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Comment by davidbanham | Hacker News Reader

How on earth can you think a free market solution is appropriate for emergency medical care? For elective procedures, sure. For the ER? How do you expect the consumer to have perfect knowledge, rationality and freedom of choice in that scenario?

If your kid is gushing blood, you call an ambulance to take them wherever they can get patched up the fastest. To expect someone to shop around until they find an equilibrium between supply and demand in that situation is ludicrous. It is absolutely the role of government to provide a safety net in these situations.

Source: I live in a first-world country and thus have universal health care.

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+1 If you priced it like an airline, you'd have dynamic pricing models to obfuscate the fact that you are ~front-running clients based on their route-inquiry history (& cookies)!

https://en.wikipedia.org/wiki/Opportunism

At the nursing stations on every floor of a “not for profit Health Care Ministry” hospital that I regularly deliver patients to, and take from them, in front of every terminal, is the following motto:

“The care we give our patients? Priceless.

For everything else there is ChargeComplete.

Bill your patients for the things you do."

Nice dig disingenuously implying the US isn't a first world country, it is of course the very definition of one. The term also doesn't relate to economic development. Anyway, even some developing countries have universal healthcare, e.g. Cuba.

The commenter is making a perfectly apt joke about the state of healthcare in the US, as exemplified in the linked article. It is indeed a "nice dig" because it's sadly true, and Americans should all know it.

It was definitely a dig, but I don't think he was seriously implying the US isn't a first world country. I think the frustration stems from the fact that the US is the most obvious example of a first world country, and yet still hasn't figured out how to provide cost-effective and universally available healthcare to its citizens.

yes, hence "disingenuous".

I'd go with 'sarcastic' myself - I assume he is not attempting to mislead anyone or to pretend that he sincerely believes it.

I suppose Cuba is the reason we don't have universal healthcare. If they do it, it must be Communist.

I have the feeling many Americans actually think this way.

> How on earth can you think a free market solution is appropriate for emergency medical care?

You could say the same thing about funeral services.

Yet it is a free market. And it works well. Because people buy plots ahead of time and negotiate services well in advance.

Nothing is stopping you from walking into an emergency room at your local hospital and negotiating a fair hourly or daily rate for care.

Well, nothing except them looking at you like you belong at a loony bin because why should anybody give a shit what things cost? Insurance pays for everything! Until it doesn't.

What a wonderful world we live in, where we don't need to worry about what something costs ... until your premium is thousands per month and you run to some halfwit politician to fix it. I would laugh, but I know many are crying right now, trying to make Obama's website work for them.

> You could say the same thing about funeral services. Yet it is a free market. And it works well. Because people buy plots ahead of time and negotiate services well in advance.

Well, except that when I die, my corpse only goes one place: the ground or the incinerator. And, as an added bonus, I get to choose that destination in advance. Oh, for the joys of only ever potentially needing emergency (or even urgent) care in a single location.

> Nothing is stopping you from walking into an emergency room at your local hospital and negotiating a fair hourly or daily rate for care.

I'm pretty sure that this is called insurance.

> until your premium is thousands per month and you run to some halfwit politician to fix it.

Or until you buy insurance on the open, free market and then have that insurance canceled for some obscure reason usually related to your suddenly becoming too expensive for your insurance carrier. Or knowing in advance that actually going to the doctor for that pain in your side will mark you as having a preexisting condition (even if the insurance doesn't pay for it and never even sees a bill) thus previously making you uninsurable or only able to receive coverage for a staggeringly high premium.

I could go on but I don't want to bore you with my real life tales of navigating our so-called health care system.

I would laugh, but I know many are crying right now, trying to make Obama's website work for them.

It's not as if the private insurance system that existed before Obama came to office was working especially well. While I agree that Obamacare's rollout has been a big mess, from the way some people talk you'd think insurers had never raised premiums or dropped people from coverage until last October. I'm guessing that a few years from now the bumps in rolling out Obamacare are going to be no more memorable than the bumps in rolling out Medicare ~50 years ago.

> I'm guessing that a few years from now the bumps in rolling out Obamacare are going to be no more memorable than the bumps in rolling out Medicare ~50 years ago.

Yes, of course. By that point, they would have gotten used to the incompetence and stupidity, fully expecting it.

Based on your reply, I can surmise that you haven't even tried to use the system and sign up for a plan.

No, I'm happy to acknowledge it doesn't work well at the moment - which is why I mentioned the problems in the first place. However, I also expect it to improve in response to consumer demand.

Sorry to nitpick but elective doesn't mean optional or frivolous, it just means planned in advance. I know this because I have some coming up.

Oh but that's the point! If you can plan it in advance, the free market solution may actually be appropriate. You have time to shop around, compare providers, etc. Whether it's necessary or not isn't the issue, just the time that you have to plan.

It's not hard. Limited only by your imagination.

Emergency calls dispatched to competing ambulance/hospitals. Competing emergency dispatch services, say 911, 922, 933,... Customized emergency dispatch services - We'll have a life flight helicopter on call for only $99 a month! Plus any ideas from millions of people looking out for their best interests.

Or you have just one number that has a broker that gets you the best rate with the fastest, or most appropriate response time.

When it's less busy, the more affordable companies do most of the work - when it's busier, the more expensive ones fill in the service gap.

Everything old is new again! We could have rival ambulance gangs battling to take custody of an unconscious patient, just like the New York fire crews of the 1800s. [1]

[1] http://jason-cochran.com/blog/when-gangs-of-thugs-put-out-yo...

This seems like "in the long run" eventually-we'll-get-to-933-then-everything-will-be-better thinking, and if so it lies at the root of the problem: market forces are non-stationary, making equilibrium-based-reasoning necessarily flawed. Most of those who work all day every day selling X have consistently been able to develop and exploit profitable inefficiencies more quickly than the market can correct them. As such, the success of such proposed free-market solutions depends on the particulars of how the system's higher-level dynamics are parameterized. In other words, naive deregulation and free-market-introduction will not reliably improve things, and could make (/definitely have made) things much much worse.

Just as there's no communist utopia, there's no laissez-faire promised land.

No, no, no, please don't promote the idea that having multiple numbers is a good thing. Coming from Brazil where such thing is the case, I can tell you the moment you have multiple numbers people have no clue what number to call on an emergency.

We need price caps for emergency care. Limiting prices to a small multiple of Medicare rates should solve the problem. Private providers can operate with price limits. Look at private electric utilities as an example. I'd like to see a price cap proposition at a future California election. I think it would pass.

I agree with you, but by definition, we in the US also live in a first-world country: http://en.wikipedia.org/wiki/First_World

Missed the joke?

Wrong. There are choices and not everybody is spastically out of control like apparently you would be for a few stitches.

You people have such a hard time with simple concepts, such as an ideologically disagreement on the role of government.

Your first world government did a good job of indoctrinating you.

And yet, almost undoubtedly, his presumably socialist nanny-state government is providing an equivalent standard of healthcare for a fraction of the cost and complexity. Sign me up!

See, first world governments really are better at everything!

Wow. That ideology you've got there is impressive, especially considering your current system either kills people who can't afford it, or bankrupts them. Any universal healthcare is the wrong system? Laughable.

When we (note: "we" is defined as the set of individuals located on plant Earth who are legally able to cast a vote in the political unit known as the United States of America) can have an ideological disagreement on the role of government that no longer includes one major participant in the debate being able to effect that participant's desired outcome (little-to-no government) by simply standing on the side and refusing to debate, I think we'll then be ready to debate the relative merits of the system we currently have versus any other system in the world.

Until then, best of luck with your trolling.

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