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Comment by cowpig | Hacker News Reader

There's no such thing as a "free market" for healthcare. The ability for consumers to exit a market is one of the prerequisites for the invisible hand effect. You can't exit the healthcare market.

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You can't exit the food market, either, and yet there is clearly a thriving free market for food. How does your theory account for this?

I think you're being purposefully obtuse, but here's why:

- 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...

> I can literally grow food in the ground for "free", put it in mason jars and save my food for a year.

This is true only in an extremely pedantic, unrealistic kinda way. If it was easy/free everyone would be growing all their own food.

At least here in the Midwest, people grow food all the time. Can’t grow strawberries in December, of course - but we eat up canned goods from friends/family throughout the winter.

This is a bad faith question asked without any basic thought.

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.

> This is a bad faith question asked without any basic thought.

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.

45 million Americans are on the SNAP (food stamp) program. Does your definition of "thriving free market" account for this?

You also can't exit the food market, or the shelter market, or the clothing market, yet those seem to work much better.

Food, shelter and clothing generally have discoverable pricing.

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.

I agree with your points, but I think there are narrower solutions. With respect to pricing, the problem seems to be the negotiations between hospitals and insurers, as well as hospitals' failures to institute cost-accounting. Forcing them to do better accounting, and have a clear price-list would probably help, but getting rid of the employer healthcare tax subsidy (or expanding it) would likely be a better solution.

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.

> though this could have horrible incentive problems

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.

> Forcing them to do better accounting, and have a clear price-list would probably help, but getting rid of the employer healthcare tax subsidy (or expanding it) would likely be a better solution.

Believe it or not, it would be way easier politically to implement Medicare For All than to do piecemeal reforms.

'Medicare for all' will cause a number of foreseeable and unforeseeable problems (and benefits). It would be interesting to see one or more states do it, and observe the results.

How can a state do universal single payer of its own design when there are multiple direct federal health care systems covering a substantial portion of the population, plus a huge tranch of the money states rely on for health care tied to a federal/state cooperative program with federal programmatic and eligibility constraints?

I think the experience in Vermont suggests that it's unlikely to ever happen at the state level. It's far more likely to be a big bang at the national level.

Sure you can. You can decide that you are not going to enrich an industry that basically does nothing for you in the long run. Everyone ends up dead, and I for one do not plan to spend my final years under constant care from a industry that is designed to drain every last dollar I have before I pass on.

I think the majority of people say something to that effect at some point in their life. But the only real alternative is suicide of some kind, and how many people actually follow through with suicide?

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