pay less. Competition can drive the price down even if the buyer isn't price-sensitive.
WalterBright 13y ago
> has never been observed in real life Frontline did a whole show on that, "Dollars and Dentists". http://www.pbs.org/wgbh/pages/frontline/dollars-and-dentists/ http://www.pbs.org/wgbh/pages/frontline/dollars-and-dentists... Frontline isn't known for having a conservative bias.
thaumasiotes 13y ago
Your opinion predicts the following: - No person would ever sell themselves into slavery (OK, this is only implied). - No person would ever kill themselves for the life insurance. Do you see any problems with that? Allow me to suggest that if your health is worth an infinite amount of money to you, you must have terrible relationships with your family.

derefr 13y ago

> definitionally, your health is worth an infinite amount of money to you (how much would you pay not to be a slave? how much would you pay not to have your hands and feet chopped off?). That is not how you measure preferences, at all. Try "what likelihood of having your hands and feet chopped off would you trade for not being a slave?" Probabilities are fungible in a way dollars aren't.

michaelt 13y ago
It depends on what part of healthcare you're thinking of, and what stage of the process you're at. If you're wheeled into ER with a knife in your chest, you don't have a fungible probability of needing healthcare. You're going to be buying the knife-removal service whether it costs $100 or $100,000. You may be unconscious. Obviously at the other extreme of choice is purely elective surgery, like breast enhancement. Lots of choice there - if you don't like one doctor's prices you can shop around or skip the surgery all together. In between are situations where treatment is required but isn't urgent, or where the problem is minor and you can live with it/use off the shelf treatments, or where there are various types of surgery available. A lot of the time when there are multiple options with complicated trade-offs, that's exactly where it would be nice to have a friendly, trustworthy doctor who can give you some unbiased guidance. How exactly to bring all the incentives into alignment and make them fair, over the entire continuum of choice and accepting that the people who need the healthcare aren't themselves experts - that's the hard part.

novalis78 13y ago

One thought: there are other industries which sell services and tools that fluctute in price or are so complex that it is amazing how they can price their products at all - but they do. Just the fact that I cannot get any reliable pricing information for most procedures from health care providers seems strange and might point to the fact that their processes and methods are under no self-regulating forces/pressure. The situation reminds of Florida, 10 years ago, when the parties could not agree on a way to fix schools and the only bipartisan solution possible was to issue grades for the schools. That little "market transparency" started a whole avalanche of changes most of which came as a surprise and all of which have moved Florida ahead ever since. It performs dramatically better now, than it did 10 years ago in almost all assessments (minorities, drop-out rate, avg. Math/Science). I think giving people a choice by posting transparent pricing information is crucial to improving the American health care situation.

novalis78 13y ago
...and btw, to anyone here who is a ruby or php developer and feels very strongly about this topic and likes to help with our project that is trying to change this (pricepain.com/why) shoot me an email, we can need some help.
jellicle 13y ago
A few years ago, I had an agonizing emergent medical condition, for which I headed to the emergency room, and ended up having surgery later that evening. Of course, the cost to me was $0, since I live in Canada and we do it right here. But supposing I lived in your "transparent pricing information" ideal society. How exactly do you suppose I would flip through the ten-thousand page pricing book to determine what brand of surgical gauze I'd like to have used in my surgery, when I'm in 11/10 pain and going to die within a few hours if left untreated? And do you think the other local hospitals would send over their ten-thousand pricing books as well, so I can price-shop? Do you think Dr. Smithers is really worth a 12% price premium over Dr. Johnson, or not? Can you really have a meeting of minds when one of the minds is unconscious from an automobile accident? Please advise.
- deleted 13y ago

bhauer 13y ago

> That's a fine bit of conservative nonsense you just regurgitated Conservative, libertarian, I guess they are more or less the same for this subject. Fine. > coming to the conclusion that the problem the U.S. is suffering from is "too much health care" I suppose you're saying that because higher prices suggest a glut of supply? Wait, no. I'm not sure why you say that is the conclusion of my argument. I certainly never said the US has too much healthcare, nor imply it. In fact, if anything the US is supply-constrained in healthcare thanks to the AMA, FDA, etc. There is plenty of demand for healthcare, but the supply is pretty well controlled through regulation. I certainly can't start selling healthcare. Even with a lot of studying, I still couldn't just sell healthcare. Making additional healthcare supply isn't like making more supply of furniture, food, or even cars (which is closer on the regulation spectrum to healthcare, meaning it requires a herculean effort to enter this industry—witness Tesla). > therefore the solution is to reduce access to healthcare and insurance What? No, I'd rather make these services more readily available to everyone by making them available in the same way nearly every other product is available to anyone. Is the iPad unavailable to me because my employer doesn't provide tablet insurance? Just sell me healthcare and health insurance on regular markets, please. Nothing could be more available in my opinion. As it is, the "availability" of healthcare in my life is extremely narrow (again thanks to what evolved from 1940s price controls). I have a small set of options from one vendor selected by my employer. With the ACA, I will now have that option (maybe, though it's an HSA and I've been told to kiss HSAs goodbye) and a few other ratified options that have been selected by a central planning committee. If I can't afford routine health care on a regular market, I'd rather work harder to get a better job. In a worst-case scenario, I'll plead with friends and family or charities. I genuinely would prefer this to the current model. I'd pick up insurance to handle catastrophic events. I'd donate more to charity to boot. > your health is worth an infinite amount of money to you Actually, not really. If I have a quality of life issue and I can improve my quality of life for $500, I will weigh the pros and cons and probably go for it. If it costs $500,000, I'll suck it up until someone innovates the cost down to something I can afford. Even if I have a catastrophic issue and I have no insurance, and the only resolution is something that costs $1M, this is something my family (friends, charities) should decide. Sell/refinance property or pull the plug? Bottom line, it's a local decision to pull the plug, not something for a central planning board. > Further, healthcare prices are unpredictable This is not a counter-argument to using regular price signals. Services that are unpredictable are usually billed at hourly rates or time and materials with an estimate. If I have the termite guy out to check my house, he's not going to be able to give me a quote until he assesses the situation. Even then, it may be worse than he thought. But he has a price sheet of hours and services and I can look at that and select a different termite guy if the price sheet seems out of line. Better yet, other people will have paid termite guys and give me a basic feel for what a termite guy charges. When he says his hourly rate is $5,000, I'll know he's a nutcase. Today, if I heard it cost $5,000/hr for some medical procedure, I wouldn't even know how to react. Is that a lot? Is it low? I don't even know who I could ask for a guess. > which has been discovered by every advanced nation on Earth except the U.S. I don't enjoy the argument that everyone else does something a given way, so why don't you get in line already. The way I see it, this country has been doing healthcare more similar to other countries (no true market, no price signals) than similar to what I want for decades. A free market can support a central-planning model inside of itself, but vice-versa is never possible. This is why those of us who support free markets are so sensitive to those who would shut them off. Central planners don't have to kill the free market to do their central planning exercise, but they always choose to. We don't ask them to kill central planning so we can have a free market. In fact, we don't even care how central planners want to arrange their centrally-planned plan inside the free market, as long as it's voluntary. Have fun! If I had my way, the ACA would make centrally-planned healthcare an entirely in or entirely out proposition. Voluntary. Don't want in? Fine, you're on your own. Entirely. I'd opt out. And soon enough, I'd find people ready to sell me health care. Then I'd give more to charity. I'd be so much happier.

Zak 13y ago

your health is worth an infinite amount of money to you No, it isn't. Avoiding certain very undesirable outcomes is worth an infinite amount of money to me, but suffering from strep throat symptoms for 3 days instead of 5 days is worth a finite amount of money. My upper bound on that is hundreds of dollars, but if I can pay less to get the result I want (if I'm certain I have strep, I want a course of amoxicillin, and I don't care if that involves seeing a doctor), I will pay less. Competition can drive the price down even if the buyer isn't price-sensitive.

WalterBright 13y ago

> has never been observed in real life Frontline did a whole show on that, "Dollars and Dentists". http://www.pbs.org/wgbh/pages/frontline/dollars-and-dentists/ http://www.pbs.org/wgbh/pages/frontline/dollars-and-dentists... Frontline isn't known for having a conservative bias.

thaumasiotes 13y ago

Your opinion predicts the following: - No person would ever sell themselves into slavery (OK, this is only implied). - No person would ever kill themselves for the life insurance. Do you see any problems with that? Allow me to suggest that if your health is worth an infinite amount of money to you, you must have terrible relationships with your family.