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Healthcare is a highly imperfect market, and that's what makes it subject to either huge amounts of regulation, or outright external management. Consumers are v

• cookiecaper 12y ago
  None of these attributes are incumbent in the nature of delivering health care. They're just things that are part of the system today. As you stated, in today's health care system, true costs are obscured. The exact problem is that nefarious corporate forces have removed most of the real market elements by adding layers of indirection (health insurance), which allows everyone in the industry to maximize their dollars billed and push some paper around, and leaves a great many people totally screwed. The issue is that there's just enough variance and division that there isn't a unified, whole-hearted call for reform, because it works great for 30% of people, works mediocre for 40% of people, and completely leaves the last 30% destroyed. I believe that those ratios are calculated and intentionally kept in place to prevent unification and meaningfully addressing the issue on a social scale. Health care has become a perverse industry because its market properties were destroyed not by government, but by malicious corporate conglomerations out to maximize their own profit at the expense of human life. People forget that one of the purposes is government is to prevent private organizations from growing too powerful and interfering with the general welfare of the people, because the narrative is rarely framed this way, but it's a very important governmental function. I don't think socialization is the answer, but something has to be done. I think health care needs to be brought back down to earth, and we should outlaw all non-catastrophic health insurance products. The insurance racket has completely destroyed that market. There are other elements that have caused the health market to get completely out of whack, but insurance is at the very core of the issue, and it has to go away. When almost half of the country's bankruptcies are due to health care debt, simply sick people trying to stay alive, we have a real social problem that we need to address. Of course, we did the opposite of this and made it illegal not to have health insurance, only further inflating the size of the monstrosity that has leeched and destroyed the system in the first place. I don't believe writing a blank check, like the other countries have done, is the way out. I believe the way out is going back to a what-you-see-is-what-you-get approach, and forcing medical providers to charge rates people can actually afford, as their business will immediately plummet if they don't seriously rework their billing structure to become affordable again since people will actually be paying it now.
  • tomp 12y ago
    I disagree about health insurance. I think that in the absence of health insurance, health care wouldn't work. Imagine getting in an accident, you're unconscious, you need emergency assistance. If the hospitals weren't reasonably sure you're insured and can pay for the services, they wouldn't be motivated to help you. Most European countries offer health insurance, and total healthcare costs are much lower (compared to the GDP), so I don't think insurance is the problem (also, AFAIK most countries are bankrupt because of bad bank loans, falling GDP/taxes, and social payments (pensions), not health care costs). The real problem is that doctors get paid when people are sick, so they are not incentivized to heal them, long-term (without regulation). If doctors were paid when the patients were healthy, you wouldn't have this problem. But I don't know how to implement that.
    • jtc331 12y ago
      There's a question though here as to how to define insurance: in your example, everything still works if everyone has catastrophic insurance. Insurance, classically understood, is risk sharing, not cost sharing. In other words taking it from a "not everyone will use this service" risk sharing model to "everyone will use this at some point" cost sharing model is what causes the problem of hidden pricing. You can have it both ways (risk sharing and visible prices) because most healthcare costs aren't unforeseen. In other words, the number of accidents where the hospital needs to be relatively sure insurance is involved pales in comparison to the cost of routine visits/care which could be paid for out of pocket and prices would then be visible allowing for competition.
      • tomp 12y ago
        That's a good point, which is why there were some suggestions in some European countries about having a "paid first visit" that is refunded if there is actually something wrong with you. I in general support things like this. I also support some parallel "private" medical system, where you can pay to "skip the line" (but e.g. in Slovenia, only certain procedures can be performed in the private system). However, there are also many medical costs that can be foreseen (even planned for) but are either "beneficial" for the society (e.g. childbirth) or still risky and essentially no-one's fault (e.g. cancer - most people will get it, but some will get it at 50, others at 95). Incidentally, it's cancer and the catastrophic treatments (e.g. heart surgery) that are most expensive. Possibly also because it's in the big-pharma's interest to keep it this way (at least for cancer).