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Comment by klipt | Hacker News Reader

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.

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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.

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.

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 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.

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.

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.

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.

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.

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