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Health care -- where Libertarian, free-market ideology goes to die. The free market simply doesn't work when there is zero price transparency, 3rd parties are

Health care -- where Libertarian, free-market ideology goes to die. The free market simply doesn't work when there is zero price transparency, 3rd parties are often responsible for payment, and purchasers are often in great distress right when they need to be able to negotiate. Laissez faire market philosophy fails in this case for the same reason it fails during major crises and disasters. Purchasers are nearly powerless but have needs that they must meet immediately; vendors can price-gauge and make out like bandits. A climate of scarcity and desperation prevail over hypothetical rational actors participating in a stable market at equilibrium.

NoMoreNicksLeft 12y ago
There is no free market here. This isn't a price transparency thing either. This is about having created a culture where every doctor in the country is constantly hustling, committing borderline fraud. Sociologically, the idea that doctors and medical care workers are always looking out for what's best for their patients helps to mask the idea that they might be doing so from a health perspective but are ignoring any other consideration. And so bringing in a friend who's also a surgeon so he can get a little kickback doesn't really raise any ethical alarms. But this isn't the fault of the libertarians. Government has meddled in this industry and even with the ideas that the typical Americans think about for so long that this was inevitable. Nor can government fix it now... the AMA and other quasi-unions won't stand for it. They'll negotiate. And, as usual, our politicians will sell us down the river. If you want to fix this (and every other problem), the answer is simple (though not particularly libertarian): outlaw all health insurance. Make everyone pay for their own care. Make them pay out of pocket. In such a nation at that, none of these shenanigans could continue. Not that I expect anyone reading this to get it. You cry "But NoMoreNicksLeft, how could that man afford $117,000 out of pocket!" And the answer is that he couldn't. The doctor (if he billed after the fact) might sue, but winning a lawsuit doesn't make someone magically capable of paying. If the doctor insisted on payment up front, then the man would just forgo his particular service (which, since he was unaware that he needed it and it sound like bullshit... wouldn't have mattered). There aren't enough rich people who can afford to pay the current prices out of pocket for 100% of the doctors to continue to bill/earn what they do currently. Maybe just enough for 1% to continue like that... the other 99% are going to have to shape up, and in a hurry. They can't hold out prices where they are now (we can't pay that out of pocket), nor can they spitefully punish us and refuse to do it at lower prices. They have bills to pay just like the rest of us, they have mortgages, they need to buy groceries, etc. Nor will they decide to become plumbers and HVAC repairmen so that they don't have to give away their surgeries for less. But again, this is lost on anyone I've ever explained it to. You all think it will result in millions of deaths and untold suffering. > Laissez faire market philosophy fails Bullshit. There hasn't been a laissez fair in the healthcare industry in the United States in 100 years.
- psychometry 12y ago
  I honestly can't tell if your comment is satire. We know from looking at other countries what a functional and effective health care system looks like. You're suggesting we do the opposite. It's almost beyond belief.
- HelloMcFly 12y ago
  > Government has meddled in this industry and even with the ideas that the typical Americans think about for so long that this was inevitable. Nor can government fix it now... I disagree with you 100%, and halfway think you're joking. This is one area where more government is the clear answer. How many other countries have to set a working precedent? You seem to make this out to be an outcome of "borderline fraudulent" doctors. That you'd call out "every doctor" as committing borderline fraud shows your lack of understanding for the system as a whole, much less nuance. Do you think the high price is because doctors are looking to make enormous profits? I'm sure that's true for some, but in general that just is not the case. Who percentage of doctors do you think get fabulously wealthy, anyway? Most do fine, but after student loans are factored in it isn't the key to wealth that you think. The high price is driven by many things, and you've focused on the one of the smallest. Your proposal is chaos, and it would turn healthcare into even more of a privilege for the wealthy than it is now (nevermind for the moment the unpredictably of care pathways that cannot be agreed to upfront).
  - NoMoreNicksLeft 12y ago
    > I disagree with you 100%, and halfway think you're joking. This is because you don't have very well practiced thinking skills. The best you can manage is to be shocked at the idea, and then to refuse to think it through. Worse, you then turn around and believe that whatever dumbass projection your small mind can come up with is some sort of reasoned extrapolation of the idea. You're barely able to anticipate how other singular individuals can and will react. Imagining millions of other people's reactions in aggregate is simply beyond your capabilities. If everyone has to pay out of pocket, and if you're a doctor selling health care... you can either sell it at a price they can afford or you can starve. Most doctors I know don't like to starve, it conflicts with their beliefs that they're well to do. No bank is going to loan someone $500,000 for a liver transplant either, they're not even going to loan you $20,000 for an appendectomy. Nor can the doctor lower prices to 90% of what they are currently... when people talk about the incredibly high prices, they're not saying "it needs to be 90% of what it is now". When I say "lower" we're talking about significantly lower, something where you could hope to afford it. But you can't see that. You're just too dim. > You seem to make this out to be an outcome of "borderline fraudulent" doctors. And this particular issue raised in the link, that's what it is. Some guy he never heard of shows up while he's out of it on painkillers, and then sends a $120,000 bill weeks later. The insurance company caves, pays the whole thing, letting him (and others that are aware of it) that they can continue to do this. It's not a price transparency thing. That happens when either the company providing the service can't know beforehand how much it will cost, or refuses to estimate. But after the bill comes in, no one, not even the customer, is going to say "this price is absurd". Instead, they say "dammit, it really does cost about that much, but it hurt me because I couldn't prepare for the price". They're saying "This price is absurd, it's unfair, and no one can even tell me what it is I'm paying for if I pay this bill". That's fraud. Worse, I believe that for the most part, the doctors don't even see it as fraud. They feel like they're doing what they have to earn the income they deserve, and that this is no big deal. > shows your lack of understanding for the system as a whole No, it proves my understanding. Fuck, you can't even be bothered to explain how it's wrong, you're just doing the "don't you dare besmirch their good name". Which might be a moving argument, if we were talking about someone specific. We're not. And the industry itself, and this practice in particular, is rotten. It stinks. > Do you think the high price is because doctors are looking to make enormous profits? Fuck no, and that's horrible. These doctors aren't driving gold-plated Ferraris and buying 2000ft long mega-yachts. In some cases they feel forced to do this. In some cases, they're paying so much on the new building for their practice or whatever, that if they didn't do this they'd go under. In others lifestyle creep has them paying what they feel are reasonable prices so that the wife can go to the resort spa once a month and the kids get their cheese-tasting lessons and all that snooty shit, and it constantly costs them more even while they feel like they're treading water. This can't be justification for any reasonable person. > Who percentage of doctors do you think get fabulously wealthy, anyway? They don't have to, fool. This can happen even while they feel like they're just a bit into the upper part of the middle class. > The high price is driven by many things None of which you understand. You're incapable of it. I understand it perfectly, and I've proposed a single simple solution for it (even if it is politically unviable). > The high price is driven by many things, and you've focused on the one of the smallest. Yes, I have. I've found the one tiny piece that if removed, the entire logjam goes away. It all unravels with this. Outcomes would be better for everyone (well, except all the health insurance workers who would be unemployed). > Your proposal is chaos, Possibly. But we've already seen what your non-chaos looks like, and it's strangling everyone.
icelancer 12y ago
I happen to agree that market intervention is necessary but immediately poking fun at libertarians is ridiculous. The healthcare in the US is nothing like a "free market." It is the worst of all worlds - corrupt intervention that enriches corporations. It is the new age of American crony capitalism.
- psychometry 12y ago
  Yes, but it's Libertarians like the Koch brothers who have done the most damage to the prospect for improved healthcare in recent years. Also, you can make the argument that free markets over time tend toward cronyism and corporate welfare. That's what happens when there are no checks on the power of corporations and no limits on how money can influence politics.
  - icelancer 12y ago
    >Libertarians ... Koch brothers Yeah... not so much. I appreciate their donations to the Cato Institute and other liberty-facing organizations, but they fund crony capitalism and modern conservatism, which is to say they love to privatize gains and socialize costs. That's hardly libertarian. That's, well... American.
- danbmil99 12y ago
  For the record, I consider myself somewhat of a libertarian. I just find it ridiculous when some self-proclaimed libertarians refuse to see past their rigid ideology on certain issues, of which health care is one of the most obvious. Free markets work great when they work, but they cannot be relied upon to achieve social aims that are inherently collectivized. Hard-core communists are just as silly.
  - seehafer 12y ago
    It's more appropriate to say free markets work great when they are allowed to work. Health care isn't allowed to function in a free market due to the moral implications of doing so given our prevailing morality.
deleted 12y ago
[deleted]
glenra 12y ago
In a libertarian system if some hospital routinely billed excessive hard-to-understand charges, somebody else would open a hospital across the street to compete with it. The new hospital could advertise open, transparent up-front pricing (complete with price comparisons), more sensible policies on consultation and out-of-network services, even money-back guarantees. Because the new hospital is so attractive, the old one would lose customers and ultimately either improve its policies or go out of business. This is how the market works with every other kind of firm: if you see an opening to provide a better supermarket or restaurant or department store you can just create it, with no regard to the impact your entry to the market might have on existing providers. Sadly, hospitals are not legally allowed to compete on price. Or compete on service. Or compete at all. You generally can't make a new hospital or expand an old one unless you can convince regulators that doing so won't hurt any existing players. Which means the existing players have no incentive to improve. Open the market to competition, and we would see vast improvement over the status quo. https://en.wikipedia.org/wiki/Certificate_of_need https://en.wikipedia.org/wiki/Certificate_of_need
- rokhayakebe 12y ago
  From Wikipedia: A number of factors spurred states to require certificates of need in the health care industry. Chief among these was the concern that the construction of excess hospital capacity would cause competitors in an oversaturated field to cover the costs of a diluted patient pool by over-charging, or by convincing patients to accept hospitalization unnecessarily It seems this bill did exactly the opposite of what it intended to.
  - glenra 12y ago
    I'm pretty sure it was intended to do just what it did do - protect entrenched interests. But I agree that it did the opposite of the claimed intention. Which is often the case for legislation. https://en.wikipedia.org/wiki/Bootleggers_and_Baptists https://en.wikipedia.org/wiki/Bootleggers_and_Baptists The real question is, who were the "baptists" in this coalition? Were there any non-doctors who honestly believed having too much capacity would make prices go up? And if there were, where did these people learn economics? :-)
silentvoice 12y ago
The lack of price transparency and emergence of 3rd party system was direct result of heavy regulations on health care dating back to WW2, and was slowly solidified into law through tax incentives and then recently became "official" through the ACA. Brief summary: http://www.forbes.com/sites/paulhsieh/2013/11/17/the-only-obamacare-fix-is-for-obama-to-legalize-real-health-insurance/ http://www.forbes.com/sites/paulhsieh/2013/11/17/the-only-ob... I don't consider myself libertarian, but facts should be straight on this issue.

NoMoreNicksLeft 12y ago

There is no free market here. This isn't a price transparency thing either. This is about having created a culture where every doctor in the country is constantly hustling, committing borderline fraud. Sociologically, the idea that doctors and medical care workers are always looking out for what's best for their patients helps to mask the idea that they might be doing so from a health perspective but are ignoring any other consideration. And so bringing in a friend who's also a surgeon so he can get a little kickback doesn't really raise any ethical alarms. But this isn't the fault of the libertarians. Government has meddled in this industry and even with the ideas that the typical Americans think about for so long that this was inevitable. Nor can government fix it now... the AMA and other quasi-unions won't stand for it. They'll negotiate. And, as usual, our politicians will sell us down the river. If you want to fix this (and every other problem), the answer is simple (though not particularly libertarian): outlaw all health insurance. Make everyone pay for their own care. Make them pay out of pocket. In such a nation at that, none of these shenanigans could continue. Not that I expect anyone reading this to get it. You cry "But NoMoreNicksLeft, how could that man afford $117,000 out of pocket!" And the answer is that he couldn't. The doctor (if he billed after the fact) might sue, but winning a lawsuit doesn't make someone magically capable of paying. If the doctor insisted on payment up front, then the man would just forgo his particular service (which, since he was unaware that he needed it and it sound like bullshit... wouldn't have mattered). There aren't enough rich people who can afford to pay the current prices out of pocket for 100% of the doctors to continue to bill/earn what they do currently. Maybe just enough for 1% to continue like that... the other 99% are going to have to shape up, and in a hurry. They can't hold out prices where they are now (we can't pay that out of pocket), nor can they spitefully punish us and refuse to do it at lower prices. They have bills to pay just like the rest of us, they have mortgages, they need to buy groceries, etc. Nor will they decide to become plumbers and HVAC repairmen so that they don't have to give away their surgeries for less. But again, this is lost on anyone I've ever explained it to. You all think it will result in millions of deaths and untold suffering. > Laissez faire market philosophy fails Bullshit. There hasn't been a laissez fair in the healthcare industry in the United States in 100 years.

psychometry 12y ago
I honestly can't tell if your comment is satire. We know from looking at other countries what a functional and effective health care system looks like. You're suggesting we do the opposite. It's almost beyond belief.
HelloMcFly 12y ago
> Government has meddled in this industry and even with the ideas that the typical Americans think about for so long that this was inevitable. Nor can government fix it now... I disagree with you 100%, and halfway think you're joking. This is one area where more government is the clear answer. How many other countries have to set a working precedent? You seem to make this out to be an outcome of "borderline fraudulent" doctors. That you'd call out "every doctor" as committing borderline fraud shows your lack of understanding for the system as a whole, much less nuance. Do you think the high price is because doctors are looking to make enormous profits? I'm sure that's true for some, but in general that just is not the case. Who percentage of doctors do you think get fabulously wealthy, anyway? Most do fine, but after student loans are factored in it isn't the key to wealth that you think. The high price is driven by many things, and you've focused on the one of the smallest. Your proposal is chaos, and it would turn healthcare into even more of a privilege for the wealthy than it is now (nevermind for the moment the unpredictably of care pathways that cannot be agreed to upfront).
- NoMoreNicksLeft 12y ago
  > I disagree with you 100%, and halfway think you're joking. This is because you don't have very well practiced thinking skills. The best you can manage is to be shocked at the idea, and then to refuse to think it through. Worse, you then turn around and believe that whatever dumbass projection your small mind can come up with is some sort of reasoned extrapolation of the idea. You're barely able to anticipate how other singular individuals can and will react. Imagining millions of other people's reactions in aggregate is simply beyond your capabilities. If everyone has to pay out of pocket, and if you're a doctor selling health care... you can either sell it at a price they can afford or you can starve. Most doctors I know don't like to starve, it conflicts with their beliefs that they're well to do. No bank is going to loan someone $500,000 for a liver transplant either, they're not even going to loan you $20,000 for an appendectomy. Nor can the doctor lower prices to 90% of what they are currently... when people talk about the incredibly high prices, they're not saying "it needs to be 90% of what it is now". When I say "lower" we're talking about significantly lower, something where you could hope to afford it. But you can't see that. You're just too dim. > You seem to make this out to be an outcome of "borderline fraudulent" doctors. And this particular issue raised in the link, that's what it is. Some guy he never heard of shows up while he's out of it on painkillers, and then sends a $120,000 bill weeks later. The insurance company caves, pays the whole thing, letting him (and others that are aware of it) that they can continue to do this. It's not a price transparency thing. That happens when either the company providing the service can't know beforehand how much it will cost, or refuses to estimate. But after the bill comes in, no one, not even the customer, is going to say "this price is absurd". Instead, they say "dammit, it really does cost about that much, but it hurt me because I couldn't prepare for the price". They're saying "This price is absurd, it's unfair, and no one can even tell me what it is I'm paying for if I pay this bill". That's fraud. Worse, I believe that for the most part, the doctors don't even see it as fraud. They feel like they're doing what they have to earn the income they deserve, and that this is no big deal. > shows your lack of understanding for the system as a whole No, it proves my understanding. Fuck, you can't even be bothered to explain how it's wrong, you're just doing the "don't you dare besmirch their good name". Which might be a moving argument, if we were talking about someone specific. We're not. And the industry itself, and this practice in particular, is rotten. It stinks. > Do you think the high price is because doctors are looking to make enormous profits? Fuck no, and that's horrible. These doctors aren't driving gold-plated Ferraris and buying 2000ft long mega-yachts. In some cases they feel forced to do this. In some cases, they're paying so much on the new building for their practice or whatever, that if they didn't do this they'd go under. In others lifestyle creep has them paying what they feel are reasonable prices so that the wife can go to the resort spa once a month and the kids get their cheese-tasting lessons and all that snooty shit, and it constantly costs them more even while they feel like they're treading water. This can't be justification for any reasonable person. > Who percentage of doctors do you think get fabulously wealthy, anyway? They don't have to, fool. This can happen even while they feel like they're just a bit into the upper part of the middle class. > The high price is driven by many things None of which you understand. You're incapable of it. I understand it perfectly, and I've proposed a single simple solution for it (even if it is politically unviable). > The high price is driven by many things, and you've focused on the one of the smallest. Yes, I have. I've found the one tiny piece that if removed, the entire logjam goes away. It all unravels with this. Outcomes would be better for everyone (well, except all the health insurance workers who would be unemployed). > Your proposal is chaos, Possibly. But we've already seen what your non-chaos looks like, and it's strangling everyone.

icelancer 12y ago

I happen to agree that market intervention is necessary but immediately poking fun at libertarians is ridiculous. The healthcare in the US is nothing like a "free market." It is the worst of all worlds - corrupt intervention that enriches corporations. It is the new age of American crony capitalism.

psychometry 12y ago
Yes, but it's Libertarians like the Koch brothers who have done the most damage to the prospect for improved healthcare in recent years. Also, you can make the argument that free markets over time tend toward cronyism and corporate welfare. That's what happens when there are no checks on the power of corporations and no limits on how money can influence politics.
- icelancer 12y ago
  >Libertarians ... Koch brothers Yeah... not so much. I appreciate their donations to the Cato Institute and other liberty-facing organizations, but they fund crony capitalism and modern conservatism, which is to say they love to privatize gains and socialize costs. That's hardly libertarian. That's, well... American.
danbmil99 12y ago
For the record, I consider myself somewhat of a libertarian. I just find it ridiculous when some self-proclaimed libertarians refuse to see past their rigid ideology on certain issues, of which health care is one of the most obvious. Free markets work great when they work, but they cannot be relied upon to achieve social aims that are inherently collectivized. Hard-core communists are just as silly.
- seehafer 12y ago
  It's more appropriate to say free markets work great when they are allowed to work. Health care isn't allowed to function in a free market due to the moral implications of doing so given our prevailing morality.

deleted 12y ago

[deleted]

glenra 12y ago

In a libertarian system if some hospital routinely billed excessive hard-to-understand charges, somebody else would open a hospital across the street to compete with it. The new hospital could advertise open, transparent up-front pricing (complete with price comparisons), more sensible policies on consultation and out-of-network services, even money-back guarantees. Because the new hospital is so attractive, the old one would lose customers and ultimately either improve its policies or go out of business. This is how the market works with every other kind of firm: if you see an opening to provide a better supermarket or restaurant or department store you can just create it, with no regard to the impact your entry to the market might have on existing providers. Sadly, hospitals are not legally allowed to compete on price. Or compete on service. Or compete at all. You generally can't make a new hospital or expand an old one unless you can convince regulators that doing so won't hurt any existing players. Which means the existing players have no incentive to improve. Open the market to competition, and we would see vast improvement over the status quo. https://en.wikipedia.org/wiki/Certificate_of_need https://en.wikipedia.org/wiki/Certificate_of_need

rokhayakebe 12y ago
From Wikipedia: A number of factors spurred states to require certificates of need in the health care industry. Chief among these was the concern that the construction of excess hospital capacity would cause competitors in an oversaturated field to cover the costs of a diluted patient pool by over-charging, or by convincing patients to accept hospitalization unnecessarily It seems this bill did exactly the opposite of what it intended to.
- glenra 12y ago
  I'm pretty sure it was intended to do just what it did do - protect entrenched interests. But I agree that it did the opposite of the claimed intention. Which is often the case for legislation. https://en.wikipedia.org/wiki/Bootleggers_and_Baptists https://en.wikipedia.org/wiki/Bootleggers_and_Baptists The real question is, who were the "baptists" in this coalition? Were there any non-doctors who honestly believed having too much capacity would make prices go up? And if there were, where did these people learn economics? :-)

silentvoice 12y ago

The lack of price transparency and emergence of 3rd party system was direct result of heavy regulations on health care dating back to WW2, and was slowly solidified into law through tax incentives and then recently became "official" through the ACA. Brief summary: http://www.forbes.com/sites/paulhsieh/2013/11/17/the-only-obamacare-fix-is-for-obama-to-legalize-real-health-insurance/ http://www.forbes.com/sites/paulhsieh/2013/11/17/the-only-ob... I don't consider myself libertarian, but facts should be straight on this issue.