Oh, are the Republicans trying to get insurance companies out of health care now? Because I’ve only ever heard the Democrats talk about plans that do that.
What does “proper functioning” look like?
For example, one of my in-laws had to be transported by air ambulance last month: 80 miles, hospital to hospital, in critical condition. I just saw the bill: $45K.
The thing is that they are the ONLY company doing air ambulance transports in my neck of the woods: you use them, or you don’t go by air. It’s a natural monopoly, because there’s really not enough business locally to keep multiple fleets flying. Further, even if there were several choices, when you need them you need them right now, and calling around trying to get price quotes in an emergency just wastes valuable time. Without insurance, that bill would be absolutely devastating financially. (Actually, we’re not sure yet how much the insurance might cover, so it may yet prove devastating.) So, what would be the free-market solution?
Air ambulances are something where third party payer would work. They are not customary expenses.
Right. Because that was the worst thing about Nazi Germany or the Soviet Union. Their policies on brutally efficient Universal Health Care.
Air ambulances, however, are typical of the kinds of big-ticket expenditures that drive up costs. Heart attack, burns, any kind of major trauma or sudden-onset illness–these all tend to yield big sudden bills. If you’re having a stroke or need an appendectomy in the middle of the night, now is not the time to do comparison shopping. Every single new cancer drug brought to market in the US in 2017 cost over $100,000; the mean price was twice that. (cite) Which patients are you expecting will choose the cheapest option instead of the option recommended by their oncologist? Routine physicals are amenable to price-shopping, but routine care isn’t what’s driving the growth in health care costs.
The greatest impediment to the optimal working of a free market in medical care is the inherent imbalance in the exchange. The customer and provider do not have an equal command of the necessary information; but unlike other imbalances in information (say, if your car or your plumbing break down), you do not - cannot - know what the implications are of your situation, nor imagine and look for alternatives.
Your need, on one side of the exchange, is absolute: the provider’s isn’t. The provider can find a customer elsewhere, or some other source of income. You can’t find a new healthy body.
Of course, in UHC systems like the NHS, the government can wield that kind of power because they negotiate on behalf of the entire population and have both the leverage to mitigate the type of gouging that goes on in the US and the scope to institute economics of scale. It evens out the balance of power quite well.
Precisely so. But it also helps if the service is accepted as a part of a broader notion of community and social contract, not just “the government” doing it. And making sure there’s an arms’ length relationship between the government of the day and NHS clinicians and other professionals.
A further footnote on the monopsonist power of the NHS: although there are free market enthusiasts in the Conservative Party who would like to break it up in various ways, they’ve stuck with it, not just because they know there’d be hell to pay if they attempted to let private providers cherry-pick the profitable bits out of it - but also because it was recognised early on as a cost control mechanism. But it’s always a balancing act with public expectations.
Ribbentrop-Molotov pact
XT, et al,
Hitler’s Make Germany Great Again program was not Socialist. German industry was financed through banks and competed for contracts just like we do in the US. Prior to their invasion of Russia Germany purchased a large portion of it’s food supply from the productive Russians. The corporations involved are the same ones we see in those countries today.
The corporate structure of Nazi Germany survived the war intact and still functions today. It was never Socialist.
So, the fantasy that Socialism leads to despotism is a myth. The converse is closer to the truth. A despotic Trump is appointing cronies to powerful government positions. They are working to narrow public access to information, substituting their propaganda instead. They are creating the world that the right wing claims to fear.
Scylla,
Again your point - how about Roosevelt/Stalin and Stalin/Hirohito and Hitler/Hirohito - how do those pacts have any bearing on defining the economic structure of those countries?
The problem with this idea is that insurance companies already have that kind of scale but cannot successfully negotiate prices down. There are 66 million people in the UK, United Health Group has 50 million people in it.
I have faith America can be the richest country in the world, I have faith that America can be the most powerful country in the world, I have faith that America can lead the world in science and technology, I have faith that America can have the highest standard of living in the world.
I have faith in those because I have seen them happen.
What I don’t have faith in is the Federal Government can rein in health spending, because I have seen it fail at that my entire life.
In 1969 they projected Medicare would cost about $12 billion by 1990 and it actually cost $90 billion.
In 1997 the passed a law to slow the growth of Medicare payments, not cut the payments, just slow their growth. They then passed a measure postponing that every year until they changed the law.
Obamacare was supposed to “bend the cost curve”. It did not. It had 10 pilot programs to cut costs, all 10 failed and may have caused deaths. The Cadillac Tax was supposed to cut insurance costs, but it is just about to be repealed.
How blind do you think our faith should be?
Seems to me assuming that current status quo is the best we can do requires quite a bit of faith in the private healthcare industry and health insurance corporations. I don’t share that particular kind of faith.
This point from **Scylla **is one of the most ahistorical points ever made in this board. It is perfect example of what happens for relying on poisoned sources of information though.
That’s not a particularly useful comparison, although I’ll note thatUnited Health Group certainly claim they’ve successfully negotiated prices down so it’s also apparently not true either.
They seem to very successful at it, too. Certainly every statement I get shows a “real” price, and what they actually paid for the service, which is always a lot less. The only problem is that United is only negotiating for it’s customers.
This post is so incoherent I’m not sure how to even answer it. First, not sure what Hitler has to do with most of this. Is it your contention that the command economy of German was capitalist? If so then we could discuss that…you would be wrong, but I suppose it IS a point. You seem to be equating having corporations with a nation state being automatically capitalist. Nazi Germany wasn’t a capitalist economy, however for many of the same reasons you failed to answer when I asked you what mental torture you were using to say the USSR was capitalist.
Next up…corporations that existed during the Nazi Germany phase are still there today and that means…something? Germany is certainly not a socialist country today…that’s true enough. They are a capitalist country with some small socialist elements. And so? That doesn’t mean that they were capitalist when the Nazi were in charge. My only guess here is that you are seeing this all from a bi-polar perspective…things are either socialist or they are capitalist. Which completely forgets that there was another option then, namely fascist. While fascist had a lot of elements of socialism, especially the economics, it wasn’t exactly socialism. But it definitely wasn’t capitalism. For, again, the same reasons you didn’t address when I posted about this up thread.
I didn’t say that socialism leads to despotism. That’s not a myth, that’s a strawman. I said it doesn’t work. That’s also not a myth…it’s a fact, born out over and over by history. Economic socialism sucks, it’s always sucked, and it has never worked. Anywhere. Command economies work, sort of kind of, in war time. But in peacetime they suck. State owned companies sort of kind of work from a monopoly standpoint to an extent, but they are outperformed by private companies. We can see this exact dynamic today in one of the countries that still DOES have quite a bit of economic socialism…China. Or how about Venezuela? Cuba? North Korea? China is the only one of those who has at least tried to bolt on some capitalist aspects…and, surprise surprise, they are the most successful, though their socialist economic parts are really holding them back more and more.
As to socialist political systems, they don’t necessarily lead to despotic regimes either…many western European nations, until the early 70’s and some even later, had a lot of political socialism as well as economic socialism, and they didn’t lead to despotic states. But couple those together and you get the potential for despotism…as we’ve seen in multiple nations in the last century or so. It doesn’t have to be…but often it is. I think there are more factors than JUST socialism at play in countries that go hog wild for despotism, but I also think that socialism by it’s very nature (when you couple economic with political) is a factor as well.
To me, you are trying to whitewash socialism by the use of no-true-Scotsman type arguments as well as deflection from the bad aspects to highlight the good ones…oh, and also some muddying the water with some Trump references and bad history of Nazi Germany. But the truth is, western Europe pretty much abandoned real economic and political socialism starting in the early 70’s, and for good reason…it wasn’t working for them. China has…well, not abandoned but definitely lowered…it’s own use of socialism wrt economic at least, and tried to at least bolt on enough capitalistic economics to make their busted ass system work. It still doesn’t work that great, it still has all sorts of issues mainly with the state owned and run industries dragging down the system, with the CCP still trying to do it’s version of a command economy, it’s market and currency manipulation, etc…but just what they have done has enabled them to push their economy to the second largest in the world, second only to the US. No other mainly socialist economy comes even close to that.
Now imagine that the negotiations were on behalf of everyone. Just think what negotiating power could be wielded.
Even better - in the UK the pharma companies can’t market directly to patients - and as, in the US, more than half the cost of drugs is due to marketing, that’s a huge saving there. AND we don’t have any prescription drug ads on television. I mean, if like puddleglum you’re happy to pay twice as much for your prescriptions just to receive the added privilege of all those commercials, then the US system is the one for you, much in the same way that it is if you’re happy to pay twice as much for healthcare per capita overall for worse outcomes.