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Comment by zozbot234 | Hacker News Reader

> That had to stop. So a plan was put together ...

Others have already addressed these specific claims, and I'll add that this whole way of thinking (where anything and everything is the outcome of shady "plans" being hatched somewhere) does not generally lead to a good understanding of social problems. But this is not to say that progress in working-class compensation hasn't clearly stalled since the 1970s. Part of the issue is of course that a lot of that putative income has been offset by the huge increase in healthcare and education costs. And that's probably something where policy interventions are warranted, if only to reduce existing market distortions that put consumers at a huge disadvantage.

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> offset by the huge increase in healthcare and education costs

These costs increase to the maximum amount the individual is willing to sacrifice to obtain these services. Because they are inelastic services - you cannot substitute healthcare. You can barely substitute education (esp. tertiary). And there's not a lot of economy of scale with these services, which makes it hard to lower the cost in competition (if there's even any).

> you cannot substitute healthcare

You can. For every health condition, there are a wide range of options varying in cost, efficacy, risk, time and pain.

I recently went to the doctor over a problem I have, and got a rather broad array of options. I decided the risks of each option were worse than the problem, and decided to live with it.

The notion that there is a one-to-one mapping of problem-to-solution is incorrect.

> You can. For every health condition, there are a wide range of options varying in cost, efficacy, risk, time and pain.

Broadly speaking: if you experience dire medical trauma — say you have a heart attack or get in a bad car accident — you need emergency care or you’ll probably die. If you have cancer, you need to treat it or you’ll die. If a vital organ stops working, you need to find a functional replacement or you’ll die.

You may have multiple options for treatment, or you may not. But for many health conditions, the choice is ultimately binary: treat your ailment or die. That sounds to me like a service that cannot be substituted.

Cancer, for example, has many treatment options available. So does a heart attack.

Besides, emergency conditions (being transported to the hospital in dire condition in an ambulance) are not at all where the vast bulk of health care is.

> has many treatment options available

is there one that's cheap? Can i buy an aspirin pill for cancer?

A substitute is not the same as options - a substitute implies lower cost but does the same job. Chicken is a substitute for beef (which is generally more expensive). Therefore, beef cannot become _too_ much more expensive than chicken, as people will just opt to buy the chicken.

But if you have cancer, and each treatment still costs thousands per visit/session, then they are not substitutes.

Yes, the cancer treatments vary in price. Even more so if you take the associated care into consideration: you can have a customized, personally adjusted treatment costing many times more than the (same ingredients) basic protocol.

For cancer, your options are:

1. radiation

2. chemo

3. surgery

4. some combination of the above

All have their pluses and minuses. Sometimes people with terminal cancer opt for no treatment, as they'd rather enjoy a shorter time than have a painful longer time.

The notion there is no choice is simply incorrect.

Generally, only a pretty specific mix of these will yield a beneficial result. There are inoperable tumors, there are patients that will not withstand chemotherapy, and radiotherapy of a tumor too close to a critical organ will also not suffice.

Usually these treatment options would be weighed by a board of experts from the different medical fields involved, taking into account the individual patient's constraints.

I don't really see how you come to the conclusion that there is much of a choice for a cancer patient. It's not like you can tell the tumor board "I want surgery" when that's not a clinically viable option. And it's also not like any of these options is particularly affordable - any of them will easily bankrupt someone living from paycheck to paycheck. Heck, the MRI scan alone can.

It's still pretty binary between "get reasonable treatment costing tens of thousands or die", as the other poster pointed out.

> I don't really see how you come to the conclusion that there is much of a choice for a cancer patient.

Because I know several people who've had dire cancers, and they all had choices and made choices among the treatment options.

Indeed. Additionally, CAR-T therapy and vaccines are peeking over the horizon.

Food is even more inelastic than healthcare, why does it not see the same increase?

because food production is much more scalable and competitive imho.

What till you see climate change decimate food production, and you will see how inelastic food is, and the resultant price increases will be eye watering.

We see in areas where healthcare is completely private or more private - that services get better and cheaper (plastic surgery and dentistry). So the claims about scale and competition don't really hold water as something inherent to the service. In fact it becomes more apparent that the government regulation is creating the shortage.

> These costs increase to the maximum amount the individual is willing to sacrifice to obtain these services.

Individuals do not pay for healthcare services, many do not know the actual true costs.

Individuals in most cases do not pay - insurance companies do. This explains the high costs moreso than your example,.

I wonder where the insurance companies get all this money...

They get the money from individuals who are not using healthcare. That's the point.

Insurance companies minimize payouts to maximize profit - but they offer coverage that they often can't control the price of. It becomes a business negotiation between the hospital and insurance company.

The actual patient and the services rendered are many times irrelevant. If pricing was based on individual consumers you would see that reflect in pricing - no one would overpay for a cotton swab, for example.

> They get the money from individuals who are not using healthcare.

:thinking-face:

That's weird, I use healthcare, and yet I still pay monthly premiums. Can you explain why I don't fit into your explanation?

Usually, no. But in this case, yes. This plan was amazingly effective in increasing the power of big business over government. Realize that from the New Deal through the 1970s, about 40 years, there was an adversarial relationship between big business and the government. That was viewed as the proper role of the government, as a counter to economic power. That was a core principle of the New Deal.

That memo, the U.S. Chamber of Commerce, and the Business Roundtable, turned that mindset around. It took a lot of time, effort, and money. It created many organizations. Conservative think tanks came from that effort.

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