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The rhetoric of medical reform draws mostly on economics: Experts differ over, among other things, how to structure “insurance mandates” and what constitutes “o

The rhetoric of medical reform draws mostly on economics: Experts differ over, among other things, how to structure “insurance mandates” and what constitutes “overutilization” of a rapidly expanding array of high-tech procedures and diagnostic tests. Sounds like the tell-tale signs of socialist dysfunction, from which all the other problems stem. The solution is simple, but, unfortunately, poorly understood and highly resisted: restore a free market for health goods and services.

blahedo 12y ago
Free market solutions don't work for health goods and services, because free market solutions require a feedback loop that is unavailable. At the provider level, in many cases you only have the option to be a repeat customer if they don't give you good service the first time round. At the level of the insurance agencies themselves, an unfettered free market approach pushes them in the direction of denied claims and policy rescissions (as we've seen!), and the customer doesn't (and often can't) discover they've made a bad choice until too late. One thing that would be good about a more free-market-y approach would be an increase in transparency about costs; but that's something that would be an improvement under a socalist or any other model as well.
- yummyfajitas 12y ago
  Free market solutions work just fine. I fled the semi-socialized US system to enjoy the unfettered free market medical system provided by India at least twice, and will probably do so for future medical treatments. Many medical services are repeated even if good service is provided. For example, 2 years ago I injured both my L5/S1 and L4/L5 disks. 2 years ago L5/S1 was treated, but the L4/L5 was left alone since it did not cause any problems. This year my L4/L5 started causing serious pain - the first guy did a great job so I went back. Another part of the feedback loop is reputation - if one of my friends needs similar treatment they'll probably go to the same guy unless they are very sensitive to cost (I didn't go for cheap). I have no idea where this meme that free market health care looks like the US comes from. Maybe Canadians don't realize there are more possibilities than simply Canadian and US health care?
  - angersock 12y ago
    So, erm, what about all the poor people in the US that can't take a journey out to Asia when they need care? (I don't automatically disagree with your free-market assertion, mind you...we have quite a captive one here. You just need to use a bit better justification.)
    - yummyfajitas 12y ago
      I didn't claim that medical tourism is the solution to all problems. I merely claimed that there are highly effective free market medical systems. I.e., the world is bigger than simply USA and Canada.
    - zo1 12y ago
      Well, medical-tourism isn't an answer to everyone's problems, at all ends of the socioeconomic spectrum. But if your assertion is indeed correct (that poor people aren't getting access to medicine in the US), then that's another argument against socialized (at least of the American-kind) medicine, and not at all a failing of free-market medicine.
  - cmollis 12y ago
    It seems more than coincidental that many of these problems began around the same time insurance companies began large health maintenance organizations (HMO's). It's clear that the original intent was to keep costs lower for the participants by spreading the fee-for-service billing model among a larger pool of subscribers. However, this has completely subverted the incentive structure. Doctors bill higher (and differently) for equivalent procedures while insurance companies spread that 'risk' by charging higher premiums. Couple that with Hospital consolidation, and incredibly strong lobby, monopoly pricing power with zero cost visibility and you have.. this. .. opaque pools of collateral (subscriber) tranches, zero cost visibility, monopoly pricing power.. sounds like they're trading mortgage-backed securities. That didn't end well either.
    - zo1 12y ago
      I'd also like to point out, as it doesn't seem like people go far enough in these sorts of analysis. We tend to draw some arbitrary line of causation, conveniently where it suits us. Obviously, the further back you go, the more difficult it is to draw conclusions and link causation/incentive, but it's important to at least try. E.g. You claim that the problem stems from HMO's spreading risk/cost using premiums, and doctors using that to over-charge fraudulently. But, have you considered why the doctors are able to do so (and get away with )? Perhaps because there is a shortage of them. Or something else, the point I'm trying to make is that we need to go a little bit further.

blahedo 12y ago

Free market solutions don't work for health goods and services, because free market solutions require a feedback loop that is unavailable. At the provider level, in many cases you only have the option to be a repeat customer if they don't give you good service the first time round. At the level of the insurance agencies themselves, an unfettered free market approach pushes them in the direction of denied claims and policy rescissions (as we've seen!), and the customer doesn't (and often can't) discover they've made a bad choice until too late. One thing that would be good about a more free-market-y approach would be an increase in transparency about costs; but that's something that would be an improvement under a socalist or any other model as well.

yummyfajitas 12y ago
Free market solutions work just fine. I fled the semi-socialized US system to enjoy the unfettered free market medical system provided by India at least twice, and will probably do so for future medical treatments. Many medical services are repeated even if good service is provided. For example, 2 years ago I injured both my L5/S1 and L4/L5 disks. 2 years ago L5/S1 was treated, but the L4/L5 was left alone since it did not cause any problems. This year my L4/L5 started causing serious pain - the first guy did a great job so I went back. Another part of the feedback loop is reputation - if one of my friends needs similar treatment they'll probably go to the same guy unless they are very sensitive to cost (I didn't go for cheap). I have no idea where this meme that free market health care looks like the US comes from. Maybe Canadians don't realize there are more possibilities than simply Canadian and US health care?
- angersock 12y ago
  So, erm, what about all the poor people in the US that can't take a journey out to Asia when they need care? (I don't automatically disagree with your free-market assertion, mind you...we have quite a captive one here. You just need to use a bit better justification.)
  - yummyfajitas 12y ago
    I didn't claim that medical tourism is the solution to all problems. I merely claimed that there are highly effective free market medical systems. I.e., the world is bigger than simply USA and Canada.
  - zo1 12y ago
    Well, medical-tourism isn't an answer to everyone's problems, at all ends of the socioeconomic spectrum. But if your assertion is indeed correct (that poor people aren't getting access to medicine in the US), then that's another argument against socialized (at least of the American-kind) medicine, and not at all a failing of free-market medicine.
- cmollis 12y ago
  It seems more than coincidental that many of these problems began around the same time insurance companies began large health maintenance organizations (HMO's). It's clear that the original intent was to keep costs lower for the participants by spreading the fee-for-service billing model among a larger pool of subscribers. However, this has completely subverted the incentive structure. Doctors bill higher (and differently) for equivalent procedures while insurance companies spread that 'risk' by charging higher premiums. Couple that with Hospital consolidation, and incredibly strong lobby, monopoly pricing power with zero cost visibility and you have.. this. .. opaque pools of collateral (subscriber) tranches, zero cost visibility, monopoly pricing power.. sounds like they're trading mortgage-backed securities. That didn't end well either.
  - zo1 12y ago
    I'd also like to point out, as it doesn't seem like people go far enough in these sorts of analysis. We tend to draw some arbitrary line of causation, conveniently where it suits us. Obviously, the further back you go, the more difficult it is to draw conclusions and link causation/incentive, but it's important to at least try. E.g. You claim that the problem stems from HMO's spreading risk/cost using premiums, and doctors using that to over-charge fraudulently. But, have you considered why the doctors are able to do so (and get away with )? Perhaps because there is a shortage of them. Or something else, the point I'm trying to make is that we need to go a little bit further.