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Comment by syki | Hacker News Reader

This what happens when a significant portion of society worships the “free market” and wants to avoid government running things. In the U.S. we have managed to fully monetize just about every aspect of life. Even something as mundane as pumping gas has been almost fully monetized by blaring ads.

EDIT: I know the U.S. healthcare system isn’t a totally free market. We’ve designed a system that isn’t government run but has mandates like ERs having to see patients. Half the country labels anything that isn’t government run as free market and anything that is government run as communism. These are proxy words.

If you want a healthcare system that isn’t government run but that has a semblance of “free market” in it but that also “treats” most people this is what you get. Well, it’s what our system has morphed into.

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The health care market is about as far from a free market as you can get.

Tons of heavy regulation everywhere limiting supplies of doctors, nurses, ability for folks to see pricing info, for pricing info to matter etc. Consumer of the service often is not the one paying. So you can do crazy stuff like make an insurance co pay $10,000 per pill for something that overseas no one would ever pay that because they'd be paying themselves.

I've been in third world countries, cash pay places, no insurance, no govt stuff. You can call and ask how much something will cost, they tell you, you go, pay and done.

My bills in California have like 10 pages of notices and warnings on them for each charge. So it's a 5 page document per copay. Its crazy.

The problem is that adam smith meant “free from economic rents” when he used the phrase “free market” but now it means “free to charge economic rent”.

Makes it hard to discuss because people use the same phrase to mean completely opposite things.

Great point!

Yeah, the rent seeking in medicine is insane.

Just residency slots are so hard to get these days.

We have partially "free market" healthcare in other countries and it works fine.

The problem with US healthcare is not that it's private, it's that it's more expensive than it has any right to be.

A private system with a good framework of regulation would be good.

It seems like what you’re talking about is the “financialization” of things rather than the “free market”. Essentially, you dislike the “market”ness of healthcare, not the “freeness” of the market for healthcare.

I certainly disagree with you that it being a market is the problem, but I think one can consider downsides to that pretty straightforwardly: the lack of price elasticity when you’re dying makes markets price poorly, discouraging people from healthcare is a societal bad, etc.

The idea that there should be a market but that it should not be free is something I just find really problematic since it’s just a steal-from-everyone-to-enrich-medical-barons thing.

If you don’t want to have the freeness argument then perhaps choosing other phrases will help. If you do want to have that argument, obviously you’ll find yourself discussing whether or not the market is free.

It's not about dying. Try to find a full price of something totally not related to dying. Some procedure or drug that you could shop for. Pretty quickly you'd find out you actually can't - you can't know the final price of almost any procedure ("estimate" is the best the could give, which does not guarantee a thing) and for the most providers the response to the request about prices is "we'll send you a bill after and then you'd find out". There's virtually no support for price discovery and zero tools for price shopping for many medical services. Maybe for drugs there are some limited ways, but outside of it, price shopping is insanely difficult if possible at all. So to which extent we can talk about the "market" if the basic activities of the market do not exist?

That’s a fair point and something that infuriates me as well.

The healthcare market in the US is anything but a free market. It is ludicrously riddled with costly regulations at every single level of care.

I never understand why do people think the government is going to do such a great job at running things. Have you never been to a DMV or had to interact with any federal/state/local authority? You get nothing but unthinking apathetic people who just want you to go away. I assure you government employees will care even less when something goes wrong.

Japan, Germany, Norway, Italy, Spain, etc. all run a national healthcare systems for far cheaper than the U.S. that covers everyone with more or less equal outcomes. The citizens of those countries don’t go bankrupt when getting care. It can be done.

DMV is quite good in my state. The Postal Service does an outstanding job of delivering packages. NIST and the Park Service provide great benefits to the nation. The U.S. military is government run and it does a great job at destroying organized state power. Should we privatize all of these organizations? How about privatizing the court system? Do you really want to live on Ferenginar?

> Do you really want to live on Ferenginar?

Hollywood caricatures should never underpin your understanding of economics.

Humor shouldn’t get in the way of understanding the point being made. Clearly this reference to Ferenginar was illustrative of a broader point. Equally clear is that it doesn’t underpin my understanding of economics. No reasonable reading of what I wrote suggests this.

"I never understand why do people think the government is going to do such a great job at running things." Because if designed competently, with audits/transparency baked in, it can.

Plenty of agencies in numerous nations have proved this out, but folks continue to have onanistic John Galt fantasies instead.

I do wonder how many other people you've interacted with.

There are many people in government trying to do a good job and many who aren't, just like private industry. I recently spent <15 mins at the DMV to get a vehicle title transferred and it was a very efficient process (granted I spent more time in the car as there aren't offices in every town).

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Perhaps you should talk to your local representative about the DMV's funding. There was a recent post to HN about how the FDA only has 10 employees to do declassification of documents, of course they will be slow at doing that. I wonder how many employees/per capita works at your DMVs.

Maybe this is splitting hairs, but it's more a problem with worshipping corporate capitalism. I don't think you can really describe healthcare in the US as a free market.

None of the people referred to in the parent want a real free market.

They don’t know what a free market is.

I think they know very well, that's why they spend so much effort avoiding it.

It’s the same thing…while the people here might be willing to split hairs on the exact meaning of those terms the people you are taking about are not going to.

Strategic ambiguity around “freedom” “free market” etc is a useful tool to prevent change. It creates a self reinforcing mythology in peoples heads and enough confusion about reality that blaming the victims for being “unprepared” can exist in the broad/abstract while also still feeling empathy and dying “that’s bad” in individual cases.

This is much worse than that. In a free market you would at least be able to find out how much something costs before agreeing to it.

It's not that it's "isn't totally free market". It's as much "not totally free market" as North Korea is "not totally a libertarian state". It's one of the most tightly regulated and controlled areas of the economy. Literally every aspect of anything needs an approval - sometimes multiple ones - from regulatory organs. You can not become provider in the market without passing a myriad of regulatory barriers, which would make an average tech startup founder faint. You can not remain a provider without constantly complying with a mountain of always changing and mutating reporting requirements and compliance checks. Pretty much every regulatory scheme ever been thought up by a man is somewhere in medicine. And yet, we have this insane system. Whatever it is, it's not lack of regulation that caused it.

Except, the people who have taken the time to study how the system works will tell you that's not the issue.

Other people who have also taken time to study how the system works will tell you that it is the issue.

Considering government policy in the US is a big reason for the problems, blaming capitalism is kinda funny.

The US government is capitalist. It primarily operates to defend the profits of large corporations. Yes, under either Democrats or Republicans, although the industries each represent only partly overlap.

I don’t understand the downvotes. It’s obvious that the each party represents differing corporate interests and those interests take precedence over everything. How much did Wall Street suffer for its malfeasance when Obama was President?

Do you have any references to their analysis? I would love to read it.

Most people talk about ideas and politics without getting into the technical details of what's happening.

The Innovators Prescription[1] is written by 3 PhD's (2 in medical and running institutions and one in business) who provide an analysis as part of the book.

[1] https://www.amazon.com/Innovators-Prescription-Disruptive-So...

https://www.acpjournals.org/doi/10.7326/M19-2415

Which system are you referring to?

There are people who want “free market” solutions and the definition of “free market” tends to be any solution that involves a corporation running it. Generally people deep down know that it is obscene for a country as rich as ours to have large numbers of people not be able to get some level of healthcare. Thus the Frankenstein system the U.S. has. We mandate ER center see patients and stabilize them but without government paying for it. Since no one works for free we get the asinine billing system the U.S. has.

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