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- SNAP / EBT / Foodstamps for people making so little money. Add onto that, Food banks.
- Farm subsidies for many cheap foodstuffs (Corn) causing massive cheap, albeit junk food that can sustain.
- I can literally grow food in the ground for "free", put it in mason jars and save my food for a year. I can't open a fresh can of broken-arm at the fixed cost.
- Food is fungible, if I'm hungry, I can wait 2, 3, 8+ hours to eat, or have a quick snack until meal time. It's not like I need a Big Mac infusion in the next 10 seconds or else I'll die from lack of special sauce.
- You have many options of food. You can eat Soylent, rice&beans, or steak for every meal at various price points. You don't really get an ala carte when it comes to Chemotherapy.
- You can always eat monkey pellets [1]
[1] https://www.reddit.com/r/moreplatesmoredates/comments/qbfkfl...
This is true only in an extremely pedantic, unrealistic kinda way. If it was easy/free everyone would be growing all their own food.
Within 5 miles, I have at least 10 different grocery stores to shop at. Each will carry hundreds of products at less than $10 each. Not only do I have tons of choices, but the pricing is completely transparent. And that's just grocery stores. Add restaurants (Both sit-down restaurants and fast food), and that number quickly reaches over 100 within a 5-mile radius.
If I'm in a medical emergency and someone dials 911, I'm likely just being brought to the nearest hospital. I have zero choice in the matter, and will come out with whatever bill they want to charge me.
Even in non-emergencies, good luck shopping on price. Doctor offices don't like giving that out.
There's competition in the food market, but not healthcare.
Where ad hominem is a hallmark of good faith discussion.
> Within 5 miles, I have at least 10 different grocery stores to shop at. Each will carry hundreds of products at less than $10 each. Not only do I have tons of choices, but the pricing is completely transparent. And that's just grocery stores. Add restaurants (Both sit-down restaurants and fast food), and that number quickly reaches over 100 within a 5-mile radius.
This makes sense if you're aware of the fact that each human being eats three meals per day.
> If I'm in a medical emergency and someone dials 911, I'm likely just being brought to the nearest hospital. I have zero choice in the matter, and will come out with whatever bill they want to charge me. Even in non-emergencies, good luck shopping on price. Doctor offices don't like giving that out.
I clearly conceded the point that you can't exit the healthcare market.
> There's competition in the food market, but not healthcare.
Are you under the impression that I disagree with this statement? Consider reading (and, ideally, understanding) the thread in which you are participating prior to commenting.
I challenge you to find the price of a cancer treatment regime protocol in the United States. I will bet you any amount of money you care to wager that no US provider exists anywhere that will give you a price quote for lung cancer treatment in writing anytime before that treatment is provided.
And even IF you could, that only covers the cases where you are still have enough health and mind to rationally evaluate the prices. If you've been in a car accident and are dragged unconscious and bleeding into the ER, you can't shop around, even if they DID give you a price, which they certainly won't until you're already treated.
With respect to ER care, it does seem impossible to 'shop around', but these cases make up a minority of healthcare expenditures. Perhaps government should cover these cases (though this could have horrible incentive problems), or this type of insurance should be separated from the rest, and somehow priced clearly and in advance (according to level of care) by a cartel arrangement or state regulated rates.
I hear this argument, but I don't buy it. What's the incentive exactly?
That people will hurt themselves, so they can go to the ER for free? That's nonsense. Nobody wants to get hurt, nobody wants to get sick, getting hurt or getting sick is not a good. The fact that they don't have to pay to "get hurt" isn't an incentive. Perhaps a few people feel this way and are insane, but those people probably need to get help at government expense either way, before the government ends up paying for them to be in prison or institutionalized anyway.
Believe it or not, it would be way easier politically to implement Medicare For All than to do piecemeal reforms.
Ahem. Regulatory capture would like a word.
The industry is an onion and in order to understand why it is the way it is today you need to peel back all of the layers that have been added by the govt over time and the unintended consequences of those.
[1] https://www.npr.org/2020/10/07/921287295/history-of-employer...
Free markets are the most efficient way for information to be transferred throughout the system.
Stricter campaign finance laws, ending revolving-door politics, etc.
But putting the blame on free markets seems like a mistake.
You can't on the one hand tout the "free market", while on the other complain that we don't have the "right" kind of governmental interference.
Even if you could square that circle, it still sounds disingenuous to argue that we could have the most efficient system if only we were to eliminate _thing that said system actively encourages_. The failure is baked into the game, my friend.
I don’t take such a libertarian view myself, by the way. Just pointing out that I don’t think you can pick apart the argument of the person you replied to in that way.
I'd sign up for a significant increase in my taxes if the US system were replaced by the system that I experienced in Belgium for the first 30 years of my life.
And by successfully, I mean: everybody, irrespective of income or status, can expect to get the care they need.
If it was as easy as paying out way out of the problem we'd have done it already.
Nobody is claiming that the US should copy the system of some specific country verbatim. But it's equally dumb to dismiss the common traits of these other systems, and say "nah, let's do just the opposite."
Well you literally said "I'd sign up for a significant increase in my taxes if the US system were replaced by the system that I experienced in Belgium for the first 30 years of my life" so why don't you tell me how that was supposed to be interpreted?
America shares a very long border with a nation with a functional healthcare system and we generally prefer to compare to them.
What all those systems have in common is that they are a mix of free market and strong regulation. The opposite of "let's do even more free market than what we have now."
I don't know how the US can get there. It's probably impossible, just like school shootings and the "No Way To Prevent This,' Says Only Nation Where This Regularly Happens" argument.
Markets exist by virtue of laws created by governments - property law being the primary example - expecting actors in a free market who aggregate enough wealth to affect those governments not to just strikes me as unrealistic. It reminds me a bit of gaming. Everyone agrees that in a competitive game the most fun part is early on before a 'meta' can be established. But of course that meta will always end up established and it's basically dumb to be mad at people for metagaming or to otherwise expect them not to.
Would such a market allow NDAs?
What do you think of VC-funded "growth" companies that lose money for years while providing products/services at below cost? Is this a case of the free market working or of it being subverted?
Whoever gave you that idea, you should stop listening to them.
Medicare payments are subject to a medicare fee schedule, which is typically much lower than a traditional private enterprise's fee schedule. What that means is medicare gets billed a lot less than a regular patient with insurance.
https://www.kff.org/medicare/issue-brief/how-much-more-than-...
"Private insurers paid nearly double Medicare rates for all hospital services (199% of Medicare rates, on average), ranging from 141% to 259% of Medicare rates across the reviewed studies."
"The difference between private and Medicare rates was greater for outpatient than inpatient hospital services, which averaged 264% and 189% of Medicare rates overall, respectively."
"For physician services, private insurance paid 143% of Medicare rates, on average, ranging from 118% to 179% of Medicare rates across studies."The magnitude of "standard" and "low" are both demonstrated by the fact that when private insurers negotiate pricing contracts (basically, a one-off fee schedule) with hospital groups, they express prices in terms of "medicare multiples".
For example, the insurer will pay up to 13x of what Medicare pays for an fMRI administered under non-emergent circumstances with medically-justifiable cause. Pretty much every multiple is >1x, many are far more than 10x.
And medicare is arguably more expensive to provide, since the probability of confounding issues from disability or age is higher than in the general insured population.
Medicare is very consistent with paying, especially in comparison to private insurance, but the a la carte fees are quite "low" by relatively-freer-market definitions (I say relatively, because the reality is that private insurers negotiating with hospital groups is the antithesis of a free market, in most conceivable dimensions).
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The main reason medical groups lobby against "medicare for all" is that they will lose lucrative "20xM" payouts from private insurers, and it's difficult to see how their ballooning administrative costs can survive on such a lean diet.
Of course, this line of thinking is deliberately ignorant of the thought that medicare fee schedules can be renegotiated to reflect the population of patients "medicare for all" would incorporate. But nobody's interested in thinking two turns ahead, let alone advancing the game state, when their pockets are nicely-lined on turn zero.
So, private insurers aren't charities that aim to support 'lucrative' payouts either. The often-huge gulf between MC and private (as you said) means that costs would have to drop massively if we did MC4A. Who's going to tell hospitals/admins, and more importantly, doctors and nurses that they have to take a 30%+ paycut?
There are three acts in care. Act 1, you receive treatment and the hospital pays the nurses, doctors, and capital equipment. Act 2, the admin submits a claim and receives a quote from the insurer. Act 3, the insurer pays the admin.
One of the reasons why a certain treatment plan is negotiated at 20x Medicare is that, 50% of the time, the private insurer rejects the claim (correctly or incorrectly), and the hospital group needs to maintain payroll for an admin whose entire job is to contest the rejection and win the ultimately agreed-upon rate.
As you might guess, a large but difficult-to-quantify proportion of the quoted cost is this song and dance in Act 2. In Medicare, the distribution of Act 2's length is more predictable and smaller.
Nobody addresses this elephant in the room, because it makes private insurers and hospital groups look bad, but it's where a lot of ballooning "costs" can be explained away.
Basically, the "expected value" of a private insurance payout is usually not too different from the "expected value" of a medicare payout.
The sticker price of a private insurance payout is very high. The accounting department of providers love the sticker price, because they can carry them forward as payable liabilities, but a large proportion of private insurer payouts and patient deductibles are never realized. Stark contrast to medicare.
They go with Medicare because the pay-out rate (i.e. "collect-ability") for billable services is much higher--and much more predictable--than if they attempted to collect/negotiate with non-governmental providers. A LOT of money is lost by hospital systems due to unpaid patient responsibility (e.g. insurance deductibles), which they can minimize by offering only services already guaranteed to be covered by Medicare.
Whoever implanted this idea into your head was lying to you and you should probably question the other claims that person or organization has said.