Why is that broken? Even systems with universal healthcare have rules like this.
Why use a $1000 per month branded drug unless you know the $5 per month generic drug doesn’t work?
Why use a $1000 per month branded drug unless you know the $5 per month generic drug doesn’t work?
You lost me there. What makes it immoral? Money is an asset allocation tool, so why is it morally wrong to use it for medicine the same way we do for food and housing?
Genuine question. I have a hard time understanding what sets medicine apart from everything else when people think healthcare should be universally free, but not food, water, clothing, housing, etc. especially considering those other things are more directly necessary for survival.
If you have cancer though than basicall the market cannot find a price, and it would tend towards to: 'give me all you have'.
Yes it can... there is more than one oncologist in the world. Competition exists.
As for if youre talking about the chemo drugs, you don't have to use the latest-and-greatest on-patent treatment. There are now decades of drugs that are off patent. They may not be as good, but then again, it is your life so many choose to pay for the new better ones. If it was illegal to pay more for better drugs than they would never exist (and don't talk to me about government funding; not a single socialized medicine country has innovated any drug of value in the past 50 years, and yes, they do steal from us in the USA by taking our IP and not paying for it).
Changing housing situations is exactly as easy as changing hospitals and emergency rooms no? Since the latter are mostly decided by where you live. In fact, most mid to large cities feature many hospitals near any given residence, so it is actually easier. I would also point out that the demand curve for housing, energy and food are far more inelastic than for medicine.
> If you have cancer though than basicall the market cannot find a price, and it would tend towards to: 'give me all you have'.
Why couldn't the market find a price? Cancer actually seems like the worse example possible. The people I've known who've been diagnosed with cancer have shopped around for care from many different hospitals. It would seem that cancer would be the perfect candidate for market forces to lower prices since a diagnosis generally affords a bit of time to find and decide on treatment options. Even in the extreme case of 'you have months to live' people tend to spend a few weeks collecting different opinions.
that's before even getting into pharma. which can charge millions of dollars for life saving/changing drugs for single course treatments. hell take a look at what happened with epipens. there is no protection against profiteering via nebulous 'markets' when your choices are 'purchase or die'.
This account, or at least should account, for a very small minority of interactions with healthcare facilities. Saying that's why the whole market is defunct is recklessly reductionist.
> markets don't deal with this situation well.
They don't deal with it at all. Imagine if some people needed bread or they'd die, would that change the price on the shelf? No, because the bread didn't get there because of that niche market, it got there because most people eat it. It is the same with healthcare. If a hospital exists because people routinely visit the doctor, some people needing their life saved isn't going to suddenly change prices.
> that's before even getting into pharma. which can charge millions of dollars for life saving/changing drugs for single course treatments. hell take a look at what happened with epipens. there is no protection against profiteering via nebulous 'markets' when your choices are 'purchase or die'.
Totally agree. The issue there is regulation and how we allow companies to be a position of no competition. If the government stepped in and payed those prices for you, it wouldn't solve the problem.
sadly its not. you're in pain? you need to visit a medical facility to figure out whats wrong. without knowing how serious it is it can lead to a life long issue. again you don't really have choices here. pay the healthcare tax or risk long term issues.
there is a reason preventative medicine is cheaper (overall) than delaying care until a condition has progressed.
the capitalists idea of a market simply doesn't apply to healthcare.
> If a hospital exists because people routinely visit the doctor.
this isn't true. we fund hospitals in rural areas because there literally isnt enough people to keep one operating via patient care.
you're also asserting that if the populace can't sustain the healthcare system then it shouldn't be available to people. which is fairly cruel and immoral.
I don't see how that is a congruent thought. The 'sadly it's not' doesn't follow from your statement after. If you are in pain without knowing how serious it is, you would likely get opinions from several doctors. You're not going to walk into the first hospital you find and say "I'll pay anything you ask just fix me."
> the capitalists idea of a market simply doesn't apply to healthcare.
You still haven't made a logically coherent argument as to why it doesn't. The vast majority of healthcare transactions are made between two lucid and consenting parties.
> this isn't true. we fund hospitals in rural areas because there literally isnt enough people to keep one operating via patient care.
That backs my point, right? Those hospitals aren't funded by emergency care either, which means the point about costs being a one sided negotiation while the other party is dying is still inaccurate.
> you're also asserting that if the populace can't sustain the healthcare system then it shouldn't be available to people. which is fairly cruel and immoral.
I don't think recognizing the limits of a given resource is cruel or immoral, it's reality. Us not having perfectly clean energy is killing us all, but it isn't cruel and immoral, it's a problem that needs solving. If a town can't afford a hospital, and you want to live in a town with a hospital, move, right? I don't see any reason why taxpayers should pay so a small mountain town in the middle of nowhere can have a staff of doctors and nurses to support a population of 100 people. If someone wants to live in the mountains of Oregon, I don't see how we have a responsibility to pay for a medical care facility to follow them up.
> You're not going to walk into the first hospital you find and say "I'll pay anything you ask just fix me."
these two statements are functionally equivalent. by running around paying every hospital for opinions you're literally saying 'I'll pay anything you ask just fix me'. It also tracks with my statement that medical pricing isn't influenced by rational markets which are what is required for a capitalist free market to 'work'. people need to be able to say 'this is unnecessary' which never happens in health care.
In healthcare you have two modes: 1. I can afford the care, price is fairly immaterial make me better. 2. I can't afford the care, doesn't matter what the price is.
> that backs my point, right? Those hospitals aren't funded by emergency care either, which means the point about costs being a one sided negotiation while the other party is dying is still inaccurate.
not sure how you get to this idea. the point is you're hung up on the dying aspect which is basically immaterial. I can torture you and get you to say anything I want. medical care is basically the same thought process for those who need care. The only thing that prevents people from paying any price is literally not being able to afford it. Otherwise people will 100% bankrupt themselves to make pain go away.
Given that the majority of bankruptcies in the US are due to health care just proves this point.
There is no way to make this kind of market work in a 'free' market system.
> I don't see any reason why taxpayers should pay so a small mountain town
we already do. you can argue whatever you want but as a society we've already mandated this level of access. for the same reason we've mandate fire and police coverage. its a public safety issue and a tax payer in bum fuck no where have the same right to have their taxes ensure they're covered as joe shmoe in NYC.
There are MANY reasons why this is economically a good thing via 2nd/3rd order effects that more than pays for itself.
> I don't think recognizing the limits of a given resource is cruel or immoral, it's reality.
every country with universal coverage disagrees with you. I'm not going to belabor this point further. Reality has proven otherwise. The US system is just completely dysfunctional. and thinking otherwise DOES make you cruel and immoral. If you want to discuss how to make a healthcare system that works, fine, but I'm not going to moralize with you on a clearly disgusting world view.
No you're not. You can choose which hospitals you're getting opinions from.
> In healthcare you have two modes: 1. I can afford the care, price is fairly immaterial make me better. 2. I can't afford the care, doesn't matter what the price is.
No it doesn't. I've shopped around for PCP. It wasn't like that at all. Do you think every doctor works in an inner city ICU or something? I'm not sure where you're pulling this view from.
> Given that the majority of bankruptcies in the US are due to health care just proves this point.
What point does it prove? I don't really see what point you're making. Is it the US system has major problems? If so, I agree. Is it that nationalized healthcare is the best choice? I haven't seen you make an argument for that at all other than conjuring your own personal ethical code.
> these two statements are functionally equivalent
I'm trying to make a coherent point, so that makes sense.
> not sure how you get to this idea. the point is you're hung up on the dying aspect which is basically immaterial...
So you agree with me now? Emergency care doesn't play a major role in the market?
> we already do. you can argue whatever you want but as a society we've already mandated this level of access
I'd like to see the mandate you're referencing. Sounds like you actually agree with codifying qualifying circumstances for care ;)
> every country with universal coverage disagrees with you
No they don't. Countries with nationalized healthcare routinely ration care. They recognize limited resources same as us, just through a bureaucratic system a oppose to a market system. Just because it's a man with an office deciding if you get to see the doctor rather than your bank account doesn't make it morally superior.
> If you want to discuss how to make a healthcare system that works, fine
This is the discussion I've been getting at the whole time. You're the one constantly conjuring some vague sense of morality as opposed to discussing which models may work better than others.
you clearly don't understand how hospitals work. getting opinions costs money. just visiting and taking their time costs money.
you can get a hospital to quote you the cost of a procedure. but to actually get a doctor to diagnose you takes time, resources, and tests. this costs money. and without doing said work you have no idea what procedures to get a quote for.
and frankly the only reason to get multiple opinions is if the current doctor has failed to resolve your problem.
no one jumps doctor to doctor unless there is something wrong with the current one like a lack of progress on resolving the issue.
> You're the one constantly conjuring some vague sense of morality as opposed to discussing which models may work better than others.
without understanding the moral outcomes of an economic system makes any such discussion meaningless. You should checkout Albert Hirschman https://www.ias.edu/press-releases/albert-o-hirschman-1915%E...
Proof? Services not typically covered, like plastic surgery or cosmetic dermatology. Clearly listed and even advertised prices for their services, openly discussed up front.
But if the govt reimbursement rate for an annual checkup is $x, why would anyone need to list that price up front, or have reason to ever charge any less?
The US has a rule about “usual & customary price”. That’s a legal definition and providers can’t charge any customer more than that.
If you’re looking to price discriminate, you set your U&C price as high as possible, maybe 2-5x what you’d accept. That way if you find a customer willing to pay 4X, you’re not running afoul of the law.
For everyone else, you negotiate a much more reasonable net price, typically through insurance.
The people who get screwed in the end are ones without insurance. They get billed the imaginary number nobody ever intended anyone to pay.
And indeed the US has many such services, though they are often overwhelmed, or performed through a complex set of nonprofits combining govt funds with donor money as best they can to provide good support. Sometimes they are overwhelmed specifically because of externalities related to the for-profit insurance healthcare system. The high and often unpredictable cost of any medical situation, means people with tight budgets become sicker before getting care, if they ever get it, leading to a higher percentage of bad outcomes, up to and including job loss and homelessness for the individual, and knock-on effects for the rest of their family. This puts extra pressure on the parts of the support system that do exist - those already mentioned, and, of course, the police, who end up getting called to many situations that could have been prevented by the people involved having better services to begin with, to meet their health, food, and housing needs.
Isn't it though? "This thing should be free for everyone all the time" is a lot different than "we should help people out a little if they're down on their luck". Temporary housing, food banks, etc are the latter, and I'm all for the same with medicine. The fact that food and housing are subject to markets makes it easier for organizations to carry out such missions, which is one of the barriers you mention in your second paragraph when you talk about the complexities of dealing with insurance companies.
And creating a public market necessarily diminishes the private, driving up costs, as purchasers are now competing with government for the same supply.
Medicine is a scarce resource at this point, and, generally speaking, giving care to X often means Y won't get it. The fundamental problem with medical care is supply, lowering barriers for demand isn't a solution to that.
That last bit is exactly what we're in disagreement about, and I haven't seen a good case for it yet.
> In the U.S. system denials of care by insurance companies are not done so another person can get said care
True.
> They are done to increase profit margins
Indirectly, sure. Its a business where money out must be less than money in.
> and profiting from denying someone care is immoral.
Again, this is the disagreement, and I'm not really seeing a good argument for that being the case. Some people should be denied care. I don't see why performing a necessary function shouldn't be profitable, especially when it's beneficial to everyone in times of scarcity, like now.
I am not more important than you or anyone else. I don’t deserve health care before you just because I have more money. That’s a perverse idea. Unfortunately too many Americans embody the Bible’s warning regarding the love of money.
> Police, most roads, and certain aspects of the legal system are free at the point of usage.
Sure, and those generally work well because the overhead is low. The per person cost of all of those services combined is extremely low compared to medical expenses. If giving everyone healthcare cost the same as giving every 911 service, this conversation wouldn't be happening.
> It’s bad to have for profit police, court system, and Air Force.
I think government and the monopoly on violence are generally good so long as the government is democratic, so sure.
> Some things ought not be profit driven
Totally agree. Executions and jails for instance. Anything were the service involves inflicting violence or removing rights is probably better left to a democratically elected organization.
> It’s quite disconcerting that someone sees no problem with a person profiting from denying healthcare. I should not be able to enrich myself by denying you health care. Tough decisions need to be made and the motive for the decision should not be profit.
You're confusing the role with the action. I think 'being the organization that prioritizes care' can be profitable and ethical. That's different from saying 'an organization should get paid for saying no to someone'. Those are two different things and you're assuming that you can't have the first without the second. The insurance company doesn't make money off 'saying no', it makes money off codifying rules that distribute healthcare and enforcing them on a set of people buying into those rules. When more people are denied they make more money, but they aren't 'denying to make money'. It's a different incentive structure from you're describing. Also, nobody in that scenario is 'denying care' they are denying paying for the care. You're still free to go receive the care and pay for it yourself. You can also find a charity and convince them to pay, or crowd fund. That's actually a benefit of the market driven system: there is no such thing as a 'hard' no.
> I am not more important than you or anyone else. I don’t deserve health care before you just because I have more money. That’s a perverse idea.
Totally agree. Having the ability to purchase something is not the same as 'deserving' that something. Two entirely different concepts that live in different systems. One is grounded in the philosophical idea of fairness, and the other in the physical process of voluntary exchange.
> Unfortunately too many Americans embody the Bible’s warning regarding the love of money.
Totally agree here too, as an agnostic, although that's kind of a tangent.
Anyway… I think both systems are very similar in the end. Rich (or even middle class) gets great service in premium facilities. Average folks get OK service with some downsides, likely paying out of pocket in various ways. The only difference may be poor people coverage which is subsidized by upper tier payers. Who themselves may never use public service and go to premium only.
Also, another major difference may be the big expensive procedures. Aside from the 1%, people would do the procedure in public hospital because it’s crazy expensive otherwise. But everything else leading up to it and recovery after it more likely to happen in premium market since it’s much more affordable.
EDIT: After further reading it appears that private health care is a murky area in some provinces. My above stated belief appears to be wrong at least in terms of how things actually work there. Here is my view. Private medical care should be banned.
On top of that, official medical staff wages were crap. People were forced either work for peanuts (IMO nurses and doctors jobs are damn hard and they have to be paid well), take money under table or... emigrate.
Now we have mixed system and it's definitely better than it was before. Doctors gets paid well. Elite doctors tend to work 2-3 days in private clinics and then 2-3 days in public hospitals so you can still get hold of them for free. Those who have an inch for premium services can pay local&legal, so local economy wins.
The only sane response to that is “okay, I won’t give my kid either of those; we’ll just stick with OTC lotions”. Which is exactly what they intended.
It’s reasonable to expect people to exhaust lower cost alternatives, that are reasonably expected to work, before stepping up costs.
The problem is, you won't be able to hammer down the health of the patient to the lowest cost option, only the most effective.
This also happens if the employer switches insurance.
So no it isn’t as innocent not as simple as saving costs for generics. This makes sense for the first time the patient seeks treatment. This doesn’t make sense if the patient already has a treatment plan that works and the insurance company decides they want to do the whole pony show again, fucking in peoples life for months.
A [relatively] well known exception is anticonvulsants. My younger brother paid for that with his life. I hope the FDA figures out how to properly evaluate generic equivalence.
They shouldn’t have, though. Injections (what I’m on now) work better. They’re easier to maintain the correct dose, you don’t have to worry about getting it on your partner/kids, you only take it once every week or two…and it’s maybe $20 a month.
That’s not just a few dollars saved. There are probably hundreds of thousands of men out there that take it. I see there’s a generic gel now but it still costs anywhere from $60-$150 a month.
Too bad it’s $1,000 a month. We’re all paying that so people can avoid sticking themselves with a needle.
We don’t spend 100x on a drug because a doctor “has a feeling”.
The insurance requirements are typically quite limited for 1st line failures. Doctor just needs to prescribe then 2 weeks later attest that it didn’t work.
Seems reasonable to save the healthcare system thousands of dollars when tens of dollars would do?
Maybe you're talking about different medicines that people are using (like different insulins), the generics use the same formula as the original.