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Comment by capdeck | Hacker News Reader

No, it works exactly as it was designed. Health insurance keep s costing more, cover less and not care about helping people in the time of need. That is not an accident. It is a result of concentrated effort of lawyers, lobbyists, salesmen, etc... - a whole system that maximizes profits and market share at all costs, and not the quality, breadth and affordability of healthcare. It is like that by design. So the results are logical - we pay more and get less. And will continue paying more and getting even less. There will be a point in future when this approach will "meet its maker", the hope is that will happen sooner rather than later.

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It's an efficient market. It's efficient at collecting money from customers who little or no choice, and at not providing those customers with a service - because providing a service costs money, which takes a cut out of profits.

This is what markets do. They amplify political and financial inequality.

Anyone who thinks that competition will somehow magically fix this isn't paying attention to how markets actually work.

> Anyone who thinks that competition will somehow magically fix this isn't paying attention to how markets actually work.

If you allowed foreign doctors to come and practice in USA the problem would get fixed extremely quickly. Competition is the solution. The problem isn't the free market here, but that the incumbents gets to control legalization and hence stifle competition. I'm not sure why private money has so much more influence in USA than other western countries, but it is the main source of this problem.

Aren't drugs very expensive in the US, too?

Isn't it illegal to move drugs across the border? Importing other goods seems much simpler. I mean, according to this you can only import drugs into USA if you are the manufacturer, meaning USA doesn't permit global market forces.

https://www.kff.org/medicare/issue-brief/10-faqs-on-prescrip...

drugs are very expensive everywhere it's possible, and implicitly expensive drugs are not available where they're unaffordable (and hence no market at the high price). This leads to bigger group buying programs and a focus on generics, but has the unfortunate effect of shifting the focus of drug companies to very high price, small-market specialty drugs and lifestyle & vanity drugs that a broad, public healthcare system would never cover.

Say you have a drug that you need to charge $100 to make it worth your time. Other countries say they will only pay $20 for it. Since the US doesn't have price controls, they will charge $180 here to make up for missing revenue in other countries. So in effect, the US subsidizes countries with universal healthcare.

we can both complain about the final outcome and disagree on how we got here. I think it's a stretch to call healthcare an efficient market. There are huge upfront and switching costs for almost every component making it rife with opportunities (intentional) and mistakes (mistakes) that erode efficiency. I also feel you conflate what markets can do with what their intent is. You seem to imply that markets have no role in a huge swath of our economy and lives, yet I look at my medical experiences in Canada (almost 100% public) and wonder if many people actually know how it works and what the outcomes look like. In a nutshell it's both harder to die and harder to get better under our system, and I think markets could help with the later without hurting the former.

You are conflating markets with meta-markets. The market for healthcare has been corrupted by activities outside of the market.

The market has been intentionally manipulated to set up little choice for individuals and even worse, little transparency on cost and benefits.

Markets DO work, but you have to set them up to succeed. Customers need to be able to choose between providers, customers need to know what the full cost of healthcare is prior to committing, and customers need to be able to walk away or find an alternative if a price is unattractive.

So markets work in theory, kind of like communism.

ha ha that's exactly how i play it to my friends.

Employer driven health insurance was pushed for by unions back in the 70s IIRC. That is how we ended up with this setup becoming normal.

It was older of a trend than that I believe back to post-WW2 when private sector was hobbled. To keep people incentivized to stay longer with employers they offered more benefits that were employer tied such as pensions and health insurance programs not available to job hoppers or self employed.

But more complex is that when people argued for a nationalized health plan a lot of people agreed with it until opponents argued that white people would be paying for minorities’ health insurance with their tax increases. These days it’s difficult to outwardly tell whom opposes public welfare policies requiring some solidarity based upon fiscal principles or social ones first.

Right, the initial were benefits offered by employers to sweeten their compensation and improve retention. Later unions demanded these everywhere and that’s what led to employer sponsored health insurance being normalized.

Separating the consumer of a insurance (the employee) from the decision of which insurance to use (the employer) is where this all went sideways.

Otherwise, in a competitive market, people would be free to jump to any provider with a better offer, forcing other providers to respond and preventing the disaster that we have now.

But now it’s a national mess to unravel and we have union demands to thank for it.

Yep, the more producers and consumers of products and services are separated the more markets are improperly incentivized even without any government involved. B2B has a place in commerce obviously but much of the problems of enterprise software is because it’s designed for a lengthy sales process to meet decision-makers’ needs rather than for those that work under the decision-makers.

Yes, the unions are 100% to blame for the current state of affairs.

Providers, trial lawyers, drug/device companies, and insurance companies are absolved of blame!

I used to tell people that when the subject of "why is healthcare so expensive" comes up, these four pigs feasting at the trough point to whomever is to their right.

Now they have someone to point to that's not even eating, and arguably died a long time ago.

The root cause is root cause.

No, it was during he Second World War. There was a labor shortage as many men were drafted or even signed up, but the federal government had instituted wage and price controls. As wages could not be raised, benefits like health care were offered to try to lure workers.

Some big companies, like the car companies, ran (and I believe may still run) their own medical systems. Most of course outsourced.

Nowadays a company would be insane to drop this because it’s a very sticky incentive. We’d probably have more innovative startups if we had ACA which is a reason the big companies lobbied against it and why having a company to simply pay your ACA premium was made more expensive than the company running a health plan the old way.

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