That said, there are definite things that increase the cost disproportionately, and the way the government subsidizes insurance through an employer makes a major disconnect between patients and providers. If the subsidy were eliminated and insurance untied to employer you would have a huge step in the direction of unleashing market forces.

Untying insurance from employment is a great idea, but it won't solve this. With HDHPs being so common the 'disconnect' between providers and patients is already not a real thing. Neither will single payer fix the underlying problem, although at least individuals will be better off.

At any rate, entrusting laymen to understand when they should and should not seek emergency medical attention means that people will die through entirely preventable causes in an attempt to ration their health care spending. Your cure sounds worse than the disease.

There are no effective market forces you can 'unleash' in the case of health care. It wouldn't matter if you removed all government regulation and subsidies tomorrow. Even in a world where it all somehow works out, do you want medical providers in a race to the bottom? In the absence of meaningful quality of care information (impossible), consumers are incredibly sensitive to one thing: price. What you will end up with is cheap(ish) providers providing incredibly substandard care by cutting corners and killing people.

Long way to go for HDHP to take over the market. But its definitely the way to go. It will however attack mostly the primary care market, not the hospitals which are 40% of the national health spending.

> At any rate, entrusting laymen to understand when they should and should not seek emergency medical attention means that people will die through entirely preventable causes in an attempt to ration their health care spending. Your cure sounds worse than the disease.

Not my "cure" thats the economic reality. Unfettered access to healthcare will give you skyrocketing costs. You cant complain about both at the same time, they are a trade-off. I do think that cost is the single most important thing to attack, and the policies to do so are very easy to enact. They are just very unpopular, because the democratic party wants to increase the state, not make healthcare cheaper, and because republicas have their head up their ass on this topic for reasons I dont understand.

> Not my "cure" thats the economic reality. Unfettered access to healthcare will give you skyrocketing costs. You cant complain about both at the same time, they are a trade-off.

Yes, if the problem is skyrocketing demand. But it isn't. Yes, if we waved a magic wand and provided unlimited free access to medical care, demand would rise somewhat. But demand is not the reason for the current high prices, and it's not the reason costs are outpacing inflation. Medical care in the US is much more expensive than in comparable countries, but demand is not appreciably different.

As long as people keep looking at this through a "market" lens, or through a "just make it single payer" lens, the problem will never be solved. The fundamental problem isn't that demand is too high. The problem is cost disease, the root of which consists of dozens of different factors. This is a decent article, albeit one that barely scratches the surface.

https://slatestarcodex.com/2017/02/09/considerations-on-cost...

Look at those graphs! It's mindblowing! Medical costs have increased ten times more than inflation, while doctor and nurse salaries were flat (actually worse, since now their salary goes to paying off educational debt) over the same time period. If there's a demand problem, why aren't salaries of medical professionals rising faster than inflation?

Lastly, I think most people would disagree that cutting costs is the most important thing. Going bankrupt is better than dying of pneumonia because you were worried about wasting money on a doctor visit.

There is definitely a sort of impasse on both ideological positions. The forces that be for some reason have not agreed to test out their ideas: a public option and deregulation simultaneously. But neither policy is popular in neither party.

I disagree with your diagnosis, but I'm willing to do a policy that satisfies both your ideas and mine. Support a public option that will not have the issues you mention, and let me have my unlicensed, foreign, cash-pay, non-subsidized doctors, non-FDA meds and malpractice waivers.

The other part that someone like Sanders is pushing is tuition-free colleges. If doctors aren't burdened with half a million in student debt, maybe we can get cheaper care.

You combine both programs and you get a real win.

I already posted a link showing doctor and nurse compensation have been flat in the same time period that medical costs increased 10x faster than inflation. While free university might be a good idea for other reasons, this isn’t it.

You don't have the benefit of government negotiation today and you cant seriously say that the government runs without overhead.

Except that quality information gets provided quite satisfactorily in plenty of industries, even ones that might appear otherwise quite opaque. Sure, sometimes it is done in distorted and counterintuitive ways (many marketing practices, including many kinds of advertising, are ultimately reputational games that are designed to signal quality), but meaningful info is far from "absent"!

It should be possible to reopen those negotiations and reach a fair conclusion, but there's going to be a lot of fighting on a case-by-case basis (with a lot of cases). I believe it would ultimately work out better for everybody, but the "ultimate" would be years -- if not decades -- away.

Welcome to vested interests.

> It should be possible to reopen those negotiations and reach a fair conclusion

As much as Uber can negotiate with taxis. The solution here is to cut all the bs out and dereg. Import free doctors from all the world for cheap, by allowing them to practice medicine and to apply to a Doctor visa. US can triple its doctoral staff in 5 years with no educational cost by simply doing less things.

That's exactly how things were in the 1930s. Healthcare was unaffordable to the degree of public outcry, which is why universal healthcare legislation was introduced repeatedly and stifled by the AMA every time. In fact, early health insurance programs were designed to bypass pay-as-you-go medical fees because they weren't meeting the needs of the hospital or patients. It wasn't a tenable system.

It seems we're regressing.

The problem is not that the AMA was able to attack socialized healthcare, but that the AMA was able to dictate who would be able to practice medicine, what their education should be, how much they should charge and how they would organize.

Any american could go abroad to a country like say, Argentina, get free medical education and come back and treat patients without half a million dollars debt. But its illegal.

Although, we certainly do spend irrational amounts on healthcare, partly because consumers don't bear consequences for going with the pricey procedures.

There's also numerous layers of regulatory capture, artificial scarcity, and rent-seeking in order to protect various industry-wide or regional cartels. The combination of that with consumers who have no reason to care about price is a potent recipe for price gouging.

The AMA is one of those. Hospital associations, medical device associations, phamaceutical associations, electronic medical record companies, and so on all take their cut.

I think public investment in educating medical providers is too small (it shouldn't be profitable to wrap a provider in like 5 people...), but doctors that aren't total fuck-ups are doing great by the time they are 45. We are likely in a supply constrained situation right now, prices would be nicer if there was excess supply.

There's plenty of people on Obamacare who are getting heavily subsidized low deductible policies, and paying very little.

The government is the largest employer, and most government employees do not care about prices.

Throw in those who are unionized or at cushy stable jobs with low deductible plans, which is innumerable millions more.

I'm thinking at least 75% of the country has little reason to care about prices, and even if they did the system is so byzantine that there isn't much they could do if they did. This is all an interlocking and self-reinforcing problem, which rewards the various layers of the healthcare industry with windfall gains irrespective of their own quality.

I think everyone here recognizes the insane inefficiencies of US healthcare. Maybe single payer could help streamline things. Or what if this price disclosure requirement could be wrapped into a more comprehensive system that allows all parties choice and visibility and interoperability?

I know it doesn’t work great for everyone though and I’ve seen some discussion that it doesn’t bring down costs because of the lack of transparency in pricing preventing comparison shopping (which is also my experience).