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Comment by Heyso | Hacker News Reader

Hospitals, healthcare, should not be a business. If money is the end goal, cheap + efficient medicine will be thrown away, it might not even be profitable ! A curse for a businessman.

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Competitive markets tend to optimize large profits away. If someone is charging lots for less effective treatment, the expectation in a market economy is that a competitor will step in.

The analysis you present is not uncommon, where the businessman somehow gets to choose how much money he makes in a vacuum, a situation that doesn't really exist.

Ironically, lots of US regulations prevent providers from entering markets, letting providers that already have regulatory approval charge more. Some regulations are literally written with this as the goal (CONs, Medicare reimbursement rules designed to prop up small hospitals with emergency rooms).

For competitive markets to work, consumers need to be able to rationally shop around. The medical system is not even close to built in such a way. You cannot shop around when you are riding an ambulance to a hospital, and those with potentially terminal diseases usually prioritize living. The existence of insurance, which no one suggests we should go without, adds another moral hazard that encourages the consumer to be less price elastic.

It would be just as massive an overhaul to turn this sector into a truly competitive market as it would be to nationalize it.

Research suggests that emergency room costs are 7% or less of total healthcare spending in the US (some studies claim it's as low as 2% of total yearly costs). In other words, there's a lot of room for shopping around.

But in the current system you can't. Nobody will tell you the cost of operation or treatment. It's not even malice: nobody knows what it'll cost. The system efficiently avoids competition.

My comment was not made in a vacuum. It was intended to address the concern raised by jbeam that emergency situation in healthcare completely preclude the use of market dynamics. My point is that emergencies are only a small part of healthcare, and by themselves are not enough to derail the idea of bringing markets back to healthcare.

Thanks for the clarification.

I'd argue its not a competitive market in many cases. There are limits on your doctor choice depending on your insurer. You cannot shop around for a treatment, the hospital lines one up connected to their doctor's network and your insurance.

Yes, absolutely, that is what I am arguing. I was trying to establish that running healthcare as a business isn't the only problem with healthcare.

Hospitals are not a “business”. They are non profit companies that rake in revenue and billions in profit while undermining the cost of care to Americans.

The overwhelming majority of hospitals in the US are nonprofits.

There aren’t sufficient amount of people willing to do the highly undesirable work of caring for sick, contagious, handicapped, possibly dangerous people without money as the end goal.

You can highly remunerate health care professionals without the entire health care system being treated as a for-profit business.

My point is someone working in healthcare is also working for money as the end goal, and a doctor/pharmacist/nurse getting paid is also a business transaction.

And none of that would change under single payer (or, as someone else suggested, a German-style model).

Absolutely no one anywhere is suggesting doctors and nurses should work for free. Single payer advocates are only suggesting that we cut out the byzantine mechanism of the US medical billing regime, and let the American people pay health care professionals directly, with taxes, instead.

I’m also not suggesting single payer is a problem. I’m simply claiming that healthcare is a business, regardless of who is paying what. People wanting money for labor to provide healthcare is business.

Don't underestimate how many people find meaning in care work, whether it's financially very well compensated or not so much. Look at places where healthcare is less subject to market forces, like substantial parts of the EU. You might get positively surprised.

And good compensation for health professionals can happen in a non-profit context too.

How can I be underestimating when it's a fact that there is a shortage of nurses, and hence nurse unions have decent sway.

Medical professionals will notice if healthcare moves somewhat away from the market. They will feel safer investing energy without expecting market based financial compensation.

Compare to an free or open source project. A project that pays some contributors, but not others is a rather unhealthy situation. Such a project would have more difficulties attracting and retaining developers.

Don't underestimate what people will do for other than financial compensation, given suitable conditions.

Doctors and nurses will still make plenty of money. Govt jobs are on a pay scale as would medical jobs be. With less administration there'd be more money to go around as well.

That statement says more about you than the general populace.

How? I don’t see the general populace lining up to work at nursing homes to perform those duties for minimum wage. There’s an extreme shortage of people willing to work at nursing homes because the pay is not commensurate with the quality of life at work.

You are assuming that all health care staff will be paid minimum wage. If you look at countries with public healthcare systems this is not the case.

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