The minimum viable remediation is a two-tier system in which the government takes the "or die" out of the conversation. The best approach IMO is single-payer where the government takes the "pay up" part out too, as it allows the system to be globally optimized.
At the end of the day health insurance isn't insurance, it's at best a structured payments plan. You buy insurance against things that may or may not happen. You will get sick and you will die. That's not insurance.
[1] https://corporatefinanceinstitute.com/resources/knowledge/ec...
And you need a citation for your claim about when free markets do and don't work.
Of course you have. The first thing you did when you walked in was hand them your ID and coverage info. You think hospitals operate on the honor system?
As a Canadian I've never been asked to pay up before or after receiving treatment [edit: at the point of care].
And before you jump into taxation, Canadians pay less per capita in taxes than Americans ($13K vs $14K), and that's before you factor in the $600 per month in private tax you directly (or indirectly via employer) have to pay your insurers.
> Especially when I arrive there unconscious.
You either have insurance or you're driven into Chapter 11. Further I suspect this is not due to good will but rather government intervention.
> And Herb Cohen would say once you've received the service, you're actually in a great negotiating position.
The debt was incurred once the service was rendered, and you are now liable. 66.5% of all bankruptcies in the US are medical -- are they just bad negotiators? I'm not sure what point you're trying to make but it's not in good faith.
> People actually negotiate hospital bills all the time. Especially in those crazy stories you hear about.
That sounds the worst.
> And you need a citation for your claim about when free markets do and don't work.
Voluntary contractual exchange is one of the undisputed key pillars to a free market economy. If you're being told you will die without the service it is a coercive exchange and therefore violates one of the key tenets. [1]
If I hold a gun to your head and tell you to buy my oranges for $1000 or I kill you, is the free market price of oranges $1000? If I tell you that you have cancer and you'll die unless you get $48,000 worth of chemotherapy, is that a free market? [2]
A free market requires both the voluntary production and voluntary consumption of services.
[1] https://en.wikipedia.org/wiki/Free_market
[2] https://www.asbestos.com/featured-stories/high-cost-of-cance...
Re: waiting times, take it from the horses' mouth, you've been fed a crock [1]. Of course the system could be better, but on the whole you're just wrong. The insurance lobby has spent a lot of time, money and effort to convince you of that.
The data backs that up. A small handful of Canadians go to the US to "shop for orthopedic surgery" out of millions of visits per year in Canada. After all a hip replacement in America costs one hundred thousand dollars. Just how many Canadians do you think there are with a spare $100K USD ($128,500 CAD) kicking around in the old piggy bank for a new hip that'd be free in a few months? [2]
If you see 50-60,000 ish numbers they tend to be the 'snowbirds' - Canadians living in Florida for half the year who choose to seek care close to their winter homes. These are folks wealthy enough to have winter homes, and also maintain private insurance.
[1] https://www.npr.org/2020/06/27/884307565/after-pushing-lies-...
[2] https://www.vox.com/2016/10/9/13222798/canadians-seeking-med...
You really are making a lot of bold assertions. If you declare bankruptcy, the hospital gets zero. Negotiation is a process by which both sides give something to meet in the middle. Yes they do it.
https://www.cnbc.com/2020/10/28/you-can-negotiate-your-medic...
The overwhelming vast majority of people have health insurance. However, due to taxation of privately-purchased insurance but not insurance that's a work benefit, people are driven to get insurance through their job. This was the government's fault, by the way. If people lose their job, they lose their insurance along with it. People without jobs have lots of financial problems. If they have a medical problem this situation gets far worse and results in a lot of bankruptcy. You seem to think bankruptcy is worse than negotiating. Clearly, it is often preferred.
As for your oranges question, no.
For the cancer one, possibly.
Do go on. Why is dying due to an explicit action any more of a free choice than dying of an explicit inaction? Why is one any more coercive than the other?
The only point I'm making is that healthcare is not a free market due to lack of voluntary agreement between buyer and seller. Once you accept that it's not a big jump to say the system should be remediated.
Because one is coercion and the other is simply an economic system. Which by the way is also used for all the other necessities of life too. How about food?
The whole point of a free market is competition, so if you were at least arguing for emergency situations there's be something to talk about since it's rather hard to shop around. But we'd still need to compare it to how well the government handles economics of emergencies. So far we have the govt driving up the cost of emergency care by requiring the ER to provide primary care for everyone without insurance.
In functioning systems the government drives down the cost of emergency care by setting the price and insuring everyone, and the results are clear. Canada's health care system costs $5447 USD, and Americas costs $10224. That's basically all I'll say about that.
Other necessities like food are in fact subsidized or socialized.
- The freeways? Socialized.
- The schools? Socialized.
- The police? Socialized.
- The fire stations? Socialized.
- The army? Socialized.
- The post office? Socialized.
- Healthcare for 40% of Americans? Socialized. (Medicare, Medicaid, VA). Medicare is socialized medicine. [1]
Food is also very much provided for if needed. SNAP and food banks provide socialized food to the poor. Americans pay less for food than anyone else on earth in no small part because the Farm Bill subsidizes production of corn and soy to the point these staples are sold at below cost to end users.
Either way that's a distraction and a red herring. Americans pay less for food than anyone else and more for medicine than anyone else. Eyes on the prize here, and stop carrying water for the insurance companies taking advantage of you :) All we're talking about doing is moving the percent of Americans covered by socialized medicine up from 40% to 100%.
> Americans pay less for food than anyone else and more for medicine than anyone else.
Is your point then that food is cheap because it is socialized at a 100% rate as you want healthcare to be? Or that your references to socialism are all red herrings?
Poor people can get free healthcare the same ways they get free food, Govt programs and charities. Food banks are private charities, by the way.
You are not defining coercion properly. It means force or threats of force.
Freeways are not a necessity of life, though we are certainly coerced into paying for them. At least they aren't as expensive as that Army you mentioned. Apparently you define all government spending as socialism, making the only other possible form of "govt" anarchy itself?
My point is food is cheap because the government intervenes, it's not a free market as you make it out to be, and yes food is provided to those in need. However, there aren't many in need in no small part because food is already the cheapest in the world in the US. That's not an exaggeration [3].
If medicine were the cheapest in the world in the US then nobody would be calling for its socialization. The current system is an abject failure. The food market, while I disagree with it, would likely be defined as a success.
I'm saying that in other countries with socialized medicine costs are controlled far better. Medicare controls costs far better than the private sector. Canada's system costs half as much, covers everyone and is ranked better along basically ever major axis. Life expectancy is declining in the US. Healthcare in the US is among the worst in the OECD and far more expensive. [4]
I'm saying that it's not as big a leap as you make it out to be, and that there's lots of precedent, domestically and abroad.
> You are not defining coercion properly. It means force or threats of force.
Coercion (/koʊˈɜːrʒən, -ʃən/) is the practice of forcing another party to act in an involuntary manner by use of threats or force. Threats or force. Pay up or get out and die is a threat, IMO, levvied by the system.
But even if you choose not to take that definition - it remains true (the only thing I've been arguing) that health care is not a voluntary contractual agreement but one taken out of necessity on an uneven playing field. This makes healthcare not a free market under most circumstances.
> Apparently you define all government spending as socialism, making the only other possible form of "govt" anarchy itself?
"In the theoretical works of Karl Marx and Friedrich Engels and subsequent Marxist writers, socialization (or the socialization of production) is the process of transforming the act of producing and distributing goods and services from a solitary to a social relationship and collective endeavor." [1]
Socialization in a primarily capitalist economy is defined as taking a for-profit institution and transforming it into an institution collectively funded and carried out for the public benefit. If the government owns and operates a service for the public benefit it is a socialized service. It is socialism - well, democratic socialism/social democracy. It is not incompatible with freedom, or democracy, or private property rights.
Yes, these are all socialized services. Explicitly yes for Medicare, Medicaid and TRICARE. [2]
The alternative to socialized services are privately owned and operated businesses. Not anarchy, necessarily, but libertarianism.
[1] https://en.wikipedia.org/wiki/Socialization_(Marxism)
[2] https://en.wikipedia.org/wiki/Socialized_medicine
[3] https://www.ibtimes.com/us-spends-less-food-any-other-countr...
[4] http://www.oecd.org/health/health-systems/health-at-a-glance...
"Threatening to not perform a service for someone" is not coercion, and does not invalidate a free market. A market is a place where scarce products can be exchanged between buyers and sellers who meet at an agreed upon price. The ability to refuse service is a prerequisite for having a market and the idea of private property itself, not some kind of unexpected flaw. The fact that something is scarce may well be problematic for some who cannot afford to outbid others who can afford it, but no system eliminates scarcity. Ask Venezuelans, who I am sure you were dying to talk about, what happens when you try to overcome scarcity with price fixing and free money. You simply achieve shortages.
In the 1980s the US did not have a 40 percent socialized system. The fraction of people on medicare was far less. Yet it was not the most expensive system in the world then. The US system is definitely failing, but it isn't the 300-year old market system that is causing it.
The only thing convenient is you not addressing my point :) The government intervention is a desparate attempt at not letting people die of disease and pestilence literally outside a point of care. You're asking for a dystopian hellscape. And that's what much of the last 300 years was with respect to medical care.
> In the 1980s the US did not have a 40 percent socialized system. The fraction of people on medicare was far less. Yet it was not the most expensive system in the world then. The US system is definitely failing, but it isn't the 300-year old market system that is causing it.
Yes it is.
Canada had a similar system until the 1970s, and it was bad. Then it switched over and things got better. America remained on the private system and it just got worse and worse.
Venezuela is totally and utterly irrelevant to this conversation. There are so many functioning systems with socialized medicine (all of Europe, especially the Scandinavians, Canada, Taiwan, etc, etc), Venezuela is an outlier and not even worth discussing. It's a failed state.
Whether you call it coercion or a power differential (you will die, the insurer or provider won't) this precludes a voluntary meeting of the minds necessary in a free market. Period.
No it isn't. Speaking of dodging the point. The US didn't remain in the private system, it half-socialized it. And you must know Canada's system has been increasing in cost like everyone else's.
And speaking of magic single-payer economics for the good of all, what's up with that "socialized" army you mentioned? Most expensive in the world also. I expect the very same wanton mishandling of other people's money when it comes to the eventual govt takeover of healthcare. Hell they are already doing it as that 40 percent govt part is outpacing world spending all its own.
Venezuela is just a difference of degree. The same effect is seen in everyone's lack of R&D spending outside the US.
The way a market works is people find ways to serve people at a price they can afford. When you always force others to pay for the cadillac service for them, no one bothers to find cheap ways to provide healthcare.
How can you be so twisted up about this? Americas system is the expensive one, everyone else's is cheap, and controlling costs better. Medicare may not be doing a perfect job but again it's controlling costs better than the private sector. What you are saying is strictly and objectively false.
Healthcare is optimized and improved in single-payer states, because there's still budgets.
You're defending the worst system out there from a cost perspective, and not top 20 in outcomes. And you're doing so by saying the system other countries are successfully using to control costs would fail to control costs, and using this to defend American's failure to control costs? You're telling me Canada is doing a bad job of controlling costs when it literally costs half as much per capita? Because their rate of cost growth is in line with their peers while America's is way, way beyond?
Your mental gymnastics are giving me a headache.
> Venezuela is just a difference of degree. The same effect is seen in everyone's lack of R&D spending outside the US.
And that? Also false. Venezuela is a difference of degree? What on earth are you talking about.
R&D spending? Guess which healthcare companies spend the most on R&D? It's not the American ones. It's all the European ones. #1 is Switzerland's Roche. #4 is Switzerland's Novartis. #6 is France's Sanofi. #9 is the UK's AstraZeneca. #10 is the UK's GlaxoSmithKlein. [1] This is yet another failed talking point.
Guess which country developed the first COVID vaccine? Germany. BioNTech's vaccine was paid for by Germany's government. Pfizer took $0 of US money and is productionizing a Turkish immigrant in Germany's German government funded research work.
You're just not right about this one, time to move on lol.
[1] https://www.fiercebiotech.com/special-report/top-10-pharma-r...
Roche has over 8000 employees in the US. https://www.roche.com/careers/our-locations/americas/usa.htm
A handful of giant international companies who obviously make a big fraction of their money in the US market (selling at higher prices due to the lack of price fixing) do not provide a useful metric. Try overall stats, such as here: https://efpia.eu/publications/data-center/the-pharma-industr...
And that'd just pharmaceuticals. The US has far greater dominance over other areas of biotech.
But you're right, I do need to move on. This immature flaming behavior is why I avoid toxic places like reddit.
1. That's in "millions of national currency units" (except in Japan which is in "hundred millions of national currency units") so the Japan bar is in 100M JPY, the Europe bar is in 1M EUR, and the US bar is in 1M USD. It was clearly not meant for comparison against regions, just over time.
2. Not only is the currency inconsistent the values weren't adjusted for purchasing power parity, i.e. how far a national currency unit goes in that country relatively.
If we convert the values to USD adjust for PPP the picture changes completely. All values in USD, PPP adjusted:
2016 - USA: $52.4B
2016 - Europe: $46.16B (PPP factor 1.225, EUR:USD factor 1.11)
This is about a 13% delta, not the seemingly 53% delta represented on the chart. Also, this is limited to EFPIA member companies.
Privatizing these would mean anarchism as there's no longer a monopoly on force.
>- The freeways? Socialized.
>- The schools? Socialized.
>- The police? Socialized.
>- The fire stations? Socialized.
>- The army? Socialized.
>- The post office? Socialized.
It's not anarchy to pay the fire department to put out your fire. It's libertarianism. Just like paying your doctor to splint your leg.
Even if I agreed with you, whether it risks losing the monopoly on force or not doesn't make it any less a socialized service.
This might be a fun read for you: https://www.newyorker.com/humor/daily-shouts/l-p-d-libertari...
I tell you to do work, and if you don't I shoot you. It's just economics; I'm trading not shooting you for your labour and everyone comes out happy
Were you making an analogy for the economics of socialized medicine with the forcing of labor?
They mail you these paper forms known as "bills". I have examples I can show you. Insurance only pays a portion. I suppose you can call it a kind of honor system.
And given your examples, you apparently aren't aware that when it comes to emergence care in the US, hospitals which have an emergency department are required by law to provide emergency care as needed to make sure a patient is stable. One's ability to pay is not a factor.
One is of course that "I suppose you can call it a kind of honor system," no, you can't, it's enforceable by law and actively collected upon. That's not an honor system.
> And given your examples, you apparently aren't aware that when it comes to emergence care in the US, hospitals which have an emergency department are required by law to provide emergency care as needed to make sure a patient is stable.
Yes, the bare minimum, then ejecting them out the back door as soon as they possibly can. Of course by waiting until they require emergency care you're fleecing everyone. Minor issues that could have been addressed earlier for pennies on the dollar are instead allowed to fester until they become life-threatening, then when the poor can't pay, it's socialized across those who can at the worst possible time for the highest possible price.
Not to mention, this is an argument against the free market approach which would just be to refuse service. This is actually bolstering my case that healthcare is not a free market because of a lack of ability to form a voluntary contract.
> One's ability to pay is not a factor.
Oh come on now. Who doesn't have health insurance? The poor. Who's going to get the bare minimum treatment required be law and getting booted out the back door? The poor. Who's then going to get a bill for it forcing them to declare bankruptcy? The poor.
This is strictly about one's ability to pay.
New goalpost eh? No they generally just treat everyone fully and pass the cost on to people with insurance. Trying to transfer uninsured people out leads to lawsuits.
This was a digression and exploration of how your specific situation exists because of government intervention. The alternative is to let poor people die outside, and that's distasteful to me, and to most.
A voluntary exchange between buyer and seller prior to exchange is necessary for a free market. You're describing a failure mode where a service provider is about to be screwed out of compensation and is willing to settle for less just to get something.
It's hard to believe you're advocating so hard for something so inhumane and dysfunctional.
45,000 people die each year in the US without care. Ending that would go a long way to reducing government violence. [1]
[1] https://news.harvard.edu/gazette/story/2009/09/new-study-fin...
Further there is also a general societal argument that we all benefit more from having a more healthy population than dealing with the external costs of a less healthy one.
On top of that, even "pay-up-or-die" doesn't mean that the price will be a billion dollars. Instead, it means that it's the price that maximizes total profits. Suppose that no one could ever pay more than $30,000 for the medical helicopter. Then the helicopter people would set a price that prompts people to pay as close to $30,000 as they can. Perhaps if patients see a bill for $50,000 they negotiate down to $30,000, but if they see $500,000, they go to court and only at the end pay $30,000. Similar dynamics can limit food prices in areas that really only have one food supplier - there's only so much you can charge, and if you charge more than that, you won't succeed in squeezing more out of them, but you may attract all kinds of trouble - violence, or legislation, or competitors, etc.
This is exactly the issue. You cannot seriously think that the trainwreck that is US healthcare is what it is solely because of government intereference?
Would Cigna fund and run the tiny little community clinics that serve with sliding-scale pricing? Would Kaiser willingly insure students with preexisting conditions at a fair price? (I know that in my case, they wouldn't)
What "free market" incentive is there for these insurance companies to cover people that would clearly cost them more money than they receive? Those people need help and sickness/viruses do not have any concept of money, and they effect people indiscriminately.
You are promoting a healthcare system for the wealthy and privileged, which is exactly what we have right now and what needs to be torn down.
It's an NPR interview with Cigna's former head of corporate comms, an executive in charge of pushing lies about socialized medicine. He has since come to terms with what he'd done and is working to undo the harm he has caused to the American people.
"Canada has done a better job [re: COVID], I think, because of having the kind of health care system you have in making sure that everyone who needs to be treated is treated. And so that was what prompted that. And I felt that to provide some context, I needed to describe what I used to do for a living to try to scare people away from the Canadian health care system because insurance companies fear that. They know that if the U.S. moves to a system like that, it would certainly put a real crimp in their profits."
"Our industry PR and lobbying group, AHIP, supplied my colleagues and me with cherry-picked data and anecdotes to make people think Canadians wait endlessly for their care. It's a lie. And I'll always regret the disservice I did to folks on both sides of the border."
[1] https://www.npr.org/2020/06/27/884307565/after-pushing-lies-...