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Comment by faeriechangling | Hacker News Reader

The free market is the most efficient system we have for optimising profits. Not sure why people think that means it's a good model for hospitals.

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What we have is not a free market. We have a system that has been consolidated and pushed towards high inefficiencies by pharma companies, insurance companies and hospital conglomerates.

A free market would be one where government hospitals exist alongside private for profit hospitals. A free market would have insurance as an optional convenience, not a mandatory one. A free market would have one price for medicine regardless of how you pay for it, where paying with insurance wouldn’t cost $34 when paying out of pocket and using GoodRx costs $2. A free market would be one where opening a private practice for a doctor would not be prohibitively expensive for family medicine because they need to hire 5 administrators to deal with the entangled mess of insurance payments.

Not to mention all the territorial regulatory capture on the provider side.

I'm supportive of greater "publicizing"(?) of healthcare but I also agree that there are many, many, many ways in which competition could be increased to actual improve free market dynamics.

I’d love to see evidence supporting the claim that a free market would make these things come to pass. Otherwise, this comes across as a list of things you’d like to see, with “the free market” standing in as the just-so story that will magically right all that is wrong

I’d like to see evidence supporting it doesn’t work. If something hasn’t been done before, it’s really hard to provide evidence without actually doing it. I unfortunately cannot change it by my own, so I cannot provide evidence on what would hypothetically happen if we ban lobbying, get politicians motivated to allow a competitive free market, have the government participate in healthcare and do bunch of other things.

I can provide examples of different models of public/private healthcare existing in the same market, if health insurance and healthcare being more accessible and being cheaper across the world. All of these systems have more than one aspect of my “wishlist” if not all. https://www.news-medical.net/health/Healthcare-Systems-Aroun...

I wanted to say that the charitable interpretation is that these things are basically prerequisites for the market to be "free" enough for any invisible hand efficiencies to arise - low barrier to entry, consumers are cost-conscious and have free choice, no anti-competitive bundling between provider, pharmacy, and insurance services.

But then I hit F5 and see that they explicitly feel these things will just come about given a "free market". Oh well.

The freest market is one that consolidates. The highest profits are made by controlling all the resources, after all.

Yes that is correct. In theory, in the freest market, there would only be one company that does everything and generates infinite profits.

I’m responding to the “free market” that most “free market” advocates refer to: a market where companies are free to do whatever they want as long as it makes them money and also have regulations only when it benefits them.

For markets with lots of competition it's pretty good at optimizing customer satisfaction at reasonable prices too. Consider food and electronics.

It fails with monopolies though.

Not even monopolies, literally no market forces. If you have a heart attack or a stroke, it doesn't matter what the prices listed for care are or customer reviews. You get to a hospital as fast as you fucking can. There are literally no market forces in play a lot of the time. Also, if you don't live in a big city, there may only be a single hospital by you that provides the treatment you need. Again, no market forces.

It’s useful to separate medicine from ER in healthcare discussions. In ER, there is no market. In healthcare, we have a deeply-flawed market. But in most zip codes, there is some competition.

The ED is the primary source of hospital admissions so I don’t think the two are that separable.

In part due to access-to-care issues. More competition in medicine should increase access thereby reducing ED use. One that comes to mind are in-house visits, something expensive for no good reason in America.

It's being reduced though. A lot of private practices are being bought out by big (in many cases for-profit) hospital or doctor's groups, and the doctors are put on salaries instead of owning their practices. In many areas there is now only one big group. Naturally this can be highly profitable.

Food is heavily regulated though, in a large part because markets failed to prevent food-borne illnesses.

It is kind of regulated. Enforcement is really poor though.

It also fails for in-elastic demand.

Nobody while having a heart-attack stops and thinks about shopping around for a lower price. "hmmm, about to die, let me see if I have any coupons".

Take insulin for example, companies can charge whatever they want, what are customers going to do? Just die?

> Nobody while having a heart-attack stops and thinks about shopping around for a lower price. "hmmm, about to die, let me see if I have any coupons".

Well in theory that's the point of insurance. You comparison shop insurance before having a heart attack, then if an attack happens you're covered.

Of course many people just wouldn't buy insurance unless forced ... many breadwinners die leaving their families nothing because they don't think of buying life insurance.

Absolutely, I'm personally super excited about my ability to choose between my single work-provided health insurance that tries to maximize the amount of money they get for a doctor's visit where the doctor doesn't even try to help me.

And I agree, we should punish those who don't understand the system. Let them die for their ignorance.

If you get insurance through work, there is zero choice.

You are locked into you're companies decisions.

You may say, 'well you can opt out', but the deck is really stacked against you trying to go it alone. This is one of the ways that employees are 'locked in' to jobs and become immobilized from seeking better jobs. The insurance is a type of 'capture'.

Maybe employers who offer insurance should be legally required to offer an equivalent value voucher toward buying your own insurance on an exchange.

The food in the US is terrible and contributes directly to many of our health problems.

Food is a terror-nightmare that can only be fixed by completely rethinking our values. We are literally seeing lifespan decline as food manufacturers addict their customers, capture regulators, destroy the environment, and pretty much single handedly reduce life expectancy. In many ways, we have regressed to the point of having a food system that works worse than it did under the better periods of communism.

Electronics I think has been mostly successful as a regulated free market.

>The free market is the most efficient system we have for optimising profits.

Um, the whole point of the free market is to destroy profit!

To paraphrase Jeff Bezos, your profit is my opportunity.

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