Comment by Justsignedup | Hacker News Reader

Comment by Justsignedup | Hacker News Reader

There is one other reason to keep the non-privileged from paying for better benefits:

Imagine for a minute that everyone had BASIC health insurance. Provided by the government. If they get cancer, it will be paid for. If they sneeze, they will pay out-of-pocket for a doctor. Doctors who are AMAZING will charge... 200 for a visit. Not so amazing ones... 30.

Woah there. If your doctor charges you 150 per visit, you will be sure as hell checking that the doctor is good. While at $30 whatever. If you pay for your drugs, you will be damn sure you need them at $150 a pop. But at $15 a pop, meh better be safe than sorry.

Now an insurance company comes along... Hold up, sure I'll pay for it but how easy is it to make claims? Are they actually paying out or are they just giving you red tape?

It goes on.

Look at the COMPETITION created:

Doctors compete on skill to get not only clients who pay next to nothing per visit but pay hundreds to the doctor, but also on how much they charge.

Treatments compete on effectiveness. Will I pay $10k for a treatment that may be equally as effective as a $1k treatment?

Insurance companies compete on coverage/serving customers. Because anyone can leave and switch, and if they don't they have the safety net. Insurance companies now stop having the per-person monopoly. Very rarely do people have any choice in insurance companies.

Employers have employees who have only the risk of lack of salary when leaving a job. Though that risk is bad, especially when owning a mortgage.

The competition created becomes crazy. Entire monopolistic business models get toppled. And all for a very very small price. The fun part is once the free market kicks in, prices will plumet too. Competition will ensure to that. We just have to make sure competition gets a chance.

Hey I love the free market too and I once thought as you did, until I looked at the data.

Back in 2006 I pulled the latest WHO data and looked at % of medical industry privatized vs overall health of the populace (an function of factors such as infant mortality and lives lost to communicable diseases) in OECD countries.

As best I could tell there was a negative correlation between privatization and quality of care. As I recall the USA was the worst (by far), Australia's hybrid system put them near the middle, and Japan was on top.

Sure the sample data is small and the USA is very very far from a pure market at this point, but it was enough of a wake-up call for me that I stopped blindly believing in economic models.

After all it is only a model, not reality.

Health care may in fact be a 'natural monopoly' such as water or power, or it may be better as a government controlled industry such as education or defence. Only a few radicals think the government should not run or regulate any industry.

Some things to consider:

> Is is better that people always visit the doctor when they have a minor concern? (like 'if they sneeze . . .') because if people are paying out of pocket even at $100 many will not go.

> Many rural areas have only one hospital. Their emergency room is a monopoly. In a perfect market they could charge whatever they wanted and people would still go.

> Can the average person 'make sure a doctor is good?' Do they know how to make such a judgement?

> If doctors needed to compete, would it necessary be a sill-based competition? Is there a correlation between customer satisfaction and early detection for things like annual physicals?

> Do we want to have a society where you level of income determines your quality of care (and probably life expectancy)

I agree that the current US system is close to the worst thing possible, virtually no competition due to insurance being tied to employers, and also virtually no safety net.

I was uninsured for two and a half years. When I went to the hospital and asked how much things cost no one knew. Twice I was misinformed by more than a hundred dollars.

So yeah I think the model you propose may well be better than what we currently have, but I sincerely doubt it is the best possible.

> If your doctor charges you 150 per visit, you will be sure as hell checking that the doctor is good.

But how would I do that? If I had even a fraction of the skill required to tell a good doctor from a bad doctor, I would be one. Hell, I can't even tell a good car mechanic from a bad one.

Competition is great when you have something approaching a perfect market, but medical care is about as far from that as you can get.

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