There has been a free market in health care up until the last century or so. The FDA was created in 1906. Employer provided health insurance became popular starting World War II. Medicare dates from 1965.
I wish the OP had excluded health care from the question, as health care dominates the responses.
A lot of people (and not all are conservatives) view public housing as a bad idea. There are very negative results from a huge mass of the underclass urban poor being concentrated. [the problem of affordability problems obtaining housing is much better dealt with by a broad program such as basic income.]
With respect to public education I think it is very good that the people from all classes mix together. However you get problems with big bureaucracies, a lack of innovation…
Health care is not the opposite, it’s the converse, given the negative externalities of someone being sick: Reduced productivity, leading to reduced profitability, and the potential for a total loss of someone who otherwise would have been productive. In addition, some healthcare is even more obviously a public good, such as vaccinations, and should be treated as a cheap investment preventative against potentially catastrophic loss. You know, like insurance.
This happens at the public or private level regardless, unless you accept the externality of old and sick people simply dying due to lack of access to health care, and doing it at the government level is more efficient due to economies of scale and the better bargaining position a larger entity is inherently in.
I think I’ve made my point about the “insurance” nature of those kinds of things above.
I think you’re so madly in love with the term “free market” that you’re blind to its zits and halitosis.
For one thing, “routine care” is generally very low cost - so low cost, and with such great benefit for those who use it, that insurance companies have voluntarily paid the whole cost for decades… because regular $50 checkups help forestall $50k ER visits and hospitalizations. So putting “routine care” costs on a menu board woudn’t change much.
Nor would putting any kind of acute care in greater public view. If you’re in distress, it’s not really going to matter to you that Hospital A has a $20k heart attack package while Hospital B (which has better ratings ) gets $25k for the same thing.
The free market and healthcare are not particularly compatible entities, because the industry is perfectly fine with letting high-risk, costly patients die rather than underwrite their expensive treatments. That’s more or less what the free market was delivering at the time of ACA, and what the neocons want to go back to - in the name of free market profit over a healthy populace.
So, as most of the civilized world has found, healthcare is indeed best with a high degree of government involvement, and only the most utopian view can see it otherwise.
It was tried for millennia. The experience of the later nineteenth and twentieth centuries clearly indicated in most developed countries that an unregulated market simply couldn’t, to most people’s satisfaction, mediate and resolve all the different interests as medical knowledge and people’s expectations developed and advanced.
Or to put it another way, a legitimate government function is one that enough voters are persuaded it is.
Does thinking something should be left to the private sector mean one thinks it’s not “legitimate” for the government to be involved? I think the government can legitimately do things I personally disagree with.
What type of government solution are you thinking of: one where govt. provides the Service - like building roads by collecting taxes and then paying a Company - or one where the govt. lets companies provide the servie - like selling Food or medication - but institutes strict rules and Regulation for safety of consumers (and controls that the regulations are obeyed)?
Well, “The Left” doesn’t exist, and doesn’t have an universal Speaker. A social democrat would give a different answer than a full leftist.
Also, social democrats would never give an answer fixed in Stone, because they start from a Moral/ ethical premise (help the weaker/ poor citizens, provide Basic infrastructure, curb the influence of the rich and powerful) and then consider evidence.
So if originally the idea is “it’s better for children < 4 years to stay at home with their parents” and then studies Show that over 50% of parents both work and Need a kindergarten place at Age 2; and that children from disadvanted households Need pedagogic, linguistic and therapeutic Intervention the earlier the better, then they will Change their opinion and campaign for govt. regulated and at least partly paid kindergarden available for at least 50% of children, and free for all disadvantaged children.
So is that why “conservatives” (if we consider Republican Party in US to be that*) have for decades cut Money in yearly Budgets for upkeep of roads and bridges**, to the Point where hundreds of bridges are at the danger of collapsing any day - necessitating either the Bridge to be closed and Drivers to detour, or the Bridge stays open but every Driver risks their live?
Because roads and bridges can also be paid privately, making every Driver pay a toll each time. With no guarantee that the Company re-invests the Money for upkeep instead of just pocketing the winnings instead.
Defunct infrastructure also hurts economy, because delivery is longer or more expensive.
But “open market” does Little work because People can’t choose between road A and road B, they can only take the crappy road or not drive at all.
And since voters Keep believing the lies about “Look at how much we reduced the Budget! Look at how much we privatized! Re-Elect us!”
Also, a lot of middle- and higher class People in the US take the Option of gated communities, where Police and road upkeep are privatized.
They are too shortsighted to care about that even if their road is in good shape, and their neighborhood well patrolled, they Need the unwashed poor masses both as workers and as customers, but that falls flat if 80% of the Population is struggling just to survive, with bad roads, bad Police …
Personally, the way they acted for the last decades, they are not the Party of small govt., but of “no govt. except for shoveling Money to the rich, who cares about consequences”
** many of which were built in the 30s to combat the economic recession by giving People Jobs and improving infrastructure to hit two flies with one swoop. Or: the govt. taking it as their Job.
Wait, you seem to say that pre-ACA the free market covered everything, yet in the next statement imply it covered nothing.
I believe that consumer protection is a legitimate function of government. If you advertise that you are selling “health insurance” that should mean what a reasonable consumer believes it to mean.
However, it went too far. As a man, I do not need contraception and maternity benefits. Twenty-six year old “children” should not have to be covered under a parent’s plan. When a person turns 26, he or she should not have to subsidize an older person (even Bill Gates!) by paying a premium that is only a given fraction of the older person’s premium. He should be charged an amount that reflects his own potential use of health care by traditional underwriting standards.
Pre-existing conditions should be protected, but you don’t get to go without insurance for ten years and then sign up once you get diagnosed with a major illness. The penalties (not that I support them to begin with) are so minor that it may make financial sense for younger people to go without insurance unless and until they get sick, then sign up for the same cost as those who did the right thing by having insurance all along and immediately take out far more in health care than their premiums justify.
It would be like going without car insurance until you get into an auto accident, pay $80 for a monthly premium and get your $30k car fully covered. Everyone would say that the latter is ridiculous and should not be allowed, but because it is health care, and because you really, really need it, you can game the system.
The ACA is seeing premiums rise out of control because it has selected AGAINST having people in the system who are healthy and don’t consume health care. In any fire insurance system, you need a large quantity of home owners who do NOT have their homes burn down.
In typical insurance underwriting, a person who plays with gasoline and matches in their bedroom gets a higher premium than those who do not. A person with 4 DUIs gets a higher auto insurance premium than safer drivers. But with health care we select against the “good driver” by charging him the same rate as the unsafe driver, making the policy not a good deal for the good driver. But we need those good drivers to make the system work.
But because of massive government involvement and tinkering with the free market since the 1940s, and most directly in the 1960s, and having found that this massive government involvement has caused problems, the solution proposed is for even MORE massive government involvement.
Your point that I have a blinding hard-on for the free market is well taken, but for hundreds of years, at least I thought, that free people believe that such a solution is the best. You would argue that for a necessity like health care, there is a market failure. However, we use the free market for air, food, shelter, and most other necessities of life. Why is health care so vastly different that the free market is unable to do the same? If that last thing is shown to be true, then I will concede, but it hasn’t ever been tried.
This is simply not true. Gated communities are not where most middle-class people live, certainly, and I’d doubt that most people who could afford to live in a gated community live in one, either.
I don’t agree or disagree with either of your statements. I think that the answer depends largely on geography. In West Virginia, there are hardly any gated communities. Wealthier people live on the “right” side of town or in the other town. In South Florida, I would live in a gated community if I had to beg, steal, or borrow to afford it so I wouldn’t have gunfire outside my home in the middle of the night.
No. That’s a revisionist and blinkered interpretation of socioeconomic history. There are few if any cases of truly free-market societies, and most collapsed because of the evident limitations of such an approach outside narrow economic (mostly manufacturing/production) avenues.
It’s those damned real people, with all their needs, faults and virtues, that completely fuck up all the lovely three-sentence economic theories. Nowhere is this more evident than in our current healthcare mess.
It’s not like it’s illegal for them to do so. It just turns out that pricing is not all that important. Which means the free market can’t handle it.
The free market with healthcare means people without enough money die. Since that is not acceptable to most Americans, a pure free market version of healthcare is not possible.
You seem to be all caught up on the fact that what we had before the ACA was not a purely free market. That is true. But what we had then arose precisely because we were trying to mitigate the effects of the free market. The regulations exist because the free market was letting people die.
Keeping people healthy saves money in the long run. This is just fact. Our insurance system is not keeping the poorest healthy, so it’s costing us more, since we don’t want to just let them die. The ACA spread that cost back on the insurance companies. But gave them a huge boon in forcing people to have health insurance, giving them a healthy population to offset the cost.
Unfortunately, due to these government restrictions, they had to go about this in a roundabout way. And the Courts severely weakened the government aid for the poor, which means less money for the insurance companies.
The free market fails to get everyone in the system, which makes costs rise unless you are willing to let people die. The ACA was an attempt to get everyone in the system without killing the insurance companies.
Also, the free market doesn’t work for food–that’s why we have food stamps. It fails on any necessity unless we are willing to let people die. Food just costs less because it requires relatively less skill to produce. Sure, were specialized more over time, but none of that is strictly necessary. But healthcare always requires highly skilled workers.
Well, that and you can’t save money by feeding people cheaply early, nor can cost rise suddenly due to individual circumstance. Hence why insurance for food is not a thing. But, once you have insurance, you need everyone on board, even those who would pay less without insurance.
That is what makes healthcare different. The free market means rose people stay out, which, long term, causes prices to be higher than they would be otherwise. This paradox is why the free market fails. It can only work when the aggregate best at the individual level (Ayn Rand style) pushes the same direction as what’s best for everyone as a whole.
Hence one reason for the protections in the ACA. There were a number of people who were quite happy with their insurance, in that it had nice low premiums, and good co-pays with low deductibles, but they did not realize that it would not cover anything serious, or that the insurance company found a “pre-existing” condition to deny coverage. If they ended up actually getting sick, they would have either been left untreated, or bankrupted by medical bills, or both.
The ACA prevented health providers from calling something health insurance, while at the same time, leaving your health uninsured.
So, on this part, I assume you like the ACA.
Sure, as a man, you don’t need contraception or maternity benefits, but as a boyfriend, husband or a father, you will actually receive benefit from them, even if it is not your body that these are being applied to. So, I would say that you should get that reduction in your premium if you are gay or sterilized, otherwise, there is a very real chance that those services will benefit you.
I am not sure if you are complaining that kids up to 26 year olds can stay on their parent’s insurance there, but if you are, keep in mind that was a republican amendment, and it actually makes the ACA that much harder to implement.
As far as not subsidizing older people, that only makes sense if the 26 year old doesn’t plan to get old. I could get behind the idea of not having a young person pay more for health insurance, but only if they agree to not receive any medical care when they are older.
And that is the reason for the mandate. Now, the mandate in the ACA was not as well done as it should be, it had not nearly enough teeth to get people to comply, but was still hated. That’s one of the reasons that I prefer a tax based UHC, you don’t get to opt out of taxes.
Health is a bit different. We make some choices as to our health, and living healthy can help, but so much of it is beyond the control of an individual that it is more like raising someone’s rates or declining their coverage because their house burned down to a lightning strike, or got blown away by a tornado.
The govt early on, under nixon, decided that it was best to leave health coverage to the employers. They did make some rules about what was considered to be healthcare, and what was quackery, and military vets have had healthcare for longer than that, medicaid and medicare came about to serve those who the free market completely kicks to the curb, but I don’t see the massive involvement in the healthcare of the vast majority of the population.
Not sure we use the free market for air, unless you are talking about the gas station that charges a couple bucks to fill your tires.
We use the free market for food, but the government has a massive hand in that, as far as agricultural subsidies, food stamps, and other food assistance programs.
The government has quite the hand in shelter, as well. We spend $50 billion on HUD, and that’s just at the federal level, states and localities make up quite a bit of contribution as well.
So, to answer your last question, health care is not so different from those other necessities of life that the free market has failed to provide for everyone who is need, and so the government provides assistance in acquiring
Note also that in the case of the US Food Stamp program, it is also an indirect subsidy to agricultural production (they are in the Department of Agriculture budget). Which is itself also subsidized directly, and is so in virtually every alleged “free market” country.
As for what should be outside the government’s purview? Whatever the people say it is. But this should be based on what actually is better for all. So that’s the line. Whatever is better.
So, basically, we don’t need any restrictions set out a priori. Just a rational populace. Fortunately, that happens through education, which is something the government is already providing. Unfortunately, corruption in government causes problems.
I guess you could argue that corruption should be outside government purview. But I can’t see how investigating that can be privatized, as the government could just pay them off. So the best we can do is keep that part separate, and define not doing so as corruption–corruption that can easily be seen and dealt with by the populace by voting out the corrupt.
Unfortunately, I don’t think that plan is working anymore.
I like consumer protection. Insofar as the law might require bold disclosures of these low limits, or even requiring a personal face to face conversation, I would support it. As far as outlawing these policies altogether, I disagree.
Yes, they will get older, but they are not old NOW, and for that reason should not pay the higher premium. When I was 26, I could pogo-stick out of bed on my hard dick. I also paid pennies for health insurance because I was young and had no pre-existing conditions. When I was 24, I paid far more than I do today for auto insurance because the underwriting standards said that young males had a greater chance of causing liability for accidents. Is that unfair? It remains today.
It shouldn’t be different. When I’m older I pay less for auto insurance and more for health care. Why? Because I’m old and my risk to the insurer is greater, just like when I was young I was more likely to get drunk and cause an accident then I am now. Pay for what you might cause. A 26 year old man does not cause the same risk to the insurance pool as a 55 year old man and shouldn’t be charged in a similar manner. Even if a 26 year old smokes, he isn’t getting lung cancer or emphysema that year. They can charge more for smoking, but if he huffs paint hourly in the garage, he cannot be charged more. It’s form and regulation over substance.
The idea that his wife might benefit from contraception coverage is a non-sequitur. She is also paying for contraception coverage. As you mentioned, the ACA doesn’t care whether I even have a wife or a girlfriend. Your suggestion that I could get a lower premium by somehow showing that I am gay, by affidavit or video presumably, is laughable and not realistically enforceable.
It’s what the ACA provided for: a tax penalty. It should certainly be higher to be enforcable, but like unconstitutional if coercive. See Roberts’ dissent.
Its beyond a 24 year old male’s control that he is a 24 year old male. He still pays higher for his auto premiums. Why? Because it’s not the 48 year old female’s responsibility to subsidize his driving.
You just said it. Employers typically provide health insurance. Why? They don’t provide auto insurance, food, or anything else except U.S. currency. This is an interference with the free market.
They don’t provide it at the consumer level. Even though food is a necessity, we don’t buy “food insurance.” We pay out of pocket for our daily or weekly food needs. The free market has robust competition, allowing you a choice of several local grocery stores, even in a small town. They publish their prices online and in flyers in the newspaper. They have customer loyalty cards to compete for your business. And this is FOOD! An even more direct need than health care.
Of course, the government subsidizes the production of food, as they do anything. Since we are in for a penny, are we required to be in for a pound?
And, also, the indigent are provided food stamps for point of purchase sales, just like they have Medicaid benefits. This remained the same before and after the ACA. The ACA attempted to change how the non-indigent received healthcare even though surveys showed that 85 plus percent of people were happy with their current care.
It was largely a solution in search of a problem. Of course, if you benefited from the ACA, you likely support it. I also support the “Lets give Ultravires $1 million” bill that I want introduced tomorrow. It doesn’t mean it is good public policy.
I understand that at the end of the day, in a society built on self-governance, a proper role of government will be whatever in the hell the people say it will be.
But you don’t have a general philosophy, like “A, B, and C are things the government should do. Now, D, E, and F, those are things that should be left to the private sector”?
[disclaimer]
I don’t have a dog in this fight, I live in Holland
[/disclaimer]
The problem with your picture of free market is that it is completely unaffordable to be in a risk pool with only old people. No insurer can make money from insuring 65-90 year olds.
Young people have to subsidize the old ones; and be subsidized when they get old.
We call it “solidarity” and “common sense”. You call it communism.