I was re-reading a recent thread of mine and noticed this comment:
Again, a concept that eludes me. What would the end game be? Assuming “free market” would mean as little regulation as possible, do we know what that would look like?
Are there people on this board that think it would be a desirable goal? I know more than a few have mentioned they want the government out of their health care. What is the logical end point?
As a couple of examples:
Doctors have to be licensed, and have graduated from a recognized program.
Medical devices have to meet standards set by the FDA.
Medications have to be tested to show they do what they claim.
Note that the healthcare system is influenced by other factors. So, a free market healthcare system–whatever that would be–could only exist alongside a fully privatized society.
I suppose if we go back to the 19th century system, it would be bereft of health insurance companies. Instead, doctors would just come to your house for a fee if you were wealthy, or you could risk going to a hospital if you were less well-off.
The main problem, I think, and the main reason that we don’t have a free healthcare market in this country (or in any other industrialized country), is that then healthcare would be rationed by the amount of money the patient can pay. While we’re pretty willing to let this be the case for things like ipods and cars and other consumer goods/services, it’s pretty clear that the public won’t stand for a system that doesn’t allow everyone to get a pretty high minimum level of care regardless of ability to pay. I think this is a good thing just on ethical grounds (and to a lesser extent, on less altruistic public health grounds, since having a poor population that can’t get treatment for virulant diseases is dangerous even if you can afford healthcare yourself), but we probably pay a price in the efficency of production of health care goods as a price for distributing them equally.
So my answer to your question then, is that a free-market for health care services is impossible. Voters won’t allow a system that rations by ability to pay, and such rationing is the essence of a free-market system. You can set up various kludges that make some aspects of the health insurance market superficially resemble a free market, but those tend to be, well, superficial, and its not really clear that they do anything to restore any of the efficiencies lost by abandoning the free-market model in the first place.
Say that you set up a system where if you file a claim with an insurance company, the insurance company must pay X% of the cost. But, however much the insurance company had to pay, the government would tax by Y%.
Say that X = 60% and Y = 50%.
Bob wants to see his doctor. The doctor will charge $100. Bob knows that he will have to pay $40 if he wants to go so he won’t unless he perceives it as being worthwhile.
He goes and files a claim with a health insurer. Bob has never paid this insurance company any money at all, he’s just a name in a computer as one of their official clients. The insurance company sends $60 to the doctor, and sends $30 in tax to the government. They’re out $90.
Now, the insurance could just say, “We’ll cover any bill up to $100 even if you’ve never paid us any money.” They know that someone Bob’s age who is on a “free” health plan rarely needs to use more than $100 in doctor’s services in a year. If they guarantee that much to non-payers, they come out ahead because they pay $60 instead of $90. The occasional person will need a bit more done, but it’s rare enough that overall they’re better to offer a minimum that’s guaranteed to non-payers than to take the tax penalty.
But at the same time, that minimum is dependent on Bob’s willingness to put up his own money. 100% of the bill isn’t covered.
On the other hand, X and Y need to be set to a value such that the minimum level of care that Bob is receiving is low enough that enough people can be up-sold to a paying plan to pay for all the non-payers.
No one can complain. The exact minimum money needed to provide for all is being collected, and that amount is based on how many people feel that their illness is dire enough to go out of pocket themselves.
I don’t get it. If I start a thread that merely suggests that UHC is okay, there are 12-15 conservatives denouncing socialism, insulting the poor, and yammering nostalgically about the good old days of free market capitalism. But I start a couple of threads asking about the basis of conservative principles and I get crickets chirping.
So here is your change, tell us how good health care would be in a free market. Free from the evils of regulation and hassles of government interference.
I started it off with three examples, would you keep those in free market health care?
I don’t think conservatives are against preventing insurance companies from denying coverage to people who paid for it and need it. You can look at their free market claim in two different ways. One way is that they want to go back to the Gilded Age and laissez faire government. Another is that they want to create a system where free choice and competition drives health care costs, rather than the system of incentives we have in place now. I think the latter is the more saner view, and liberals often assume all conservatives want the former.
You can read a proposal that would fix our system of incentives here. Would it work? I don’t know, but it would be more free market based than the system we have now.
Maybe you are getting crickets because your OP is obviously so biased, and your perspective on the issue is already so clear, that people have (rightly) judged that you aren’t interested in any real discussion or debate.
A free market basically means there aren’t any distortions caused by government (backed with legal means of force) on either the supply or demand side of the equation.
That means both consumers and providers of healthcare can meet on their own, in the marketplace, and agree to a voluntary transaction without any outside influence from the government.
‘Supply’ means doctors, drug and medical device manufacturers, and intermedaries like insurance companies.
‘Demand’ means people like you and me, along with intermedaries like insurance companies.
And that’s about it. It isn’t really any more complicated than that.
So for your 3 examples above…I’ll bite, since the NCAA games just ended and I have time.
Doctors or other healthcare providers are free to get whatever licensing they desire, from whatever accreditation or guild they desire to get it from. But they don’t have to. They don’t even need to get a medical degree. They can hang out a shingle and start business tomorrow. So could you, if you want to. You can choose to go to whomever you want, and spend your money in whatever way you want. It’s up to you.
Same with the FDA. If you want to buy only devices and drugs approved by the FDA, fine. If not, that’s fine too. But the FDA does not have the authority to restrict anything that is sold on the market.
The 3rd point is a little murkier, since fraud (or breach of contract) can be punishable in a court of law.
On the demand side, the government immediately gets out of any all business of distorting demand (and also, supply) via differential tax breaks, subsidies, price-fixing, etc. that it does today.
I’m biased for asking proponents of free market health care to elaborate? Are you worried that your ideas will be critiqued and debated?
Do you see any advantages to government involvement on the protection side of things? As a comparison, is there any advantage to the government requiring safety features in cars?
I am so on board with this idea. I even have my shingle all made up. Emack’s House of Cancer Prevention, 100% Guaranteed*
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P1. No, as a matter of fact I do not see any advantage to the government requiring safety features in cars. Your tone suggests that (of course) you do…and that the point is so self-evident that it doesn’t require debate.
But for example, I drive a 1979 Mercedes S-class diesel with 350,000 miles on the odometer. I intend to drive it for another 250,000 miles, God willing.
That car could not be manufactured and sold today. It is illegal without certain safety features that are required on modern cars. Yet millions of the 1970’s and 1980’s Merc diesels are on the road today, provide utility to 100s of millions of people around the world.
I lived in Europe for several years and loved driving the small diesel cars there (primarily the VW TDIs, BMWs and Volvo diesels). Those cars are also illegal to import into the United States for now - but I don’t see people dropping dead on the highways in Europe due to their lax safety standards in automobiles.
P2. Go for it. See if anyone bites. That’s the beauty of a free market, is it not?
Apparently the idea of making your own choices, and living with the consequences of those choices, is terrifying for you. You clearly prefer to sign over your rights of choice to a benevolent government dictator to tell you what you can and cannot do.
A truely free market would look pretty much like what we have for car insurance now, minus the mandate that some states have. In a true Libertarian country, anyone not able to afford health care would have to rely on charity. You could get any kind of treatment or drug you want. There would probably be independent labs that took up testing of drugs and information would be available, but not no authority would forbid you from trying any given drug.
In a country like the US, you’d have some regulation and a social safety net for poor people. No special tax treatment for HCI. Hospitals would not be required to treat anyone who showed up at the door, but most probably would anyway.
FYI, OP, I usually don’t bother with these types of threads because they quickly devolve into rants about how libertarians are evil and enjoy watching people suffer.
How could they? We have the example of the Children’s Hospital of Oakland being in financial difficulty in part because their clientele is not paying them, because of insurance issues, no doubt. Hospitals offering care to anyone would either need a gigantic endowment or go out of business.
In the OP you are quoted as saying that we can’t say the free market has failed because we don’t have one. Not a totally free one, sure, but freer than England or Canada. How sensitive is success to the amount of freedom in the market? If a tiny bit of regulation means that a 95% free market fails, and free market principles can’t be blamed, I’d contend that free market economics is not very practical in the real world. I’d say that any reasonable solution has a mix of free market and regulation, and, since we do so poorly as compared to less free systems, we are probably too heavy on the market, not too light. But no matter where you place the dividing line, if you think at least some regulation is necessary you can’t blame it for the failure of a system.
Pretty amusing, considering that in the post above yours IMM is saying that anyone not as clever as he thinks he is can die from unsafe cars or quack remedies, and it is all their fault.
It’s interesting that you choose to use Europe as your example. I did a lot of driving around India. There, you can literally build your own car. Well, not so much a car, as a platform with wheels and a water pump, that can transport up to 22 people, some livestock, and quite a bit of hay.
Here is the luxury version. The kid in the back doesn’t usually get something to hold on to.
A moped is also considered a family vehicle. Dad drives, with jr standing in front of him, mom on the back, sitting sideways, holding a baby. Here is the Vietnamese version. The adults are obviously required to wear helmets, the kids get to choose for themselves if they want the hard kind or the knitted kind.
I also got the feeling they could use what ever they wanted to for fuel. Judging by the smell I think it was used motor oil mixed with tires and goat hair.
The family I was staying with had a metal shop on their land, making metal gates and fences. After a bunch of animals started to die, they realized it was a bad idea to pour toxic chemicals near the stream in their back yard. I think they now pour them closer to the pit where they burn their garbage.
So forgot the old concept of government protecting you from yourself. As we all hurl ourselves down the highway at an unregulated speed, would you feel more or less safe knowing the other drivers have cars with functioning breaks and steering? Would we be better off with more home-made cars on the road? Wouldn’t you like some government protection from other Libertarians?
I’m actually unaware of Europe’s auto standards, have they changed since the 70s?
I’m all for making my own choice, when information is free and available. What terrifies me is the lengths people will go to to prevent information. I have a friend that tried to sell me Melaleuca. Her pitch was that her mom died of cancer, and these products contain all natural ingredients. Right now, “natural products” do not need FDA approval, so they are free to make all sorts of claims, that all sorts of people believe. But don’t respond to this point, consider this:
Again, I spent a lot of time in India, and it’s damn hard to exist in a world where EVERYTHING is suspect. Are you buying a banana, or a banana peal that’s been filled with shit and glued back together? The big craze while I was there were kids collecting used water bottles, filling them with tap water, putting a new cap on them, and selling them as new. Think about that the next time you have bottled water. Would you be able to tell if it was from a pure mountain spring or some kid’s tap? Are you prepared to test and treat each individual bottle you buy?
Would charities continue to get tax breaks?
If they probably would, and I think that would be the case, what does a regulation matter? I’m required to wear my seat belt, but I would even without the law.
Ya, I don’t like that either. But the libertarian view point is fascinating to me. The more I read the less I get it. The words are all English, but they don’t fit together in a sentence.
Auto insurance was just compared to health insurance. I can’t imagine a worse example to choose from. I have zero confidence in auto insurance, I keep $10,000 liquidable to replace my car. I don’t like to sift through 42 pages of legalese, designed with the specific intention of fucking me. Teams of lawyers and actuaries working to get the most money out of my while having an out should anything happen.
So when I start a thread like this, I’m actually hoping to hear a libertarian not just say, “we wouldn’t have any regulation, so everything would be great.” I’d really like to hear the how’s and why’s. The most important one being, “how and why does this not terrify you?!”
I recently needed some plumbing work done. That is a process I loath. I brought in 4 guys who all told me something different, quoting me wildly different prices, and then tried to guilt me into a variety of other services. Now, 6 months later, I’m not quite sure the guy did what he said he’d do. The thought of going through this with when my life is on the line scares the be-jesus out of me.
Is there anything in the Libertarian handbook that would help alleviate that fear?
Exactly; such accusations are made about libertarians because they are true. Or rather, there are the ruthless, arrogant “I’m superior to everyone else, nothing bad will happen to me and anything awful that happens to anyone else isn’t my problem” libertarians; and then there are the rose-tinted-glasses libertarians who think everyone will get together and sing kumbayah in a perfectly free and wealthy society if that evil government gets out of the way and who insist that the bad parts of an uncontrolled free market Just Won’t Happen.
This bears repeating. In a truly FREE free market, all drugs are legal. Cocaine, heroin, LSD, crack, pot, magic mushrooms, all that hillbilly shit people make out of cough syrup, et cetera.
Such free marketeering seems at odds with conservative philosophy.
Now it stands to reason that there will be websites out there that try to give you accurate information about given practices/drugs/clinics/et cetera. But if a free market is really free, anybody can claim anything. Here’s an example. Right now, there is a diet product out there called Isagenix. It’s pretty transparently obvious that this product is a multi-level marketing scam that relies more on the stupidity of those who buy in rather than any actual effectiveness of the product.
Now go Google “Isagenix scam”. You’ll find that that term has been Google-bombed by staunch defenders of the scheme who have filled dozens if not hundreds of webpages with “Is Isagenix a scam? HELL NO! It works for me… (now if you’ll just hand over your credit card details and set yourself up at the bottom of my buy line over here…)”
That’s your future in a free market for health care. Health care isn’t regulated because perverse bureaucrats get their jollies from shitting on your freedom. Rather, there are a lot of unscrupulous assholes in this world who will sell you baking soda while claiming it’s laboratory pure Colombian cocaine. And they’ll smile with you as you snort it off their ass like it was the best idea you ever had.
You’re deluding yourself if you think that is truly the case. That benevolent, caring government employees restrict us from buying drugs that are legal in Europe and Africa, or restrict people in New York from buying insurance policies that are legal in North Dakota because they care about us so, so very much.
Let me ask you something - would YOU buy ‘pure Colombian cocaine’ from an unscrupulous asshole? If not, why not? If so, why?
Back alley, coathanger abortions for the poor, eh? The poor wouldn’t be able to afford real doctors, so they’d be going to whomever they could afford.
Who needs clinical trials, anyway? Sure, the wealthy get the good stuff… but the poor will take anything they can afford. Sucks to be them.
But, Your Honor, my (sadly deceased) client clearly signed this waiver releasing me from any and all liability! He knew what he was getting into- if he wanted *safe *medical care, maybe he should’ve paid extra and bought the upgrade package. On the plus side, his leukemia isn’t bothering him anymore.
In a libertarian society I would pretty much have to if I wanted some, because there would be no one else; the same goes for every other product. It’s always, barring regulations and laws cheaper and more profitable to cheat. “Honest businessmen” exist, because laws discouraging dishonest business make it possible for them to compete. Without such laws they’d be forced out of business in a race to the bottom where only the more dishonest, ruthless and corrupt profited.
Especially since in a libertarian society scruples or any concern for other people is going to be looked down upon.
Like Der Trihs said, they would ALL be unscrupulous assholes. The term “pure Colombian cocaine” would be meaningless. Right now there are regulations about what can be called yogurt, and regulations about food labeling so that you can see for yourself that it actually contains milk and bacterial cultures. There is also regulation about what is considered “milk.” Remove that, and you have no idea what is in a container labeled “yogurt.”
There is a certain cynicism that can be applied here, because [cow] milk producing industry has a lot at stake, and doesn’t want the goat/sheap/coconut milk producers cutting into their business. They push for regulation and government complies. But at the end of the day, I’m happy knowing that the standard in place isn’t “rat or better.”
I remember a joke in the early days of the second Iraq war, as civil unrest was growing. One of the chief concerns was getting everyone power. Once they had power they were happy and didn’t blow things up. Problem was, that Iraq had no regulations government utility poles. Anyone and everyone just went up and “plugged in” using what ever wire they found lying around. As a result the poles were a mess and took months to sort out.
As far as I can tell, under Libertarianism, everything falls to the lowest common denominator. Even the most honest and truly good doctor won’t last a day, not because doctors are inherently evil. But because he’ll be screwed by the first patient he sees.
Regulation is there to protect us from “other” libertarians.
All snarkyness aside, I am still trying to figure out how a libertarian society would work. How would someone buy “pure Colombian cocain” when:
“pure” no longer means of or pertaining to greater than 97%
“Colombian” no longer meas of or pertaining to something from the country of Colombia
“cocaine” no longer means a crystalline tropane alkaloid that is obtained from the leaves of the coca plant.
I keep getting told that without regulation we’d be free to buy the things we want from the people we want. But there is a pretty significant “how” that needs to be addressed.
That is the point where I’m still waiting for an explanation. I get that you want to buy health insurance from North Dakota, and that you see regulation as stopping you. But I don’t see the flip side, after deregulation, what makes you think ND will still have that insurance plan?
My belief is this
if a regulation prevents you from doing something
it does not necessarily follow that
deregulation will allow you to do that something
