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Comment by RockyMcNuts | Hacker News Reader

Medicare is more efficient than private insurers. of course it helps that it just says, F u, we're paying X, instead of making everyone jump through hoops and hoping they screw up and provide an excuse for denial, and Medicare doesn't need to market or grow profits.

http://healthaffairs.org/blog/2011/09/20/medicare-is-more-ef...

sounds like this project is a colossal clusterf*k. Innovation and customer service are not in the government's wheelhouse, and I would certainly rather have market-based systems anywhere they work. It just hasn't worked for health care. And governments provide roads, schools, water etc. And the private sector has its share of disastrous projects, Webvan and Boo.com and Pets.com burning through hundreds of millions and going nowhere.

I sort of wish Google or Elon Musk or somebody would step up and volunteer to fix it, instead of saying, government sucks, people have to keep getting crappy/no health care.

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I think only the weakest level of "market-based" can apply here. The government has grossly intervened in the health care market since the WWII wage and price controls implicitly created the business model of employers playing for health care as non-controlled additional compensation, to the explicit post-WWII requirement for emergency rooms to treat everyone who entered.

Now Medicare shifts quite a bit of additional costs onto others, you need federal government approval for every new hospital bed, I remember reading some time ago that one state's hospitals were screwed because the state and the federal government had incompatible requirements for hot water temperature, etc. The FDA has massive and politicized control over many system inputs such as drugs and devices, the government has failed to intervene when almost every other country insisted companies sell drugs at near cost (our market supports way more than half the cost of new drug development), etc. etc. etc.

And just before Obamacare was passed the government (mostly Federal with states "partnering" Medicaid) was paying for almost half the nation's healthcare.

A market that was thoroughly intertwingled with governments doesn't really seem up to allowing statements like "It just hasn't worked for health care."

insurance doesn't work unless it's universal. it just falls apart once either side picks and chooses. the young people don't buy it, and then they fall off their bike and they're screwed. and the insurers can't get stuck with just sick people, they have the whole pre-existing condition thing, so your kids get sick and you can't leave your job.

a sick person looking for treatment is the opposite of everything that makes a market efficient, there's no perfect information, non-coercion etc.

if people want to say, I'd rather people be sick and die and have the freedom to not pay for universal insurance or get vaccinated, that's a values choice. but it's a serious error to say that the free market will result in optimal health outcomes.

That's more than a bit of a strawman you've constructed.

I for one am willing to admit that I'm not smart enough to construct a path to a "free market" (a phrase I've never used in this discussion till this message) system after three quarters of a century of massive government intervention.

Heck, it would require an end to "democracy", and/or a few generations of radically changed public schooling, and/or "reeducation" camps for starters. Enough of the people want "socialism", and right now we're seeing the wisdom of Menken's "Democracy is the theory that the common people know what they want, and deserve to get it good and hard.", after the Left has captured just about every institution that matters. The very idea of free market anything in the current environment is ludicrous.

no straw men in sight. that's your choice: efficiency, equality, liberty...pick how you want to trade them off. if you think liberty is the only value that matters, that's a (questionable) values choice. if you think liberty always leads to efficiency, that's a questionable (IMHO clearly wrong) analysis.

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