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Ok, I'll bite. The author says: It may seem to Americans that U.S.-style free enterprise -- private-sector, for-profit health insurance -- is naturally the mo

by furyg3 17y ago

Ok, I'll bite. The author says: It may seem to Americans that U.S.-style free enterprise -- private-sector, for-profit health insurance -- is naturally the most cost-effective way to pay for health care. But in fact, all the other payment systems are more efficient than ours. To which you respond: That misses three obvious points about the American system: First, healthcare is tax advantaged, which causes even the most standard health issues to go through middlemen. Second, the supply of doctors is kept artificially low with very heavy licensing requirements. Third, the FDA approval process is very lengthy and expensive. Implying that the effect of a bloated, inefficient system is due a cause of free enterprise, private-sector, and for-profit insurance leaves out these well known points. But many of the other systems are also in the same situations, and thus are comparable. In Holland (a country mentioned in the article, and where I'm currently living), all of those three things are also true. Same goes for many other nations listed in the article. So while you're claiming that the author can't use America as a free-market example to bash on, that's not the real point. The general debate out there is that a lot of people are saying "we don't want socialism" and "the free-market is more effective" while refering to the American system. We can sit around a debate whether or not it's really a free-market, whether that's possible, or whether or not it's even desirable. The authors point is, free-market or not, the system doesn't produce the same results when compared with many other systems, which are accused of being less free-market. That's a compelling argument for change, specificly change in the direction of the type of healthcare that the other countries are currently practicing.

bokonist 17y ago
The authors point is, free-market or not, the system doesn't produce the same results when compared with many other systems, which are accused of being less free-market. If people accuse other systems of being less free-market, and those systems are actually more free market, it simply shows that the accusers are either idiots or lying or both. It does not prove that a free-market is a bad idea. Nor is there some linear continuum between socialism and free markets. Imagine you have two financial systems, one a complete free market, the other covered in a web of regulations. The free market one might be considerably better. But let's then say that one single regulation gets introduced: "Banks that fail get bailed out". With that single regulation, the system is now infinitely bad, much worse than the highly regulated system. What matters most is the particular details of a system, along with its implementation and its management. The real reason that the U.S. system so bad is that our political system is so completely dysfunctional. I could describe a half-dozen plans that on paper would be perfectly acceptable to you and lionhearted, to conservatives and liberals. But none of these plans will happen. Neither will the liberals' dream, European-like plan happen. The actually plan winding its way through Congress is a continuation of the same problems. By funneling more money away from the American people into the pockets of the various factional interests in the healthcare industry, it will most likely make things much worse.
- netsp 17y ago
  Let me get this right: Your position is that it is impossible to change this industry no matter what because of a deeply flawed political process unique to the US.
  - bokonist 17y ago
    Basically.
    - netsp 17y ago
      no matter how bad it gets?
      - bokonist 17y ago
        My crystal ball only goes so far out. But in the next five or ten years, I'd be quite surprised if Congress passes a plan that produces a very significant positive impact. The core problem is that any policy that actually improves healthcare will by definition result in far lower healthcare spending. That means lots of doctors, nurses, insurance companies, etc will lose money and jobs. In a Congressional system, determined, concentrated factions will always beat the public as a whole. Very few people will vote out their own Congressman if healthcare reform fails. But if it succeeds, and results in cutting healthcare spending, then many nurses and doctors will switch their vote and stop donating money. Read "Government's End" by Jon Rauch. I interned on Capitol Hill, and his take on the problem is one of the most accurate - http://www.amazon.com/Governments-End-Jon-Rauch/dp/1891620495 http://www.amazon.com/Governments-End-Jon-Rauch/dp/189162049...
lionhearted 17y ago
> So while you're claiming that the author can't use America as a free-market example to bash on, that's not the real point. I'm claiming there's problems with the American system that everyone, regardless of party or political affiliation, can agree with. I'm further claiming that they have fairly simple fixes that would reduce cost and increase quality. That means healthier people with more options. Here's one such way: Tax-advantaged health insurance is one reason the system is so expensive - frequently, all health care purchases are routed through insurance if a person can afford health insurance. That means there's these huge administrative costs and conflicts over treatments. There'd be lots of ways of addressing it: You could gradually remove the tax break on it, you could give everyone the option to receive any of their benefits in cash tax-free instead of the tax-free benefit, you could allow people to deduct all health and medical spending regardless of insurance. I don't know where those three ways of changing things would fall in the political continuum, but one increases taxes, one lowers taxes, and one keeps the tax yields about the same while reducing the reliance on the inefficient insurance system with its associated bureaucracy. > The general debate out there is that a lot of people are saying "we don't want socialism" and "the free-market is more effective" while refering to the American system. Yes, I'm intentionally sidestepping that debate, pointing out three issues that are not backed by either party, that everyone can agree on. We can fix those and be more prosperous, and then continue to the general debate in which people have been having a very hard time of agreeing. The American system is more expensive than it should be for the quality. There's a few elegant, low cost, simple improvements that can be made. I think we ought to make them.

by furyg3 17y ago

bokonist 17y ago

The authors point is, free-market or not, the system doesn't produce the same results when compared with many other systems, which are accused of being less free-market. If people accuse other systems of being less free-market, and those systems are actually more free market, it simply shows that the accusers are either idiots or lying or both. It does not prove that a free-market is a bad idea. Nor is there some linear continuum between socialism and free markets. Imagine you have two financial systems, one a complete free market, the other covered in a web of regulations. The free market one might be considerably better. But let's then say that one single regulation gets introduced: "Banks that fail get bailed out". With that single regulation, the system is now infinitely bad, much worse than the highly regulated system. What matters most is the particular details of a system, along with its implementation and its management. The real reason that the U.S. system so bad is that our political system is so completely dysfunctional. I could describe a half-dozen plans that on paper would be perfectly acceptable to you and lionhearted, to conservatives and liberals. But none of these plans will happen. Neither will the liberals' dream, European-like plan happen. The actually plan winding its way through Congress is a continuation of the same problems. By funneling more money away from the American people into the pockets of the various factional interests in the healthcare industry, it will most likely make things much worse.

netsp 17y ago
Let me get this right: Your position is that it is impossible to change this industry no matter what because of a deeply flawed political process unique to the US.
- bokonist 17y ago
  Basically.
  - netsp 17y ago
    no matter how bad it gets?
    - bokonist 17y ago
      My crystal ball only goes so far out. But in the next five or ten years, I'd be quite surprised if Congress passes a plan that produces a very significant positive impact. The core problem is that any policy that actually improves healthcare will by definition result in far lower healthcare spending. That means lots of doctors, nurses, insurance companies, etc will lose money and jobs. In a Congressional system, determined, concentrated factions will always beat the public as a whole. Very few people will vote out their own Congressman if healthcare reform fails. But if it succeeds, and results in cutting healthcare spending, then many nurses and doctors will switch their vote and stop donating money. Read "Government's End" by Jon Rauch. I interned on Capitol Hill, and his take on the problem is one of the most accurate - http://www.amazon.com/Governments-End-Jon-Rauch/dp/1891620495 http://www.amazon.com/Governments-End-Jon-Rauch/dp/189162049...

lionhearted 17y ago

> So while you're claiming that the author can't use America as a free-market example to bash on, that's not the real point. I'm claiming there's problems with the American system that everyone, regardless of party or political affiliation, can agree with. I'm further claiming that they have fairly simple fixes that would reduce cost and increase quality. That means healthier people with more options. Here's one such way: Tax-advantaged health insurance is one reason the system is so expensive - frequently, all health care purchases are routed through insurance if a person can afford health insurance. That means there's these huge administrative costs and conflicts over treatments. There'd be lots of ways of addressing it: You could gradually remove the tax break on it, you could give everyone the option to receive any of their benefits in cash tax-free instead of the tax-free benefit, you could allow people to deduct all health and medical spending regardless of insurance. I don't know where those three ways of changing things would fall in the political continuum, but one increases taxes, one lowers taxes, and one keeps the tax yields about the same while reducing the reliance on the inefficient insurance system with its associated bureaucracy. > The general debate out there is that a lot of people are saying "we don't want socialism" and "the free-market is more effective" while refering to the American system. Yes, I'm intentionally sidestepping that debate, pointing out three issues that are not backed by either party, that everyone can agree on. We can fix those and be more prosperous, and then continue to the general debate in which people have been having a very hard time of agreeing. The American system is more expensive than it should be for the quality. There's a few elegant, low cost, simple improvements that can be made. I think we ought to make them.