You realize, that sort of thing encourages the lower classes to breed.
You also realize, that sort of thing encourages the lower classes to read.
Taking you at your word, that just means the original definition is so bad as to be useless, and probably was created to be deliberately deceptive. Like “People’s Republic”, a definition of “free market” that includes coerced transactions means the opposite of what it says.
Yes. One important point you hint at but didn’t emphasize is that, despite being the “buyer”, insurance companies have a long-term incentive for higher costs! (5% of X increases as X increases.) The big U.S.A. healthcare problem is the high costs, driven by unnecessary tests, etc. While insurance companies have a short-term incentive to deny an individual an expensive test, the general growth of costs is good for the insurance industry’s revenues and profits.
You say that health care should not be a for-profit enterprise, and then say there’s nothing fighting for lower prices to force health insurance companies into doing a better job. You said that after Icarus asked about the difference between health care and health insurance; I’m curious as to your take on the question. What’s the real target? Who is setting the price for something that – as Der Trihs puts it – is a pay-or-die need?
My thoughts exactly. The problem that needs to be addressed in not that some people don’t have insurance, it is that some people don’t have health care.
Insurance has its place and there is no question that the insurance business could use some reform but, in the end, the health insurance industry is just the bill collector for the medical industry. If we don’t do something to control the outflow of money then all the insurance in the world is not going to allow some people to get the care they need. Unless the government just pays the difference. This is a result that the medical industry would love.
People are willing to pay almost any price for the health care they need and the medical industry is perfectly willing to take it. That is not a “free market”.
- Health Insurance has never been shown to increase longevity or health. The purpose of health insurance is combat the chance of catastrophic expenses. People vary on their ability to live with risk, one third of the uninsured in America make enough to afford insurance, but choose to do without. To those people it is obviously not a necessity.
2.This applies to all products. When I go to Burger King they would make more money if they kicked me out after I gave them my money and did not give me a Whopper. My auto repair place would make more money if they only pretended to change my oil. The reason they do not is that businesses that screw their customers, get a bad reputation and people do not frequent businesses with bad reputation. For instance the insurance companies in Germany paid off claims after Kristallnacht despite pressure from the government not to. This is not because they liked Jews any more than the average German but because they wanted a reputation of always paying off. - This is a relic of WW2’s wage controls and is a distortion in the market. This distortion in the market causes much of the problems with US healthcare and getting rid of it would make the market more free and work better.
- Making insurers pay for pre-existing conditions is allowing home owners to wait and buy insurance when there house is one fire. Depending on the condition it could be possible to buy risk adjusted coverage but this illegal in most places. Forcing people to pay for others health care is forced charity not insurance.
- There are many ways to innovate in health insurance, integrated care, electronic records, HSA’s, etc. This is where the profit motive comes in, it motivates innovation. The best way to stop innovation is to remove profits.
There are many things wrong with the US healthcare system, most of those problems are because the market has been distorted and making the market freer would ameliorate the system.
I dunno. Do you know many actual other people? I have friends who used to rush their daughter to the ER for things like bumps and scrapes, and once because she was constipated. They did this even though their copay for ER visits was 4 times what it was for a doctor’s office visit. And their nurse helpline recommended not going as well. I also mentioned the old folks in my example above.
Beyond that, many folks, even if covered for doctor visits, will go to the ER or urgent care ebcause they don’t have time to wait for a doctor appointment in a week. If you’re a low-income, hourly worker, when you don’t work you don’t get paid.
So yeah, people overuse care, and the freer you make it, the more it will be overused.
The notion that the free market can’t be applied to health care because people die without health care is misguided for a couple of reasons - [ul][li]Most interactions between individuals and the health care system are not life-or-death. Most of the complaints that drive people to the doctor resolve on their own.There are all kinds of other goods that are necessities of life that operate just fine under the free market - food and water, for instance.[/ul]People are just as ‘coerced’ into buying food as they are buying health care, but the middle and upper classes don’t buy “food insurance” and have a third party pay their grocery bill. [/li]
The two major factors driving health care inflation are technology - we can do more now that we could twenty years ago - and the fact that consumers are shielded at the point of sale from the cost of their health care. It is not a failure of the market; the US has just gotten further and further away from letting it apply.
Regards,
Shodan
Thanks for the anecdote and the assertion.
I wonder if you could provide some factual evidence. Thanks.
Nice OP. This is one of the debates I haven’t really decided on. I lean libertarian and definitely support the free-market, but I am willing to be convinced that UHC may be a better way to provide health care. I (think I) understand the arguments to both sides, and haven’t made up my mind one way or the other. I’ll take your points one by one, and hopefully spark some more debate.
Well, health care is a necessity, not health insurance. If we had enough money, or care was cheap enough, no one would need health insurance. But yes, health care is. But so is food, water, and shelter, and the free market does an outstanding job of delivering these products to those that need them. The difference I do recognize between these goods is that one knows food, water, and shelter is always necessary. Health care is necessary at points in one’s life, but it’s much harder to anticipate when for most people.
And arguably, this would be better handled in a freer market than the clusterfuck that is the current health insurance market in the US. If people were customers, and could easily purchase insurance across state lines, there would be more competition and better response to customers needs and expectations. Or you jump ship and find a new insurance agency.
This, to me, is one of the sticking points, one of the hardest things to tackle. The common belief seems to be: you buy health insurance, it pays for all your medical needs. But insurance in every other context covers catastrophes, not day to day expenses. I don’t buy car insurance and expect it to cover replacing my brake pads and changing my oil; I don’t buy it expecting to cover an accident I had the day before. I can’t imagine a way to fix this. Some people are going to have to spend more money every month to stay healthy, or at least in the process of trying to stay healthy. It seems in the US, that we believe insurance should cover these costs. But it’s not really the business of insurance; the risk is known, it’s not unexpected, and the costs will continue.
The question as I see it is, should we provide a system to help those that have pre-existing conditions and will continue to have medical costs for the rest of their lives? If so, how? Because frankly, it’s not the business of insurance anymore.
I think you are in danger of conflating health insurance with health care when you consider this, though you state otherwise. I mean, what kind of innovation are you expecting from insurance? They assess a risk, demand a fee, and are obliged to pay out if you fall ill. On the other hand, there have been and continue to be amazing advancements in health care. What we should expect is better care at lower prices, and without looking at any numbers, I believe that has been the case.
True enough but… The food and water business is not set up the same way as the medical industry. If you had to make an appointment a week ahead of time in order to grocery shop and then, on the day of the appointment, you were told when and if you were allowed anything based on a single persons assessment of your needs and THEN you were told the cost only after you get the groceries home. That might make the the food industry sort of similar to the way the medical industry is run. Kind of reminds me of images of Soviet run grocery stores back in the good old days.
The food industry is heavily regulated and there is huge amounts of competition - it is actually legal for me to grow food in my own yard - so costs are low.
The water industry is also heavily regulated and/or completely government run.
The medical industry may have regulation but for the most part the only laws us customers see are the ones that force us into paying for services and that restrict our access. We are required to pay a doctor to allow us access to medicine, for example. That is not true of food and water. Competition in the medical industry is somewhat controlled by the medical industry itself. That don’t sound like free enterprise to me.
I’ll dispute anecdotes (“Hey, I have low copays and I NEVER go to the doctor”) with anecdotes of my own, thanks.
I’ll try to dig up some info on ER usage in urban areas, but it’s skewed a bit by indigent patients.
While I am searching, though, do you not agree that the overuse/misuse of antibiotics is leading to antibiotic resistant bacteria? This is something documented and spoken about by many doctors here. Antibiotics are largely inexpensive, so patients demand them whether they are justified or not. Do you not agree that this sort of pattern would be likely to repeat itself in other areas of medicine?
And clean drinking water isn’t a “necessity”, because some people won’t catch botulism and die from it. And shelter isn’t a “necessity” because people can live under bridges. In other words, I guess we just disagree.
There are a few key differences here. The most important one is the variability. Imagine if Burger King had an all-you-can-eat policy, so most people would come in and pay $6 and eat $5 worth of food, and everyone is happy. Except that in this hypothetical, there’s a crazy bell curve of how much food people can eat, and one person in 100 pays $6 and eats $10 worth of food, and one in 1000 pays $6 and eats $100 worth of food, and one in 100000 pays $6 and eats $1000000 worth of food. Obviously, if everyone who comes in and pays their $6 gets treated horribly, they won’t come back, BK goes out of business. But if only the super-rare people who would eat millions of dollars worth of food get treated badly, the savings in food is likely worth the bad publicity they’d get.
Another key difference is that if you go to Burger King and have a bad experience, you can easily just go to McDonald’s the next day. Switching restaurants, or even something more expensive like car manufacturers, is simple and automatic. On the other hand, switching insurance providers is very very hard. Part of that is the issue of insurance being linked to jobs, part of it is the preexisting condition issue, and part of it is just the fundamental hassle of dealing with that kind of crap. There’s a much higher threshold of bad service I’d have to get from something as complicated and irritating as health insurance before I’d switch health insurance (assuming I could) than from something like a restaurant.
Finally, there’s a big difference in the extent to which people have a basis for comparison. People eat meals every day. People frequently take rides in other people’s cars. But to what extent can most people really meaningfully say “hey, I can definitely compare the service one gets with Blue Cross to the service one gets with Kaiser, and really realize that Kaiser is screwing me over” or anything of that sort? I’m not saying it’s impossible, but (probably not coincidentally) health insurance is not something where it’s easy to point at individual units of health insurance interaction and easily compare them and rate them and contrast them to what other insurers provide.
Again, my point is not “insurers should have to insure everyone despite the fact that they’re evil”. It’s “this problem is one which makes it hard for the classic free model market to work”. As mentioned above, Burger King has an incentive to treat me well and provide me with a quality product at a low price because they know that if I get treated badly, I’ll go somewhere else. But if I have insurance and develop an expensive condition, there’s no reason any other company would offer me insurance, as it would be guaranteed unprofitable for them to do so. So I can NOT go anywhere else. So there’s no incentive for my current company to treat me well, and a massive incentive for them to screw me. And if I do NOT have insurance and develop a condition, well, I’m a lot of trouble. Which, from a purely economic standpoint is fine… I knew the odds, I took a risk, I pay the price. But is that OK from a humanitarian standpoint? Do we want to live in that society?
This is a different argument… you’re trying to point out problems with a hypothetical UHC system. And my answer to any such thing is: go look at any of the countries that have UHC and see how much of a problem it is there and how they solve it. That’s really a topic for a different thread, but it seems 100% certain to me that there is not some insurmountable problem with UHC, because lots of countries successfully have UHC. Not that that proves that we should, but I’m quite sure you’re not going to come up with some gotcha along the lines of “if we had UHC, then x would happen and the system would fall apart”.
[quote=“Shodan, post:29, topic:530927”]
[li]There are all kinds of other goods that are necessities of life that operate just fine under the free market - food and water, for instance.[/li][/QUOTE]
Well, there is a massive bottled water market now, it’s true. But that’s 99% bullshit and marketing. Water is delivered to almost all Americans through municipal water sources at a fixed rate and everyone pays for it. One might almost call it socialized water!
Food is a different issue, as it’s clearly a necessity and clearly generally sold via the free market (with regulation), but there are lots of reasons why it’s not particularly comparable to health care. If you look at the OP, all the points except point #1 (whether or not it’s a necessity) don’t really apply to food.
As I said in an earlier post, this issue and the preexisting conditions issue go together very very badly. Also, I’m very suspicious of this “across state lines” idea, as it seems to be an incessantly repeated Republican talking point. So yes, one can imagine the insurance market being much closer to a classic free market than it is in the US. That doesn’t necessarily mean it would be better, though, which is the point of this thread.
Right. That’s a situation that a free market just plain doesn’t deal well with, period.
I think you agree with my point precisely. One of the arguments FOR a free market is that the increased competition drives innovation. So having a market for health CARE is good, because we want people to think “oh, I will work hard at curing cancer, because if I do so, not only will I have cured cancer, I will become rich! Rich as Croesus!”. But it’s just not clear to me that the same possibility for innovation exists in health INSURANCE.
An analogy: back in the cold war, we had a free market for cars and the soviet union did not. Thus, predictably, our cars ended up much better than theirs. Today, we have something that is vaguely like a free market for health insurance and (say) Australia does not. But are we benefiting from awesome new progress and innovation in health insurance that those poor Aussies are missing out on? It’s hard to see how.
I will certainly agree to this.
Having a background in infectious diseases, I find it amazing that this country abuses two of the most significant advances in the last two centuries - e.g. overuse of antibiotics (both medical and agricultural) and vaccines - which are underused to the point there have been outbreaks of measles.
Incredible.
A fine example of the medical professionals doing what makes them the most money rather than what is best for patients. Sure, patients “demand” the drugs the TV tells them they need but that doesn’t mean that doctors have to completely abdicate their responsibilities. Reforming health insurance will not fix this and will probably just make it worse when doctors are guaranteed payment no matter what they do.