Price controls don't work. This will only lead to a shortage of doctors that take an insurance plan.

> we should also add that paying cash means you get the Medicare price.

Medicare doesn't pay enough. What if the doctor doesn't accept medicare?

Medicare's reimbursement rates are already higher than every other developed nation. The idea that it doesn't pay enough is, frankly, bs.

Of course, reimbursement rates are hardly our only problem. We also use more expensive treatment options for the same conditions, give doctors (and thus patients) a level of flexibility unheard of elsewhere that allows to spend money on unnecessary medicine just to make a patient happy and have ridiculous administrative overhead costs.

> Medicare's reimbursement rates are already higher than every other developed nation. The idea that it doesn't pay enough is, frankly, bs.

Medicare's reimbursement rates could just as well be published by Gosplan. If you squint hard enough, they are almost an application of the Labor Theory of Value: There is an intrinsic value of everything determined by how much labor went into producing it. That, of course, leads to all sorts of fun stuff like seniors in Florida loading up on cosmetic surgery and ED medication on the backs of the younger generations.

So with true state provided healthcare:

The “price” is really just the unit cost. Companies seem to have no problem computing unit costs (and thus margins!), no gosplan-like apparatus is required for this beyond supply-chain management and accounting. The U.S. situation is complicated considerably by all the different parties involved which I guess is why this idea might work less well there.

Correspondingly I suppose the “true value” would be the value provided to the recipient of the procedure and society as a whole, and as you observe is much more subjective and probably best not even measured in dollars. I think “quality of life adjusted years” is a thing. The major problem is when the you and the state disagree on the value of a procedure and whether it justifies the costs...

Another way to look at it, “socialised medicine” is just health insurance collected by the state with full vertical integration; your insurer also runs the hospitals and provides the care. The upside is you’re covered, the downside is you don’t get to choose a plan.

We overtrain docs and we’ve built hospitals that focus on private rooms instead of wards. Both of those hugely increase the labor cost and will take a long time to undo.

Not really.

You tell the working parents that they can deliver the baby in the shared room for no additional cost or upgrade to the private suite for $100k.

What are you trying to say? It wasn’t clear.

See, the OP said:

> We overtrain docs and we’ve built hospitals that focus on private rooms instead of wards. Both of those hugely increase the labor cost and will take a long time to undo.

If I was a patient at a hospital, I would not be able to control this:

> We overtrain docs

That part is outside my control.

... but, I, as a patient at a hospital, would be able to control this:

> we’ve built hospitals that focus on private rooms instead of wards

Infact, some of hopitals in the U.S. do have ward deliveries - I believe Kaiser Permanente have shared rooms?

However, that is the rub - people are not explicitly requesting private rooms - hospitals just have them so they can charge as much as they can.

If you walk into a hospital, you cant ask to have a ward delivery. They take you to a private room by default - no questions asked. That's all they have.

Then the bill comes and the game begins - if the insurance company does not pay, the hospital will then come after you. They will put you on a payment plan.

If you can't make payments, they will sell you to collections. Some hospitals might settle for an upfront cash payment but then it cannot go through your insurance and you are out of money AND you did not meet your family deductible either.

If there was a choice to new parents between ward deliveries for $50k and private rooms for $150k, I know which one I would take.

I don't have that choice because my employer might not be offering care though Kaiser Permanente and the hospitals in network might only have private rooms.

So change employers because I prefer ward deliveries?

OK thanks. I was confused. I thought you were saying patients wouldn't accept shared rooms and this is built into our cost structure.

My pleasure.

Thank you for pointing out where I can end up confusing a reader. I write occasionally. Example: https://www.quora.com/Do-all-citizens-have-a-right-to-afford...

Perhaps that the actual cost to use private rooms for delivery is being subsidized?

I did not mean exactly that, but this happens too.

Not every new parent can afford the expense of birth. So the hospitals try and squeeze out as much as they can from every party to try and even it out.

As a high income earner, I'm specially vulnerable to this practice.

No judge or newspaper or activist has particular empathy that I got charged $200k for a delivery or $6k for an 2 mile ambulance ride.

I can afford to pay it so why am I being so picky about it?

Are you serious with the $200k?!?

You seem surprised.

It's such a regular occurrence that it does not make news anymore.

Much higher amounts make the news now:

https://www.theguardian.com/us-news/2018/jan/16/why-does-it-...

https://www.cbc.ca/news/canada/saskatoon/jennifer-huculak-ki...

Price controls have been demonstrated to work in a number of other countries. I agree, in general, but when you have a proof by existence of efficacy, you can't really claim that they don't work in medicine.

Which countries? Price control doesn't work. It generates scarcity and supply problems. The case against price controls is not merely an academic exercise, restricted to economics textbooks. There is a four-thousand-year historical record of economic catastrophe after catastrophe caused by price controls. This record is partly documented in an excellent book entitled Forty Centuries of Wage and Price Controls by Robert Schuettinger and Eamon Butler, first published in 1979.

I live in Ontario where prices for medical care are negotiated by the provincial government, which you might regard to be a price control. The result is excellent, and one of several reasons I would never consider living in the United States.

Switzerland is one of many examples.

The system is universal, but not complete. In fact, you should pay and that's how it works and it doesn't generate scarcity. There is 3 types of services in Switzerland: public with 2500 bed, subsidised private and private.

I will quote:

> The insured person pays the insurance premium for the basic plan up to 8% of their personal income. If a premium is higher than this, the government gives the insured person a cash subsidy to pay for any additional premium.

So, it's a basic insurance that doesn't cover everything. Also quoting:

> "Health insurance covers the costs of medical treatment and hospitalization of the insured. However, the insured person 'pays part of the cost of treatment' and 'For hospitalisation, one pays a contribution to room and service costs'."

As you can see, there's no 'free' but subsidizied basic healthcare treatments, but then you should pay everything.

I believe we were discussing price controls, not whether it is "free".

Simple don't let doctors choose patient by insurance plan or negotiate a higher rate. Everyone pays the same. There are first world countries wherein the massive profit potential at every step between patient and care just doesn't exist and they in general have better health outcomes than we do.

I’m pretty certain that would violate the Constitution. Any lawyers around that could comment on this?

What part of the Constitution covers medical billing? Doctors can get tort protection but patients can't get billing protection? Wages have been set by the U.S. government before so I'm not sure you could argue that, and there's no personal expression protection with accepting insurance. I'm really unsure of where this could possibly become Constitutional other than the right to life.

Perhaps it’s the ambiguity when I read the parents post about not allowing doctors to charge different rates. Does that mean not allowing me to charge more than you, or not allowing a doctor to charge one patient more than the former.

When I originally read it, it seemed like the former, but given everyone’s responses it must be the latter.

I'm for capping costs AND not allowing a provider to charge different rates to different patients for clarity.

Neither would violate the constitution. It's not that long a document and written reasonably clearly. If you disagree please cite the section.

USA already has the common carrier law which states that certain services are not allowed to discriminate against specific customers, everyone pays the same price. So all you would need is institute a similar law for medical practice, like a "Common Health Provider" law. If you think that net neutrality is a good idea then you should also think that this is a good idea.

So you're saying we have too many doctors? Because this is how you get rid of doctors.

I would gladly pay more to be seen sooner by a more qualified doctor. If I have to fly to another place to do that, I would.

Only a fraction of the population can afford to fly somewhere to be seen. We are trying to improve the situation for everyone else.

Other counties pay less and have plenty of doctors per capita plus waste far less on middle men.

Parent comment didn't mention price controls.

Why people downvoted this. Price control doesn't work. Just read any economic book and you will realize it's true. It hurts, but it's true. If price control works, then why prices never were freezed. Why don't freeze it forever? Because it doesn't work.

A theory that isn’t validated in practice isn’t much of a theory. I’ve lived in several countries with price controls (at least on reimbursements, you’re free to get price gouged at some doctor but not many people will follow) and things are fine.

If anything I ended up having issues at the few parts that _arent_ price controlled (eyecare in France is a pain, though I think mostly because supply of optometrists are limited)

You can read Forty Centuries of Wage and Price Controls by Robert Schuettinger and Eamon Butler, first published in 1979. The case against price controls is not merely an academic exercise, restricted to economics textbooks. There is a four-thousand-year historical record of economic catastrophe after catastrophe caused by price controls.

In the case of price controls for medical services and products, there are a bazillion cases of it working. Your theory goes up against the universe's facts on this specific case.

I'm not arguing for price controls on everything in general. I'm pointing out that _in this context_ price controls are a proven strategy and work and mean that people don't _die due to not affording their insulin_.

The best healthcare system in the world is private and it's made on Singapur. Every single citizen can afford it, since it starts from 16$/mo. I want to hear one case of those 'bazillion' of price-controlled system.

I wonder whether it’s price discovery that controls price. It’s hard deny service for a price you’re already accepting/accepted elsewhere.

Price control is not a theory. There are several books, papers (Hayek, Mises, Friedman), topics that address this topic. If it is so good, why isn't implemented? It's the same argument than communism: if it is so good, why we don't implement it? Because it doesn't work. It never worked.

Price control generates scarcity. Because bureaus can't have all the information about the market, it's impossible. The moment a bureau determinate a price you're generating an impact on the different areas without having the possibility to address it. The gov. is not the market, the gov can't be an omnipotent entity that knows everything, that's why they screw everything.

It's more or less implemented for medical care in most other first-world countries and it seems to work better than ours* in all of them.

I lived in Canada for three years, and growing up in a fairly conservative area in the US, I was prepared for the worst - six-month wait times for life-saving procedures, etc. What I saw was more like Star Trek - people who needed medical care went to a clinic or hospital and got it, and they didn't have to worry about being bankrupted in the process.

After I moved back to the US, I got to see what it was like for most people - delaying or never getting critical procedures done, people with teeth rotting in their heads because they can't afford to go to the dentist, almost everyone 1 unexpected medical bill away from permanent financial ruin. Our system is objectively bad, and we deserve to feel bad for sticking with it.

You can cite all the market theory you want, but the US is a perfect empirical example of why those theories are wrong.

* Except for the tiny minority of the ultra-wealthy who can afford to pay any price for health care.

> Hayek, Mises, Friedman

What a diversity of thinkers!

Do you want more? I've read others. You want me to bow before Marx or Keynes? LOL

People call economics the dismal science but the truth is that it isn't even a science. Its predictive power is laughable and it seems to consist mostly of just so stories told after the fact.

You can't just claim something which is demonstrably functional somewhere doesn't in fact work because your half baked theory trumps actual reality. This is why this sort of comment is downvoted.

> You can't just claim something which is demonstrably functional somewhere doesn't in fact work because your half baked theory trumps actual reality. This is why this sort of comment is downvoted.

What actual reality? Because there's price controls doesn't mean it works. It generates scarcity, always.

Go to SF, put all rentals to 100 dollars and see the effects of the price controls. They will be the same there and in China.

I am not surprised people who deny the fact of economic science is downvoting this.

There is more than enough money in the system to pay for the actual health care providers.

Some of the middle men would have to get bent.

Not true. Not forever. Proven already. Same argument as Universal Wage.

There's countless volumes of information on price controls and their failures to have the desired outcomes.

Price control works in other countries for healthcare.

Largely because the US continues to subsidize medical R&D. Free riding is a good gig if you can get it.

Now that advertising drugs to the public had ballooned marketing budgets beyond R&D is that still true?

I imagine that dollar-for-dollar a non-profit with the right incentives and oversight could out do the VC-backed leeches driving up prescription med prices.

The vast majority of pure research has funding generated directly from government funds. Medical funding is roughly half from public funds. This wouldn't change with price controls. More profits don't lead to more research.

You're assuming that the profit on the item is enough that it's still worth it if the price is reduced. Why do you make that assumption?

Medicine will never not happen. People will continue to get sick. People will continue to become doctors. We've literally seen this before.

The US subsidizes drug development, that's about all. Other medical R&D doesn't really come out of any publicly funded research system, it comes from medical practitioners. The cost of US drug development subsidy is maybe $40 billion, accounting for basic research and development by pharmaceutical companies. This is pretty much peanuts compared to global healthcare spending. Also, this money is arguably not really that well spent, since most of drug development is useless, and nations can improve their health systems and outcomes much more through things like routine care and monitoring than they will through expensive research.

Can't we keep paying for the R and D and just not let a minority of private actors profit?

The private actors are the ones who pay for the R&D, to the tune of $70 billion/year. That's on the same order as total annual venture capital spending nationwide ($70-$80 billion/year from 2014-2017, though 2018 was an outlier at $130 billion).

These amounts are small enough where the U.S. government could pretty easily cover the expenditures. So by your logic, why do we need Silicon Valley venture capital? Why not just have the government pay for the R&D and make the results freely available to everyone?

Either the government is good at allocating capital for high-tech R&D or its not. Whether you're talking about medical tech or computer tech doesn't make a difference.

Price control doesn't work on healthcare. I give you an example: Spain, "free" healthcare: they realized people went to socialize to hospitals, making impossible to address the demand. People went to hospitals for headaches, colds, creating an incredible ammount of problems. How they solved it? They charged money (little) for any consult you wanted to do. This reduced instantly a big ammount of the consults and false positives. This was tested in Barcelona and in other provinces. This was also a case for Singapur, where everyone have access to healthcare (starting from 16$/mo) and healthcare is subsidised by demand.

Which ones and for how long?

> Price control doesn't work. Just read any economic book and you will realize it's true.

This sounds like a bit of an oversimplification.

Sounds that way, but it isn't. Price control doesn't work.

Price controls force efficiency gains. If wages go up you don't stop paying your employee wages, you either train cheaper employees, find a way to get more work out of them, or find a better way to do it. The same applies to price controls.

This is not true. The moment you set a red line, you're making impossible for the lesser trained to join the wagon for getting a chance to climb the ladder. Also, you're making the capitalist not paying for not hiring lesser people, since none has to hire, there are not faults. The idea is that investors should fight to get you in, but if they're denied, they get the monopoly since no one can enter the market to compete with them by hiring people who is willing to work for less than the regulated wage price is meant is. Plus, wages will not go up easily, since you're killing the force supply by setting a line on it. Milton Friedman explained this properly, you can see his speech on Youtube.

Milton Friedman is only one school of economic thought. Nothing is proven in economics and likely won't be since it involves human psychology. When gas prices rose dramatically economists expected the US to move away from large vehicles. That's not what happened. The rational thought is almost never what happens in economics. People buy high and sell low, their purchases are often emotional, and investors pour money into acting blockchain.

Or stop competing in that business.

That's already been happening though, so I'm not sure how much that would change what's already been happening.

> Just read any economic book and you will realize it's true.

In theory, theory always beats practice. In practice, however...

Case in point: nearly every other developed country.

Why you say theory, when you never readed about price controls in economic books: they're filled with factual data, not with opinions.

Why don’t you read on how every other developed nation does it then?