Comment by derbOac | Hacker News Reader

Comment by derbOac | Hacker News Reader

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Yes I had a similar reaction. I've been involved in healthcare long before the ACA, and my family before that, and I thought it was absurd to tie any of these trends to Obamacare. Pretty much everything decried in the piece was on track long before the ACA, in the sense that even if something occurred after the ACA, it was predictable from trends prior to the ACA.

I'm also tired of all the focus on insurance and payment, and not on the monopolies (monopsonies?) in health care provision. We can focus on payment all we want but if we don't open up healthcare services to real competition and innovation prices will continue to go through the roof with declining returns.

I give some credit to the piece for somehow touching on that issue, but it's superficial and again tied to insurance and payors.

It's infuriating being on the inside of all of this and seeing the way it usually is discussed in policy forums. It's like everyone wants everything to remain the same but be cheaper, and that's not going to happen.

What does it take to open it up? You can't get to competitive pricing without transparent pricing, which you can't have with our opaque payment system. No one can tell you how much something is gonna cost, even after services are rendered, until much later usually with a bill in the mail.

With how dysfunctional healthcare is, you'd think if real competition were possible we'd already be seeing disruption in this space. That's not happening! The most obvious culprit is the private payer, so that's a natural place to look.

A lot of the problems come from Medicare acting like a central planner that doesn't regulate prices for people outside of their system.

Like my local hospital is blessed, it runs an ER in an area with few hospitals, so Medicare pays it at a higher rate for all care. But Medicare also won't make an agreement to pay for care if someone tries to open up a competing hospital (and investors know this, so they won't bother trying to compete), and they don't tell the hospital that they have blessed that it's not okay to charge ridiculous prices to other customers.

"the market" is why we're in this situation. The healthcare cost crisis is simply not a problem that capitalism has any mechanism to address.

Capitalism balances supply and demand by modulating prices. When demand is above supply, prices go up until demand drops. When supply is higher than demand, prices go down to bring demand up. But demand for healthcare can't go down. There is no force opposing price increases, so prices must tend toward infinity.

When it comes to life-or-death situations, people will pay just about anything. The market will bear almost any price, and the entire operating principle of capitalism is to increase prices to the limit the market will bear.

There just is no mechanism by which capitalism can consider the value of human life. Otherwise we wouldn't have to write laws to prevent children being maimed in factories, or prevent people selling snake oil as a miracle cure, or create entities like the EPA to prevent companies poisoning entire towns. The only solution is for the government to intervene and cap prices.

The only reason you'd ever lower prices for healthcare is because it's the morally right thing to do. Capitalism does not recognize the concept of morality. There is no internal force which could lower prices, so it must be an external force.

I guess I can kind of understand why you think demand "can't go down." But I have no idea why you ignore the possibility of supply increasing.

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