This isn't the best example to have chosen. All of these procedures are discretionary and nonessential. If I find the cost of an elective nose job too pricey, I can take my time and shop around. Or I can just go without a nose job altogether and be totally fine. The only thing that will suffer will be my vanity, and, well, it's suffered before. :)
On the other hand, let's imagine my kidney is catastrophically failing, and I need it removed or replaced. I'm probably not going to shop around at that point; I'm going to accept my doctor's recommendation that I be hustled into the nearest ER as soon as humanly possible, and I'll be stuck with the bill after the fact. I have neither the time, nor the expertise, nor the inclination to wait and comparison shop. For another thing, nobody is generally in a "market" for emergency kidney surgery. It's not something you anticipate. It's not something you expect to have done, much less seek out and shop around for. And there are no economic substitutes for the surgery. It doesn't lend itself to a market-based system in the same way that elective goods and services do.
This is the source of the problem. There is no 'market' to speak of. There needs to be laws requiring hospitals to provide prices up front and honor them after the fact.
Even auto mechanics are required by law to give you a written estimate.
The government does a lot of coercing people to do things against their will. That's why we have police, court systems, jails, and so on. Heck, we've had drafts! That's literally coercing young men to march headfirst into combat to protect the country!
[1] http://gregmankiw.blogspot.ca/2006/11/rangel-and-friedman-on...
P.S. Extreme sarcasm above...
[1] http://www.palgrave.com/page/detail/the-problem-of-political...
"I don't think the role of government is to protect our country, because it isn't the government protecting our country. It's the government coercing others to protect our country, against their will."
Obviously, we have a volunteer force, but haven't always had that - conscription, as you brought up. It's fine to have a volunteer force, until we need more. Then force is brought in.
no, it assumes those in control of the state believe it is worth sacrificing young lives for.
>It's fine to have a volunteer force, until we need more. Then force is brought in.
No, it's a consistent argument for those who think beyond themselves; it's good for society as a whole. One doesn't have to believe one personally benefits, that's now how liberals work.
> A good market would be one where you paid your doctor
A good market for healthcare is one where it isn't a market, but a social good provided to everyone, like other civilized countries do. The market is not the correct answer to every question of how to distribute goods and services.
Propaganda Americans seem always believe, as if the rest of the world were a third world country. The Nordic countries top the world standard of living, America, not so much. Quality of life, the U.S. doesn't even break the top 10. The U.S. isn't a shining city on a hill, it's a waning rotten empire slowly sinking back into 3rd world status for its average citizen.
> The "market" is just a synonym for individuals co-operating together for their mutual benefit.
That's a nice theory, it's just not true in the real world.
> I have lived decades with a single payer system and left in part because of it.
And which country would that be?
No you didn't.
No it isn't; and that which can be asserted without evidence, can be refuted without it as well.
Be enlightened: http://wiki.mises.org/wiki/Price
There is no need to believe or not believe. We are not talking about alternate realities, other modern, successful countries with better healthcare, longevity and quality of life have a single payer option.
> After that, let the market bring costs down by removing regulations.
Right. Point to any country where removing of regulations for healthcare has resulted in higher quality care.
This is hilarious, given that the US has the most expensive healthcare system in the world, outpacing far more regulated countries by vast amounts....
You might be right that you're hampered by bad regulation, but heavy regulation of the healthcare system have beaten the US consistently on cost for most of the developed world.
Yeah, I know! Outrageous! Next thing you know they'll be asking me to pay to educate other peoples children!! Oh wait....
Having a society full of healthy babies (remember those babies are going to grow up to be adults someday) and people without substance dependency is beneficial to you.
Are you also upset that the people who live across town from you have roads that you never use?
The whole idea of "insurance" is to pool risk anyways. Do you also go on a rant like this every year you don't get into a car accident?
>because it was considered unfair that I should pay less for consuming less (why this argument doesn't transfer to auto insurance, where men pay higher rates, I don't know).
There are some countries (and Montana) where gender discrimination in auto insurance is illegal.
That works great if everyone is basically healthy. And it falls apart completely for people with ongoing medical conditions who either don't make a lot or are too sick to hold down a job.
Well... isn't that sort of the point of insurance all together? There's always going to be someone in an insurance plan getting some treatment that I'll never need, no?
You're neglecting the fact that unless you get hit by the proverbial bus, you will eventually have one or more very expensive medical conditions, just like those freeloaders you're being forced to pay for now.
The whole idea of selling "insurance" in a market where you know that everyone is eventually going to file expensive claims is just stupid. No other insurance market works that way, nor could it.
IANAL but it's my understanding that the individual mandate only passed Constitutional muster because it was not punitive. If it were a penalty or crime instead of a tax, the legal interpretation might change. Then again, the Supreme Court had been all over the place lately.
US government currently pays more per capita than eg UK NHS, and you still get stuck with insurance, co-pay, and bills for your very expensive health care.
In fact, giving the sheer amount of bloat the entire billing apparatus of hospitals, the machinations of health insurers, the weird regulatory captures, and whatnot of the current system, I don't think it's unreasonable at all to at least give it it's day in court.
Your writeup to me basically reads as a "Fuck you got mine" libtertarian approach to healthcare, and one that frankly falls flat on its face if you acknowledge even the slightest personal responsibility to one's civilization or even to one's older, more enfeebled self.
The young and healthy needed to enroll for the economics to work, but the individual mandate was delayed for years -- because coercion isn't popular politically, and there was a reelection to win in 2012. Without the coercion, why would a 20-something buy insurance?
So begins the death spiral. The only thing that can save it is very high penalties for failing to get insurance on the individual marketplace. This would be politically disastrous -- "we know the plans are expensive, but it will be even more expensive to not get one!" isn't a great selling point.
It's not only that you have to pay up so that others may wait until they're sick -- you have to buy a plan that covers things you don't need. I have to pay for all sorts of treatments I'll never use -- addiction counseling, prenatal care (I'm a man), etc. -- because it was considered unfair that I should pay less for consuming less (why this argument doesn't transfer to auto insurance, where men pay higher rates, I don't know).
I know liberals are going to argue "that's why you need to take the market out of it and have single payer." It's a consistent argument only if you believe that you'd be better off with single payer. Some people would be; I know I wouldn't be. I'd end up paying even more for everyone else who isn't paying.
But, politically, that's dead on arrival. Democrats just voted to abolish the cadillac tax. Everyone knows the ACA is an albatross on the Democrats' neck. The sorts of anecdotes in this thread are all over the place. "We just didn't go far enough, try single payer" is not going to win the day anytime soon.
If a Republican wins the presidency, we'll see a full repeal of the entire thing (Dems will not filibuster if they know what's good for them). If a Democrat wins, we'll see gradual repeal, marketed as tweaks and improvements.
Personally, I'm fine with a strong subsidized public option for the truly indigent (oh wait, I just invented Medicare). After that, let the market bring costs down by removing regulations. It's no coincidence that laser eye surgery, teeth whitening, cosmetic surgery is all generally affordable -- markets and competition have formed.
A good market would be one where you paid your doctor out of pocket for recurring, predictable costs and then bought insurance from a private company in order to guard against unforeseen catastrophes -- kind of like how your auto insurance policy doesn't pay for oil changes and car washes.
And what if someone is irresponsible and didn't qualify for Medicare but also didn't buy insurance? What happens if they get cancer? I hope they have family and friends to bail them out. It would be great for charities to lend a hand. I don't think the role of government is to take care of you, because it isn't the government taking care of you. It's the government coercing others to take care of you, against their will. It is not charitable to hold a doctor at gunpoint and force him to perform a surgery. So for everyone who believes that healthcare is a "right," I expect that you're freely giving away your excess time and money away? Or do you just expect others to?
I'm already paying someone else's medical bills -- I can calculate how much I give to Medicare each year, it's more than enough for someone else in this country to see a doctor for the entire year. I'm also paying way more than I should for my family's insurance plan because I'm indirectly subsidizing others. I wonder how many people are getting free healthcare on my dime, and what excuses they have for not being able to afford it on their own. I'm a little tired of being told how great it would be if I just paid a little more and others paid a little less.