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Comment by spectrum1234 | Hacker News Reader

In the long run these corporate solutions are what is needed. Why? Because currently there is no financial incentive, in the short term, to stay healthy. Health insurance costs continue to increase and adverse selection continually makes this worse.

The bias in this article is disturbing because currently even the government is doing nothing to incentive people financially in the short term in this same way. Think 50 years down the line - if systems like this aren't in place we are in serious trouble. There is no perfect solution but to blame companies for tying health and its costs to short term costs is insane. This is a GOOD THING. Wake up people!

This reminds me of a quote (paraphrasing). "The market is the worst form of economic distribution, except for all others."

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> This reminds me of a quote (paraphrasing). "The market is the worst form of economic distribution, except for all others."

Yeah, let's ignore all that has been done in Europe in terms of health, which did not involve markets but did work in practice.

Us being rich, it's much more pleasant to financially harass the poor, rather than doing stuff like public health care, a preventive medical policy, or a real education system which would cost money to us, but would have a real impact.

... except that the market for health services is anything but healthy in the US. That's BTW also a major reason for the exploding cost of the health care - the lack of personal short term incentives isn't.

It sounds like you are agreeing with me not disagreeing... This is a short term incentive. That's why the bias here is disturbing!

I do not agree with your views. Apologies if I did not make myself clear here -- English is not my first language (or second.. or even third...)

Let me try to reword then:

1. Free market is NOT an appropriate solution for healthcare. There are plenty of reasons for this (assymetry of information, natural monopolies etc)

2. We can argue whether the US healthcare system is based on free market principles or not. It's exploding cost is however NOT driven by the lack of short-term personal incentives, but by the failure to link the amount billed to the true cost of the service rendered.

3. Every bill from a doctor you see is a very clear short-term incentive for keeping yourself healthy -- clearly more so than a $50 discount on your monthly insurance payment.

> 1. Free market is NOT an appropriate solution for healthcare. There are plenty of reasons for this (assymetry of information, natural monopolies etc)

Also:

* The free market distributes goods based on ability to pay; it's wrong to deny people health care based on their wealth.

* The free market requires failures of businesses and services; that is not acceptable when people's health is involved. It's ok that the solution to bad casual gaming software vendors is that their customers are screwed and they go out of business. That's not ok for bad doctors, drugs, hospitals, etc.

I agree with both, but these are normative statements, expressing what one expects to be right or moral. As these are based on belief systems, they may not be convincing to some of us in the forum.

There's plenty of positive reasons explaining why free market is NOT the right solution for health care, essentially boiling down to distorted incentives which lead to sub-optimal solutions.

I see the distinction, but as an important aside ...

> these are normative statements, expressing what one expects to be right or moral. As these are based on belief systems, they may not be convincing to some of us in the forum.

While I respect that people have varying moral beliefs, many much different than mine, I don't believe that morals are infinitely relative and any belief is possible or acceptable. It's sort of the new political correctness, never to discuss morality, assume it, or argue for it. I think there are some pretty universal, natural morals; morals aren't artificial constructs and amoral people aren't normal or common, they are ill and called sociopaths.

Yes, there are among our 7 billion fellow humans some that believe people should be left to die at the hospital door because they can't afford care, but it's so few that I don't have to take them into account. More might argue it theoretically, but if someone was dying in front of them they would be horrified and help.

> Yes, there are among our 7 billion fellow humans some that believe people should be left to die at the hospital door because they can't afford care,

Wow, strawman argument much? What if they're dying of an acute cancer that requires a million dollar treament? A treatment that could provide food or medical treatment for thousands of other people?

What if they were dying of some incurable disease and would simply take up a hospital bed for no use?

You seem to think of costs as floating in a vaccum, rather than a redistributive method for limited resources.

Complete inelasticity of demand and lack of the ability for consumers to inform themselves (read: I will never understand the finer points of organ transplantation or be able to assess value for money) are two very factual ECON101 reasons.

> it's wrong to deny people health care based on their wealth.

Why? There are certain heroic attempts that are not economically feasible to attempt unless you're incredibly wealthy.

Is the government responsible for funding extremely expensive treatments at the cost of denying health care/food subsidies for many other people who happen to be in need?

Once you start making absolute statements like that, you can justify any atrocity on the altar of your absolute right.

All those arguments also apply to food production. But that's a free market, and does rather well.

(Yes, I know there are agricultural subsidies. It's not a perfect free market.)

It's true that there's no shortage of food. In fact we're throwing away more than enough food to feed everyone in the country, around half the food that we produce. That's not very efficient.

Meanwhile we stigmatize people who need food assistance, make them jump through bureaucratic hoops designed to demoralize and suppress them, demand that they present proof that their children deserve to not starve, even while incentivizing them to remain in need of food assistance. That's not very effective.

So food production isn't doing 'rather well' yet, more like 'almost acceptable but needs work'. (Still much better than it was a century or two ago.)

It's doing very well indeed if you compare it to any other system tried for producing food. It is still experiencing price declines (unlike health care). For example, steak was a luxury when I was a kid. Now, it's cheap as dirt at $6.99 a pound.

I'll take its imperfections any day over the gaping holes and incredible costs in the not-so-free-market health care system.

A lot of the cheapness of food is coming from using natural resources at an unsustainable rate, like draining the Ogallala Aquifer at far beyond its replenishment rate. I'd call that more along the lines of kicking the problems along for someone in the future to deal with all at once and not "doing very well"

The spectre of famine ended in the US around 1800 with free market agriculture, long before anyone heard of the Ogallala Aquifer. It also ended for every other country that adopted free market agriculture.

Non-free market agriculture, on the other hand, has a pretty sorry historical record with no evidence that it was more sustainable or equitable.

US food production is decidedly non free market with the amount of subsidies the industry gets.

Additionaly, you can say the system is working great now, but if it's only doing so by pushing off externalities in an unsustainable way into the future in a forseeable manner, that does not mean the system is doing a great job

> The spectre of famine ended in the US around 1800 with free market agriculture

I'm not sure how you define "famine", but many people have been malnourished since; some are right now AFAIK. Think of the Great Depression, for example, for a much greater scale problem. I would bet some have starved.

But most of all, any research you have would be appreciated; I feel like everyone, including me, is a bit naked out here.

One objective way is to look at average height, which increased throughout the 19th century in the US, and increased in other countries when they adopted free market agriculture. Height is a good proxy for having sufficient nutritious food.

> One objective way is to look at average height, which increased throughout the 19th century in the US, and increased in other countries when they adopted free market agriculture. Height is a good proxy for having sufficient nutritious food.

An insightful way to look at it; thanks. However, the question at hand isn't about the average, but the low end: Was there malnutrition or starvation? Yes, there was and is.

EDIT: See this post for some numbers:

https://news.ycombinator.com/item?id=13298775

I'm not debating whether free market food works very well for 90% in wealthy countries (just a guess at a number) and far better than whatever was done in the 18th century, but that doesn't mean we should call it sufficient or the 'best of all possible worlds'. If millions (tens of millions?) of people in wealthy countries and (hundreds of millions? billions?) in other countries are not getting sufficient food, that's failure - just less failure than we experienced before.

Compare free market food production with any other system. Starvation in the world is in countries without free market agriculture.

I don't get the impression that you read my comment.

> cheap as dirt at $6.99 a pound

Cheap for most people reading HN, but unaffordable for many.

> It's doing very well indeed if you compare it to any other system tried for producing food

Yes for producing (AFAIK) but not for distributing. I believe, but have no research to back it up, that countries with better social safety nets have less malnourishment than the U.S.

The USDA recommendation for a healthy amount of beef per day is 5-6 ounces. That's about $2.25 per day. Heck, a pound of apples cost more than that. A loaf of bread costs more than that. $6.99 is the regular price, too - it's often on sale as it nears its expiration date.

How cheap does it have to be before it is successful?

> How cheap does it have to be before it is successful?

A good question, but the fact is that many cannot afford sufficient food. A quick search turned up this article from 2014 at the top (and many others too):

Hunger in America: 1 in 7 rely on food banks

http://www.usatoday.com/story/news/nation/2014/08/17/hunger-...

1 in 7 Americans is around 45 million people (I know that's taking the headline at face value, but clearly there are many people who need it).

If they're getting fed by a food bank, then they are getting fed.

Making steak cheaper than it already is isn't going to make any difference.

For a smart guy, it must take work ... I have no doubt you can see what that comment seems to overlook.

> All those arguments also apply to food production. But that's a free market, and does rather well.

I disagree; it does poorly:

Poor people in the U.S., the richest country in the history of the world, need subsidies (such as food stamps) to have enough to eat, and even then often can't afford healthy food. I read awhile ago that over 50% of children in U.S. public schools needed subsidized lunches (but my memory is hazy, so it might be that over 50% came from families that used food stamps or something similar; sorry I'm too lazy to look it up).

Despite there being enough food and money in the world to feed everyone, people still starve and others are malnourished in many places. At least some researchers attribute the Arab Spring to increased food prices, as a proxy indicator of the impact (again, too busy to look up the data).

> Yes, I know there are agricultural subsidies. It's not a perfect free market.

Agreed, and there are other distortions besides agricultural subsidies, esp. when it comes to international trade. I don't know enough about that market to characterize it.

Food could be free and there'd still be malnourishment. It's necessary to look at a bigger picture when looking at the overall performance.

> Food could be free and there'd still be malnourishment. It's necessary to look at a bigger picture when looking at the overall performance.

Hmmm ...

I'm talking about the whole economic system of production and distribution, the 'free market' (or whatever it is), so I agree with the second statement - I wouldn't throw the whole thing out, but it needs to be supplemented. It doesn't seem like much defense of the current system that radically changing one element of it, the price, won't achieve a perfect outcome (and I frankly doubt you mean it that way but I don't want to speak for you).

You seem strongly attached to the free market concept - what if another system worked better? What's more important, the people or the economic system which feeds them?

To be fair: I strongly support a 'free market' as a great tool for a great many use cases, but it's not a universal tool or panacea and it's not the goal; it's merely the means - my favorite one in the toolbox.

----

Happy New Year Walter!

> You seem strongly attached to the free market concept - what if another system worked better?

None has yet, not even close. And it's not for lack of trying other systems. Me, I'm familiar enough with history to be disinterested in trying other schemes and risking mass starvation.

Keep in mind that Kansas in the 80s was known as the "Breadbasket of the Soviet Union". See "Ronald Reagan" by Broussard.

You didn't answer the question - not that you are on the witness stand, of course.

Many, maybe not you, seem to be much more interested in the ideology and forget about the people. There is not much interest in the 'details' - serious questions about, and thought and attention to, how real people are really faring. Some even sacrifice real people to their ideology; they defend the ideology at all costs, not the people.

> Every bill from a doctor you see is a very clear short-term incentive for keeping yourself healthy -- clearly more so than a $50 discount on your monthly insurance payment.

It's also an incentive to avoid going to the doctor unless you really need to. Something that I'm not sure helps with healthcare costs in the long run.

There's already a health incentive to stay healthy, by definition. If people won't obey a health incentive, why will they obey a financial incentive?

And there's already a financial incentive as well: Discrimination provides a financial advantage to people who appear more healthy (younger, thinner, taller).

I disagree with OP point... but I also disagree with yours.

For example, in the new year eve, my parents asked me my objective for 2017, I told them to become strong and healthy.

Both of them were VERY skeptical, and thought it was absurd, specially because in their view, being strong and healthy won't make me pay my bills...

And they are in a way, correct, to stay healthy you need resources and time, not always those are available, for example right now I am unemployed and have no contract, I have plenty of time, but no resources, and I am begging my parents to buy me some gymnastic rings I need for my exercises... but short term, I would be better if I stopped worrying for my health and went to get some short term job, even one blatantly unhealthy one (for example working with garbage).

The thing is, I chased money (Because I was in debt) disregarding my health (out of necessity) from my 18 years until I was about 27 or 28... It is clear now the long term cost has been very, very high, my health is very damaged, yet if I had to go back, I don't think what I could have done differently, the path I took was the only path available to pay my debts, and in my country personal bankruptcy doesn't exist, not paying my debts wouldn't work.

Staying healthy is a really long term goal. You need to do it every day but there's no immediate penalty for not being healthy on a day to day basis. Penalizing someone financially is much more real and tangible than "that pizza you ate today is contributing very slightly to your degrading health"

That sounds plausible, but on the other hand, it also sounds plausible that the immediate discomfort of dieting for most people would outweigh the immediate financial incentive.

An additional plausible explanation, that always has to be considered until it's eliminated, is that wellness reward programs don't work at all, but tap into the psychology of the HR managers who buy that kind of stuff.

I was only thinking in terms of a simplistic "homo economicus" model, in which a worker acts rationally in their own best interest. If we abandon that model, I'm not sure we have a useful alternative.

The better way to tackle that problem is to turn the incentives around in the US health sector, which currently runs on a piece rate model, which rewards the medical professions for finding as meany treatments as possible to deliver to the population as long as possible. Give them a flat rate percentage of GDP per patient, and motivate them to reduce the amount of work they do, by keeping everybody healthy, and you'd have a much better system.

Yes!!! And since this isn't happening how is what innovative corporations are doing a bad thing?

It's embarrassing for the US government that they can't find other methods for short term incentives and the private sector is stepping up here.

Not all increases in health care costs are bad. When we learn how to treat new diseases or conditions, that's good, even if it costs money.

Im so healthy my doctor told me I need to drink more and consume more salt. I don't need HR knowing anything about my health. F them and F crypto-fascists who argue this is a good thing.

You have a choice!!! Why are more short term incentives that are clearly lacking in the market a bad thing?!?!?!

Because it MY data. It's voluntary now, but will it always be?

You're a free market guy. What would you say about insurance companies deciding they'll only cover people who release all their data to them.

Now I don't have a choice to release my data, do I? (since I'm forced to have insurance)

How do I know what my doctor does with my electronic data? Legally, I have some assurances. Except we now know how much these legal assurances are in the electronic domain.

This is soft paternalism. Freedom is being able to smoke a cigarette in your car with your 2 mo. old daughter in the back waving your middle finger at any holier-than-thou puritan who has a problem with it.

The free market solution is different tiers of service that offer different qualities.

Health care is tech which means it advances very quickly. It's illegal in the US to get the top tier service of 20 years ago (the only option is the best care right now).

If I were you I would simply choose a lower tier service that is still nearly state of the art. Because the top tier is so expense you must share your data but the lower tier services is 95% as good for much lower cost.

Look at literally every other industry to see how this is true - you have quality choices and its amazing and a beautiful thing. OR, get health care in say India.

Cliffs: You don't have a choice in health care quality and since that's unsustainable corporations are also reducing choices when it comes to privacy.

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